UPDATED: March 15, 2025
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When I began researching this article, I was hoping that the majority of the scientific evidence regarding the health impact of this widely distributed and hardy plant would be overwhelmingly positive, but it seems to be a mixed bag. It would be great to grow your own medicine, at least in those more enlightened states where it is legal for one’s personal consumption.
However, as with any herbal remedy or pharmaceutical drug, there are both its desired effects, and side-effects that would rather be avoided. Thus, one must weigh any potential benefits against the potential risks, and seek out those treatments with the most favorable benefit-to-risk ratios.
Cannabis is the genus name of an annual, dioecious, flowering plant that originated in Asia. Although the number of species within this genus is disputed, three main species are generally recognized; C. sativa, C. indica, and C. ruderalis. Here’s what a mature bud looks like, in all its glory:
The term “cannabis” broadly refers to all the unprocessed parts of the plant, along with its extracts and the synthetic analogs of naturally occurring cannabinoids. In common usage, cannabis is considered to be a less pejorative term than the more familiar marijuana, maryjane, pot, weed, dope, ganja, and hemp, but call it what you want; “… a rose by any other name would smell as sweet” (from Shakespeare’s “Romeo and Juliet”).
History
First domesticated about 12,000 years ago, the plant has played a role in many cultural traditions. Historically, cannabis has been used in shamanic divinations and rituals, to facilitate spiritual practices, as a religious sacrament, and as a medicinal herb. Evidence for its use to produce altered states of consciousness has been found at prehistoric archaeological sites in Eurasia and Africa. In third-century China, cannabis smoke from incense burners was inhaled by meditating Taoists. Perhaps it precipitated Lao Tzu’s pithy wisdom: “Those who speak do not know, those who know do not speak.” To that I might add, if those who are stoned do speak, it is likely to be, “Oh, wow! Far out, man!”
The plant's resinous buds and their extracts enjoy a worldwide popularity, joining ethanol, nicotine, and caffeine as yet another recreational drug with a potential for abuse. As of 2024, 24 U.S. states and all of Canada have legalized recreational cannabis. Medical cannabis is legal in an additional 13 states. Once the cannabis genie is out of the bottle, it will be very difficult to put it back, despite recent findings about the harms caused by prenatal exposure, and the increasing number of children seen in the emergency department after they discovered mommy’s stash of canna-gummies.
The chemical potency of cannabis buds has increased 10-fold over the past half century, due to genetic modification through selective breeding. Consequently, doctors have been seeing adverse health consequences unknown during its hippie heyday. The National Academies of Sciences, Engineering and Medicine, chartered by Congress to advise government officials on pressing scientific matters, has issued a new report on the hazards of unregulated cannabis use, and calls for urgent public health actions to protect people from harm.
Botany
Some non-hybrid, “heritage” subspecies have been long established as geographic landraces, such as Hindu Kush, Kona Gold, and Panama Red. Other non-hybrids that maintain the genetic profile of the original landrace but are grown in different locales are known as heirloom varieties, such as Northern Lights and Lamb’s Bread.
Today, there are hundreds of sativa-indica hybrids, genetically manipulated strains, and cultivars that have been selectively bred in order to deliberately enhance the concentrations of their cannabinoid compounds, primarily cannabidiol (CBD), cannabinol (CBN), and tetrahydrocannabinol (THC). In short, they bear little resemblance to what your hippie grandparents toked, and are generally far more potent.
Biochemistry
It is only recently that the plant's medicinal qualities have received serious scientific scrutiny. Unfortunately, most of the research has not been high enough quality, which would involve knowing the precise amounts of the different substances found in plants being studied for their medicinal effects. The preferred method for the quantitative analysis of cannabis compounds is high-performance liquid chromatography used in conjunction with mass spectrometry, which means that any research will need to be well funded.
The nearly 500 substances produced by the flowers of female Cannabis plants include at least 144 known cannabinoids (so far), plus terpenes and terpenoids, about most of which very little is known. Tetrahydrocannabinol (THC), the primary psychoactive cannabinoid, produces its effects by binding to the CB1 cannabinoid receptors.
