MARIJUANA-WHERE DO WE GO FROM HERE?

Dr. Michael J. De Vito

marijuana plant

The cheers rang out and the pundits heralded the election results of November 2012. Exhilarated followers in college dorms, faculty lounges, and city parks across our nation had won their long sought victory. Others in less reported locations and less organized groups shook their heads in disbelief. Not due to the re-election of a President, but the legalization of recreational Marijuana in two western states, Washington and Colorado. Cheetos, oatmeal cookies, and S’mores will soon be in short supply. With the possibility of more states to follow in upcoming referendums much of the nation will be looking close at the implementation and the results of this monumental shift in acceptable and now legal social behavior.

We all have our biases whether we label ourselves as Liberal, Conservative or Libertarian. Those biases can and often do cloud the facts available before us and our willingness to take an objective look. We are led in the direction of our own world view. The more liberal among us may see the use of Marijuana to be relatively harmless and not worth the time, money and effort to criminalize and prosecute its use. The more conservative mind set will perhaps make the case that a society has the right to codify conduct and that includes maintaining laws against all non-medical use of Marijuana. The libertarian may believe even small government has the potential to infringe on our individual rights. Such as legislating on private behavior and an adult citizen’s right to cultivate, distribute, use or possess Marijuana in any amount. I would like to leave my own biases behind, at least for the moment, and take a look at some of the history and research relating to the societal and health effects of Marijuana use.

Is Marijuana harmless? The National Organization for Marijuana Reform Law (NORML) makes that very claim. They even substantiate the claim by citing the highly respected British Medical Journal, Lancet, November 11, 1995 “The smoking of cannabis, even long-term is not harmful to health…it would be reasonable to judge smoking cannabis as less of a threat than alcohol and tobacco”. Very direct and concise, however, we find that the quote is from an opinion editorial and not a peer reviewed article. NORML’s bias and world view is leading their agenda. An opposing view regarding the harm and value of Marijuana is held by Citizens against Legalizing Marijuana (CALM). CALM states that Marijuana is a mind altering, highly toxic drug. They cite various concerns by medical societies and associations including the British Medical Association who CALM quotes as saying “Marijuana has been linked to a greater risk of heart disease, lung cancer, bronchitis and emphysema.” The BMA goes on to raise concerns that downgrading the criminal status of Marijuana would “mislead’ the public into believing the drug is safe. CALM is presenting information that supports their agenda and world view, and from some of the same sources as NORML. No wonder the public becomes confused and ends up returning to their personal bias and agenda regarding Marijuana legalization. Who is right? What side has reasonable and valid support from existing research and empirical data?

Cannabis contains over four hundred chemicals. The most notable for its psychoactive effect is THC which is present in the resin near the flowering tops of the female cannabis plant. The sacred writings from India, over three thousand years ago, made note of the headache and stress reduction benefits of Marijuana. They considered it one of the five sacred plants. THC has been found in the internal organs of Egyptian mummies and records show that the Chinese have cultivated the plant for fiber and its medicinal effects well over two thousand years ago. Marijuana use has been with us for quite some time.

Over the past 2 decades we have discovered receptor sites in specific regions of the brain such as the Hippocampus, Cerebellum, Basal Ganglia, Limbic Systems and other reward centers that were receptive and compatible with the THC molecule present in Marijuana. Therefore, as with the discovery of the opiate receptor prior to the discovery of endorphins, it follows that we must have an endogenous neurotransmitter similar to THC that has some benefit to our physiologic function. Two such neurotransmitters so far have been found, Anandamide and 2-AG. Both found shortly after detecting the brain’s cannabinoid receptor sites and more may soon be discovered.

We use Marijuana for its physical, mental and emotional effect. These effects are both short term and long term. The research and empirical data tend to indicate that those effects can be brief and slightly beneficial but can also be highly detrimental over the short and long term. Let’s take a look at some possible benefits. One of the short term benefits is physical relaxation, euphoria and sedation, the primary desired effect by the recreational user. Marinol, the synthesized form of THC has been shown to have a positive effect on reducing nausea, enhancing appetite and the eventual weight gain of cancer patients on chemotherapy. Other beneficial therapeutic uses may be with Glaucoma, although the benefit is short term, and alleviating some of the symptoms of Multiple Sclerosis. All seem to be a reasonable and valid benefit, a benefit that supports a medical use for Marijuana, in the pharmaceutical form.

