HIGH RISKS
As marijuana gains acceptance, opponents point to its dark side
In less than 25 years, marijuana has gone from illegal everywhere in the USA to legal for at least some uses in all but four states. ❚ Advocates say the drug can help patients suffering from chronic pain, multiple sclerosis-triggered muscle spasms and the grueling side effects of chemotherapy. Some states are exploring whether cannabis could help wean people from addiction to opioids.
Beyond the medical claims, 10 states and the District of Columbia legalized marijuana for recreational use, and more are considering it. The advocates’ long-repeated argument: It’s safer than alcohol or tobacco.
As cultural acceptance of cannabis grows, opponents warn of potential downsides.
These critics – doctors, police and auto safety officials, parents – point to stories and studies that link the drug to suicide, schizophrenia
and car crashes. Marijuana might be safer than alcohol or tobacco, they say, but that doesn’t make marijuana safe.
An increase in impaired driving by people under the influence of drugs including marijuana, for example, is threatening the huge progress made in recent decades to reduce drunken-driving crashes.
Car crashes rose 6 percent from 2012 to 2017 in four states that legal-
ized marijuana – Nevada, Colorado, Washington and Oregon – more than four comparable states that didn’t, the Highway Loss Data Institute found.
“It makes me very nervous about highway safety as many more are considering legalizing it for recreational use,” says Matt Moore, senior vice president at the institute, which is funded by the insurance industry.
Some in medicine warn of possible links between marijuana and psychosis. They say more study is needed.
Bucknell University neuroscientist Judy Grisel, author of “Never Enough,” a new book on addiction, warns that the laws have outpaced the science. “It’s astounding how short our memory is,” she says. “We always think the next thing is the answer.”
Others say worries about marijuana are mostly overblown.
Sue Sisley, a doctor in Phoenix who has studied cannabis, says the reason states are loosening marijuana laws is that lawmakers and the public realize the plant is largely safe.
Sisley studied veterans who smoked marijuana to treat post-traumatic stress disorder under a $2.1 million grant from the state of Colorado. She calls the drug “relatively benign overall.”
“The cannabis plant is far safer than prescriptions I write for patients every day here in my clinic,” Sisley says.
Jolene Forman, senior staff attorney at the Drug Policy Alliance, which advocates for the legalization and regulation of marijuana, says there’s no convincing evidence that marijuana legalization worsens mental health or increases vehicle crashes. A better measure of traffic safety, she says, is whether more people are arrested for driving under the influence of marijuana. “We are seeing DUI rates stay steady or even decline in states that have legalized,” Forman says. “Moreover, marijuana use is not new. It was widely accessible and socially acceptable in these states before marijuana was legalized there.”
California became the first state to authorize the medical use of marijuana in 1996. States have been easing their own laws ever since.
All but four – Idaho, Kansas, Nebraska and South Dakota – allow marijuana for medical or recreational use or permit public use of low-THC cannabidiol formulations, according to the National Conference of State Legislatures.
Several Democratic presidential candidates have said they would seek legalization. Last week, Sen. Cory Booker, DN.J., introduced the Marijuana Justice Act, which would legalize marijuana nationwide and expunge convictions of people convicted of marijuana offenses. Sens. Kamala Harris, D- Calif.; Elizabeth Warren, D-Mass.; Kirsten Gillibrand, DN.Y.; and Bernie Sanders, I-Vt., are cosponsors.
Psychiatrist Andrew Saxon opposes legalizing marijuana for medical use because he says evidence that it works is scant. Saxon, a professor in the University of Washington Department of Psychiatry and Behavioral Sciences, chairs the American Psychiatric Association’s Council on Addiction Psychiatry. “I just don’t think it’s a good idea,” he says. “It’s not like any other medication I might prescribe that I can tell you exactly how much to take, how to take it and decrease the dosage and increase.”
Saxon does support legalization for recreational use, but “not because I think it’s a good thing.” People are going to use it whether it’s legal or not, he says, so it’s better to have it regulated and for “some of the profits to go back to the states.”
Some states have turned to marijuana in hopes of finding an answer to the opioid epidemic. New York, New Jersey, Pennsylvania and Illinois allow marijuana as a substitute for addictive painkillers such as OxyContin or as a way for people to wean themselves from opioid addiction.
Some say that’s another example of state laws outpacing science.
“The evidence is just not there yet,” says Ziva Cooper, research director of the UCLA Cannabis Research Initiative. “What we have are anecdotal reports.”
Scientists and doctors are concerned about the potency of modern-day cannabis products.
In the 1990s, Cooper says, marijuana plants typically contained about 3 percent THC, the psychoactive component that makes users feel “high.”
Today, Cooper says, marijuana sold at medical marijuana dispensaries can be as much as 25 percent THC. Other products, such as wax, vaping pens and dabs of concentrated marijuana, can be packed with still higher levels.
