Introduction
Contrary to popular myth, marijuana is an addictive and debilitating drug, and currently at the center of much political, legal, medical and social controversy. The best available evidence reveals that 22.2 million Americans currently use marijuana, with more starting every day. In fact, marijuana use is increasing in nearly all demo-graphic groups. It seems that everyone’s favorite drug of abuse is viewed as safe until proven dangerous. In spite of the evidence that, on average, 9 percent of those who use marijuana will become ad-dicted to it—and for those who are initiated as children or adoles-cents, that percentage nearly doubles, to 17 percent, or 1 in 6.
“Marijuana use is associated with adverse health consequences, including damage to specific organs and tissues and impairments in behavioral and neurological functioning. Among these are acute impairments in the performance of complex tasks such as driving a motor vehicle. Marijuana-related crashes, deaths and injuries are currently a major highway safety threat in the United States.”
~ ASAM, 2013
In spite of these data, many people, including some physicians and healthcare professionals, believe that the use of cannabis is benign, or at least no more harmful than small amounts of alcohol. In recent years the controversy has escalated, as several states have legalized the use of cannabis for either medical or recreational use, and some states have done both. As scientist’s we look to the peer reviewed literature for evidence regarding the nature and effects of psychoactive drugs, including their safety profile, as we are honor bound to “do no harm”. We have also witnessed, up close and personal, the tragic effects of marijuana in our patients, their families, as well as our friends, family members and colleagues. We have seen far too to many promising medical and professional careers derailed because of marijuana. Depression, severe anxiety, psychosis and suicide are strongly correlated with high potency cannabis. Yet, if crude marijuana was assessed via scientific methodology, like all other proposed therapeutics, instead of at the ballot box, it would have been disapproved for lack of efficacy and numerous safety concerns. This is why pro legalizers reject FDA standards and scrutiny. They know what we know. If medical marijuana advocates were seeking FDA approval as a medicine to treat a specific medical condition, it would have to demonstrate, via double blind, placebo controlled clinical trials that it is equal to, or exceeds the safety and efficacy of medicines currently approved by the FDA for that specific condition. The medical marijuana advocates know that crude cannabis is not an effective medicine for the conditions they have claimed. If it were, those advocates would jump on the chance to own this patent. The truth is, there is NO empirically derived evidence to support FDA approval of crude marijuana for any medical problem. Conversely, there is a plethora of high quality evidence demonstrating the harmful effects of even moderate and occasional use, especially for children, teens and the unborn. This is not to say that there are no benefits associated with cannabis. For example, the off-label use of smoking or vaping marijuana by patients with stage 4 cancers, receiving palliative care, to limit their nausea, pain and suffering is widely practiced and acceptable. We do not know of any physician opposed to this practice. And, as we will discuss in part two, there is some exciting new research investigating the therapeutic use of a novel constituent of cannabis, Cannabidiol (CBD), (which is not mood altering), for the treatment of spasms associated with Multiple Sclerosis, Lennox-Gastaut Syndrome (LGS), a rare seizure disorder, and as a preparation to treat anxiety. But until any medication is proven safe and effective, it should not be approved by the FDA, or the ballot box.
The Epidemiology of Cannabis Use in the US
Today, 8,000 Americans will use an addictive drug for the first time—most of whom are children and teens. Of these first timers, 65.6% will use marijuana.
Figure 1: Breakdown by percentage of the drug of choice
In truth, most teens will escape their adolescence relatively un-damaged by drugs. But those who use marijuana early in life—are at greater risk for addiction. In addition, research bears out that these same early initiates often have other risk factors that make addiction more probable.
1. Parental addiction. Genetic factors now contribute at least 50%of risk for developing addictive disease.
2. Social and environmental risks include: Early life trauma, family dysfunction, concurrent medical or psychiatric disease (ADHD, depression or anxiety disorder), easy access to intoxicants, early maturation and looking older than age mates, etc.
3. Developmental transitions unique to the adolescent brain also influence the emergence and progression of substance abuse. The adolescent brain simply lacks the hard wiring associated with inhibitory control. In males, the prefrontal cortex does not fully function until age 25 and in females, until age 18 or 19. Thus, when intoxicants are consumed, the hedonic midbrain, through a complicated cascade of neurobiological events is energized, while the frontal areas, which serve to mediate and, when required, inhibit hedonically driven behavior that is potentially dangerous or contrary to one’s beliefs, goals and morality, fails to function. As a result, this drug induced state results in seeking quick rewards while minimizing or miscalculating the associated risks. It is not surprising that the number one cause of death for teenage males is alcohol and drug related trauma.
Monitoring the Future (MTF) 2016
MTF, in partnership with the University of Michigan, has been tracking adolescent drug use since 1975. It is gold standard of epidemiological data relevant to substance abuse among teens. In 2016, 45,473 students from 372 public and private schools participated in the MTF survey.
According to the 2016 MTF annual survey, the prevalence of cannabis use among students from 6th to 12th grade reveals that trends in marijuana use have remained stable for several years.
Highlights
7 percent of high-school seniors report smoking marijuana daily. Daily use of cannabis increases the risk of addiction by 4-7-fold, skyrocketing to somewhere between 25–50 percent. And because the MTF is a “snapshot” of current use, we can extrapolate these data, and see the dramatic increase between students in the 8th grade and those in the 12th grade. Thus, many young teens are well on their way to addiction, and all the consequences associated with growing up stoned.
In 2016, 9.4 percent of 8th graders reported marijuana use in the past year and 5.4 percent in the past month (current use). Among 10th graders, 23.9 percent had used marijuana in the past year and 14.0 percent in the past month. Rates of use among 12th graders were higher still: 35.6 percent had used marijuana during the year prior to the survey and 22.5 percent used in the past month; 6.0 percent said they used marijuana daily or near-daily.
Figure 2: Past-Year, Month & Daily Marijuana Use
*Percentages are rounded to the nearest whole number
Summary of Part One
Marijuana is a poorly understood psychoactive substance. Recent epidemiological data reveal that the prevalence of marijuana use is increasing among nearly all demographic groups, but especially among those under age 18. This is cause for concern for many reasons, but none more so, than the deleterious effects of cannabis on the developing brain. Recent research has demonstrated the multiple harmful effects associated with the use of cannabis.
For instance, adolescents who smoke marijuana once a week over a two-year period are likely to have lower scores on IQ tests, nearly six times more likely to drop out of school and over three times less likely to enter college.
The life trajectory for those who begin using earliest in life is wrought with academic failure, psychopathology, underemployment, multiple failed relationships and decreased life expectancy.
Part Two of this article will explore in depth the unique pharmacology and psychoactive effects of cannabis, including its potential for addiction, depression, low motivation, risky
sexual behavior, and the potential for using other drugs. Lastly, the challenges of prevention, treatment and recovery unique to adolescence will be described as well as recommendations to improve treatment participation, adherence and outcomes.
References Provided Upon Request
Mark S. Gold, MD, Chairman of the RiverMend Health Scientific Advisory Boards, is an award-winning expert on the effects of opiates, cocaine, food and addiction on the brain. His work over the past 40 years has led to new treatments for addiction and obesity which are still in widespread use today. He has authored over 1000 medical articles, chapters, abstracts, journals, and twelve professional books on a wide variety of psychiatric research subjects, including psychiatric comorbidity, detox and addiction treatment practice guidelines.
Dr. Drew Edwards is a behavioral medicine / addictive disease researcher, clinician, author, medical writer, and clinical consultant.
