Pubdate: Sun, 17 Apr 2016
Source: Call, The (Woonsocket, RI)
Copyright: 2016 The Call.
Author: Joseph B. Nadeau


Forum Offers Sobering Opinions on Push for Legalization of Marijuana

The increasing speculation that Rhode Island will further ease 
restrictions on the use of marijuana had area prevention coalitions 
raising a flag of caution at a recent Town Hall Meeting, hosted on 
the campus of Amica Insurance, to talk about how those changes could 
affect young people.

The forum on marijuana focused on how the drug affects adolescents 
and the developing teenage brain with the help of Dr. Lilia 
RomeroBosch, a psychiatrist, and also presented information on 
existing trends in drug use among teens from Margaret Johnson, a 
student assistance counselor for the Warwick school department. There 
was also a youth panel of students who gave first-hand accounts of 
what is happening in their schools in North Smithfield, Lincoln, 
Cumberland, Woonsocket and Scituate. The discussion was moderated by 
Nancy Denuccio, chairwoman of the Ocean State Prevention Alliance. 
Romero-Bosch related her experiences in counseling family members 
with substance abuse problems, and her experiences with patients who 
are trying to quit substance abuse while also participating in 
marijuana production.

After describing how one patient declined to pursue treatment in 
light of family involvement in the legal production of marijuana, 
Romero-Bosch said she believes the impacts of the drug industry on 
families need to be studied further.

"I think it highlights some real life concerns," she said. She said 
the laws governing the new marijuana industry in Rhode Island would 
be "confusing" to most physicians and also "confusing to most people."

More questions will need to be answered in the future as some 
families begin to rely on the income of their caregiver licenses and 
having increasing business traffic in their homes, she said.

"There is a lot of pressure to say look we want to be substance free 
but my family has just invested all this money how can I go and say 
you have to get rid of it," RomeroBosch said.

"It becomes very, very difficult. And trying to convince families to 
let go of this potentially lucrative livelihood I think is going to 
be a hard argument to make," she said.

She also sees problems in the risks of marijuana use being overlooked 
as more adolescents experience the drug.

Romero-Bosch related how she had seen a male patient, 17 to 18 years 
old who had begun to show signs of a psychotic disorder, 
schizophrenia, that may have been linked to his use of the drug.

"The parents were in crisis because this patient started to have very 
serious behavioral problems, very serious problems at school. He was 
a really talented athlete and he started to have difficulty in 
sports," she said.

Making such a diagnosis is not easy since there are no diagnostic 
tools to help as in the case of a medical aliment, she noted.

"We have to use our best clinical skills to make an assessment and 
make a likely diagnosis," she said. In that particular case, 
Romero-Bosch said she had to tell "this family is that there is 
schizophrenia or that there is marijuana-induced psychosis."

What remains under review in the medical community is whether or not 
"in some cases of psychosis, where there is marijuana use, it is an 
intoxication issue and a side effect of the marijuana itself - which 
we hope for that," she said.

"That means that it's possible, if we stop the marijuana use, the 
brain recovers and then the individual can get back to their 
functioning, healthier lifestyle.

That is one scenario, she said. The other scenario is that "the 
marijuana is actually triggering schizophrenia, or psychotic illness 
in people who are genetically susceptible to that. And right now we 
don't really have a way of determining who is genetically susceptible 
and who isn't," she explained.

The genetically susceptible theory would be the more difficult in 
that once triggered, an illness like schizophrenia doesn't go away, 
she explained.

"It doesn't go away. It is a lifelong illness and its gets 
progressively worse and progressively more severe and that usually 
shows up in late adolescents, in high school and in college," she said.

'Some doctor signs the form'

Romero-Bosch said she finds it to be "amazing how many relatively 
safe things are so strictly managed, and then for marijuana, which is 
still a big unknown, there is no physician or medical professional input."

Under the present system of medical marijuana "some doctor signs the 
form," she said. "We don't know anything about dosing, we don't know 
anything about monitoring, increases in dosing. There is no protocol 
or standard of care in place for that. And there amazing amount legal 
permissibility about the whole process that just shocks me," she said.

Romero-Bosch said she has never considered being one of the 
physicians giving the licenses for those reasons, "Because I'm 
putting my name to a treatment that I can't vouch for. I get no 
follow up with the patients. I can't dose them appropriately. It 
feels very scary to me," she said. "I think marijuana can have its 
uses but if it going to be treated as a medicine it should be treated 
as such. It should be monitored the way medicines are monitored," 
Romero-Bosch said.

