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Credit: University of Virginia

Teen drama is all-consuming; jealousy and conflicts with friends can make adolescents feel the whole world is against them.

Now, new research from the University of Virginia has found ramifications from these conflicts may have long-term links to premature aging in adulthood.

The clue to this new discovery was found in the bloodstream, in the form of something called interleukin-6, a protein that's been associated with the development of cancerous tumors, arthritis, osteoporosis and a number of other problems associated with aging.

That substance was found at high levels in the bloodstreams of 28-year-olds who experienced chronic social conflict beginning at the early age of 13.

Joseph Allen, UVA's Hugh Kelly Professor of Psychology, led the study, titled "The Body Remembers" and published in the journal Development and Psychopathology.

Allen and his team began following 127 Charlottesville middle schoolers in 1998. They asked the students how well they managed conflict and then posed the same question to their peers. They then observed the students interacting with their close friends.

The researchers touched base with the students several more times over the years. At the age of 28, blood was drawn from all of the study participants; those who had chronic difficulty managing conflict beginning at 13 had higher levels of interleukin-6 in their bloodstreams.

Why is this happening?

"What we think is that the stress-response system that all humans have is particularly open to influence in adolescence," Allen said. "There is a lot changing in the brain. There is a lot changing in terms of hormone development. We think the system is particularly primed in adolescence to be affected by peer relationships."

While it is well-known that increased stress levels in adulthood can lead to health problems, the idea that stress in adolescence can have lasting effects is counterintuitive.

"We don't think of that typically with adolescence because adolescents are so healthy," Allen said.

The researchers, who were largely UVA undergraduate and graduate students, would pose vignettes to the research subjects, starting at age 13. One took place on a basketball court, where the student is pushed and called a wimp. "What would you do?" asked the researchers.

Pushing back would be a demonstration of poor conflict management. Continuing to play and ignoring the shoving is the healthier response.

At 21, researchers observed the subjects with their romantic partners. "We bring them into our offices and we interview them separately and we ask them to identify topics about which they disagree," Allen explained. The pair then comes together and discusses one of those topics. "The 21-year-old who came in and their partner was really rude and hostile and aggressive to them, those were the kids who were at risk."

The conflict could be over anything, from jealousy to the amount of time people spent together and how they deal with each other's friends.

Allen said neither gender nor socioeconomic status appeared to affect interleukin-6 levels. Neither did personality traits like extroversion or introversion. "What that really says is that people with all different personalities can learn to handle conflict well or can struggle with handling it badly, and it's not just simply some trait that people have inherited that's not likely to be able to be changed."

Allen said the results are alarming. "It's frightening because with many things in life, we get second chances. We can fix things," he said. "The possibility, and at this point, it's just a possibility, that our struggles at 13 could stick with us, even if we later learn to overcome them, is what is really concerning."

Allen said the results are important because adults tend to trivialize adolescents' social experiences as something over-dramatic.

"This says that when the adolescents are so upset about their relationship problems, they are actually onto something. That these relationship problems are potentially far more significant than we realized," he said.

As children become adolescents, it can be challenging for parents to realize their kids are struggling because the teens are trying to handle things on their own. "They can be going through terrible social stress or terrible bullying or terrible conflict and they might tell their friends, but they won't necessarily tell their parents," Allen said.

That is why Allen says it is important that parents model good conflict resolution with one another and their children, because they are always watching.

More information: Joseph P. Allen et al. The body remembers: Adolescent conflict struggles predict adult interleukin-6 levels, Development and Psychopathology (2017). DOI: 10.1017/S0954579417001754

Provided by: University of Virginia

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Study finds teen stress may have health consequences later in life

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Teen drama is all-consuming; jealousy and conflicts with friends can make adolescents feel the whole world is against them. Now, new research from the University of Virginia has found ramifications from these conflicts may have long-term links to premature aging in adulthood.

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I hate school it has to be the worst place and I get treated like a dog

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It comes as no surprise that we're stressed. One in four Canadians cite stress as the reason for leaving their job, while 73 per cent of all working adults aged 20 to 64 report at least some level of stress.

