February 03, 2015

 Photo ©istock/ kitiara65

The recent Monitoring the Future survey of students’ drug use and attitudes revealed that adolescents have taken to e-cigarettes in a big way. When asked in early 2014, 17.1 percent of high school seniors and 16.2 percent of 10th graders reported using e-cigarettes in the previous month (see infographic, bottom). We are still wrestling with whether or not e-cigarettes pose a danger, but their popularity among youth combined with society’s past experiences with tobacco and other addictive substances demands that we urge caution around these products.

E-cigarettes are being aggressively marketed as glamorous devices that empower users—such as by giving them the freedom to “vape” in public places where cigarette smoking is banned or taboo. And even though sellers are often careful not to make explicit health claims, another part of the “freedom” being sold is, implicitly, the freedom to enjoy the smoking experience without fear of long-term health consequences such as death from cancer or heart disease.

Those who know the history of cigarette marketing in America will experience a sense of déjà vu. Freedom was the concept used in the 1920s and 1930s to market cigarettes to women, a vast then-untapped market for what had previously been only a male pleasure. Cigarette smoking was sold to women as an image to help them feel liberated and empowered.

Although the vapor produced by e-cigarettes contains no tar—the main cause of lung cancer—it may contain other potentially harmful chemicals. There are currently no regulatory controls over these products, most are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself. And that is to say nothing of the risks of nicotine exposure. Whether or not e-cigarettes turn out to have fewer physical health harms than traditional cigarettes, it is still ridiculous to describe any product containing an addictive substance as “freeing.”

E-cigarette fluids vary widely in their nicotine concentrations, and the amount a user is exposed to probably depends on a range of factors (like how many puffs they take, how deeply they inhale, and how long they hold it), but there is clearly a potential for these products to promote addiction—especially when users start in their teens. Recent research in rodents suggests nicotine may even promote addictive behavior by altering gene expression: A 2011 study by Eric R. Kandel and colleagues at Columbia University found that nicotine exposure increased mice’s sensitivity to cocaine’s rewarding effects via an epigenetic pathway; if the same holds true in humans, nicotine could serve as a gateway to abuse of other substances.

Apart from the possible dangers of nicotine, e-cigarette use is normalizing and even glamorizing smoking behavior, which had been successfully stigmatized through public-health campaigns of the past decades. The MTF survey found that many kids who are using e-cigarettes are also smoking traditional cigarettes. It would be tragic if e-cigarettes re-opened the door to teen tobacco use, which has been slowly but surely declining since the late 1990s.

As scientists, we should be cautious and not sound alarm bells prematurely. It will be good if future research shows e-cigarettes are indeed helpful aids for smokers who have trouble quitting otherwise. But if vaping is hooking new users on nicotine—young people and those of any age who had never smoked before—then that could pose a serious problem. We should not allow e-cigarettes, with their promised “freedoms,” to rewind public health to the 1920s.

Past month use, 8th grade – Cigarettes: 4.0%, e-Cigarettes: 8.7%; 10th grade – Cigarettes: 7.2%, e-Cigarettes: 16.2%; 12th grade – Cigarettes: 13.6%, e-Cigarettes: 17.1% (Only 14.2% of 12th graders view e-cigarette use as harmful, which is less than 5 students in the average class)

Other Useful Resources

A Letter to Parents

Please join the effort to raise awareness about overdoses.

An informational event will be held in Friday Harbor from 6:30 -8:30 p.m. at San Juan Island Public Library.  Presenters will be Compass Health, San Juan County Sheriff’s Office, SAFE San Juans, and San Juan Island Emergency Medical Services.

Refreshments will be served.  San Juan Island Prevention Coalition (SJIPC) has assisted Compass Health in organizing, marketing, and implementing the event because this is a very important issue that must be addressed collaboratively.

Members of the coalition are collaborating to help educate community members about the signs of overdose and the signs of depression, anxiety, and suicidal ideation that often lead to self-medicating and overdosing.

Please circulate the attached information within you circle of influence.

