6 ms·

> In the study, the researchers used a national insurance claims database, identifying more than 1.1 million knee patients and nearly 748,000 shoulder patients.

> In the study, the researchers used a national insurance claims database, identifying more than 1.1 million knee patients and nearly 748,000 shoulder patients. Nearly 22,000 of the patients had been diagnosed with marijuana dependence. The term "marijuana dependence" suggests either bias in the diagnoses, or extremely heavy users. Smoking marijuana is still smoking, and I've always been under the impression that some (though far from all) of the risk from smoking tobacco was just because of inhaling smoke. Also, as another comment mentions, I can't see anything indicating they controlled for tobacco smoking.

PragmaticPulp 4y ago
> The term "marijuana dependence" suggests either bias in the diagnoses, or extremely heavy users. I wouldn’t dismiss it as bias. Marijuana dependence is a very real phenomenon, despite the pop culture “it’s not physically addictive” trope that tries to downplay drug dependence. They’re looking at 22,000 out of 1.85 million patients, or around 1% of patients. They weren’t trying to look for casual or intermittent users. Focusing on those diagnosed according to the criteria of marijuana dependence is the clearest way to remain objective and get a clear signal out of the study. Those with marijuana dependence are the people consuming frequently, and therefore likely to consume during the recovery period.
- delecti 4y ago
  > Marijuana dependence is a very real phenomenon, despite the pop culture “it’s not physically addictive” trope that tries to downplay drug dependence Yes, I accounted for that by mentioning the alternate possibility of extremely heavy users. A typical user ([edit: at most] a few nights a week) shouldn't pay much mind to this study, and likely neither should someone who primarily vapes or consumes edibles.
  - brigandish 4y ago
    The definition of marijuana dependence doesn't state that volume of use is a factor. From[1]: > The definition of marijuana (Cannabis) dependence (addiction) contains three critical elements. These are (a) preoccupation with the acquisition of marijuana, (b) compulsive use of marijuana, (c) relapse to or recurrent use of the marijuana. It reminds me of the best description of alcoholism I read, via a charity, that pointed out it was a mistake to think of it in terms of heavy drinking but whether someone was able to control their drinking (or more accurately, themselves when drink is around). If you can't turn down a drink, or you find there are environments where you can't turn down a drink, you're not in control. That's what leads to heavy drinking but they're not the same thing. [1] https://pubmed.ncbi.nlm.nih.gov/2677398/ https://pubmed.ncbi.nlm.nih.gov/2677398/
    - bumby 4y ago
      The DSM V provides 11 criteria, 2 of which need to be met for meeting the definition of substance use disorder. This is the standard clinical definition. Control is part of it, but there are other aspects as well. Many of them deal with control, but not all. Meaning you could ostensibly be “in control” and still be diagnosed with a substance abuse disorder.
      - brigandish 4y ago
        All of them deal with control except for one (development of withdrawal symptoms). If a user is in control then there is no problem because any resultant problem from use would be moot, as they could simply stop or reduce and it goes away. Hence it is incorrect to say you could be in control and still diagnosed with marijuana dependency. From [1]: - Taking the substance in larger amounts or for longer than you're meant to - Wanting to cut down or stop using the substance but not managing to - Spending a lot of time getting, using, or recovering from use of the substance - Cravings and urges to use the substance - Not managing to do what you should at work, home, or school because of substance use - Continuing to use, even when it causes problems in relationships - Giving up important social, occupational, or recreational activities because of substance use - Using substances again and again, even when it puts you in danger - Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance - Needing more of the substance to get the effect you want (tolerance) - Development of withdrawal symptoms, which can be relieved by taking more of the substance [1] https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926#toc-dsm-5-tr-substance-use-disorder-criteria https://www.verywellmind.com/dsm-5-criteria-for-substance-us...
