Marijuana use and quality of sperm for fertility competency: a preliminary investigation

OBJECTIVES: The literature was contradictory about the effects of marijuana use on sperm parameters. Laboratory findings, of excellent sperm quality for some Jamaican males who are chronic marijuana users, support these contradictory findings. This paper describes and compares levels of marijuana smoking with sperm quality and pregnancy history among Jamaican men concerned with their fertility potential. DESIGN AND METHODS: Ninety-four male clients referred to a fertility clinic over an 8-month period completed a standard form which included demographics, employment data, general health, lifestyle practices, fatherhood and medical history, and an additional questionnaire which detailed their marijuana use. RESULTS: Significantly more chronic marijuana users had poor sperm quality, particularly preparation sperm count and motility, compared to those who had never smoked marijuana. This effect was found without differentiating current from chronic use. There were no differences in the distribution of marijuana use between men with extremely low or excellent sperm quality. A surprising finding was that males under 30 years old, who were less likely to be chronic users, had similar critically low sperm count as males over 50. CONCLUSIONS: Chronic marijuana use seems to negatively affect sperm quality (especially preparation sperm parameters). However, the effects need to be more thoroughly investigated with the use of a larger sample size, more robust testing using DNA, and by examining socio-cultural practices associated with marijuana smoking.

Evidence summary: the therapeutic effectiveness of Cannabis sativa

This Evidence Summary is prepared in response to a request from the Assistant Secretary-General, Human and Social Development, CARICOM. Given the debate internationally with respect to Cannabis sativa’s safety and efficacy, and given that CARPHA’s role is to provide direction in analyzing, defining and responding to public health priorities, we have interpreted this broad request as requiring our response to the following question: What is the current state of scientific knowledge regarding the effectiveness of marijuana and its chemical constituents in medical treatment in humans? We present a synthesis of research findings, of international relevance, that answers the specified question.

Cannabis use: context and controversy

Cannabis and its most active ingredient delta-9 tetrahdrocannabinol (THC) are derived from the plants cannabis indica and cannabis sativa which were transported to Trinidad during the indentureship period. Locally referred to as marijuana, ganja, hashish, pot and weed, the substance was originally intended for medicinal purposes but due to its hallucinatory and euphoric effects has found a place in creativity, religion and as a street drug of abuse. The lethality of this drug is increased when the smoke is inhaled directly, facilitating easy entry into the blood stream and quick absorption into the brain. Commercial cannabis is compressed, soaked in embalming oil and spices for removal of the scent in order to facilitate smuggling and these preservatives in themselves may have adverse effects. Despite reports of its use as a drug associated with artistic creativity in the 1970's, cannabis remains today a serious drug of abuse both by adolescents and adults and a major problem in the educational system. This chapter reviews the clinical effects of marijuana use, its relationship with suicide, mood disorders, psychoses and other mental disorders and discusses controversies associated with the decriminalization and de-legalization. Those who support the latter have not looked far enough.

Drug use and syphilis: co-factors for HIV transmission among commercial sex workers in Guyana

A cross-sectional survey was conducted among 124 street-and brothel-based female commercial sex workers (CSWs) in Georgetown in January and February 1997 to determine the seroprevalence of human immunodeficiency virus (HIV) infection and describe the sexual practices and drug use patterns. Their median age was 30 years (range 17 to 52 years). 119 (88 percent) reported regular alcohol consumption while looking for clients, 27 (22 percent) said they smoked cocaine and 51 (42 percent) reported use of marijuana. Street-based CSWs were significantly more likely to report marijuana use (p = 0.033). 72 percent reported that they never used condoms with regular sex partners and 35 percent reported that they never used condoms with clients. Brothel-based women were significantly more likely to report consistent condom use with their clients (p = 0.05). 46 percent (54/118) tested HIV positive and 28 percent (33/118) had a positive serological test for syphilis. Factors that were significantly associated with HIV infection included a positive serological test for syphilis (OR = 7.56; 95 percent CI = 2.7-21.97; p < 0.01) and a history of having received treatment for syphilis (OR = 2.93; 95 percent CI = 1.12-7.8). Weak associations were also found between HIV infection and a history of cocaine use (OR = 2.57; 95 percent CI = 0.95-7.11; p = 0.039); having more than four clients per night (OR = 5.14; 95 percent CI = 1.65-16.74; p = 0.04; and a history of receiving treatment for salpingitis (OR = 2.31; 95 percent CI = 0.93-5.75; p = 0.0035). No statistically significant association was found between HIV infection and marijuana use nor any sociodemographic variables (age, place of work, and duration of sex work). There is an urgent need for a community based behavioural intervention programme targetting this high risk population (AU)

