A Vermont Scorecard
We are concerned by the marijuana misinformation in circulation – and in particular by the number of “expert” sources ignoring relevant scientific data. These include organizations such as the Vermont Medical Society, the Vermont Academy of Family Physicians, the Vermont Psychiatric Association, the Vermont Association of Child and Adolescent Psychiatry, the Vermont Chapter of the American Academy of Pediatrics, the Vermont Chapter of the American College of Physicians, the Vermont Public Health Association, Vermont Department of Liquor Control, the Vermont Department of Health, and individuals such as Dr. Paul Parker of Richmond. Why are so many experts repeating half-truths and outright falsehoods? This is especially disturbing because we Vermonters look to these medical and scientific bodies to inform our marijuana policy discussion. Further, when young people learn the real science, or gain experience of their own, they develop a legitimate cynicism that undermines their trust in our institutions. Hence, we write to promote greater integrity on the information-based side of our marijuana policy discussion.
Myth: Marijuana Makes People Lazy
Dr. Parker’s commentary (“Don’t make pot problem worse,” Feb. 4 in the Herald and Jan. 20 in the Times Argus) is typical. He claims that science proves cannabis consumers develop “amotivational syndrome” – used here as a scientific-sounding way to say “lazy pothead.” This overgeneralization persists due to ignorance, so it warrants comment: Indica-heavy varieties of cannabis are known by science to promote relaxation of body and mind, while sativa-heavy cannabis is energizing, uplifting, and cerebral. Marijuana does not make people lazy. Ignorance can, though. Just as the differences between beer, wine, and liquor are covered in the first lessons in alcohol education, a world in which marijuana is legal would be one in which such basic information would facilitate smarter cannabis use while eroding unhelpful stereotypes.
Myth: Marijuana Makes People Dangerous
Dr. Parker tells Vermonters that “science has shown … [m]arijuana … will lead to even more motor vehicle accidents and deaths.” An alliance of six physicians’ organizations which appears to be led by the Vermont Medical Society likewise asserts “a doubling of the risk of motor vehicle accidents” (“Six Vermont Physician Groups Caution Legislature About the Dangers of Legalized Marijuana,” Vermont Medical Society website). The Vermont Department of Health echoes this claim, too, in an 84-page document it provided the Legislature, “Marijuana Regulation in Vermont,” in which it purports to referee relevant data so that we will know which policies are supported with “scientific rigor.” The report concedes a lack of proof that marijuana causes fatalities (p. 35); but as Josh O’Gorman reported, it claimed “very strong evidence to indicate marijuana use leads to more motor vehicle crashes” (“Vt. report examines pot’s health impact,” Jan. 16, 2016). When we checked the source of the “very strong evidence,” we were startled: It comes from the 2014 report of a well-known anti-drug task force, the Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA), whose output has long been seen as politically motivated and scientifically suspect. Its report has been criticized for obscuring the fact that what it refers to as “marijuana-related traffic deaths” do not necessarily have anything to do with marijuana. It groups together all fatalities from accidents in which a driver “tested positive for marijuana,” while it ignores (a) that inactive metabolites cause people who are not high to test positive; (b) that the upward trend in adult marijuana use made an increase in false-positive tests likely; and (c) that the tripling of cannabinoid screens by law enforcement agencies between 2009 and 2014 itself guarantees a bump in the numbers. These are serious omissions. Why would the Department of Health pass this on to Vermonters as “very strong evidence”? As for Dr. Parker’s evidence, he provides none; nor does the alliance of physicians’ organizations.
In Colorado, where recreational marijuana was legalized in 2012, traffic fatalities actually went down in 2014, according to data released by the Colorado Department of Transportation, continuing a 12-year downward trend. In Washington State, which also legalized marijuana in 2012, the number of traffic fatalities remained stable in the first year that adult possession was legalized. But we are especially disappointed that our experts ignored one of the most important recent sources on the issue at hand, a February 2015 drug and alcohol crash risk study from the Department of Transportation which found that, when adjusted for age, gender, and alcohol use, there was no significant increase in the level of crash risk associated with marijuana. Vermonters deserve to know these facts, because they bear directly on our legitimate questions about traffic safety.
