Debunking the Myths About Marijuana

Although Marijuana is a “Schedule I Controlled Substance” under the Controlled Substances Act, meaning that it is forbidden by federal law to manufacture, distribute, or dispense, or possess with intent to manufacture, distribute, or dispense it, sixteen U.S. states and the District of Columbia have adopted laws decriminalizing personal Marijuana use and, in most cases, allowing patients with certain medical conditions to obtain marijuana legally if they have a doctor’s prescription.  These laws are controversial, as is the federal law listing marijuana as a Schedule I controlled substance.  As always, with great controversy comes a great propensity to circulate political myths.  Some of the myths that deal with marijuana will be addressed here.

Political Myth: Marijuana is not addictive.

Reality: It depends on what you mean by “addictive.”

Explanation

Stedman’s Medical Dictionary defines “addiction” as “Habitual psychological or physiologic dependence on a substance or practice that is beyond voluntary control.”  The problem is, “psychological dependence” and “physiologic” dependence are two very different things (though sometimes they are related).  The other problem is that both psychological dependence and physiologic dependence can manifest themselves in different ways with different substances.  Here are some of the distinct processes that characterize what most people call “addiction”:

  • Chemical dependence, meaning that a person who has been taking the drug will experience harmful “withdrawal” symptoms of he stops taking it.  In the case of marijuana, this typically happens only in serious cases of heavy prolonged use, and then, the most common physical withdrawal symptoms are irritability, anger, depressed mood, headaches, restlessness, lack of appetite.  A recent study has shown that roughly 42% of long-term heavy marijuana users who quit experience at least one withdrawal symptom, although there is substantial controversy over the extent to which these withdrawal symptoms are physical as opposed to psychological.
  • Tolerance, meaning the need to take increasing amounts of the drug in order to achieve the same effect, has been observed in long-term, heavy marijuana users, but like physical dependence, it is more rare in the case of marijuana than it is in the case of some other drugs (e.g. alcohol).
  • Psychological Addiction, however, is a serious issuewith marijuana, as it is with any mood altering substance, for the simple reason that marijuana alters one’s mood.  One of the hallmarks of an “addictive” drug in this sense is that people use it to self-medicate for emotional problems (e.g. anxiety, depression, etc.) that are going on in other areas of their lives.  Since marijuana is very effective in making a depressed person feel less depressed, or an anxious person feel less anxious, it certain fits profile of a drug with an addictive potential.The problem is that marijuana has a number of harmful side-effects such as impaired motor function and impaired ability to concentrate, that make marijuana use incompatible with everyday life activities like driving, working, going to school, and so-forth. A person who depends on marijuana to relieve their depression, anxiety, or other underlying psychological condition has to stop self-medicating in order to do many of the things that enable then to function as members of society. One of the other hallmarks of psychological condition is that the substance becomes more important than, and therefore interferes with, things like work, school, hobbies, family life, and so-forth. Marijuana certainly does do these things.

Political Myth: Marijuana is not harmful / is less harmful than cigarettes.

Reality: Whether the “harm” outweighs the benefits is in the eyes of the beholder, but marijuana certainly is harmful.

Explanation

Short term use of marijuana causes tachycardia, high blood pressure,  and increased rate of breathing, red eyes,  dry mouth, increased appetite, slowed reaction time, a distorted sense of time, altered thinking, and short-term memory loss.  In the long term, the harmful effects of  smoked  marijuana are similar to the harmful effects of smoked cigarettes (e.g. lung cancer, COPD, emphysema), since, despite the fact that Marijuana has a different primary active ingredient (THC) than tobacco (nicotine)  many of the same harmful toxins that are present in tobacco smoke are also present in marijuana smoke.

As with any other drug being considered for medicinal use, however, the question isn’t simply whether marijuana is “harmful” in the abstract, but it is, instead, whether its harms are outweighed by its medicinal benefits.  The FDA has approved a drug called Marinol — basically THC in pill form, anorexia and nausea.   Marinol is, unfortunately, quite a bit more expensive than Marijuana, and because it is in pill form the THC from Marinol takes longer to enter the system than the THC from Marijuana.


Political Myth: Marijuana is a “gateway drug” whose use leads to the abuse of more harmful drugs.

Reality: Marijuana users are more likely than others to try other drugs later, but that doesn’t necessarily mean that marijuana use  causes people to try other drugs.

Explanation

As discussed above in the section on addiction, many marijuana users use marijuana to self-medicate and obtain temporary relief for some other psychological issue (e.g. depression, anxiety, etc.) .  While studies have shown that marijuana users, as a group, are more likely than non-marijuana users to try other drugs, they haven’t established a causal link.  It is quite possible that the kind of person who is likely to use marijuana is also the kind of person who is likely to use Heroin.  Since both substances are often used to self-medicate for the same underlying conditions, that is probably an avenue of research worth exploring.

Or, to put it more another way:  People who use Tylenol are more likely to try Aspirin.  Does that mean that taking Tylenol causes people to take Aspirin, or is the underlying headache what makes Tylenol users more likely to take Aspirin?


Political Myth: Marijuana fits the criteria for classification as a Schedule I Controlled Substance.

Reality: That is very much a judgment call.

Explanation

Here is what the Controlled Substances Act has to say about which drugs should be classified as Schedule I drugs:

Except where control is required by United States obligations under an international treaty, convention, or protocol, in effect on October 27, 1970, and except in the case of an immediate precursor, a drug or other substance may not be placed in any schedule unless the findings required for such schedule are made with respect to such drug or other substance. The findings required for each of the schedules are as follows:
(1) Schedule I.—
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has no currently accepted medical use in treatment in the United States.
(C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.
(2) Schedule II.—
(A) The drug or other substance has a high potential for abuse.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.
(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.
(3) Schedule III.—
(A) The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.
(4) Schedule IV.—
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule III.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III.
(5) Schedule V.—
(A) The drug or other substance has a low potential for abuse relative to the drugs or other substances in schedule IV.
(B) The drug or other substance has a currently accepted medical use in treatment in the United States.
(C) Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule IV.

Perhaps the most controversial aspect of the decision to treat marijuana as a Schedule I drug is the finding that it has “no currently accepted medical use in treatment in the United States.”  Marijuana certainly does have medical uses:  It can be used as an appetite suppressant to help cancer patients maintain their body weight, it can temporarily relieve glaucoma, and it has certain analgisic uses.  As noted above, the FDA has approved THC in pill form to treat some of these conditions.

The question is whether smoked marijuana has currently accepted medical uses that aren’t met identically well by Marinol. One benefit of Marinol over smoked marijuana is the ability to regulate the dosage:  If a doctor prescribed a certain number of THC pills, the doctor knows exactly how much THC the patient is getting.  But if a patient smokes marijuana, the amount of THC he will get varies widely.  On the other hand, there is a good argument that “a patient-determined, self-titrated dosing” is more effective in treating something like recurring nausea than having the doctor prescribe a particular does.  Also, smoked marijuana does not take nearly as long as orally ingested THC to take effect.  The trade-of is that orally ingested THC lasts a great deal longer.

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