IOAD FlyerPoster.08312016.Final

Recognize and Respond AGENDA

Learn How to Prevent OverDose

August 31, 2016

6:30 – 8:30

San Juan Island Public Library

• 6:30 to 6:45  Welcome and overview of purpose and outline of event, Barbara Starr, Mental Health Professional and Program Manager, Compass Health

• 6:45 to 7:10  Presentation by Shannon Reitan, Chemical Dependency Professional, Compass Health

• Prevalence of overdoses with various substances
• Importance of co-occurring disorders treatment
• Signs of overdose

• 6:10 to 7:30 Presentation by Ron Krebs, Sheriff, San Juan County Sheriff’s Office

• First responder actions
• Education for prevention and intervention
• Community collaboration efforts

• 7:30 to 7:50 Presentation  by Kim Bryan, Director, SAFE San Juans

• Education for prevention and intervention
• Working with youth
• Community collaboration efforts

• 7:50 to 8:10 Presentation by Chief Jerry Martin, Chief and Lainey Volk,  Education and Prevention Director, San Juan Island Emergency Medical Services (EMS)

• First responder actions
• Education for prevention and intervention
• Community collaboration efforts

• 8:10 to 8:30 Dialogue and Refreshments

 An INTERNATIONAL OVERDOSE AWARENESS DAY Community Event  www.overdoseday.com

What is an overdose?

An overdose means having too much of a drug (or combination of drugs) for your body to be able to cope with. There are a number of signs and symptoms that show someone has overdosed, and these differ with the type of drug used. All drugs can cause an overdose, including prescription medication prescribed by a doctor. It is important to know your correct dosage, what drugs definitely should not be mixed, and know to seek help if you feel you are not in control of your drug use.

Depressant overdose

Opioids, benzodiazepines & barbituates (medical Depressants), and alcohol all slow the central nervous system to produce a calming effect These substances are often prescribed to relieve pain, help you sleep, or in the case of alcohol, used recreationally when socialising. depressants, which means they slow the central nervous system, including breathing and heart rate. However, when taking in excessive amounts or in combination, they can depress normal functions such as breathing and heart rate until they eventually stop, resulting in death.

Opioids are narcotics which are either derived from opium (called opiates) or share a similar chemical structure but are manufactured without opium. Fentanyl, methadone, morphine and heroin are all opiates. Examples of opioids include oxycodone and hydromorphone.

Benzodiazepines are used medically to reduce anxiety, help people sleep and to relax the body. They include diazepam or Valium, oxazepam or Serepax , alprazolam or Xanax and a number of other drugs. Taken in high doses or in conjunction with alcohol they are responsible for many overdoses. Taking these kinds of drugs in higher than prescribed quantities can slow your breathing to dangerous levels or stop it altogether. Mixing these drugs can be extremely dangerous.

People’s tolerance to a drug can drop quickly and for a variety of reasons, such as having not used for a while (eg: having been in custody or having done detoxification/rehabilitation) or cutting down.

Signs of depressant drugoverdose (e.g. heroin, morphine, oxycodone, fentanyl, methadone) include:

• shallow breathing or not breathing at all
• snoring or gurgling sounds (this can mean that a person’s airway is partly blocked)
• blue lips or fingertips
• floppy arms and legs
• no response to stimulus
• disorientation
• unrousable (can’t be woken up) unconsciousness.

If you can’t get a response from someone, don’t assume they are asleep. Not all overdoses happen quickly and sometimes it can take hours for someone to die. Action taken in those hours could save a life. This is a medical emergency: call the ambulance immediately if you can’t rouse them.

Alcohol poisoning/overdose

Generally people do not automatically think of alcohol when they think of overdose, but alcohol is a depressant and it is all too possible to overdose on it. Acute alcohol poisoning, which is usually a result of binge drinking, is an example.

Our bodies can process about one unit of alcohol an hour. If you drink a lot quickly the amount of alcohol in your bloodstream (blood alcohol concentration, or BAC) may become dangerously high, which can stop your body from working properly. In extreme cases, alcohol poisoning could stop you breathing, stop your heart or cause you to choke on your own vomit.

Signs of alcohol intoxication to the point of overdose include:

• disorientation
• loss of coordination
• vomiting
• seizures
• irregular or slow breathing (less than eight breaths a minute)
• blue-tinged or pale skin
• low body temperature (hypothermia)
• stupor (being conscious but unresponsive)
• unconsciousness (passing out).

Stimulant overdose

It is possible to overdose on amphetamines such as speed and ice. Amphetamine overdose increases the risk of heart attack, stroke, seizure or drug-induced psychotic episodes.