Cannabigerol (CBG) is a minor cannabinoid that serves as a chemical precursor in the biosynthesis of a number of other cannabinoids, including THC, CBD, and CBC. Extracted from hemp, CBG is non-intoxicating. A small study found that it might reduce anxiety and possibly improve memory, without causing any significant side-effects over the short term.
Cannabinol (CBN) is a mildly psychoactive cannabinoid that has a low affinity for both CB1 and the CB2 receptors. Cannabidiol (CBD) has little affinity for CB1 and CB2 receptors, but acts as both a serotonin 5-HT1A receptor agonist, and as an indirect antagonist of both THC and CBN at low doses.
Animal studies suggest that CBN has potential as a non-intoxicating sleep aid, while CBD could exert a beneficial effect on mood and pain. Another cannabinoid, CBC (cannabichromene), is not psychoactive and possibly has anti-inflammatory properties, along with the ability to potentiate the effects of naturally occurring endocannabinoids such as anandamide.
Endocannabinoids are produced by the body and regulate many functions by activating cannabinoid receptors on cell membranes. CB1 receptors are primarily found in parts of the brain, while CB2 receptors are found elsewhere, mostly in tissues of the immune system and the gut.
Anandamide (arachidonoyl ethanolamine) was the first endocannabinoid identified, followed by the discovery of several others. Anandamide, found in nearly all tissues in a wide range of animals, is about as potent as THC when it binds to CB1 receptors. The pleasurable psychological effect of chocolate and the so-called “runner's high” have been attributed to endocannabinoids. According to a 2018 study, acetaminophen provides pain relief by indirectly activating CB1 receptors.
Once inside the body, most cannabinoids are metabolized in the liver. Being lipid soluble, they can also accumulate in the body’s fatty tissues and continue to produce positive “drug tests” following cessation of their consumption. Urine tests for THC do not provide evidence of a driver being “under the influence” as does an alcohol breath or blood test. However, a positive urine test, plus a failed field sobriety test, can lead to a DUI arrest.
Medical Research
Research suggests that the effects of the different cannabinoids are modulated by their interactions with each other, as well as with the terpenes. This is known as the “entourage effect,” which makes it impossible to do good research using whole buds or unassayed extracts. The relative proportions of the different phytochemicals can vary from one part of a single plant to another. So, when you buy a bud from a cannabis dispensary, any purported assay of its cannabinoids can only provide a rough estimate, at best.
Reliable medical research must involve randomized, controlled trials (RCTs) of single cannabinoids, or a very limited combination of them, in precisely known amounts. RCTs are known as the “gold standard” of medical research because they are able to establish a causal relationship between a treatment and an outcome. Since RCTs are very costly to perform, it is highly unlikely that they will ever be done with consumer-grade, over-the-counter cannabis products. There would need to be a sufficient profit incentive for a drug company to develop, patent, and test synthetic cannabinoids or specific formulations of the plant's extracts.
Current cannabinoid-based pharmaceuticals include nabiximols (Sativex), which contains about a 1:1 ratio of CBD to THC, along with some other cannabinoids and terpenoids, ethanol, propylene glycol, and peppermint. It is used to treat muscle spasticity and pain associated with multiple sclerosis. Epidiolex is a CBD-containing drug with FDA approval for treating two rare kinds of childhood epilepsy. Dronabinol (Marinol, Syndros) contains delta-9-THC, and Nabilone (Cesamet) is a synthetic analog of THC. Both of the THC drugs are used by cancer patients to alleviate chemotherapy-induced nausea and vomiting.
In sharp contrast to other federally regulated substances, such as opioids and alcohol, medically prescribed cannabinoids have not been associated with severe adverse effects or overdose deaths, but that doesn’t mean they should be considered harmless. A new study found that otherwise healthy patients who were prescribed medical cannabis for chronic pain had an increased risk for developing cardiac arrhythmias.
