Recreational cannabinoid use: The hazards behind the “high”

Use linked to car accidents. More recent work indicates cannabis use is associated with injuries in motor vehicle,³² non-traffic,³³ and workplace³⁴ settings. In fact, a meta-analysis found a near-doubling of motor vehicle accidents with recent use.³² Risk is dose-dependent and heightened with alcohol.^35-37 Psychomotor impairment persists for at least 6 hours after smoking cannabis,³⁸ at least 10 hours after ingesting it,³⁷ and may last up to 24 hours, as indicated by a study involving pilots using a flight simulator.³⁹

Cannabis contains at least 33 carcinogens and may be contaminated with pesticides.In contrast to alcohol, there is a greater decrement in routine vs complex driving tasks in experimental studies.^35,36 Behavioral strategies, like driving slowly, are employed to compensate for impairment, but the ability to do so is lost with alcohol co-ingestion.³⁵ Importantly, individuals using marijuana may not recognize the presence or extent of the impairment they are experiencing,^37,39 placing themselves and others in danger.

Data are insufficient to ascribe to marijuana an increase in overall mortality,⁴⁰ and there have been no reported overdose deaths from respiratory depression. However, a few deaths and a greater number of hospitalizations, due mainly to central nervous system effects including agitation, depression, coma, delirium, and toxic psychosis, have been attributed to the use of synthetic cannabinoids.²⁰

Cannabis use can pose a risk to the fetus. About 5% of pregnant women report recent marijuana use² for recreational or medical reasons (eg, morning sickness), and there is concern about its effects on the developing fetus. Certain rare pediatric cancers^22,25 and birth defects⁴¹ have been reported with cannabis use (TABLE 2^22,25,41,42). Neonatal withdrawal is minor, if present at all.⁴² Moderate evidence indicates prenatal and breastfeeding exposure can result in multiple developmental problems, as well as an increased likelihood of initiating tobacco and marijuana use as teens.^41,42