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大麻的不良反应。

Adverse effects of cannabis.

出版信息

Prescrire Int. 2011 Jan;20(112):18-23.

Abstract

Cannabis, Cannabis sativa L., is used to produce a resin that contains high levels of cannabinoids, particularly delta9-tetrahydrocannabinol (THC), which are psychoactive substances. Although cannabis use is illegal in France and in many other countries, it is widely used for its relaxing or euphoric effects, especially by adolescents and young adults. What are the adverse effects of cannabis on health? During consumption? And in the long term? Does cannabis predispose users to the development of psychotic disorders? To answer these questions, we reviewed the available evidence using the standard Prescrire methodology. The long-term adverse effects of cannabis are difficult to evaluate. Since and associated substances, with or without the user's knowledge. Tobacco and alcohol consumption, and particular lifestyles and behaviours are often associated with cannabis use. Some traits predispose individuals to the use of psychoactive substances in general. The effects of cannabis are dosedependent.The most frequently report-ed adverse effects are mental slowness, impaired reaction times, and sometimes accentuation of anxiety. Serious psychological disorders have been reported with high levels of intoxication. The relationship between poor school performance and early, regular, and frequent cannabis use seems to be a vicious circle, in which each sustains the other. Many studies have focused on the long-term effects of cannabis on memory, but their results have been inconclusive. There do not * About fifteen longitudinal cohort studies that examined the influence of cannabis on depressive thoughts or suicidal ideation have yielded conflicting results and are inconclusive. Several longitudinal cohort studies have shown a statistical association between psychotic illness and self-reported cannabis use. However, the results are difficult to interpret due to methodological problems, particularly the unknown reliability of self-reported data. It has not been possible to establish a causal relationship in either direction, because of these methodological limitations. In Australia, the marked increase in cannabis use has not been accompanied by an increased incidence of schizophrenia. On the basis of the available data, we cannot reach firm conclusions on whether or not cannabis use causes psychosis. It seems prudent to inform apparently vulnerable individuals that cannabis may cause acute psychotic decompensation, especially at high doses. Users can feel dependent on cannabis, but this dependence is usually psychological. Withdrawal symptoms tend to occur within 48 hours following cessation of regular cannabis use, and include increased irritability, anxiety, nervousness, restlessness, sleep difficulties and aggression. Symptoms subside within 2 to 12 weeks. Driving under the influence of cannabis doubles the risk of causing a fatal road accident. Alcohol consumption plays an even greater role. A few studies and a number of isolated reports suggest that cannabis has a role in the occurrence of cardiovascular adverse effects, especially in patients with coronary heart disease. Numerous case-control studies have investigated the role of cannabis in the incidence of some types of cancer. Its role has not been ruled out, but it is not possible to determine whether the risk is distinct from that of the tobacco with which it is often smoked. Studies that have examined the influence of cannabis use on the clinical course of hepatitis C are inconclusive. Alcohol remains the main toxic agent that hepatitis C patients should avoid. In practice, the adverse effects of low-level, recreational cannabis use are generally minor, although they can apparently be serious in vulnerable individuals. The adverse effects of cannabis appear overall to be less serious than those of alcohol, in terms of neuropsychological and somatic effects, accidents and violence.

摘要

大麻,即大麻属植物大麻(Cannabis sativa L.),用于生产含有高含量大麻素的树脂,尤其是Δ⁹-四氢大麻酚(THC),这些都是精神活性物质。尽管在法国和许多其他国家使用大麻是非法的,但因其具有放松或欣快的效果而被广泛使用,尤其是青少年和年轻人。大麻对健康有哪些不良影响?在使用期间?以及长期影响?大麻会使使用者更容易患上精神障碍吗?为了回答这些问题,我们使用标准的《处方》方法审查了现有证据。大麻的长期不良影响很难评估。因为在使用者知情或不知情的情况下,大麻使用往往与烟草和酒精消费以及特定的生活方式和行为相关联。某些特质通常会使个体更容易使用精神活性物质。大麻的影响具有剂量依赖性。最常报告的不良影响是思维迟缓、反应时间受损,有时还会加重焦虑。据报道,高剂量中毒会导致严重的心理障碍。学业成绩不佳与早期、经常且频繁使用大麻之间的关系似乎是一个恶性循环,二者相互影响。许多研究聚焦于大麻对记忆的长期影响,但其结果尚无定论。大约15项纵向队列研究探讨了大麻对抑郁情绪或自杀念头的影响,结果相互矛盾且尚无定论。几项纵向队列研究表明,精神疾病与自我报告的大麻使用之间存在统计学关联。然而,由于方法学问题,尤其是自我报告数据的可靠性未知,这些结果难以解释。由于这些方法学限制,无法确定二者之间的因果关系。在澳大利亚,大麻使用的显著增加并未伴随着精神分裂症发病率的上升。基于现有数据,我们无法就大麻使用是否会导致精神病得出确凿结论。告知明显易受影响的个体大麻可能会导致急性精神失代偿,尤其是高剂量时,这似乎是谨慎之举。使用者可能会对大麻产生依赖,但这种依赖通常是心理上的。在定期使用大麻停止后48小时内往往会出现戒断症状,包括易怒、焦虑、紧张、不安、睡眠困难和攻击性增强。症状会在2至12周内消退。在大麻影响下驾驶会使致命道路事故的风险增加一倍。酒精消费在这方面的作用甚至更大。一些研究和许多个别报告表明,大麻在心血管不良反应的发生中起一定作用,尤其是在冠心病患者中。众多病例对照研究调查了大麻在某些类型癌症发病率中的作用。其作用尚未被排除,但无法确定这种风险是否与常与之一起吸食的烟草的风险不同。研究大麻使用对丙型肝炎临床病程影响的结果尚无定论。酒精仍然是丙型肝炎患者应避免的主要毒性物质。实际上,低水平、用于消遣的大麻使用的不良影响通常较小,尽管在易受影响的个体中可能明显较为严重。就神经心理和躯体影响、事故及暴力而言,大麻的不良影响总体上似乎比酒精的要轻。

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