Behavioral Healthcare Tomorrow By Peter Provet, Ph.D.
The debate over the legalization of marijuana is of paramount importance to treatment providers, healthcare professionals, educators, criminal-justice officials, families, and the millions of American men, women and adolescents whose lives are at risk because of marijuana.
It’s a debate that has shifted focus over the years from libertarian “freedom of choice” positions to medical applications to, most recently, a ballot initiative in Nevada that proposes the creation of far-reaching legislation that would eliminate penalties for possession of an amount less than three ounces, and regulate marijuana in a similar manner to tobacco and alcohol.
Several years ago the idea of marijuana as a state-regulated industry would have seemed far-fetched at best, but that was before marijuana achieved its current status of a cause célèbre, thanks in large measure to well-funded, private advocacy groups. These groups (NORML, Drug Policy Alliance, etc.) have successfully captured media attention by pointing to excessive prison sentences, by highlighting medical benefits of marijuana use for the chronically ill, and by distancing marijuana users from other drug abusers.
While I agree with some of these positions, and have for example argued in favor of reform of the criminal-justice system, as a treatment provider I believe legalizing marijuana would fundamentally harm our nation’s youth, and that the increased harm to adolescents far outweighs the concerns of adults who wish to possess and use marijuana in a less restrictive, more public manner.
It is critical to first recognize that marijuana abuse has damaged the lives and well-being of countless American youth, some to the extent that they require intensive, residential treatment, and others through derailed educational and career goals, strained family relations. In general, lost potential.
Adolescent marijuana users – such as the ones admitted to treatment at Odyssey House and other residential treatment centers across the country – exhibit a disturbing range of psychosocial and developmental deficits that require intensive treatment. These include: learning difficulties, cognitive impairment, a lack of motivation, antisocial attitudes and behaviors, an egocentricity fueled by hostility and self-doubt.
It is based on my 15 years’ experience treating drug-troubled adolescents and young people – the majority of whom were in treatment because of marijuana use – that I categorically believe marijuana must not be legalized. Legalizing marijuana would undoubtedly lead to increased general use and, despite any well-intentioned age restrictions, increased use among our nation’s children.
A comparable example, where a law was changed to protect a minority at some inconvenience to the majority, is speed limits.
In 1973, national speed limit guidelines were significantly reduced from 75 mph to 55 mph. One year later, 4,000 fewer people died on the nation’s roads.
The point is this – many of us drive faster than stated speed limits, perhaps on a consistent basis. Huge numbers of otherwise law-abiding citizens break the law without harm, while many find pleasure in doing so. Why should we not raise the speed limits further? Four thousand more deaths vs. the pleasure and convenience of many.
Marijuana legalization follows a similar argument. Why inconvenience the majority of responsible adult users – just who this group is, I’m not sure – for the sake of a minority of irresponsible, young users?
Let’s start here:
1. On par, pot is bad for you. Its negative effects on teenagers – physical, psychological, social – are well-documented. In 1998, nearly 77,000 people were admitted to hospital emergency rooms suffering from marijuana-related problems. This was an increase of more than 373 percent since 1991 (National Institute on Drug Abuse (2001), NIDA InfoFacts: Marijuana).
2. Pot is addictive. Addiction is presently defined by how the use of a substance impairs a broad array of life arenas, not just whether the substance is physically addictive, demonstrated by tolerance and withdrawal states. Ironically, however, recent studies (Gianluigi et al. (2000), Nature Neuroscience, 3, 1073-1074 and Budney et al. (2001), Archives of General Psychiatry, 58, 917-924) have discovered a withdrawal pattern in marijuana users shortly after they quit, which includes persistent cravings, decreased appetite, sleep difficulties, weight loss, increased aggression, irritability and restlessness.
3. Teen pot use is steady, if not on the rise – as are pot-related arrests. The latest data from the well-respected Monitoring the Future Survey, a national survey of high school kids, show that in 2001, past marijuana use among 12th graders is 37 percent and daily use is holding steady at 5.8 percent, a significant increase from a low of 2 percent in 1991. The number of cannabis-involved arrests by year in New York City has climbed from 4,762 in 1991 to 50,830 in 2000 (NIDA (2000), Epidemiologic trends in drug abuse. NIH Community Epidemiology Work Group). In New York City, 33 percent of 1999 arrestees were 16- to 20-year-olds.