According to Statistics Canada, 23 per cent of people over the age of 15 report that most days are "quite a bit" or "extremely" stressful, and that number rises to 30 per cent among the 35 to 54 age group.

Work is the leading cause of stress among our population, followed (albeit far behind) by finances, but the addition of new modern concerns - like terrorism and the state of the environment - are adding to the load. In addition, they're changing how we as a society look at stress and who we consider to be the most stressed among us.
READ MORE: 3 steps to teach your brain to manage stress and crush it at work
Stress is no longer a white-collar affliction

The General Social Survey conducted in 2010 found that educated, white-collar professionals were more likely to report their job as the largest source of stress, 45 per cent of whom had an annual income of $100,000 or more; immigrants, visible minority groups and those without a post-secondary education were more likely to pin their stress on finances.

"Initially the message was clear: people doing important or difficult work under pressure were particularly susceptible," Jill Kirby, a teaching fellow at the University of Sussex, wrote in The Conversation. "The Daily Mirror carried stories about the risk to students from elite universities and suggested that 'the boss got more 'stress disorders' than those working under him.'"
LISTEN: Marilisa Racco joins the Tasha Kheiriddin show on 640 Toronto
Over time, society began to grasp just how far-reaching the hand of stress could be. As Daniel Akst wrote in the New York Times in 2004, traditionally, the media painted the most stressed population as educated, middle-class professionals who, in fact, had the luxury of making choices that would lead to less stress.

But that largely glossed over the lower classes who had more pressing issues that precluded them from de-stressing:

"Those who are paid $7 or $8 an hour don't have health insurance and lack the skills or education to better their lot."

Add to that life-altering events that worked to shake Westerners' sense of security in the world, and stress was suddenly democratized.

"Events like 9/11 made terrorism global, and that transcended a lot of cultural perceptions and definitions of stress," says Dr. Richard Amaral, a registered psychologist in Markham, Ont. "Suddenly, people of all financial and social status were now susceptible and we realized how vulnerable all of society was. That kind of awareness brought the concept of stress to the forefront for people of all races and socioeconomic status."
READ MORE: Follow this one tip the next time you're stressed, anxious or nervous
But the profile of those most susceptible to stress and its negative outcomes has been further refined in recent years. Here's what we know today.

Young people are more stressed than ever

For starters, young people are excessively stressed out these days. A study published in December in the journal Psychological Bulletin found that there was a 33 per cent spike in two types of perfectionism among college students in Canada, the U.S. and the U.K.: "self-oriented," or having high expectations of yourself, and "other-oriented," where they have rigorous standards for others.

In its most acute forms, the researchers say, the stress of perfectionism can lead to eating disorders, high blood pressure, depression and thoughts of suicide.

"The younger generation feels a lot more stress today than they did in the past," says Dr. Katy Kamkar, a clinical psychologist at Toronto's Centre for Addiction and Mental Health.

"There are worries about being educated and not being able to find a job; concerns about cost of living and debt that's causing them to live with their parents longer. All this translates to more stress. And we know that 70 per cent of mental health problems are onset in younger years."

The advent of technology adds another layer to young people's stress, experts say. For one thing, it makes them more susceptible to cyberbullying, and for another, it is affecting their ability to focus and relax.

"A lot of young people are having difficulty maintaining their attention span because they're always looking to see what's coming through on social media," Amaral says.
READ MORE: Kids and stress: How to identify it and how to help them cope
"There's research that talks about how [kids] who are constantly looking at their phones and who are being bombarded with this information are structurally changing their brain. It's creating a background noise that prevents them from relaxing and being more mindful. And that, in turn, makes them feel stressed."

Racialized and impoverished women are especially vulnerable

Recent research suggests that people of colour, especially mothers and their babies, are particularly vulnerable to the health hazards brought on by stress. Faculty at the University of West Florida (UWF) announced in March they would conduct an exploratory study to examine chronic stress in mothers to understand if stressors like sexism, racism, discrimination and poverty were at the root of poor health outcomes for mothers and their babies.