Amphetamine overdoses look different from an opioid OD, and signs and symptoms include:

• chest pain
• disorientation/confusion
• severe headache
• seizures
• high temperature (overheating, but not sweating)
• difficulty breathing
• agitation and paranoia
• hallucinations
• unconsciousness.

Understanding tolerance and half-life

When a person uses a drug regularly they develop tolerance to it. This means they need to use more to get the same effect. Similarly, if a person hasn’t been using regularly – or if they’ve not been able to get drugs – their tolerance will drop. When people take their usual amount of drugs after a break from using, it could be too much for the body to cope with and lead to an overdose. This is why high-risk situations for drug overdose include post-release from prison, detoxification and rehabilitation. Someone on naltrexone can also be at risk if they use soon after stopping oral medication, or skipped a dose, or when the effects of a naltrexone implant have ceased.

“Half-life” refers to the time it takes for a drug to drop to half the strength of its original dose. Some drugs have a long half-life, for example some benzodiazepines. If a person has used yesterday, they may still have enough in their system today to overdose if they use more. Diazepam (Valium) has one of about 24 hours, so if you took 20mg yesterday you would still have approximately 10mg of diazepam active in your system today. If you were then to use heroin or morphine, you would have an increased risk of overdose as you would be using the opioids in addition to that 10mg of diazepam.

Mixing drugs

Taking more than one kind of drug at a time puts strain on the body and can increase both effect and the risk. For example, most heroin-related overdoses are caused when other depressant drugs are taken too. Alcohol and benzos like alprazolam (marketed as Xanax) and temazepam (Temaze) are depressants, and mixing them with drugs like heroin, oxycodone (Oxycontin®) or morphine (MS Contin®) greatly increases the risk of an overdose.
What to do if someone is overdosing

• stay with them and assure them everything will be okay
• if they appear unconscious, try to get a response from them (eg: call their name).
• If you can’t get a response put them in the recovery position and call an ambulance.
• Commence first-aid. Emergency operators can give CPR instructions.
• Keep an eye on them. People can go in and out of consciousness.
• If stimulants such as amphetamines are thought to be involved, a person may feel hot, anxious or agitated. Try to move them somewhere cooler and quieter. Or try to make the place quieter.

When to call an ambulance

People are often reluctant to call an ambulance for fear of police involvement or concern about the cost of a call-out. The police will only attend if there is a fatality or if their presence is requested, for example if the ambulance crew feel threatened. This is an issue worldwide.

In addition to unconsciousness, call for emergency help when someone is:

• having a seizure
• experiencing severe headache
• experiencing chest pain
• experiencing breathing difficulties
• extremely paranoid, agitated and/or confused.

It is not necessary for someone to have all of these signs or symptoms for them to be overdosing. Exhibiting only a few could still mean they are in trouble and need emergency help.

Don’t ignore gurgling and snoring

Snoring and gurgling can mean a person is having trouble breathing.

With substance use, especially substances that slow down the systems of the body (eg: benzodiazepines, opioids, GHB), snoring may indicate a serious and potentially life threatening obstruction of the airway.

The noise generated results from reduction in the size of the airway, and the result is a reduction in the volume of air that is able to move in and out of the lungs with each breath, and vibration of tissues around the airway as the comatose person struggles to move air in and out of the lungs. The larger the obstruction, the smaller the amount of air that gets in, and the greater the effort that is required to try and get air into the lungs. The obstruction occurs when the person is unable (due to their substance use) to move their head/neck/body to allow better air flow, and because collapse of the airway due to decreased muscle activity around the airway that normally keeps it open – this is because they are unconscious, not because they are sleeping.

In the setting of substance use, snoring is not something that should be seen as ‘normal’. Don’t let people ‘sleep it off’ if they are snoring – this may be a sign of significant and life threatening emergency – attempt to wake them immediately.

If they do wake then the snoring (airway obstruction) will resolve. If they do not wake, call emergency services and ask for an ambulance. Follow the instructions from the operator (you will probably be asked to roll the snoring person onto their side and open their mouth to maximise the flow of air).

Naloxone half-life

Naloxone (also known by one of the brands Narcan®) is the used by paramedics to revive people who have had an opiate or opioid drug overdose. Anyone who has been revived using naloxone needs to understand the danger of taking more drugs afterwards because they can overdose a second time. Naloxone can precipitate withdrawal symptoms which bring a powerful urge to take more drugs.  Because naloxone has a half-life of 1-1.5 hours, considerably less than heroin and morphine, taking more opiates can bring on a second overdose. Drugs like methadone, and sustained-release opioids like OxyContin® and MS Contin®, provide the drug over 12 hours or more, so the effect of naloxone will wear off long before those drugs have exited your system.