Most cannabinoid-based medicines (CBMs) lack convincing research that supports their therapeutic utility. When it comes to managing patients in acute pain with cannabinoid compounds, only two of the 11 clinical trials that evaluated the post-operative efficacy of different cannabinoid interventions showed any positive results, according to a 2024 review.
After a systematic review of 47 studies involving the management of chronic pain, including 22 RCTs, a Canadian joint task force published the following recommendations: “CBMs can be used as monotherapy, replacement, or adjunct treatment, for the management of chronic pain, including central and/or peripheral neuropathic pain. Oral products may be preferred for their longer duration of action (6 to 8 hours). The strongest evidence for reduction of chronic pain symptoms is for THC formulations, not CBD.
Use by Seniors and Children
A recent University of Michigan poll found that 21 percent of people ages 50 and older reported using some form of cannabis at least once in the last year. Increasing numbers of older adults have been trying cannabis to relax, improve sleep, alleviate pain, elevate their mood, or deal with other medical conditions. More than half of older users simply liked getting stoned.
Since its legalization in many states, cannabis use among younger people has been surging. The CDC reports that more than 30 percent of 12th-graders in 2022 said they consumed cannabis in the past year, and more than 6 percent said that they had used it daily during the past 30 days. That is truly alarming.
Parents need to be vigilant, especially those who use cannabis themselves. They need to make it perfectly clear that not only is smoking cannabis harmful for children, but that consuming it in candy, baked goods, gummies, and other edibles is also dangerous. Children can much more easily overdose on edible cannabis products.
The science is already clear about cannabis interfering with the brain development of children and young adults if used before age 25. Early life use is associated with lower IQ scores, learning delays, and higher rates of failing to graduate from high school and college. Women who use cannabis during their pregnancy are more likely to give birth to children who have difficulties with their attention, memory, and problem-solving abilities. Another study found cannabis use associated with adverse effect on brain function and working memory.
Curious to Try?
Raw cannabis needs to be heat activated to have a physiological effect. The cannabinoids in dried cannabis buds are in their acidic form. For example, THC is present as THCA (tetrahydrocannabinolic acid). When THCA is heated, it loses its carboxyl group and becomes THC, its psychoactive form. Cannabis buds are typically decarboxylated at temperatures between 220-280°F before being inhaled or ingested, to ensure that the cannabinoids are active.
For those who prefer the oral route of administration, keep in mind that cannabinoids are lipid soluble. Cooking raw buds with butter or oil increases cannabinoid bioavailability. So does extracting decarboxylated cannabinoids with ethanol to make tinctures. Classic cannabis recipes include brownies and bhang. Remember, to reduce the potential for adverse effects, begin with a small amount and slowly increase it, as tolerated.
The conventional wisdom about using CBD in combination with THC to attenuate its psychotropic effects has been called into question by a new double-blind, placebo-controlled, five-way crossover study using oral administration of the cannabinoids. The researchers found that a high dose of CBD significantly enhanced the psychotropic effects of THC by increasing its blood levels, without increasing its analgesic effects.
Oral CBMs containing THC might be helpful as part of an overall strategy for the management of chronic pain conditions in otherwise healthy adults, but caution is advised. The important thing is to begin with a low dose and proceed slowly when increasing the dosage. It is also important to be aware of the potential for cannabinoids, including CBD, to have adverse interactions with other medications (including anti-epileptic drugs, antidepressants, and acetaminophen), as well as with opioids and alcohol.
Be aware that there are individual differences in the ways that people respond to different cannabinoids, including the influence of a person's genetic makeup. Cannabis buds, plant extracts, and edibles are not regulated by the FDA, so purity and potency cannot be assured, despite what the label says or the salesperson at the dispensary tells you. Anecdotal information about the properties of any particular C. sativa or C. indica strain and their many hybrids does not meet the requirements for scientific evidence. Let the buyer beware that their effects are unpredictable, and can vary widely from batch to batch of the same strain.
