Marijuana and Other Drugs: A Link We Can’t Ignore

by SAM (Smart Approaches to Marijuana)   Smart Approaches to Marijuana’s 2017 publication references academic studies which suggest that marijuana primes the brain for other types of drug usage.  Here’s the summary on that subject from page 4, Marijuana and Other Drugs: A Link We Can’t Ignore :

MORE THAN FOUR in 10 people who ever use marijuana will go on to use other illicit drugs, per a large, nationally representative sample of U.S. adults.(1) The CDC also says that marijuana users are three times more likely to become addicted to heroin.(2)

Although 92% of heroin users first used marijuana before going to heroin, less than half used painkillers before going to heroin.

And according to the seminal 2017 National Academy of Sciences report, “There is moderate evidence of a statistical association between cannabis use and the development of substance dependence and/or a substance abuse disorder for substances including alcohol, tobacco, and other illicit drugs.”(3)

RECENT STUDIES WITH animals also indicate that marijuana use is connected to use and abuse of other drugs. A 2007 Journal of Neuropsychopharmacology study found that rats given THC later self administered heroin as adults, and increased their heroin usage, while those rats that had not been treated with THC maintained a steady level of heroin intake.(4) Another 2014 study found that adolescent THC exposure in rats seemed to change the rodents’ brains, as they subsequently displayed “heroin-seeking” behavior. Youth marijuana use could thus lead to “increased vulnerability to drug relapse in adulthood.”(5)

National Institutes of Health Report

The National Institutes of Health says that research in this area is “consistent with animal experiments showing THC’s ability to ‘prime’ the brain for enhanced responses to other drugs. For example, rats previously administered THC show heightened behavioral response not only when further exposed to THC, but also when exposed to other drugs such as morphine—a phenomenon called cross-sensitization.”(6)

Suggestions that one addictive substance replaces another ignores the problem of polysubstance abuse, the common addiction of today.

ADDITIONALLY, THE MAJORITY of studies find that marijuana users are often polysubstance users, despite a few studies finding limited evidence that some people substitute marijuana for opiate medication. That is, people generally do not substitute marijuana for other drugs. Indeed, the National Academy of Sciences report found that “with regard to opioids, cannabis use predicted continued opioid prescriptions 1 year after injury.  Finally, cannabis use was associated with reduced odds of achieving abstinence from alcohol, cocaine, or polysubstance use after inpatient hospitalization and treatment for substance use disorders” [emphasis added].(7)

Moreover, a three-year 2016 study of adults also found that marijuana compounds problems with alcohol. Those who reported marijuana use during the first wave of the survey were more likely than adults who did not use marijuana to develop an alcohol use disorder within three years.(8) Similarly, alcohol consumption in Colorado has increased slightly since legalization. (9)

Data on Marijuana Policy for 2017

Here’s the complete Data on Marijuana Policy for 2017 in pdf form.

FOOTNOTES:

  1. Secades-Villa R, Garcia-Rodríguez O, Jin CJ, Wang S, Blanco C Probability and predictors of the cannabis gateway effect: a national study. Int J Drug Policy. 2015;26(2):135-142

2. Centers for Disease Control. Today’s heroin epidemic Infographics more people at risk, multiple drugs abused. CDC, 7 July 2015.

3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health andPublic Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda (“2017 NAS Report”).

4. Ellgren, Maria et al. “Adolescent Cannabis Exposure Alters Opiate Intake and Opioid Limbic Neuronal Populations in Adult Rats.”Neuropsychopharmacology 32.3 (2006): 607–615.

5. Stropponi, Serena et al. Chronic THC during adolescence increases the vulnerability to stress-induced relapse to heroin seeking in adult rats. European Neuropsychopharmacology Volume 24 , Issue 7 (2014), 1037 – 1045.

6. “Is marijuana a gateway drug?” National Institute on Drug Abuse. Jan. 2017. See also Panlilio LV, Zanettini C, Barnes C, Solinas M, Goldberg SR. Prior exposure to THC increases the addictive effects of nicotine in rats. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2013;38(7):1198-1208; Cadoni C, Pisanu A, Solinas M, Acquas E, Di Chiara G. Behavioural sensitization after repeated exposure to Delta 9-tetrahydrocannabinol and cross-sensitization with morphine. Psychopharmacology (Berl). 2001;158(3):259-266.

