Destined to Get Worse…Before It Gets Better

Addiction is crippling our nation. Over 27.7 million people in the US used illicit drugs or abused prescription drugs in 2015(1). This marked a dramatic increase of several million over a SAMHSA2 report published just a few years earlier. We are in the midst of the worst modern epidemic the US has ever faced and it’s about to get worse.

This is especially aggravating because we don’t even see it coming, this generational shift will unleash a Tsunami of repercussions. Many Americans are celebrating the marijuana revolution sweeping the nation. Now at least partially legal in 28 states plus the District of Columbia (and counting), it has alternatively been touted as a safe recreational alternative to alcohol; or a wonder drug for treating chronic pain, nausea and symptoms of multiple sclerosis.3

The Dangers of Cannabis

While marijuana most certainly may be medically appropriate in certain circumstances, the rapid, haphazard proliferation of availability throughout the country is creating a human assembly line of addicts passing through our Junior High and High Schools that is already beginning to demonstrate a Pandora’s Box of unintended consequences. Chronic or heavy cannabis abuse is associated with poor educational outcomes and a wide range of health related concerns including schizophrenia, depression, bronchitis, lung cancer and reproductive problems.4 Moreover, easier access to marijuana has made it more readily available to adolescents and young adults who are most susceptible to its long term effects of cognitive impairment. ‘First Use’ of drugs at a young age is one of the prime causal factors of addiction, because the brain does not mature until someone is in their mid-20s. While not everyone exposed becomes an addict, because genetic and environmental factors also play a role, getting triggered at a young age is a major issue for three key reasons.

First of all, early use becomes socially ingrained, as habits form and use becomes psychologically associated with having fun.5 Secondly, marijuana use (like other drugs) actually re-wires the developing brain to increase physical addictive cravings.4 Finally, while marijuana is not generally considered addictive in the physical ‘cravings’ sense, the re-wired brain is nonetheless more vulnerable to other drugs.4 That is why marijuana is often considered a “gateway” drug to other harsher, illicit drugs, and since most addicts are highly susceptible to cross addiction, we’re talking about a cascading problem of drastic proportions. The evidence of this is substantiated by a recent National Survey on Drug Use & Health which indicated that 16-25 year olds had the highest rates of illicit drug use at 20-21%, as compared to an average rate below 10% for those 26 and older. Sure, this issue existed prior to marijuana’s mass legalization, but it is now being unharnessed with greater fury to dramatic, destructive effect. For example, in 2011, there were over 2.5 million Americans aged 12 or older who were diagnosed with OUD (Opioid Use Disorder) and that number has only gone up.2

Marijuana is also troubling for some very clear, more direct reasons as well. It increases the risk of car crashes from driving while impaired, has contributed to general health care costs and its negative impact on memory and attention has led to an elevated rate of emergency room admissions.4 Employees who test positive have accident rates (55%) and injury rates (85%) higher than their non-marijuana counterparts. These facts are generally overlooked by marijuana advocates but are too prevalent to be ignored.

And it’s Still Illegal

Marijuana still remains illegal under federal law and it will be interesting to see how that resounds with the new Sherriff in town. The Trump administration started with tough talk, but has since walked that back in a haze of mixed messages. Attorney General Jeff Sessions is notorious for his fierce law and order bent and has indicated a strong desire to take a hard line, but strict enforcement would be a precarious position to take against the expressed will of the people. So, it appears that the rampant expansion of marijuana use will most likely only continue to, pardon my pun, grow like a weed.

This is of particular concern since the price of marijuana has fallen dramatically since legalization began (down 48% in Colorado according to a January 2017 Bloomberg Businessweek Infographic) and several new states are now strongly considering adding voting measures on marijuana to the ballot. Moreover, even as the price is dropping marijuana is becoming more potent. THC (tetrahydro-cannabinol) levels are reported to have increased from a low of around 4 percent to as high as 30 percent, depending on the study.6 The most frustrating part is that this problem is bubbling to the surface just when seeds of hope are beginning to sprout on the opioid front. Greater awareness led to the November 2016 US Surgeon General Report “Facing Addiction in America”, $1 billion in funds for the 21st Century Cures Act and a 30% reduction in opioid prescriptions last year. It feels as if we may be taking one step forward and two steps back. I fear we’re destined to endure another long-term failed social experiment comparable in magnitude to China’s one-child population control policy, and our own experience with cigarette smoking which took mass tort litigation and decades on anti-smoking initiatives to finally turn the tide. (The prevalence of US smoking is projected to continue to fall from 25% in the year 2000 to a record low of 11% in 20256.)

Just recently, I was in downtown Denver-ironically, for an addiction conference, and was shocked to my core. It had changed drastically since my last visit prior to legalization of marijuana. There was now an overwhelming presence of stores selling pot and an unbelievable abundance of homeless strewn about the streets. One was wearing a sign that read, “Punch me as hard as you can for $10,” just so he could buy marijuana. It stands out as an unsung indictment on the current state of affairs.

Marijuana Gummy Bears?…Really?

So how in the world can we possibly stop this runaway freight train?  Vigilance and education.  As the marijuana juggernaut continues to steamroll, we need to bear testament to, and diligently publish stories about, its ill effects.  The negative impact of marijuana will continue to grow over time.  Its nice, rosy perspective will eventually begin to fall under the burden of its own weight.  The sad fact though, is that this strategy requires patience, and too many people will suffer in the interim.  We must, therefore, also take it upon ourselves to help those now struggling with addiction or in recovery, and their families that share the burden.  These individuals warrant a louder voice, greater access to the most up-to-date treatment options and a message of hope about their futures.  Medical marijuana may deserve a limited place in treatment of disease, but serving THC infused gummy bears and variety packs of chocolate is probably not one of the brightest moments in our nation’s glorious history.  Freedom is vital, but at what cost?  We are all part of the same social contract, requiring a balance.  I fear that with the widespread approval and acceptance of marijuana for recreational use, the scales might be teetering in the wrong direction.

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Footnotes:

  1. US Surgeon General’s Report, “Facing Addiction in America” – November 2016.

  2. Substance Abuse and Mental Health Services Administration.

  3. USA Today, “Marijuana can ease certain conditions” – January 13, 2017.

  4. Journal of Addiction Medicine, “Medicine Trends and Correlates of Cannabis-Involved Emergency Department Visits” – November/December 2016.

  5. Journal of Addiction Medicine, “Weeding out the Truth: Adolescents and Cannabis” – March/April 2016.

  6. The Economist, “Plucky Strike”, January 21, 2017.