• Users Online: 462
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2020  |  Volume : 36  |  Issue : 4  |  Page : 317-320

Medical students and marijuana, attitudes and beliefs: A comparative study

Department of Psychiatry, Sri Devaraj Urs Higher Education and Research, Kolar, Karnataka, India

Date of Submission08-May-2020
Date of Acceptance22-May-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Gurappa Puttanna Gururaj
Associate Professor, Department of Psychiatry, Sri Devaraj Urs Higher Education and Research, Tamaka, Kolar, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_36_20

Rights and Permissions

Background and Objectives: Various studies indicating that cannabis is associated with various psychiatric disorders despite which is a controversy existing regarding the legalisation of cannabis by all the promoters and consumers of the substance. Our objective was to find out the knowledge and awareness among the 1st year and final year medical students toward the effects and experiences with the consumption of cannabis. Methodology: It was a cross-sectional study done on first and final year medical students between July 2019 and August 2019 in Sri Devaraj Urs higher education and research center, who are assessed using a structured and validated instrument, Marijuana Effect Expectancy Questionnaire-Brief (MEEQ-B) questionnaire. Results: Both the first-year and final-year medical students in our study had poor awareness and inadequate knowledge about the various adverse effects of cannabis, especially on all the six parameters of the MEEQ questionnaire. Conclusion: Extensive and elaborative teaching regarding substance use, especially of cannabis and its implication must be updated in the curriculum of both UG teaching and PG teaching in other specialities as well.

Keywords: Awareness and knowledge, cannabis, 1st-year and final-year students

How to cite this article:
Gururaj GP, Chandrakumar RS. Medical students and marijuana, attitudes and beliefs: A comparative study. Indian J Soc Psychiatry 2020;36:317-20

How to cite this URL:
Gururaj GP, Chandrakumar RS. Medical students and marijuana, attitudes and beliefs: A comparative study. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Jan 28];36:317-20. Available from: https://www.indjsp.org/text.asp?2020/36/4/317/305946

  Introduction Top

Knowledge and awareness regarding psychoactive substances or drugs, which include licit and illicit drugs, other than which are medically indicated and its effects are still less, easy access to drugs at certain places, and other factors contribute to substance addiction.[1]

The National Survey on Extent, Pattern, and Trends of Drug Use in India also found Cannabis to be the most common illicit substance of use in the country.[2]

Controversy exists regarding the legalization of cannabis by the promoters and consumers despite various studies indicating that cannabis is associated with various psychiatric disorders. Understanding the perspectives of medical students would be helpful to find their perceptions, which might have an impact on their practices as clinicians.

  Methodology Top

This cross-sectional study proposal was approved by the ethics committee of the institute, Sri Devaraj Urs Higher Education and Research Centre, and only after obtaining approval, the study was conducted on the medical students. The inclusion criteria were medical students of the 1st and final year of SDUMC and RH, providing with written informed consent. Students with a history of undergoing psychiatric treatment currently or in the past, or students with a history of drug dependence apart from nicotine were excluded.

After obtaining the permission of the respective teachers, postlunch hours were selected so that students had adequate time to fill the scales meant for the study. The assessment was done during the 1st week of August 2019. Students were orally instructed by the Principal investigator/Co-investigator about the study, its objectives and their written informed consent were taken before the main instrument was given to them.

The tools of the study were social demographic profile and Marijuana Effect Expectancy Questionnaire-Brief (MEEQ-B).

The MEEQ-B is a 6-item index scale that purports to measure adolescents' marijuana effect expectancy during interventions and provide a sensitive but briefer tool for use in fast-paced correctional/clinical environments. The wording of each item on the MEEQ-B corresponds to the six original scales of the MEEQ: (a) cognitive and behavioral impairment, (b) relaxation and tension reduction, (c) social and sexual facilitation, (d) perceptual and cognitive enhancement, (e) global negative effects, and (f) craving and physical effects. A scaled score closer to 5 reflects more potential negative expectancies for marijuana on a Likert scale.[3]

Descriptive and inferential statistical analysis has been carried out in the present study. The Statistical software, namely SPSS 22.0 (IBM Corp, Armonk, NY) and R environment ver. 3.2.2 were used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables etc.[4],[5],[6],[7] A P < 0.05 was considered statistically significant.

  Resuts Top

A total of 200 students participated in this study. All the students were in the age group of 18–30 years only [Table 1]. There were 60 males in the 1st year compared to 40 females, and 46 males and 54 females in the final–year category. Ninty four percent of students were single in both groups and an equal number of 5% of them were in live-in relationships. The majority of the students were from the urban background before joining this college and the majority of parents in both the groups hailed from a business background. The maximum amount of expenditure per month was in the range of 10–15 thousand in both groups.
Table 1: Salient socialdemographic variables of first and final year medical students studied

Click here to view

Only 10% of final-year students reported using more than two drugs. The majority of students in both the groups had friends who did not use drugs regularly; however, 31% of final-year students had friends who had a history of occasional use of cannabis. Five percent of parents of the 1st year and 6% of parents of the final year students knew about their children using drugs.

