For Michele Leonhart, the administrator of the Drug Enforcement
Administration, there is no difference between the health effects of marijuana
and those of any other illegal drug. “All illegal drugs are bad for people,” she
told Congress in 2012, refusing to say whether crack, methamphetamines or
prescription painkillers are more addictive or physically harmful than
marijuana.
Her testimony neatly illustrates the vast gap between antiquated federal law
enforcement policies and the clear consensus of science that marijuana is far
less harmful to human health than most other banned drugs and is less dangerous
than the highly addictive but perfectly legal substances known as alcohol and
tobacco. Marijuana cannot lead to a fatal overdose. There is little evidence
that it causes cancer. Its addictive properties, while present, are low, and the
myth that it leads users to more powerful drugs has long since been disproved.
That doesn’t mean marijuana is harmless; in fact, the potency of current strains
may shock those who haven’t tried it for decades, particularly when ingested as
food. It can produce a serious dependency, and constant use would interfere with
job and school performance. It needs to be kept out of the hands of minors. But,
on balance, its downsides are not reasons to impose criminal penalties on its
possession, particularly not in a society that permits nicotine use and
celebrates drinking.
Marijuana’s negative health effects are arguments for the same strong regulation
that has been effective in curbing abuse of legal substances. Science and
government have learned a great deal, for example, about how to keep alcohol out
of the hands of minors. Mandatory underage drinking laws and effective marketing
campaigns have reduced underage alcohol use to 24.8 percent in 2011, compared
with 33.4 percent in 1991. Cigarette use among high school students is at its
lowest point ever, largely thanks to tobacco taxes and growing municipal smoking
limits. There is already some early evidence that regulation would also help
combat teen marijuana use, which fell after Colorado began broadly regulating
medical marijuana in 2010.
Comparing the Dangers As with other recreational substances, marijuana’s health
effects depend on the frequency of use, the potency and amount of marijuana
consumed, and the age of the consumer. Casual use by adults poses little or no
risk for healthy people. Its effects are mostly euphoric and mild, whereas
alcohol turns some drinkers into barroom brawlers, domestic abusers or maniacs
behind the wheel.
An independent scientific committee in Britain compared 20 drugs in 2010 for the
harms they caused to individual users and to society as a whole through crime,
family breakdown, absenteeism, and other social ills. Adding up all the damage,
the panel estimated that alcohol was the most harmful drug, followed by heroin
and crack cocaine. Marijuana ranked eighth, having slightly more than one-fourth
the harm of alcohol.
Federal scientists say that the damage caused by alcohol and tobacco is higher
because they are legally available; if marijuana were legally and easily
obtainable, they say, the number of people suffering harm would rise. However, a
1995 study for the World Health Organization concluded that even if usage of
marijuana increased to the levels of alcohol and tobacco, it would be unlikely
to produce public health effects approaching those of alcohol and tobacco in
Western societies.
Most of the risks of marijuana use are “small to moderate in size,” the study
said. “In aggregate, they are unlikely to produce public health problems
comparable in scale to those currently produced by alcohol and tobacco.”
While tobacco causes cancer, and alcohol abuse can lead to cirrhosis, no clear
causal connection between marijuana and a deadly disease has been made. Experts
at the National Institute on Drug Abuse, the scientific arm of the federal
anti-drug campaign, published a review of the adverse health effects of
marijuana in June that pointed to a few disease risks but was remarkably frank
in acknowledging widespread uncertainties. Though the authors believed that
legalization would expose more people to health hazards, they said the link to
lung cancer is “unclear,” and that it is lower than the risk of smoking tobacco.
The very heaviest users can experience symptoms of bronchitis, such as wheezing
and coughing, but moderate smoking poses little risk. A 2012 study found that
smoking a joint a day for seven years was not associated with adverse effects on
pulmonary function. Experts say that marijuana increases the heart rate and the
volume of blood pumped by the heart, but that poses a risk mostly to older users
who already have cardiac or other health problems.
