As defined by the CDC, an epidemic is the occurrence of more cases of disease than would normally be expected in a specific place or group of people over a given period of time. Drug addiction in the United States has reached epidemic proportions and continues to grow. Certain things have been shown to make drug addiction epidemics worse, especially substance availability and perceptions of safety. The recent pain pill crisis is a good example to illustrate both. Many people who would otherwise never have gotten into opioid addiction did so because a clean looking little blue pill with a precisely measured dose is far less scary that a baggie of mysterious powder that seems to have different colors depending on the grade or where you buy it. Heroin has been around for ages but opiate addiction really took off when the pill mills were selling oxycodone like if it was the newest version of the iPhone. The combination of perceived safety and availability quickly resulted in the pain pill epidemic. Once addiction develops it is treatable but not curable. A second epidemic developed when the pill mills were shut down and the supply of heroin continued to increase. Because they were already addicted to one opioid drug, a transfer to the increasingly abundant heroin was very easy. Most of the northeast coast is still trying to figure out what to do about their heroin epidemic.
The pain pill and heroin epidemics are actually good predictors of some of the expected trends with legalized marijuana.
We already discussed perceptions of safety. Availability of cannabis would surge, and to a greater degree than in Colorado and other states. Florida, especially South Florida, is very entrepreneurial and is very quick to jump on the next big cash cow. Remember when every strip mall in Broward and Palm Beach counties had a pain clinic? It would be less than 2-3 years before we saw equally if not even more marijuana dispensaries. Colorado is already having great difficulty even attempting to regulate the dispensaries in their state. A similar problem would be seen here, as was the difficulty and delay in regulating the pill mills in Florida being the prime example of how it would look.
So why are pain pills and marijuana so difficult to manage? This difficulty has to do with the principle of “legalized vice”. Humans really like vice. They go out of their way to break laws and spend large amounts of money to get vice. So what happens when you legalize it? In the human mind, it is still a vice and has the allure of vice but now just easier to get. Pain pills were actually not widely considered vice until one of them came out that could be easily crushed and snorted or used intravenously. Marijuana has always been a vice. Legalizing it will not change this conscious, if not at least subconscious perception. Like other vices, cannabis is typically not consumed in small or precise quantities. It is most often consumed to excess, to a point of intoxication. It is a fundamental part of the marijuana culture. Medications are taken in small and precise quantities. Good luck breaking that habit with medicinal marijuana. This behavioral propensity would be even worse in someone who had reached the point of Cannabis Dependence or was in recovery from other drugs.
The effect of legalized marijuana on the recovery population is potentially catastrophic. The last thing someone in recovery needs is to be inundated with hype regarding overstated medicinal benefits of a legalized vice. Some may become psychologically enabled by a diagnosis of PTSD that could give them a license to consume THC. It is very difficult to change the mind of someone who believes you are trying to take away a part of their “treatment” and thus hurting them. In reality the recommendation against Cannabis as a treatment option would be no different than a recommendation against Xanax, another legal but problematic “medication”. Xanax has “legally” been around for years and it is no better now for someone in recovery than it was when it first came out. Those that are strong in their recovery can look past this, but those that are more vulnerable, are at risk of being seduced. This effect has already been seen with all of the Kratom dependence problems and precipitated drug relapses caused by the Kava bars. Many Kratom users argue that their use is “medicinal” and that they are treating themselves in a way that bypasses the greed of Big Pharma. They are often ferocious in the defense of their Kratom use despite stunted personal growth and a progressive decline in their global functioning. Attempts at banning Kratom have come close but have been sabotaged by political interference from special interest groups (Kratom users and Kava bar owners). The impact from medicinal marijuana stands to be worse due to the greater cultural following of cannabis and the much greater degree of media exposure.
Medicinal marijuana is not without some potential benefits but it is also not without serious far-reaching problems. On its best day, it is a problematic and controversial medication. It may help some people with certain specific conditions but unfortunately will hurt far more due to the human vulnerability to vice and problems with the culture we all live in. It will be especially damaging to individuals with active drug use or early in recovery. In light of the escalating addiction crisis, the legalization of the quintessential “gateway” drug really adds fuel to the fire. The overall risks of legalized cannabis to a large segment of the population far outweigh the potential benefits to a very small segment. It was legalized due mostly to the shortsighted financial benefits and unfortunately the aforementioned problems will ultimately manifest. The best hope to contain the problems is a massive drug education campaign directed at the entire population, but especially the segments that are most vulnerable such as our youth and those in recovery.
Dr. Rodriguez is the founder and Medical Director of the Delray Center
For Healing, the Delray Center for Brain Science, and the Delray Center
For Addiction Medicine. He is board certified in both Adult Psychiatry
and Addiction Medicine, with a clinical focus on Treatment Resistant
Depression, Bipolar Disorder, Anxiety Disorders, Addiction and Eating
Disorders. The Delray Center is a comprehensive outpatient treatment
center that incorporates the most advanced psychotherapeutic and
medical modalities, such as Dialectical Behavioral Therapy (DBT) and
Transcranial Magnetic Stimulation (TMS), in the treatment of complex
and dual-diagnosis cases. www.delraycenter.com,