Should you smoke marijuana?

I hope everyone had a healthy and happy New Year's, 

I want to start off 2014 with a post to answer a question posed to me by a good friend. His question was very timely, as of yesterday, Colorado became the first state to legalize 'marijuana retail stores.' Like many Americans, my friend wanted to know if the recent wave of marijuana legalization and discrimination by some states, and public endorsements by the likes of Dr. Sanjay Gupta, means that smoking marijuana is safe. He told me that he felt as if ‘smoking pot’ helped to relax him and helped him to focus.

However, he wanted to know my thoughts… "Is smoking marijuana [like this] okay" or would it make the situations he is facing more difficult to manage?

There are many facets to consider when answering a question like this. There are legal, moral, physical and mental health related aspects that need to be considered. While all of these factors contribute to a well-rounded and fully informed understanding, I am going to focus on the mental-health related aspects, as this is the focus of this blog. 

To answer his questions, I want to look at 3 recently published articles that look at how marijuana impacts quality of life.

To give some background information, Quality of Life (QoL) is a multidimensional construct that primarily concerns an individual's personal evaluation of his or her life with regard to global health, handicaps or impairments, and daily living activities. QoL research helps us to better understand how someone interacts with the world around them and their satisfaction with social, educational, and occupational functioning.


The three studies that I reviewed on how marijuana impacts QoL revealed the following:

1)     Marijuana use trajectories during the post-college transition: Health outcomes in young adulthood:

1. The highest prevalence of marijuana smokers is among 17 to 22 year-olds. (Substance Abuse and Mental Health Services Administration, 2010). These individuals generally fall into categories based on their smoking behavior a) non-users b) low-stable c) early-decline (use decreases through college years) d) late-increase (use increases through college years) e) college peak  f) chronic.
2. The six trajectory groups did not differ significantly on health-related variables or QoL when they entered college, but did differ on all ten post-college health outcomes (including QoL) tested seven years later.
3. Individuals who consistently abstained from marijuana use fared significantly better than all five marijuana-using trajectories, including the Low-Stable group.
4. The Chronic group fared the worst on all three of the psychiatric symptom measures and had the lowest QoL scores. However, the Late-Increase group had the highest levels of service utilization for both physical and mental health, and the greatest number of impairment days due to illness or emotions.

2)     Gender differences in health-related quality of life among cannabis users: Results from the national epidemiologic survey on alcohol and related conditions:

1. Cannabis use was associated with significantly poorer overall mental well-being and the effect was particularly pronounced in females.
2. Physical well-being was found to be significantly higher among female and male cannabis smokers compared to non-smokers. (They attribute this to fact QoL generally decreases with age and the cannabis smokers being younger and relatively healthier than the general population (which was older and subsequently had more health concerns.)
3. Overall poorer QoL was associated with increasing doses of daily cannabis used.

3)     Cannabis use and mental health-related quality of life among individuals with anxiety disorders:

1. Compared to non-users, both female and male regular users reported significantly more often that their emotional or physical problems interfered with social activities.
2. They also reported accomplishing less and doing work or other activities less carefully due to emotional problems.
3. Regular users feel calm and peaceful less often and down-hearted and depressed more often.
4. Compared to non-use, occasional cannabis use was associated with poorer mental QoL scores among females, but not among males.
5. These results are consistent with other studies that have suggested that females are more susceptible to the effects of cannabis.

Looking over the data, it is clear that marijuana smoking, especially when on a regular basis, negatively impacts mental QoL. Sometimes the physical impacts (cough, fatigue, hunger) are more easy to identify than the sub-clinical aspects that QoL scales measure. These studies help us to understand that from mental-health standpoint, smoking marijuana negatively impacts a person's well-being and satisfaction with their life. In conclusion, I recommend the following to you and my friend if you are considering starting to smoke marijuana, now that it is legal in your area (see map below): 

1) Assuming you are out of college and older than 25, you would be most similar to the Late-Increase group from the 1^st study. These are individuals who did not smoke marijuana in high school and began smoking at the end of or shortly after college. In general these individuals have been found to have significantly worse QoL than nearly all other groups on most of the outcomes tested (i.e., more psychiatric symptoms, impairment days, and provider visits).

2) QoL has been found to be significantly lower among female and male cannabis users compared to non-users, and each joint smoked daily is associated with a greater decrease in mental QoL scores. So it appears the more marijuana you smoke the larger the negative impact on QoL.

3)  If you are using marijuana to treat anxiety, smoking marijuana has been found to make your QoL worse. Among individuals with anxiety disorder, regular cannabis use is associated with poorer mental QoL compared to occasional and non-use. Regular users report accomplishing less due to emotional problems and more commonly have emotional problems interfering with social activities. Again, they found that the more (or in this care the more often) that you smoke, the larger the negative impact. Compared to non-use, occasional cannabis use was associated with poorer mental QoL among females, but not among males.

With all of this said, everyone is unique and these studies have both strengths and limitations. Medications and all substances that we ingest impact everyone differently, but the above studies give us some general guidelines to go by. Based on these studies, others I have reviewed, and my clinical experience, I would not recommend smoking marijuana to improve your quality of life or treat a mental health concern (like anxiety or depression). If you are depressed or anxious, we certainly have better treatment options available (both medication and counseling.) If you have been using or are considering using marijuana to treat mental-health symptoms, I would speak with your primary care doctor or call your insurance company to find a psychiatrist in your area. If you are using marijuana recreationally, you should now better understand the negative impact marijuana is having on your quality of life.

As I mentioned, there are many aspects to consider to truly understand the impact of marijuana. However, these research articles help us to better understand how smoking marijuana impacts the overall quality of our life.

I hope this helps to answer your questions,

Dr. Goldenberg

Docgoldenberg@gmail.com

Author

Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.