        bumby 4y ago
        >If a user is in control then there is no problem The argument you’re making is flawed because it’s based on the users perception of a problem and not the standardized clinical definition. People (especially addicts) are not wholly rational. People will rationalize away a problem to suit their irrational biases. If a substance is detrimental to my health and I say “well, I don’t care. I could quit if I wanted to” it doesn’t negate the fact that it’s still detrimental to one’s health. It’s still a substance abuse problem by the clinical definition even if I’m claiming to be “in control”. If your doctor diagnoses you with obesity and you claim you can diet if you wanted to, it doesn’t make your obesity diagnosis moot. Your perception of self control doesn’t impact the objective diagnosis. Your take is a bit like the way people say the best way to solve the problems with illegal drugs is to make drug use legal. (And FWIW I’m pretty libertarian on this issue) Sure, by definition it’s no longer a legal problem but it’s a bit of a hand wavy effort that leaves most of the residual problems intact. It just reframes it in a way that ignores them. It’s also one of the problems with modern debate in that anyone can “do their own research” (which often means just reading an abstract that suits their confirmation bias without a grounded understanding of the full context). It devolves into rules-lawyering where people argue about what the definition of “is” is. We have standardized definitions for a reason.
  - rascul 4y ago
    I smoke moderately. If I go without, I get appetite and sleeping issues for a few days.
    - delecti 4y ago
      If you smoke to the point where you feel negative effects from going without, then you might be smoking more than just moderately.
      - rascul 4y ago
        I consider a few times a day to be moderate. I've cut back a lot over the last couple years, I would not call myself a heavy cannabis smoker nowadays. I don't keep up with heavy smokers anymore.
        brigandish 4y ago
        A few times a day is not moderate. I would wonder if even a few times a week was moderate, but daily, no way. It's like someone smoking a pack of cigarettes a day (which is quite usual but still heavy) to someone who smokes two packs a day. You'd both be heavy users.
        delecti 4y ago
        I don't know what else to say except that I strongly disagree that once a day is only "moderate". That's solidly into heavy usage by my standards. I think "a few times a day" is well beyond even just "heavy" usage.
        rascul 4y ago
        Heavy usage to me is when you're rarely without and you're generally some level of high all the time. I used to smoke like that. I know many people who still do. Light to me is no more than once a day. A friend of mine takes at most a few hits in the evening and we call that light smoking. I'm somewhere in between that. It's quite OK to disagree. Edit: I realized I said nothing about amount. I go through approximately 1/2 to 1 gram daily.
- awillen 4y ago
  But the title of the study is misleading as a result - marijuana users is a larger population than people who are dependent on marijuana, which is a subset of the larger population. It's incorrect to draw conclusions about the broader population of all users based on a non-representative sample of that population.
- 2devnull 4y ago
  I might agree with your general thought pattern here, but I suspect that those who are diagnosed with marijuana dependence are not representative of the population of daily marijuana users. Self censorship is a problem in other lines of research too, it’s not just street drugs. People don’t accurately self report diet, alcohol consumption, cigarette use, domestic violence etc… Science can’t get at certain things, and we have to deal with that reality. Truth is much bigger than the science of the day, and science doesn’t benefit from being overhyped.
nerdponx 4y ago
Not just the physically damaging effects of smoking, but I also wonder if being a heavy marijuana user is correlated with other features that are causal for infection risk, e.g. unhealthy diet, inconsistent sleep, lack of exercise.
- j0hnyl 4y ago
  I don't think there's good documentation for any of these features having correlation with marijuana use besides being pop culture tropes.
- sd232 4y ago