Permanent brain damage and overdose

Hypoxic brain injury, which is caused by a lack of oxygen to the brain, is an under-reported consequence of heroin overdose. These brain injuries can cause coma, seizures and, in worst case scenarios, brain death. The long-term consequences of hypoxia depend on how long the brain is without adequate oxygen supply. Basically, the longer a person is not breathing, the more potential damage is being done to the brain. In many overdose cases such information is unknown. Health outcomes depend on the success of damage control measures, the area and extent of brain tissue deprived of oxygen and the speed with which oxygen was restored to the brain.

A brain injury can result in mild to severe impairment of:

• movement, balance and co-ordination
• senses such as hearing or vision
• spoken and written communication
• thinking, concentration and memory.

In severe cases, brain injuries from overdoses can leave people in a vegetative state.

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International Overdose Awareness Day is committed to providing a platform to acknowledge the grief felt by families and friends who have lost a loved one to overdose. We aim to raise awareness that the tragedy of overdose death is preventable. Support our work today.

TRIBUTES

• My son, Travis, died of an overdose on July 28, 2015.  He was only 23.  He had been sober 3 months at the time of his death.  I know that he fought so hard, and he was a beautiful soul trapped in the hell of addiction.  I miss him every day and so wish I could tell him how much I love him and that I know he tried.  Rest in peace sweet boy!

Saturday, August 20th at 6pm Main Stage with the Fashion Trashion Show, join our Rock Solid Youth in a Flash Mob! DANCE 4 HEALTH!

Cigarettes: Also known as: “smokes,” “cigs,” or “butts”

Smokeless tobacco: Also known as: “chew,” “dip,” “spit tobacco,” “snus,” or “snuff”

Hookah: Also known as: ”waterpipe,” “narghile,” “shisha,” “hubble-bubble,” or “goza”

Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco or created by burning it (as in cigarettes), but nicotine is the ingredient that can lead to addiction. Other chemicals produced by smoking, such as tar, carbon monoxide, acetaldehyde, and nitrosamines, also can cause harm to the body. For example, tar causes lung cancer and other serious diseases that affect breathing. Carbon monoxide causes heart problems, which is one reason why people who smoke are at high risk for heart disease.

Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarettes cause more than 480,000 premature deaths in the United States each year—from smoking or exposure to secondhand smoke—about 1 in every 5 U.S. deaths, or 1,300 deaths every day.1 An additional 16 million people suffer with a serious illness caused by smoking. Thus, for every 1 person who dies from smoking, 30 more suffer from at least 1 serious tobacco-related illness.2

When nicotine enters the body, it initially causes the adrenal glands to release a hormone called epinephrine (adrenaline). The rush of adrenaline stimulates the body and causes an increase in blood pressure, heart rate, and breathing.

Most of the harm to the body is not from the nicotine, but from other chemicals contained in tobacco or produced when burning it—including carbon monoxide, tar, formaldehyde, cyanide, and ammonia. Tobacco use harms every organ in the body and can cause many problems. The health effects of smokeless tobacco are somewhat different from those of smoked tobacco. But for both types of tobacco products, the risks are real.

Smoking Tobacco Effects

• Cancer. Tobacco use can be blamed for about one-third of all cancer deaths, including 90% of lung cancer cases. Tobacco use is also linked with cancers of the mouth, pharynx, larynx, esophagus, stomach, pancreas, cervix, kidney, ureter, bladder, and bone marrow (leukemia).
• Lung or respiratory problems. Bronchitis (swelling of the air passages to the lungs), emphysema (damage to the lungs), and pneumonia have been linked with smoking.
• Heart disease. Smoking increases the risk for stroke, heart attack, vascular disease (diseases that affect the circulation of blood through the body), and aneurysm (a balloon-like bulge in an artery that can rupture and cause death).
• Cataracts (an eye condition). People who smoke can experience this clouding of the eye, which causes blurred vision.
• Loss of sense of smell and taste.
• Lowered lung capacity. People who smoke can’t exercise or play sports for as long as they once did.
• Aging skin and teeth. After smoking for a long time, people find that their skin ages faster and their teeth discolor or turn brown.
• Harm to the unborn baby of a pregnant woman who smokes. Pregnant women who smoke are at increased risk for delivering their baby early or suffering a miscarriage, still birth, or experiencing other problems with their pregnancy. Smoking by pregnant women also may be associated with learning and behavior problems in children.
• Accidental death from fires. Smoking is the leading cause of fire-related deaths—more than 600 deaths each year.6

