Medical and recreational marijuana have each been legal in Colorado for a number of years now, and the tide of social opinion is rapidly changing. Today, the general consensus is that as marijuana use continues to become more acceptable, it will be decriminalized in more places. Right now, some degree of use is legal in all but four states. This is why many people look at pot as at worst similar to alcohol—a personal choice for relaxation and social interaction. They think marijuana is harmless. But is it REALLY? https://www.womensrecovery.com/wp-content/uploads/2019/04/latisha-bader.jpg To clear up some misconceptions and to get a different perspective on marijuana, we spoke to Dr. LaTisha Bader, Ph.D., our Chief Clinical Officer at Women’s Recovery. Dr. Bader has worked in the addiction and mental health field for over 16 years, and her opinion of cannabis use is based on the latest medical and scientific evidence. To learn more about Dr. Bader or any other member of Women’s Recovery’s staff, click here.
Marijuana as a Gateway Drug
Q: Marijuana has been described by many addiction industry professionals and experts as a “gateway drug,” in that its recreational use creates the possibility that users will go on to illegal and higher-class drug use to seek a more powerful “high.” U.S. government statistics appear to back this theory up. Do you consider marijuana to be a “gateway drug”? A: This is one of my least favorite questions to answer because of the nuanced definition that has been misused, regarding cannabis, for almost the last 60 years. The strict definition of a gateway drug is: /ˈɡātwā ˌdrəɡ/ noun
- a habit-forming drug that, while not itself addictive, may lead to the use of other addictive drugs.
- “many believe that alcohol and cigarettes are gateway drugs that increase the risk of subsequent involvement with illegal drugs”
So if you join me on an honest journey, it has always been addictive. The addiction rates for cannabis continue to replicate those of other drugs. One in ten (10) adults who try cannabis will become addicted, and one in six (6) adolescents. These rates are based on research that used cannabis with a THC content of 12%, so there is a concern when we are living in a world of up to 42% THC in plants and 99% THC in concentrates. (And my numbers are probably out of date by the time this is posted). When it comes to “recreational” use, I don’t believe we can use that term any longer. Age of onset, frequency of use, and the intensity (potency) have made the use of cannabis its own drug journey that leads to rapid dependency, sometimes irreversible mental health impacts, and a drug that now has no perceptible ceiling. Thanks to the industrialization of this drug, I don’t think individuals have to change substances to “seek a more powerful high” they just have to learn how to use cannabis bigger, harder and faster.
Fact Check #1
According to recent research, today’s dispensary marijuana is around eight times stronger than what was typically available on the street a generation ago. And as far as marijuana being a typical gateway drug to other substances, consider this—chronic marijuana use results in:
- A quintupled risk of alcoholism.
- A more than doubled likelihood of prescription opioid misuse.
- This is significant because 80% of heroin addicts start off by abusing prescription painkillers.
- A risk of cocaine use that is up to 323 times higher than people who don’t use any sort of gateway drug.
Marijuana is NOT Medicine
Q: Do you consider that the rise in the decriminalization of marijuana globally and its use as a prescribed medicinal treatment has or will cause an increase in its rates of dependence? A: I do not believe that decriminalization has as much of an effect on dependency, as the publicized stance that it is medicinal. This is not a prescribed substance; this drug can be recommended by a provider that can sometimes be benefitting from the sale of it. It would be like comparing it to a provider who recommended you drink 2 glasses of wine each evening, then be paid by a manufacturer. Then you go to a dispensary or the streets and self-determine how much and how potent your cannabis will be. Often an individual is not monitored by the provider that recommended cannabis use as they interact with this substance on a regular basis, i.e., blood work, liver tests, urine analysis. Cannabis is not medication. Although it might have some effect on your health, it has not met criteria for medicinal use. The Controlled Substances Act outlines that to have a “currently accepted medical use in treatment in the United States,” a substance must meet a five-part test:
- The drug’s chemistry must be known and reproducible,
- There must be adequate safety studies,
- There must be adequate and well-controlled studies proving efficacy,
- The drug must be accepted by qualified experts, and
- The scientific evidence must be widely available.
According to the DEA, botanical marijuana meets none of these requirements.
- First, marijuana’s chemistry is neither fully known nor reproducible.
- Second, adequate safety studies have not been done.
- Third, there are no adequate, well-controlled scientific studies proving marijuana is effective for any medical condition.
