Pubdate: Fri, 04 May 2018
Source: Boston Globe (MA)
Copyright: 2018 Globe Newspaper Company
Author: Felice J. Freyer


Dr. Nora D. Volkow, director of the National Institute on Drug Abuse,
was in Boston on Thursday to speak at a symposium sponsored by Boston
University's Clinical and Translational Science Institute and Boston
Medical Center's Grayken Center for Addiction. Before her talk, she
sat down with the Globe to talk about marijuana legalization and the
opioid crisis. Here are edited excerpts:

* Dispensaries that sell legal marijuana will soon open in
Massachusetts. What are your thoughts on pot legalization?

The greatest mortality from drugs comes from legal drugs. The moment
you make a drug legal, you're going to increase the number of people
who get exposed to it, and therefore you increase the negative
consequences from its use. When you legalize, you create an industry
whose purpose is to make money selling those drugs. And how do you
sell it? Mostly by enticing people to take them and entice them to
take high quantities.

* But isn't marijuana much safer than the other legal drugs,
alcohol and tobacco? Can you die from marijuana?

You can die from marijuana if you're intoxicated and driving a car. I
don't know that it is safer. It depends on what stage in your life you

For example, if you're a teenager, marijuana is much more dangerous
than nicotine, because it is likely to interfere with the development
of your brain. Marijuana dumbs you down. When you're a teenager and
your job in life is to learn, then to slow that down puts you at
tremendous jeopardy. Nicotine will not do that. Of course you'll pay a
price when you're at 60 years of age and you may end up with lung
cancer. But how do you determine what is worse? Dropping out of
school, when you're 16 or 17, that's one of the predictors of poor
health outcomes. It's not as simple as people like to make it.

* What about the medicinal uses of marijuana?

We have evidence for its benefit for certain conditions, such as the
painful muscle contractions that occur with multiple sclerosis. But
there is much more work to be done. There hasn't been a large enough
study to determine: Are the effects larger than a placebo, do you
become tolerant, and how should you be managing it? When you smoke,
it's very difficult to control how much of the active ingredient you

We have gone into practices that are not supported by the evidence,
like the management of chronic pain. We don't want to give inadequate
solutions to patients. We owe it to them to actually do the studies,
in order to understand what may be potential benefits or harms.

* Why do people become addicted, and how can they recover?

Some individuals have a genetic vulnerability. Others don't have the
vulnerability but they are brought up in an environment that is very,
very stressful - the parent is in jail or the mother neglects them.
That social deprivation component affects how the brain develops.

We have medications [for opioid addiction] that are very useful, that
improve outcomes significantly, but they are vastly underutilized.
Medication is a tool that significantly improves the likelihood of
that person being able to recover but it will require that there is a
change in the system that will allow that person to go back to work or
go back to school or to have the social support interactions that are
necessary for all of us to succeed.

Unfortunately, we've made addiction a very stigmatizing, isolating
condition that removes that social support.

* Do you think addiction will always be with us?

Addiction can be addressed, but that will require that we make
significant changes to the social structure. Our culture has one of
the highest rates of addiction in the world. It's telling you that
there's something in the social system, culture, economics, that is
driving access to drugs.

More and more states are legalizing marijuana; we're going to have
more people become addicted to cannabis. We have to figure out how do
we prevent that from happening.
- ---
MAP posted-by: Matt