Changing the Way We Think About Marijuana
Marijuana cannot be understood without the neuroscientific perspective.
Posted Apr 02, 2020
You cannot understand marijuana without understanding a few basic things about how the brain works. People often focus too much on the plant, which I call the botany perspective. They study different hybrid varieties, their different chemistries, and how each produces a slightly different experience. This one is relaxing, that one is activating, etc. But you cannot understand marijuana without also focusing on the neuroscientific perspective—how does the brain respond to an influx of marijuana?
Perhaps I should begin at the beginning. I vividly remember the 1960s, which may be why I still remain more comfortable using the word "marijuana" rather than the more current inclusive "cannabis." Marijuana is, of course, only the dried flowers and leaves of the cannabis plant. But in the Summer of Love, marijuana and hash (its extracted and concentrated resin) were basically the only available cannabis products.
I was curious and indulged for the first time at age 22. And I was fascinated by how marijuana changed the texture of my experience, enhanced sensations such as taste and music, stimulated delightful reveries, was thoroughly enjoyable, and appeared to have no adverse consequences (as long as you stayed clear of the long arm of the law).
At the time, we proudly recited the scientific term delta-9-tetrahydrocannabinol (discovered to be the most psychoactive ingredient in pot in 1964) as though this explained everything. We might have continued calling it Pixie Dust for all we really understood about how THC actually worked.
Medical school soon required too much time and attention to permit more than the occasional use of marijuana. Gradually, the experience it evoked became repetitious and less desirable, but my curiosity about how it modified my brain, and thus my experience, remained. Despite entering into psychiatric training and then into addiction medicine, I still found no clues to this mystery, until…
After California voters legalized the medicinal use of marijuana in 1996, I led the California Society of Addiction Medicine's effort to develop educational and policy responses to the new cannabis reality. I reviewed the literature at that time to write two papers on the potential medical uses of cannabis-based medications and the impact of cannabis on youth. Since then, I have followed the basic science and clinical literature to provide research updates at CSAM conferences.
As it became increasingly obvious that California was going to follow the lead of Colorado and Washington State and legalize the recreational use of cannabis in 2016, then Lt. Governor Gavin Newsom convened a Blue Ribbon Commission to study potential frameworks for the inevitable legalization. As chair of the commission's youth workgroup, I did an even deeper dive into the literature to provide a series of briefs. During this time, it became even more clear to me that it is impossible to understand cannabis without at least some familiarity with the basic science of how the brain reacts to the drug.
Forty years of addiction medicine practice and the last two and a half decades of studying the literature culminated in my completing From Bud to Brain: A Psychiatrist's View of Marijuana. The book summarizes the basic science needed by clinicians to answer patients' questions with objective, relevant information. As clinicians, we have the responsibility to help people who use cannabis recreationally to use it safely, and those who use it medicinally to use it safely and effectively. Understanding the basic science of our brain's natural marijuana-like (cannabinoid) chemistry that regulates the brain's other neurotransmitters is the critical and essential foundation needed to understand cannabis.
Fewer than 10 percent of physicians report any education about cannabis, and even less is provided to nurses, therapists, counselors, and social workers, so I make no apology for pushing health care professionals into studying the basic science research about marijuana, in part because it is so incredibly fascinating. My goal is to help the medical community provide a wide variety of patients, from recreational and medicinal users to heavy users, worried parents, and all adolescents, with empathic and objective answers to their questions.
When thinking about marijuana is informed by neuroscience, and not just botany and anecdotes, perspectives on its use change. Those who are convinced marijuana is an inevitably dangerous drug begin to see that many psychologically healthy people use marijuana occasionally and without apparent negative effects. Like alcohol, marijuana can be used safely by people who know their limits. Whether you see this as a good use of one's time is of no medical concern.
On the other hand, those who use marijuana heavily will be more likely to understand that they run some risk of subtle, but pervasive, cognitive, emotional, or behavioral consequences. Understanding these potential consequences permits people to make better-informed choices about their use. Medicinal users deserve this information regarding marijuana as much as they do about any pharmaceutical medication. And heavy recreational users may, just may, eventually become dissatisfied with the unintended effects of regular use once they become more aware of them.
Future blog posts will review some of the fascinating discoveries about the brain that have resulted from researchers' efforts to understand marijuana.