Pubdate: Sun, 26 Jun 2016
Source: Orange County Register, The (CA)
Copyright: 2016 The Orange County Register
Author: Brooke Edwards Staggs


Is marijuana an addictive gateway drug that lowers IQs, triggers 
psychotic episodes and makes roads less safe?

Or is it a miracle plant that can ease pain or provide a pleasant 
buzz with health risks on par with forgetting to floss?

Clashing portrayals of cannabis have endured through decades of 
research and a gradual easing of public resistance to the drug's use.

Twenty years after California legalized medical marijuana  and as the 
state appears poised to vote on allowing recreational consumption of 
weed  sorting fact from fiction, anecdotal evidence from rigorous 
research and "Reefer Madness"-type scare tactics from legitimate 
health concerns still isn't easy.

Scientists have been limited in their ability to assess long-term 
effects of marijuana. That's largely because the federal government 
classifies cannabis alongside heroin as a top-tier illegal substance, 
which among other things means researchers must comply with an 
ultra-strict set of requirements that they say can prove insurmountable.

Also, as with most drug studies, researchers are forced to rely 
heavily on self-reported data that are often muddied and can skew 
results, such as gauging health effects among cannabis consumers who 
also smoke cigarettes.

"We do need more research," said Madeline Meier, a psychologist at 
Arizona State University who's authored several widely cited studies 
on marijuana. "Really, in the big scheme of things, this is a new 
area, an emerging area where we don't have strong conclusions yet."

California voters may not have years to wait for science to catch up 
with public policy choices.

In just four months, voters likely will decide whether to legalize 
recreational pot use in the state. Thursday is the deadline for 
election officials to finish validating signatures on an initiative 
aimed at the Nov. 8 ballot. And if the measure reaches the ballot and 
is approved in November, all residents 21 and over will be free to 
legally partake.

Big players in the medical community are split on the issue.

The California Medical Association, which represents more than 41,000 
physicians, was an early supporter of the legalization initiative. 
The group stresses it isn't encouraging marijuana use. But, it adds, 
"the most effective way to protect the public health is to tightly 
control, track and regulate marijuana and to comprehensively research 
and educate the public on its health impacts, not through ineffective 

However, the California Hospital Association, which represents 
hundreds of hospitals and health care systems, has joined law 
enforcement groups in opposing legalization. In May testimony before 
a legislative committee, the hospital group's Connie Delgado 
expressed concern that emergency room visits and infant exposure to 
marijuana might increase as they reportedly did in Colorado following 

So how do adults make an informed decision with the science largely unsettled?

"There's a cost-benefit analysis that voters have to make," said Dr. 
Igor Grant, a psychiatrist who oversees the Center for Medical 
Cannabis Research at UC San Diego.

One the one hand, Grant said, there are costs tied to prohibition. 
They include lost opportunities to collect tax revenue and spending 
on law enforcement. He also pointed to studies showing criminal 
enforcement efforts have disproportionately penalized minority populations.

On the other hand, research suggests marijuana use poses some 
potential risks - particularly for vulnerable populations, such as 
teens and those prone to mental illness.

"There's no 'safe' about it," Meier said.

At the same time, there's growing evidence that the health effects 
aren't as severe as many people have believed. And, if precautions 
are taken - such as limiting access for minors  advocates say many 
remaining risks are modest and manageable.

In research released this month, Meier used data from a New Zealand 
study that tracked more than 1,000 people for 20 years to compare the 
health of cannabis users and nonusers.

"In general," she said, "people who use marijuana did not show poor 
physical health by midlife with one exception: They are more likely 
to have gum disease."

With the November campaign already gearing up, surveys and studies on 
marijuana that might otherwise only draw attention from the 
scientific community are being endorsed and critiqued, lauded and 
torn apart by the population at large.

Against that backdrop, the Register is beginning an occasional series 
that will survey current research and interview experts on common 
questions about marijuana use: the potential health risks, issues of 
government regulation and the experience of states where recreational 
use of cannabis is legal.

Is marijuana addictive?

For some consumers, yes - but less so than with alcohol.

About 9 percent of people who use marijuana become dependent on it, 
according to research from the National Institute on Drug Abuse. The 
study found the dependence rate is about 15 percent for people who 
drink alcohol, 17 percent for cocaine users and 32 percent for tobacco users.

"Some people can drink normally. Some people can smoke weed normally. 
But some people can't," said Corey Richman, an admissions coordinator 
at Hope by the Sea drug addiction treatment center in San Juan Capistrano.

