Marijuana’s addiction potential may be no big deal, but it’s certainly big business.
According to a widely publicized 1999 Institute of Medicine report, fewer than 10 percent of those who try cannabis ever meet the clinical criteria for a diagnosis of “drug dependence” (based on DSM-III-R criteria). By contrast, 32 percent of tobacco users and 15 percent of alcohol users meet the criteria for “drug dependence.”
Nevertheless, it is pot — not booze or cigarettes — that has the federal government seeing red and clinical investigators seeing green. As I reported for Alternet last year, the National Institute on Drug Abuse (NIDA) — which overseas more than 85 percent of the world’s research on controlled substances — recently appropriated some $4 million in taxpayers’ dollars to establish the nation’s first-ever “Center on Cannabis Addiction.” It’s mission: to “develop novel approaches to the prevention, diagnosis and treatment of marijuana addiction.”
Of course, what good is a research center if it isn’t conducting clinical research? To this end, the U.S. National Institutes of Health recently made millions of dollars in grant funding available “to support research studies that focus on the identification, and preclinical and clinical evaluation, of medications that can be safe and effective for the treatment of cannabis-use and -induced disorders.”
According to NIH’s request for applications: “Cannabis-related disorders (CRDs), including cannabis abuse or dependence and cannabis induced disorders (e.g., intoxication, delirium, psychotic disorder, and anxiety disorder), are a major public health issue. … Nearly one million people are seeking treatment for marijuana dependence every year and sufficient research has been carried out to confirm that the use of cannabis can produce serious physical and psychological consequences.
“Currently, there are no medications approved by the Food and Drug Administration for the treatment of CRDs. Given the extent of the use of cannabis in the general population, and the medical and psychological consequences of its use, … there is a great public health need to develop safe and effective therapeutic interventions. The need to develop treatments targeting adolescents and young adults is particularly relevant in view of their disproportionate use patterns.”
Sounds dire, huh? It’s meant to. But as usual, the Devil is in the details.
First, there’s the issue of the so-called “one million people seeking treatment for marijuana dependence.” Or not. According to the U.S. Department of Health and Human Services (HHS), Office of Applied Studies, Substance Abuse Mental Health Services Administration (SAMHSA), the actual number of persons seeking drug treatment for marijuana “as a primary substance at admission” in 2007 (the most recent year for which data is available) was 287,933. Still a large total to be sure, but even this tally is highly misleading. Think these folks are seeking treatment for pot “dependence?” Think again.
According to SAMHSA, over 37 percent of the estimated 288,000 thousand people who entered drug treatment for marijuana in 2007 hadn’t used weed in the 30 days previous to their admission. Another 16 percent of those admitted said that they’d only used cannabis three times or fewer in the month prior to their admission. Do these individuals sound like they meet the clinical standard of dependence (defined as “the state of being psychologically and physiologically dependent on a drug”)? Hardly. In truth, the only reason these people are in ‘treatment’ at all is because they were arrested with a small quantity of pot and were ordered to treatment in lieu of jail.
According to the August 13, 2009 issue of The TEDS Report, published by SAMHSA, nearly six out of ten individuals enrolled in drug treatment for marijuana are referred there by the criminal justice system. Stated the report: “In 2007, the criminal justice system was the largest single source of referrals to the substance abuse treatment system. [T]he majority of these referrals were from parole and probation offices.”
In other words, it is not marijuana use per se that is driving treatment admission rates; it is cannabis prohibition and the increased emphasis on pot arrests that are primarily responsible. Yet you’d never know this by listening to NIDA. And that’s just the way the agency wants it.
As for the Feds’ claim that today’s pot “can produce serious physical and psychological consequences,” it’s apparent that the potential adverse effects of cannabis use are relatively minor when compared to those of legal drugs such as opiates (which are both physically habit forming and capable of lethal overdose), alcohol (ditto), and tobacco. As for the potential physical and psychological consequences of kicking the pot habit, a newly published clinical trial in the scientific journal Drug and Alcohol Dependence raises some serious doubts about this fear as well.
Investigators at four separate German universities assessed the self-reported withdrawal symptoms of 73 subjects diagnosed with “cannabis dependence” who resided in an inpatient facility. Overall, investigators determined that less than 50 percent of the trial subjects reported experiencing physical or psychological withdrawal symptoms of any clinical significance, even though all of the patients had a diagnosis of cannabis dependence according to DSM-IV criteria. Further, among the minority who did report such symptoms, “The intensity of most self-reported symptoms peaked on day one and decreased subsequently.”
And just what were the most commonly reported symptoms? Authors concluded: “The most frequently mentioned physical symptoms of strong or very strong intensity on the first day were sleeping problems (21 percent), sweating (28 percent), hot flashes (21 percent), and decreased appetite (15 percent). … Other often highly rated psychological symptoms included restlessness (20 percent), nervousness (20 percent), and sadness (19 percent).” In short, marijuana’s withdrawal symptoms, when documented at all, are mild and subtle compared with the profound physical syndromes associated with ceasing chronic alcohol or heroin use, which can be fatal, or those abstinence symptoms associated with daily tobacco use, which are typically severe enough to persuade individuals to reinitiate their drug-taking behavior. This explains why most marijuana smokers voluntarily cease their cannabis use by age 30 with little physical or psychological difficulty.
Finally, what about NIDA’s claim that “therapeutic interventions” for marijuana dependence are necessary for adolescents and young adults “given the extent of the use of cannabis in the general population.” Ironically, NIDA’s warnings come at a time marijuana use rates among young people are falling — and have been for some time. According to the Feds’ annual Monitoring the Future study on adolescent drug use, roughly 42 percent of 12th graders admitted having tried pot in 2008, down from 50 percent in 1999, and a whopping 60 percent in 1979. Yet back then the federal government was mum regarding the need for medications to treat so-called cannabis dependence.
Not anymore. On November 3, the Kentucky-based pharmaceutical company All Tranz Inc. announced that it had been awarded a $4 million NIDA research grant to promote a “transdermal tetrahydrocannabinol (THC) patch” for the treatment of marijuana dependence and withdrawal. (THC is the primary psychoactive ingredient in cannabis.) “NIDA is interested in exploring the role of transdermal THC delivery as an innovative way to treat marijuana withdrawal symptoms and dependence,” explained the agency’s Director Nora Volkow. “This is especially relevant to our efforts to fill a critical gap in available treatments for the many Americans struggling with marijuana-related disorders and their detrimental medical and social consequences.”
Never mind that THC permeates the skin, at best, slowly and inefficiently (because of the compounds’ fat solubility) or that the symptoms of marijuana dependence and withdrawal are infrequent, short-lived, and relatively insignificant. After all, NIDA has a research center to staff, tax dollars to spend, and a myth to perpetuate. And the Feds aren’t about to let the facts get in the way.
Paul Armentano [send him mail] is the deputy director of NORML and the NORML Foundation. He is also the co-author of the new book Marijuana Is Safer: So Why Are We Driving People To Drink? (Chelsea Green Publishing, 2009).