  > being a heavy marijuana user is correlated with other features that are causal for infection risk, e.g. unhealthy diet, inconsistent sleep, lack of exercise. FYI, I've smoked weed every day for 44 years straight. Today, I am at, or near the peak, of my physical health (180 lb, 6'2, daily swimmer), I sleep like a baby and wake up every day at 8 am. And I swim every day.
  - colinmhayes 4y ago
    FYI, I've smoked every day for about 6 years and definitely get inconsistent sleep and less exercise than I'd prefer. Correlation doesn't have to be an r-squared of 1.
  - pelasaco 4y ago
    if you were so proud about it, you wouldn't create a socket puppy to post it...
    - tannedNerd 4y ago
      or s/he could be in a country or position where for whatever reason it is prohibited, or could be see as admitting to a crime as no where in the US had legalized weed 44 years ago... I have zero problem stating that I am frequent user but I also have the benefit of only every smoking with a medical card and have never frequented a black marker dealer, so what is your response to me? Still want to tell me im evil and smoking the devils lettuce?
eganist 4y ago
> Also, as another comment mentions, I can't see anything indicating they controlled for tobacco smoking. Give it a bit; it was just discussed at a conference and not even the preprint is out. This is why I hate the scientific press; everyone jumps the gun, and people who want more information are left hanging until the study no longer has public attention.
noasaservice 4y ago
So many problems with that "study". "marijuana dependence" - there is no chemical dependence with cannabis. None. Nada. Zilch. > smoking tobacco was just because of inhaling smoke The danger is inhaling burnt plant matter along with the slew of crap companies spray on tobacco. Straight tobacco has a VERY DIFFERENT taste and "cleaner". Still not great for you. And most cannabis is vaped these days. In that way, it's with the THC oil with terpenes. And that profile is very different than burning plant matter, since in a vape it's vaporized oils (and some metal from the ceramic/metal filament).
- JoeAltmaier 4y ago
  As observed in other comments, physical dependence is not the only kind.
  - noasaservice 4y ago
    So it's in line with chewing fingernails, eating chalk, blowing bubbles in bubblegum, and "habits". Lets be clear what this "psychological dependence" is.
    - JoeAltmaier 4y ago
      More like, alcohol dependence? It provides a profound mental effect that is easy to become an addiction perhaps, so different from blowing bubbles. This is pretty obvious, and it takes a certain strained logic to ignore it. I suspect folks who over-react to the suggestion that strong chemicals can become a detrimental habit, have perhaps some vested interest in believing it.
    - meowfly 4y ago
      What you seem to be confused over is how poorly we talk about addiction. Alcohol and Benzos can kill you, so when people talk about physical dependence, they usually mean them. I feel like this is often used to obfuscate the fact that because ____ can't kill you it must not be addictive. Then there is psychological addiction: Anything that makes you "feel good" and "want more" falls in this category. So amphetamine, weed, sweets, and coffee, for example are generally cited as addictive because they are easy rushes to feeling good irrespective of their harm. Where cannabis gets deserved flack is that proponents are downplaying the harm and addictiveness by comparing it to "chewing your nails" Here is a very good source that illustrates the benefits and harms of medical cannabis. https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.1187 https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/pha...
kerblang 4y ago
The article makes it pretty clear that the suspected element in cigarettes is the nicotine, not "smoke", as many noxious chemicals as there are in the latter.
MichaelCollins 4y ago
> The term "marijuana dependence" suggests either bias in the diagnoses, or extremely heavy users. Respectfully, objecting to "marijuana dependence" suggests bias on your part. What else would you call heavy users who loath going a day without it, even though it's having a deleterious effect on their life? There has long been a popular stigma against recognizing the existence of marijuana dependence, backlash to DARE-style anti-drug propaganda I think, but let's be real. There are a lot of people who use it habitually and heavily and feel unable or unwilling to stop even though it's negatively effecting their relationships, work, etc. Sure it's not chemically addictive in the same was as alcohol or heroin, but dependence is a broader phenomenon than that.

