Cannabis: consumo, efectos y consideraciones sobre legalización y tratamiento

  1. Castillo Toledo, C. 1
  2. Gutiérrez Rojas, L. 2
  3. Molina Ruiz, R.M. 3
  4. Álvarez Mon, M.Á. 4
  1. 1 Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, España Departamento de Psiquiatría y Salud Mental, Hospital Universitario Infanta Leonor, Madrid, España
  2. 2 Servicio de Psiquiatría, Hospital Universitario San Cecilio, Granada, España Departamento de Psiquiatría y Grupo de Investigación CTS-549, Instituto de Neurociencias, Universidad de Granada, Granada, España
  3. 3 Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, España Departamento de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España
  4. 4 Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, España Departamento de Psiquiatría y Salud Mental, Hospital Universitario Infanta Leonor, Madrid, España Instituto de Investigación Sanitaria Ramón y Cajal, Madrid, España
Revista:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Año de publicación: 2023

Título del ejemplar: Actualidad clínico-terapéutica (IV)

Serie: 13

Número: 92

Páginas: 5452-5462

Tipo: Artículo

Otras publicaciones en: Medicine: Programa de Formación Médica Continuada Acreditado

Resumen

El cannabis es la droga ilegal más consumida en el mundo, generando una gran repercusión en la salud física y mental. Existen diferentes factores de riesgo que pueden aumentar la adicción a esta sustancia como son la frecuencia y duración del consumo y los factores genéticos, sociales o ambientales. Se sabe que el cannabis está formado por diferentes compuestos químicos que se unen a los receptores del sistema endocannabinoide en el organismo y que son responsables de sus múltiples efectos en el organismo. En el DSM-5 existen diversos trastornos relacionados con el uso de cannabis. Los efectos adversos del cannabis sobre la salud pueden variar según la cantidad consumida y la susceptibilidad individual, pero es bien conocido su efecto negativo sobre la capacidad de concentración, atención y memoria. También aumenta el riesgo de desarrollar patologías psiquiátricas como esquizofrenia, depresión, ansiedad o incluso aumenta el riesgo de suicidio. El tratamiento debe estar dirigido a lograr la abstinencia y mejorar la calidad de vida y la prevención de recaídas, siendo más eficaz la combinación del tratamiento farmacológico y psicológico.

