Pubdate: Thu, 19 Jan 2017 Source: Chicago Tribune (IL) Copyright: 2017 Chicago Tribune Company Contact: http://www.chicagotribune.com/ Details: http://www.mapinc.org/media/82 COULD MEDICAL MARIJUANA USERS BECOME ADDICTED TO POT? Depressed, withdrawn and coping with a death in the family, Joseph thought getting high would help him feel better.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 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 much. 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 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 benefit. "It does have a low risk of addiction, but the risk is there," she said. "There are risks to everything we do." - --- MAP posted-by: