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Cannabis Maintenance as Addiction Treatment
Cannabis Maintenance as Addiction Treatment
ADDICTION RISK & Cannabis studies
A study of 4000 indicates that cannabis discourages use of alcohol and hard drugs.
Science & Research
inverse agonist: a randomized, double-blind, placebo- and active-controlled, crossover
study in recreational polydrug users.
Features, and Emerging Specificities of the Two Major Endocannabinoids
Users and Controls
Global Burden of Disease: Results from the GBD 2010 Study
Adolescent Cannabis Use
cognitive dysfunction and drug addiction.
expression of morphine-induced conditioned place preference.
Brains of Cocaine Addicts and Cocaine-Treated Rodents.
and in Behavioural Traits Predisposing To Drug Addiction: Effect of Ovarian Hormones.
levels of kynurenic acid.
Hydrolase (FAAH) Genes, and Marijuana-Related Problems
cues in cannabis-dependent individuals.
induces long-term depression via production of endocannabinoid.
addiction: confirmation in an independent sample and meta-analysis
longitudinal fMRI study in heavy cannabis users and controls
substitution effect in Canadian medical cannabis patients
Randomized Clinical Trial.
Results from the national longitudinal study of adolescent health.
GATEWAY THEORY? (studies say no)
CLAIM #9: MARIJUANA IS AN ADDICTIVE DRUG
It is now frequently stated that marijuana is profoundly addicting and that any increase in prevalence of use will lead inevitably to increases in addiction.
Essentially all drugs are used in "an addictive fashion" by some people. However, for any drug to be identified as highly addictive, there should be evidence that substantial numbers of users repeatedly fail in their attempts to discontinue use and develop use-patterns that interfere with other life activities.
National epidemiological surveys show that the large majority of people who have had experience with marijuana do not become regular users.
In 1993, among Americans age 12 and over, about 34% had used marijuana sometime in their life, but only 9% had used it in the past year, 4.3% in the past month, and 2.8% in the past week.
A longitudinal study of young adults who had first been surveyed in high school also found a high "discontinuation rate" for marijuana. While 77% had used the drug, 74% of those had not used in the past year and 84% had not used in the past month.
Of course, even people who continue using marijuana for several years or more are not necessarily "addicted" to it. Many regular users - including many daily users - consume marijuana in a way that does not interfere with other life activities, and may in some cases enhance them.
There is only scant evidence that marijuana produces physical dependence and withdrawal in humans.
When human subjects were administered daily oral doses of 180-210 mg of THC - the equivalent of 15-20 joints per day - abrupt cessation produced adverse symptoms, including disturbed sleep, restlessness, nausea, decreased appetite, and sweating. The authors interpreted these symptoms as evidence of physical dependence. However, they noted the syndrome's relatively mild nature and remained skeptical of its occurrence when marijuana is consumed in usual doses and situations. Indeed, when humans are allowed to control consumption, even high doses are not followed by adverse withdrawal symptoms.
Signs of withdrawal have been created in laboratory animals following the administration of very high doses. Recently, at a NIDA-sponsored conference, a researcher described unpublished observations involving rats pretreated with THC and then dosed with a cannabinoid receptor-blocker.
Not surprisingly, this provoked sudden withdrawal, by stripping receptors of the drug. This finding has no relevance to human users who, upon ceasing use, experience a very gradual removal of THC from receptors.
The most avid publicizers of marijuana's addictive nature are treatment providers who, in recent years, have increasingly admitted insured marijuana users to their programs.
The increasing use of drug-detection technologies in the workplace, schools and elsewhere has also produced a group of marijuana users who identify themselves as "addicts" in order to receive treatment instead of punishment.
10 Things Every Parent, Teenager & Teacher Should Know About Marijuana (4th Question)
Tue Dec 18 22:02:54 1990
From: [email protected] (Darryl House)
Date: 12 Dec 90 22:09:48 GMT
Organization: Informix Software, Inc.
Originator: [email protected]
[ Reprinted in the public interest without permission from a flyer by
the Family Council on Drug Awareness. This flyer is being distributed
at public functions such as concerts, school gatherings, trade shows,
and craft shows. Any typographic errors, unless noted, are mine. The
author of this post has no affiliation with any agency or persons
related to this document, and refrains from editorial comment. ]
10 Things Every Parent, Teenager & Teacher Should Know
"Prohibition...goes beyond the bounds of reason in that it attempts to
control a man's appetite by legislation and makes a crime out of things
that are not crimes. A prohibition law strikes a blow at the very
principles upon which our government was founded."
-- Abraham Lincoln
This pamphlet was researched and produced as a public service
by the Family Council on Drug Awareness P.O. Box 71093, LA CA
Additional copies available from:
BACH, PO Box 71093, L.A., CA 90071-0093
35 cents apiece, Ten for $2.00, 100 for $10
1 Q. What is Marijuana?
A. "Marijuana" refers to the dried leaves and flowers of the cannabis
plant , which contain the non-narcotic chemical THC at various
potencies. It is smoked or eaten to produce the feeling of being
"high." The different strains of this herb produce different sensual
effects, ranging from sedative to stimulant.
2 Q. Who Uses Marijuana?
A. There is no simple profile of a typical marijuana user. It has been
used for 1000s of years for medical, social, and religious reasons
and for relaxation . Several of our Presidents  are believed
to have smoked it. One out of every five Americans say they have
tried it. And it is still popular among artists, writers, musicians,
activists, lawyers, inventors, working people, etc.
3 Q. How Long Have People Been Using Marijuana?
A. Marijuana has been used since ancient times . While field hands
and working people have often smoked the raw plant, aristocrats
historically prefer hashish  made from the cured flowers of the
plant. It was not seen as a problem until a calculated disinformation
[sic] campaign was launched in the 1930s , and the first American
laws against using it were passed .