At Odyssey House, drug-troubled teens overwhelmingly identify marijuana as their drug of choice. In 2001, 98 percent of the teens admitted to treatment, 14- to 18-year-olds, cited marijuana as their primary drug of abuse. In the next oldest peer group, 19- to 21-year-olds, 62 percent cited marijuana, 6 percent heroin, 12 percent cocaine, and so on. But in the 22- to 30-year-olds, 21 percent claim marijuana, 30 percent crack, and 13 percent cocaine, and amongst 31- to 40-year-olds, only 7 percent claim marijuana as their primary drug of abuse, 30 percent heroin, 47 percent crack, 6 percent cocaine.
Granted this is but a snapshot of the approximately 800 individuals admitted to Odyssey House in one year; what is significant, and replicable across numerous treatment centers, is how quickly marijuana retreats as the primary drug of abuse and how quickly hard-core drugs, such as heroin, crack, and cocaine, take its place.
What does this suggest? To me, it shows that marijuana makes way – or paves the way – to hard-core drug use. Let me be clear. This is not to claim that marijuana is a gateway drug. I don’t believe occasional use of marijuana necessarily leads to hard-core addiction; in fact, usually it does not. But, and this is the key point among the men and women who are addicted to heroin and cocaine, the overwhelming majority abused marijuana first.
While we may not yet know all the biological ramifications of marijuana exposure, there is a growing body of scientific evidence that is beginning to document biological impact.
Driven to a large extent by the debate over the use medical marijuana for pain relief, nausea and loss of appetite by people with AIDS, cancer and other debilitating diseases, scientific understanding of cannabis has evolved such that researchers have discovered receptors for cannabis molecules – known as endocannabinoids – in the brain and body.
What is so compelling about these scientific discoveries is how clearly they bear out the treatment community’s understanding of treating kids addicted to marijuana. How so? What we observe in treatment as cognitive and psychosocial deficits – or delays – in the youngsters we treat can at least partly be explained by the effect of flooding the brain (in particular the hippocampus which is known to be the part of the brain involved in learning and memory) with endocannabinoids.
A report published in Nature (Wilson, R., and Nicoll, R. (2001), Endogenous cannabinoids retrograde signaling at hippocampel synapses. 410, 588-592) earlier this year found that endocannabinoids occur naturally in the body, and researchers suspect they play an important role in helping to lay down new memories by strengthening the connections between nerve cells. But when the brain is flooded with cannabinoids through marijuana use, everything is marked for memory, the system is overwhelmed and little is remembered.
Many of the youngsters – and young adults – we treat tell us that marijuana’s ability to help them forget is what attracted them to the drug. These are kids whose lives are in sufficient turmoil that they are compelled to use a substance that numbs them out – gives them a way out, or a respite from personal and family pain. But they don’t just forget emotional pain, they also drop out of school, disengage from family and friends, lose interest in sports, etc.
How do we control teenagers’ access to marijuana if the drug becomes legal? I believe prohibition, while problematic, limits access and use by teens, and that is argument enough.
But another important aspect of prohibition that needs to be further developed is the interface between the addict, the criminal-justice system and treatment. In New York City we are fortunate to have well developed criminal-justice programs that effectively divert addicts from incarceration and into treatment.
These programs (DTAP, TASC, drug courts, etc.) work with us to identify individuals arrested for non-violent crimes with small to moderate amounts of drugs for personal use. We welcome these initiatives, but we need more community treatment as an alternative to incarceration.
Treatment is the most sensible, cost-effective, and successful solution to these problems. It can also be the most critical means of keeping drug-using adolescents from entering the criminal-justice system as addicts.
Of course, we need drug law reform. In New York, where Odyssey House is based, we need to reform the draconian Rockefeller drug laws, mandatory minimums, and penalties for crack. But we also need the means of pressure – I call it extrinsic motivation – that bring into treatment (often as an alternative to prison) those addicts who are most troubled, troublesome, and deep in denial.
No legalization formula eliminates all restrictions, but it would be much more difficult to regulate use of a presently illicit drug than to prohibit it. Even in the Netherlands, the country most quoted as a model example of legalization, efforts are now underway to control the commercialization and marketing of marijuana, as the number of marijuana coffee shops in Amsterdam alone has reached 450. Understandably, the Dutch public is alarmed over the unwelcome increase in so-called Narco-tourism.
I cannot emphasize this strongly enough: Drug laws have not created the problem. Drug abuse is the problem, and all the social ills that derive directly or indirectly from it.