Marijuana causes Aspergillosis in Kidney Transplant Patient

A 48 year old successful kidney transplant patient who heavily used marijuana immediately following his transplant developed invasive pulmonary aspergillosis (IPA), a fungus transmitted in the smoke of marijuana. Marks et al reported on their use of an experimental antifungal drug to effectively treat this life threatening condition (Transplantation, Vol. 61, 1771-1773, No. 12, June 27, 1996), and noted that IPA "is a devastating complication in the immuno-compromised patient" such as patients with AIDS, chronic granulomatous disease, bone marrow transplants and those receiving chemotherapy for small cell lung cancer. Aspergillosis has up to a 90% fatality rate if contracted by transplant patients.

Commentary: Marijuana was the only risk factor for IPA in this patient who was a marijuana smoker prior to transplantation. The researchers stated that transplant patients should be strongly warned against the use of marijuana following surgery or during periods when they are being medicated with high doses of steroids and other drugs used to suppress rejection of the transplant.

Even infrequent marijuana use impairs cognitive skills

Long term use of marijuana is known to result in progressively impaired ability to process complex information. Solowij of the National Drug and Alcohol Research Center in Sydney Australia examined whether cessation of marijuana use would normalize the intellectual performance of users. (Life Sciences, Vol. 56, pp.2119-2126, 1995.) Subjects were recruited from the general community by advertising. To be included, subjects had to have regularly used cannabis within the past five years and to have ceased within the past few years, and in particular, the last six weeks prior to testing. Abstinence was confirmed by urine samples. Sophisticated auditory testing, which required reaction to a variety of stimuli, was compared in 16 long-term users, 16 short term users, 28 ex-users, and 16 age and sex matched controls. All marijuana users had abnormal reactions compared to the controls. Reaction time was 11% longer in long-term users, 11% longer in short-term users, and did not return to normal even after six months of abstinence.

Commentary: This study confirms that marijuana use produces difficulty in complex brain functions and, more disturbingly, even after up to six months of abstinence these effects were still present. A companion paper (Life Sciences, Vol. 56 pp 2127-2134, 1995) by Solowij et al, reports that the brain event-related measures normalize during acute marijuana intoxication, suggesting a basis for the physical dependence component of marijuana use.

Study implicates THC in suppression of immune system response

The major psychoactive component of marijuana, delta-9 THC, has been shown in human and experimental animals to affect the immune system. Freidman et al in Advances in Experimental and Medical Biology, Vol. 373, pp 103-113, 1996, present studies in mice given THC. These mice have reduced antibody formulation and abnormalities of other chemicals which help the body fight viral and bacterial infection. When these mice are exposed to a bacteria, Legionella pneumophila, a rapid toxic shock-like death occurs - within one day.

Commentary: Individuals who chronically use marijuana may be more subject to adverse reaction to common bacteria and viruses in the environment than non-users. This correlates with the study by Polen, et al as reported in the Western Journal of Medicine, June 1993, which found that "Daily marijuana smoking, even in the absence of tobacco, appeared to be associated with an elevated risk of health care use for various health problems."

Study describes cannabis dependence

Lundqvist, Life Science, Vol. 56 pp 2145-2150, 1995, tested patients in treatment for chronic cannabis use with a standard psychological instrument to determine "which patients showed improvement in manage-ability and meaningfulness of life". Twenty patients were drug-free for 40 days or more, but none had undergone treatment. Thirty-one other patients were tested after being drug free for two weeks, and a third group of 15 patients was tested before and after six weeks of treatment. For comparison, nine patients on methadone maintenance, 62 former poly-drug users, and 26 counselors were also tested. Some improvement was demonstrated in the group that underwent treatment, and post treatment scores were in the range of the control subjects. Users who had not participated in therapy had lower scores. Both patients in methadone programs and former poly-drug users who had undergone psycho-social treatment had scores below normal.

Commentary: Again, impaired cognitive skills and functioning were documented in chronic cannabis users. These changes create "a new state of consciousness that can be described as a cannabis dependent effect." It takes 14 days of abstinence before a user is able to control the processes of cognitive functioning, and it takes up to six weeks before a user is able to make complex intellectual decisions that are normal. Weaknesses occur in comprehension, classifying information correctly, differentiating time and space, and poor routines of daily life. The mental changes associated with the physical consequence of marijuana use on the brain undoubtedly combine to produce the poor level of functioning commonly observed in these individuals.

Marijuana use associated with Antisocial Personality Disorder

Scherrer et al (The Journal of Nervous and Mental Disease, Vol. 184, No. 10) studied Antisocial Personality Disorder (ASP) in 1874 pairs of identical male twins who were veterans from the Vietnam era. When twins were randomly selected, 8 out of 10 ASP symptoms were more prevalent in persons with a lifetime history of marijuana use compared to those twins who had never used drugs. Reckless regard for their own or others' safety and failure to conform to social norms were 2.5 to 3 times more likely in marijuana-using twins compared to their non-using twin brother. Some of this was explained by concomitant alcohol abuse and combat in Vietnam, but marijuana users were still 2.5 times more likely to fail to observe lawful behavior than their twins.

Commentary: Identical twins have the same genetic makeup. This study clearly shows that marijuana use is not an inherited weakness but instead that drug use causes antisocial personality traits and symptoms.

Material used in this publication has been reviewed and commented on by William M. Bennett,MD, Professor of Medicine, Division of Nephrology, Clinical Pharmacology and Hypertension at Oregon Health Sciences University, Portland, Oregon