"Discrimination can be embodied," Dr. Meredith Marten, an assistant professor of anthropology at UWF and a lead author of the study, tells Global News. "Experiences of chronic stress, which engage the human stress response, can lead over time to poor health outcomes, particularly cardiovascular conditions and immune suppression, among others."

"People who experience more discrimination and encounter racism have a higher risk for negative health outcomes, in part because of the stressor of experiencing discrimination."

Although Marten was unable to share any conclusions from her study as it's still too early to report data, she said that concerns for "black sons and their safety as they grow older has been one issue frequently mentioned."

A mother's stress can affect her baby's brain development

Researchers at Wayne State University in Detroit have found that a mother's stress levels directly impact the brain development of babies in-utero - specifically that her stress can change the neural connectivity of her unborn baby's brain.
READ MORE: These are the worst jobs for your physical and mental health
Researchers used fetal imaging to examine 47 fetuses between the 30th and 37th week of gestation in women from a high-stress urban setting, many of whom reported high levels of anxiety, depression, worry and stress. They found that in the mothers who reported high stress, their fetuses showed a reduced efficiency in how their neural functional systems are organized.

This suggests that the brains of these fetuses don't develop in a simple sequence (i.e. vision, motor), but perhaps in a more complicated system that could compromise the baby's stress responses.

Our stress is contagious

When it comes down to it, stress is among our greatest health threats. It's been linked to complications like high blood pressure, heart disease, obesity and diabetes. It can also present immune issues, higher risk of infertility and miscarriage, headaches, muscle tension or pain, anxiety and depression.

What's worse, a small study conducted at the University of Calgary has found that stress can be contagious. Published in the journal, Nature Neuroscience, researchers examined pairs of sibling mice, one of which was exposed to stress while the other was relaxing in a cage, and found that once reunited, the chemical stress signal was transferred to the non-stressed mouse.
READ MORE: 'It's a traumatic moment': How everyday racism can impact mental, physical health
Considering what's already known about chronic stress and its effects on the hippocampus (the learning and memory section) of the brain - that long-term stress can weaken the connection between neurons, and diminish memory and learning ability - it is noteworthy that this effect can be transferred from the stressed party to a neutral one.

"The neurons that control the brain's response to stress showed changes in unstressed partners that were identical to those we measured in the stressed mice," lead study author and postdoctoral scholar at the University of Calgary, Toni-Lee Sterley, said to Medical News Today.

However, there's good news for females: researchers discovered that stressed female mice were able to reverse the negative effects of stress by hanging out with non-stressed partners. An effect that was exclusive to the females.

"If some of the effects of stress are erased through social interactions, but this benefit is limited to females, this may provide insights into how we design personalized approaches for the treatment of stress disorders in people," Jaideep Bains, co-author and professor of physiology and pharmacology, said.

"What we can begin to think about is whether other people's experiences or stresses may be changing us in a way that we don't fully understand."

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It comes as no surprise that we're stressed. One in four Canadians cite stress as the reason for leaving their job, while 73 per cent of all working adults aged 20 to 64 report at least some level of stress.

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"Veterans and a lot of patients across the country are finding, especially as it relates to chronic pain, that CBD-based products are working very effectively."

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Ryan Miller describes the year after his leg amputation as the best year of his life. He worked out. He traveled. He tanned. He was done with opioids.

After an explosively formed projectile destroyed his leg and damaged his stomach in Iraq, Miller had been caught in a vicious cycle of surgery and prescribed painkillers. The wounded Army infantry captain would have a surgery every few months, broken up by unsuccessful physical therapy.

"It wasn't just a pain, physical thing," Miller said. Physical dependence on opioids, coupled with pain from the injury, crushed Miller's spirit. "It just sucks. You feel like a prisoner."

The opioid crisis, which killed more than 42,000 Americans in 2016, continues to devastate the country. Doctors prescribe opioids for chronic pain, an ailment that is especially prevalent among military veterans. Of all the veterans returning from the Middle East, about 60 percent experience chronic pain.

