Marijuana: harmless indulgence or health threat?

Among Ontario adults, 14.1 percent used cannabis during 2013, according to a recent report from Toronto’s Centre for Addiction and Mental Health (CAMH). In 1997, the equivalent figure was only 9.1 percent. Researchers at CAMH say that the steady increase in cannabis use underscores the need for a public health—rather than a criminal justice—approach to cannabis control.

This statistic, along with the legalization of marijuana in some parts of the U.S. and efforts for the same in Canada, seem to have de-stigmatized its use. The “stoner culture” depicted in popular culture treats marijuana as a comedic device; its users small-minded and detached from reality, but of no threat to themselves or anybody else. Lovable losers. This adds to the cultural acceptance of the drug as a harmless indulgence.

Like many of our colleagues in the scientific and treatment communities, we have a different opinion.

In a recent paper published in the journal Addiction, Wayne S. Hall, Ph.D. studied two decades of research to address the issue of potential adverse health effects of recreational cannabis use. Hall notes that during the past half-century, recreational cannabis use has become almost as common as tobacco use among adolescents and young adults.

Hall concluded that there are consistent associations between regular cannabis use and poor psychosocial outcomes and mental health in adulthood.

Meanwhile, scientists at the Massachusetts General Hospital Center for Addiction Medicine published a recent study in which 84 percent of teenagers seeking treatment for Cannabis Use Disorder (the medical term for what most of us call addiction) at an outpatient clinic met diagnostic criteria for marijuana dependence. For 40 percent of these teens, this dependence included withdrawal symptoms when they stopped using marijuana.

Those who work in the area of addiction treatment are familiar with patient histories whose downward spiral began with “harmless” experimentation with marijuana.  Unfortunately, little about their experience is comedic. In our experience, dependence on marijuana is very real. It tends to be much more difficult to treat because of the depth of depression, impaired motivation and users’ initial inability to form authentic, intimate, trusting relationships with peers as well as therapists.

Chronic marijuana users often display a limited emotional intelligence that compromises their ability to cope with the stresses of daily life. For some, the escape from this functional quagmire is to resort to using stimulants such as ADHD medication, cocaine or crystal methamphetamine. The reliance on external sources of sedation and stimulation is always at the expense of our own natural biological chemicals, which become suppressed. Reliance on external chemical relief is never as effective and efficient as our own naturally occurring substances such as dopamine, serotonin and gamma aminobutyric acid (GABA). The escalating use of marijuana in Ontario will inevitably result in more individuals naively transcending pleasure into pain and problems. The naive belief that there are no negative consequences to the chronic use of cannabis borders on magical thinking.

The Ontario health care community should take such insights seriously as it grapples with the proper response. We should seriously analyze the new federal laws governing medical cannabis that came into effect April 1, 2014. Although further research remains to be done, the implications are serious not only for the public but also for those charged with overseeing the medical treatment of regular marijuana smokers. We must take care to ensure that careless prescribing does not contribute to a repeat of the opioid crisis we now find ourselves in.

A related, and similarly serious, question is whether there might be a link between substance abuse, mental health and suicidality. A future challenge for researchers will be to determine what association, if any, exists between marijuana use and these serious concerns.

Substance abusers in Canada seeking to improve their lives have options for treatment. One is to seek individualized care featuring a holistic treatment plan in order to best support their road to recovery. Facilities exist with teams of skilled physicians, psychiatrists, psychologists, therapists, nurses, nutritionists and physical fitness experts to aid individuals in the recovery process. In our view, the ideal approach utilizes teams of medical professionals as well as the inclusion of the individual’s primary supports, such as family and friends. But while high-quality substance abuse treatment programs exist, it is clear that a more enlightened public policy might drastically reduce the need for such services.

As the debate over marijuana continues to rage and legalization spreads, we must remember to ask the deeper questions about this drug’s ultimate effects. As public attitudes toward marijuana become ever more liberal, and the risk of widespread abuse remains, there is a likelihood that high-quality substance abuse treatment will be in ever-greater demand.