Pubdate: Sun, 19 Jul 2009
Source: New York Times (NY)
Page: ST1
Copyright: 2009 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Sarah Kershaw and Rebecca Cathcart

MARIJUANA IS GATEWAY DRUG FOR TWO DEBATES

IT was as if she woke up one day and decades of her life had disappeared.

Joyce, 52 and a writer in Manhattan, started smoking pot when she was 
15, and for years it was a pleasant escape, a calming protective 
cloud. Then it became an obsession, something she needed to get 
through the day. She found herself hiding her addiction from her 
family, friends and co-workers.

"I would come home from work, close my door, have my bong, my food, 
my music and my dog, and I wouldn't see another person until I went 
to work the next day," said Joyce, who like most others in this 
article asked that her full name not be published, because she does 
not want people to know about her past drug use.

"What kind of life is that? I did that for 20 years."

She tried to stop, but was anxious, irritable, sleepless and lost. At 
one point, to soothe her cravings, she took morphine that she found 
at her dying father's bedside. She almost overdosed.

Two years ago, she checked into the Caron Foundation, a treatment 
center in Wernersville, Pa. Even there, she said, some other addicts 
- -- cocaine and heroin users or alcoholics -- downplayed her 
dependence on marijuana.

"The reality is, I was as sick as them," Joyce said. She now attends 
Alcoholics Anonymous, which is also open to drug addicts, and recently married.

Smoking pot, she said, "was a slow form of suicide."

Marijuana, the country's most widely used illicit drug, is typically 
not thought to destroy lives. Like alcohol, pot has been romanticized 
by writers and musicians, from Louis Armstrong to Bob Dylan, and it 
has been depicted as harmless or silly in movies like "Harold and 
Kumar." And addiction experts agree, marijuana does not pose as 
serious a public health problem as cocaine, heroin and 
methamphetamine. Its hazards pale in comparison with those of 
alcohol. But at the same time, marijuana can be up to five times more 
potent than the cannabis of the 1970s, according to the National 
Institute on Drug Abuse.

And this new more-potent pot and the growing support for legalization 
has led to an often angry debate over marijuana addiction. Many 
public health officials worry that this stronger marijuana has 
increased addiction rates and is potentially more dangerous to 
teenagers, whose brains are still developing. And officials say the 
movement to legalize marijuana -- now available by prescription in 13 
states -- plays down the dangers of habitual use.

"We need to be very mindful of what we are unleashing out of a 
Pandora's Box here," said Dr. Richard N. Rosenthal, chairman of 
psychiatry at St. Luke's-Roosevelt Hospital in Manhattan and 
professor of clinical psychiatry at Columbia University. "The people 
who become chronic users don't have the same lives and the same 
achievements as people who don't use chronically."

More adults are now admitted to treatment centers for primary 
marijuana and hashish addictions than for primary addictions to 
heroin, cocaine and methamphetamine, according to the latest 
government data, a 2007 report by the Substance Abuse and Mental 
Health Services Administration.

Even though alcohol and opiates (which includes painkillers and 
heroin) are the two leading primary addictions, the percentage of 
those seeking treatment for marijuana addiction, compared with 10 
years ago, has increased significantly to 16 percent in 2007 from 12 
percent in 1997. The percentages of those seeking treatment for 
cocaine (13 percent of admissions in 2007) and alcohol addiction (22 
percent in 2007) declined slightly.

Advocates for legalizing marijuana and some addiction specialists say 
these concerns are overwrought. The admissions data, they say, is 
deceiving because it was collected by government agencies that oppose 
legalization; 57 percent of those admitted for marijuana addiction 
treatment were ordered to do so by law enforcement. (The percentage 
of those ordered into treatment was lower for other drugs, except for 
methamphetamine. For alcohol abuse, 42 percent were ordered into treatment.)

Advocates and even some addiction specialists say cannabis is an 
effective treatment for medical and emotional problems, and can even 
help some battling addictions to harder drugs.

The risk of addiction, they say, is less problematic than for alcohol 
and other drugs. For instance, of the people who had used marijuana, 
only 9 percent became addicted, according to a 1999 study by the 
Institute of Medicine of the National Academies, a nonprofit research 
organization on science and health. Of those who drank alcohol, 15 
percent became addicted. For cocaine, the figure was 17 percent, and 
heroin, 23 percent. (These are the latest figures from the institute; 
advocates and addiction experts said there were no more recent data available.)

"The word addiction is so fungible in our society, and cannabis just 
doesn't fit that tidy definition, though it can be abused," said 
Allen St. Pierre, executive director of the National Organization for 
the Reform of Marijuana Laws, a legalization advocacy group. "Science 
really has proven, if anything, that cannabis is likely one of the 
safest substances we can interact with."

Many people can smoke marijuana every day without ill effects, 
advocates say, just as many casually drink wine in the evening.