4 Q. Is Marijuana Addictive?
A. No, it is not . Most users are moderate consumers who smoke it
socially to relax. We now know that 10% of our population have
"addictive personalities" and they are neither more nor less
likely to overindulge in cannabis than in anything else. On a
relative scale, marijuana is less habit forming than either sugar
or chocolate but more so than anchovies. Sociologists report a general
pattern of marijuana use that peaks in the early adult years, followed
by a period of levelling off and then a gradual reduction in use .
5 Q. Has Anyone Ever Died From Smoking Marijuana?
A. No; not one single case, not ever. THC is one of the few chemicals for
which there is no known toxic amount . The federal agency NIDA says
that autopsies reveal that 75 people per year are high on marijuana
when they die: this does not mean that marijuana caused or was even a
factor in their deaths. The chart below compares the number of deaths
attributable to selected substances in a typical year:
Tobacco...............................340,000 - 395,000
Alcohol (excluding crime/accidents).............125,000+
Drug Overdose (prescription)............24,000 - 27,000
Drug Overdose (illegal)...................3,800 - 5,200
*Source: U.S. Government Bureau of Mortality Statistics, 1987
6 Q. Does Marijuana Lead to Crime and/or Hard Drugs?
A. No . The only crime most marijuana users commit is that they use
marijuana. And, while many people who abuse dangerous drugs also smoke
marijuana, the old "stepping stone" theory is now discredited, since
virtually all of them started out "using" legal drugs like sugar,
coffee, cigarettes, alcohol, etc.
7 Q. Does Marijuana Make People Violent?
A. No. In fact, Federal Bureau of Narcotics director Harry Anslinger once
told Congress just the opposite - that it leads to non-violence and
pacifism . If he was telling the truth (which he and key federal
agencies have not often done regarding marijuana), then re-legalizing
marijuana should be considered as one way to curb violence in our
cities. The simple fact is that marijuana does not change your basic
personality. The government says that over 20 million Americans still
smoke it, probably including some of the nicest people you know.
8 Q. How Does Marijuana Affect Your Health?
A. Smoking anything is not healthy, but marijuana is less dangerous than
tobacco and people smoke less of it at a time. This health risk can
be avoided by eating the plant instead of smoking it , or can be
reduced by smoking smaller amounts of stronger marijuana. There is
no proof that marijuana causes serious health or sexual problems 
but, like alcohol, its use by children or adolescents is discouraged.
Cannabis is a medicinal herb that has hundreds of proven, valuable
theraputic uses - from stress reduction to glaucoma to asthma to
cancer therapy, etc. .
9 Q. What About All Those Scary Statistics and Studies?
A. Most were prepared as scare tactics for the government by Dr. Gabriel
Nahas, and were so biased and unscientific that Nahas was fired by
the National Institute of Health  and finally renounced his own
studies as meaningless . For one experiment, he suffocated monkeys
for five minutes at a time, using proportionately more smoke than the
average user inhales in an entire lifetime . The other studies
that claim sensational health risks are also suspect, since they lack
controls and produce results which cannot be replicated or
independently verified .
10 Q. What Can I Do About Marijuana?
A. No independent government panel that has studied marijuana has ever
recommended jail for users . Concerned persons should therefore
ask their legislators to re-legalize and tax this plant, subject to
age limits and regulations similar to those on alcohol and tobacco.
For More Information, Write:
Family Coucil on Drug Awareness
P.O. Box 71093, LA CA 90071-0093
FOOTNOTES TO THE TEXT:
1. The same plant, known as hemp, has an estimated 50,000 non-drug
commercial uses including paper, textiles, fuels, food and sealants,
but these uses are also banned by existing laws. Sources: Encyclopedia
Britannica, federal documents and historical records.
2. Coptic Christians, Rhastafarnians [sic], Shintos, Hinus, Buddhists,
Sufis, Essenes, Zoroastrians, Bantus, and many other sects have
traditions that consider the plant to have religious value.
3. Their personal correspondence and records reveal that U.S. Presidents
Jefferson, Madison, Monroe, and others smoked hashish, as did Benjamin
Franklin and Mary Todd Lincoln. President John F. Kennedy is also
reported to have smoked marijuana to relieve his back pain. Many of
America's greatest leaders and Founding Fathers (including George
Washington) were hemp farmers. Sources: National Archives, published
4. Archeologists report that cannabis was possibly the first plant
cultivated by humans - about 8000 B.C. - and was used for linen,
paper, and garments. Source: Columbia University, _History of the
World_. It was being smoked in China and India as early as 2700 B.C.
5. Turkish smoking parlors were popular in both Europe and America. as
well as the Middle and Far East, as recently as the turn of the
6. The exhaustive Indian Hemp "Raj" Commission report (1986) by British
authorities found no reason to restrict its use. But the notorious
yellow journalist William Randolph Hearst fabricated and published
horror stories about marijuana that were eventually investigated and
shown to be lies, but not until long after the marijuana prohibition
was enacted in 1938. Source: Larry Sloman, _Reefer Madness_.
7. Laws against marijuana were passed a year after the invention of a
machine to harvest and process hemp so it could compete commercially
against businesses owned by Hearst, the DuPonts and other powerful
families. Source: Jack Herer, _The Emporor Wears No Clothes_.
8. Marijuana does not lead to physical dependency. Costa Rican Study,
1980; Jamaican Study, 1975; Nixon Blue Ribbon Report, 1972, et. al.
9. Source: Psychology Today, Newsweek, et.al.
10. Source: All univerity medical studies: UCLA, Harvard, Temple, etc.
11. Costa Rican Study, 1980; Jamaican Study, 1975; "The legal drugs for
adults, such as alcohol and tobacco...precede the use of all illicit
drugs." Source: National Academy of Sciences.
12. The FBI reports that 65-75% of criminal violence is alcohol related.
"Pacifist syndrome" testimony was given by Federal Bureau of Narcotics
Director Harry Anslinger before Congress (1948). However, the "Siler"
Study conducted by the U.S in Panama (1931) reported "no impairment"
in military personnel who smoked marijuana while off duty.