- Fourth, marijuana is not accepted by even a significant minority of experts qualified to evaluate drugs.
- Fifth, published scientific evidence concluding that marijuana is safe and effective for use in humans does not exist.
We interact with many substances that bring us mind/mood altering effects and can provide relief for unthinkable emotional and physical pain. Cannabis does this for some, but it also has severe consequences. If you interact with it like a medicine, taking it daily, you would put yourself at risk knowing that, 1 in 2 daily users develop cannabis dependence. Just like alcohol, if used as a daily medication, it would put you well above at-risk use determined by the surgeon general. I don’t believe we can use universal terms like medicinal and then not have a safety protocol in place, like regular check-ups with a physician, dosing, or appropriate warnings.
Fact Check #2
From the Food and Drug Administration: “To date, FDA has not approved a marketing application for cannabis for the treatment of any disease or condition and thus has not determined that cannabis is safe and effective for any particular disease or condition.” And in regard to Dr. Bader’s statement about risk, numerous independent studies have shown that regular marijuana use can result in:
- Premature brain aging.
- Decreased brain volume and lowered IQ.
- Higher risk of heart attack or stroke.
- Reduced bone density, increasing the chances of a fracture
- Sexual dysfunction in men.
- A risk of psychosis that is five times higher than non-users.
- Worsened bipolar disorder.
- Increased risk of schizophrenia.
- Harm to fetal development.
Marijuana is Marijuana
Q: What is the pharmacological difference between medicinal marijuana and the contents of a spliff or pipe used to get high? A: Nothing. It is the same drug. When purchased medically, it has a lower tax rate and can be obtained by a younger population.
Fact Check #3
The main difference is who may legally buy and use the drug. In the State of Colorado, medical marijuana may be purchased by anyone 18 or older, if they have a qualifying condition and written consent from a medical doctor. They may not fill their marijuana prescription at a pharmacy, and must instead use a licensed dispensary or caregiver, or cultivate their own plants. Qualifying medical conditions include:
- Chronic pain
- Multiple Sclerosis
- Nervous system disorders
- Spastic disorders
Recreational marijuana, on the other hand, can be purchased and possessed by anyone age 21 or older, without the need for a medical qualification. It is important to note that ALL marijuana use, medical or recreationally, remains against Federal law. Because of this, the Colorado Court of Appeals ruled that employers may fire workers for using marijuana, even on their off hours. In other words, workers have no protection to use marijuana at any time.
Q: Clearly, there has been a change in attitudes globally toward marijuana over recent years, which will surely lead to it becoming more socially acceptable and, hence, an increase in the number of active users. Does this acceptability mean that all demographics, not just your typical 20-something college student, are more likely to engage in its recreational use? A: Statistics and marketing are screaming that the industry is looking for new users. Whether providing arthritic relief to baby boomers, adding flavor and smaller devices to the youngest of users, or keeping regular users interested with uncountable strains (marketed by the most famous of individuals) this industry is using every profiteering strategy they can. They have learned the best lessons from the alcohol industry by targeting demographics of culture, to the duplicity of big tobacco testifying to its innocuous existence. If you read any basic business article reflecting on how to attract and retain customers, the key is to….entice new users, to make recreational users regular users, and keep regular users loyal. If you interact with cannabis marketing, the industry is knocking it out of the park! And if you haven’t received a recent BOGO from them, I just saw that you can earn a free Whip It, or 10 pack of Kratom on your next visit. There was a coupon for organic cannabis and lubricants, followed by a walk to the local farmer’s market to see the same product being marketing to alleviate 13 different types of ailments, many experienced by the 40+ crowd. I think they are covering the market from young to old.
Fact Check #4
According to recent research, the more medical marijuana ads a teenager watches, the more likely they are to smoke pot themselves. The study’s lead author, Elizabeth D’Amico, a senior behavioral scientist at the RAND Corporation, said: “Our findings suggest that increased exposure to medical marijuana advertising is associated with increased marijuana use and related negative consequences throughout adolescence. This work highlights the importance of considering regulations for marijuana advertising that would be similar to rules already in place to curb the promotion of tobacco and alcohol across the United States…we must think carefully about the best ways to regulate marijuana advertising so that we can decrease the chances of harm all occurring, particularly for adolescents.” A 168-page report put out by investigators with the Rocky Mountain High-Intensity Drug Trafficking Area says:
- Colorado ranks #1 in the nation for adult marijuana use, with a rate that is 124% higher than the national average.
