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Medicine or menace? The marijuana argument is rekindled

‘The harm that comes from cannabis is insidious. It’s not overdose. It’s not DUIs. It’s looking in the mirror 10 years later and wondering why your life isn’t where it should be.’

marijuana plantsCreative Commons/Guilhem VellutDr. Joseph Lee: “Some kids are going to smoke pot recreationally and be OK. But the kids who are vulnerable for addiction are more likely to be pulled in and use and more likely to justify their use.”

The argument over pot seems tiresome and worn out. But as more states move to legalize, including efforts in Minnesota, the debate is getting yet another hearing. In November, the Dakota County Prevention Partners hosted a forum to “expose the science, facts and myths” around legalization, featuring Ken Winters, a professor in the University of Minnesota’s Psychiatry Department and specialist in adolescent addiction, and Tom Gorman of the Rocky Mountain High Intensity Drug Trafficking Area Initiative. At about the same time, the UMD Center for Ethics and Public Policy hosted a panel discussion of legislators and experts, who debated (pro and con) a medical marijuana bill that’s expected to come up when the Legislature reconvenes in February.

The headlines are hopping: Former President Bill Clinton is still explaining himself, epileptic children are cured of their seizures, growers are generating greenhouse gases, and buyers can choose from Pineapple Express, Lime Haze and Cat Piss.

Of particular concern are young people, especially those who are vulnerable to addiction and who are exposed to substances before their brains are fully formed (at age 24-25). To get the perspective of someone who works with this population, I spoke with Joseph Lee, M.D., medical director of Hazelden’s youth continuum. These views are his own, and do not necessarily reflect those of his employer.

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MinnPost: What will be the impact of the nationwide trend to legalize marijuana, especially among young people?

Dr. Joseph Lee: The issue is far more complex and nuanced than many people care to believe. I don’t think marijuana will be the downfall of society. It’s not going to save society, either. I’m not anti-marijuana. I just understand that some people can use and some people can’t. I know there are plenty of people out there who are struggling with it, and who can’t stop using. The discussion of legalizing cannabis has merit – on legal, criminal and medical grounds. And I’m not defending the ill-fated drug policies of a bygone era. But we can’t pretend that it’s a panacea for social ills.

There have been some data that suggest that medical marijuana dispensaries have not necessarily increased marijuana use among young people in states that have them. But juxtapose that with Monitoring the Future data [PDF], which clearly show that teen use has been increasing nationwide and that kids are perceiving marijuana to be “safer.” And that coincides with changing attitudes in society.

You have 1 in 10 young people who get addicted. Any time you want to legalize something that is potentially harmful to a significant minority of the population, you have to do the math and see if it’s going to be worth it. I would say that outside of caffeine there hasn’t been anything legalized in the history of mankind that has really offset the social costs. What you’re going to see with the marijuana trend is this: Some kids are going to smoke pot recreationally and be OK. But the kids who are vulnerable for addiction are more likely to be pulled in and use and more likely to justify their use. Research shows that when young people perceive any substance to be less harmful, they use more. That goes for marijuana, meth, cigarettes and prescription drugs. Pretty simple. 

It’s like any other public health decision: What will you do for a significant minority who have problems and who will impact society?

MP: What exactly happens to a young person who becomes a chronic marijuana user? What do you see in your practice?

JL: We have been so blighted by heroin and opioid use that our demographic has changed. But I do see a lot of kids who are addicted to cannabis who have a harder time coming to grips with it. They’ll say things like, “It’s not physically addictive.” Anyone who tells you that it’s not physically addictive doesn’t understand addiction. What they are referring to is that the physical withdrawal from cannabis is modest in comparison to alcohol or benzodiazepines or opiates. Addiction, though, is a process that is physiologically driven through your brain. So fundamentally all addiction is “physical.” I think people like to say that marijuana is not physically addictive to minimize its gravity. Gambling is another well-known addiction that some might say is not “physical.” But gambling addiction is very real and very crippling. 

