Marijuana: Life Style or Looming Crisis?

Dr. Barry L. Jackson

Emeritus Professor and Director of the Drug, Alcohol and Wellness Network (DAWN)

Commonwealth University

Cannabis is second only to alcohol use in adolescents in North America, and marijuana has been identified as the first drug of choice for adolescents and young adults in Europe (1). Although not legalized or decriminalized in all U.S. states, Canadian provinces, or European Union countries, cannabis use seems to have been normalized and become socially acceptable (1).

Lobby groups and some business sectors, along with governments seeking increased revenues1, have so far ignored long-term consequences of the decriminalization and legalization of cannabis. Proponents of its use assert cannabis poses no greater harm to individuals and society than alcohol or tobacco. Such assertions understate the known harms of these substances: lung and other cancers; hypertension and heart diseases; and stomach, liver, kidney, and brain damage. All of these diseases are also likely consequences of cannabis, especially when use commences in adolescence.

Direct and indirect messages by media, celebrities, and social influencers supporting marijuana have advanced social acceptance (2). Media’s influence is significant, but family members and peers who condone marijuana provide the greatest endorsement (3). The insidious nature of societal endorsement of THC (delta-

1 Colorado increased its annual revenue by $129 million in the first year of legalization and Washington State’s revenue went up by $70 million (4).

9-tetrahydrocannabinol) bearing products is underestimated. Even the seemingly innocuous reference to marijuana as “weed” implies the drug is a harmless botanical.

Advocates of legalization minimize the dangers of cannabis while promising that new tax revenues would fund drug, alcohol and tobacco education and treatment initiatives. There are claims that legalization of marijuana would lower opioid use and its overdose rate while governmental regulation could control purity standards reducing drug contamination risks. Counter arguments cite increases in hospitalizations and deaths from marijuana due to the significant increase in users. Allegedly overdoses and deaths due to edibles have increased among young children2, and the gateway drug theory worry many. Finally, it is stated that legalization will remove incentives for organized crime.

Due to the limited number of unbiased, credible studies on the long-term consequences of cannabis in general, and specifically marijuana use, many of these positions have not been adequately demonstrated. The relative absence of well-designed research may be attributed to cannabis’s U.S. Federal Food and Drug Administration’s listing as a Schedule I3 drug which limited funding and impeded authorization for research. Mixed research findings and biased reporting of dangers associated with marijuana allow people to select studies supporting their personal prejudices. What is needed are doubleblind, placebo-controlled research with sufficient subjects to be conducted in order to begin to determine potential consequences of long-term use to both the individual and society.

There are some well documented medical studies (5, 6) identifying serious health consequences which seem to have been lost in the rush to decriminalize and legalize cannabis use. Gilman and Blood (7) reported in the Journal of Neuroscience that THC has a negative effect on adolescents’ and children’s brain development resulting in anhedonia and amotivational syndrome. Increases in schizophrenia and schizotypal mental diagnoses are associated with early on-set use of marijuana (8, 9).

The theory that marijuana is a “gateway” to harder drugs received support from a longitudinal study completed in Malta (10). The national comorbidity rates of heroin addiction revealed that more than 95% of heroin addiction started with use of marijuana between ages 9 and 18 years.

Cannabidiol (CBD) oil which does not contain THC has been successfully used to treat Post Traumatic Stress Disorder (PTSD), anxiety, Multiple Sclerosis spasticity symptoms, chemotherapy-induced nausea and vomiting, anxiety and some forms of epilepsy. CBD does not induce euphoria (“the high”) experienced when THC is present.

2 The idea that cannabis use is safe is contradicted by hospital records. In Utha, in 2018, 52 cannabis poisonings were reported. Between 2014-2016 Colorado hospitals reported 11% of emergency room visits were due to edible cannabis (11). Edible products (cookies, brownies, candies) pose a particular threat to young children.

3 The FDA identifies cannabis as an addictive drug and lists it in Schedule I with other drugs with no recognized medical value. Medical prescriptions cannot be written for cannabis however, state governments permit physicians to write medical cannabis authorizations for a person to receive a medical card which allows individuals to purchase cannabis from state authorized stores. Cards are not prescriptions and do not identify the strength of THC, amount or frequency of purchase and use.

Products containing THC are used for medical and recreational purposes. However, the FDA does not regulate their production, purity, or marketing due to their Schedule I listing. Individual states are left to regulate the industry. In most states where cannabis products are legal one must apply for a medical cannabis card from a physician. Once a card is received, few restrictions are placed on the patient’s ability to purchase cannabis (with or without THC). The lack of consistency in THC content (ranging from 4% - 28%) (11) and the absence of control of the frequency of patient use, makes it impossible to control for THC dosage in the medical treatment of a patient. Frequency of use is at the discretion of the patient. The fact that one receives a permission card from a physician implies that it is to be used as a medicine. However, the lack of control over the frequency of use and the dosage of THC begs the question of whether marijuana is used as a medicine or for recreation.

Benefits of CBD oil seem medically justified. But if cannabis without THC (CBD) is an effective medical intervention without inducing euphoria (“the high”), why are THC products also medically authorized? A clear distinction needs to be made, between cannabis as a medicine, and cannabis as a recreational drug. If we consider it a recreational drug, the question we should ask is: are we prepared to address the attendant longterm problems similar to those of tobacco and alcohol abuse?

The numerous concerns about the use of marijuana only add to the existing list of societal dangers and the deleterious health impacts of tobacco use, excessive alcohol consumption, vaping, and illicit drug use which have long been documented. To endorse the use of yet another substance with a high potential of harm seems self-destructive. Despite this, use of cannabis has become a lifestyle for many people and segments of society have developed an entitlement mentality for its use.

References

1. World Health Organization. (2016). The health and social effects of nonmedical cannabis use. Report dated 11 November. who.int/publication/i/ item/978924150240 ISBN: 978924150240

2. Bandura, A. (1997). Social Learning Theory. New York: General Learning Press.

3. BDAP Risk Factors. (2005). Department of Health, Commonwealth of Pennsylvania. Bureau of Drug and Alcohol Programs, Division of Prevention. Harrisburg, Pennsylvania.

4. Imam, J. (2015). Pot Money Charging Heart in Washington. CNN aired on July 11, 2015. CNN.com/ TRANSCRIPTS/asb.html

5. Meier, H. et al. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences. 109: no. 40, 2657-2664.

6. Filbey, M. et al. (2014). Long-term effects of marijuana use on the brain. Proceedings of the National Academy of Sciences. 111: 16913–16918. Center for Brain Health, University of Texas, Dallas, Texas. And The Mind Research Network, Albuquerque, New Mexico.

7. Gilman, JM, Kuster, JK, et al. (2014). Cannabis use is quantitatively associated with nucleus accumbens and amygdala abnormalities in young adult recreational users. Journal of Neuroscience, Apr 16:34 (16): 5529-5538. doi:10.1523/ JNEUROSCI.4745-13.2014.

8. Di Forti, M. et al. (2009). High-potency cannabis and the risk of psychosis. British Journal of Psychiatry. 19: no. 6, 488–491.

9. Di Forti, M. et al. (2014). Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users. Schizophrenia Bulletin. 40: no. 6, 1509–1517.

10. Jackson, BL. (2013). Malta: A study of the lifestyle of its youth population. Fulbright Research Report. University of Malta. Msida, Malta. For retrieval contact the author.

11. AARP Bulletin: Real Possibilities. (2019). Special Report. Marijuana and Your Health. September. 60: no. 7, 10-18.

Barry L. Jackson