- But Colorado also leads the country in underage marijuana use, with a rate that exceeds the national average by 55%.
Marijuana Addiction is Real
Q: Yes or no. Is marijuana actually addictive? A: Yes.
Fact Check #5
According to the National Institute on Drug Abuse, up to 30% of marijuana users have some degree of Marijuana Use Disorder, the modern term for addiction. Let’s do the math:
- There are approximately 5.7 million Colorado residents, with around 4.42 million adults and 1.29 million juveniles, per the US Census.
- The Colorado Department of Public Health and Environment reports that 15.5% of adults and 19% of youths are current marijuana users.
- That works out to over 695,000 adult and more than 245,000 underage marijuana users in Colorado.
So right now, there are 280,000 Coloradans with some degree of marijuana addiction.
What You Need to know about Marijuana Use Disorder
Q: What is Marijuana Use Disorder and what are the symptoms? A: Because of the increasing concern about this substance, the following criteria were amended in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Intoxication:
- Recent use of cannabis
- Clinically significant problematic behavioral or psychological changes (e.g., impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment, social withdrawal) that developed during, or shortly after, cannabis use
- At least 2 of the following signs, developing within 2 hours of cannabis use:
- Conjunctival injection
- Increased appetite
- Dry mouth
- Symptoms not due to a general medical condition and not better accounted for by another mental disorder, including intoxication with another substance
- Cessation of cannabis use that has been heavy and prolonged (ie, usually daily or almost daily use over a period of at least a few months).
- Three or more of the following signs and symptoms develop within approximately 1 week after cessation of heavy, prolonged use:
- Irritability, anger or aggression
- Nervousness or anxiety
- Sleep difficulty (ie, insomnia, disturbing dreams)
- Decreased appetite or weight loss
- Depressed mood
- At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache
- The signs or symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
(This can often be misdiagnosed for other mental health concerns, and they might not follow up with substance use questions or screeners.) Withdrawal peaks at 4 days, can last up to 16 and is more severe in women.
Criteria for Substance Use Disorder:
- Taking the substance in larger amounts or for longer than you meant to
- Wanting to cut down or stop using the substance but not managing to
- Spending a lot of time getting, using, or recovering from use of the substance
- Cravings and urges to use the substance
- Not managing to do what you should at work, home or school, because of substance use
- Continuing to use, even when it causes problems in relationships
- Giving up important social, occupational or recreational activities because of substance use
- Using substances again and again, even when it puts you in danger
- Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
- Needing more of the substance to get the effect you want (tolerance)
- Development of withdrawal symptoms, which can be relieved by taking more of the substance.
2-3 of the criteria: Mild Use Disorder 4-5 of the criteria: Moderate Use Disorder 6+ of the criteria: Severe Use Disorder
Fact Check # 6
Dr. Wes Boyd, PhD, an Associate Professor at Harvard Medical School, says, “Even though the physiological effects of cannabis withdrawal are generally mild, it is not correct to conclude that marijuana is not addictive, because being addicted to something is more than simply being physically dependent on a drug and experiencing physiological effects if the drug is stopped suddenly.”
Defining the Term
Q: Can Marijuana Use Disorder lead to an actual addiction? A: It IS an actual addiction.
Fact Check #7
The terms mean the same thing. In the latest literature, including the DSM-5, the phrase “use disorder” replaces the word “addiction”. This change was made to highlight that addiction is a disease. As such, it has identifiable symptoms and specific recommended treatments.
Treating Marijuana Use Disorder
Q: What is the optimum treatment for someone who has a marijuana dependence and/or addiction? Please describe the various elements of that. A: The optimum treatment, follows that of any substance. It would start by participating in the evaluation and completing a comprehensive assessment of the individual. It is important to take into account addiction, mental health, and trauma histories, and to gather biological, psychological and social information. Then, evaluate the ASAM (American Society of Addiction Medication) dimensions of addiction and place the individual in the appropriate level of care. This may range from inpatient treatment, if the individual is experiencing severe symptoms, to outpatient care. The best treatment would include individual therapy, group therapy, case management/recovery coaching, addiction psychiatry, family counseling, mutual aid groups, sponsorship, and community. MA (Marijuana Anonymous) has become a place to support the individuals that know this is a disease and that cannabis is addictive. We have learned that the longer an individual can stay engaged in treatment and a fellowship community the likelihood of their recovery increases significantly. And since cannabis is becoming more pervasive in our daily lives, it’s important to provide holistic, individualized, wrap-around services for an individual.
