Long-Term Cannabis Use Significantly Increases Risk of Heart Disease and Death

Recent research links heavy cannabis use to higher risk of cardiovascular disease and mortality, especially in women.

Catalyst Cannabis Company cannabis samples in Santa Ana, Calif., on Feb. 18, 2021. John Fredricks/The Epoch Times

A study published June 6 in JAMA Network Open found that long-term use of Cannabis sativa significantly increases the risk of death from cardiovascular disease, cancer, and overall causes. Another study published in the Journal of the American Heart Association (JAHA) in February indicated that as the frequency of cannabis use increases, the risks of heart attack and stroke rise sharply.

According to the latest data from the National Survey on Drug Use and Health (NSDUH), the number of daily cannabis users in 2022 increased to 17.7 million, surpassing the 14.7 million daily alcohol users for the first time. Between 1992 and 2022, as negative perceptions of cannabis use decreased, there was a 15-fold increase in the proportion of people reporting daily or near-daily use of cannabis.

Additionally, due to changes in cultivation methods, the level of the psychoactive component delta-9-tetrahydrocannabinol (THC) in cannabis has increased one- to twofold compared to the past. Therefore, understanding the health effects of habitual cannabis use has become increasingly important.

While U.S. federal law still prohibits the use of cannabis and its derivatives (except for cannabidiol (CBD) extracted from cannabis, which is allowed for medical use as long as THC levels are below 0.3 percent), cannabis is currently legal for medical use in 38 states, three territories, and the District of Columbia. Additionally, 24 states, three territories, and the District of Columbia also permit limited recreational use.

Cannabis is the most widely used illegal drug globally, with THC and CBD being two of its primary active compounds. THC has psychoactive effects, while medical cannabis with CBD as the main ingredient is used to treat conditions such as severe epilepsy, chronic pain, and post-traumatic stress disorder (PTSD).

Heavy Cannabis Use Increases Risks, Especially in Women

The JAMA Network Open study analyzed data from over 120,000 individuals in the UK Biobank. About 55 percent of participants were female, with an average age of 55, and about 45 percent were male, with an average age of 56. The median follow-up period was nearly 12 years. In this study, heavy use was defined as having used cannabis more than 100 times in one’s lifetime. A self-reported questionnaire determined cannabis use.

The study showed that females with heavy cannabis use had a more than 1.5-fold higher risk of cardiovascular disease mortality compared to nonusers. After comprehensive adjustments to exclude other influencing factors, it was found that the risks for all-cause mortality, cardiovascular disease mortality, and cancer mortality in women increased by 49 percent, 167 percent, and 61 percent, respectively. These risks increased by 28 percent, zero percent, and 9 percent for men, respectively. This suggests that heavy cannabis use has a greater impact on mortality risk for women, particularly with a significant increase in the risk of cardiovascular disease mortality.

Additionally, the data revealed that those with heavy cannabis use tend to be younger and more likely to smoke, but they exhibit lower levels of alcohol use, hypertension (high blood pressure), dyslipidemia (abnormal lipid levels), obesity, and diabetes. They also tend to have lower levels of education and income.

Further analysis showed that overweight women with heavy cannabis use had significantly increased risks of all-cause mortality and cancer mortality—by 123 percent and 179 percent, respectively. For women without hypertension, these risks increased by 114 percent and 143 percent, respectively. Additionally, women without diabetes experienced a nearly twofold (192 percent) increase in the risk of cardiovascular disease mortality.

Although heavy cannabis use has a more pronounced effect on mortality risk for females, particularly concerning cardiovascular disease, a similar study on atherosclerotic cardiovascular disease conducted in 2023 found that long-term cannabis use has a greater impact on the risk of developing this condition in males than females.

More Frequent Cannabis Use Increases Risk

The observational study published in JAHA studied nearly 435,000 people across 27 U.S. states and two territories.

In contrast to the previously mentioned study, this research evaluated the impact of cannabis use on cardiovascular disease risk based on the frequency of use. It found that frequent use significantly increases the risk of heart attacks and strokes, with the risk rising sharply as the frequency of use increases.

Specifically, daily cannabis use was associated with increased risks of coronary heart disease, heart attack, stroke, and overall cardiovascular disease by 16 percent, 25 percent, 42 percent, and 28 percent, respectively, compared to nonuse. Even those who used cannabis less frequently, such as once a week, experienced a slight increase in the likelihood of heart attack and stroke.

In addition to controlling for demographic factors and tobacco use, the study found that even among nonsmokers, daily cannabis use significantly increased the risks of heart attack by 49 percent, stroke by 116 percent, and overall cardiovascular disease by 77 percent, respectively.

The researchers used data from the Behavioral Risk Factor Surveillance System, conducted by the U.S. Centers for Disease Control and Prevention (CDC), from 2016 to 2020.

The study found that among individuals at risk of premature cardiovascular disease, cannabis use was similarly associated with cardiovascular disease but had a relatively more significant impact.

