Pubdate: Mon, 19 Oct 2015
Source: Chicago Tribune (IL)
Copyright: 2015 Chicago Tribune Company
Author: Robert McCoppin


Small Percentage of Patients May Be at Risk, Experts Say

Depressed, withdrawn and coping with a death in the family, Joseph 
thought getting high would help him feel better.

Instead, he said, his marijuana smoking grew into a daily habit that 
made him paranoid and constantly question how others saw him. He went 
days without going home, showering or eating much besides potato chips.

"I always thought (marijuana) would bring down my anxiety, but it 
just made it that much worse," the Rockford-area man said.

One day, after getting so high that he was pacing around, alarmed by 
his own gaunt appearance and generally "freaking out," Joseph was 
taken by his brother to a Rosecrance drug treatment center in 
Rockford, where he entered an inpatient program.

Joseph, who asked not to be identified by his full name, managed to 
quit until after he finished his high school final exams, but then 
started smoking heavily again. Eventually, feeling suicidal, he 
checked himself back into Rosecrance and entered a 12-step program. 
Now 19, he's still in treatment and said he's been sober for seven months.

Some pot users dismiss such stories as "Reefer Madness"-style scare 
tactics. Research suggests the vast majority of users don't get 
addicted, and many quit as they get older. But the National Institute 
on Drug Abuse, based on a 1994 study, estimated that 9 percent of 
users will become dependent - a number that can rise significantly 
for those who smoke daily or started as teens.

Legal marijuana is due to hit the market in Illinois in coming weeks, 
bringing highly touted medicinal benefits for a range of conditions 
from Tourette's syndrome to HIV. But some addiction specialists also 
worry that the legalization of pot - even just for medical uses - 
could lead to more abuse of the drug.

One concern is that qualifying patients will be able to buy about an 
ounce of marijuana a week - roughly 50 joints' worth - which some 
experts say is enough to form a dependency.

"I think we're entering a critical time, because it gives people a 
license to say, 'I'm going to use this for a medical reason,' " said 
Linda Lewaniak, director of the Center for Addiction Medicine for 
Amita Health at Alexian Brothers Behavioral Health Hospital in 
Hoffman Estates. "It opens the door to a lot of potential abuse."

Yet some advocates and researchers are challenging such warnings 
about pot's dangers. They point out that its rate of dependency is 
far less than alcohol, cocaine, heroin or nicotine; that the symptoms 
of withdrawal are less severe; and that it's virtually impossible to 
die from an overdose, according to the Institute of Medicine.

Mitchell Earleywine, a psychology professor at the University of 
Albany, is also chairman of the board of NORML, which advocates for 
legalizing marijuana.

He questions the claim that 9 percent of marijuana users became 
addicted, saying that if you look more closely at which users have 
serious problems attributed to their marijuana use, the number is 
about half that. Those who do become addicted can typically be 
treated successfully, he said.

Earleywine also doubts that medical marijuana will lead to increased 
overall pot abuse. A study this year in The Lancet medical journal 
found no increased use among adolescents in states that have 
legalized medical marijuana. Another study by the University of 
Pennsylvania last year found that states with medical marijuana had 
lower rates of overdose deaths from prescription painkillers, 
suggesting that pot may be safer for treating chronic pain.

"It's not harmless, but it's not the satanic weed we grew up being 
told it was," Earleywine said.

To those who treat drug abusers, cannabis is far from benign. The 
drug can impair short-term memory, judgment, thinking and driving, 
and long-term use has been associated with problems like chronic 
coughs and cognitive impairment, according to the National Institute 
on Drug Abuse.

Craving marijuana is a potential sign of a substance use disorder, as 
defined by the American Psychiatric Association, along with an 
inability to stop using or cut back, even when it interferes with 
relationships, work or other aspects of life.

Nationally, the use of marijuana - the most popular illicit drug - 
led to more substance abuse treatment than any other drug besides 
alcohol. In Illinois in 2013, there were more than 8,000 instances of 
people seeking drug treatment where pot was the primary substance of 
abuse, according to the U.S. Substance Abuse and Mental Health 
Services Administration. Three-quarters of them were male, and the 
vast majority were under 30.

Those who support further decriminalization assert that most people 
who seek treatment were ordered by the courts, schools or parents 
because pot is illegal, not necessarily because of abuse or addiction.

Another measurement of marijuana use has caused concern in recent 
years. In 2011, the most recent year reported by SAMHSA, people who 
had used marijuana accounted f or about 450,000 emergency room visits 
nationwide. Often, they had also used other substances or simply had 
pot in their systems from earlier use.

In a sampling of states that allow medical marijuana, there were 
significant increases in ER visits involving cannabis between 2007 
and 2012, according to a study presented last year to the American 
Academy of Addiction Psychiatry.

Addiction counselors continue to warn about cannabis' potential 
risks, particularly for adolescents whose minds are still developing 
and who are more prone to poor judgment and addiction.

Dr. Thomas Wright is a psychiatrist and chief medical officer at 
Rosecrance. While most of Rosecrance's adult clients are treated for 
alcohol or opiate abuse, most adolescents are there for marijuana 
use. Many are trying to self-medicate for conditions like depression 
or anxiety, Wright said, though the American Psychiatry Association's 
policy states broadly that there is no scientific evidence that 
marijuana benefits any psychiatric condition.

While pot doesn't have the same physical symptoms of addiction, 
Wright said it's often combined with alcohol or other substance use, 
amplifying its negative effects.

Those who qualify for Illinois' new medical marijuana program should 
be careful about the dosage and their method of ingesting the drug, 
said Dr. Joshua Straus, a psychiatrist who treats people with 
substance abuse problems at North Shore University Health System. 
Modern marijuana strains are much stronger than in years past, and 
can be much more concentrated in extracts, such as butane hash oil, 
also known as "dabs," which reportedly have concentrations of THC, 
the psychoactive ingredient in pot, of up to 80 percent.

Eating food containing marijuana can also lead to taking too much, 
Straus warned, because the drug's effects come on much more slowly 
than when it's smoked. And one study of West Coast states where 
medical marijuana is legal found wide discrepancies between actual 
THC content and what was stated on product labels.

Straus said he's seen some heavy marijuana smokers experience 
psychotic episodes. Cannabis has been correlated with psychosis in 
some studies, though it's not clear whether one causes the other.

Despite his reservations, Straus is open to the medical marijuana 
program. Research has shown marijuana to be effective in treating 
pain and improving appetite, and Straus has recommended one of his 
patients for the drug after the woman tried numerous other treatments 
for painful inflammation without success.

He worries, though, that when she picks up her first dose, it won't 
include the label warnings of potential side effects and drug 
interactions, as is required for federally approved drugs.

"There isn't an adequate informed consent," he said. "It's on every 
other medication. ... It's a big missing piece."

Dr. Leslie Mendoza Temple, head of the Illinois Medical Cannabis 
Advisory Board, acknowledged the potential dangers, but said 
patients' doctors should be able to monitor and manage them, in light 
of the potential benefit.

"It does have a low risk of addiction, but the risk is there," she 
said. "There are risks to everything we do."
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