Twenty percent of final year students had friends who had a history of academic impairment/decline due to a history of drug abuse in them and about 5% had legal issues due to the use of drugs.

Eighteen percent of final-year students had medical disorders in their parents and 13% had psychiatric disorders in their parents.

Both the 1st year and final year medical students in our study had poor awareness and inadequate knowledge about the various adverse effects of cannabis, especially on all the six parameters of the MEEQ questionnaire (a) cognitive and behavioral impairment, (b) relaxation and tension reduction, (c) social and sexual facilitation, (d) perceptual and cognitive enhancement,(e) global negative effects, and (f) craving and physical effects and they lacked knowledge with regards to the effects of cannabis on the mind and behavior [Table 2] and [Table 3].
Table 2: Marijuana Effect Expectancy Questionnaire-Brief responses

Click here to view
Table 3: Knowledge report of the medical students about the marijuana effects

Click here to view

Only about 32% of both the 1st year and the final year students” agreed strongly” about the cognitive impairment effects of cannabis. Only 5% of both the groups “strongly” disagreed to the statement that marijuana helps a person relax and feel less tense and equal amount 4% replied yes to “disagree somewhat when in reality cannabis blunts a person's emotional response for a while, till the effects of the consumed quantity lasts which can vary from person to person. Twenty-one percent of the final year students “strongly agreeing” to the temporary effects of cannabis as a positive experience. It is bothering to know about 44% of both the groups being “uncertain” to the effects of cannabis on social behaviors indication poor awareness about the effects of cannabis.

Only 13% of both the groups “strongly agreed” that cannabis makes people more creative and perceive things differently then what they are. Seventeen percent of both the groups given “uncertain” replies indicating the lack of awareness of the global burden because of cannabis in the population.

Concerning the physical and the craving properties of cannabis, only 4% in both the first and final year medical students “strongly disagreed.” There was also no statistically significant difference in both the groups on any of the items.

  Discussion, Conclusion, and Recommendation Top

There are hardly any studies done on medical students comparing at the entry and exit level of their UG teaching level and we believe ours is the first study of this kind on this regard in the country and worldwide. This is the highlight of this study.

Marijuana users experience “mild euphoria, relaxation, and perceptual alterations, including time distortion and intensification of ordinary experiences such as hunger, eating, and listening to music.”[8]

Structural differences are present in the brains of adolescents who are chronic marijuana users when compared with nonusers. White matter, gray matter, the limbic system, and the cerebellum all showed abnormalities with cannabis use.

These findings were summarized as, “Cannabis users show thicker cortices in the left entorhinal cortex and thinner temporal lobes and frontal cortex-volume changes in the cortex, prefrontal cortex, parietal cortex, amygdala, and hippocampus.” These same cannabis users performed less well “in tasks requiring attention, memory, processing speed, visual-spatial functioning, and executive function.”[9]

A similar study concerning the risk perception about medical marijuana in medical students of Mexico found that the students underestimated the risk with marijuana in a study done in 2017.[10]

A cross-sectional observational study, done in 2018 in India only on 2nd-year medical students, regarding the knowledge and awareness toward substance addiction in a rural district in Valsad, Gujarat, India, reported that they had little knowledge about various drugs causing addiction and clinical features of various addictive drugs,[9] and their findings are similar to our study findings as well.

Poor knowledge toward cannabis in the 1st-year students could be attributed to the academic priorities in the selected candidates as they were all selected after qualifying through National Eligibility and Entrance Test (NEET) which is a must to get entry to any medical college in the country.

Most of the students would be occupied even on holidays in the NEET coaching classes and there is hardly any time left for recreational activities, let alone, for the curiosity to do drugs.

About 10% of the final year students had a history of drug use which could be attributed to the as the coping mechanism for stress arising to the various exams, freedom from parental supervision, peer pressure to use drugs, romantic adjustment with modified lifestyles to suit their partners and it was not also noted that the final year students choose independent/sharing paying guest accommodation rather than hostel facilitieswhich are always monitored by the warden/security personnel.

Seventy-eight percent of the 1st-year students and 58% of the final year medical students' expenditure was below 15 k per month. The high cost of cannabis, difficulty in getting access to cannabis, despite the curiosity would have a contributing factor not to use substances is also to be considered.

Frequent updates in both the print media and the social media regarding the punishment and complications of cannabis and also the placards of no to drugs posted everywhere in the hostel and hospital facilities could have also contributed to the lesser use of cannabis in the students in our study group.

