Marijuana Use and Addiction: Update, One Year Later
Its been a year since I wrote about marijuana addiction, focusing on the difficulties it causes, and the very real problems of attempting to stop, including a withdrawal that may include depression, anxiety, insomnia and even psychotic symptoms that may persist for four to six months. I described the effects of amotivational syndrome, and this too remains. While I continue to see these problems associated with long-time marijuana addiction, I have to make clear this is based on “anecdotal data,” or what I have seen in my clinical practice. Single cases do not constitute science; they may be important for the clinician, but they don’t answer the major questions discussed today. Most professionals—even pot advocates—would agree that long-term marijuana addiction may lead to trouble. Marijuana addiction is by itself, problematic. But the story of cannabis use is far more complicated than what is seen by a clinician treating people addicted to drugs, including alcohol, amphetamines, cocaine, and marijuana.
While 20 states have now made it legal to be treated with marijuana for medical purposes and Colorado and Washington have voted to make recreational marijuana legal, scientific studies of the pros and cons of pot use have largely been conducted outside of the U.S. The U.S. Drug Enforcement Administration has continued to make it difficult for researchers to get permission to scientifically study the pros and cons of marijuana, treating pot as more dangerous than cocaine and morphine, both of which are legally used in medicine. Unable to point to empirical studies, the DEA proclaims it can’t possibly Ok a drug that hasn’t been tested and demonstrated safety and efficacy. In Federal law, marijuana is high up on the list of the most dangerous drugs, equivalent to heroin for example. While people may be smoking pot at a party in Denver without breaking state law, in New York State adults arrested with even a small amount of marijuana are likely to be in serious trouble, even if they are undergoing chemotherapy for aggressive cancer and are suffering from severe nausea and pain, and their oncologists would like to be able to prescribe THC as part of their treatment.
So what’s the story? I wish I could give a definitive answer. I have seen many promising older adolescents and young adults who have blown their potential falling under the spell of amotivational syndrome, loosing “interest,” in building a productive life. But they are people who have had the opportunities available. One study reported a significantly higher rate of marijuana use in those suffering from chronic mental illnesses such as psychotic disorders. That said, lets face it, the mentally ill in our culture may be the most stigmatized of all; in the sliding scale of oppression they beat out the stigma and discrimination based on race, sexism, sexual preference. They lack the opportunity to create a productive life, so of course they’re bored and hanging out becomes the way of being. Another study of the institutionalize elderly demonstrated the improvement in wellbeing, when marijuana was introduced in the lives of the residents. Like the mentally ill, the stigmatized races and many from low SES, they are deprived of the opportunity to growth in our society.
Another study conducted by Meier’s group at Duke University, using data collected in New Zealand, claimed that pot use in adolescents led to a significant drop in IQ later. However according to Norway’s researcher Ole Rogeberg and his team, the Duke study somewhat ignored most obvious confounds. Going back to the original data they found socioeconomic class was largely responsible; subjects who were from higher SES didn’t show the drop in IQ later. People who grow up in lower SES aren’t often exposed to the intelligence-boosting stimulus afforded to those of higher classes. Despite what many believe, intelligence isn’t fixed, it’s incremental and its growth depends upon opportunity and effort. Those from the New Zealand study who lost IQ points were from the lower SES portion of the population studied. Those from the higher SES group who were exposed to educationand mental stimulation, failed to show the later decline in intelligence. I have to conclude that the mentally ill, the elderly, the low SES population are barred from the very things that increase IQ scores. Smoking pot may become their only occupation. So much for the original conclusion that marijuana lowers IQ years later. When people are excluded from the institutions and life-styles that promote productivity, they don’t do well whether or not they smoke marijuana. The association is just that; it by no means suggests the arrow of cause and effect. Lack of life opportunities may lead to marijuana and other drug use, rather than visa versa. Having said this, I should add that a NIDA study concluded that teen pot use continues to be of concern, negatively affecting cognitive skills (intelligence) along with other developmental problems.
As important in this brief summary is the use of medical marijuana and the rather wild debate going on about it, as it differs from state to state and of course from the Federal Government. Increasing evidence is appearing that marijuana is helpful in pain, and the mechanism through the “amygdala,” the seat of emotions by which it appears to be working. Finn and his team from Ireland have found that the sensation of pain can be suppressed, when fear is controlled through our naturally occurring marijuana-like substances called endocannabinoids in the amygdala. So the clinical experience of oncologists treating painful cancer with marijuana (in states where its legal, and again “anecdotal”) is being corroborated. Studies at Duke Universityare in fact finding that fear itself may, to some extent end up controlled by marijuana. In their studies they found that brain-wide deletion of cannabinoid receptor type 1 in mice led to a loss of ability to regulate fear. The scientists aren’t saying anything suggesting that marijuana might help with anxiety disorders, but the implications are clear.