Dr. Joseph Lee
Courtesy of HazeldenDr. Joseph Lee, M.D., medical director of
Hazelden’s youth continuum

I see a lot of kids who have psychotic symptoms from marijuana. They get paranoid. They start talking about the Illuminati. They start talking about government conspiracies. They believe there are intricate hidden messages that link lyrics, cars that drive down the road, people looking at them. … Some get really confused and can’t get their words out the right way. I saw three last week and more than 30 this year. Marijuana increases the risk of youths having a psychotic episode by at least two- to threefold. It’s a few people out of 100, but it’s more than a couple.

The harm that comes from cannabis is insidious. It’s not overdose. It’s not DUIs. It’s looking in the mirror 10 years later and wondering why your life isn’t where it should be. It hits people below the belt. For all the rhetoric, when kids who are “pro pot” sit down in my office and look me in the eye, that’s what they tell me. More or less already at the age of 18, 20, 22, their life is full of regret. Regret is possibly the worst thing in life. And these young people have so much regret.

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You can always find poster children for any cause. There are some people who smoke or drink way too much and for some reason are able to walk the tightrope. You can always find those people. But what do you do with the vulnerable population? That’s the population I’m here to serve. These kids get stuck in this kind of Dante’s inferno over what level of hell, what drug, is worse? What they don’t understand is that their brains are wired differently.

MP: And what are you seeing about costs to the culture at large?

JL: For a lot of people, even people who aren’t addicted, marijuana use is associated with higher dropout rates and lower quality of life on almost all the physical- and mental-health measures.

A University of Maryland study of 1,000 college kids found that 25 percent drop out over four years – that’s the baseline for those who don’t smoke at all, sort of the norm. Among the college kids who smoke a lot of pot [more than 17 days a month], about 41 percent drop out. Even infrequent smokers had a much higher rate of drop out. And in fact even infrequent smokers had on average a worse quality of life on all sorts of measures.

And here’s the rub: These are college kids, so they’re technically adults. But there is clear evidence that even for people who are technically adults, marijuana impairs them.

There’s also a study done in New Zealand that tracked 1,000 kids before and after they smoked pot. The study, which tracked its subjects over 25 years, found that the kids who smoked a lot of pot showed a drop in their IQs, and the longer they smoked pot the lower their IQs stayed.

That study has been incredibly controversial, although the authors have been able to successfully defend it.

There is one counterargument that has merit, which is that kids who use drugs like marijuana are vulnerable anyway, so these kids are not going to do so well in life, period. So they argue that marijuana, though it can complicate things, is more of a red herring – these kids are vulnerable inherently and wouldn’t do well in life regardless of whether they smoked marijuana. Frequent marijuana use then is a marker for vulnerable youth but not the driving cause of their struggles. I believe there is truth in that, but I don’t think it’s all one way or the other.

Just look at the statistics: If you have a family issue with addiction, the earlier your child is exposed to a substance, the more likely your child is to be an addict. Period.

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MP: What do you think of the nature of the debate, and how do you answer charges of hypocrisy – comparing marijuana use to alcohol use, for example?

JL: The biggest problem I have with the public-policy debate is that it’s not balanced. People who have problems with marijuana, and there are many, can’t have a voice. They’re told, “You don’t have a problem.” And that’s a problem. With other substances, we can have that discussion. But this is much more polarized than that. Lady Gaga came out recently and said she was addicted to pot. She has been under some scrutiny for saying that. It’s almost as if she would have had more credibility if she said she were addicted to video games or shopping. 

In discussions, I sometimes find proponents of cannabis to be disproportionately angry. Where does this vitriol come from? I wonder if a lot of them look at their lives, and know on some level that they smoke too much pot. Yeah, they hold down a job. Yeah, they have a family. But their lives didn’t turn out quite like they wanted them to. It’s always easier to blame a third party.

