Pubdate: Sun, 07 Aug 2016
Source: Orange County Register, The (CA)
Copyright: 2016 The Orange County Register
Author: Brooke Edwards Staggs


Today's pot is typically four times stronger than the marijuana of 
just a couple of decades ago.

That's timely to note in the current push to legalize the drug, 
because much of the research showing marijuana has only modest health 
effects on adults is based on weaker strains that have been largely 
bred out of the marketplace.

That means that, as Californians prepare to vote this November on a 
recreational marijuana initiative, they'll do so without conclusive 
answers from the medical community on how today's pot may affect 
mental health and the debate over the gateway drug theory.

"We're all riding this green rush right now," said Staci Gruber, a 
psychiatry professor at Harvard Medical School who studies the 
effects of marijuana use on the brain. "But there's still so much 
that we don't know."

Leading up to the fall vote, the Register is publishing an occasional 
series that surveys current research and interviews 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 riskier now than it used to be?

Updated research is needed, experts say, with pot potencies and 
products constantly evolving.

Through the 1990s, marijuana typically had about 4 percent THC, the 
main compound that makes consumers high, according to Madeline Meier, 
a psychologist at Arizona State University. Thanks to cultivators 
who've crossbred strains to boost potency, today's cannabis commonly 
has 15 percent, 20 percent, even 30 percent THC. And concentrates - 
such as waxes, tinctures and oils - can reach 60 percent or 80 percent.

Such potencies can lead to negative experiences for baby boomers who 
haven't lit up in decades or for inexperienced consumers who don't 
know how to properly dose their intake, Gruber said. There's also 
concern among experts that increasingly potent products heighten health risks.

"That definitely increases the potential for addiction," said Kevin 
Alexander, clinical manager at Hoag Hospital's After-School Program 
Interventions and Resiliency Education program in Newport Beach.

Hope by the Sea treatment center in San Juan Capistrano has seen a 
slight uptick in patients seeking treatment for marijuana abuse, 
according to admissions coordinator Corey Richman. Anecdotally, he 
said, those patients seem to exhibit more serious symptoms of 
dependency, such as hoarding supplies rather than embracing the 
sharing, "puff, puff, pass" culture of marijuana's low-THC days.

Requiring products to be tested and clearly labeled for potency can 
help consumers make more informed decisions, Gruber said.

California is developing regulations on testing, labeling and 
packaging for medical marijuana that would carry forward if 
recreational pot were legalized.

Colorado considered an initiative for the November ballot that would 
have gone a step further, capping THC at 16 percent and requiring 
edibles to be sold in low-dose, single-serving packages. But backers 
recently dropped the effort amid fierce pushback from those who said 
such limits violated rights now incorporated in the state 
constitution and would have wiped out 80 percent of the legal pot market.

Is pot a gateway drug?

The theory that cannabis use leads to harder drugs - advanced by some 
politicians and public-safety officials - remains divisive in the 
medical community, even as it has been discounted by federal medical 

It's a fact that surveys show the majority of people who try 
substances such as cocaine or heroin say they first used pot.

The same surveys find most people who try marijuana first used 
cigarettes and alcohol. And national drug-use data indicate the 
majority of people who try marijuana never move on to other more 
powerful, addictive drugs.

Nearly 8.5 percent of the population said they'd used marijuana in 
the past month, according to the latest National Survey on Drug Use 
and Health. Just 2.5 percent said they'd used the next most common 
family of abused drugs: prescription medications. And fewer than 1 
percent had tried drugs such as cocaine, LSD or heroin.

Marijuana use is also increasing, the national survey shows. With the 
exception of a surge of heroin use in recent years, consumption of 
other drugs is flat or declining.

Some experiments on rats have indicated that marijuana causes a 
change in brain circuitry that triggers the use of harder drugs. If 
that's true, Gruber said, researchers would expect to see a higher 
percentage of people making the jump to more powerful substances.

What correlations may exist appear to be tied more to social factors, 
such as peer pressure and family environment, than physiological 
ones, experts say.

People who want the mind-altering effect of harder drugs might start 
with pot because it's easier to get, for example. Legalization 
advocates argue that allowing recreational marijuana use would reduce 
consumer migration to more dangerous narcotics by curbing 
interactions with street dealers, who have a financial incentive to 
push harder drugs.

A study from the federal Institute of Medicine sums it up this way: 
"Because underage smoking and alcohol use typically precede marijuana 
use, marijuana is not the most common, and is rarely the first, 
'gateway' to illicit drug use. There is no conclusive evidence that 
the drug effects of marijuana are causally linked to the subsequent 
abuse of other illicit drugs."

Can cannabis trigger mental health problems?

The answer's not simple. Recent studies have concluded that cannabis 
can both intensify and relieve various mental health conditions.

"For people with a predisposition, marijuana can exacerbate certain 
symptoms," Gruber said. "But you also have the flip side: There are 
people with psychological disorders who find some therapeutic 
benefits from marijuana use."

Look, for example, at anxiety.

Anxiety is one of the most common conditions u sers say prompts them 
to turn to medical marijuana. And a study published in February in 
the journal JAMA Psychiatry that tracked users over time found no 
link between marijuana consumption and an increase in mood disorders.

But some people do experience temporary anxiety or paranoia when they 
use marijuana, particularly when it has a high concentration of THC. 
In rare cases, Hoag Hospital's Alexander said, potent pot can trigger 
anxiety that escalates to psychotic episodes.

For people with a family history or symptoms of conditions such as 
schizophrenia, a 2014 study published in the journal Frontiers in 
Psychiatry suggests heavy cannabis use might trigger or worsen the illness.

At the same time, Gruber's research shows promise that medical 
marijuana can ease symptoms of bipolar, post-traumatic stress and 
attention deficit disorders. Notably, she said, patients showing 
success are using products that are low in THC and higher in CBD, a 
compound believed responsible for much of marijuana's medical 
benefits without the mind-altering effects.

"So much depends on exactly what products people are using," she 
said, adding that consumers respond differently to various strains, 
doses and methods of ingestion. "It can be a very personalized experience."

Alexander recommends people seeking to treat a mental health 
condition with cannabis do so under the guidance of a knowledgeable doctor.
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