In 2021, marijuana was the most commonly used illicit drug, with 18.7% of people aged 12 or older (or 52.5 million people) using it in the past year.
The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people). (https://www.samhsa.gov/data/sites/default/files/2022-12/2021NSDUHFFRHighlights092722.pdf)
According to CDC, 3 in 10 marijuana users have marijuana use disorder, or in other words are addicted to cannabis. We also know that individuals that use marijuana before age 18 are at even great risk for becoming addicted. (https://www.cdc.gov/marijuana/data-statistics.htm)
Regular & Heavy Use
The Canadian Centre on Substance Use and Addiction (CCSA) defined regular cannabis use as weekly or more frequent cannabis use over a period of months to years.
In a report on regular use and cognitive functioning published in 2019, CCSA noted that regular cannabis use is associated with mild cognitive difficulties, which are typically not apparent following about one month of abstinence.
In addition, heavy (daily) and long-term cannabis use is related to more noticeable cognitive impairment. (https://www.ccsa.ca/sites/default/files/2019-09/CCSA-Cannabis-Use-Cognitive-Effects-Report-2019-en.pdf)
With marijuana use disorder prevalent among marijuana users, and regular use associated with cognitive impairment, one question is whether it’s possible to use marijuana in moderation or in such a way as to avoid or at least limit the potential for addiction and other common health and social problems.
Research with Adolescents
A study published in the journal Addiction (2009) examined whether moderation of cannabis use among adolescent cannabis users is associated with reductions in cannabis use frequency and risk of dependence in young adulthood.
Using a ten-year representative cohort study with six surveys in adolescence and two in young adulthood, the study found most adolescent users had moderated their use: from occasional to abstinence (71% of occasional users), weekly to abstinence or weekly to occasional (28% and 48% of weekly+ users, respectively).
The author’s concluded that a pattern of moderating adolescent cannabis use was associated with less risk of later problematic use than among those persisting, but risks were still elevated substantially compared with never-users. (https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2009.02534.x)
A Spectrum of Cannabis Use
CCSA also publishes Knowing Your Limits with Cannabis: A Practical Guide to Assessing Your Cannabis Use (2022) which presents a spectrum of cannabis use. (https://www.ccsa.ca/sites/default/files/2022-04/CCSA-Knowing-Your-Limits-with-Cannabis-Guide-2022-en.pdf)
This spectrum can help individuals reflect on their cannabis use and determine if they are using it in moderation.
The spectrum of cannabis use includes:
- Abstinence (Non-use). Choosing to abstain from or not use cannabis to avoid all health risks or for other personal reasons. For example, a person who has chosen to never begin using cannabis or who has quit using cannabis.
- Beneficial Use. Use that might have some positive impact, either physically, mentally, socially or spiritually. For example, a person who has been authorized to use cannabis for medical purposes by a healthcare provider.
- Non-Problematic Use. Cannabis use that might have negligible health and social impacts. For example, a person who uses cannabis occasionally.
- Problematic Use. Cannabis use that begins to affect a person’s health and interferes with their school, work, family, social or financial responsibilities. For example, a person who continues to use cannabis daily or almost daily despite the negative impact on their mental or physical health.
- Cannabis Use Disorder. Cannabis use that has led to dependence or addiction to cannabis. For example, a person who has persistent cravings for cannabis and has a hard time reducing or controlling their cannabis use (page 4).
How to Use Cannabis More Safely
Canada’s Lower-Risk Cannabis Use Guidelines presents 10 recommendations for using cannabis more safely. (https://www.camh.ca/-/media/files/pdfs---reports-and-books---research/canadas-lower-risk-guidelines-cannabis-pdf.pdf)
These include:
- The only way to completely avoid these risks is by choosing not to use cannabis.
- You’ll lower your risk of cannabis-related health problems if you choose to start using cannabis later in life.
- If you use, choose low-strength products, such as those with a lower THC content or a higher ratio of CBD to THC.
- Don’t use synthetic cannabis products.
- Smoking cannabis (for example, smoking a joint) is the most harmful way of using cannabis because it directly affects your lungs. T
- If you choose to smoke cannabis, avoid inhaling deeply or holding your breath.
- Try to limit your use as much as possible.
- Cannabis use impairs your ability to drive a car or operate other machinery. Don’t engage in these activities after using cannabis, or while you still feel affected by cannabis in any way
- Specifically, people with a personal or family history of psychosis or substance use problems, and pregnant women should not use cannabis at all.
- Avoid combining any of the risky behaviours described above.
The Partnership to End Addiction also hosts a webpage on Reducing the Risks of Marijuana Use. (https://drugfree.org/article/reducing-the-risks-of-marijuana-use/)
Some of the research-based suggestions for reducing cannabis risks include:
- Use lower strength products
- Read the label
- Don’t combine marijuana with alcohol or other drugs
- Get products from a medical dispensary
- Keep it secured
- Watch out for vomiting
Conclusion
While it’s estimated that 3 in 10 marijuana users are addicted and regular use is associated with cognitive impairment, there is some evidence that adolescents can moderate their cannabis use and experience less risk of later problems.
The spectrum of cannabis use includes abstinence, beneficial use and non-problematic use, which represent less risky and therefore more desirable goals for consumption than problematic use and cannabis use disorder.
Guidelines and suggestions are available on how to practice lower-risk cannabis use, which should be made more widely available to cannabis users and potential users.
The key caveat, however, is that even moderate cannabis use holds some risks for users and only non-use eliminates all risks of marijuana use.