Applied Evidence

Recreational cannabinoid use: The hazards behind the “high”

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Marijuana use can cause concerning physical, psychomotor, cognitive, and psychiatric effects, not to mention a near-doubling of car accidents.




› Screen all patients for use of addiction-prone substances. A
› Screen cannabis users with a validated secondary screen for problematic use. A
› Counsel patients that there is no evidence that use of recreational cannabis is safe; advise them that it can cause numerous physical, psychomotor, cognitive, and psychiatric effects. C

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

Approximately 156 million Americans (49% of the population) have tried cannabis.1 About 5.7 million people ages 12 years and older use it daily or almost daily, a number that has nearly doubled since 2006.2 There are 6600 new users in the United States every day,2 and almost half of all high school students will have tried it by graduation.3

There is limited evidence that cannabis may have medical benefit in some circumstances.4 (See “Medical marijuana: A treatment worth trying?” J Fam Pract. 2016;65:178-185 or As a result, it is now legal for medical purposes in 25 states. Recreational use by adults is also legal in 4 states and the District of Columbia.5 The US Food and Drug Administration, however, has reaffirmed its stance that marijuana is a Schedule I drug on the basis of its “high potential for abuse” and the absence of “currently accepted medical uses.”6

The effects of legalizing the medical and recreational use of cannabis for individuals—and society as a whole—are uncertain. Debate is ongoing about the risks, benefits, and rights of individuals. Some argue it is safer than alcohol or that criminalization has been ineffective and even harmful. Others make the case for personal liberty and autonomy. Still, others are convinced legalization is a misdirected experiment that will result in diverse adverse outcomes. Regardless, it is important that primary care providers understand the ramifications of marijuana use. This evidence-based narrative highlights major negative consequences of non-medical cannabinoid use.


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