Referencias bibliográficas

  • Sugerida C. Monografía cannabis 2022. Consumo y consecuencias. Madrid: Ministerio de Sanidad; 2022.
  • Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281-95.
  • Calabria B, Degenhardt L, Hall W, Lynskey M. Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use. Drug Alcohol Rev. 2010;29(3):318-30.
  • Drummer OH, Gerostamoulos D, Woodford NW. Cannabis as a cause of death: A review. Forensic Sci Int. 2019;298:298-306.
  • Fergusson DM, Horwood LJ, Boden JM. Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study. Accid Anal Prev. 2008;40(4):1345-50.
  • Cougle JR, Hakes JK, Macatee RJ, Zvolensky MJ, Chavarria J. Probability and correlates of dependence among regular users of alcohol, nicotine, cannabis, and cocaine: concurrent and prospective analyses of the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2016;77(4):e444-50.
  • Richter L, Pugh BS, Ball SA. Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana. Am J Drug Alcohol Abuse. 2017;43(3):247-60.
  • Volkow ND, Han B, Einstein EB, Compton WM. Prevalence of substance use disorders by time since first substance use among young people in the US. JAMA Pediatr. 2021;175(6):640-3.
  • Han B, Compton WM, Blanco C, Jones CM. Time since first cannabis use and 12-month prevalence of cannabis use disorder among youth and emerging adults in the United States. Addict Abingdon Engl. 2019; 114(4):698-707.
  • Prom Wormley EC, Ebejer J, Dick DM, Bowers MS. The genetic epidemiology of substance use disorder: A review. Drug Alcohol Depend. 2017;180:241-59.
  • López León S, González Giraldo Y, Wegman Ostrosky T, Forero DA. Molecular genetics of substance use disorders: An umbrella review. Neurosci Biobehav Rev. 2021;124:358-69.
  • Vink JM, Veul L, Abdellaoui A, Hottenga JJ, Boomsma DI, Verweij KJH. Illicit drug use and the genetic overlap with cannabis use. Drug Alcohol Depend. 2020;213:108102.
  • Hjorthøj C, Posselt CM, Nordentoft M. Development Over Time of the population-attributable risk fraction for cannabis use disorder in schizophrenia in Denmark. JAMA Psychiatry. 2021;78(9):1-8.
  • Soler Artigas M, Sánchez Mora C, Rovira P, Richarte V, Garcia Martínez I, Pagerols M. Attention-deficit/hyperactivity disorder and lifetime cannabis use: genetic overlap and causality. Mol Psychiatry. 2020;25(10): 2493-503.
  • Blanco C, Flórez Salamanca L, Secades Villa R, Wang S, Hasin DS. Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Am J Addict. 2018;27(6):47784.
  • Madras BK, Han B, Compton WM, Jones CM, López EI, McCance Katz EF. Associations of parental marijuana use with offspring marijuana, tobacco, and alcohol use and opioid misuse. JAMA Netw Open. 2019; 2(11):e1916015.
  • Myers B, McLaughlin KA, Wang S, Blanco C, Stein DJ. Associations between childhood adversity, adult stressful life events, and past-year drug use disorders in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Psychol Addict Behav J Soc Psychol Addict Behav. 2014;28(4):1117-26.
  • ElSohly MA, Radwan MM, Gul W, Chandra S, Galal A. Phytochemistry of Cannabis sativa L. Prog Chem Org Nat Prod. 2017;103:1-36.
  • Lu HC, Mackie K. Review of the endocannabinoid system. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6(6):607-15.
  • Atakan Z. Cannabis, a complex plant: different compounds and different effects on individuals. Ther Adv Psychopharmacol. 2012;2:241-54.
  • Mechoulam R, Parker LA. The endocannabinoid system and the brain. Annu Rev Psychol. 2013;64:21-47.
  • Diagnostic and statistical manual of mental disorders: DSM-5 5th ed. Washington: American Psychiatric Association; 2013.
  • Ghasemiesfe M, Ravi D, Vali M, Korenstein D, Arjomandi M, Frank J. Marijuana use, respiratory symptoms, and pulmonary function: A systematic review and meta-analysis. Ann Intern Med. 2018;169(2):106-15.
  • Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):221927.
  • Martinasek MP, McGrogan JB, Maysonet A. A systematic review of the respiratory effects of inhalational marijuana. Respir Care. 2016;61(11):1543-51.
  • Tashkin DP. Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 2013;10(3):239-47.
  • Ghasemiesfe M, Barrow B, Leonard S, Keyhani S, Korenstein D. Association between marijuana use and risk of cancer. JAMA Netw Open. 2019;2(11):e1916318.
  • Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2018;15(3):151-66.
  • Laudermilk LT, Marusich JA, Wiley JL. Δ9-tetrahydrocannabinol effects on respiration and heart rate across route of administration in female and male mice. Cardiovasc Toxicol. 2023;23(11-12):349-63.
  • Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S. Associations between marijuana use and cardiovascular risk factors and outcomes: A systematic review. Ann Intern Med. 2018;168(3):187-94.
  • Singh A, Saluja S, Kumar A, Agrawal S, Thind M, Nanda S. Cardiovascular complications of marijuana and related substances: A review. Cardiol Ther. 2018;7(1):45-59.
  • Latif Z, Garg N. The impact of marijuana on the cardiovascular system: A review of the most common cardiovascular events associated with marijuana use. J Clin Med. 2020;9(6):1925.
  • Scott JC, Slomiak ST, Jones JD, Rosen AFG, Moore TM, Gur RC. Association of cannabis with cognitive functioning in adolescents and young adults: A systematic review and meta-analysis. JAMA Psychiatry. 2018;75(6):585-95.
  • Maynard M, Paulson D, Dunn M, Dvorak RD. Relationship between cannabis use and immediate, delayed, and working memory performance among older adults. Cannabis Albuq NM. 2023;6(2):22-9.
  • Meier MH, Caspi A, R Knodt A, Hall W, Ambler A, Harrington H. Long-term cannabis use and cognitive reserves and hippocampal volume in midlife. Am J Psychiatry. 2022;179(5):362-74.
  • Stypulkowski K, Thayer RE. Long-term recreational cannabis use is associated with lower executive function and processing speed in a pilot sample of older adults. J Geriatr Psychiatry Neurol. 2022;35(5):740-6.
  • Becker MP, Collins PF, Schultz A, Uroševic´ S, Schmaling B, Luciana M. Longitudinal changes in cognition in young adult cannabis users. J Clin Exp Neuropsychol. 2018;40(6):529-43.
  • Weinstein A, Livny A, Weizman A. Brain imaging studies on the cognitive, pharmacological and neurobiological effects of cannabis in humans: Evidence from studies of adult users. Curr Pharm Des. 2016;22(42): 6366-79.
  • Broyd SJ, van Hell HH, Beale C, Yücel M, Solowij N. Acute and chronic effects of cannabinoids on human cognition-a systematic review. Biol Psychiatry. 2016;79(7):557-67.
  • Morie KP, Potenza MN. A mini-review of relationships between cannabis use and neural foundations of reward processing, inhibitory control and working memory. Front Psychiatry. 2021;12:657371.
  • Lynskey MT, Heath AC, Bucholz KK, Slutske WS, Madden PAF, Nelson EC. Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA. 2003;289(4):427-33.
  • Kerridge BT, Pickering R, Chou P, Saha TD, Hasin DS. DSM-5 cannabis use disorder in the National Epidemiologic Survey on Alcohol and Related Conditions-III: Gender-specific profiles. Addict Behav. 2018;76:52-60.
  • Hindocha C, Freeman TP, Ferris JA, Lynskey MT, Winstock AR. No smoke without tobacco: A global overview of cannabis and tobacco routes of administration and their association with intention to quit. Front Psychiatry. 2016;7:104.
  • Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011;119(1-2):28-36.
  • Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry. 2019;76(4):426-34.
  • Fresán A, Dionisio García DM, González Castro TB, Ramos Méndez MÁ, Castillo Avila RG, Tovilla Zárate CA. Cannabis smoking increases the risk of suicide ideation and suicide attempt in young individuals of 11-21 years: A systematic review and metaanalysis. J Psychiatr Res. 2022;153:90-8.
  • Shamabadi A, Ahmadzade A, Pirahesh K, Hasanzadeh A, Asadigandomani H. Suicidality risk after using cannabis and cannabinoids: An umbrella review. Dialogues Clin Neurosci. 2023;25(1):50-63.
  • Devin J, Lyons S, Murphy L, O’Sullivan M, Lynn E. Factors associated with suicide in people who use drugs: a scoping review. BMC Psychiatry. 2023;23(1):655.
  • Single A, Bilevicius E, Ho V, Theule J, Buckner JD, Mota N. Cannabis use and social anxiety in young adulthood: A meta-analysis. Addict Behav. 2022;129:107275.
  • Moore THM, Zammit S, Lingford-Hughes A, Barnes TRE, Jones PB, Burke M. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet Lond Engl. 2007;370(9584): 319-28.
  • Starzer MSK, Nordentoft M, Hjorthøj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry. 2018;175(4):343-50.
  • Manrique García E, Ponce de León A, Dalman C, Andréasson S, Allebeck P. Cannabis, psychosis, and mortality: A cohort study of 50,373 swedish men. Am J Psychiatry. 2016;173(8):790-8.
  • Schlienz NJ, Lee DC, Stitzer ML, Vandrey R. The effect of high-dose dronabinol (oral THC) maintenance on cannabis self-administration. Drug Alcohol Depend. 2018;187:254-60.
  • Levin FR, Mariani JJ, Brooks DJ, Pavlicova M, Cheng W, Nunes E. Dronabinol for the treatment of cannabis dependence: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend. 2011;116(13):142-50.
  • Vandrey R, Stitzer ML, Mintzer MZ, Huestis MA, Murray JA, Lee D. The dose effects of short-term dronabinol (Oral THC) maintenance in daily cannabis users. Drug Alcohol Depend. 2013;128(1-2):64-70.
  • Budney AJ, Vandrey RG, Hughes JR, Moore BA, Bahrenburg B. Oral delta-9-tetrahydrocannabinol suppresses cannabis withdrawal symptoms. Drug Alcohol Depend. 2007;86(1):22-9.
  • Haney M, Hart CL, Vosburg SK, Comer SD, Reed SC, Foltin RW. Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology (Berl). 2008;197(1):157-68.
  • Copeland J, Swift W, Roffman R, Stephens R. A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. J Subst Abuse Treat. 2001;21(2):55-64; discussion 65-66.
  • Miller WR, Rollnick S. Motivational interviewing: Helping people change. New York: Guilford Press; 2012. p. 497.
  • Hoch E, Bühringer G, Pixa A, Dittmer K, Henker J, Seifert A, et al. CANDIS treatment program for cannabis use disorders: findings from a randomized multi-site translational trial. Drug Alcohol Depend. 2014;134:185-93.
  • Hendriks VM, van der Schee E, Blanken P. Multidimensional family therapy and cognitive behavioral therapy in adolescents with a cannabis use disorder: a randomised controlled study. Tijdschr Voor Psychiatr. 2013;55(10):747-59.
  • Carter T, Heaton K, Merlo LJ, Roche BT, Puga F. Relapse prevention and prediction strategies in substance use disorder: A scoping review. J Addict Nurs. 1 de junio de 2023;34(2):146-57.
  • Assanangkornchai S, Kalayasiri R, Ratta-Apha W, Tanaree A. Effects of cannabis legalization on the use of cannabis and other substances. Curr Opin Psychiatry. 2023;36(4):283-9.