Today SAM issued a statement refuting the notion that states with medical marijuana have fewer opiate deaths. We have noticed that marijuana is an adjunct to opiate dependence and abuse, not a replacement. Here is what the SAM (Smart Approaches to Marijuana) statement said:
Celebrity doctors who channel their education into the pursuit of fame should be especially careful of misleading people with harmful advice. One wonders why Dr. Sanjay Gupta and more recently, Dr. Oz, are singing the praises of medical marijuana. Most likely the marijuana industry has been working hard to get their support.
Smart Approaches to Marijuana has the Answer for Senator Warren
Last year Sen. Elizabeth Warren asked the CDC if marijuana can be used to fight the opioid epidemic. There’s an answer in Smart Approaches to Marijuana’s recent publication, its educational toolkit for 2017. The publication refers to academic studies which suggest that marijuana primes the brain for other types of drug usage, alcohol and heroin. 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)
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)
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)
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)
Senator Warren, you’re deeply respected by youth. You could be a powerful spokesperson by advocating for them not to use drugs. The problem is that — for some young people — that critical first choice to use a drug turns into a game of Russian Roulette.
Parents who lost children to drugs overwhelmingly insist their children initiated drug use with marijuana and alcohol. Marijuana advocates insist marijuana is “not a gateway” drug, but studies show otherwise. Marijuana is a gateway to other drugs for 40+ percent of those who start using pot. It is never wise to substitute one drug of addiction for another drug of addiction. Please consider that not everyone who becomes addicted to opiates started because of pain. Many started for fun. According to a Jon Daily of Recovery Happens, most begin pain pill abuse because their relationship with intoxication began as a relationship with marijuana and/or alcohol.
There are many other ways to treat the opiate epidemic: better prevention programs, mandating education in the schools and clamping down on internet sellers of these drugs. Studies claiming fewer overdose deaths occur in marijuana states need to consider the availability of suboxone, other drugs to counter the overdose.
Senator Warren, please check out Smart Approaches to Marijuana, which advocates an alternative to legalization which does not include incarceration. In our next article, Senator Warren, we will discuss the marijuana-mental illness links………… once again.
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.
9. Rocky Mountain HIDTA Investigative Support Center Strategic Intelligence Unit. The Legalization of Marijuana in Colorado: The Impact, Volum
“If you only know opiate addiction through the media or the political debates right now, or the political rhetoric, you’re going to be under the impression it’s because doctors are over-prescribing opiate medication.” It’s not true at all, said Jon Daily LCSW, CADC II, on March 17, 2016, at Sierra Vista Hospital in Sacramento. The topic of his talk was Heroin to Marijuana: A Paradigm Shift We Need Now.
Daily challenged the counselors, therapists and physicians in the room to think differently about the connection between the choice of drug and addiction. “I want you to close your eyes and imagine your child. And then imagine that you got a call that that your child was caught using alcohol. Now imagine that you got a call that your child was using marijuana,” he said. Daily paused a few seconds to let those thoughts settle in. “And now imagine that you got a call that your child was using heroin. It feels different, doesn’t it?” he said.
“Drug bias” gets in the way of intervening sooner and more effectively when parents and professionals discover that a young person is using. Daily explained: “Addiction doesn’t really matter which drug is involved.”
“So if you’ve been using drugs for a long time, say weed, or alcohol, then you might try a lot of pills, then try another drug,” Daily explained. He emphasized that addiction is not so much about the specific drug but about the development of reward systems. (The most recent surveys of drug use by American teens shows that 6% of high school seniors are daily marijuana users, 3x the rate of the next biggest drug of abuse, alcohol. With this rate of abuse, it’s logical to predict that heroin problems will continue, or get worse.)
Before his talk, Daily surveyed the doctors with whom he associates. He asked them, “Of the opiate addicts you treated, how did it start?” He found that 98% percent of the clients his associates work with were already addicted to another drug when they started to get pain pills. (He acknowledges there are those who get addicted to pain pills after a car accident and multiple surgeries, but he emphasizes that this group is in a tiny minority.) Daily doesn’t explain addiction as simply being about genetics, or about addictive personality. One’s first reaction to opiates is affected by trauma experiences earlier in life, shame experiences in childhood. It’s affect disregulation, but not clearly understood.
There needs to be greater understanding of the nature of addiction with medical practitioners. Prescriptions for opiate painkillers can lead to a dependency that evolves into heroin use which is cheaper and easy to access via the internet.
However, the low perception of harm with youth using marijuana contributes to the heroin epidemic because most people do not understand a) that addiction to heroin and marijuana are essentially the same disease, and b) the THC levels of marijuana (the chemical component that gives the intoxication) are much higher today than in previous time periods.
The ways in which kids are using pot in high concentrations, known as wax/dabs and oils consumed as edibles (cookies, candies, etc.), makes it very addictive and can also cause psychotic breaks.
Daily urges medical and healing professionals to advocate for education and intervention when the first known instance of use of alcohol and drugs by a minor child. “It is much easier and more cost-effective to do prevention and early intervention than to reverse the harm from long-term addiction,” he said. Daily supports the CARA Act which will provide Naloxone or Suboxone to addicts. “And yet our system is set up to reverse the harm too long after onset of addiction.”
Daily’s comments are consistent with a position we have advocated to advance drug prevention. Jon Daily is the founder and clinical director for Recovery Happens Counseling Services in Fair Oaks, Davis and Rosedale. He specializes in the outpatient treatment of adolescents, young adults and their families with addictive disorders and dual diagnosis issues. He is the co-author of (2006) “How to Help Your Child Become Drug Free,” and (2012) “Adolescent and Young Adult Addiction: The Pathological Relationship to Intoxication and the Interpersonal Neurobiology Underpinnings.” Jon has been an instructor to nurses, medical residents and has taught post-doctoral students for UC Davis. Currently he instructs graduate students for University of San Francisco.