The detrimental effects of the use of Marijuana would be disruptions in short term memory and the inability to store and retain new information. THC remains in the brain 2 to 3 days after use resulting in a distorted cognitive function during that time. Since THC is fat soluble a past user can, and in my practice has, tested positive for THC even after stopping use for a month or more. With that in mind how do we test for impairment with drivers, machine operators, healthcare or travel personnel in states that have legalized recreational Marijuana? In other words, how do we know when they are under the influence? Other long term negative effects of Marijuana and its four hundred associated chemicals, including significant levels of the carcinogen Benzopyrene, are chronic respiratory conditions such as bronchitis and emphysema. Marijuana use increases
heart rate by about 30% and reduces heart pumping efficiency. Studies have suggested that the risk of heart attack can increase up to 4 times normal shortly after Marijuana use. Other studies have found immune system deficiencies due to Marijuana leading to possible increases in severity and rates of infection. Alterations in the reproductive systems in both men and women have been shown as a result of the suppression of reproductive hormones.

Is Marijuana Addictive? Addiction is proportional to the degree that a substance or an activity will stimulate the reward system of the brain, primarily the Midbrain, the Nucleus Accumbens, and the Limbic System. Marijuana is not the equivalent of Heroin, Alcohol or even Cocaine in the degree and potential for defined clinical addiction. However, we know that THC stimulates the brain’s reward system. Therefore, it follows that the greater the frequency of Marijuana use and the higher the potency of THC, through improved cultivation of the product or increased resin concentration as in Hashish, the greater the potential risk for addiction. I see Marijuana addiction in my practice on a regular basis. It can manifest various symptoms of withdrawal such as anxiety, restlessness, tremors, and insomnia in those who have had increased concentrations and frequency of use over time. Yes, Marijuana is addictive. Marijuana is addictive to the Mind, to the Body, and to the Spirit.

Is Marijuana a Gateway Drug? It is for some and it is not for others. Did The Illustrated Man begin with one Tattoo? Yes, but everyone who gets a tattoo does not end up with full body ink. Even in abuse and addiction we eventually choose our drug of choice. The Marijuana user may stay with that drug or stop completely. They may partner it with another drug of a different physiologic effect such as Alcohol, Nicotine or Methamphetamines. They may discard Marijuana totally and move on to other drugs or behaviors that provide a change in physical, mental and emotional states. I would refer you to an article I wrote in the October 2013 issue of The Sober World Magazine, page 10, entitled Family, Personality, Brain Chemistry and Addiction. I discuss why and how we discover our drug of choice. Why every addict is not addicted to everything, just some things. Now we are back with the question at hand. Should Marijuana be legal for recreational use? Two states have voted yes. Where do we go from here? You will have to decide for yourself and you may have to do it before the next election. For what it may be worth I will give you my opinion on the subject.

We are not winning the war on drugs and as a nation I don’t believe we ever will. We only win this war by being responsible informed individuals and setting standards, based on our moral and ethical foundations. I believe the recreational use of Marijuana is, and eventually will lead to, destructive behavior. The destructive effects of that behavior extend beyond the individual user. As citizens we have the right to debate and to determine the type of society we want to live in. I believe a society willing to tolerate and condone destructive behavior is a society in decline. Therefore, I am against the legalization of recreational Marijuana. It will not take long to see whether I am right or wrong.

Dr. Michael J. De Vito is a diplomate and is board certified in Addictionology. He has been an instructor of Medical Ethics, Clinical Pathology, Anatomy and Physiology at the College of Southern Nevada. He is the founder and program director of NewStart Treatment Center located in Henderson, Nevada. He is presently in private practice helping patients from all parts of the world attain and successfully live a life of recovery from substance abuse and addictive behavior. NewStart Treatment Center utilizes a drug free and natural approach to addiction treatment. www.4anewstart.com
Dr. De Vito is the author of Addiction: The Master Keys to Recovery www.AddictionRecoveryKeys.com