July 30, 2012
Physicians should take lead against efforts in Colorado, Washington and Oregon.
The American Society of Addiction Medicine (ASAM) opposes proposals to legalize marijuana anywhere in the United States, including three state measures on November 2012 ballots.
Legalization initiatives in Colorado, Washington and Oregon create unacceptable risks to public health, according to a white paper approved by the ASAM Board of Directors at its July 25 meeting. Physicians and other health professionals must learn more about the real health threats posed by marijuana use, all of which are made worse by legalization. Physicians should encourage public education about these facts and lead efforts against ballot initiatives to legalize marijuana, the report said.
ASAM is the nation’s foremost association of physicians dedicated to the diagnosis and treatment of the disease of addiction.
“ASAM has brought to bear its commitment to science and public health in taking a strong position against marijuana legalization,” said Robert DuPont, M.D., the report co-author, who is a former White House Drug Czar and former director of the National Institute on Drug Abuse (NIDA). “ASAM can provide leadership to all physicians and all medical associations about the dangerous and seductive mirage of drug legalization, including marijuana legalization, as a so-called solution to serious health problems resulting from drug use.”
ASAM asserts that the significant public health problems and costs related to marijuana legalization are not well-understood by the public or policymakers. ASAM’s conclusion that marijuana legalization would threaten public health is based on the following:
- Marijuana use is neither safe nor harmless. Marijuana contains psychoactive cannabinoids which can produce a sense of discomfort and even paranoid thoughts in some users. Cannabinoids interact with brain circuits in comparable ways to opioids, cocaine and other addictive drugs. Marijuana use is associated with damage to specific organs and tissues and impairments to behavioral and brain functioning.
- Of greatest concern is marijuana use during adolescence—a time of ongoing brain development and heightened vulnerability to addiction. Research shows that heavy marijuana use decreases neurocognitive performance, with worse neurocognitive effects seen among those who begin marijuana use early.
- Marijuana is addictive. Repeated marijuana use is reinforcing because the drug increases activation of reward circuitry in the brain. Approximately 9% of people who try marijuana become dependent. For those who begin using the drug in their teens, approximately 17% become dependent. These figures are similar to alcohol dependence.
- Legalization would promote the public perception that marijuana is harmless at the same time that availability of the drug would grow exponentially. The rate of marijuana use and marijuana-related substance use disorders, including addiction, would increase.
- Increased marijuana addiction would heighten demand for substance use disorder treatment services, which already are inadequate for current needs.
- Marijuana use is associated with increased rates, and worsening symptoms, of psychosis. Increased marijuana use caused by legalization and increased access to high-potency marijuana could result in rising rates of psychotic illnesses.
- Marijuana-related crashes are major traffic safety threats; marijuana use doubles the risk of a crash. Research in Washington State showed that 12% of drivers killed in car crashes were positive for marijuana. Legalization would increase drugged driving.
Marijuana legalization will increase its availability to young people, who are the most at risk from this drug. Research shows that marijuana leads to a host of significant health, social, learning and behavioral problems in young users.
“Children who use marijuana are more likely to struggle in school, because it impairs their ability to concentrate and retain information during their peak learning years when their brains are developing,” said Andrea Barthwell, M.D., the report co-author who is a former ASAM president and former Deputy Director for Demand Reduction in the Office of National Drug Control Policy. “Even short-term use can cause problems with memory, learning, cognitive development and problem solving. Research shows a clear link between adolescent marijuana use and a decrease in academic achievement.”
ASAM has previously issued policy statements urging that people addicted to marijuana, like those addicted to any drug, should receive treatment rather than punishment for their illness. That position, however, makes no reference to the question of legalization, the report stated.
“ASAM believes that addiction should be primarily treated as a health issue rather than a criminal justice issue,” said Stuart Gitlow, M.D., ASAM Acting President. “But that does not mean we would support a social experiment dramatically changing the legal status of marijuana and resulting in an upsurge in marijuana use. Health problems caused by marijuana would grow with increased use; marijuana addiction rates would undoubtedly rise. ASAM must oppose any public policy changes that would cause a significant increase in addictive substance use.”