Fact Check # 8
According to an article in the Los Angeles Times, the length of time a person remain in treatment is an excellent predictor of success or failure in recovery. People who stay in rehab for 90 days or more—residential, outpatient, or a combination — relapse at half the rate of those who leave sooner or participate in shorter programs. Addiction expert Dr. Harry Haroutunian says, “Treatment is dose-related. More is often better, depending on what you do with the time.”
Marijuana and Your Child
Q: From a medical perspective, what advice would you give a parent who believes that either their son or daughter is using marijuana or, should they already be aware, that the recreational use of the substance is now getting out of control, eg. affecting their mood, coherence, studies, etc. A: I would encourage a parent to address any changes in behavior or mood, quickly. The effects of cannabis can be subtle or drastic, depending on potency, frequency of use, and route of administration. Individuals may only interact with the drug a couple of times and have something occur or use small amounts and changes could be less noticeable. Although the psychoactive nature of cannabis can pass quickly, components of the drug are known to stay in the body for very long periods of time. Parents can look for…. Effects on the Body:
- Motor: slowed reaction time, (poor) motor coordination and perceptual accuracy
- Cardiovascular: difficulty intaking oxygen, increased heart rate, increased risk of bronchitis, increased risk of heart attacks and strokes
- Autonomic nervous system: inhibits sweating and temperature control
- Electrolyte imbalance
- Changes physical structure of the brain
- Weakens immune system
- (Negatively affects) reproductive systems
- Causes cannabinoid hyperemesis syndrome.
Mental Health Changes: (Acute)
- Impaired memory
- (Poor) judgment
- Risk of depression is higher
- Acute anxiety
- Increased risk of anxiety disorders
- Worsened outcomes in bipolar disorder
- Risk of suicide attempts requiring hospitalization (2 x higher)
- Reduced verbal learning
- Memory (loss)
- (Shortened) attention
Fact Check #9
The effect of marijuana on your child’s still-developing brain cannot be ignored. The Centers for Disease Control and Prevention specifically mentions how young people are particularly susceptible to marijuana’s harmful effects, especially to those regions of the brain responsible for attention, learning, memory, coordination, reaction time, emotions, and decision-making. Impairments to these abilities can negatively impact mood, relationships, academic achievement, and even future success.
Recovering from Marijuana Use Disorder
Q: Can a marijuana addict hope for a full and long-lasting recovery? A: Yes. If they engage in treatment to the level of the severity of the disorder, they have a great change of long-lasting recovery. We often underestimate how much and how long we need to engage in treatment (it’s a marker of distorted thinking). But when we engage in treatment and a recovery community it brings a message of hope, happiness, and a life worth living!
Fact Check #10
Today, we know more about the disease of addiction than ever before. For example, although we are still learning, it is now understood that addiction is a disease of the brain and that knowledge helps to shape the evidence-based treatment strategies that help support a successful recovery. Treating an addiction as a legitimate medical condition allows caregivers to apply the same treatment approaches that are used for other chronic illnesses such as asthma, high blood pressure, or diabetes. In each case, the combination of lifestyle changes approved medications, and support is the key to managing the disease and avoiding the worst complications. It is the same way with marijuana addiction. While there are no currently-approved medications to reduce cravings for marijuana, there are prescription drugs that can alleviate some of the physical and mental discomfort of withdrawal. In fact, Medication-Assisted Treatment—the combination of counseling and approved prescriptions—is considered the “gold standard” of evidence-based addiction treatment.
The Bottom Line about Marijuana
Our thanks to Dr. Bader for the interview. As the facts show, she is absolutely right about the dangers associated with marijuana use. Despite anecdotal evidence and wishful thinking, science clearly debunks the notion that marijuana is completely harmless. Because of legalization and the increased availability of high-potency marijuana in Colorado, it is entirely possible that you or someone you care about has developed a Marijuana Use Disorder. If this is the case, the best thing you can do for your/their current and future health is to seek specialized professional help TODAY.