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population. 60 percent of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18 percent of the women and 8 percent of the men had never their blood pressure taken. 40 percent of the women had never had a Papanicolaou smear, 29 percent had never had a breast examination and 33 percent said that they were overweight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as were drinking alcohol (79 percent of men, 41 percent of women) and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the previous five years were reported by 40 percent of the men and 15 percent of the women. 34 percent of the men and 12 percent of the women regularly carried a weapon and 18 percent of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10 percent were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54 percent vs 17 percent, p<0.001) or reported ever having a sexually transmitted disease (29 percent vs 9 percent, p<0.001). Younger persons were more sexually active and more likely to use condoms during the most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.(AU)

Maternal lifestyle and pregnancy outcome in Jamaica: the effects of cigarette and marijuana smoking, alcohol use and sexual activity

Cigarette smoking, marijuana and alcohol use, and coital activity have been investigated for effect on foetal birth weight and gestation chiefly in developed countries. Apart from the relationship between cigarette smoking and heavy alcohol intake and growth retardation, the evidence for poor birth outcome is controversial. Little is known of the effect of these lifestyle factors in developing countries where poor pregnancy outcome is common. Using data from a population based perinatal study in Jamaica, the effect of lifestyle factors was ivestigated in 8486 babies. Data collected by midwives at birth included the date of the last menstrual period, socio-demographic characteristics and frequency of tobacco, marijuana and alcohol use during pregnancy, as well as coital frequency at quickening and at delivery. Babies were weighed and measured. Live birth outcomes investigated were low birth weight, preterm birth and growth retardation, with population rates of 10.1 percent, 8.7 percent and 9.7 percent, respectively. Data were processed using SPSS and BMDP statistical packages. The prevalence of cigarette, marijuana and alcohol use was 7.0 percent, 2.1 percent and 16.4 percent respectively. 74 percent and 27 percent of women were having sexual intercourse at quickening and in the week prior to delivery, respectively. Apart from coital frequency at quickening, life style factors were strongly associated with each other. All life style factors were associated with social class. On univate analysis, significant associations were found between cigarette smoking and low birth weight (p,0.04) and growth retardation ,0.05). Association between marijuana use and low birth weight and between alcohol use and lower incidence of preterm birth failed to reach significance (p=0.05, p=0.16). When stratified by frequency of use, there was a significant trend in both cases (p<0.05, p<0.04). After controlling for socio-demographic characteristics and other life style factors, associations were maintained between cigarette smoking and low birth weight. Foetal effects of maternal cigarette smoking are present even in al low prevalence country. The effect of marijuana use is less conclusive, but the data suggest that this activity may be detrimental to the foetus. (Au)

Characteristics of Jamaicans who smoke marijuana before sex and their risk status for sexually transmitted diseases

Because of the high prevalence of marijuana smoking in Jamaica, it is important to know if this practice is associated with increased risk for STD infections. A national sample of 2,580 randomly selected Jamaicans, aged 15 to 49 years were administered a questionnaire to measure a number of health and behavioural variables. The results indicated that more persons who smoked marijuana before sex had a history of STD infections than non-marijuana smokers, the difference was significant among men (46 percent vs 26 percent, p < 0.001) but not among women (19 percent vs 8 percent, p = 0.09). There was no difference in age, however, more of the smokers were unmarried, poorly educated and unemployed than persons who did not smoke marijuana before sex. They were also more likely to engage in high risk sex behaviours and other risk taking behaviors than non-smokers. The results of multiple logistic analyses indicated that marijuana smoking before sex was an independent risk factor for STDs among men (Odd Ratio = 2.0, p = 0.04). Although it was not possible to determine if the association was causal, the increased risk for STDs among men who smoke marijuana before sex should be incorporated into the Jamaican STD/AIDS control programme by making special efforts to encourage condom use among marijuana smokers (AU)