Myth: Marijuana Kills IQ
The Vermont Department of Liquor Control offers its publication, “Making the Right Decisions,” as a guidebook for teens sorting out “myths and facts.” It claims, “Heavy marijuana use is associated with cognitive decline in about 5% of teens, which suggests that the heaviest users could lose 8 IQ points.” That claim contradicts a lot of science, including the brand new study in The Proceedings of the National Academy of Sciences. Researchers comparing long-term marijuana use in teen twins found no IQ differences traceable to using or not using marijuana over 10 years. (The study is covered in lay terms in last month’s issue of Science.) In fact, cannabis can be an IQ-saver: In Israel, which leads the world in medicinal marijuana research, doctors inject marijuana’s main psychoactive component into brains “to prevent long-term cognitive damage after brain injury” (Jerusalem Post, May 27, 2013).
Myth: Marijuana Is Bad For Your Health
The Department of Health’s report relies again on the partisan RMHIDTA for claims about increased school suspensions and marijuana-related emergency room visits. Their numbers lump together as marijuana-related emergencies all ER patients who mentioned using marijuana at some point. This, too, is highly misleading. Dr. Randolph Knight of Weathersfield, who works at Valley Regional Hospital in Claremont, N.H., told members of the Vermont Senate Judiciary Committee that in his 20 years of practice as an emergency room doctor – with close to 50,000 patients – he had yet to see an overdose from marijuana (“ER doctor urges pot legalization,” Jan. 20, 2016). But it is worth addressing what many of us think of as the main potential concern, children becoming stoned by accidental ingestion of edible marijuana. As with so many things children eat accidentally, this ought to be addressed by education, not prohibition. For perspective, consider that more than 17,000 children under 6 years old were injured due to ingestion of the candy-colored detergent packets between 2012 and 2013. No one thinks prohibition is the measured response to this “danger,” although better warnings make sense.
Dr. Parker admits that while it is “not yet… shown to be the case,” he is “confident that smoking marijuana will eventually be shown to be a cause of lung disease, including cancer, emphysema and chronic obstructive pulmonary disease.” The Department of Liquor Control, like Parker, warns of cancer (“Making the Right Decisions”). It’s a commonsense guess; but we expect more than that from experts. Check the American Lung Association page on marijuana, and you’ll find the words “cancer,” “emphysema,” and “pulmonary disease” are absent. Check the annals of the International Journal of Cancer for the most recent study looking for the link to cancer, and you’ll find the investigators conclude, “Results from our pooled analyses provide little evidence for an increased risk of lung cancer among habitual or long-term cannabis smokers.” There are many such significant studies, including one based on measurements of over 5,000 tokers’ pulmonary function over 20 years (Journal of the American Medical Association, 2012), and others showing that cannabis even retards tumor growth. (To the credit of the Department of Health, its report lists the effect of marijuana on respiratory cancer as “unclear” (p. 3). Still, we believe a more positive assessment is justifiable, especially factoring in the options for consuming cannabis without smoking it.)
Dr. Parker claims that marijuana “has been shown to be associated with the development of mental health illness including depression, anxiety and paranoia.” In “Making the Right Decisions,” Liquor Control likewise claims that studies show “an association between heavy marijuana use and increased rates of anxiety, depression, suicidal thought and schizophrenia.” The alliance of physicians’ organizations, too, claims marijuana causes “increased future mental health problems, including a 40-percent increase in the rate of psychosis, and development of later anxiety disorders” (“Six Vermont Physician Groups Caution Legislature About the Dangers of Legalized Marijuana,” Vermont Medical Society website). These were certainly common views in the medical community during the 1960s and 70s. But what does today’s science say? This month’s Journal of the American Medical Association reports new research based 34,000 American adults finding that marijuana does not pose a risk of mood or anxiety disorders for the general populace. Cannabis can even be used to treat depression and anxiety effectively; moreover, there are strains of marijuana with elevated levels of the non-psychoactive component used medicinally to mitigate the effects of schizophrenia. On the other hand, cannabis may trigger or exacerbate schizophrenia in those genetically predisposed. The largest ever study of acute response to cannabis, published in this month’s Translational Psychiatry, identifies a variation in the ATK1 gene that predicts acute psychotic response. The authors note that this affects “only a very small minority of individuals” (a fraction of the 1% of the population classifiable as schizophrenic). To quantify this concern, one study assessing risk factors concluded that in order to prevent one case of schizophrenia from emerging, we would have to stop more than 3,000 teens from using cannabis. Legal prohibition is surely a cumbersome, ineffective way to address this health problem, especially given that science is already sorting out who this concern affects, and who it doesn’t. (Again, to the credit of the Department of Health, its report acknowledges the genetic factor, and notes that “schizophrenia is a rare disorder, whether marijuana is an exacerbating risk factor or not” (p. 36).)
