Pubdate: Sun, 26 Jan 2014 Source: Houston Chronicle (TX) Copyright: 2014 Houston Chronicle Publishing Company Division, Hearst Newspaper Contact: http://www.chron.com/ Details: http://www.mapinc.org/media/198 Author: Matthew Poling Note: Poling, a family practice physician and assistant professor at Texas A&M Health Science Center in College Station, is the father of three. SMOKING POT CARRIES BIG RISKS On a rare blessed Monday when I arrived home from my medical practice in time to watch the 5:30 p.m. news with my precocious 13-year-old daughter, I abruptly found myself engaged in a conversation that, as an American father, I never expected to have: Explaining to her why the president of the United States was wrong to tell us that marijuana use is "no more dangerous" than alcohol "in terms of its impact on the individual consumer" and "not very different from cigarettes." No matter what we may have concluded about the policy judgment of our current president, I think we all believed he demonstrated sound judgment as a father. But he has called even that into question with his ambiguous theoretical (or perhaps, actual) advice to his daughters that marijuana use would be "a waste of time." As if drug use was akin to downloading an Angry Birds app or a Justin Bieber song. The medical facts are more clear. Multiple peer-reviewed studies in the U.S. and the United Kingdom demonstrate increased rates of severe chronic mental illness like schizophrenia with the relative risk increase in the 200 percent to 300 percent range, and this increased risk applies to casual users or "experimenters," as well. While the absolute risk is small, no such effect on the "individual consumer" is seen with even chronic use of tobacco or alcohol. Other less severe but more common psychiatric symptoms such as anxiety, depression and insomnia are associated with even casual use, and longer term use adversely affects cognition and memory and is associated with many lung diseases and physical effects seen with tobacco smoking. With the media, celebrity doctors like CNN's Sanjay Gupta and now even the president either celebrating pot's potential benefits or minimizing its known risks, one must ask: Why such a disconnect on the question of risk? I think the answer is bias. In this case, selection bias. Today's doctors, journalists, presidents and most of their social circle who may have smoked pot when they came of age in the '60s or '70s happened not to have suffered the ill effects of drug use personally and thus assume, based on their small, unscientific sample, that it must not be so bad. What parent who does their homework could be anything but mortified by the potential for normalization of illicit drug use in our society? The association between marijuana use and social pathologies is well documented. But, pot apologists claim that association is not causation, which is true (for example, pot legalization would not be expected to cause a football team to advance to the Super Bowl, even though such an association exists) and that troubled people may turn to drugs in an attempt to "self-medicate," making their condition worse. Causation is very difficult to prove, a fact that allowed tobacco companies to claim for decades that there was no "proof" that smoking caused lung cancer and many smokers live to a ripe old age. But at some point, associations are so strong that we must acknowledge that the answer to the "which came first" argument is irrelevant, as the cause of disease is usually multifactorial. Drug legalization is first promoted by utilizing the Trojan horse of "medical marijuana." Such a strategy coupled with heart-rending anecdotes of human suffering can garner support from the left, right and center. I might be more sympathetic to this agenda, too, if I had ever encountered a situation where smoking pot would clearly do more good than harm. Such clinical scenarios may exist, but after more than 70,000 encounters with patients in all walks of life carrying diagnoses that span the spectrum of disease, I have yet to see it. What I have seen is myriad mental health problems triggered or worsened by pot use. The mixed message here is of particular concern as the typical consumer of health information approaches such issues simplistically. Is Vitamin D good for me or not? Should I be eating oily fish or avoiding them? This is certainly more true for the adolescent population where an ambivalent message will do the most harm. Hippocrates' 2,400-year-old advice still applies: First, do no harm. Or let's at least be certain we're doing more good than harm. This principle should be applied not only to the individual patient but to the public health. An August Quinnipiac poll of Colorado voters predicts a 40 percent increase in pot use with legalization. The most recent National Institutes of Health survey shows that 6.5 percent of high school seniors smoke marijuana daily, up from 5.1 percent five years ago, while use of tobacco has declined. Only 44.1 percent see regular use as harmful, the lowest since 1979. Message received. It is not the sign of a healthy culture that we have become more concerned with what goes into children's lungs than what goes into their brains. Decriminalization also finds support from libertarians who claim that we have "lost the war on drugs." Except that we don't really know how much more drug use there would have been without such efforts. We may eventually find out in the statewide drug legalization experiments taking place now. Such experimentation might be a worthy scientific endeavor, were today's youths not the guinea pigs. Perhaps you've heard that it isn't harmful because it isn't addictive. First, you will note that it has a remarkably committed following for a drug that supposedly isn't. Research shows addiction potential with marijuana. Even if it weren't addictive, it is a misconception that drugs are harmful only because they are addictive. If that were the case, caffeine use would be our No. 1 public health concern. Illicit drugs are harmful because of their effects on the brain. Fortunately, studies show that when teens rank those who have the most influence on their decisions, politicians and media personalities barely register. Parents consistently rank as the most influential people in their lives and by a wide margin. A clearly communicated expectation that drug use of any kind should have no place in their lives is the best protection we can give them. Unfortunately, it is clear that our culture and leaders will be giving us little help. While I'd hoped that the after-work topic du jour would be her new braces or Martin Luther King Jr., I found there was one more consultation needed and administered a dose of parental love and preventive medicine. I pray it will be enough. - --- MAP posted-by: Jo-D