7.  2017 NAS report.

8.  Weinberger AH, Platt J, Goodwin RD. Is cannabis use associated with an increased risk of onset and persistence of alcohol use disorders? A three-year prospective study among adults in the United States. Drug Alcohol Depend. February 2016.

This is the second recent article on the gateway effects of marijuana use.   Since marijuana has already primed the brains of most people who get addicted to opioids, marijuana cannot replace pain pills.

marijuana-for pain

Current Research on Marijuana for Pain is Lacking

Is Marijuana Use for Pain Driving Negative Societal Effects?

by Kenneth Finn, MD

Pain is the most common diagnosis associated with marijuana being recommended for medical use 1. With more states moving towards accepting marijuana use for medical purposes, there is a call from the medical and scientific community for more research and
evidence that it actually works for common pain conditions.

Out of the top 20 medical diagnoses presenting to the primary care physician nationally, there are only 3 that are associated with a painful condition 2: spinal disorders (i.e., lower back pain), arthropathies and related disorders (i.e., knee arthritis), and abdominal pain.

There were no other pain diagnoses in the top 20 diagnoses which present to the primary care physician for treatment, including cancer pain or neuropathic pain.

What does the medical literature tell us about the use of marijuana for pain? In 2011, The British Journal of Pharmacology released a paper looking at the use for cannabinoids for the treatment of chronic non-cancer pain 3. They narrowed a broad literature review to only 18 trials with a total of 925 participants. Most of the trials reviewed studied neuropathic pain (72%), including HIV neuropathy, in multiple sclerosis (3 trials), and single studies looked at arthritis or chronic spinal pain. There were only 4 studies which looked at smoked cannabis and in neuropathic pain only. Six studies evaluated synthetic cannabinoids (Dronabinol, Nabilione) for pain (off-label use).

From these trials, the average number of patients was 49 with average duration of 22 days, some of which were one week long. Despite their conclusion that cannabinoids may be helpful for chronic non-cancer pain, they note there were limitations with small sample sizes, modest effects, and stressed the need for larger trials of longer duration to determine safety and efficacy.

In 2015, the Journal of the American Medical Association (JAMA) released an article on cannabinoids for medical use 4. Chronic pain was assessed in 28 studies, involving 63 reports and 2454 participants. 13 studies evaluated nabiximols (not available in the US), 4 for smoked THC, 6 evaluated synthetic THC, 3 for oromucosal spray, 1 for oral THC, 1 vaporized cannabis. The majority of studies looked at some form of neuropathic pain or cancer pain. Two studies were at low risk of bias, 9 at unclear risk, and 17 at high risk of bias. Studies generally suggested improvements in pain measures associated with cannabinoids but these did not reach statistical significance in most individual studies. Despite that, they concluded that there was moderate-quality evidence to suggest that cannabinoids may be beneficial for the treatment of chronic neuropathic or cancer pain (smoked THC and nabiximols). Note these are less common pain conditions that present to the physician for treatment nationally. The authors noted an increased risk of short-term adverse effects with cannabinoid use, including some serious adverse effects. Common adverse effects included asthenia, balance problems, confusion, dizziness, disorientation, diarrhea, euphoria, drowsiness, dry mouth, fatigue, hallucination, nausea, somnolence, and vomiting.

In 2017, The National Academies of Science, Engineering, and Medicine released a paper on the health effects of cannabis and cannabinoids 5. It may be important to note that none of the authors had a background in Anesthesia or Pain Medicine. The authors felt the above JAMA article was the most comprehensive and that the medical condition most often associated with chronic pain in that article was a neuropathy and a majority of studies evaluated treatment with nabiximols, which are not available in the United States.

The committee found that only a handful of studies evaluated the use of cannabis and that many of the cannabis products sold in state regulated markets bear little resemblance to the products available for research at the federal level in the United States. They also note that very little is known regarding efficacy, dose, routes of administration, or side effects of commonly used and commercially available products in the United States. Despite that, they still concluded that “cannabis is an effective treatment for chronic pain in adults”.

The above noted papers are all that is available to the public and medical community and are the only information available regarding treatment of pain with marijuana. Despite that, the public has embraced that marijuana can treat all pain conditions and state governments have followed suit, without scientific evidence, and have allowed an industry to prosper on the thin ice of what is currently and scientifically available.