So is marijuana dangerous? As Dr. Lester Grinspoon, Professor Emeritus of Psychiatry at Harvard Medical School, puts it, “Marijuana is not only non-toxic—but remarkably non-toxic.” “Despite its use by millions of people over thousands of years, cannabis has never caused an overdose death.” Its record as a medicine extends back more than 4,500 years, at least to the father of Chinese medicine, Emperor Shen Nung. It runs through the 19th century Irish doctor William O’Shaughnessy (whose insights led to the development of IV therapy); his use of cannabis from India to successfully treat a range of ailments (from the pain of rheumatism to convulsions and muscle spasms) made it popular in England. It continues on to modern hero of medicine, Rafael Mechoulam (Professor of Medicinal Chemistry at Hebrew University in Israel, where medical marijuana has kosher status). Marijuana’s natural ingredients are used to counter seizures (e.g., in epilepsy), and treat basal-cell carcinoma and many other cancers, post-traumatic stress disorder, fibromyalgia, AIDS, glaucoma, psoriasis, Alzheimer’s, Parkinson’s, multiple sclerosis, insomnia, lack of appetite – and to replace or reduce use of synthetic painkillers. Crohn’s patients are foregoing steroids and surgery. According to a study in the American Journal of Medicine, consuming marijuana (even smoking it) is associated with a decrease in the likelihood of developing type 2 diabetes. For the majority of the human population, cannabis is less dangerous than most medicines, including common pain relievers like aspirin, which the American Nutrition Association reports cause between 7,600 – 20,000 deaths per year in the United States.
Myth: Marijuana as a “Gateway”
Dr. Parker also plays the well-worn “gateway drug” card, asking, “Why would we legalize something that has the potential to promote even more drug abuse?” It is disturbing that Dr. Parker ignores the data most relevant to people concerned about youth: Not only did incidence of drug use not increase among teens after legalization in Colorado, it actually dipped: for teens, marijuana use went down after legalization, notwithstanding a slight uptick in use generally. Use in Colorado increased from 10.7% in 2009 to 11.16% in 2013, after legalization. This rise is neither alarming nor concerning: Is anyone surprised that a fairly small fraction of Colorado’s citizens who chose not to use marijuana when it was illegal now feel comfortable using it?
“Where do legalization proponents stop?,” Dr. Parker asks. “Do we move on to legalizing heroin? Cocaine? Methamphetamine?” He claims, “Legalization would result in more use of each of these substances.” These candidates for legalization are interesting because it is pharmaceutical versions of drugs like these that are in fact among the most prominent gateway drugs in our communities. They feature labels signalling the establishment’s approval, and are prescribed by our medical doctors at a startling rate: for pain, there are opioids under names like OxyContin and Vicodin (which, as Dr. Parker knows, are heroin-like, chemically), not to mention SSRIs like Prozac for depression, and, for ADHD, Adderall (an amphetamine) or Ritalin (methylphenidate), and even Desoxyn (methamphetamine). Who can forget the Prozac suicide scare of the 2000s? Studies on children linking it to suicidal thought and behavior prompted not prohibition, but a warning from the FDA. Despite the marijuana death count holding at zero, fervent prohibitionists bemoan the “risks.” All the while, the pharmaceutico-medical complex cranks out fatal prescriptions with impunity.
Dr. Parker warns that if we are not careful, we will see a marijuana crisis that parallels the opioid epidemic – which in turn he believes is caused by the availability of opioids in homes: If it’s available, it will be abused. Parker’s claim here, too, conflicts with the science. A Brandeis/Johns Hopkins study published in the Annual Review of Public Health clarifies that it is addiction created while on prescription that fuels the heroin epidemic and accounts for overdoses, not recreational use. We know the story: In the 1990s, pharmaceutical companies prevailed upon doctors to dramatically increase opioid prescriptions. For perspective on where we are, the CDC recently reported that we Vermonters have 67 painkiller prescriptions per 100 residents.