A woman in the audience of the forum told Romero-Bosch how marijuana 
use had impacted her brother's college aspirations after he began 
smoking in Thailand and he lost the option of going to school.

Here in the United States, she said she found different attitudes and 
now thinks that people may try the drug but then move on with life. 
"I'm just thinking of how to find the balance that it being 
acceptable but at the same time it is not stigmatized to the point 
that someone gets in trouble because of marijuana and they can 
continue with their education," she said.

Romero-Bosch said she believes that it is important to "educate 
people so they can self monitor and be empowered by information.

"Maybe for a lot of people once in a while is not going to have 
lasting consequences, but how do you define once in a while, how do 
you know which of those people who genetically can do it and its ok, 
and how do you know you're the person that is going to have one try 
of marijuana and it triggers psychosis. That's what I think those 
people need to be taught about," RomeroBosch said.

'They don't really think it is harmful'

During her turn before the forum, Johnson explained her own work as 
one of 43 counselors with the Student Assistance Program serving 25 
high schools and 18 middle schools in the state.

She says there's a danger that kids will think marijuana is safe once 
it has been decriminalized. From the counselor's perspective, like 
Romero-Bosch, the concern is for the adolescent brain, Johnson said.

"The adolescent brain is in such a vulnerable state right now and I 
think most of you in this room know that," she said.

"Smoking marijuana on a regular basis impairs their cognitive 
ability, their learning rate  how much they can pick up, it impairs 
their memory, their coordination if they are athletes, and it stays 
with you for easily for three or four days while your brain is not at 
full function," she said.

"It stays in your system sometimes up to 20-25 days depending on the 
person, the concentration, what you took in. So there is a lot of 
information here that kids need to know," she said.

She told the panel she worries that drug use will increase as it 
becomes destigmatized socially and legally. In a recent survey in her 
own school, students said they believed 86 percent of the student 
body was using marijuana, even though the percentage is actually far lower.

"They don't really think it is harmful and that's a problem because 
we know it is in many ways," she said.

Research shows that the younger a person is when they start, the 
greater the risk for addiction to a substance, she said.

"It's more likely that its going to have a major impact on your life 
and that if you wait until after your brain is finished developing, 
it less likely that is going to have a major impact," she said.

"When I talk to students I beg them to wait. And I use the word beg. 
I beg them to wait.

"If you can wait until your brain is finished developing, there is an 
86 percent chance you'll never be in trouble with an addictive 
substance," Johnson said.

'Prevention is better than intervention'

Statistics show "about 39 percent of high school students in Rhode 
Island have tried marijuana, about 24 percent have used it within the 
past 30 days and about 7 percent are what we call daily users which 
means they used it 20 out of 30 days this month," she said.

"We're concerned about the 7 percent because that has the biggest 
impact. They are under the influence of marijuana most of the time 
while they are in school. We know it impairs cognitive development, 
that it will impact their ability to learn. We know they will be 
twice as likely to drop out of high school. We know that 65 percent 
of them never finish high school. So these are kind of big deals," 
Johnson said.

"We know that they are twice as likely to have poor grades. So 
collecting data is important, using the data in ways that benefits 
everybody is really important," she said.

The data also shows that behavior problems and suspensions go up with 
the use of marijuana.

"So I agree with Dr. Romero-Bosch, we have to start early, and I 
think we could start earlier that what were starting," she said. 
Johnson said she works at the middle school level for that reason, 
"because I think prevention is better than intervention. I think it 
saves a lot of money. I think that is the place to be," she said.

"Most kids that become addicted as adults started at 12 to 14 years 
old, they took their first toke or first drink at that point," she said.

Information does help, she said.

"We know that when you have people talking about this to adolescents 
we know that a higher proportion of students will graduate, we know 
that a higher proportion of students will come to school everyday and 
attendance will improve," she said.

"And we know that discipline problems decrease when we have students 
in the buildings for periods of time," she said.

Johnson said she also was concerned about parents who are habitual 
marijuana users.

"When they are around it all the time, it's in their vocabulary and 
they are much more likely to use it, and their friends are much more 
likely to come into contact with it at a young age." she said.

For those reasons, Johnson also called for greater study of the 
"ramifications of increased use and legalization" and whether that 
will lead to increased adolescent use.
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