A 2011 Veterans Affairs study found that veterans were twice as likely to die from an opioid overdose compared to the rest of the population. A 2014 study examined 2,500 soldiers after a deployment and found that 15 percent regularly used opioids. Many veterans also take benzodiazepines (antianxiety medication) for post-traumatic stress disorder. Benzodiazepines and opioids are both sedatives, and the combination is especially deadly.

The devastating toll opioids have taken on veterans has the VA scrambling to find alternative solutions. The VA enacted the Opioid Safety Initiative in 2013 and cut the number of veterans on opioids by almost a third. Although the initiative was enacted with good intentions, studies show the safest way to wean patients off opioids is in conjunction with alternative treatments. "This my-way-or-the-highway stuff is what really causes a lot of harm, and that's one of the things that I think we're running into a lot," said Michael Krawitz, an Air Force veteran and the executive director of Veterans for Medical Cannabis Access.

VA clinics have implemented practices like yoga, meditation and acupuncture as alternatives to opioids. But activists like Nick Etten, a former Navy SEAL and the founder and director of the Veterans Cannabis Project, believe medical marijuana can help. "We see cannabis not as a gateway drug," Etten said. "We see it as an exit path off opiates."

Etten argues that chronic pain is the signature war wound of the past 16 years. "Veterans and a lot of patients across the country are finding, especially as it relates to chronic pain, that CBD-based products are working very effectively."

CBD is short for cannabidiol; CBD oil is a cannabis extract.

"They're obviously much safer and less addictive than anything in the realm of opiates," Etten said.

A 2014 JAMA study found significant decreases in opioid overdose deaths where states had legalized medical marijuana. On average, these states had a near-25 percent lower mortality rate from opioids than states without such laws, and this correlation strengthened the longer medical marijuana was legal. Despite the potential for medical cannabis to curb the opioid epidemic, Attorney General Jeff Sessions repealed a memo from the Obama era in January that allowed state's with legal marijuana to operate without federal interference.

The VA's opioid crisis echoes the nationwide pattern of suspect partnerships between painkiller companies and medical professionals. Purdue Pharma, the maker of OxyContin, donated $200,000 to the VA pain management team in 2001, and concerns about opioid addiction were labeled as "barriers" to appropriate care in 2003 by the VA. These 2003 guidelines called opioids "the most effective option" for many patients, and they "only rarely cause addiction."

The American Pain Foundation, an organization that received most of its funding from pharmaceutical companies and has fought tighter opioid regulation, furthered the VA's dangerous practices. The foundation created the Freedom from Pain campaign in 2006 and wrote the "chronic pain" chapter in The American Veterans and Service Members Survival Guide in 2007. The Senate Finance Committee began investigating the American Pain Foundation in 2012, and the foundation shut down days later.

Air Force veteran and medical marijuana advocate Krawitz experienced a non-combat motorcycle accident in Guam. His stomach was so damaged, he couldn't tolerate opioids well for the chronic pain from the accident. Medical cannabis is crucial for his pain relief, and he finds the gateway drug argument indefensible.

"Based on their line of thinking, if you parked your car illegally, it's going to cause you to rob banks, because most people who rob banks park their cars illegally," Krawitz said.

Prescription painkillers, however, have been linked to heroin use. For every five new heroin users, four started with prescription pills.

A comprehensive program is required

Miller considers himself fortunate because he had access to important resources that got him off opioids. Before his amputation, doctors at Fort Sam Houston in San Antonio gave him a state-of-the-art orthotic brace. His doctors insisted he try the orthotic before resorting to surgery. He scoffed at the idea and just wanted to get rid of his leg once and for all, but it ended up being a turning point in his recovery.

Although he eventually needed the amputation, Miller credits his time with the orthotic for getting him off opioids. He could finally be active again. He had a support group recovering with him. He had doctors weaning him off prescription painkillers. "You need a comprehensive program," Miller said. "You need to give them every tool available." Nerve damage was still causing functionality issues, so despite being pain-free, off opioids and in good shape, the leg had to go.