It is important to understand that pain covers a broad spectrum of disorders and pain of different origins does not necessarily respond the same to different medications. It is also important to understand that dispensary cannabis is considered a generic substance without defined or accepted dosing guidelines and will vary in purity as well as potency. It may also contain hundreds of other compounds, some of which may have physiologic activity. Cannabinoids are purified components of the plant which have been isolated in a
laboratory and have more scientific foundation, but are currently not available for study or use in pain conditions in the United States.

Since de facto legalization in Colorado in 2009, there has been a significant increase in public health and safety concerns, which include utilization of the health care system, an increase in adolescent substance use treatment for cannabis, as well as an increase in marijuana related driving fatalities 6. The addiction rates are reportedly 9% in the adult and roughly 18% in the adolescent, which was based on the potency of marijuana nearly 20 years ago. The potency has significantly increased in the past 5 years alone, so we are now in uncharted waters and unable predict the long term effects or addiction rates of currently available, highly potent products, with variable delivery systems.

As the number of medical marijuana patients increased in Colorado, there appears to be a parallel increase in the number of adolescents needing substance use treatment, most often for cannabis. Colorado is now contending with a huge opioid and heroin epidemic and despite the widespread availability of Narcan, does not appear to have leveled off or curb the number of opioid or heroin deaths in the state which continue to rise 7.

Although the concept of using marijuana to decrease opioid use is attractive and there is little data to suggest that may be the case. According to the CDC, the number of drug overdose deaths in Colorado has continued to increase, ahead of the national average 8. The above problems are now landing in the laps of other groups such as law enforcement and mental health providers who are pushing back and are straining their respective resources.

In summary, the problem of increased marijuana use has origin in its purported use for pain, but the medical literature is completely void of evidence for the treatment of common pain conditions with cannabinoids or cannabis. Current medical literature suggests benefit in less common pain conditions, with products not commercially available in the United States, or with synthetic THC, not with dispensary cannabis. The variability of available products changes regularly and their use in medicine, particularly pain, is unproven. The end game is in the court of law enforcement, mental health providers, the medical community, and our educational systems, at unknown societal costs, which are only now
becoming apparent.

Kenneth-Finn-MD
Dr. Kenneth Finn is a pain medicine specialist

Kenneth Finn, MD
Board Certified, Physical Medicine and Rehabilitation
Board Certified, Pain Management
Board Certified, Pain Medicine
American Board of Pain Medicine
Exam Council
Executive Board
Appeals Committee

 
 
 
 
 

1. https://www.colorado.gov/pacific/sites/default/files/
CHED_MMR_Report_April_2017.pdf
2. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/
2013_namcs_web_tables.pdf, Table 16
3. https://www.ncbi.nlm.nih.gov/pubmed/21426373/
4. http://jamanetwork.com/journals/jama/fullarticle/2338251
5. https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-andcannabinoids-
the-current-state
6. http://www.rmhidta.org/html/
2016%20FINAL%20Legalization%20of%20Marijuana%20in%20Colorado%20The%20Imp
act.pdf
7. http://www.thedenverchannel.com/news/local-news/heroin-deaths-skyrocket-756-
percent-in-colorado-over-15-years
8. https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/

See Dr. Finn’s article, The Clinical Conundrum of Medical Marijuana

See PopPot’s previous article, Marijuana Can’t Substitute for Pain Pills

Marijuana Can’t Substitute for Pain Pills

The pot industry pushes marijuana use as a substitute for pain pills.  With a massive Public Relations effort, it uses the media to do its bidding.  However  — upon closer examination — the opiate and heroin epidemic mirror the legalization of marijuana.

The Opioid Commission headed by Governor Chris Christie should not pause one second to consider marijuana as a substitute for pain medication.  Save Our Society from Drugs asks that we petition this group not to consider marijuana as a treatment for pain.

Why So Much Chronic Pain?

Not everyone who becomes addicted to opiates started because of pain.  Those under age 35 who are dying from drug abuse at an unprecedented rate, often started abusing drugs just for fun.