When I was growing up and watching Cheech & Chong movies, it used to be that if you laughed at people being stoned and lazy who can’t remember anything it was funny. But now if you bring it up in a public forum, they [legalization advocates] get offended. It strikes me as very ironic.

I understand that we treat substances hypocritically. I just want to have a balanced discussion so that we can discuss whatever merit it may have, and also be able to say in the same sentence that a significant minority of people may struggle with it – and what do we about those people? There isn’t a one size fits all here. And that’s the discussion that needs to be had, and it’s very hard to have in a public forum because everybody just knows their own experience.

I will say that alcohol and cigarettes have been around long enough so that a balanced conversation can be had. Hyper vigilance is always the mark of immaturity. When you talk about a social or public-policy issue, whenever something hasn’t fully formed and there’s still a lot of insecurity about it, people tend to be very black and white. And I think with marijuana, the discussion is still in its infancy. There are a number of people who are incredibly vocal about it. There is a silent majority of people who can’t really see why it’s illegal but who aren’t protesting on the streets. And there are some people who are scared because they have family members who are affected by it.

If people want to research it, fine. If people want to legalize it because they see hypocrisy compared with other substances, fine. But we need to have a balanced discussion, one in which we can also say that it’s not as harmless as people think. The loss of productivity and the mental-health problems are real. It may not impact a lot of people, but those few people impact everyone. Isn’t it 5 percent of the population that accounts for 50 percent of health-care expenditures? That’s what we’re talking about. It’s not just “live and let live.” I don’t think people understand that in the end we all pay for those decisions.

MP: Do you see other flaws in the arguments, including claims of marijuana’s medicinal value?

JL: If scientists are able to isolate a chemical compound in marijuana that is medically valuable, I’m all for it. But to decide whether marijuana can be medicinal in the popular forum is ridiculous. We wouldn’t do that for a heart catheterization procedure – or anything else.

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There’s a blurring of the line between what science is dictating and what people want. Proponents of legalizing marijuana use harsh words like “apartheid.” We’re talking about pot, not Nelson Mandela. People want to frame this as a life-and-death freedom issue, and it’s not.

The whole “medicinal marijuana” thing is just a sham. Again, that’s not to say there can’t be medicinal value found in marijuana. But the great majority of people lined up outside a dispensary do not have terminal cancer, glaucoma, seizures or intractable pain.

There’s also this notion out there that if you would just legalize pot, kids won’t choose other more harmful substances. If you look at the Monitoring the Future data though, alcohol and tobacco use in the country among 8th- to 12th-graders has gone down in the past decade – long before any powerful rhetoric came out about pot. So people who are promoting pot can’t really take credit for that trend, because it was already occurring.

But young people who are vulnerable to addiction are going to use marijuana and other substances, as opposed to marijuana or other substances. This is not to say that I subscribe to a “gateway” hypothesis for drug use, but rather the truth that many addicts are poly-drug users. People who use a lot of one thing use a lot of other things [PDF]. If you snort a lot of cocaine, you’re probably going to drink alcohol. If you drink a lot of alcohol, you’re probably going to smoke pot. If you smoke a lot of cigarettes, you’re probably going to smoke pot.

So this idea for the very highly vulnerable population that they will chose one or the other just doesn’t work out. And that matches up with brain science, because fundamentally the problem is in your reward system and other parts of the brain. You may prefer one thing over another, but in the end it’s your brain that’s the problem.

MP: What does legalization look like in the long term?

JL: What I predict will happen is that it will become a business. Capitalism will dictate things. And capitalism demands bigger, better, faster, more. We already have potent concentrates (marijuana dabs, wax, earwax). Young people are coming up with ways to basically make the marijuana equivalent of “crack.” They’re purifying it and they’re able to get an incredibly powerful high from it.

We don’t want to be doomsayers, but I think there’s this notion with marijuana that it will be this natural, local, organic kind of movement. And I think people might be blindsided by what a big business it could become and by how much capitalism will likely drive this.