According to the study, nearly 75 percent of respondents primarily used cannabis by smoking it, while 25 percent used it through vaping, drinking, or ingesting. When cannabis is burned, it releases toxins similar to those found in tobacco smoke.

“We’ve known for a long time that smoking tobacco is linked to heart disease,” Abra Jeffers, a data analyst at Massachusetts General Hospital and former researcher at the Center for Tobacco Control Research and Education at the University of California–San Francisco, said in a press release. “This study is evidence that smoking cannabis appears to also be a risk factor for cardiovascular disease, which is the leading cause of death in the United States.”

The researchers pointed out that while the exact mechanisms linking cannabis to heart disease remain unclear, several factors may be involved. In addition to the release of toxins, the widespread presence of endocannabinoid receptors—proteins on cells responsible for detecting THC in cannabis—in cardiovascular tissues could potentially contribute to an increased risk of heart attack.

Early Cannabis Use in Adolescence Leads to More Severe Effects

Cannabis use has been shown to be significantly associated with an increased risk of cardiovascular disease mortality among American adults, particularly those who began using it before the age of 18. A study published in the American Journal of Preventive Medicine in 2020 indicated that individuals who started using cannabis before age 18 had a twofold increase in the risk of cardiovascular disease mortality compared to nonusers.

Additionally, starting cannabis use during adolescence, particularly frequent or heavy use, can have permanent effects on the developing teenage brain and significantly increase the risk of addiction. In 2021, nearly 5 million young adults aged 18 to 25 and 1.3 million adolescents aged 12 to 17 in the United States could have been diagnosed with marijuana use disorder.

In 2022, nearly 31 percent of 12th-grade students in the United States reported using cannabis. The American Academy of Child and Adolescent Psychiatry noted that teenage cannabis use has reached its highest level in 30 years, recommending that parents help their children understand the adverse effects of cannabis, encourage them to delay their first use, and monitor for behavioral changes. If cannabis use is suspected, parents should support the child in an honest and open way.

7 Effective Strategies for Quitting Cannabis

To address cannabis addiction, in addition to seeking professional counseling and detox programs, some psychological and habit-related issues can be tackled independently or with family support.

The Cleveland Clinic interviewed Dr. David Streem, an addiction psychiatrist, who outlined the following seven strategies for quitting cannabis:

1. Identify the root cause: When trying to change an unhealthy habit, reflect on how it developed in the first place. Understanding these root causes is essential for successfully breaking bad habits. People often use cannabis in hopes of alleviating issues such as depression, anxiety, social stress, sleep problems, or trauma. However, cannabis only offers temporary relief and does not address the underlying issues. It is advisable to work with family or a therapist to find safer and more effective alternatives. Once you find new ways to tackle the root problems, quitting cannabis will become easier.
2. Develop a quit plan: Assess your life and determine the most effective strategy for quitting. You can choose to go cold turkey or go with a gradual approach. Going cold turkey is quick but may lead to withdrawal symptoms and various challenges. Seeking support from others can help in navigating these difficulties. For long-term cannabis users wanting a gradual approach, set a deadline and gradually reduce your usage. An addiction specialist or substance use counselor can assist throughout the process.
3. Seek support: Share your decision to quit cannabis with those around you. This will foster a sense of accountability and provide you with encouragement from others. Additionally, consider joining support groups like Marijuana Anonymous. These groups follow a structured 12-step program and hold regular meetings to offer mutual support and encouragement. You can also attend Alcoholics Anonymous meetings, even if you do not drink. Following the recovery process used in alcohol addiction programs can help you change your cannabis use behavior. Additionally, seeking help from a therapist can be beneficial, especially if they have training or credentials in addiction treatment.
4. Avoid triggers: People tend to associate certain items, activities, places, and people with specific habits, which can increase the desire to use cannabis. The most straightforward approach is to remove items like e-cigarettes and rolling papers from your home. Additionally, it is essential to distance yourself from individuals who use cannabis.
5. Focus on the positive: Resisting the temptation can be difficult if all you think about is not using cannabis. Instead, concentrate on new activities and interests to occupy your mind and time. You can also practice meditation, spend more time with pets, and reconnect with friends and family. Changing habits becomes easier when you focus on the positive aspects of life.
6. Overcome cravings: When the urge to use cannabis becomes strong, distract yourself and avoid triggers. Reach out to your support network by calling a friend or family member or attending a support group meeting. Engage in activities that make it impossible to use cannabis at the same time, such as bowling, jogging around the block, or shopping. These actions can help reinforce your determination to quit until the craving passes. You might also consider taking N-acetyl cysteine (NAC), an antioxidant that protects cells. Research suggests that NAC can help individuals trying to quit cannabis by reducing cravings.
7. Stay committed, and do not give up: Changing a habit can be challenging, and if you slip up, try not to be too hard on yourself. Adjust your plan based on what you have learned, and keep trying. Success often requires multiple attempts. When repeated attempts fail, it is easy to feel discouraged and believe that success is out of reach. However, this mindset is mistaken, as each attempt represents progress. The more you try, the greater your chances of success in the future. Set a new quit date for cannabis as soon as possible and start the process again.