The Marijuana Conundrum
Rarely a day goes by where we do not encounter political, legal or medical news and arguments asking or declaring how we should handle marijuana. As an addiction medicine physician, I too encounter these questions almost daily. My own research and attempt at crystallizing an opinion is frustrated by many paradoxes. Several questions are really being asked about marijuana, but they are disguised or misrepresented as a single question: “Yes or No” concerning marijuana? This is an extreme oversimplification when asked this way, but it avoids and dodges potholes (sic).
Proponents for the use of marijuana for medical reasons cite growing evidence of proven medical benefits. Legalization arguments are convincing too. A purported failure of prohibition and the enormous economic and societal costs of attempts at enforcement burden us all. Perhaps the loudest chorus for making marijuana legal and medically available comes from those whose real goal is recreational use with a cultural refrain written with Cheech and Chong asking “hey man, am I driving OK…I think we’re parked man…”
The argument of what to do with marijuana can and should be discussed as three separate issues, all related, but all with specific considerations. 1) medical use, 2) legalization, and 3) recreational use. More often what we find in reported stories, quotes and political questions about marijuana is an argument covering only one of these issues, and it is used to answer all three questions. This creates confusion and obfuscation inherent in finding “the answer” for marijuana. We listen to Sanjay Gupta on CNN “doubling down” for the medical uses of marijuana. Our Justice Department describes the inequities of prosecution leaving a disproportionate number of Blacks and Hispanics serving time for “minor marijuana offenses”. Our own President in an interview in the New Yorker a few months ago has made statements supportive of marijuana comparing it to alcohol while the government he represents bans it. He explicitly states that he tried marijuana when he was younger, while implicitly seeming to say “I turned out all right, how bad could it be”. Each of these points of view are then used to support any and all use of marijuana by zealous proponents. Some more specifics:
1) Medical Issue- A growing body of evidence exists suggesting positive medical uses of marijuana for pain, epilepsy, multiple sclerosis, chemotherapy patients, diabetes, Crohn’s disease, and others. Most of the evidence is anecdotal yet much is compelling. Marijuana or its 480 ingredients and 66 various cannabinoids has undergone a relative paucity of the kind of research considered standard for potential pharmaceuticals. Marijuana’s categorization as a Schedule I (one) drug says it is “dangerous and without known medical use” essentially placing a firewall between marijuana and medical research. This firewall is bolstered and sealed by the holding of US Patent # 6,630,507 by the US Government for medical uses of marijuana. It would be patent infringement for other pharmaceutical companies to develop medical uses for marijuana without express permission from the US government. Our government states unequivocally at Whitehouse.gov on the Office of National Drug Control Policy page that “The Administration steadfastly opposes legalization of marijuana…it would pose significant health and safety risks to all Americans…” Sitting atop the myriad obstacles to meaningful medical research on marijuana is our government, no matter how compelling the evidence for potential benefits. This conundrum has created a situation where five brothers in Colorado nicknamed “the chemical brothers” are at the forefront of developing medical uses for marijuana. They have no medical background, yet opportunity and a vacuum places them on the cutting edge of standardizing extractions, potencies and components of medicinal marijuana. The Stanley brothers are sincere and honest I believe, but for them to be the pioneers of medical discoveries in this country of vast medical infrastructure is a travesty.
2) Legalization- Our overburdened and costly prison system is partly so because of the 1.3 million drug arrests made yearly. Of these arrests, Blacks are 6 times more likely to be imprisoned than whites, and Hispanics are 2.5 times more likely according to the Bureau of Justice in 2012. Many of these involve small amounts of marijuana. Although these statistics represent a problem with our justice system as a whole, they provide a pillar in the argument for legalization of marijuana. Other arguments for legalization are economic and involve standardization and safety. Pros and cons debate issues such as DUI’s, availability to minors, promotion vs control of use, marijuana as an addiction gateway, associated crime, and other issues.
3) Recreational- This is the category that astounds me as an addiction physician. Proponents of recreational use uniformly compare it to alcohol and/or cigarettes. It seems that the best argument for recreational use involves comparison to substances and products that kill hundreds of thousands every year. As if there were some value to a “relative risk of dying” in the argument. “Obesity and hang gliding can be fatal and they are not illegal, why is marijuana” goes the argument. This can be debated concerning personal freedom to harm yourself, but our laws are also designed to protect others. Most quoted studies evaluating driving and marijuana use are several years old, but the potency of marijuana increases every year. In 2005 the journal Addiction stated that one joint was equivalent to a blood alcohol level of .05% concerning motor and executive function. What is that level today?
We live in a country where New York outlaws Big Gulps, while Colorado enables marijuana use. Tobacco smokers are exiles while marijuana smokers are cheered. Regularly ignored in all of the above arguments except to be minimized is the addiction issue associated with marijuana. It coopts our brain’s reward system just as any other addictive drug, leading to tolerance and the subsequent search for perceived reward with other substances.
Several paradoxes are described above. Answers to the questions can be described as riddles- puzzles requiring creativity and ingenuity to answer. I and others propose that marijuana be reclassified as a schedule II or even schedule III drug and treated as such medically and legally. This would change the legal issues making it similar to having morphine or hydrocodone. There are obviously problems with these drugs too, progress not perfection. The goal is to make marijuana available for research, standardization, oversight as a controlled medication, and perhaps freeing billions of dollars currently wasted on failed prohibition to these endeavors. Dispensing, oversight, and research would then all have already delineated pathways and mechanisms. Simply making marijuana available and controlled like alcohol is an appealing argument for some, but as an addiction professional that encounters the ravages of alcohol and addiction daily, I can only hope that this approach is never taken.
“Conundrum” involves paradoxes and puzzles and unresolved questions. Here is a doozy.
The Marijuana Conundrum – by Dr. Reeves.