Ganja smoking and sex in Jamaica - abstract

The characteristics and risk status for STD infections of Jamaicans who smoked marijuana before having sex were investigated. The study comprised 2580 individuals, aged 15 to 49 years, who were selected using a multi-stage random sampling technique. The results indicated that the prevalence of marijuana smoking before sex was higher among men (12 per cent) than among women (2 per cent). More Jamaicans who smoked marijuana before sex were unemployed and unmarried, had lower education levels and lived in poorer neighbourhoods than those who did not smoke. In addition, more of them were regular alcohol drinkers, took hard drugs and gambled. When their sex behaviour were examined, there was no difference in condom use; however, more marijuana smokers had multiple sex partners, had had STD infections and began having sex at an earlier age than the non-smokers. More male smokers had sex with prostitutes, viewed ponographic material and were involved in partner swapping than the men who did not smoke marijuana. The prevalence of anal and oral sex was higher in women who smoke marijuana before sex compared to the female non-smokers. The results of logistic regression analyses indicated (after controlling for the demographic and behavoral variables mentioned above (OR = 2.3, p<0.01) that men who smoked marijuana before sex had an increased risk of having STD infections. No increased risk was found in women who smoked marijuana before sex. Because of the high prevalence of marijuana smoking among men, it is important that their increased risk for STDs be considered by health authorities in the planning of STD/AIDS control programmes (AU)

Prenatal marijuana exposure and neonatal outcomes in Jamaica: an ethnographic study

OBJECTIVE. To identify neurobehavioral effects of prenatal marijuana exposure on neonates in rural Jamaica. DESIGN. Ethnographic field studies and standardized neuro-behavior assessments during the neonatal period. SETTING. Rural Jamaica in heavy-marijuana-using population. PARTICIPANTS. Twenty-four Jamaican neonates exposed to marijuana prenatally and 20 nonexposed mnonnates were compare at 3 days and 1 month old, using the Brazelton Neonatal Assessment Scale, including supplementary items to capture possible subtle effects. There were no significant differences between exposed and nonexposed neonates on day 3. At 1 month, the exposed neonates showed better physiological stability and required less examiner facilitation to reach organized states. The neonates of heavy-marijuana-using mothers had better scores on autonomic stability, quality of alertness, irritability, and self-refulation and were judged to be more rewarding for caregivers. CONCLUSIONS. The absence of any differences between the exposed on nonexposed groups in the early neonatal period suggest that the better scores of exposed neonates at 1 month are traceable to the cultural positioning and social and economic characteristics of mothers using marijuana that select for the use of marijuana but also promote neonatal development (AU)

The Rastafarian community and the "gateway" theory: lessons to be learned

The findings presented in this paper are drawn from a national ethnographic study conducted in six Jamaican populations, one of which was composed of members of the Rastafarian religion recruited from Kingston and south coast villages. Ninety-one members of the Rastafarian sect were formally interviewed and observed. The ethnographic study purposely over-sampled the Rastafarian community (1) because it was not sufficiently represented in the 1987 survey and (2) in order to examine the relationship between use of ganja and crack/cocaine. If ganja is, in fact, a "gateway" drug to cocaine, we would anticipate a high prevalence of crack/cocaine in this population. The data revealed that, as a group, members of the Rastafarian community were the most vigorous in shaping the definition of the term "drug". Cocaine is considered a drug but ganja, despite its illegal status, is considered a "natural" substance with health rendering properties and ritual functions. Not surprisingly, 0.4 percent of the Rastafarians surveyed believed that ganja should be legalized. Of all the populations investigated, Rastafarians were most likely to report that crack/cocaine was easy to obtain and to rank crack and cocaine as the most commonly used drugs. As a group, they are, in many ways, the most at risk for crack/cocaine use and addiction; compared with the rest of the sample, they have more urban, tourist and overseas experience as well as high potential for exposure to crack/cocaine. Yet the Rastafarian doctrine and design for living frequently were cited as the justification for preventing and/or for relinquishing the use of crack/cocaine. In its exception to the gateway theory, the Rastafarians community suggests protective mechanisms that inhibit the shift toward crack/cocaine use in high risk populations. (AU)

Newborn outcomes with maternal marihuana use in Jamaican women

Cluster scores on Brazelton Neonatal Behavior Assessment Scales (BNBAS) are analyzed for babies whose mother used marihuana during pregnancy and compared to a control group. Environmental variables explained significant differences in BNBAS scores. (AU)

