The pros and cons of marijuana use: Cannabis helps manage pain, but can cause psychosis and addiction.

President Donald Trump recently loosened restrictions on medical marijuana, which millions of Americans already use to treat chronic pain and other conditions. The pros and cons of its use are discussed in The New York Times.

Doctors hope this move will lead to expanded research on the drug. This could reveal new uses for cannabis and its components, such as cannabidiol, or CBD. However, they caution, this could perpetuate misconceptions about the substance's safety and effectiveness. Here's what they believe you need to know about the risks and side effects of marijuana, the conditions it can help with, and where its effects have been insufficiently studied.

The U.S. Food and Drug Administration (FDA) has approved several drugs containing cannabis, its components, or similar synthetic substances that are prescribed to treat chemotherapy-induced nausea, AIDS-related wasting syndrome, and a type of seizure.

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Coping with pain

The most compelling data currently concerns the use of cannabis for pain relief. About 53% of people who say they use cannabis for medical purposes do so for pain relief, and most states legalize medical marijuana for this purpose.

Doctors say cannabis provides only moderate pain relief, but it appears to help people cope.

"Their pain intensity itself doesn't change much, but their mood improves, they sleep better, their quality of life improves," said Dr. Ali John Zarrabi, an internist and palliative care specialist and researcher at the Winship Cancer Institute at Emory University.

However, some medical societies, such as the International Association for the Study of Pain, do not recommend cannabis as a primary treatment because there is insufficient evidence and there is a risk of side effects, including dizziness, drowsiness, and nausea.

Psychiatrists do not recommend it

Medical marijuana is sold in specialized stores and online. For example, in Illinois, the list includes 56 medical conditions. Several states allow medical use for any reason a doctor deems justified.

However, according to Almuth Gertrud Winterstein, director of the Medical Marijuana Research Consortium at the University of Florida, there is no reliable evidence of its effectiveness for many conditions, including post-traumatic stress disorder, Parkinson's disease, glaucoma and amyotrophic lateral sclerosis.

After pain, anxiety is the second most common reason for medical cannabis use. The American Psychiatric Association opposes the medical use of cannabis, stating that there is insufficient evidence to support its effectiveness in treating any mental illness. The organization notes that there is a strong link between cannabis use and the onset and exacerbation of mental disorders, particularly in children, adolescents, and young adults.

Another common use is to combat insomnia. However, evidence that cannabis improves sleep is also limited, and sleep researchers do not recommend its use.

The drugs are stronger than they may seem

Modern cannabis products contain significantly higher concentrations of THC (the component of the plant that causes psychoactive effects) than they did decades ago.

While estimates of potency growth vary widely, analyses by the National Institute on Drug Abuse found that the THC content of illicit products quadrupled between 1995 and 2022. Cannabis concentrates sold in specialty stores can contain up to 40% THC.

Experts say stronger products are more likely to lead to addiction.

"There's a clear misconception that cannabis isn't addictive," said Dr. Smita Das, a professor of psychiatry and behavioral sciences at Stanford University School of Medicine.

"This may have been true in the past, when people simply rolled up joints from dried buds," Dr. Das said. But today's ultra-potent products produce a more intense euphoria.

"As the substance begins to leave the body, the desire intensifies, so the person may use more next time," she explained.

It is difficult to predict who will develop the disorder, which is estimated to affect up to three in 10 cannabis users.

"Cannabis is similar to alcohol. Many adults can use it responsibly, but for others, it's life-destroying," explained Dr. Kevin Gray, professor of psychiatry and behavioral sciences at the Medical University of South Carolina.

Those at higher risk include men, people who started using in adolescence, those with family members with substance use disorders, and people with mental illnesses such as depression who use cannabis to self-medicate.

Side effects and interactions with other drugs

Canadian research links cannabis use disorder to an increased risk of death, including from injury, suicide and other causes.

Like any other substance, cannabis has side effects and can interact dangerously with other prescription medications, especially blood thinners, antidepressants, and painkillers.

This is one reason why it's important to tell your doctor if you use cannabis. Another reason is the need to monitor potential short-term and long-term effects.

Most studies do not establish a cause-and-effect relationship. However, they do link cannabis use to an increased risk of cardiovascular disease, stroke, and heart attack, even in younger adults. The risk appears to begin with weekly use and increases with frequency and THC levels. Chronic use is associated with an increased risk of schizophrenia and other psychotic disorders, with the greatest risk in frequent users.

Long-term smoking is also associated with worsening respiratory symptoms, such as bronchitis and wheezing.

Additionally, some heavy cannabis users may develop cannabinoid hyperemesis syndrome, which causes abdominal pain, nausea, and vomiting. In one study, nearly one in five long-term daily marijuana users reported similar symptoms.

As Dr. Samer Naruse, chief of pain medicine at University Hospitals in Cleveland, noted, doctors avoid recommending cannabis because of differences in its ingredients.

"At a specialty store, they give you whatever's on the shelf, and you don't know how many milligrams you're getting," Dr. Naruse concluded. "You recommend low or high THC, but you don't know if that's what you're getting."

Pregnant women and teenagers are at risk

Some groups are particularly vulnerable, notably pregnant women who use cannabis to combat nausea and vomiting.

Last year, the American College of Obstetricians and Gynecologists issued new guidelines urging pregnant and breastfeeding women to abstain from its use. The organization noted a link to adverse pregnancy outcomes, including low birth weight and even stillbirth. Furthermore, it has been linked to neurocognitive and behavioral problems in children.

"Whether you eat it or smoke it, it's going into your body, it's going through the placenta, and it can get to your baby," explained Dr. Melissa Russo, a maternal-fetal medicine specialist and one of the guidelines' authors.

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Teenagers are also very vulnerable because their brains are still developing, Dr. Gray said.

"Regular cannabis use impairs cognitive function," he stated. "While it's believed that cognitive function can recover after cessation, one of the main tasks of adolescence is learning and development, and cannabis interferes with this."

Dr. Gray emphasized that adolescents are at higher risk of developing addiction than adults. A Canadian study found that they have a significantly higher risk of psychosis than their peers who do not use cannabis. No such increased risk was found in young adults.

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