Miller describes himself as a stubborn jock in high school who yelled at other players on the football team for smoking marijuana, and he laughs when he remembers endorsing alcohol. After avoiding marijuana most of his life, Miller got a medical card in California, at least initially, for the novelty of it. This was after his amputation and military service. Much to his surprise, he actually enjoyed how marijuana made him relax. He no longer feels the need for alcohol in social situations. The Staten Island native now lives in Oakland and has seen the power of medical marijuana for veterans firsthand.

Miller is working on two businesses tied to the marijuana boom. He firmly believes hemp and marijuana farming will help veteran employment. But it's the healing powers of marijuana that Miller feels is invaluable to veterans. He has become involved in an organization called Operation EVAC (founded by another Ryan Miller, who is a former Marine). The organization hosts meetings at various marijuana dispensaries, where veterans talk for an hour, then use medical marijuana and do guided meditation. EVAC meets in dispensaries in the Bay Area and Sacramento.

Many veterans come to EVAC after hitting rock bottom. Miller recalls meeting a veteran who had been on the streets before finding Operation EVAC. Miller doesn't know what started this specific veteran down a destructive path, but he knows many recovering addicts in EVAC who started on prescription painkillers. The veteran started each day by purchasing a bag of heroin and injecting the drugs. He was equally at peace with the two possible outcomes: getting high or death. The shame made him feel afraid to reach out to other veterans. When he finally reached out to EVAC, the group put him in rehab that very night.

EVAC's focus on discussion therapy and inclusion has kept the veteran off heroin, and he is now planning on reuniting with his daughter. Miller asked the former heroin addict what was appealing about EVAC after years of failed rehabilitation. The veteran told Miller he felt he wouldn't be judged at EVAC.

"Even now, thinking about that, hearing him say that in my head, I'm kind of choking up a little bit," Miller said. He thinks more groups like Operation EVAC would get veterans off narcotics and help curb the veteran suicide rate, which has been shown to worsen with opioid use. In fact, when he was first considering getting a medical card, many veterans told Miller they were suicidal before using cannabis. Miller uses marijuana before workouts because he feels less tired during and less sore after; he can only imagine how much this would have helped him when he was recovering from his leg injury.

The VA is stuck in a difficult position

Twenty-nine states and the District of Columbia have legalized medical marijuana, but the VA remains stuck in a difficult position because it is a federal entity and must abide by federal law, which still labels marijuana as a Schedule I drug (no medical use and high potential for abuse). For years the VA simply looked the other way; veterans using marijuana (even if done legally) didn't disclose this use, because they feared losing benefits. They could lose access to other medications if the VA thought they had a substance problem.

But new VA guidelines that came out in December are as close to endorsing medical marijuana as they can get without actually endorsing it.

The guidelines state that providers "are prohibited from completing forms or registering veterans for participation in a state-approved marijuana program." But they are supposed to "discuss with the veteran marijuana use, due to its clinical relevance to patient care, and discuss marijuana use with any veterans requesting information about marijuana."

The VA is required to document any disclosed marijuana use, but doing so won't force veterans to lose their benefits.

VA Secretary David Shulkin has admitted medical marijuana might help veterans, but he won't allow VA doctors to officially recommend marijuana until the federal law changes. And the stance from Attorney General Jeff Sessions - that regardless of state legalization efforts, the federal government should prosecute - could mean trouble for veterans using medical cannabis, memo be damned.

"We certainly hope that they don't take action in that way," Etten said. "We, as veterans, with already limited and imperfect access at the state level, will have even less access."

The "limited and imperfect access" Etten is referring to lies in mixed messaging. Although the new guidelines allow veterans to disclose marijuana use to their VA provider, the VA still labels cannabis use as a substance-use disorder. Etten knows of cases where veterans have been taken off their other medications after testing positive for marijuana during a urinalysis. The VA is simultaneously condemning marijuana and telling veterans to be open about their marijuana use with VA providers, and many veterans simply avoid cannabis altogether because of the confusion.
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Almost half of veterans rely on the VA for health care. These veterans must rely on outside sources to get a medical marijuana recommendation, which isn't a very strenuous process. But veterans advocates argue that the longer the VA keeps a hands-off approach, the more veterans will suffer. Etten says many veterans are afraid to get medical cards, because they think being on some kind of government list will come back to haunt them, and Attorney General Sessions' statements intensify this fear.