Secondhand Smoke

For people who do not smoke, secondhand smoke—exposure to exhaled smoke and smoke given off by the burning end of tobacco products—increases the risk for many diseases. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 41,000 nonsmokers die from diseases caused by secondhand smoke exposure.3

Inhaling secondhand smoke increases a person’s risk for developing:

• Heart disease. Secondhand smoke increases the risk for heart disease by 25% to 30%. It is estimated to contribute to as many as 34,000 deaths related to heart disease.4
• Lung cancer. People exposed to secondhand smoke increase their risk for lung cancer by 20% to 30%. About 7,300 lung cancer deaths occur per year among people who do not smoke.5
• Lung problems. Secondhand smoke causes breathing problems in people who do not smoke, like coughing, phlegm, and lungs not working as well as they should.
• Health problems for children. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, lung infections, ear problems, and more severe asthma.

Smokeless Tobacco Effects

People who use smokeless tobacco products, such as chewing tobacco, snuff, or dip, are at risk for several health problems:

• Tooth decay, gum problems, and mouth sores. Smokeless tobacco increases the chance of getting cavities, gum disease, and sores in the mouth that can make eating and drinking painful.
• Cancer. Close to 30 chemicals in smokeless tobacco have been found to cause cancer. People who use smokeless tobacco are at increased risk for oral cancer (cancers of the mouth, lip, tongue, and pharynx) as well as esophageal and pancreatic cancers.
• Other potential health problems. Recent research shows smokeless tobacco may play a role in causing heart disease and stroke.

E-Cigarettes have emerged over the past decade and researchers in the early stage of investigating what the health effects are for people who use these products or who are exposed to the aerosol (vapor) secondhand.

E-Cigarettes are designed to deliver nicotine without the other chemicals produced by burning tobacco leaves. Puffing on the mouthpiece of the cartridge activates a battery-powered inhalation device (called a vaporizer). The vaporizer heats the liquid inside the cartridge which contains nicotine, flavors, and other chemicals. The heated liquid turns into an aerosol (vapor) which the user inhales—referred to as “vaping.”

There are conflicting studies about whether or not e-cigarettes help smokers to quit. For tobacco cigarette smokers, e-cigarettes may be a safer alternative, if the goal is not to quit nicotine all together. However, health experts have raised many questions about the safety of these products, particularly for teens:

• Testing of some e-cigarette products found the aerosol (vapor) to contain known cancer-causing and toxic chemicals, and particles from the vaporizing mechanism that may be harmful. The health effects of repeated exposure to these chemicals are not yet clear.
• There is animal research which shows that nicotine exposure may cause changes in the brain that make other drugs more rewarding. If this is true in humans, as some experts believe, it would mean that using nicotine would increase the risk of other drug use and for addiction.
• There is an established link between e-cigarette use and tobacco cigarette use in teens. Researchers are investigating this relationship. The concern is that e-Cigarette use may serve as a “gateway” or introductory product for youth to try other tobacco products, including regular cigarettes, which are known to cause disease and lead to early death.
• The liquid in e-cigarettes can cause nicotine poisoning if someone drinks, sniffs, or touches it. Recently there has been a surge of poisoning cases in children under age 5. There is also concern for users changing cartridges and for pets.

Are E-Cigarettes Regulated?

Yes. The U.S. government’s Food and Drug Administration (FDA) announced on May 5, 2016 that effective in 90 days, the FDA will now regulate how and to whom e-cigarettes, as well as hookah tobacco and cigars are sold. This means that the FDA will now regulate these types of tobacco products in much the same way they regulate cigarettes.

This means that beginning on August 5, 2016:

• It is illegal to sell e-cigarettes, hookah tobacco or cigars in person or online to anyone under age 18;
• Buyers have to show their photo ID to purchase e-cigarettes, hookah tobacco or cigars, verifying that they are 18 years or older.
• These products cannot be sold in vending machines (unless in an adult-only facility); and
• It is illegal to hand out free samples.