13. "The only clinically significant medical problem is that
scientifically linked to marijuana is bronchitis. Like smoking
tobacco, the treatment is the same: stop smoking." Source: Dr. Fred
14. Coptic study (UCLA), 1981; "There is not yet any conclusive evidence
as to whether prolonged use of marijuana causes permanent changes in
the nervous system or sustained impairment of brain function and
behavior in human beings." Source: National Academy of Sciences.
15. Source: Dr. Tod Mikuriya, _Marijuana Medical Papers_. Marijuana could
replace at least 10-20% of prescribed drugs now in use. Source: Dr.
Raphael Mechoulam. Marijuana was a major active ingredient in 40-50%
of patent medicines before its ban.
18. The U.S. Government reports that the oral dose of cannabis required to
kill a mouse is about 40,000 times the dose required to produce
symptoms of intoxication in man. Source: Lowe, _Journal of
Pharmacological and Experimental Therapeutics_, Oct. 1946.
19. In another famous study, Heath/Tulane (1974), wild monkeys were
brutally captured, then virtually suffocated in marijuana smoke over a
period of 90 days. Source: National Institute of Health.
20. Examples: the "LaGuardia" Committee Report (New York, 1944) and
President Richard Nixon's Blue Ribbon "Shafer" Commission (1972)
Relative Addictiveness of Various Substances
"To rank today's commonly used drugs by their addictiveness, we asked experts to consider two questions: How easy is it to get hooked on these substances and how hard is it to stop using them? Although a person's vulnerability to drug also depends on individual traits -- physiology, psychology, and social and economic pressures -- these rankings reflect only the addictive potential inherent in the drug. The numbers below are relative rankings, based on the experts' scores for each substance:
99 Ice, Glass (Methamphetamine smoked) 98 Crack 93 Crystal Meth (Methamphetamine
injected) 85 Valium (Diazepam) 83 Quaalude (Methaqualone) 82 Seconal (Secobarbital)
81 Alcohol 80 Heroin 78 Crank (Amphetamine taken nasally) 72 Cocaine 68 Caffeine
57 PCP (Phencyclidine) 21 Marijuana 20 Ecstasy (MDMA) 18 Psilocybin Mushrooms
18 LSD 18 Mescaline
Research by John Hastings
Relative rankings are definite, numbers given are (+/-)1%
Is Nicotine Addictive?Philip J. Hilts, New York Times, August 2, 1994
Is Nicotine Addictive? It Depends on Whose Criteria You Use. Experts say the definition of addiction is evolving.
WASHINGTON - When heavily dependent users of cocaine are asked to compare the urge to take cocaine with the urge to smoke cigarettes, about 45 percent say the urge to smoke is as strong or stronger than that for cocaine.
Among heroin' addicts, about 3 percent rank the urge to smoke as equal to or stronger than the urge to take heroin. Among those addicted to alcohol, about 50 percent say the urge to smoke is at least as strong as the urge to drink.
Yet seven chief executives of tobacco companies testified under oath before a Congressional subcommittee in April that nicotine was not addictive. Experts in addiction disagree with that assessment, hut they say that the definition of addiction is evolving, and that they can see how such a statement might be made. Hearings on Smoking This week, the Food and Drug Administration is holding hearings to consider whether cigarettes fit in the array of addictive drugs and whether the Government should regulate them.
The standard definition of addiction comes from the American Psychiatric Association and the World Health Organization, which list nine criteria for determining addiction. The two groups, which prefer the term drug dependence, base their definition on research done since the 1960's, which has determined that multiple traits must be considered in determining whether a substance is addictive. Thus although cigarettes do not offer as intense an effect as drugs like heroin and cocaine, they rank higher in a number of other factors. They not only create dependence among users but also elicit a high degree of tolerance, the need for more and more of drug to satisfy a craving. When all the factors are added up, the consensus among scientists is that nicotine is strongly addictive.
In smoking, it is not the nicotine addiction that is most harmful, but other toxic chemicals produced by burning tobacco, which cause most of the 400,000 deaths each year that are attributed to smoking.
Dr. Lynn T. Koslowski, an addiction expert at Pennsylvania State University, said addiction could generally be defined as "the repeated use of a psychoactive drug which is difficult to stop." He added that there might be many explanations for why it was hard to stop, including withdrawal that was too disturbing, or a high that was too enticing.
A diagnosis of mild dependence on a psychoactive drug is determined by meeting three of the nine criteria. Five items show moderate dependence and seven items indicate a strong dependence. (Not all nine items apply to each drug. For example, time and effort spent acquiring a drug are a significant feature of heroin addiction, but have no meaning in nicotine addiction.)
Criteria of Addiction
1. Taking the drug more often or in larger amounts than intended.
2. Unsuccessful attempts to quit; persistent desire, craving.
3. Excessive time spent in drug seeking.
4. Feeling intoxicated at inappropriate times, or feeling withdrawal symptoms from a drug at such times.
5. Giving up other things for it.
6. Continued use, despite knowledge of harm to oneself and others.
7. Marked tolerance in which the amount needed to satisfy increases at first before leveling off.
8. Characteristic withdrawal symptoms for particular drugs.
9. Taking the drug to relieve or avoid withdrawal.
Before applying a test of the nine criteria, the expert first determines if the symptoms have persisted for at least a month or have occurred repeatedly over a longer period of time.
Asked about the tobacco executives' testimony on addiction, Dr. Kozlowski said, "In a way, I can see how they could say that. It has to do with a mistaken image of what addiction is, and I have many well-educated, intelligent people say something like that to me. People often think of a person taking one injection of heroin and becoming hopelessly addicted for the rest of their lives. That is wrong."
In addition, he said, when people tend to think of the high that heroin produces, one that is about as intense as cocaine and alcohol, they cannot believe cigarettes are in the same category. And they are not.
Even though in large doses nicotine can cause a strong high and hallucinations, the doses used in cigarettes produce only a very mild high.