The Veterans Cannabis Project wants clear guidelines protecting veterans who legally use cannabis. The group wants cannabis removed from the Schedule I list, and it wants more research on cannabis' medical potential.

Advocacy groups believe the VA has good intentions with the new guidelines. "I don't look at it as kicking the can down the road," Etten said. "Cannabis has become so politicized, it's difficult for the VA to do what it wants to do."

Despite the VA's checkered past regarding prescription drugs, the agency has taken responsible steps in recent years. The VA's Opioid Safety Initiative flagged providers with dangerous prescribing habits and started a prescription drug monitoring program to catch patients with multiple prescriptions.

"We all know [legal cannabis] is going to happen; it's just when. If this happens in a year, there will be people that will probably be alive in a couple years as opposed to dead." -Ryan Miller, Army infantry captain, wounded in Iraq

At the local level, Krawitz believes VA doctors are less likely to line up in support of the new VA policy that encourages discussion of medical marijuana. "Often, the [VA] doctors and the local staff perceive it very, very differently through a very different lens," he said. He argues that local VA doctors still associate social stigmas with cannabis.

The VA declined to comment or provide any of its medical professionals to answer questions.

Medical marijuana still needs help

The fight for medical and recreational marijuana has long stood counter to traditional conservative values. But as more veterans advocate for medical cannabis, the dynamic is shifting. Krawitz believes his dad, a "real conservative World War II vet," would support medical marijuana. As the opioid crisis worsens for veterans, coupled with a veteran suicide rate that is much higher than that of the general population, traditional politics are fading.

Miller says state Rep. Eric Nelson of Pennsylvania, an "old-school conservative" who has the 10 Commandments on his wall, is now eager to bring in medical marijuana throughout his state. The business of it appeals to his libertarian side, but it's the potential to curb the opioid crisis that really changed the Republican's mind. The American Legion, the nation's largest wartime veterans service organization, has voted twice in favor of medical marijuana access for veterans.

Dr. Edward Bilsky, the provost and chief academic officer at Pacific Northwest University of Health Sciences, spent years educating medical professionals about opioids. With a background as an opioid pharmacologist neuroscientist, Bilsky has spent his career studying opioid receptors in the brain. He doesn't know if medical marijuana can treat chronic pain or curb opioid use, but he says the topic is in dire need of more research.

"This is the million-dollar question," Bilsky said. "There is, in the scientific literature, very few well-controlled and well-powered studies that have addressed this."

Through his advocacy work, he has met patients with chronic pain who use cannabis, and they report helpful effects such as better sleep and numbing the pain. There is not enough evidence, however, to call it a true analgesic. "We're just thinking that marijuana is all bad, but we need to do the studies. Until we have those studies in hand, we can't conclude strongly one way or the other," Bilsky said.

He understands cannabis has detrimental side effects on developing brains, such as short-term memory loss and learning impairment. But until there is more research on its medical potential, physicians won't know if it has positive uses for specific medical conditions.

For advocates, every day that goes by without further research and federal immunity for veteran cannabis use hurts.

Despite Sessions' threats, states are continuing to support legal cannabis, and there has been bipartisan disapproval of Sessions' stance. The day when veterans don't have to worry about having a medical card or talking to their provider about marijuana might soon be over.

"We all know it's going to happen; it's just when," Miller said. "If this happens in a year, there will be people that will probably be alive in a couple years as opposed to dead."
- By Rick Morgan, special to CNBC.com

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Military veterans defy Jeff Sessions, fight for medical marijuana to kick opioid addiction

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Ryan Miller describes the year after his leg amputation as the best year of his life. He worked out. He traveled. He tanned. He was done with opioids. After an explosively formed projectile destroyed his leg and damaged his stomach in Iraq, Miller had been caught in a vicious cycle of surgery and prescribed painkillers.