FDA regulation also means that the Federal government will now have a lot more information about what is in e-cigarette’s, the harmfulness of the ingredients, how they are made, and what risks need to be communicated to the public (for example, on health warnings on the product and in advertisements). They will also be able to stop manufactures from making statements about their products that are not scientifically proven.

Regulation does not mean that e-cigarettes are necessarily safe for all adults to use, or that all of the health claims currently made in advertisements by manufactures are scientifically proven. But what it does mean is that e-cigarettes, hookah tobacco, and cigars now have to follow the same type of rules cigarette manufacturers have been following since 2009.

teens.drugabuse.gov

Yes, marijuana is addictive. A user may feel the urge to smoke marijuana again and again to re-create the “high.” Repeated use could lead to addiction—which means the person has trouble controlling their drug use and often cannot stop even though they want to.

An estimated nine percent of people who use marijuana will become dependent1,2; people who begin using marijuana before the age of 18 are 4-7 times more likely to become addicted than adults.3

It is estimated that about 1 in 6 people who start using as a teen, and 25% to 50% percent of those who use it every day, become addicted to marijuana. What causes one person to become addicted to marijuana and another not to depends on many factors—including their family history (genetics), the age they start using, whether they also use other drugs, their family and friend relationships, and whether they take part in positive activities like school or sports (environment).

People who use marijuana may also feel withdrawal when they stop using the drug. Withdrawal symptoms may include:

• Irritability
• Sleeplessness
• Lack of appetite, which can lead to weight loss
• Anxiety
• Drug cravings

These effects can last for several days to a few weeks after drug use is stopped. Relapse (returning to the drug after you’ve quit) is common during this period because people also crave the drug to relieve these symptoms.

The main chemical in marijuana that affects the brain is delta-9-tetrahydrocannabinol (THC). When marijuana is smoked, THC quickly passes from the lungs into the bloodstream, which carries it to organs throughout the body, including the brain. As it enters the brain, THC attaches to cells, or neurons, with specific kinds of receptors called cannabinoid receptors. Normally, these receptors are activated by chemicals that occur naturally in the body. They are part of a communication network in the brain called the endocannabinoid system. This system is important in normal brain development and function.

Most of the cannabinoid receptors are found in parts of the brain that influence pleasure, memory, thinking, concentration, sensory and time perception, and coordinated movement. Marijuana triggers an increase in the activity of the endocannabinoid system, which causes the release of dopamine in the brain’s reward centers, creating the pleasurable feelings or “high.” Other effects include changes in perceptions and mood, lack of coordination, difficulty with thinking and problem solving, and disrupted learning and memory.

Certain parts of the brain have a lot of cannabinoid receptors. These areas are the hippocampus, the cerebellum, the basal ganglia, and the cerebral cortex. (Learn more about these areas and how THC affects them.) The functions that these brain areas control are the ones most affected by marijuana:

• Learning and memory. The hippocampus plays a critical role in certain types of learning. Disrupting its normal functioning can lead to problems studying, learning new things, and recalling recent events. A recent study followed people from age 13 to 38 and found that those who used marijuana a lot in their teens had up to an 8 point drop in IQ, even if they quit in adulthood.3,4
• Coordination. THC affects the cerebellum, the area of our brain that controls balance and coordination, and the basal ganglia, another part of the brain that helps control movement. These effects can influence performance in such activities as sports, driving, and video games.
• Judgment. Since THC affects areas of the frontal cortex involved in decision making, using it can cause you to do things you might not do when you are not under the influence of drugs—such as engaging in risky sexual behavior, which can lead to sexually transmitted diseases (STDs) like HIV, the virus that causes AIDS—or getting in a car with someone who’s been drinking or is high on marijuana.

When marijuana is smoked, its effects begin almost immediately and can last from 1 to 3 hours. Decision making, concentration, and memory can suffer for days after use, especially in regular users.2

If marijuana is consumed in foods or beverages, the effects of THC appear later—usually in 30 minutes to 1 hour—but may last for many hours.

Long-term, regular use of marijuana—starting in the teen years—may impair brain development and lower IQ, meaning the brain may not reach its full potential.3,4

Learn more about how the brain works and what happens when a person uses drugs.

teens.drugabuse.gov