May 17: Marijuana is the most commonly consumed illegal drug in the world. Consumption of marijuana has been a topic of debate for several years, with calls for its legalization for medicinal and recreational purposes. 

The World Health Organization reported in 2016 that 4% of the global population (192 million people) consumes marijuana illegally, with 40% of Americans having taken the drug at least once in their lifetime. 

Marijuana consumption is most prevalent among males and teenagers, but its use is also growing among women. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) present in Cannabis sativa, indica, and ruderalis are known to have the power to intoxicate and cause addiction.

Marijuana is consumed in various forms and quantities, for example cannabis has about 1% and sinsemilla up to 5-6%. The plants are also used to make textiles, pickles, and drinks. 

The voices for the legalization of marijuana farming, sale, and use for entertainment and medicinal purposes are being raised worldwide, including in Nepal.

In 2020, Nepal voted to reclassify and reconsider marijuana from Schedule IV, which includes drugs that cannot be used even for medical treatment.  There has been estimation that if legalized, marijuana could generate up to NPR 146 billion by 2025, transforming the country's development. 

Apparently, there has been flood of fiery and attractive speeches, deliberations, interviews, news and articles from so-called leaders and scholars in its favor.  

However, as an expert in mental health working for over two decades, I have witnessed marijuana destroying many lives and families in all setups, including out-patient departments, wards, emergency, and other setups. 

Even today while sitting to write this article, one third of psychiatry ward patients has history of cannabis use and 23% fulfill the criteria for dependence.

  I have seen many people losing their lives to the drug, and many families suffering for years due to the drug. But few of them including literate college students have scientific knowledge and information about it. 

They claim that marijuana is good for health and easily available. It is extremely distressing to witness the current state with the flood of ideas and arguments in its favor on one hand and my own first hand observation of devastating effects on the other. It warrants reviewing the harm and benefits of this substance as a medicine.

 This article is an audacity based on our effort to review the benefits and harms of medicinal use of cannabis which has been published as a journal article.  The author leaves the responsibility of analyzing and adopting the fact to the wise readers themselves. 

CBD present in marijuana is used as medicine to treat some health issues, including vomiting and special type of seizure. The US Food and Drug Administration has given permission to use marijuana for these two purposes. 

Claims have also been made that marijuana has a positive impact on the treatment of Parkinson's disease and multiple sclerosis, but there is no evidence to support these claims. 

While cannabis is touted to stop vomiting and treat problems in ligaments, its use is reported to have aggravated these problems to the intractable forms. 

During the COVID-19 pandemic, some chemicals in marijuana were publicized to have a positive effect on lungs, but later, they were found to have other chemicals causing serious problems in lungs, including even cancer. 

Reports have come out showing that marijuana has various types of cancer-causing chemicals more than in tobacco and cigarettes.  People who take marijuana to increase their appetite for food usually have further lost their interest in food and fallen victim to malnutrition. 

Although marijuana has been mentioned in some medical literature as beneficial for the treatment of mental problems, its uses for emotional and mood disorders are not appropriate, as it may cause panic and other anxiety disorders among the users. 

Marijuana is also considered beneficial to treat mood disorders, such as depression and mania. However, those people using cannabis usually require visiting psychiatrist when they are hit severely with co-morbid depression and mania. It has also been seen in one of our recent studies. 

Using marijuana as medicine for mood disorders is, hence, not appropriate. It is common to see that people taking alcohol and other drugs often turn to marijuana and vice-versa.

Marijuana is believed to have some benefit even in some type of psychosis. Whereas the reality is that marijuana consumption may cause the onset of serious mental problems such as psychosis, with single use of small amount, frequent or regular longstanding use.

 For those who have genetic predisposition, it may act like a match stick. The worsening of situation and increasing prevalence of psychosis has lately increasingly been reported in countries that have legalized it and have increased marijuana consumption. 

Those who advocate for marijuana legalization argue that marijuana can be used as medicine, like opiate in the right amount. The issue of marijuana consumption is a complex one that requires a thorough analysis of its potential benefits and harms. 

Before we allow the widespread use of marijuana, it is important to carefully consider its intended purpose, the types of positive and negative effects it may have, and whether we can accurately predict its effects.

While some argue that marijuana consumption has potential therapeutic benefits, evidence shows that it can have more harms than good sides. 

There is an established evidence to show the harms of marijuana. But, we are yet to receive the evidence to substantiate its positive side. Reports suggest that its use may cause death by obstructing the heartbeat and lead to psychosis.

 Studies have also shown that marijuana can have serious impacts not only on frequent users but also on one-time users.Moreover, since marijuana is plant-based rather than a medicine, its quantity is extremely variable and unpredictable and it has some impurities in products in reality as well. 

Legalization may result in uncontrolled use of the drug, leading to severe outcomes, also raising false impression among common people about its benefits. Therefore, it is crucial to implement strict regulations and to educate the general public, students, teachers, and parents on the potential risks of using marijuana.

However, a complete ban on marijuana and legal restrictions may not be the solution. Such measures may create a black market, cause the state to lose revenue, and increase criminal activity.

 Instead, we need to promote scientific research studies, update existing laws based on scientific evidence, and aim to promote public health and awareness of policies.

As a country with ignorance, poverty, weak governance, and a backward economy, Nepal must be vigilant when observing other countries' stance on marijuana legalization. We must not blindly follow their example but make decisions based on our specific circumstances.

Therefore, if you hear someone say or see an advertisement claiming that "marijuana is a wonder drug," it is important to verify the facts and think twice before using it. We must analyze the available evidence thoroughly before making any decision regarding its use.

Prof. Dr. Dhana Ratna Shakya is Head at the Department of Psychiatry 
in B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.