Influence of marihuana smoking on female reproductive activity in albino rats

In recent years interest has mounted concerning the role of marihuana on reproductive physiology. Various reports in the literature suggest that marihuana influences female reproduction, and pose significant risks for the offspring. It has also been blamed for its embryotoxic/foetotoxic and teratogenic manifestations in animals. These reports are conflicting, confusing and sometimes contradictory. However, it could be conceived that marihuana use induces reproductive hazard. Moreover, marihuana has been used for facilitating childbirth and was tried in the management of menstrual disorders, but there is no evidence to establish the scientific basis for such claims. Despite the widespread use of marihuana, there are only a few studies available describing the effects of this drug in the female. This study was designed to investigate the potential effects of marihuana smoking on female reproductive process and foetal development. Albino rats were utilized for this experiment due to various practical advantages like availability, low cost, large number of animals per litter and brief gestational periods. Marihuana smoking has been employed to mimic human use and to restrict the use of heavy doses. Uterine smooth muscle contractility was studied to determine the influence of marihuana extract and the consequences of smoke exposure on uterine contractility. A chronic study, i.e. follow-up through two generations, was carried out since acute effects of marihuana may be insignificant and since continous maternal exposure could damage the foetus and chronic use could further deleterious effects. During this study a close watch was kept on the body weight to rule out the possible influence of undernutrition which may affect the reproductive function. Marihuana smoking has resulted in the reduction of body weight within the first week, but these animals later demonstrated a positive gain in weight and did not exhibit any obvious signs of undernutrition which may affect the reproductive function. Marihuana smoking has resulted in the reduction of body weight within the first week, but these animals later demonstrated a positive gain in weight and did not exhibit any obvious signs of undernutrition. A positive gain in body weight suggests development of tolerance following the smoking exposure. All the marihuana smoke-exposed rats exhibited delayed onset of oestrous activity but frequent oestrous cycles with a reduction in the duration of oestrous period. Such a change could interfere with fertility rate. Smoking also has resulted in suppression of ovalution. The fertility index (number of pregnant females/number of mated females) was significantly lowered. Other observations were shortened gestation period, low birth weight and diminished litter size. Reduction in fertility index and the gestation period may be the consequence of uterine stimulatory action of marihuana or suppressed ovarian activity. Low birth weight and reduction in the litter size could be due to probable embryotoxic effects of interference with transport mechanisms. Uterine contractile responses produced by crude aqueous marihuana extract (CAME) were significantly higher in smoke-exposed rats. CAME seems to depolarize the uterine smooth muscle, by activiting the muscarinic receptors. Chronic exposure to marihuana smoke seems to alter this response at receptor level. CAME is shown to possess both contractile and relaxing properties with dominant activity of the former. Chronic exposure to marihuana smoke resulted in appearance of tumours, like serous cystomata, follicular cysts, telengiectatic cysts, adenofibroma and adenocarcinoma in 50 percent of the experimental animals. The significance of this uterine stimulatory and tumorigenic potential of marihuana may have far-reaching consequences due to interference with foetal blood flow. Such a situation couls lead to deficient transport of O2, nutrients and toxic metabolities and precipitate not only foetal underdevelopment, but also reduction in litter size. Use of marihuana seems to influence the reproductive activity in females as evidences by delayed onset of oestrous activity, frequent oestrous cycles with reduced fertility index, shortened gestation periods, increased litter mortality, low birth weight, etc. This study clearly indicates that the marihuana smoke not only affects the maternal well-being but also jeopardizes the conditions under which the foetuses grow and develop (AU)

Marijuana use among women: an anthropological view

This paper suggests that the concept of intra cultural diversity is a more useful framework for understanding non-conforming behavior among Jamaican rural women than social psychological explanations of deviance from culturally approved sex roles. A comparison of female cannabis smoking in two rural communities, permits us to identify some of the social processes which underly variation in the nature and extent of marijuana use by women in the two settings (AU)