People usually don’t get addicted to opiates by taking them as pain medications, according to Jon Daily, of Recovery Happens, outpatient addiction treatment centers in California.  He explains that the pain pills given after surgery and taken as prescribed, won’t produce a high for most people.  However, there’s a subset of people who respond differently and feel euphoria.  The difference for these people may be that they’re responding to unresolved issues of painful experience earlier in their lives.

Dr. Libby Stuyt, addictions psychiatrist and advisor to Parents Opposed to Pot said: “Most patients with chronic pain issues find that holding onto emotional pain from past trauma comes out in the form of physical pain.  When they work through this and are able to let go, the physical pain greatly diminishes.”

Too much medical intervention and surgery is also an issue.  Ten years ago Shannon Brownlee wrote Overtreated: How Too Much Medicine is Making us Sicker and Poorer, and now people are noticing that overtreatment create problems.

A wise Chinese doctor said:  “When a body has an imbalance, which is displayed in the form of some or other dis-ease, it will continue to display this imbalance.  If we cut out the place where that imbalance is currently occurring, then chances are, it will simply move to the next area of the body.”    It could be that unnecessary surgeries and too many surgeries contributed to chronic pain and the addiction problem.

Why People Get Addicted to Opiates

According to Jon Daily, most people in his practice begin pain pill abuse because they were already using alcohol and marijuana.  Their relationship with getting intoxicated began through these substances.  It is why Daily recommends an addiction paradigm shift away from heroin to marijuana.

Studies show that only about six percent of the population gets addicted to pain pills after surgery.   A recent study shows that states with the highest drug abuse are also the states that have legalized marijuana.

Overprescribing by doctors was a major issue in the past, but it is not the major issue today.   If pot is recommended as an alternative to avoid opioid addiction, it will probably be the same pill mill doctors who will be giving such recommendations. 

We believe the future of pain medicine is not prescribing marijuana, but in utilizing alternatives that treat the root of the pain.  Some of these techniques may need to be combined with Dialectical Behavior Therapy or Cognitive Behavior Therapy and spiritual help.   Cannabis, a psychotropic plant, is anything but “natural.”

Marijuana lobbyists have played a trick on America’s children by using the green pharmaceutical cross and pretending to be doctors.  They insist marijuana is “not a gateway” drug, but studies show otherwise.

Let’s push back on the pot industry’s promotion of marijuana as a cure-all drug and the media’s advocacy on their behalf.   Remember, “medical” marijuana was planned as a hoax.

The United States uses 80 percent of the world’s opiate pain pills.  The United States and Canada have 56% of the world’s illegal drug users.   Polydrug use is the rule today and marijuana is usually part of the drug cocktail.

Prevention and Treatment

There are many other ways to treat the opiate epidemic:  better prevention programs; mandating education in the schools; clamping down on internet sellers of these drugs, and reversing America’s constant craving to be high.

As for using drugs to treat an addiction, this practice is questionable.  What works for some will not work for others. Perhaps long-acting naltrexone (Vivitrol)  which blocks the effects of opiates, and apparently the craving, can help.  Let’s hope Governor Christie’s Commission devises some good recommendations.

Marijuana Crack Weed Advertised on Instagram

By Patricia Silva-Duran, Texans Against Legalizing Marijuana

It’s so difficult to be happy when my 19-year-old daughter is succumbing to using illicit drugs; I pray and wish she’d stop using but with this new drug culture in our country.  This culture is trying to normalize recreational drugs such as marijuana which makes it difficult for her to stop.

This is a picture from a drug dealer on Instagram; they sell to people on social media; does this look natural to you? It’s today’s crack weed marijuana and THC levels are extreme.

I was able to snap this picture from my daughter’s Instagram of someone she follows. This is not natural.  I oppose ever legalizing marijuana because it’s causing mental illness and breaking apart families; that’s the real drug war.

“Dabs” and “wax” are considered the crack weed of today. There are websites which promote these products that can cause immediate psychosis. It’s not “natural.”

I feel like a failure as a parent; I couldn’t protect her from drugs because society is influencing her.   Please, other parents, please be warned about the drugs and drug dealers, and what they are doing to your kids.  Watch out for crack weed.

Follow Patricia Silva Duran in Facebook at Texans Against Legalizing Marijuana

Editor’s Note: Alternative names are “wax,” budder,” “rosin,” “earwax”  “710,” “shatter” and more.  Search for our other articles on dabbing for a better understanding.