If you’re considering trying cannabis for the first time, here is primer, written by a pro-cannabis medical doctor:
Cannabis Cautions
A recent observational study of cannabis use during pregnancy found an association with adverse outcomes for the baby, such as preterm birth, lower birth weight, and increased admissions to neonatal intensive care units. Another study found the prenatal cannabis exposure impacted children’s brains by altering the DNA of genes involved in neurodevelopment.
For the mother, there was a greater risk of gestational hypertension, pre-eclampsia, and placental abruption. Researchers suspect that cannabinoids may bind to receptors in the placenta, disrupting estrogen signaling and affecting placental development and function.
A person's age also influences how they will be affected by cannabinoids. Healthy brain development is crucial during adolescence, more so than at any other stage. During this period of brain growth the endocannabinoid system plays a critical role. I don’t want this to sound like the hyped-up claims made in the 1936 film, “Reefer Madness,” but the dangerous effects of THC on brains that have not yet matured should be taken very seriously.
The brains of teenagers have many more CB1 receptors than the adult brain, and irreversible damage to learning mechanisms and memory functions can occur when THC binds with the brain’s CB1 receptors, blocking their normal activity in neurodevelopment. This can cause psychological and behavioral problems in adulthood, according to a study published in 2014. A 2021 clinical review summarized some potential pharmacological interventions for these psychiatric consequences.
A new study found that teens who use cannabis have an 11 times greater risk of developing a psychotic disorder. According to a recent review, the effects of CBD on teenagers’ brain development has not been studied. However, a new study of the acute effects of different cannabinoids on the brains of young adults and adolescents found that CBD did not counteract THC’s disruptive effects on brain connectivity. In some cases CBD further reduced connectivity, both within specific neural networks the brain as a whole.
These results challenge the assumption that CBD can make cannabis use safer for developing brains. Unless there is a compelling reason for its use, such as last resort treatment for a seizure disorder that fails to respond to conventional medications, both CBD and THC avoidance is advised.
Following legalization, there has been a dramatic increase in direct-to-consumer marketing of cannabis products, specifically CBD. Most of the medical marijuana research has been done on synthetic oral cannabinoids that do not translate to the real-world use by patients purchasing products from pharmacies and cannabis dispensaries, and the FDA has repeatedly issued warnings to companies about unsubstantiated claims.
A recent review highlighted a disturbing connection between cannabis use and chromosomal damage that appears to be related to rising rates of some cancers, birth defects, and accelerated aging. For example, testicular cancer risk was 2.6 times higher among cannabis users. Even more alarming was the suggestion that the DNA damage could be passed on to future generations, but the evidence seems weak. While a causal relationship has not been established, new and updated epidemiological studies are warranted.
Age-related mental, physical, and physiological changes in older adults can result in much different effects in this population, compared to those seen in younger individuals. Many seniors using CBD products have been influenced by marketing strategies specifically targeting their demographic, but the science simply doesn’t support the marketing assertions.
A 2023 scoping review of 134 unique studies, including 36 RCTs, examined the evidence for benefits, harms, and health outcomes related to cannabis consumption by older adults. Medical cannabis had inconsistent therapeutic effects in conditions such as pain due to cancer, dementia, and Parkinson’s disease. Some studies suggested possible benefits, while others found they had no value, and the number of harmful associations outnumbered those that were beneficial. The RCTs were more likely to find negative effects than the other types of studies.
Cannabis use by seniors was associated with increased rates of anxiety, depression, cognitive impairment, substance use problems, accidental injuries, and acute healthcare. Most of the studies reviewed were small, did not consistently assess the harms, and did not adjust for enough of the confounding variables. Researchers were unable to compare consumption methods, such as smoking, vaping, or ingesting edibles. Neither were comparisons of the different kinds of products possible.
The take-away from this review is that within the general population of older adults, there is some limited evidence that the harms of regular cannabis use could outweigh any purported benefits. The effects of cannabis in older adults clearly deserves further study in order to more accurately assess both its risks and benefits, including comparisons that target specific products and routes of delivery. Better evidence will be needed to guide any public health messaging and doctors’ recommendations.
