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:
A new peer-reviewed study about to be published in the January 2018 issue of the Journal of Studies on Alcohol and Drugs found that marijuana use at exit from a 3-year case management intervention program for pregnant and parenting women increased significantly after marijuana legalization in Washington state.
“This study adds to the data we have about legalization driving up use and negatively impacting society,” said SAM President Kevin A. Sabet, Ph.D. “States should slow down and realize that their actions have real consequences, especially among populations highlighted in this study — parents and children.”
The researchers divided the study sample into two cohorts based on whether participants had completed the program before or after legalization.
Researchers reported the following results:
“Most study participants reported complete abstinence from alcohol and nonprescription drugs at program exit. Among those who were still using substances, women who completed the intervention after marijuana legalization were significantly more likely to report marijuana use at program exit compared with women who completed the intervention before marijuana legalization. Across both cohorts (pre- and post-legalization), we found a positive association of exit marijuana use with alcohol, illegal methadone, other opioids, amphetamines, and cocaine use; even when we controlled for historical period, the association with some of these substances with marijuana use remained evident. Independent of marijuana use, we saw increased use during the post-legalization period of alcohol, illicit methadone, and other opioids.”
The study concluded that “Women who were not abstinent from marijuana at program exit were likely to report use of other substances as well. Our study design demonstrates an association but does not allow us to conclude that marijuana use leads to other substance use among this sample of women with a history of polysubstance use.”
Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states.
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)
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)
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)
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.
The discussions of H.170, which would legalize possession and home-growing of small quantities of marijuana, have focused a lot on the danger to teenagers, which is appropriate since adolescents are in a stage of neural development that makes them much more likely to become addicted, develop mental health conditions, and suffer decreases in cognitive processing and memory retention. The problem with this focus is that people over 21, particularly up to the age of 25 or 26, are still susceptible to all of these effects, just at a lower level of risk.
That point aside, the area where every age runs the same risk is on the highway. Again, teens and young adults are more at risk because they tend to take more risks in the first place. They are also less experienced with driving and with the use of alcohol and drugs. But adults do make the same stupid mistake of driving under the influence.
According to the best data we have available, drinking alcohol before driving increases the risk of accident five-fold at the still-legal .08 blood level. Driving under the influence of marijuana doubles your risk. That being the case, we would expect to find considerably more people dying on the roads because of alcohol then because of marijuana. The data on traffic accident fatalities that we have from the Vermont Department of Safety tell a somewhat different story:
This data is based on blood tests that measure active THC, so we can be reasonably sure that the drivers had used marijuana recently enough to still be DUI.
Driving Under the Influence of Marijuana Imperils Safety
Note the small difference between the number of deaths due to alcohol and the number due to marijuana. The most likely reason for this is that many marijuana users think it’s OK to drive after using. For teenagers, we have clear evidence for that from our Youth Risk Behavior Survey.
Here’s the 2015 data:
Reports from both Colorado and Washington indicate that the same must be happening there. While accidents and fatalities involving drunk drivers went down in recent years, the numbers involving marijuana went up.
Why is this happening? Because we are not teaching people – young or old – that marijuana impairs your ability to drive. At a well-attended forum on marijuana effects held in Burlington last month, one attendee stood up and insisted that marijuana helps people drive more carefully, and this message pervades the popular websites that cater to people interested in learning more about marijuana from sources “untainted” by officials like police officers and scientists.
It’s important to note that the traffic fatality data shown above only includes deaths in accidents. It does not include the five Harwood teenagers killed on I-89 last October. The driver of the car that hit theirs, Steve Bourgoin (36, hardly a teen), has been charged with second-degree murder, so their deaths are not considered to be due to a traffic accident.
Addiction is Not a Crime
Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction.
When Bourgoin’s blood toxicology report was completed, authorities withheld the contents pending trial; however, Vermont investigative reporter Mike Donoghue, writing for Vermont News First, quoted several sources in saying that there was active THC in Bourgoin’s blood at the time of the accident. Since then, Vermont Rep. Ben Joseph, D-Grand Isle-Chittenden, a retired judge, has reported being told the same thing by contacts of his in the state legal apparatus.
As reported on VTDigger, Bourgoin told friends that he suffered from anxiety and PTSD due to childhood trauma, and his former girlfriend told detectives that he self-treated with marijuana for “mood spells.” Court documents quote her saying, “It was always very evident when he was out [of marijuana], as he would be more angry and violent during those times.”
Anger is one of marijuana’s withdrawal symptoms, and it is a more addictive drug than most people think. A review of several studies of treatment methods for marijuana addiction found that one-year abstinence rates for adults, even under the most effective treatments, ranged only from 19 to 29 percent.
In a 20-year study involving more than 2000 U.S. war veterans being treated for PTSD, the vets who used medical marijuana along with the standard therapy reported more violent behaviors and worse outcomes after treatment than vets who didn’t use marijuana. The heaviest users showed the strongest effects. Another study found that marijuana use resulted in increased suicidal ideation among marijuana users.
Marijuana and Mental Health Problems
There are other correlations between marijuana and serious mental health problems. Since 2002, a series of studies in Europe have reported that individuals who use cannabis have a greater risk of developing psychotic symptoms. Not only does marijuana bring on symptoms earlier and make them worse, it is a causative factor.
A Finnish study published this past November compared sets of twins where one used marijuana heavily and the other did not. Heavy use increased the risk of developing psychosis by a factor of 3.5. Again, the data indicated that, in many cases, marijuana abuse caused the psychosis, not the other way around. The newly released report on marijuana from the U.S. National Academies of Sciences agrees with these findings.
Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction. These sufferers needs effective treatment far more than jail time. And these new research findings, combined with Vermont’s recent traffic fatality data, highlight the fact that marijuana is not harmless. Legalizing recreational marijuana in Vermont would not be a simple matter.
Vermont has already decriminalized marijuana use. What we haven’t done is provide a mental health system that can deal with the thousands of cases of addiction, psychosis, and other mental illnesses that we already have in our state, nor have we done nearly enough to educate Vermonters about marijuana’s harms, in order to prevent tragedies from happening.
Legalizing marijuana – whether like alcohol or tobacco – will only make our mental health burden worse, while it makes our highways far less safe.