Almost Addicted

The slippery slope of recreational drug use

Is Marijuana Addictive? Part 2

Marijuana is addictive for some and its consequences can be extreme.

Is Marijuana Addictive? (Part 2)

Marijuana is the most commonly used drug after alcohol. It is fully legal in two states in the US and legal for medicinal purposes in a number of other states. Despite its increasing legalization around the US and its popularity — given that it is the most commonly used “illicit” drug — marijuana is undoubtedly addictive for a small minority of its users.

I have written similar things before, so I already anticipate the objections that some will raise to what I am about to write: 

--Marijuana is all-natural so it can’t be bad for you!  (This is a bad argument. See my previous post along these lines. Many all-natural things are potentially lethal, from tobacco to black widow spiders to hemlock.)

--Alcohol is worse!  (No argument from me on this point — of course alcohol is the single most dangerous drug in our midst.) 

--Psychiatrists are tools of the drug industry and simply don’t want to see an herb supplant Xanax and Klonopin as an effective and safe relaxant. (This is a bit of sleight of hand which misses the real point that in-and-of-itself marijuana causes problems.  Besides, I am at the far end of the spectrum of psychiatrists who regularly and repeatedly have decried the influence of the pharmaceutical industry.)

An article just published in the New England Journal of Medicine (NEJM--see reference below) states that 9 percent of marijuana users will become addicted to it and that cannabis withdrawal syndrome is real, given that heavy users will experience cravings, anxiety, irritability, dysphoria, and sleeping difficulties when they abruptly stop marijuana. 

The article — which is well written and cites numerous previous studies — notes that those who start smoking in adolescence are 2 - 4 times more likely to eventually become dependent on it and that heavy marijuana use over the course of one’s life is linked to earning a lower income, having greater need for public assistance, being unemployed, and having a lower satisfaction with life.  Even though many of my patients who smoke marijuana are gainfully employed and quite happy with their lives, these findings jibe with my overall observations of those who I know who consume cannibis.

Additionally, the NEJM piece notes that those who started using marijuana heavily in adolescence are much more likely to become addicted to marijuana, experience withdrawal symptoms if they suddenly stop, become addicted to other drugs besides marijuana, experience depression and anxiety, and suffer even more problems as a result of using a drug heavily and regularly in adolescence given that our brains continue to develop into our mid-late 20’s.

We can become addicted to anything that feels good — exercise, food, gambling, sex, shopping — and marijuana is obviously no exception.

Most people who consume cannabis do so without difficulty and do not become addicted, and most enjoy marijuana without negative consequences.  But any adolescent who smokes regularly — and everyone who does so out of a compulsion — might think hard about whether or not he or she ought to stop or seriously cut down.  The upshot is that marijuana is addictive for some and its dangers for those who smoke while young are real and potentially very dangerous over the long-term.

 

*Volkow ND, Baler RD, Compton WM, Weiss SR.  Adverse health effects of marijuana use.  N Engl J Med. 2014 Jun 5; 370 (23):  2219-27.

 

Wes Boyd is on faculty at Harvard Medical School and is an Attending Psychiatrist at Cambridge Health Alliance and Children’s Hospital Boston.

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