Although there are some notable scientists and older celebrities who have regularly used recreational cannabis, some of whom proclaim its medicinal benefits as well, your own experience could vary, a lot. A recent study found that cannabis legalization in Canada was associated with a significantly increased rate of emergency department visits by older adults who had overdosed on cannabis edibles. In the U.S. the FDA warned about the processes used to synthesize delta-8 THC found in some edibles, because impurities or variations in the process can result in products that may be harmful or have unpredictable effects.
There has also been an alarming rise in cannabinoid hyperemesis syndrome, coinciding with the ready availability of high potency cannabis products. You surely won’t want to go through that. I'm not trying to scare seniors away from cannabis as an “alternative medicine,” but rather suggesting that if they're inclined to experiment, that they proceed with caution: Start low, go slow, and stay low.
If you are a senior who is considering self-medicating with cannabis, please be aware that even if you smoked buds or hash back in the day, today’s weed is a whole lot stronger! With inhaled (vaped or smoked) products, the effects come on quickly and don’t last too long.
Avoid vaping cannabis extracts such as oils and shatter. Choose buds that are low in THC, and have an equal or greater amount of CBD. To minimize pulmonary consequences, the lower temperature of vaping is preferable to combustion, and it’s even better if your vape is cooled with water. Although head and neck cancers are typically associated with smoking tobacco, a recent study found that cancers of the mouth, throat and nasopharynx were between 3.5 and 5 times more common among heavy cannabis smokers than those who didn’t partake on a daily basis.
It is difficult to titrate appropriate dosages with edibles, whether homemade of commercially produced, mostly due to the delayed onset of effects and their much greater duration, and partly the result of inconsistencies in cannabinoid content. As for the topical application of CBD creams, oils, and salves, I fail to see how they could work unless they contain a transdermal delivery component, which some claim to do. There are transdermal CBD patches available, which may offer advantages over oral CBD products.
There’s also an element of risk when consuming some edibles. For example, as of September 13, 2024, Diamond Shruumz edibles have caused 169 illnesses across 33 states. Of those affected, 66 have required hospitalization. Two potentially linked deaths are currently under investigation.
If you’re a senior, you may be less resilient to the potential adverse effects of cannabinoids and any adulterants that they might contain. Even though Willie Nelson is still going strong despite being a heavy user, caution is advised.
Altered States
I don’t recommend the recreational use of any drugs. If you’re having trouble coping with your socially conditioned “conventional reality,” there are effective cognitive-behavioral psychotherapies and mindfulness practices that can help to restructure maladaptive patterns of thinking and acting. I believe that coming to terms with oneself is preferable to getting stoned or drunk in order to avoid dealing with psychological discomfort.
There are deeper experiential realities that can be revealed through altered states of consciousness, and there are far better choices than cannabis for seriously exploring them. For a deep look into ayahuasca sessions, see:
A recent study of older adults found that guided psychedelic group sessions enhanced their well-being. One can also gain highly beneficial insights through their judicious application. Such explorations are best guided by a skilled practitioner. In other words, don’t go on a psychedelic “trip” without a competent “travel guide.”
Psilocybin (the psychoactive ingredient “magic mushrooms”) has been legalized by the state of Oregon and can be administration by licensed facilitators. It has also recently been legalized in Colorado. The use of psilocybin as part of palliative care for terminal illness has helped many patients overcome their fear of death. This psychoactive drug was called a “breakthrough therapy” by the FDA, but remains on the DEA’s nonsensical Schedule 1, along with cannabis, as having no currently accepted medical use and a high potential for abuse.
The brain-desynchronizing psychedelic effects of psilocybin clearly warrant further study. As for the cannabis-containing products that you’ll find at your friendly neighborhood dispensary, especially those with high concentrations of THC, please be aware that you’ll be venturing into unknown territory. Be careful, and hope for good luck, but don’t count on it.
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