But researchers now know, says Dr. Jack Henningfield, chief of clinical pharmacology at the Addiction Research Center of the Government's National Institute on Drug Abuse, that many qualities are related to a drug's addictiveness, and the level of intoxication it produces may be one of the least important.
If one merely asks how much pleasure the drugs produce, as researchers used to do and tobacco companies still do, then heroin or cocaine and nicotine do not seem to be in the same category. Dr. Kozlowki said, "It's not that cigarettes are without pleasure, but the pleasure is not in the same ball park with heroin."
But now, he said, there are more questions to ask. "If the question is How hard is it to stop? then nicotine a very impressive drug," he said.
"Its urges are very similar to heroin."
Among the properties of a psychoactive drug - how much craving it can cause, how severe is the withdrawal, how intense a high it brings - each addicting drug has its own profile.
Heroin has a painful. powerful withdrawal, as does alcohol. But cocaine has little or no withdrawal. On the other hand, cocaine is more habit-forming in some respects, it is more reinforcing in the scientific terminology, meaning that animals and humans will seek to use it frequently in short periods of time, even over food and water.
Drugs rank differently on the scale of how difficult they are to quit as well, with nicotine rated by most experts as the most difficult to quit.
Moreover, it is not merely the drug that determines addiction, says Dr. john R. Hughes, an addiction expert at the University of Vermont. It is also the person, and the circumstances in the person's life. A user may be able to resist dependence at one time and not at another.
A central property of addiction is the user's control over the substance. With all drugs. including heroin, many are occasional users. The addictive property of the substance can be measured by how many users maintain a casual habit and how many are persistent, regular users.
According to large Government surveys of alcohol users, only about 15 percent are regular. dependent drinkers. Among cocaine users, about 8 percent become dependent. For cigarettes, the percentage is reversed. About 90 percent of smokers are persistent daily users, and 55 percent become dependent by official American Psychiatric Association criteria, according to a study by Dr. Naomi Breslau of the Henry Ford Health Sciences Center in Detroit. Only 10 percent are occasional users.
Surveys also indicate that two-thirds to four-fifths of smokers want to quit but cannot, even after a number of attempts. Dr. John Robinson, a psychologist who works for the R. J. Reynolds Tobacco Company, contests the consensus view of nicotine as addictive. Using the current standard definition of addiction, he said at a recent meeting on nicotine addiction, he could not distinguish "crack smoking from coffee drinking, glue sniffing from jogging, heroin from carrots and cocaine from colas."
It is not that Dr. Robinson and other scientists supported by tobacco companies disagree with the main points made by mainstream scientists.
But that they define addiction differently. Dr. Robinson says intoxication that is psychologically debilitating is the major defining trait of an addicting substance. It is a feature that was part of standard definitions of the 1950's, and is still linked to popular ideas about addiction, but which experts now say is too simplistic and has been left behind as scientific evidence accumulates.
Experts Rate Problem Substances
Dr. Jack E. Henningfield of the National Institute on Drug Abuse and Dr. Neal L. Benowitz of the University of California at San Francisco ranked six substances based on five problem areas.
Withdrawal: Presence and severity of characteristic withdrawal symptoms.
Reinforcement: A measure of the substance's ability, in human and animal tests, to get users to take it again and again, and in preference to other substances.
Tolerance: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached.
Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm.
Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.
RATINGS 1 = Most serious 6 = Least serious
RATINGS 1 = Most serious 6 = Least serious
Study of 4000 indicates marijuana discourages use of hard drugs.
A ground-breaking study of 4117 marijuana smokers in California1 reveals that the 'Gateway Theory' probably had it backwards. Instead of enticing young people to use other drugs, this study suggests that marijuana may have the opposite effect.
This first-ever clinical examination of a large number of medical marijuana applicants depicts a population that is remarkably normal. The percentages earning bachelors' degrees and doctorates are nearly identical to the national numbers. They are, in the main, productive citizens with jobs, homes and families who smoke marijuana weekly or daily – and have in some cases for decades.
For the vast majority of these applicants, their use of cannabis ultimately led to a decrease in the use of tobacco, alcohol, and hard drugs. Asked to compare their current alcohol consumption with their lifetime peak, over 10% claimed to be abstinent and nearly 90% claimed to have cut their drinking in half.
They also report using cannabis as self medication for stress and anxiety – with fewer side effects than the legal pharmaceutical alternatives.
As children, a significant percentage of the male applicants had been treated for ADHD (Attention Deficit Hyperactivity Disorder). Today their routine morning use of minimal amounts of cannabis strongly suggests that it enhances their ability to concentrate by allowing them to focus on one problem at a time.
As one construction company estimator said, "After two hits and my morning coffee, I'm the best estimator in the company."
| Common Sense for Drug Policy |
Long term marijuana users seeking medical cannabis in California (2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. – Thomas J O'Connell and Ché B Bou Matar
Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants
Harm Reduction Journal 2007, 4:16 doi:10.1186/1477-7517-4-16
The electronic version of this article is the complete one and can be found online at: http://www.harmreductionjournal.com/content/4/1/16
|Received:||29 April 2007|
|Accepted:||3 November 2007|
|Published:||3 November 2007|
© 2007 O'Connell and Bou-Matar; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cannabis (marijuana) had been used for medicinal purposes for millennia. Cannabinoid agonists are now attracting growing interest and there is also evidence that botanical cannabis is being used as self-medication for stress and anxiety as well as adjunctive therapy by the seriously ill and by patients with terminal illnesses.
California became the first state to authorize medicinal use of cannabis in 1996, and it was recently estimated that between 250,000 and 350,000 Californians may now possess the physician's recommendation required to use it medically. More limited medical use has also been approved in 12 additional states and new initiatives are being considered in others. Despite that evidence of increasing public acceptance of "medical" use, a definitional problem remains and all use for any purpose is still prohibited by federal law.