How Addictive Is Marijuana? Marijuana isn’t addictive in the same sense as
heroin, from which withdrawal is an agonizing, physical ordeal. But it can
interact with pleasure centers in the brain and can create a strong sense of
psychological dependence that addiction experts say can be very difficult to
break. Heavy users may find they need to take larger and larger doses to get the
effects they want. When they try to stop, some get withdrawal symptoms such as
irritability, sleeping difficulties and anxiety that are usually described as
relatively mild.
The American Society of Addiction Medicine, the largest association of
physicians specializing in addiction, issued a white paper in 2012 opposing
legalization because “marijuana is not a safe and harmless substance” and
marijuana addiction “is a significant health problem.”
Nonetheless, that health problem is far less significant than for other
substances, legal and illegal. The Institute of Medicine, the health arm of the
National Academy of Sciences, said in a 1999 study that 32 percent of tobacco
users become dependent, as do 23 percent of heroin users, 17 percent of cocaine
users, and 15 percent of alcohol drinkers. But only 9 percent of marijuana users
develop a dependence.
“Although few marijuana users develop dependence, some do,” according to the
study. “But they appear to be less likely to do so than users of other drugs
(including alcohol and nicotine), and marijuana dependence appears to be less
severe than dependence on other drugs.”
There’s no need to ban a substance that has less than a third of the addictive
potential of cigarettes, but state governments can discourage heavy use through
taxes and education campaigns and help provide treatment for those who wish to
quit.
Impact on Young People One of the favorite arguments of legalization opponents
is that marijuana is the pathway to more dangerous drugs. But a wide variety of
researchers have found no causal factor pushing users up the ladder of harm.
While 111 million Americans have tried marijuana, only a third of that number
have tried cocaine, and only 4 percent heroin. People who try marijuana are more
likely than the general population to try other drugs, but that doesn’t mean
marijuana prompted them to do so.
Marijuana “does not appear to be a gateway drug to the extent that it is the
cause or even that it is the most significant predictor of serious drug abuse,”
the Institute of Medicine study said. The real gateway drugs are tobacco and
alcohol, which young people turn to first before trying marijuana.
It’s clear, though, that marijuana is now far too easy for minors to obtain,
which remains a significant problem. The brain undergoes active development
until about age 21, and there is evidence that young people are more vulnerable
to the adverse effects of marijuana.
A long-term study based in New Zealand, published in 2012, found that people who
began smoking heavily in their teens and continued into adulthood lost an
average of eight I.Q. points by age 38 that could not be fully restored. A
Canadian study published in 2002 also found an I.Q. loss among heavy school-age
users who smoked at least five joints a week.
The case is not completely settled. The New Zealand study was challenged by a
Norwegian researcher who said socio-economic factors may have played a role in
the I.Q. loss. But the recent review by experts at the National Institute on
Drug Abuse concluded that adults who smoked heavily in adolescence had impaired
neural connections that interfered with the functioning of their brains. Early
and frequent marijuana use has also been associated with poor grades, apathy and
dropping out of school, but it is unclear whether consumption triggered the poor
grades.
Restricting marijuana to adults is more important now that Colorado merchants
are selling THC, the drug’s active ingredient, in candy bars, cookies and other
edible forms likely to appeal to minors. Experience in Colorado has shown that
people can quickly ingest large amounts of THC that way, which can produce
frightening hallucinations.
Although marijuana use had been declining among high school students for more
than a decade, in recent years it has started to climb, in contrast to
continuing declines in cigarette smoking and alcohol use. Emergency room visits
listing marijuana as the principal cause of admission soared above 455,000 in
2011, up 52 percent from 2004. Nearly 70 percent of the teenagers in residential
substance-abuse programs run by Phoenix House, which operates drug and alcohol
treatment centers in 10 states, listed marijuana as their primary problem.
Those are challenges for regulators in any state that chooses to legalize
marijuana. But they are familiar challenges, and they will become easier for
governments to deal with once more of them bring legal marijuana under tight
regulation.
