Pubdate: Thu, 19 Jan 2017
Source: Chicago Tribune (IL)
Copyright: 2017 Chicago Tribune Company


Depressed, withdrawn and coping with a death in the family, Joseph thought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.

See ongoing Chicago Tribune stories on the legalization of medical pot,
who is selling it, who is using it and why.

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 purchase 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

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 much.
Those who do become addicted can typically be treated successfully, he

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 for 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 NorthShore University HealthSystem. 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

"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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