California's 1996 initiative allowed cannabis to be recommended, not only for serious illnesses, but also "for any other illness for which marijuana provides relief," thus maximally broadening the range of allowable indications. In effect, the range of conditions now being treated with federally illegal cannabis, the modes in which it is being used, and the demographics of the population using it became potentially discoverable through the required screening of applicants. This report examines the demographic profiles and other selected characteristics of 4117 California marijuana users (62% from the Greater Bay Area) who applied for medical recommendations between late 2001 and mid 2007.
This study yielded a somewhat unexpected profile of a hitherto hidden population of users of America's most popular illegal drug. It also raises questions about some of the basic assumptions held by both proponents and opponents of current policy.
Development of standardized interview
The early discovery that nearly all applicants had tried (initiated) cannabis, alcohol, and tobacco during adolescence eventually led to selection of a standardized clinical interview (SCI) as the optimum way to obtain the basic information required to assess their past use of cannabis.
Data gathered using a prototype of the SCI to screen 622 consecutive new applicants between July 1 and December 31, 2002 were analyzed in a simple relational database.
Results were later reported at a May 2004 meeting and eventually published in 2005.
Meanwhile, the original questions, in somewhat modified form, have been used to screen all new applicants including those seeking annual "renewals," from January 2003 on.
Thus 199 of 951 (21%) of those originally screened with less searching examinations while the SCI was being developed, eventually served as their own controls. Their responses confirmed that they shared the same general characteristics as the others and also that the sensitive information sought would be provided only if specifically requested.
In late 2005 a more sophisticated relational database was created and later customized with drop-down menus to allow responses to be entered directly into a laptop computer in real time, thus incorporating the database as an intrinsic part of the medical record.
Selection of areas of interest
Once the linkage between cannabis, alcohol, and tobacco had been appreciated, questions focusing on initiation and subsequent use of all three drugs were asked of several hundred consecutive applicants.
The further discovery, that many had tried other "drugs of abuse" was explored by adding questions requiring yes-no responses about their initiations of 8 specific illegal agents.
When patterns in personal histories suggested that family relationships and school experiences had also played a significant role in their adolescent drug initiations, the inquiry was broadened to include those areas. A prototype of the standardized clinical interview (SCI) became ready for clinical use by July 1, 2002.
4117 individual applicants were seen on as many as four occasions between November 2001 and June 30, 2007.
All were seeking a physicians' approval of their use of cannabis; 3187 (77.4%), were male, ranging in age from 16 to 91 when first seen (median age 31). 930 (22.6%) were female, ranging in age from 16 to 89, with a median age of 36. The median age of the entire population was 32, reflecting both the smaller number of females and their somewhat greater age when first seen.
Table 1 shows race/ethnicity for the entire population. Analysis by year-of-birth (Table 2) reveals more Asians and Hispanics among the younger applicants, reflecting the two groups that have been immigrating to California in the greatest numbers in recent years. Analysis by both age and race also revealed other differences.
Table 1. Race/ethnicity of entire population (N = 3515). As subsequently shown by a more searching analysis, the composition of the applicant population has been changing steadily.
Table 2. Cohort analysis of race/ethnicity (N = 3185). Analysis of racial composition by year of birth cohorts also shows that the applicant population has reflected immigration trends.
Tables 3 and 4 summarize educational and occupational histories; Table 5 provides data on applicants who were unemployed when first seen. Overall, this population exhibited lower High School drop out rates and higher percentage of graduates than national averages. The percentages earning Bachelors' degrees and Doctorates are nearly identical to the national average, but only about one half as many had earned Masters' degrees.
Table 3. Highest Education Attainment over 25, Applicants compared to US Population (N = 936). In general, cannabis applicants compared favourably with national averages.
Table 4. Occupational divisions for employment for applicants and US population (N = 2092). The two groups are quite similar with the exception of Construction and Extraction, Office and Administrative Support, which are gender specific professions.
Table 5. Non-occupational divisions for applicants and US population (N = 494) The two groups are quite similar except for the relative scarcity of retirees in the applicant population.
Their occupations resembled US averages in some employment areas and were quite different in others (Table 4); in terms of non-occupational divisions (Table 5), a much smaller percentage are retirees, a finding that reflects both their relative youth and the paucity of applicants born before 1946.
Although the extremes of applicant age ranged from 16 to 91, only 3 were under 18 when first seen. The great majority (84.16%) were between 21 and 60, a finding further emphasized when the population is examined by year of birth (Table 6), a perspective that also discloses how few (4.53%) had been born before 1946.
The overall male female ratio was nearly four to one (Table 7); however when examined as year of birth cohorts, it varies from over 5:1 for the youngest applicants to almost 3:1 for the oldest. Nearly 70% were Caucasians and 16% were Black, with sizable numbers of Hispanics and Asians (Table 1).
Table 6. Distribution by year of birth cohorts (N = 3946). This further emphasizes that one's birth cohort determines what drugs one can try during adolescence.
Table 7. Birth cohorts and gender (N = 3906). Although women were outnumbered by men in each cohort, there were significant differences noted with age.
Initiation and use of cannabis
An overwhelming majority (87.9%) of 3038 applicants queried about the details of their cannabis initiation had tried it before the age of 19, usually in the company of older siblings, cousins or peers.
After subtracting those born before 1946, the percentage of applicants who had tried marijuana before the age of twenty went up to 90%. Some became regular users almost immediately, while others remained sporadic users for years (that interval was estimated by asking them when they first began to "buy their own").
Amounts and patterns of cannabis use
Essentially all applicants queried about their current use were consuming inhaled cannabis on a regular basis in amounts that varied considerably, but tended to remain stable over time. The range is from less than one sixteenth ounce per week to over one ounce, with about 70% estimating they consume between 1/8 and 1/4 oz./week. Almost 90% acknowledge daily, or near daily ("six days a week") use, with about 10% insisting their use is far less frequent, in the range of two to five days/week.