PragmaticPulp 4y ago

> The term "marijuana dependence" suggests either bias in the diagnoses, or extremely heavy users. I wouldn’t dismiss it as bias. Marijuana dependence is a very real phenomenon, despite the pop culture “it’s not physically addictive” trope that tries to downplay drug dependence. They’re looking at 22,000 out of 1.85 million patients, or around 1% of patients. They weren’t trying to look for casual or intermittent users. Focusing on those diagnosed according to the criteria of marijuana dependence is the clearest way to remain objective and get a clear signal out of the study. Those with marijuana dependence are the people consuming frequently, and therefore likely to consume during the recovery period.

delecti 4y ago
> Marijuana dependence is a very real phenomenon, despite the pop culture “it’s not physically addictive” trope that tries to downplay drug dependence Yes, I accounted for that by mentioning the alternate possibility of extremely heavy users. A typical user ([edit: at most] a few nights a week) shouldn't pay much mind to this study, and likely neither should someone who primarily vapes or consumes edibles.
- brigandish 4y ago
  The definition of marijuana dependence doesn't state that volume of use is a factor. From[1]: > The definition of marijuana (Cannabis) dependence (addiction) contains three critical elements. These are (a) preoccupation with the acquisition of marijuana, (b) compulsive use of marijuana, (c) relapse to or recurrent use of the marijuana. It reminds me of the best description of alcoholism I read, via a charity, that pointed out it was a mistake to think of it in terms of heavy drinking but whether someone was able to control their drinking (or more accurately, themselves when drink is around). If you can't turn down a drink, or you find there are environments where you can't turn down a drink, you're not in control. That's what leads to heavy drinking but they're not the same thing. [1] https://pubmed.ncbi.nlm.nih.gov/2677398/ https://pubmed.ncbi.nlm.nih.gov/2677398/
  - bumby 4y ago
    The DSM V provides 11 criteria, 2 of which need to be met for meeting the definition of substance use disorder. This is the standard clinical definition. Control is part of it, but there are other aspects as well. Many of them deal with control, but not all. Meaning you could ostensibly be “in control” and still be diagnosed with a substance abuse disorder.
    - brigandish 4y ago
      All of them deal with control except for one (development of withdrawal symptoms). If a user is in control then there is no problem because any resultant problem from use would be moot, as they could simply stop or reduce and it goes away. Hence it is incorrect to say you could be in control and still diagnosed with marijuana dependency. From [1]: - Taking the substance in larger amounts or for longer than you're meant to - Wanting to cut down or stop using the substance but not managing to - Spending a lot of time getting, using, or recovering from use of the substance - Cravings and urges to use the substance - Not managing to do what you should at work, home, or school because of substance use - Continuing to use, even when it causes problems in relationships - Giving up important social, occupational, or recreational activities because of substance use - Using substances again and again, even when it puts you in danger - Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance - Needing more of the substance to get the effect you want (tolerance) - Development of withdrawal symptoms, which can be relieved by taking more of the substance [1] https://www.verywellmind.com/dsm-5-criteria-for-substance-use-disorders-21926#toc-dsm-5-tr-substance-use-disorder-criteria https://www.verywellmind.com/dsm-5-criteria-for-substance-us...
      - bumby 4y ago
        >If a user is in control then there is no problem The argument you’re making is flawed because it’s based on the users perception of a problem and not the standardized clinical definition. People (especially addicts) are not wholly rational. People will rationalize away a problem to suit their irrational biases. If a substance is detrimental to my health and I say “well, I don’t care. I could quit if I wanted to” it doesn’t negate the fact that it’s still detrimental to one’s health. It’s still a substance abuse problem by the clinical definition even if I’m claiming to be “in control”. If your doctor diagnoses you with obesity and you claim you can diet if you wanted to, it doesn’t make your obesity diagnosis moot. Your perception of self control doesn’t impact the objective diagnosis. Your take is a bit like the way people say the best way to solve the problems with illegal drugs is to make drug use legal. (And FWIW I’m pretty libertarian on this issue) Sure, by definition it’s no longer a legal problem but it’s a bit of a hand wavy effort that leaves most of the residual problems intact. It just reframes it in a way that ignores them. It’s also one of the problems with modern debate in that anyone can “do their own research” (which often means just reading an abstract that suits their confirmation bias without a grounded understanding of the full context). It devolves into rules-lawyering where people argue about what the definition of “is” is. We have standardized definitions for a reason.
- rascul 4y ago
  I smoke moderately. If I go without, I get appetite and sleeping issues for a few days.
  - delecti 4y ago
    If you smoke to the point where you feel negative effects from going without, then you might be smoking more than just moderately.
    - rascul 4y ago
      I consider a few times a day to be moderate. I've cut back a lot over the last couple years, I would not call myself a heavy cannabis smoker nowadays. I don't keep up with heavy smokers anymore.
      - brigandish 4y ago
        A few times a day is not moderate. I would wonder if even a few times a week was moderate, but daily, no way. It's like someone smoking a pack of cigarettes a day (which is quite usual but still heavy) to someone who smokes two packs a day. You'd both be heavy users.
      - delecti 4y ago
        I don't know what else to say except that I strongly disagree that once a day is only "moderate". That's solidly into heavy usage by my standards. I think "a few times a day" is well beyond even just "heavy" usage.
        rascul 4y ago
        Heavy usage to me is when you're rarely without and you're generally some level of high all the time. I used to smoke like that. I know many people who still do. Light to me is no more than once a day. A friend of mine takes at most a few hits in the evening and we call that light smoking. I'm somewhere in between that. It's quite OK to disagree. Edit: I realized I said nothing about amount. I go through approximately 1/2 to 1 gram daily.
awillen 4y ago
But the title of the study is misleading as a result - marijuana users is a larger population than people who are dependent on marijuana, which is a subset of the larger population. It's incorrect to draw conclusions about the broader population of all users based on a non-representative sample of that population.
2devnull 4y ago
I might agree with your general thought pattern here, but I suspect that those who are diagnosed with marijuana dependence are not representative of the population of daily marijuana users. Self censorship is a problem in other lines of research too, it’s not just street drugs. People don’t accurately self report diet, alcohol consumption, cigarette use, domestic violence etc… Science can’t get at certain things, and we have to deal with that reality. Truth is much bigger than the science of the day, and science doesn’t benefit from being overhyped.