These marijuana users do not meet the clinical definition of 
addiction, which includes an inability to stop using the drug, an 
uncontrollable obsession with it and increased tolerance. Javier V., 
a 24-year-old supervisor in an industrial park in Miami, said he has 
smoked pot regularly, without a problem, since he was 14. "After a 
busy day at work," he said, "I come home, roll up a J and -- I mean, 
it's stress relief."

Then there are people like Milo, 60, who recently attended his first 
Marijuana Anonymous meeting in Los Angeles. He said he started 
smoking pot at 13, and has struggled to quit.

He is also an alcoholic, he said, but has not had a drink since the 
early 1980s.

"I'm a pothead, a marijuana addict, a stoner, we call ourselves a 
million things," he said. He is trying to quit, he said, because his 
girlfriend is threatening to leave him. Besides, the drug no longer 
alleviates his depression and anxiety.

"I'm losing things and people," Milo said after the meeting. "I'm 
estranged from my children. I've lost two houses, and I'm living in 
my R.V., basically homeless."

He added, "There are a whole lot of pieces, and I can't get them together."

Many addiction experts would say marijuana abuse has, at the very 
least, added to Milo's problems. And the drug's new potency has made 
the likelihood of addiction that much greater, public health officials say.

"It's like drinking beer versus drinking whiskey," said Dr. Nora D. 
Volkow, director of the National Institute on Drug Abuse, a 
government agency and a strong opponent of legalizing marijuana. "If 
you only have access to whiskey, your risk is going to be higher for 
addiction. Now that people have access to very high potency 
marijuana, the game is different."

A 2004 study in the Journal of the American Medical Association 
suggested that the stronger cannabis is contributing to higher 
addiction rates. The study, conducted for the National Institute on 
Drug Abuse, compared marijuana use in 2001 and 2002 with use a decade earlier.

While the percent of the population using the drug remained stable 
during that time, dependence or abuse on the drug increased 
significantly, particularly among black and Hispanic men. Higher 
concentrations of delta-9-tetrahydrocannabinol, known as THC, the 
study said, was the likely reason for the growing dependency.

Dr. Volkow, who spearheaded federal research into treatment for 
marijuana withdrawal, had studied cocaine in the 1970s and early 
1980s. Back then, she said, she was unsuccessful in winning grants to 
study cocaine addiction.

"People thought cocaine was a very benign drug," she said.

Only after the basketball player Len Bias died of a cocaine overdose 
in 1986, and the crack epidemic began, did the government start a 
campaign to warn of cocaine's dangers.

With marijuana, "it's going to take some real fatalities for people 
to pay attention," she said. "Unfortunately that's the way it goes."

Like any addiction, quitting pot can be daunting. Jonathan R. has 
been a member of Marijuana Anonymous in Los Angeles since the early 
'90s, shortly after the 12-step program was founded. He has seen many 
members in meetings say they would rip up their medical marijuana 
cards, available in California and used to fill prescriptions for 
problems ranging from severe pain and discomfort from cancer, to 
headaches and insomnia.

But then, inevitably, he said, they secure another one, much like "an 
alcoholic who pours booze down the drain and then goes out to get 
another bottle."

The difficulty in quitting has spurred psychologists and 
psychiatrists to debate whether "Cannabis Withdrawal Syndrome" should 
be in the next edition of the Diagnostic and Statistical Manual of 
Mental Disorders.

Yet, marijuana withdrawal is not nearly as severe as withdrawal from 
most other drugs. Giving up drinking can cause fatal seizures. Heroin 
users vomit and sweat for days; sudden withdrawal can be fatal.

In fact, some doctors specializing in treating addicts would rather 
prescribe marijuana for anxiety and insomnia than sleeping pills or 
Valium and Xanax, which are highly addictive.

"I see people every day dying from alcohol, stimulants and opiates," 
said Dr. Matthew A. Torrington, an addiction specialist and clinical 
researcher at the University of California, Los Angeles. "Marijuana 
may be an up and comer, it may be transforming into something that 
will become a bigger problem in the future, but at the moment I don't 
see that."

Still, even one of Dr. Torrington's patients, Jonathan James, has 
concerns about his own marijuana use. Mr. James, 50, a former 
choreographer, has been a regular pot smoker for 35 years.

He said smoking marijuana helped inspire some of his most original 
ideas. But Mr. James is afraid to stop smoking, even after kicking 
heroin and cocaine. When he stopped the harder drugs, he stayed off 
pot for six months. When he started again, he planned to smoke only a 
few times a week.

After a month or so, "I started smoking it more," he said. "Two 
months later, I was smoking it in the morning, and four months later 
I was smoking all day."

He said he would be more successful without pot.

"It keeps me back -- from engaging in the dreams and aspirations I 
have," he said. "I would like to feel I don't need to take anything 
to feel better." 
- ---
MAP posted-by: Richard Lake