Mode of cannabis use
There was a decided preference for inhaled cannabis. Most had not tried edibles until their own recommendation, or that of a friend, gave them access to edibles from a club or dispensary. Only 50 of 830 (6%) questioned about edibles were using them on a regular basis. The reasons given were that edible effects were more difficult to control and more likely to be undesirable and/or prolonged.
Initiation and use of tobacco and alcohol
One of the more significant patterns revealed by comparing average initiation ages for cannabis, alcohol and tobacco within the context of birth cohorts was that the oldest Baby Boomers had tried cannabis at a considerably later age than their younger successors.
By 1975, less than ten years after the "Summer of Love," in 1967, cannabis was being initiated by over half of all American adolescents at close to the same average ages they also were trying alcohol and tobacco (Table 8, Figure 1).
Table 8. Average initiation ages for entry level agents (N = 2498). This table is depicted by Figure 1 and emphasizes the rapid fall in age at initiation of cannabis after it first became available in high schools.
Figure 1. Average initiation age tobacco, alcohol and cannabis. Those born before 1940 were fewest in number; they had also tried cannabis at the oldest average age. Baby Boomers born after 1946 were the first large cohort, and their successors were still younger when they tried cannabis. The 61–65 cohort initiated cannabis, alcohol, and tobacco at essentially the same average age.
Essentially all applicants also admitted to trying alcohol. Nearly two thirds (64.3%) of the 1226 specifically queried about alcohol blackouts had experienced at least one and 6.26% admitted to four or more. Of 1214 applicants asked to compare their current alcohol consumption with their previous lifetime peak, 130 (10.7%) claimed to be abstinent, 341 (28%) said they were drinking less than 5% of their lifetime peaks, and an overwhelming 1058 (87%) claimed to be drinking less than half as much. Most of those who noted little change from their lifetime peaks had been moderate drinkers to begin with.
This is evidence that once cannabis was established as their drug of choice, this population's subsequent alcohol consumption diminished; both collectively, and as individuals, a finding that clearly deserves further evaluation.
A history of cigarette initiation, later followed by chronic use, was prevalent in this population. 2559 of 2741 (96.4%) applicants, when asked if they had ever tried inhaling a cigarette, had done so; of 1324 who were specifically queried about their lifetime cigarette use, 872 (65.8%) had become daily smokers for some length of time.
Although all but four of those still smoking claim they want to quit, only 316 (36.2%) of all smokers (23.9% of respondents) had been able to do so by the time of the interview. Most who are still smoking have reduced their daily cigarette consumption; a majority relate temporary increases in their daily cigarette use to "stress."
Thus the impact of daily cannabis use on cigarette consumption, although less impressive than is the case with alcohol, also seems significant and worthy of further exploration.
Other drug initiations
When examined from the standpoint of both year of birth (YOB) cohorts and admitted initiations of other illegal agents (Table 9, Figure 2) noticeable and consistent differences are revealed: whites in every age cohort had consistently tried all other illegal agents more frequently than other racial groups (Table 10).
Table 9. Initiation rates for other illegal drugs by YOB cohorts (N = 2364). With the exception of "magic mushrooms," and ecstasy (a psychedelic made illegal in 1988), initiation rates for all Schedule One drugs have declined since 1975.
Table 10. Initiations of other illegal drugs by race (N=2400). Although race seems related to initiation rates throughout, this shows that drug initiations by all aces trying cannabis have been falling proportionately as the adolescent market matured.
Figure 2. Other illegal drugs tried by 10 year cohort analysis. Interestingly, while all cohorts sampled other illegal drugs aggressively during adolescence, the rates at which they've done so have fallen progressively. Note also the striking generational differences in peyote/mescaline initiations by older cohorts and ecstasy by younger ones.
Further cohort analysis of this population's adolescent interest in other illegal drugs, plus its nearly universal initiation of alcohol and tobacco, suggest that while race (Table 10), and generation (Table 9) exert significant influences, gender merely parallels ethnicity (Table 11).
Table 11. Initiations of Other Illegal Drugs by Gender (N=2464). Similarly, although women consistently tried all agents somewhat less often than men, the close parallels and internal consistency suggests the data are reliable.
Despite such differences all cohorts and racial groups have shown steady downward trends in their initiation of all other illegal drugs, with the interesting exception of psychedelic mushrooms (psilocybin) and, perhaps, ecstasy (MDMA).
It has long been recognized that users of illegal drugs may be difficult to identify, let alone recruit into a study. That chronic users of cannabis would seek medical evaluations and be so willing to share sensitive personal information within the context of their required evaluations was the unanticipated benefit of Proposition 215 that made this study possible.
Birth cohort analysis of the average ages at which applicants reported first trying alcohol, tobacco and cannabis demonstrates that a surge in youthful marijuana use began in the US in the mid Sixties.
However, that event was not documented until publication of the first Monitoring the Future (MTF) data in 1975 demonstrated that over half of American adolescents were trying marijuana while still in High School.
Close questioning of applicants suggests that the majority had been motivated by a mix of physical and emotional symptoms which had been experienced at varying times in their lives. Further, that a majority had become initiates, and later chronic users of cannabis under circumstances that suggest that it was for relief of emotional symptoms in most instances.
Their discovery (usually later), that cannabis also relieved physical symptoms, was most frequently made within a context of established chronic use. That notion is further supported by recent literature indicating that phytocannabinoids, newly discovered endocannabinoids, and synthetic cannabinoid agonists all seem to manifest anxiolytic effects in both humans and animals.
More than 85% of applicants had tried other illegal drugs, principally lysergic acid diethylamide (LSD), psilocybin, cocaine, and/or MDMA. The majority of those doing so hadn't remained chronic users of any except cannabis. While a majority have continued to use alcohol occasionally, the volumes consumed and the occurrence of events related to alcohol excess have sharply diminished.
A "gateway" hypothesis had developed from observations that most marijuana users studied in the early Seventies were adolescents and young adults who had first tried alcohol and tobacco; also that many had tried marijuana before later trying heroin.
