After I finished a lecture on alcohol and drug use, at a prestigious area college, a student asked me a question. “Hey, do you think it’s OK to smoke pot? I mean, my friends all smoke it and say it’s OK. And a lot of states have legalized it for recreational use and it’s also used as medicine, too. So, is it OK or not?”
Although she was a very bright young woman, by virtue of having been admitted to a particular college, I wondered how she missed the major points of my lecture. The auditorium was empty and, with the exception of the course professor, we were alone. She’s asking for herself, I thought. She seriously wants to know.
I began by saying that just because something is prescribed for a health problem doesn’t mean it’s safe to take it recreationally. I said, “When people have cancer, they may decide to have major organs removed from their body, or receive high doses of radiation, or take toxic doses of anticancer drugs. They do this in an effort to live. They do this because they believe it’s their only hope of survival. Otherwise, no one in their right mind would have these surgeries, receive the radiation or take toxic drugs. If cannabis is truly a medicine, then only people with specific illnesses should take it — and then only if it works for their particular disease.”
She nodded and said, “But, it’s natural.”
“So is arsenic,” I replied. “Arsenic is also organic. Just because a chemical or substance is natural or organic doesn’t mean it’s OK to take it into your body.”
“I get it. Thanks,” she said as she turned and walked away.
As a dual-licensed mental health and chemical health professional, I witness the problems with substance-use disorders every day. Patients often ask me if I’m against alcohol. I tell them there is very little about alcohol that’s worthy of a recommendation, and that 80 percent of the population can use it with no serious problems. On the other hand, 20 percent of people who consume alcohol develop very serious problems at some point in their lifetime. Although the percentages are not as high with cannabis, for the subset of the population that develops problems, the issues are serious and sometimes irreversible.
We live in a permissive society. As a nation we tried a grand experiment with Prohibition. During those years the only social problem that improved was a steep decline in domestic violence. Most people believe the price was not worth the benefit. In our culture we permit the sale of tobacco products, but it took decades to regulate it. In contrast, vaping nicotine is permitted. Vaping among minors is doubling every year and is driven in part by flavored products and slick advertising. Only now is research showing there are serious health consequences associated with the habit.
Make no mistake. The cannabis that is available today is many times more potent than the weed grandma and grandpa smoked in the 1970s. In the states where marijuana has been legalized, the potency is skyrocketing.
We have some understanding of the fundamental difference between low-alcohol-content beer (4.2 percent alcohol by volume) and alcohol beverages that exceed 90 percent ABV. It is obvious that the risk of death from alcohol poisoning is in the order of magnitudes higher with the latter. Among adolescents or adults, is this concept of potency as clear with respect to cannabis concentrations?
What about methods of ingestion? Alcohol is primarily ingested orally — although there are increasing incidents of it being ingested anally and vaginally. Few people understand that the health risks are not the same. Cannabis used to be ingested by smoking the weed itself — leaves, flowers, stems, seeds. Not so today. Today, very highly concentrated oils are vaped or eaten. Does the manner in which a chemical is ingested really make any difference? It does for most chemicals.
With medications approved by the FDA, the manufacturers must carefully isolate the active ingredient. Careful research must be performed to determine the amount, the frequency and the duration of time the drug should be used. The FDA requires that the drug be dispensed only for specific conditions, and manufacturers must notify the public of all known complications from using the medication. If they omit any relevant fact or falsify information, they can be sued for millions of dollars.
With cannabis it’s the Wild West. The active ingredients of cannabis are largely unknown and poorly understood. There is not an agreed list of conditions for which its use is recommended. When “dispensed,” there is no peer-reviewed research that supports the amount to be used, the method of ingestion, the frequency of use or the duration of time it should be used. There are no public warnings about possible adverse reactions. Who are you going to sue if a relevant fact is omitted or information is falsified? Are promoters warning the public about the increased occurrence of very low motivation, memory loss, anxiety, depression, paranoia, violence, psychosis? How about declines in academic and work performance and increases in welfare participation?
Consuming cannabis slows motor reflex, reduces concentration, lowers impulse control and increases risk-taking behavior. Each year more Minnesota residents die in vehicular crashes that are caused by chemical impairment than die by homicide. Nationally, more than 80 percent of on-campus sexual assaults involve chemical impairment. Does anyone seriously believe that legalizing the sale of recreational cannabis will improve these dismal statistics?
Should pregnant women be prescribed cannabis? Should nursing mothers? Should infants? Should adolescents? Kids are given smaller doses of vitamins, aspirin and cough syrup. Should they be given less cannabis or more? Should the elderly be given more or less? These questions have not been adequately answered in the clinical context. Yet we are rapidly moving to approve its recreational use!
If cannabis is a legitimate medication (and I believe it will be proven to be), then it should be regulated as a drug. Because of the serious known side effects, it should not be available over the counter. For recreational use, its manufacture, distribution or sale should never be legalized.
I agree that the war on drugs is a colossal failure because it primarily focuses on supply. When there is no buyer for drugs, there are no sellers. The solution is not legalization. The solution is solving the core problems that create the appetite for alcohol and drugs. When we cannot sufficiently reduce the core problems on the user side of the equation, the only other viable solution is treatment. Incarceration should be reserved for the manufacturers and major distributors, and for the crimes that are committed while under the influence — and there are many.
There is no doubt that the herd is on the move. A stampede seems imminent. In the resulting confusion it will be easy for those at greatest risk to be trampled. It is time to be careful, because a lot of people may get hurt — especially young people whose brains are not fully developed until approximately 27 years of age. During this developmental period, humans are at the greatest risk for developing long-lasting psychiatric illness. The legalization of the manufacture, distribution and sale of recreational cannabis will be a legacy we will have to live with for generations.
Jerry Lee Holt is the program director of The Journey with Ark Counseling, an outpatient treatment facility in Plymouth that specializes in the treatment of adolescents who have co-occurring mental health and chemical use problems. He has graduate degrees in public health and mental health.