Now compare addiction- and death-rates in marijuana and opioid use. At worst, marijuana “addiction” affects a very small segment of the population who are predisposed to dependency, and is a problem better addressed by counseling than by law. But Laural Ruggles, who works on marijuana policy for the Vermont Public Health Association, claims an alarming number of teens are addicted: “Marijuana use already represents over 60% of adolescent abuse treatment admissions” (“Marijuana: The right questions,” Jan. 24). Ruggles provides no evidence, so one is left to wonder what these statistics mean. Do they represent those predisposed, either genetically or psychologically, to dependency on marijuana? Or are they rather those who were caught with pot in school and assigned to treatment on the bogus principle that “use = abuse” – in other words, teens caught consuming cannabis, even for the first time, are classified as abusers in need of treatment. Similarly, in many American colleges, students caught illegally consuming alcohol or marijuana are likely to be sent to a substance abuse education program … or else! Opioid addiction indices, by contrast, are much clearer: The number of Americans seeking treatment for painkiller addiction increased 900% since 1997.
Turning to death-rates, the number of people who died from opioid overdose quadrupled between 1999 and 2007, and there were close to 15,000 deaths in 2008 alone (the CDC says we’re at about 46 opioid deaths per day in America). Deaths from marijuana use during the same periods: Zero. And according to the Journal of the American Medical Association, access to cannabis is associated with lower opioid overdose mortality rates; marijuana even reduces the severity of symptoms of opiate withdrawal. Marijuana is good news for those wishing to drop opioids, because it is much safer than the standard withdrawal medications approved by the pharmaceutico-medical establishment, which often create physical dependence themselves.
From the standpoint of public health, it is safer for many Vermonters to purchase their dealers’ marijuana illegally than it is to accept their doctors’ prescriptions for legal OxyContin, Desoxyn, or Adderall. The most common gateway to heroin is the pharmaceutico-medical complex, not marijuana. As long as marijuana prohibition lasts, the law actually helps set-up an additional gateway to more dangerous drugs: Drug dealers also pushing heroin will continue to reach youth only seeking access to the marijuana economy. Kimberly B. Cheney is right: “Marijuana prohibition is [a] true gateway to other drugs, not marijuana itself” (“Taking pot out of the shadows,“ Feb. 14). Legalization will help close that secondary gate.
Vermonters Be Wary
If you are willing to sift through a mix of facts and reefer-mad misinformation, then tune in to Dr. Parker, the Department of Liquor Control, these physicians’ organizations, and the less-misleading but still disappointing Department of Health. Their attention to the evidence is highly selective, and certainly does not provide an adequate informational basis for Vermonters thinking about marijuana policy.
Dr. Parker – who chastised legislators for “not listening to the scientists and experts on scientific topics” – writes that anyone who opposes his warnings about “the deleterious mental, physical and cognitive effects of marijuana” “is in serious denial, or ignorant.” Such self-righteous authorities who pose as experts, but who turn a blind eye to the science, bring us back to our other main concern, the crisis of confidence among the youth. 68% of Millennials (currently between the ages of 18 and 34) support the legalization of marijuana. Remember that they have access to science via the internet, and also have the testimony of brilliant proponents of marijuana from within the scientific community (e.g., true medical experts like Dr. Andrew Weil, Dr. Sanjay Gupta, and Dr. Grinspoon, as well as prominent names from across the sciences, such as Carl Sagan and Richard Feynman in physics, Stephen Jay Gould in paleontology, Kary Mullis in chemistry, etc. – some of whom are Nobel Prize winners). Robert Gershon is right (“Aligning law with good sense,” Feb. 12): Authorities who defend hypocrisy-laden marijuana policy demonstrate their untrustworthiness to teens – which is dangerous, given that authorities’ warning are, in some important cases, fact-based. How are youth to know when they’re being told the truth? This is why we believe it is essential that real, honest experts run the “drug education” programs to be funded by revenues collected from marijuana sales.
Let’s make marijuana legal, and let’s start telling ourselves and our children the truth about it.
Brendan Lalor, Ph.D. is a resident of Rutland.
Philip Lamy, Ph. D. is a resident of Castleton.