What gets ignored in the pot debate: it's not good for you!

This week, in light of the recent widely-reported New York Times editorial advocating the legalization of marijuana ("Repeal Prohibition, Again" July 27, 2014) we are reprising a timely article that I wrote a few months back.

My article is particularly relevant as a counter to the Times' assertion that "the evidence is overwhelming that addiction and dependence are relatively minor problems . . . Moderate use of marijuana does not appear to pose a risk for otherwise healthy adults. Claims that marijuana is a gateway to more dangerous drugs are as fanciful as the 'Reefer Madness' images of murder, rape and suicide."

I tackle some of these claims in my weekly "Clinical Focus" podcast. Part One evaluates the scientific evidence that underscores the hazards of marijuana, both physical and psychological; Part Two is a fascinating look at the potential medical benefits of marijuana and its derivatives, like cannabidiol (CBD).

The Times is cavalier about the potential risks of marijuana legalization, but this week's New England Journal of Medicine (July 31, 2014) features an article entitled "Big Marijuana--Lessons from Big Tobacco". It's worth a look. It envisages an unregulated campaign by newly-legitimized marijuana manufacturers to mobilize advertising and social media to promote pot use among novelty-craving and non risk-averse youth.

Commercializing pot on an unregulated open market would unleash a hoard of unintended consequences on our society. But the potential medical benefits of cannabis need to be explored and promise to offer beneficial therapies if properly researched and regulated.

So without further ado....

What Gets Ignored in the Pot Debate: It's Not Good For You!

Last week I was invited to appear on MSNBC News to provide a medical perspective on marijuana use. You can see the interview in its entirety on the Intelligent Medicine website.

It was a crowded segment, and I shared it with Ryan Grim, author of This is Your Country on Drugs and an advocate for marijuana legalization. He made some great points, and I squeezed in some comments, but time was short.

I'll concede that Draconian laws against possession of even small quantities of pot are ruining the lives of many Americans, disproportionately inner-city minority youth. They're a waste of money and law enforcement resources, and they're crowding our prisons with kids who will stand little chance of rejoining the mainstream once they get out.

I'll confess I'm a child of the '60s and '70s, and I inhaled during my days at Columbia University; it was a time when the drug culture went mainstream on campuses across America. I managed to graduate with grades and brains intact, and, well . . . the rest is history, as they say.

Recently, I attended a 40-year reunion dinner with several of my college roommates, all of whom were "stoners" in the day. They're a remarkable bunch: prominent, successful doctors, lawyers and executives with amazing careers and families. We all enjoyed a couple of cocktails as we reminisced, but NONE of us had touched pot for decades, nor would we condone its use for OUR kids.

But some caught up in those halcyon days were not so lucky. A gifted student from my high school in California whom I roomed with freshman year descended into a marijuana and hashish-fueled oblivion before my eyes within weeks of arriving at Columbia. He stopped attending classes and spent the entire day sleeping, and every night stoned or tripping on LSD and mescaline. He dropped out after the first semester and I haven't heard from him since.

The smartest classmate of mine in high school was accepted to Stanford, a huge academic accomplishment. He was a clean-cut kid with a penchant for physics and math. In college he grew his hair long and started smoking pot and then got into heavier drugs. Tragically, he leaped off the roof of his dorm building sophomore year.

Of course these are the rare exceptions, and it could be argued that alcohol takes a worse toll. And some studies claim to debunk the notion that pot is a "gateway drug." But for a significant minority, pot is not just an innocuous pastime, it becomes a form of escapism, and it's conducive to experimentation with more dangerous and addictive drugs.

Additionally, studies show that adolescent pot smokers have a higher rate of schizophrenia. This is important because dissociative experiences in individuals genetically programmed for susceptibility to mental disorders have a kindling effect on the developing brain. Adolescence is tough enough without the brain-addling effects of marijuana.

Then there's "Amotivational Syndrome," perfectly embodied in every Cheech & Chong movie ever made. Blissed-out stoners just want to groove to whatever vibe is close at hand. Another of my college roommates exemplified that. Drafted as a promising quarterback for Columbia, he soon switched from beer to pot and traded his jock crew cut for dreads and a Grateful Dead bandana. He lost his football scholarship and had to leave school.

The central theme of the MSNBC interview I did boiled down to "Why are we making it harder to smoke cigarettes but easier to smoke pot?"

Surely, cigarettes are known to cause heart disease and cancer while pot is not. But what we don't know yet is what the cumulative effects of inhaling pot smoke are. Surely marijuana is less physically addicting than nicotine, but you're still sucking down burning plant vapors deep into your lungs. A pot "toke" is usually a bigger inhale than a drag on a cigarette. What are the long-term effects?

According to recent studies, marijuana smoke contains more than 4,000 identified chemicals, including more than 50 that are known to cause cancer.

And a 2011 review of the research showed that long-term marijuana smoking is associated with an increased risk of some respiratory problems. That only makes sense. What we still don't yet know is whether pot is directly linked to lung cancer-too few studies have been done.

But here's a bigger concern: According to a recent Columbia University study, fatal car crashes involving pot use have tripled in the U.S.-and that's even before legalization!

Moreover, researchers found that while alcohol was the major contributor to car crashes, marijuana contributed to 12 percent of fatal crashes, up from just 4 percent in 1999. The combination of alcohol and marijuana compounds the risk; drivers under the influence of both have 24 times the risk of a fatal accident than a sober person.

At least there are handy Breathalyzer tests for alcohol-comparable tests for marijuana are less sensitive and rely on urine or blood, not readily accessible to cops. Until we have reliable roadside testing for pot intoxication, there's little deterrent for stoned drivers.

Medical marijuana? Sure there are times when intractable pain or nausea of chemotherapy necessitates marijuana or its derivatives. But medical marijuana legalization in some states has become a cynical "nose under the tent" prelude to free access for everyone.

Is that really a message we want to send to our kids?