An impressive study is going on in Israel, where they have a government approved medical marijuana farm –in which they are actually growing different types of marijuana that emphasize different types of metabolites –marijuana is obviously a very complex substance. A New York Times article, Jan 1, 2013, suggests that researchers from the Israeli study are saying “..,cannabis can be beneficial for a variety of illnesses and conditions, from helping cancer patients relieve pain and ease loss of appetite to improving the quality of life for people with post traumatic stress disorder and neuropsychological conditions. The natural ingredients in the plant, they say, can help with digestive function, infections and recovery from a heart attack.”
I don’t want to leave the impression that all is golden on the marijuana front. One study has demonstrated that high potency pot use in the first few weeks of pregnancy—when women often don’t know they are pregnant—seriously damage embryonic development, exactly when the brain is first forming. Another study found a statistically higher incidence of strokes in young people in emergency room intakes, although it is unclear if marijuana is the only drug responsible as all but one stroke patient also smoked tobacco. Likewise a study demonstrated that a combination of alcohol and marijuana by youth may compromise white-matter (brain) integrity. The problem is we don’t know whether marijuana is the lethal contributor. Obviously in multiple ways alcohol is a far more damaging drug –just check hospital records, and how many people have been admitted related to alcohol use, so it seems important to study alcohol and marijuana separately, and any study that combines them is subject to serious question. Marijuana also has been associated with testicular cancer in young men, something that might cause young users to pause at least for a moment.
Another rather disturbing report is related to driving accidents; these are not limited to people who have used alcohol. People who have smoked marijuana within the past few hours have twice the number of car accidents as abstainers. Pot use interferes with tracking moving objects in simulated studies, up to 72 hours, and has other deleterious effects on motor capacities. There are now road tests using saliva to see if there is pot in a driver’s system. The problem is there is no specific “amount” indicated –no one ever knows how much THC they are really getting, and nor do testing police. They just know if it’s there or not, which seems like a rather crude test.
Finally, everything I could find on synthetic marijuana or “spice” is seriously bad. It can be dangerous to the kidneys. It has been connected to thousands of hospital emergency room visits each year with a variety of symptoms such as nausea, agitation, rapid heartbeat, high blood pressure, tremors, seizures, paranoia and apparent non-responsiveness.
My advice is still in line with my original post. Avoid marijuana in general, it is addictive, the withdrawal is awful, it leads to amotivational syndrome and there are far better things to do with your life –that is if you have opportunities, job possibilities, careers to be built, even a potential calling. Marijuana will hold you back in ordinary circumstances. That said, neither I nor anyone else can possibly have an intelligent perspective or advice to those who are scorned by the society because they are poor, or mentally ill, or institutionalized because of age. Further, there are obviously medical conditions in which marijuana can be helpful and doctors, again from their “anecdotal” clinical experience, know it. As for the people in Colorado and Washington, if you can afford marijuana, you probably have many opportunities and you might be holding yourself down by your recreational use of marijuana. That said, in general, none of our drug laws make sense, what is considered “good” in one era is “bad” in another; it is in the end, political. That means it’s all related to economics, the drug and alcohol lobby, and the current culture. No one in the U.S. government moves against alcohol, probably one of the most dangerous drugs we have, available in every flavor, strength, color, almost on every city block. The “War on Drugs” is and has been absurd. We need a DEA that promotes science because only serious research will provide answers.
One final comment: There seems to be a built in desire –or even a need—to on occasion change our state of consciousness. Our animal cousins (and those more distant) also use drugs found in their natural environments. Children spin in circles until they’re dizzy while giggling with pleasure, adults attend competitive sporting events, or rock concerts, or political rallies all of which change participants state of consciousness. The problem may be when we start doing drugs daily, repetitively, and often in isolation, removed from socially sanctioned rituals. As a clinician I see people who have long ceased to use drugs as part of a legal, occasional ritual, and this often ends up harmful.
I have not written the string of references here, there are too many. If anyone wants to get the reference to a particular study, get in touch with me. I read every comment.