nerdponx 4y ago

Not just the physically damaging effects of smoking, but I also wonder if being a heavy marijuana user is correlated with other features that are causal for infection risk, e.g. unhealthy diet, inconsistent sleep, lack of exercise.

j0hnyl 4y ago
I don't think there's good documentation for any of these features having correlation with marijuana use besides being pop culture tropes.
sd232 4y ago
> being a heavy marijuana user is correlated with other features that are causal for infection risk, e.g. unhealthy diet, inconsistent sleep, lack of exercise. FYI, I've smoked weed every day for 44 years straight. Today, I am at, or near the peak, of my physical health (180 lb, 6'2, daily swimmer), I sleep like a baby and wake up every day at 8 am. And I swim every day.
- colinmhayes 4y ago
  FYI, I've smoked every day for about 6 years and definitely get inconsistent sleep and less exercise than I'd prefer. Correlation doesn't have to be an r-squared of 1.
- pelasaco 4y ago
  if you were so proud about it, you wouldn't create a socket puppy to post it...
  - tannedNerd 4y ago
    or s/he could be in a country or position where for whatever reason it is prohibited, or could be see as admitting to a crime as no where in the US had legalized weed 44 years ago... I have zero problem stating that I am frequent user but I also have the benefit of only every smoking with a medical card and have never frequented a black marker dealer, so what is your response to me? Still want to tell me im evil and smoking the devils lettuce?

eganist 4y ago

> Also, as another comment mentions, I can't see anything indicating they controlled for tobacco smoking. Give it a bit; it was just discussed at a conference and not even the preprint is out. This is why I hate the scientific press; everyone jumps the gun, and people who want more information are left hanging until the study no longer has public attention.

noasaservice 4y ago

So many problems with that "study". "marijuana dependence" - there is no chemical dependence with cannabis. None. Nada. Zilch. > smoking tobacco was just because of inhaling smoke The danger is inhaling burnt plant matter along with the slew of crap companies spray on tobacco. Straight tobacco has a VERY DIFFERENT taste and "cleaner". Still not great for you. And most cannabis is vaped these days. In that way, it's with the THC oil with terpenes. And that profile is very different than burning plant matter, since in a vape it's vaporized oils (and some metal from the ceramic/metal filament).

JoeAltmaier 4y ago
As observed in other comments, physical dependence is not the only kind.
- noasaservice 4y ago
  So it's in line with chewing fingernails, eating chalk, blowing bubbles in bubblegum, and "habits". Lets be clear what this "psychological dependence" is.
  - JoeAltmaier 4y ago
    More like, alcohol dependence? It provides a profound mental effect that is easy to become an addiction perhaps, so different from blowing bubbles. This is pretty obvious, and it takes a certain strained logic to ignore it. I suspect folks who over-react to the suggestion that strong chemicals can become a detrimental habit, have perhaps some vested interest in believing it.
  - meowfly 4y ago
    What you seem to be confused over is how poorly we talk about addiction. Alcohol and Benzos can kill you, so when people talk about physical dependence, they usually mean them. I feel like this is often used to obfuscate the fact that because ____ can't kill you it must not be addictive. Then there is psychological addiction: Anything that makes you "feel good" and "want more" falls in this category. So amphetamine, weed, sweets, and coffee, for example are generally cited as addictive because they are easy rushes to feeling good irrespective of their harm. Where cannabis gets deserved flack is that proponents are downplaying the harm and addictiveness by comparing it to "chewing your nails" Here is a very good source that illustrates the benefits and harms of medical cannabis. https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/phar.1187 https://accpjournals.onlinelibrary.wiley.com/doi/10.1002/pha...

kerblang 4y ago

The article makes it pretty clear that the suspected element in cigarettes is the nicotine, not "smoke", as many noxious chemicals as there are in the latter.

MichaelCollins 4y ago

> The term "marijuana dependence" suggests either bias in the diagnoses, or extremely heavy users. Respectfully, objecting to "marijuana dependence" suggests bias on your part. What else would you call heavy users who loath going a day without it, even though it's having a deleterious effect on their life? There has long been a popular stigma against recognizing the existence of marijuana dependence, backlash to DARE-style anti-drug propaganda I think, but let's be real. There are a lot of people who use it habitually and heavily and feel unable or unwilling to stop even though it's negatively effecting their relationships, work, etc. Sure it's not chemically addictive in the same was as alcohol or heroin, but dependence is a broader phenomenon than that.