Links to schizophrenia?
The Colorado state committee that oversees legalization reported in February that for the first time, more adults of all ages are using marijuana, using it more often and ingesting it in more ways, including edibles.
Eating food that contains marijuana gives users a far stronger dose of THC.
The National Academies of Sciences, Engineering, and Medicine concluded in 2017 that schizophrenia and other psychoses are correlated with, but not necessarily caused by, heavy marijuana use. Cooper, who was part of the National Academies’ research team, says the comprehensive review of studies concluded frequent users face more risk, but it’s “premature” to say heavy use causes schizophrenia and psychosis. “We don’t know what’s coming first,” Cooper says. “Is it that people who are heavy users are more likely to develop schizophrenia and psychotic disorders? Or is it that heavy users might be quote-unquote self-medicating?”
Further underscoring the complicated relationship between cannabis use and mental health, Cooper says, is evidence that cannabis users with a history of psychotic disorders had better cognitive performance. “There is an association there that shows cannabis might be protective to some degree,” she says.
Alex Berenson, author of the new book “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence,” says there’s plenty of evidence that high-strength cannabis causes psychosis.
He says the evidence has only gotten stronger since he finished his book.
“The stories are now so much worse than that kids failed out of school or went on to use other drugs,” Berenson says. “A lot of suburban families who never thought this would be a problem” are starting to share their stories.
Berenson met last month with Florida state legislators. He says groups and legislators in about a dozen other states have asked him to speak.
Maria McFarland Sanchez-Moreno, executive director of the Drug Policy Alliance, says Berenson’s claim that marijuana “frequently causes” psychosis is “over the top.” Most scientists, she says, avoid saying marijuana causes psychosis. “The fact is that the overwhelming majority of people who use marijuana do not develop a mental disorder as the simple result of using it,” she said in an online discussion hosted by the Marshall Project.
Lori Robinson started Moms Strong in 2016. Her son, Shane, 25, died by suicide in 2012. He had been hospitalized twice with psychosis. Lori Robinson says doctors denied his mental illness could be linked to his heavy cannabis use. “This is all about money,” she says. “And unfortunately, our kids are the ones who have been sold down the river.”
In parents’ hands
Six months ago, Heidi and Dave Curtis never would have advocated for the legalization of medical marijuana.
But after seeing how it helped their youngest daughter, the Indiana couple want their voices added to the chorus calling for legalization in their state.
The Indiana General Assembly has not advanced any of the handful of bills on marijuana proposed this session.
Even if a bill were to pass, it would not help Charly Curtis. The 6-year-old, who had a rare genetic condition that causes severe autism and seizures, died in her sleep last month.
As the seizures grew more frequent and more severe, her parents began to give her small doses of THC.
The day Charly first took a peanut-sized piece of a brownie with THC, they say, she had no seizure. For the first time in her life, they say, she went to her room and sat quietly flipping through books.
The Curtises gave Charly THC drops twice a day. The decision wasn’t easy. Heidi had always been against drugs, and she feared the consequences of doing what she knew was illegal.
Now that Charly is gone, her family wonders what might have happened if they’d given her THC earlier. In the short time she was on the drug, they say, she had fewer seizures and her behavior improved dramatically.
All Heidi Curtis says she wants is the chance for parents in similar situations to be able to use medical marijuana to help their children. “This is not a be-all and end-all miracle drug,” she says. “We as parents should have that opportunity to make the decision here.”
Medical experts do not endorse the use of THC to control seizures for patients of any age. Anup Patel, section chief of neurology at Nationwide Children’s Hospital in Columbus, Ohio, and medical cannabis editor for the Epilepsy Foundation of America, says that based on limited animal data and case reports, THC is thought to have a neutral effect on seizures or, if anything, promotes the episodes.
CBD, which is derived from cannabis, has been thoroughly researched. CBD does not produce the same high as THC because it binds to a different part of the brain. Last year, the Food and Drug Administration approved Epidiolex, the first drug with purified CDB oil, to treat seizures. Patel, who helped conduct trials of the drug, says scientists found that about 40 percent of patients saw at least a 50 percent reduction in seizures.
The cognitive factor
Researchers at Duke University gave subjects IQ tests at age 13, before any of them had smoked marijuana, and again at age 38. They reported in 2012 that those who started using cannabis in adolescence and continued for years afterward showed an average decline in IQ of 8 points. Quitting cannabis apparently didn’t reverse the loss.
The researchers who conducted the review by the National Academies found that learning, memory and attention are impaired immediately after cannabis use. But they concluded that the evidence that use impairs academic achievement is limited.
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“Unfortunately, our kids are the ones who have been sold down the river.” Lori Robinson Moms Strong