There are also very strict rules that the students to be returned to the hostel at a fixed time could have been an effective barrier for them to use drugs.

Final year students having poor knowledge regarding the lack of cognitive impairment due to cannabis, whether it can be attributed to the fact they had reported that 80% of their friends with a history of drug use had no academic difficulties, and 95% of their friends with a history of substance use did not have any legal complications is be considered as well.

According to the Department of Revenue, Government of India, the cultivation of cannabis without a license can lead to “rigorous imprisonment-up to 10 years-and fine up to one lakh rupees.”

The government website further mentions that the “production, manufacture, possession, sale, purchase, transport, import inter-state, export inter-state or use of narcotic drugs and psychotropic substances” carries the penalty of “rigorous imprisonment up to 6 months or fine up to Rs 10,000 or both (for small quantity).”

Again, “more than small quantity but less than commercial quantity” can lead to “rigorous imprisonment up to 10 years and fine up to Rs one lakh.

A commercial quantity of the same, on the other hand, will involve “Rigorous imprisonment 10–20 years and fine up to one to two lakh rupees.”[11]

Recent reports about the legalization of cannabis for medicinal purpose is promoted by the recreational users and drug addicts with huge financial interests in mind rather than real patients who are on palliative care for recovery or curative purpose.

Limitations of the study

Internal consistency of MEEQ-B (0.42–0.60) is lower than the original version and replication with different sample sizes is recommended. Our study was conducted in medical students which are located in a rural setting with limited/no facilities to pubs, discotheques, and hi-fi restaurants, and the findings cannot be generalized to medical students across all students all over the state/country.


Extensive and elaborative teaching regarding substance use, especially of cannabis and its implication must be updated in the curriculum of both UG teaching and PG teaching in other specialties as well. Medical students must be frequently sensitized about the harmful effects of cannabis by conducting continuing medical education, symposiums in their academic curriculum. There must be a strict prohibition on the sales of drugs placed on public places, religious centers, and educational institutes and in hostel facilities with placards emphasizing on its ban and implications as per the Narcotic Drugs and Psychotropic Substances Act.[12]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

de Jong JT, Komproe IH, Van Ommeren M. Common mental disorders in postconflict settings. Lancet 2003;361:2128-30.  Back to cited text no. 1
Ray R, editor. The Extent, Pattern, and Trends of Drug Abuse in India-National Survey. New Delhi: Ministry of Social Justice and Empowerment, Government of India and United Nations Office on Drugs and Crime; 2004.  Back to cited text no. 2
Schafer J, Brown SA. Marijuana and cocaine effect expectancies and drug use patterns. J Consult Clin Psychol 1991;59:558-65.  Back to cited text no. 3
Rosner B. Fundamentals of Biostatistics. 5th ed. 5TH ed, published by Duxbury Press, Boston, United States of America: Duxbury; 2000. p. 80-240.  Back to cited text no. 4
Riffenburg RH. Statistics in Medicine. 2nd ed. Elsevier Academic Press publications,SanDiego,California,USA: Academic Press; 2005. p. 85-125.  Back to cited text no. 5
Sunder Rao PS, Richard J. An Introduction to Biostatistics, A manual for Students in Health Sciences. 4th ed. New Delhi: Prentice-Hall of India; 2006. p. 86-160.  Back to cited text no. 6
Suresh KP, Chandrasekhar S. Sample size estimation and power analysis for clinical research studies. J Human Rep Sci 2012;5:7-13.  Back to cited text no. 7
Manzanares J, Julian M, Carrascosa A. Role of the cannabinoid system in pain control and therapeutic implications for the management of acute and chronic pain episodes. Curr Neuropharmacol 2006;4:239-57.  Back to cited text no. 8
Meruelo AD, Castro N, Cota CI, Tapert SF. Cannabis and alcohol use, and the developing brain. Behav Brain Res 2017;325:44-50.  Back to cited text no. 9
Arredondo-Mendoza JC, Alcala-Alvarado OV, Alonso-Bracho SA, Becerrril Gaiton DA, Gonzalez-Santiago O. Risk perception of medicinal marijuana in medical students from northeast Mexico [version 1; peer review: { approved with reservations, 1 not approved]. F1000Res 2017;6:1802. https://doi.org/10.12688/f1000 research.12638.1.  Back to cited text no. 10
Pragnesh P. Knowledge and attitudes regarding substance addiction among medical students of Valsad, Gujarat. Forensic Sci Add Res 2018;3:FSAR.000585.  Back to cited text no. 11
The Narcotic Drugs and Psychotropic Substances Act; 1985.  Back to cited text no. 12


  [Table 1], [Table 2], [Table 3]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Discussion, Conc...
Article Tables

 Article Access Statistics
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal