The Controlled Substances Act (CSA) of 1990 categorizes marijuana as a Schedule I drug. This classification means that the government has adjudged marijuana to have a high potential for abuse while having no officially approved medical utility.[1] THC (delta-9-tetrahydrocannabinol) is the main active chemical in marijuana, and it is responsible for the drug’s psychoactive effects. However, research shows that both THC and cannabinoids have therapeutic value for certain health conditions, such as spasticity symptoms associated with multiple sclerosis. Further, synthetic cannabinoids feature in at least two prescription medications used to ease side effects in chemotherapy patients.[2]
The Politics of Pot
From both a medical and public health standpoint, there is concern that the hot-button nature of marijuana unduly influences research in this area. As discussed in Science Magazine, Dr. Ian Mitchell, a Canadian emergency room physician and prescription-pot advocate, believes that politics drives the public’s opinion about marijuana more than science. In Dr. Mitchell’s opinion, some stakeholders in the marijuana debate have an anti-marijuana agenda while others are decidedly pro-marijuana.[3]
Over 102 million Americans (41 percent of the population) have tried marijuana at least once in their lifetime. Source: Alternet
For example, the National Institute on Drug Abuse (NIDA) has a mission to stop all drug abuse and, for this reason, tends to fund research that focuses on marijuana abuse rather than the potential medical merits of marijuana. Even further, according to Dr. Mitchell, NIDA has the discretion to decline to supply marijuana to research studies on the drug’s therapeutic value.[4] Dr. Mitchell is concerned that anti-marijuana sentiments in the political arena will continue to undermine research efforts into the possible medicinal value of this drug across different treatment contexts.
Since 1996, there have been 23 states, in addition to Washington DC and Guam, that have passed some form of legislation allowing for marijuana use either for medical treatment or recreational use.[6] The states that have legalized recreational use of marijuana are Alaska, Oregon, Colorado, and Washington. There are 16 states that allow for medical marijuana use for state-specified medical conditions. Examples of medical marijuana states are Florida, New York, New Jersey, Michigan, and California. States that have not passed any legislation, and therefore are entirely prohibit marijuana consumption, include Pennsylvania, Texas, and Utah.[7]
The divisive politics around marijuana and its varying legal status state to state may undoubtedly confuse Americans. One strategy to gain clarity within the marijuana debate is to consider scientific findings regarding the drug’s addictiveness. This approach can help individuals to balance marijuana’s known benefits against its risks and thereby consider a more utilitarian based attitude toward marijuana rather than one based on politics and law.
The difference in political opinion around marijuana is one of the factors that has led to the differences in the drug’s legal status. Marijuana is illegal under federal law. However, in October 2009, the Obama administration sent a national memo to federal prosecutors that encouraged them not to prosecute individuals who distribute medical marijuana in accordance with state laws in which the dispensaries operate.[5] This is one way the government has tried to reconcile how marijuana is illegal at the federal level but appreciates a different status in some state jurisdictions.
Depending on the laws of any given state, marijuana may be:
- Criminalized
- Delegalized
- Legal for medical purposes
- Legal for recreational use
Since 1996, there have been 23 states, in addition to Washington DC and Guam, that have passed some form of legislation allowing for marijuana use either for medical treatment or recreational use.[6] The states that have legalized recreational use of marijuana are Alaska, Oregon, Colorado, and Washington. There are 16 states that allow for medical marijuana use for state-specified medical conditions. Examples of medical marijuana states are Florida, New York, New Jersey, Michigan, and California. States that have not passed any legislation, and therefore are entirely prohibit marijuana consumption, include Pennsylvania, Texas, and Utah.[7]
The divisive politics around marijuana and its varying legal status state to state may undoubtedly confuse Americans. One strategy to gain clarity within the marijuana debate is to consider scientific findings regarding the drug’s addictiveness. This approach can help individuals to balance marijuana’s known benefits against its risks and thereby consider a more utilitarian based attitude toward marijuana rather than one based on politics and law.
Is Marijuana Addictive?
The short answer is: yes, it can be. Any question as to marijuana’s addictiveness necessarily includes consideration of hallmarks of biological dependence: building a physical tolerance that in turn causes withdrawal symptoms to manifest when the familiar dosage is stopped or significantly reduced. Note that physical dependence is different from addiction. When a person is psychologically addicted to drugs, they manifest unhealthy behaviors, such as becoming remiss in important duties associated with work, family, and/or schools. According to Dr. John Kelly, the lead author of a study published in the Journal of Addiction Medicine (2014), marijuana definitely leads to addiction in certain individuals.[8]According to Psychiatrist Dr. John Kelly, approximately 8-10 percent of US marijuana users are at risk for addiction. Source: Medical Daily
Dr. Kelly’s study focused on 127 teenagers in the 14-19 age group who were receiving treatment at an outpatient rehab center. In the study, 90 teens advised that marijuana was their primary substance of abuse, and 84 percent of this group were identified as being physically dependent on the drug (various criteria were used to reach this diagnosis). Of the dependent group, 40 percent experienced withdrawal symptoms after ceasing to use marijuana. According to Dr. Kelly, the withdrawal symptoms experienced were akin to those associated with withdrawal from sedative drugs and included cravings for marijuana, anxiety, irritability, and sleep problems. Compared to withdrawal from other drugs, such as opiates, marijuana is considered to have a mild withdrawal profile. However, Dr. Kelly impresses upon the public that marijuana withdrawal is a significant biological event and occurs because there has been damage to the brain and central nervous system.[9]
How Marijuana Works in the Brain
The cannabinoid chemicals found in THC naturally occur in the brain (as part of the endocannabinoid system). The brain houses cannabinoid receptor sites that are designed to activate when cannabinoids attach to them. Once cannabinoids dock at their receptor sites, their main effect is to send out chemical messages that help to slow down communications between cells. When marijuana is consumed, more cannabinoids are released into the brain than would naturally occur.
The brain is a delicate orchestra of chemicals working in concert. When THC is consumed, a disruption to the brain’s balance occurs and can have both short-term and long-term effects. Withdrawal, a short-term effect, occurs because the brain has adapted to the increase in cannabinoids associated with marijuana abuse and then reacts when deprived of the familiar level of cannabinoids. According to the National Institute on Drug Abuse, a long-term effect of marijuana abuse is an impairment in neural connectivity that can causes diminished memory, lowered impulse control, and decreased learning capacity.
Sources: Scholastic, NIDA
An informative Psychology Today article discusses that in addition to physical dependence, a psychological addiction to marijuana can occur.[10] Some marijuana users may have a “take it or leave it” attitude while others feel distress if they do not have access to marijuana. Users may find that they want to stop using marijuana but are unable to do so for various reasons, such as they have become habitually accustomed to using the drug, it is an integral part of their social interaction, or they experience brain cravings for it. One sign that a psychological addiction to marijuana has taken hold is that the user will continue to use this drug despite negative consequences, such as job loss, financial setbacks, a lack of interest in other pursuits, and/or disruption to the family or home life.[11]
Denial of marijuana abuse is often a protective measure to stop anyone or anything from interfering with the use. Some individuals will point to pro-marijuana groups and the legality of the drug in some states to justify the use, even in the face of mounting personal problems associated with it.
Per the National Institute on Drug Abuse, approximately 17 percent of marijuana users who started in their teens will become addicted. Source: NIDA
The Gateway Drug Argument
According to the National Institute on Drug Abuse, early marijuana use may “prime” the young brain for dependence on other drugs later in life.[12] This phenomenon is known as cross-sensitization. The studies that support marijuana and cross-sensitization are animal-based. For example, a study found that rats who received THC had a greater behavioral response later on to THC and other drugs, such as morphine. These results are thought to apply to humans as well.[13] The Institute recognizes that drugs other than marijuana can also cause cross-sensitization. Further, many marijuana users will not progress to taking more potent drugs of abuse, such as heroin. As the Institute notes, social interactions also play a role in predisposing youth to drug use, which in turn may condition their brains to graduate to other drugs of the abuse in the future. One possible explanation is that youth in drug-using environments have easy access to marijuana, nicotine, and alcohol. Since these youths already have a substance use history, they graduate to more aggressive drugs as they age, and these drugs become more readily available.[14] The Institute does not provide any insight into whether the biological or social factors have more weight in the cross-sensitization process.The Pro-Marijuana Opinion
Studies that conclude marijuana is addictive do not necessarily thwart the pro-cannabis position. Perhaps the strongest pro-cannabis argument is that the drug has valuable medicinal properties. If cannabis can gain greater therapeutic legitimacy, it will be more difficult to oppose support for cannabis. Take, for instance, that there is currently a prescription pill abuse epidemic in America. Some opponents of America’s pill culture argue that prescription medications (sedatives, stimulants, and pain relievers) should be removed from the market in order to stop abuse. However, the medical community always prevails in their argument that prescription medications must be used, despite high risks for abuse potential, because they have outstanding therapeutic value.
