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August 10, 2010

Can any tangible harms be directly traced to marijuana going mainstream in California?

7W8MARIJUANA1.xlgraphic.prod_affiliate.4 The Sacramento Bee on Sunday had this front-page report on marijuana's widespread use in California. The piece is headlined "Weed goes mainstream," and here are some of the highlights:

As California voters prepare to decide in November whether to become the first state to legalize marijuana for recreational use, a new Field Poll conducted for The Sacramento Bee reveals that weed already is deeply woven into society.

Those who use the drug, and their reasons for doing it, may be as diverse as the state itself.

Forty-two percent of adults who described themselves as current users in the July poll said they smoke pot to relieve pain or treat a health condition. Thirty-nine percent use it recreationally, to socialize or have fun with friends.

Sixty percent say marijuana helps them relax or sleep. Twenty-four percent say it stimulates their creativity.

Historically, marijuana use in California remains lower than during peak years of the late 1970s. But voters' approval of Proposition 215, the Compassionate Use Act – which made the state the first to legalize medical marijuana – is changing the social dynamic, according to poll results and interviews with users in 15 counties....

• More than 400,000 Californians use marijuana daily, according to the state Board of Equalization. And state residents consume 16 million ounces of weed a year, from legal and illegal sources.

• More than 3.4 million Californians smoked pot in 2008, according to the latest research by the National Survey on Drug Abuse and Health.

And, in the Field Poll, 47 percent of registered voters said they have used marijuana at least once in their life. That exceeds the registration of any political party in the state....

Nationally, more than 100 million Americans have tried marijuana, and 10 states – led by Rhode Island, Vermont and Alaska – have higher per capita use than the Golden State.

But in California, a proliferating industry of medical cannabis dispensaries, offering exotic strains such as "Blue Dream," "Train Wreck" or "Green Crack," helps supply a vast market, including many people who never venture inside a pot shop.

According to the state Board of Equalization, California marijuana dispensaries – intended to serve bona fide medical users, including AIDS, cancer and chronic pain sufferers – produce up to $1.3 billion in marijuana transactions for people reporting a vast range of ills.

"I'm sure there are people who suffer from any number of maladies that seek therapy from marijuana use," said Sacramento County Sheriff John McGinness. "But for at least as many, I think it's a ruse for healthy people who enjoy the effects of marijuana.....

[Ngaio] Bealum [editor of West Coast Cannabis] says readily available weed – and the reduced stigma and penalties – make people less wary of consequences. "As the boomers get older, those guys realized it is really no big deal," he said. "And the younger kids don't think it's a big deal, because their parents used to do it."

The July Field Poll shows plummeting support for tougher marijuana laws and increased backing for softer penalties. Yet marijuana arrests continue to rise.  In 2008, California authorities cited 61,388 people on misdemeanor pot offenses and 17,126 for felonies such as illegal trafficking, cultivation or possession for sale.  Total arrests were up by nearly one-third since 2003.

According to the Bee-commissioned poll, current marijuana use is most prevalent in the Bay Area and Northern California, including North Coast and Sierra Nevada counties with pot-receptive climates and cultures.  Use is lower in the Central Valley and lowest in San Diego/Orange counties.

And, following previous trends, reported pot use is higher among whites than African Americans, Latinos and other ethnic groups.

Marijuana has found niches in the California lifestyle with young people starting their careers, affluent baby boomers and urban professionals.... Though current use is highest among people between 18 and 29 and earning less than $40,000 a year, pot also is finding a significant foothold among many reaching their prime career earning years....

According to the Field Poll, the overwhelming majority of current pot smokers prefer to use it at home or a friend's house. Smaller numbers say they enjoy it at parties, concerts or outdoors.... 

Many marijuana users have friends who bring home dispensary pot as easily as picking up the groceries....  Sociologist Reinarman said, "The line that separates recreational use from medical use is blurred" by the infusion of medical pot into California's popular culture. "There is no contradiction from people who sometimes use it for pain or sometimes use it for sleep or sometimes use it because it is fun and or stimulates their creativity," he said.