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A good ted talks I listened to and it has really explained a lot to do with stress

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Jennifer Senior: For parents, happiness is a very high bar

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The parenting section of the bookstore is overwhelming -- it's "a giant, candy-colored monument to our collective panic," as writer Jennifer Senior puts it. Why is parenthood filled with so much anxiety? Because the goal of modern, middle-class parents -- to raise happy children -- is so elusive.

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Marijuana has helped me drastically in the past 6 years and i recommend it to anyone with anxiety to try it

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Medical marijuana facts

Medical marijuana is a plant-based medicine from theCannabis sativa or Cannabis indica species with three major active compounds: THC, CBD, and CBN.

Medical marijuana is used for

The health benefits of medical marijuana include relief from pain and muscle spasm,nausea associated withchemotherapy, andanorexia.

Benefits are seen in immune function, neuroplasticity, emotional and mood regulation, vascular health and digestive function. Research is limited but studies of the endocannabinoid system suggest benefits may include neuroprotection (in MS,epilepsy, other movement disorders), and benefit in a number of mood andanxiety disorders.

The side effects of medical marijuana are minimal when used at low doses and include dry mouth and fatigue. At higher doses, side effects includedizziness, paranoia, and psychoactive effects.

What is medical marijuana or medical cannabis?

Medical marijuana is the medical use of the Cannabis sativa or Cannabis indica plant to relieve symptoms of, or treat diseases and conditions. The Cannabis plant was used medically for centuries around the world until the early 1900s. Medical marijuana facts can be difficult to find because strong opinions exist, both pros and cons. Medical uses and emerging research on off-label uses are summarized in this article.

THC or tetrahydrocannabinolis the psychoactive compound in marijuana. It is responsible for the "high" people feel. There are two man-made drugs called dronabinol (Marinol) and nabilone (Cesamet) that are synthetic forms of THC. They are FDA-approved to prevent nausea and vomiting in people receiving chemotherapy.

CBD or cannabidiol is another compound in marijuana that is not psychoactive. CBD is thought to be responsible for the majority of the medical benefits.

Epidiolex is a CBD oil extract that is undergoing clinical trials for epilepsy.

THC:CBD: Nabiximols (Sativex) is a specific plant extract with an equal ratio of THC:CBD. It is approved as a drug in the UK and elsewhere in Europe for the treatment of multiple sclerosis, spasticity, neuropathic pain, overactive bladder and other indications.

Medical marijuana products are available with a huge range of THC and CBD concentrations. Expert opinion states that 10mg of THC should be considered "one serving" and a person new to medical marijuana should inhale or consume no more until they know their individual response.

What are the uses for medical marijuana?

Medical uses of marijuana include both studied and approved uses and off-label uses. In a recent research survey, the most common reasons people use medical marijuana are for

pain,

anxiety,

depression,

muscle spasticity, and

inflammatory bowel diseases such as Crohn's disease.

More research has been conducted on the compound CBD. Medical CBD is anti-inflammatory, anticonvulsant, antioxidant, neuroprotective, and anxiolytic, antipsychotic, and anti-emetic. The CBD compound in medical marijuana appears to be neuroprotective in Huntington's, Parkinson's, and Alzheimer's disease, fetal hypoxia, and other neurodegenerative conditions and movement disorders.

What are the health benefits of medical marijuana?

There are over 60 peer-reviewed research studies examining the benefits of medical marijuana. Sixty-eight percent of these studies found benefit while 8% found no benefit. Twenty-three percent of the studies were inconclusive or neutral. Most research has been conducted on the compound CBD. The benefits of medical marijuana can be attributed to binding to the endocannabinoid system. This has many effects including

modulating the immune system,

promoting neuroplasticity,

emotional and cognitive modulation including learning and motivation, appetite, vascular function, and digestive function.

Are there any side effects of medical marijuana?