Effect of cigarette smoking and marihuana on respiratory tract function

Studies were conducted to elucidate the effect of tobacco smoking and marihuana on respiratory functions in both animals and human subjects. The airway resistance (Raw) was measured in apparently healthy Wistar rats using whole body plethysmograph. Histopathological and histochemical observations were also made to ascertain the damage induced by the inhalation of tobacco or marihuana smoke. Various pneometric tests viz. Vital capacity (VC), Functional Residual Capacity (FRC), Residual Volume (RV), Total Lung Capacity (TLC), Forced Expiratory Volume in one second (FEV1.0), Mean Transit Time (MTT), Peak Expiratory Flow Rate (PEFR) and Closing Volume (CV) were carried out in chronic tobacco, marihuana smokers and clinically assessed asthmatic patients. The effect of crude aqueous marihuana extract on specific airway resistance (sRaw) as well as on various pneometric parameters were observed both in animals and human subjects respectively. Animal Studies - inhalation of either marihuana or tobacco smoke significantly increased (p<0.01) airway resistance (Raw), functional residual capacity (FRC) and specific airway resistance (sRaw) as compared to the control rats. Apparent increases in the airway resistance were observed after the first week of exposure but significant differences were only noted in rats exposed for a period of 12 weeks or more. The smoking of either marihuana or tobacco increased the sensitivity of airways to acetylcholine from 18 weeks of exposure onwards. Attempts to elucidate the mechanism of action suggested that the increase in airway responsiveness of alpha adrenoceptors and increased vagal activity which may have resulted in the narrowing of the airways. This has been suggested on the basis of the following observations: i) Intraperitoneal administration of adrenaline (400 ug/kg body weight) following propranolol (2 mg/kg body weight) resulted in an increase in sRaw, whereas a decrease was observed following phentolamine (2 mg/kg body weight). ii) Intramuscular administration of atropine (2 mg.kg body weight) decreased sRaw. Bilateral vagotomy of marihuana or tobacco smoke to exposed rats. iii) The administration of subthreshold concentrations of acetycholine (0.25 ug and 0.5 ug Ach) in 36 weeks smoke exposed rats significantly increased sRaw in contrast to control rats. The administration of atropine prior to acetypcholine in subthreshold concentrations prevented such increase in sRaw in smoke exposed rats indicating the involvement of vagus in inducing the hypersensitivity. The possible existence of bronchitis in marihuana and tobacco smoke to rats from 12 weeks onwards has been further supported by histopathological and histochemical changes which include inter alia catarrhal inflammation resulting in ulceration of the bronchial mucosa, squamous cell metaplasia, increased goblet cell, increased sulphation of mucus, focal alveolitis and alveolar collapse. The interperitoneal administration of 1 ml aqueous crude marihuana extract (1.27 gm/100 ml) significantly decreased the value of sRaw in both marihuana and tobacco smoke exposed rats. This is suggestive of its bronchodilatory effect and has been further demonstrated to be acting through beta adrenoceptors. The cessation of smoking for one month resulted in a decreasing trend of sRaw in rats exposed to either marihuana or tobacco smoke for a period of 36 weeks. This suggests that improvement in the lung picture may be achieved if a longer recovery period is allowed. Human Studies - the comparison of lung functions in chronic marihuana smokers and non-smokers indicated narrowing of both central and peripheral airways as demonstrated by slight decreases in FEV1.0 percent and PEFR and increases in RV/TLC percent, CV/VC percent and CC/TLC percent. These lung functions were found to be more affected in chronic smokers. The bronchodilatory effect observed immediately after smoking a single dose of marihuana to the chronic marihuana smokers may be due to the presence of THC. This bronchodilation was followed by bronchoconstriction when observed after 60 minutes of marihuana smoking. The mechanism of initial bronchodilation is at present unclear but may be due to a direct effect of THC on the bronchial smooth muscle. The bronchoconstrictory effect of marihuana or tobacco smoke is probably due to increased vagal activity and increased responsiveness of alpha adrenoceptors as observed in the animal studies. The presence of a low responsive and a high responsive group of subjects in chronic marihuana smokers has been demonstrated. The high responsive group seems to be more susceptible to marihuana smoke as exemplified by greater decrease in FEV1.0 percent and increase in CV/VC percent. These changes further indicate that the impairment occurs predominantly in the larger airways even though there are signs of onset of small airway disease. The decreases in FEV1.0 percent and PEFR in the asthmatic subjects indicated abnormalities in the larger airways. Significant increases in MTT, CV/VC percent and CC/TLC percent is suggestive of obstruction in the peripheral airways. Administration of 30 mls aqueous extract (200 mg/100 mls) of marihuana to asthmatic subjects resulted in the improvement in lung functions after 30 minutes with the maximum improvement being observed at 60 minutes post administration. The bronchodilatory effect of marijuana extract was quite comparable to a known bronchodilator, ventolin (Salbutamol 200 ug), used in this study. However, the effect of ventolin was faster than aqueous marihuana extract. The bronchodilatory effect of aqueous marihuana extract may be due to the presence of some active ingredients other than THC and may be partly due to the increased activity of beta adrenoceptors (AU)