However, subsequent efforts to establish a definitive causal link between marijuana and "harder" drugs have been largely unsuccessful. More recently, a theoretical alternative was shown to provide an explanation for accumulated MTF data that is at least as coherent .
A significant percentage of male applicants under 30 had been treated or evaluated for treatment with Ritalin or other stimulants for attention deficit hyperactivity disorder (ADHD) as children and their histories of a preference for morning use of minimal amounts strongly suggest that inhaled cannabis enhances their ability to concentrate.
The statement of one, a construction company estimator, was revealing: "after two hits (of marijuana), and my morning coffee I'm the best estimator in the company." Another, a dental technician, stated that, when I first look at my workbench, I think I'll never finish, but after a couple of tokes (of marijuana), I'm through (with work) by two o'clock."
Thus, reduction of work related anxiety seems a major factor in deciding to apply for legalized use of cannabis.
Analysis of the demographic and social characteristics of a large sample of applicants seeking approval to use marijuana medically in California supports an interpretation of long term non problematic use by many who had first tried it as adolescents, and then either continued to use it or later resumed its use as adults. In general, they have used it at modest levels and in consistent patterns which- anecdotally- often assisted their educational achievement, employment performance, and establishment of a more stable life-style. These data suggest that rather than acting as a gateway to other drugs, (which many had also tried), cannabis has been exerting a beneficial influence on most.
Anecdotal evidence from repeated clinical contacts, and other data gathered incidentally over five years of experience with this population suggests that, except for very modest alcohol consumption and obligatory (addictive) use of tobacco by those trying to quit, cannabis is the only drug used past the age of twenty-five by most. Indeed, their total drug use histories suggest that by competing successfully with other, potentially more harmful agents, cannabis may have actually been protective. Evidence from federal agencies confirms that, since 1970, there has been a gradual decrease in consumption of both tobacco and alcohol (with correlated improvements in health outcomes) even as cannabis initiation by adolescents has remained at significant levels and overall chronic use by adults has been rising steadily.
While this is a self-selected sample (which restricts the generalizations that can be made from the observations reported), its large size, the consistency of the patterns uncovered, as well as their alcohol and tobacco outcomes, seem significant. For the majority, cannabis can be seen as an effective anxiolytic/antidepressant, performing as well or better than many currently available pharmaceutical agents prescribed for the same symptoms. This finding lends important support to the concept of allowing cannabis to be used medically by all those who have been chronic users and found it beneficial.
Attention deficit hyperactivity disorder (ADHD)
Lysergic acid diethylamide (LSD)
Monitoring the Future (MTF)
Psychedelic mushrooms (Psilocybin)
Standardized clinical interview (SCI)
Year of birth (YOB)
TJO conceived the study, designed it, conducted all the clinical interviews, and wrote the report.
CBB designed the relational data-base for data analysis and later modified it to serve as medical record since December 2005. Conducted statistical analysis of data and contributed several other valuable suggestions and helped write and edit the report.
Robert Field: Provided funding for the project.
Mike Gray: Coordinated the project team, funding and editing.
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Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future national survey results on drug use, 1975–2006. Volume I: Secondary school students. [http://www.monitoringthefuture.org/pubs/monographs/vol1_2006.pdf] webcite
Bethesda, MD: National Institute on Drug Abuse; 699.
(NIH Publication No. 07-6205)
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Nat Rev Drug Discov 2004, 9:771-784. Publisher Full Text
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Kandel DB, Jessor R: The gateway hypothesis revisited. In Stages and Pathways of Drug Involvement, Examining the gateway hypothesis. Edited by Kandel DB. New York: Cambridge University Press; 2002:365-392.
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Addiction 2002, 12:1493-1504. Publisher Full Text
The Surprising Effect Of Marijuana On Morphine Dependence
Posted on: Monday, 6 July 2009, 11:33 CDT On The Net:
Injections of THC, the active principle of cannabis, eliminate dependence on opiates (morphine, heroin) in rats deprived of their mothers at birth.
This has been shown by a study carried out by Valérie Daugé and her team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / INSERM) in the journal Neuropsychopharmacology.
The findings could lead to therapeutic alternatives to existing substitution treatments.
In order to study psychiatric disorders, neurobiologists use animal models, especially maternal deprivation models. Depriving rats of their mothers for several hours a day after their birth leads to a lack of care and to early stress.
The lack of care, which takes place during a period of intense neuronal development, is liable to cause lasting brain dysfunction. Valérie Daugé's team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / Inserm) analyzed the effects of maternal deprivation combined with injections of tetrahydrocannabinol, or THC, the main active principle in cannabis, on behavior with regard to opiates.
Previously, Daugé and her colleagues had shown that rats deprived of their mothers at birth become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent
In addition, there is a correlation between such behavioral disturbances linked to dependence, and hypoactivity of the enkephalinergic system, the endogenous opioid system.To these rats, placed under stress from birth, the researchers intermittently administered increasingly high doses of THC (5 or 10 mg/kg) during the period corresponding to their adolescence (between 35 and 48 days after birth). By measuring their consumption of morphine in adulthood, they observed that, unlike results previously obtained, the rats no longer developed typical morphine-dependent behavior. Moreover, biochemical and molecular biological data corroborate these findings. In the striatum, a region of the brain involved in drug dependence, the production of endogenous enkephalins was restored under THC, whereas it diminished in rats stressed from birth which had not received THC.
Such animal models are validated for understanding the neurobiological and behavioral effects of postnatal conditions in humans. In this context, the findings point to the development of new treatments that could relieve withdrawal effects and suppress drug dependence.
The enkephalinergic system produces endogenous enkephalins, which are neurotransmitters that bind to the same receptors as opiates and inhibit pain messages to the brain.
Active Ingredient In Cannabis Eliminates Morphine Dependence In Rats
ScienceDaily (July 15, 2009) — Injections of THC, the active principle of cannabis, eliminate dependence on opiates (morphine, heroin) in rats deprived of their mothers at birth. The findings could lead to therapeutic alternatives to existing substitution treatments.