Medical marijuana side effects are minimal when used at low doses and include

At higher doses, side effects include

There are concerns about adverse effects of cannabis among adolescents because the risks are greater to the immature brain and neurological system. Concerns include increased risk of schizophrenia and loss of IQ.

There are public health concerns about the safety of driving under the influence of medical marijuana. A JAMA study found lower rates of opioid overdose deaths in states with legal medical marijuana.

Is medical marijuana legal?

At the time this article was written, 23 states have legalized medical marijuana with varying restrictions. However, it is classified as a Schedule I substance by the Federal Drug Administration (FDA), and thus is illegal at the Federal level. In most states with legal medicinal marijuana, a prescription, authorization, or medical recommendation is required, and a card or license is issued. This allows a person to buy medical marijuana.

How do you get medical marijuana?

In states where medical marijuana is legal, shops, often called dispensaries, sell marijuana products in a variety of forms. Medical marijuana is available in edible forms (candies or cookies), oils and extracts, and as the plant which can be smoked or otherwise inhaled. Dispensaries require a medical marijuana card before they will sell products. How people can get a medical marijuana card varies by state. It requires a prescription from a licensed health-care professional.

Is medical marijuana "addictive?"

Most research suggests a very low risk of addiction and very low toxicity of medical marijuana when taken as recommended in low therapeutic doses. There is concern about psychological dependence in heavy users and whether this constitutes marijuana abuse. Some research has suggested CBD oil might be useful in treatment for marijuana addiction or marijuana abuse.

What research is being done for medical marijuana?

There are numerous studies underway on medical marijuana, but research is challenged by limited access given the FDA classification. A search of the National Institutes of Health funded projects list in 2016 revealed 165 studies related to cannabis and 327 studies related to the search term marijuana. The majority of these studies are surveys into use patterns. Many are also basic science studies investigating how the endocannabinoid system in the brain and immune system works. Survey studies that anonymously assess users habits and reported benefits may provide insight into the effects of real-world use patterns. There are over 60 peer-reviewed research studies that have been published about medicinal cannabis. Sixty-eight percent of these studies found benefit while 8% found no benefit. Twenty-three percent of the studies were inconclusive or neutral. The most promising areas of research appear to be in the use of CBD for neuroprotection.

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REFERENCES:

Teesson, M. et al. "The relationships between substance use and mental health problems: evidence from longitudinal studies." In: Stockwell, T. et al. "Preventing harmful substance use: the evidence base for policy and practice." Chichester, UK: John Wiley; 2005. p. 43-51.

Fernández-Ruiz, J. et al. "Cannabidiol for neurodegenerative disorders: important new clinical applications for this phytocannabinoid." Br J Clin Pharmacol. 2013 Feb;75(2):323-33.

Sexton, M., et al. "A Cross-Sectional Survey of Medical Cannabis Users: Patterns of Use and Perceived Efficacy." (Under Review 2016: Cannabis and Cannabinoid Research).

Murnion, B. "Medical Cannabis." Aust Prescr. 2015 Dec; 38(6): 212-215.
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Bachhuber, MA., et al. "Medical cannabis laws and opioid analgesic overdose mortality in the United States." 1999-2010. JAMA Intern Med. 2014 Oct;174(10):1668-73. Erratum in: JAMA Intern Med. 2014 Nov;174(11):1875.

Allsop, DJ., et al. "Nabiximols as an agonist replacement therapy during cannabis withdrawal: a randomized clinical trial." JAMA Psychiatry 2014;71:281-91.

Brunt, TM., et al. "Therapeutic satisfaction and subjective effects of different strains of pharmaceutical-grade cannabis." J Clin Psychopharmacol. 2014 Jun;34(3):344-9.

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Medical marijuana facts Medical marijuana is a plant-based medicine from theCannabis sativa or Cannabis indica species with three major active compounds: THC, CBD, and CBN. Medical marijuana is used for The health benefits of medical marijuana include relief from pain and muscle spasm,nausea associated withchemotherapy, andanorexia.

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