The notion offends Lanette Davies, who runs Sacramento's Canna Care dispensary, which serves 5,000 registered marijuana patients. Davies believes many illicit marijuana users may be self-medicating for undiagnosed medical conditions. But she said, "I don't support people using strictly for recreation. If you want to take Vicodin simply because it feels good, that doesn't make it OK."

The question in the title of this post spotlights what I consider to be the most important and also the most challenging question as "weed goes mainstream"  in California and elsewhere.  The proponents of legalizing and regulating the marijuana industry can point to potential income from tax revenues and potential savings from reduced criminal justice expenditures.  Only time may tell if these claims of tangible benefits of legalization prove accurate, but proponents of legalization can also always fall back on the (intangible?) benefits of personal liberty and autonomy.

In contrast, opponents of legalizing and regulating the marijuana industry have an inherently harder (intangible) case to make unless marijuana use is viewed as inherently wrong as a truly wicked weed.  Consequently, we see opponents claim that the potential tangible harms to kids and from pot-produced accidents on the roads and in the workplace justify keeping marijuana from being legalized and regulated like alcohol.  But, given the evidence now of widespread availability and use of marijuana in California, I am wondering if these proponents have any data to support their claims that pot has such harmful potential.

I hope that some researcher might soon try to use the data indicating that pot use is greater in northern California and in certain counties to really try to assess and quantify if greater pot use can be directly linked to tangible societal harms.  If such evidence can be found, I know I will be significantly more respectful of the concerns expressed by opponents of marijuana legalization.

Some related posts on pot policy and politics:

August 10, 2010 at 11:12 AM | Permalink

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"But, given the evidence now of widespread availability and use of marijuana in California, I am wondering if these proponents have any data to support their claims that pot has such harmful potential."

The sad thing is, they don't, but that doesn't stop them from claiming that marijuana is the root of all sort of evils, from so-called "drugged driving" to cancer, to higher crime rates. There is no data backing up any of these fears, but fear mongers don't need data.

Posted by: Anonymous | Aug 10, 2010 12:39:05 PM

Here is a recent review. If marijuana has bad effects, they are weak. If one claims it causes amotivational syndrome or psychosis in adolescence, compare to alcohol, which causes half of all psychiatric problems and a lot of crimes, with perpetrators and victims having 50% rates of being legally intoxicated.

Drug Alcohol Rev. 2010 May;29(3):318-30.
Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use.

Calabria B, Degenhardt L, Hall W, Lynskey M.

National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia. b.calabria@unsw.edu.au
Abstract

ISSUES: To conduct a comprehensive search of the peer-reviewed literature to assess risk of cannabis-related mortality. APPROACH: Systematic peer-reviewed literature searches were conducted in Medline, EMBASE and PsycINFO to identify data on mortality associated with cannabis use. Search strings for cannabis and mortality were used. Searches were limited to human subjects and the publication timeframe of January 1990 to January 2008. Reference lists of review articles and of specific studies deemed important by colleagues were searched to identify additional studies. A list of the selected articles was emailed to experts in the field asking for comment on completeness. KEY FINDINGS: There is insufficient evidence, particularly because of the low number of studies, to assess whether the all-cause mortality rate is elevated among cannabis users in the general population. Case-control studies suggest that some adverse health outcomes may be elevated among heavy cannabis users, namely, fatal motor vehicle accidents, and possibly respiratory and brain cancers. The evidence is as yet unclear as to whether regular cannabis use increases the risk of suicide. CONCLUSIONS: There is a need for long-term cohort studies that follow cannabis using individuals into old age, when the likelihood of any detrimental effects of cannabis use are more likely to emerge among those who persist in using cannabis into middle age and older. Case-control studies of cannabis use and various causes of mortality are also needed.

Posted by: Supremacy Claus | Aug 10, 2010 1:06:21 PM

"compare to alcohol, which causes half of all psychiatric problems"

Cite please? This is a fantastic claim.

Posted by: flop | Aug 11, 2010 4:16:57 PM

It is bad practice to diagnose a primary psychiatric disorder in any heavy alcohol user until abstaining for at least three months, preferably a year, and most conservatively, four years, since the brain scans take that long to recover to normalcy.