In order to study psychiatric disorders, neurobiologists use animal models, especially maternal deprivation models. Depriving rats of their mothers for several hours a day after their birth leads to a lack of care and to early stress. The lack of care, which takes place during a period of intense neuronal development, is liable to cause lasting brain dysfunction.
The study was carried out by Valérie Daugé and her team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / INSERM).
Valérie Daugé's team at the Laboratory for Physiopathology of Diseases of the Central Nervous System (UPMC / CNRS / Inserm) analyzed the effects of maternal deprivation combined with injections of tetrahydrocannabinol, or THC, the main active principle in cannabis, on behavior with regard to opiates.
Previously, Daugé and her colleagues had shown that rats deprived of their mothers at birth become hypersensitive to the rewarding effect of morphine and heroin (substances belonging to the opiate family), and rapidly become dependent. In addition, there is a correlation between such behavioral disturbances linked to dependence, and hypoactivity of the enkephalinergic system, the endogenous opioid system.
To these rats, placed under stress from birth, the researchers intermittently administered increasingly high doses of THC (5 or 10 mg/kg) during the period corresponding to their adolescence (between 35 and 48 days after birth).
By measuring their consumption of morphine in adulthood, they observed that, unlike results previously obtained, the rats no longer developed typical morphine-dependent behavior.
Moreover, biochemical and molecular biological data corroborate these findings. In the striatum, a region of the brain involved in drug dependence, the production of endogenous enkephalins was restored under THC, whereas it diminished in rats stressed from birth which had not received THC.
Such animal models are validated for understanding the neurobiological and behavioral effects of postnatal conditions in humans. In this context, the findings point to the development of new treatments that could relieve withdrawal effects and suppress drug dependence.
The enkephalinergic system produces endogenous enkephalins, which are neurotransmitters that bind to the same receptors as opiates and inhibit pain messages to the brain
(Credit: iStockphoto/Guillermo Perales)
Cannabis plant. Injections of THC, the active principle of cannabis, eliminate dependence on opiates (morphine, heroin) in rats deprived of their mothers at birth.
Adolescent Exposure to Chronic Delta-9-Tetrahydrocannabinol Blocks Opiate Dependence in Maternally Deprived Rats
Neuropsychopharmacology (2009) 34, 2469–2476; doi:10.1038/npp.2009.70; published online 24 June 2009
- Institut National de la Santé et de la Recherche Médicale (INSERM), U952, Université Pierre et Marie Curie, 9 quai Saint Bernard, Paris, Ile de France, France
- Centre National de la Recherche Scientifique (CNRS), UMR 7224, Université Pierre et Marie Curie, 9 quai Saint Bernard, Paris, Ile de France, France
- UMPC Université Paris 06, 9 quai Saint Bernard, Paris, Ile de France, France
- Department of Psychiatry, Douglas Hospital Research Center, McGill University, boulevard Lasalle, Verdun, QC, Canada
- Université Paris Descartes, 12 rue de l’Ecole de médecine, Paris, Ile de France, France
Correspondence: Dr V Daugé, Physiopathologie des maladies du système nerveux central, INSERM UMRs 952, Université Pierre et Marie Curie, 9 quai St-Bernard, Paris, ile de france, 75005, France, Tel: 331 44 27 61 09, E-mail: [email protected]
Received 16 April 2009; Revised 19 May 2009; Accepted 21 May 2009; Published online 24 June 2009.
Maternal deprivation in rats specifically leads to a vulnerability to opiate dependence. However, the impact of cannabis exposure during adolescence on this opiate vulnerability has not been investigated. Chronic dronabinol (natural delta-9 tetrahydrocannabinol, THC) exposure during postnatal days 35–49 was made in maternal deprived (D) or non-deprived (animal facility rearing, AFR) rats.
The effects of dronabinol exposure were studied after 2 weeks of washout on the rewarding effects of morphine measured in the place preference and oral self-administration tests. The preproenkephalin (PPE) mRNA levels and the relative density and functionality of CB1, and μ-opioid receptors were quantified in the striatum and the mesencephalon.
Chronic dronabinol exposure in AFR rats induced an increase in sensitivity to morphine conditioning in the place preference paradigm together with a decrease of PPE mRNA levels in the nucleus accumbens and the caudate–putamen nucleus, without any modification for preference to oral morphine consumption.
In contrast, dronabinol treatment on D-rats normalized PPE decrease in the striatum, morphine consumption, and suppressed sensitivity to morphine conditioning. CB1 and μ-opioid receptor density and functionality were not changed in the striatum and mesencephalon of all groups of rats.
These results indicate THC potency to act as a homeostatic modifier that would worsen the reward effects of morphine on naive animals, but ameliorate the deficits in maternally D-rats. These findings point to the self-medication use of cannabis in subgroups of individuals subjected to adverse postnatal environment.
Excerpt from the Merck Manual
The following is an excerpt from the Merck Manual, the US military's field guide to medicine:
...no physical dependence [as a result of cannabis usage]; no abstinence syndrome when the drug is discontinued.
Cannabis can be used on an episodic but continuous basis without evidence of social or psychic dysfunction. In many users the term dependence with it's obvious connotations probably is misapplied.
Many of the claims regarding severe biological impact are still uncertain, but some others are not. Despite the acceptance of the 'new' dangers of marijuana, there is still little evidence of biologic damage even among relatively heavy users. This is true even in the areas intensively investigated, such aspulmonary, immunologic, and reproductive function.
Marijuana used in the USA has a higher THC content than in the past. Many critics have incorporated this fact into warnings, but the chief opposition to the drug rests on a moral and political, and not a toxicological, foundation.
(Merck Manual of Diagnosis and Therapy, 15th edition, 1987,Robert Berkow, MD, Editor-In-Chief. Published by Merck Sharp and Dohme Research Laboratories Division of Merck and Co, Inc)