Pro-cannabis arguments range from making the drug legal for recreational use to limiting legalization to use for an approved medical condition. In view of the formidable opposition to marijuana legalization in America, pro-cannabis arguments that are skewed in favor of legalization for medical necessity are more palatable. But does marijuana has a therapeutic effect? If so, for which conditions?
As mentioned earlier, marijuana’s Schedule I classification means that doctors and researchers will need a special dispensation to study marijuana benefits, which is difficult to obtain. Therefore, there is a dearth of studies in this area.[15] Of the studies that do exist, THC (whether natural or synthetic) has been shown to be an effective or promising treatment for conditions including relief of nausea associated with cancer and AIDS, seizure reduction in epilepsy, slowing or stopping cancer cell growth, and for relief from the symptoms of Crohn’s disease.[16] If greater therapeutic value is found in medicinal marijuana, pro-cannabis organizations and individuals would have greater leverage in the current debate.
Cannabis sympathizers may also seek to directly challenge claims about the addictive potential of marijuana. At present, marijuana is the most used illicit substance in America. Yet, as mentioned earlier, only approximately 9 percent of users will become physically dependent on marijuana.[17] Compare that statistic to the corresponding findings about other drugs: 15 percent of alcohol users will become dependent, 17 percent of cocaine users, and 23 percent of heroin users.[18] Cannabis supporters feel that when looked at with a wide lens, the addiction potential of marijuana does not justify its prohibition at the federal level or in those states which have not passed pro-cannabis legislation.
Proponents of marijuana legalization also address the argument that marijuana is a “gateway drug.” A main point they make is that marijuana does not cause further drug abuse. Rather, marijuana use may only be correlated to future abuse of other drugs. In other words, future drug use could occur even if marijuana was not the initial drug of initiation into substance use. Cannabis proponents make the point that a predisposition to drug use (be it biological, social, or a combination of both) could be a greater determinant than a drug user’s attraction to marijuana in specific. In this way, drug use is more about the presence of drug-seeking behavior rather an interest in a particular drug, such as marijuana.
Marijuana Anonymous and Teens
Marijuana Anonymous is a fellowship organization based on the 12-step model of recovery, and group meetings are the main resource it provides to members.[19] Life With Hope, the fellowship’s main guide, provides extensive information on how the fellowship works, facts about marijuana addiction, and how to successfully recover. According to MA, there are more teen members today than ever before.[20] The MA official site shares “Teen Stories” that shed light on how easily an addiction can develop, but also how effective rehab treatment can be. One teen writing for the “Teen Stories” page shares that he was 14 years old when he started smoking marijuana and became hooked the first time he got “stoned.” He had started drinking at 13, but after he tried marijuana, it became his drug of choice. He then experience two years of what he calls “hell.” In high school, he joined a “stoner circle,” his grade point average fell to 1.6 overall, and he started to deal marijuana. His parents caught him, but his use continued, in part because he felt in control of marijuana, and that he could stop at any time. He was later caught shoplifting. He fought often with his parents, which had a negative emotional impact on his younger brother. After a big fight with his father, he ran away from home. He was using marijuana daily by this point. When he was found one week later, he had finally had enough, started attending MA group meetings, and began working with a sober sponsor. His life dramatically improved, and he has remained abstinent.[21]Treatment for Marijuana Abuse
Although the political debate on marijuana continues, one fact that is not debatable is that individuals addicted to marijuana are best advised to seek recovery services. According to the drug use information site The Fix, the typical adult who seeks treatment for marijuana abuse has been a chronic user for more than a decade and has attempted to stop using marijuana more than six times.[22] Unfortunately, marijuana abuse is associated with a high relapse rate. Approximately 50 percent of all marijuana abusers who seek treatment will achieve abstinence in the first two weeks of recovery. However, of this group, 50 percent will resume marijuana abuse within one year.[23]
Regarding treatment, one significant consideration is whether the person has co-occurring disorders. When substance abuse occurs simultaneously with at least one mental health disorder, the person is deemed to have co-occurring disorders. Individuals who abuse marijuana, especially youth, often have a mental health disorder. Studies show that treatment of the mental health disorder can help to decrease marijuana use, especially in the case of heavy marijuana users and those individuals with chronic mental health disorders.[24]It is always advisable that a person with co-occurring disorders receive simultaneous treatment for both the substance abuse issue and the mental health disorder(s). The best advice is for treatment to take place in a center equipped to address co-occurring disorders, where a psychiatrist and other mental health specialists are on staff.