Non-scientific discussion of association with depression.

http://www.netdoctor.co.uk/diseases/depression/alcoholanddepression_000486.htm

Summary of findings in antisocial personality disorder, the trait associated with criminality.

http://pubs.niaaa.nih.gov/publications/arh25-1/5-11.htm

Alcohol consumption at time of criminal offense, including murder.

http://pubs.niaaa.nih.gov/publications/arh25-1/20-31.htm

Here is a study of first diagnosis of psychosis (hallucinations, delusions, and incomprehensible speech - not in a law grad).

Barnett JH, Werners U, Secher SM, Hill KE, Brazil R, Masson K, Pernet DE, Kirkbride JB, Murray GK, Bullmore ET, Jones PB (2007) “Substance use in a population-based clinic sample of people with first-episode psychosis.” Br J Psychiatry 190:515-20

Abstract:

BACKGROUND: Substance use is implicated in the cause and course of psychosis. AIMS: To characterise substance and alcohol use in an epidemiologically representative treatment sample of people experiencing a first psychotic episode in south Cambridgeshire. METHOD: Current and lifetime substance use was recorded for 123 consecutive referrals to a specialist early intervention service. Substance use was compared with general population prevalence estimates from the British Crime Survey. RESULTS: Substance use among people with first-episode psychosis was twice that of the general population and was more common in men than women. Cannabis abuse was reported in 51% of patients (n=62) and alcohol abuse in 43% (n=53). More than half (n=68, 55%) had used Class A drugs, and 38% (n=43) reported polysubstance abuse. Age at first use of cannabis, cocaine, ecstasy and amphetamine was significantly associated with age at first psychotic symptom. CONCLUSIONS: Substance misuse is present in the majority of people with first-episode psychosis and has major implications for management. The association between age at first substance use and first psychotic symptoms has public health implications.

There are hundreds of studies, dating back 150 years, pointing in the same direction, with alcohol inducing violence, psychiatric disorders.

A review of which came first, the disorder or alcohol abuse.

Drug Alcohol Depend. 2008 Apr 1;94(1-3):234-45. Epub 2008 Jan 22.
Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders.

Falk DE, Yi HY, Hilton ME.

Alcohol Epidemiologic Data System, CSR, Incorporated, 2107 Wilson Boulevard, Suite 1000, Arlington, VA 22201-3085, United States. dfalk@csrincorporated.com
Abstract

CONTEXT: Understanding the temporal sequencing of alcohol use disorders (AUDs) and comorbid mood and anxiety disorders may help to disentangle the etiological underpinnings of comorbidity. Methodological limitations of previous studies, however, may have led to inconsistent or inconclusive findings. OBJECTIVE: To describe the temporal sequencing of the onset of AUDs relative to the onset of specific comorbid mood and anxiety disorders using a large, nationally representative survey. RESULTS: AUD onset tended to follow the onset of 2 of the 9 mood and anxiety disorders (specific and social phobia). The onset of alcohol abuse tended to precede the onset of 5 of the 9 mood and anxiety disorders (GAD, panic, panic with agoraphobia, major depression, and dysthymia), whereas the onset of alcohol dependence tended to precede the onset of only 2 of the 9 mood and anxiety disorders (GAD and panic). Lag times between primary and subsequent disorders generally ranged from 7 to 16 years. Comorbid individuals whose alcohol dependence came after panic with agoraphobia, hypomania, and GAD had increased risk of persistent alcohol dependence. CONCLUSION: Alcohol abuse, but not dependence, precedes many mood and anxiety disorders. If the primary disorder does in fact play a causative or contributing role in the development of the subsequent disorder, this role can best be described as "temporally distal." However, in assessing the risk for persistent alcohol dependence, clinicians should not only consider the type of comorbid mood/anxiety disorder, but also the temporal ordering of these disorders.

Posted by: Supremacy Claus | Aug 11, 2010 10:52:42 PM

Hallucinations are something that many people seek, maybe a way to leave this reality for a while, maybe for religious purpose, or just to get a nice ride. I think the most common way to do it is by consuming LSD.

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