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Marijuana: The Tide Has Turned... Now What?

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On New Year's Day, recreational marijuana sales officially began in Colorado. Legal pot shops opened to great fanfare with customers lined up at 2 a.m., some arriving in limos, others carrying guitars to serenade the crowd. Similar celebrations are expected later this year when the marijuana industry opens in Washington state. Elsewhere in the country, similar legalization bills have been introduced and political leaders aren't putting up much of a fight. President Obama has said there are "bigger fish to fry" than prosecuting marijuana users -- almost 60 percent of Americans reported to pollsters that they agree.

The tide has turned. Even those of us who are opposed must acknowledge it. But if legalization is indeed inevitable, we must prepare for the consequences: Usage will go up. It already has as a result of the widespread legalization of medical marijuana. Teen use of marijuana has reached a 30-year high with one of out every 15 high school seniors smoking marijuana on a near daily basis. What's more, fewer and fewer teens see pot as risky, which could foretell even greater usage in the future. As usage continues to increase, we must begin to anticipate and plan how we will be able to identify and treat the individuals who have abuse or addiction problems.

The shift in public sentiment around legalization is tied to the perception that marijuana is not addictive. For 90 percent of adults and 84 percent of teens, this is true. For the other 10 percent of adults and 16 percent of teens, marijuana is as dangerous and destructive as any other illicit substance.

At Phoenix House, we see in terrible detail the devastation marijuana can cause. For almost all of the kids we treat, marijuana is a problem. About 70 percent of our teen admissions nationally list marijuana as their primary drug of choice. We serve some of the country's most vulnerable teens. These young people are with us because marijuana has seriously impacted their lives, making it impossible for them to succeed in school, ruining their relationships with their families, and often, leading them to try even more harmful drugs when they seek an even greater high.

Currently, 57 percent of people admitted to treatment facilities for marijuana abuse or addiction are referred by the criminal justice system. By the time an individual has an encounter with the law, their drug use has very likely escalated to drug abuse or addiction. It is far from ideal that our country relies on the criminal justice system to be the main interceptor of individuals whose use of marijuana is problematic. That's why we support decriminalization over incarceration -- because you can't cure a disease with handcuffs. However, without a better alternative in place, marijuana legalization removes the one backstop we have for identifying and helping individuals who need some form of treatment, whether brief intervention or a long-term treatment program, before they slip through the cracks.

Imagine if we had systems in place that could identify symptoms early on and spare individuals and their loved ones the heartache and struggle of full-blown addiction and all its terrible consequences.

There's a lot of work to do to make that happen.

First, our health care system must change. Emergency room physicians and primary care providers need training to recognize the varying degrees of marijuana dependency -- and then know how to intervene. Marijuana affects a person differently than alcohol or illicit drugs, and medical care providers need to be able to tell the difference between occasional recreational use, a problem, and addiction. There also needs to be more collaboration with treatment providers so that doctors can refer patients to places where they can get help.

Second, the treatment community needs to advance and adapt. We need to provide a much broader spectrum of treatment options, so that individuals in the early stages of marijuana abuse can seek help tailored to their needs. People may be more inclined to seek treatment when they feel like it does not mean wearing the scarlet letter of "addict" or "criminal."

Third, health care reform will provide insurance coverage to millions of individuals who are uninsured and allow them to get coverage for treatment. Paired with legalization of marijuana, this policy change could result in more patients struggling with marijuana abuse. We need to have a dynamic diagnostic, referral and treatment system in place to support this wave of new patients.

We also need to watch Colorado and Washington closely -- and objectively -- to see how legalization will play out. Will substance abuse rates increase? Will marijuana users be more likely to use other illegal substances? How will states deal with legal driving limits? I believe we will soon see just how harmful and dangerous marijuana is, and I think the public will be surprised.

Finally, family and friends are the first line of defense for loved ones struggling with marijuana abuse and addiction, and we all must be vigilant about the signs and informed and empowered to help.

To be sure, there is a silver lining in marijuana legalization. It will undoubtedly demonstrate that we need to put a better system in place for helping the millions of Americans who have a substance abuse disorder, but are not getting the treatment they need. We have a real opportunity now to create the education initiatives and programs that will enable a much bigger community -- healthcare providers, teachers, family and friends -- to spot a problem and step in to help.

 
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