Roughly 2 percent of patients at Hope by the Sea are there for 
marijuana abuse, said Richman, a former addict himself. They're 
almost always teenagers brought in by concerned parents, he said.

The earlier young people start using marijuana, the more likely they 
are to get hooked, with the National Institute on Drug Abuse 
reporting dependence jumps to 17 percent for teen users.

Stopping heavy marijuana use is often more of a mental struggle than 
a physical one, said Kevin Alexander, clinical manager at Hoag 
Hospital's ASPIRE program in Newport Beach. It can trigger mild 
withdrawal symptoms similar to quitting tobacco, including 
irritability and sleep issues. In rare cases, he said, patients 
experience psychosis.

At the same time, doctors are tapping marijuana's painkilling 
benefits to help patients avoid riskier substances such as opioids. A 
study published in 2014 by the American Medical Association found 
lower rates of opioid overdoses in states where medical marijuana is legal.

Waiting until at least 18 to start using marijuana lessens the 
chances of becoming dependent, as does avoiding heavy use of potent 
pot products, experts say. And people with a family or personal 
history of addiction might consider avoiding marijuana altogether.

Does marijuana cause brain damage?

More studies are needed to answer this complex question. But while a 
growing body of research indicates even heavy marijuana use seems to 
have few long-term health effects for adults, it may negatively 
affect developing teen brains.

People who started using cannabis as teenagers lost about eight IQ 
points by the time they were 38, according to a 2012 study by Meier.

Overwhelmingly, studies by Staci Gruber, a psychiatry professor at 
Harvard Medical School and director of the Marijuana Investigations 
for Neuro scientific Discovery team at Boston's McLean Hospital, show 
that chronic marijuana smokers who start using before age 16 perform 
more poorly on cognitive tests. They show reduced impulse control and 
issues with staying focused on a task, she said.

Even the brain structure itself can be altered in young smokers, she 
said, decreasing the amount of white matter, which affects how we learn.

"It's not as if these people appear to have brain injuries," she 
said. "In all actuality, these people are able to function the same 
as people who don't smoke."

Other studies contradict such results, and some researchers question 
whether family environment and other factors account for some of the 
cognitive decline. And even if IQ declines are correlated to 
marijuana use, it's tough to know whether the drug changed the brain 
or subjects simply weren't paying attention in school because they were high.

"I think it's fair to say, as far as heavy adolescent use, we have an 
open question here," said UC San Diego's Grant.

Most researchers agree such unanswered questions justify regulations 
akin to those in the proposed California legalization measure  that 
are aimed at keeping marijuana away from young people. So, where 
should the age line on legal use be drawn?

In her study, Meier said negative impacts on IQ disappeared for 
people who started using at age 18, which is the age limit for 
California medical marijuana patients.

However, four states that have legalized recreational use set 21 as 
the age limit - the same being proposed for California.

Gruber said brain development continues until around age 25, making 
it tough to say that marijuana users are "out of the woods" at 21.

Can you overdose on marijuana?

Unlike with alcohol and most other drugs, researchers say there's 
been no recorded death attributed to using too much cannabis. But 
experts say overdoing it can cause highly unpleasant and, rarely, 
dangerous experiences.

Consuming large amounts of potent pot can temporarily trigger rapid 
heartbeats, nausea and hallucinations.

"It's not that you'll die from it," Gruber said. "But you might be so 
sick that you'll wish you could die."

"Bad trips" typically happen when inexperienced consumers try a 
cannabis-infused food, don't feel anything after 30 minutes and eat 
more. Since the effects of cannabis edibles can take up to two hours 
to be felt, it's easy to overindulge.

Most adverse symptoms wear off within a couple of hours, so medical 
experts suggest users relax and have a sober friend watch over them. 
They stress driving while impaired can be dangerous, as can the 
actions of someone who slips into a severe state of psychosis.

A lawsuit pending in Denver against an edibles company claims a man 
ate large quantities of cannabis-infused candy, started 
hallucinating, then killed his wife. And in the last two years, 
officials or family members have attributed two Colorado suicides to 
high doses of cannabis edibles.

Colorado now requires edibles to be sold in serving sizes of 10 
milligrams, which it considers one dose. There's also a push for 
stricter packaging and labeling requirements to help consumers dose more wisely.
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MAP posted-by: Jay Bergstrom