Currently, in America, the great Marijuana debate continues. Legalize or not? Canada, our benevolent neighbor to the North, has completely legalized it as of January 1, 2018. Uruguay is soon likely to pass legislation making the industry the world’s first state-run program regulating marijuana production, marketing, and consumption.
In the United States, there exists a potpourri of legislative positions, reflecting wide variations in perceptions and definitions of legality. These attitudes vary due to confusion over verbiage such as legalization, decriminalization and the great oxymoron “medical marijuana”
As a physician practicing Addiction Medicine, I feel there are important points within these debates that are not being made with enough clarity for the average citizen to develop a coherent point of view.
At the recent annual convention of the American Society of Addiction Medicine (ASAM), a fascinating symposium regarding this issue was held. Physicians and scientists who have spent their careers in Addiction Medicine discussed safety, toxicity and addictive potential, as well as addressing the gateway notion that are the foci of fierce public debate. Legalization versus decriminalization concepts were addressed and “medical marijuana” was revisited. These experts advised caution, patience and restraint.
A central concern was to be wary of “Big Weed”. This is the powerful lobby of those who stand to benefit from rapid rise in popularity and use of marijuana/weed. Collectively the speakers warned of the similarity of today’s environment with that regarding tobacco decades ago. The amount of money being made, and the potential for more profit is behind the increasingly prevalent attitude of widespread acceptance and use of marijuana. These attitudes are subtly and not so subtly being shaped by the weed industry and its proponents and have little to do with the safety of the general public. Just as Big Tobacco successfully pushed a terrible product that continues to wreak havoc and will for years to come, those that promote total legalization, widespread use and “medical marijuana” are not motivated by promoting health and safety. The facts do not support the enthusiasm.
Decriminalization likely makes sense. If tobacco and alcohol are legal (and are no question far more deadly and dangerous drugs than weed), then labeling young people (as well as old folks) as felons and incarcerating them for transgressions of current laws seems stupid. We need to respect the science and facts and make better decisions regarding public policy. By allowing the voice (and money) of Big Weed to enter into the fray, society risks repeating the sad history of tobacco.
There are many facets of the debate that are easily overlooked. Variations in laws in different states, the economic costs to the public and the public health impact are arguments that those promoting full access to weed would like to sweep away. To do so would be irresponsible and we all need to learn more before we begin discussing legalization. Healthy and Productive Illinois, HPILL (www.healthyillinois.org), a public watchdog has eloquently advocated against legalization of weed and has a website that is very interesting and fact-filled.
The public needs to be educated that there are more than 100 different cannabinoids in marijuana. The component that Big Weed is most interested in is THC (4 tetrahydrocannabinol). This is the primary agent responsible for the high associated with weed. It has been used for years as a prescribed medication called Marinol to stimulate appetite and to act as an anti -emetic. Recently the FDA has approved cannabidiol (CBD) for use in specific types of seizures. There are potentially other cannabinoids that can achieve medical utility but the needed research studies likely will never be done if weed becomes completely legal. The weed industry is fundamentally concerned with the THC. Many ordinary citizens have no understanding of these issues and hence there exists confusion. This provides perfect fodder for a good marketing campaign.
In the past 30 years the average THC concentration of weed has skyrocketed so the weed available today is a tiger to a kitten compared to that of years ago. Given new methods of ingestion including vaping, edibles and other techniques, the experience to the user is typically vastly more intense than it has been previously. For some users this is great news. For the average casual user, it can be daunting and dangerous. In the April 2018 edition of Annals of Emergency Medicine is an article describing a mass casualty incident from San Francisco where weed edibles which looked like commercially available and safe gummy candies were ingested at a child’s birthday party. This resulted in multiple hospitalizations No deaths resulted, but ponder this for a minute and consider your reaction if you or your child were involved.
This new potency has yet to be fully studied and to get good controlled clinical trials will likely prove very difficult to complete before the rush to legalize more “medical marijuana” gains critical mass.
There are populations that absolutely need to be protected from weed use. The effect on the developing adolescent human brain has been well studied and is depressing. Young people between 10 and 25 years of age experience, proportional to use, a permanent decline in IQ. This affects cognition, memory and performance academically and in the workplace.
Folks with underlying psychiatric conditions and those with co-existing substance use disorders are particularly vulnerable populations that need to avoid weed use. Lost in the fray is the simple fact that weed is an addictive substance and that many casual users become habitual users. This is related to age of first use and amount used. Associated use of tobacco and other drugs is higher in weed users. These are facts refuted by Big Weed just as the risks of tobacco were refuted years ago. We need to counter the trend of decreased harm perception being promoted by those who wish to legalize weed.
ASAM says marijuana is NOT a safe and harmless substance and its use is not health promoting. Marijuana is a drug with distinct effects on the brain and on behavior. The fact is that addiction to cannabinoids and marijuana is a significant health problem. ASAM opposes proposals to legalize marijuana anywhere in the USA. These are the experts, not the industry shills who make it out as all fun and games.
We do not need to repeat the mistakes of the past (e.g. tobacco). The public is being fed a big lie and we need to respect the science and facts regarding marijuana. We need to remember when Big Tobacco was giving away free cigarettes, advertising on TV in prime time and arguing that their product was NOT dangerous. We are there again.
In America, incumbent politicians need money to stay in office. If you contribute money to them you are more likely to be heard by them then if you are not able to give them money. Sadly, we can no longer trust our elected officials to protect the public’s best interests over those lobbying for Big Weed. This is why it is important to be skeptical of the increasingly powerful voice of those involved in profiting from “medical marijuana” and legalization.
In California weed can be prescribed for anything (if in the mind of the prescriber the patient may benefit). Laws such as this are so lax as to be laughable. I have seen jars of weed with the medical Caduceus emblem emblazoned on them. This must be very confusing to the general public.
Decriminalization of marijuana makes sense. Legalization does not. Physicians have had the ability to prescribe cannabinoids to the public for quite some time for specific indications. Otherwise there are a plethora of anecdotal indications (“it cured my aunt’s cancer “etc.) that will likely never be studied appropriately. In general, the term “medical marijuana” is nonsensical and promoted only by the most avid weed advocates.
Lastly, my biggest concern is letting the fox into the henhouse. We need to respect the science and the scientists. I urge folks to honestly educate themselves on the facts rather than the myths that permeate the debate. Marijuana is a complex plant and a complex issue. Our society needs to be careful.