This often-asked question is a legitimate concern, given the fact that marijuana has been classified as a Schedule I drug (“no accepted medical use and a high potential for abuse”) since the early 1970s. Other Schedule I drugs include highly addictive heroin and cocaine, while the addicting and potentially lethal opioids (more than 70,000 deaths from opioid overdose in 2017) are apparently deemed less harmful than cannabis, with a Schedule II classification.
Given recent research findings along with the remarkable therapeutic benefits and safety demonstrated for more than two decades of medical marijuana use in (currently) 30 states, this DEA classification makes no rational sense and needs to be revised.
The short answer to the question is, “yes” marijuana can potentially become addicting. But this is also true of any substance or behavior that affects the “reward system (dopamine)” of the brain, including food, sex, and even television. Anything that directly or indirectly affects dopamine metabolism, gives it the potential for dependence and possible addiction. Dopamine plays a significant role in feeling “high.”
THC (the psychoactive ingredient in marijuana) is known to trigger the release of dopamine, the neurotransmitter in the brain stimulating feelings of pleasure.
Having said that, marijuana is much less addictive than opioids, cocaine and heroin, because these have a far more pronounced ability to affect the reward system more quickly. They also have an increased potency and lethality associated with their side effects, including respiratory depression, hypoxia, cardiac arrest, overdose, and death. The National Center for Health Statistics has not recorded any deaths directly related to marijuana.
Marijuana use can lead to the development of problem use or dependence, known as a marijuana use disorder, which in severe cases takes the form of addiction. To avoid misunderstanding, it is important to distinguish addiction from chronic (daily) use, problem use (dependence), recreational use, or medicinal use.
In 2014, 4.176 million people in the U.S. abused or were dependent on marijuana (problem use), and 138,000 voluntarily sought treatment for their marijuana use. Research has clearly demonstrated that people who begin using marijuana before the age of 18 are four to seven times more likely to develop problem use as adults.
Dependence becomes addiction when the person can’t stop using marijuana even though it interferes with his or her daily life. Studies suggest that nine percent of people who use marijuana will become dependent on it, and this rises to about 17 percent in those who start using in their teenage years. These are similar numbers to the amount of people that can become addicted to other drugs such as alcohol, cocaine, or opioids. Addiction can cause a host of problems in daily life, especially maintaining a job or relationships.
Any drug that affects the brain reward system in the vulnerable individual, can lead to problem use/dependence, and in severe cases, addiction. In most cases of addiction, especially with marijuana, it is not the drug, but the user of the drug that is the major contributor to causing addiction.
An individual’s mental health history, such as a diagnosis of addiction, depression, anxiety, a mood disorder, psychosis, or a family history of addiction or schizophrenia, should serve as a warning to the possibility of marijuana being a potential problem. Even though the risk of addiction with marijuana is relatively low, these factors need to be taken into account before beginning daily cannabis use as a medicine, and should be discussed with your physician.
The brain is not fully developed until our mid- to late twenties. THC can interfere with the proper development of the brain and potentially lead to schizophrenia, a serious mental illness. This presents another potential risk for the young adult cannabis consumer.
Marijuana potency has steadily increased over the past two decades. THC content has increased from 3.7 – 7.5 percent in the early 1990s to 9.6 – 16 percent in 2013. With the advent of THC concentrates, such as shatter and wax, the addiction potential of marijuana has increased considerably. The highest-potency marijuana flower available today, contains at most, 25 to 30 percent THC. But the concentrates can contain up to 95 percent or more THC. The effect is so intense and the addiction potential so much greater that they have been described as the “crack cocaine of marijuana.”
Researchers do not yet know the full extent of the consequences when the body and brain (especially the developing brain) are exposed to very high concentrations of THC. Nor are we certain whether the recent increases in emergency department visits by people testing positive for marijuana or the increased incidence of schizophrenia in young adults are related to rising potency.
I believe the risk of using concentrates and dabbing (vaporizing concentrated marijuana) far outweighs their benefit, especially in late adolescence and early adulthood. I strongly advise my patients to avoid them.