"Sam," by his own admission, is a marijuana addict. In the two years since he started smoking pot, he "graduated" to opioids, which is the reason he landed in treatment. He was willing to stop using the pills, accepting the program as a means of breaking the ties of his debilitating opiate dependency.
But to Sam, freeing himself from marijuana was not a goal of therapy. Instead, his need to continue smoking weed became the reason he walked away.
Sam, a real patient whose name has been changed for this article, embodies the paradox of marijuana addiction. While most patients with addiction will tell you their substances of choice have made their lives unmanageable, marijuana addicts will often tell you that pot makes their lives better.
In Sam's case, the continuing compulsion to smoke marijuana resulted in an untreated opiate addict going back on the street. Entering therapy, he said he was willing to lay off the prescription painkillers that were taking over his life, but couldn't guarantee he would stop smoking pot. The therapist made it clear that he was in an abstinence-based program and that, in order to remain, he needed to at least make an effort to stop using marijuana. With the support of the group and the therapist's own interventions, Sam was allowed to remain for at least a few sessions.
However, after four meetings, Sam was gone. In the end, the need to keep smoking pot was greater than the need to halt the downward spiral of his opiate addiction.
A Permissive Tidal Wave
The danger of marijuana use is not a popular subject in today's media. Marijuana is everywhere. While pot has been enjoyed globally, if discretely, for decades by people of all walks of life, it is currently reaching its apex of acceptability. In the U.S., we are witnessing a permissive tidal wave as more and more states take steps to legalize both medical and recreational marijuana. Fast food chains are even marketing to stoners with late night "munchies" menus.
Despite popular opinion, marijuana is addictive and damages both physical and psychological health, but more on the "bad stuff" later. In the spirit of at least attempting to offer a balanced blog, I will not deny its myriad benefits. In many studies, the most popular drug on the planet has been shown to decrease nausea, stimulate hunger and ease muscle spasms.
So, is Sam, and people who share his proclivity for pot, just flat-out wrong when they believe this addictive drug actually improves their lives?
Admittedly, I feel somewhat overqualified to opine on the matter. Unlike Clinton, I did inhale. Quite deeply and regularly, if truth be told. As a matter of fact, if you told the then-Jason that he would be helping marijuana addicts stay off weed, he would have laughed so hard as to... well, let's just say there may have been a need for "back-up" undershorts.
But I no longer wear that younger man's clothes. While I know a thing or two about the herb, I have also seen the dark side of pot and drugs like it. Perhaps that's why I was recently asked to bring out the old crystal ball and look into the future -- five or 10 years from now -- and share my visions of a world in which pot is universally, or at least nationally, legal. What I see when I look into the near future is based on the wisdom of history and the present. It's not always a foolproof method of future telling, but it's usually pretty darn accurate.
Quite simply, as more states legalize marijuana, I see more people winding up in treatment, not only for marijuana, but for all addictions. No matter which side of the legalization debate you fall on, it's hard to deny that marijuana is a "gateway" drug. A Columbia University study found that teens who had used pot at least once in the last 30 days were nearly 26 times more likely than their peers who had never used marijuana to try meth, cocaine, heroin, LSD or Ecstasy.
In addition, the younger an individual is when exposed to any mind-altering drug, the greater the chance that he or she will develop a chemical addiction. Since young people interpret the tidal wave of legalization as signifying weed is "no big deal," the perceived harm is low. Perceived harm is inversely related to use -- when we think a drug is harmful, we simply don't use it as much.
A Big Deal
Where legalized, marijuana use, especially by the young, has increased. The message translated by its legalization is unmistakable and wrong. Marijuana, in fact, is a big deal.
Scientists who discovered that marijuana's taste-enhancing effects also came with a host of brain problems, such as profound memory impairment and... well, there was much more, they stated, but they forgot the rest. Marijuana impacts brain development, cognitive processing and emotions. It is linked with not only depression, but also with paranoia and schizophrenia. It slows reaction time and can kill motivation.
If this isn't enough to make you put down your bong, consider the following:
- Marijuana smoke contains more carcinogens than tobacco smoke. In addition, marijuana users inhale more deeply and hold their breath longer, resulting in inflammation of the bronchial tubes and increased phlegm production.
- Marijuana smokers show significant impairment in the function of the small airways inside the lungs -- the major site of COPD.
- Marijuana causes immune system dysfunction, leading to pre-malignant lung changes associated with lung cancer.
- Marijuana increases the heart rate and blood pressure, which puts users with pre-existing heart disease at risk for heart attack.
- THC, the active ingredient in marijuana, crosses the placenta and can impact the fetus' brain long after birth, potentially limiting how much information the brain can process.
- Marijuana use during pregnancy has been linked to low birth weight and developmental delay. At ages 3 or 4, the children of women who smoked marijuana while pregnant have reduced verbal skills and reasoning ability. The children are also prone to depression and anxiety as they get older.
- Marijuana use is linked to decreased fertility in men and women. Studies show a reduced sperm count in men and abnormal ovulation in women.
I caution that we take a long, hard look at the permissive tidal wave in favor of marijuana legalization. Even the concept of "medical marijuana" is at best, suspect. In the current scientific community, there simply is no such animal. There is no known "dose" of marijuana to treat any FDA-approved diagnoses because there is no good science out there to support it. There may be some day, but until then, I would question any doctor who tells you to "inhale fire" as a form of treatment.
As for condoning recreational use, we need to be careful before we unlock that door. Because, in a tidal wave, once you open a door, it may not be so easy to close.
Just ask Sam.
Jason Powers, M.D., is chief medical officer at Right Step's family of Texas rehab centers and Promises Austin. He is the pioneer of Positive Recovery, a scientifically validated approach to addiction treatment that helps people discover meaning and purpose in their lives upon achieving sobriety.