Cerebrum Winter 2021

Any ethical evaluation of marijuana policies should consider the latest scientific understanding of marijuana’s effects on cognitive abilities on adolescents and its potential downstream impacts on education, employment, job performance, and income.

vehicle accidents, threatening harm to others in the same car or in other vehicles on the road. And whether smoking marijuana causes lung cancer, as cigarette smoking does, remains an open question. Considerable evidence suggests that students who smoke marijuana have poorer educational outcomes, such as reduced chances of graduating, than their non-smoking peers. But whether marijuana use directly causes these associations remains unanswered. The “Gateway Drug” Question Although some studies suggest that marijuana may be a “gateway drug” whose users progress to “harder” substances, most marijuana users do not follow that pathway. A more plausible hypothesis is that people inclined to take drugs start with what’s readily available, such as marijuana, tobacco, or alcohol, and then interact with people who use other drugs that they, too, decide to try. NIDA calls for further research to explore this question. Heavy users can become dependent on marijuana to function in life, but there are vigorous debates over whether they can be considered “addicted.” The CDC says that about one in six teens who repeatedly use marijuana can become addicted, which means that they may make unsuccessful efforts to quit using marijuana or may give up important activities with friends and family in favor of using marijuana. Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance-use disorders, but the evidence is mixed and hard to interpret. The strongest evidence links marijuana use and psychiatric disorders in those with preexisting genetic conditions or other vulnerabilities. A clear-minded article by a British psychiatrist in Cerebrum in early 2015 noted that most people enjoy cannabis (marijuana) in moderation and suffer no ill effects, but he cited studies that cannabis users had an increased risk of psychotic symptoms and full-blown schizophrenia. That judgment was more readily accepted in Europe than in North America, he wrote. Looking ahead, it is important to recognize that several factors make marijuana more dangerous today than it was 20-30 years ago, especially for young people. The amount of tetrahydrocannabinol (THC) in marijuana, the main ingredient that causes a person to feel high, has increased greatly over the past few decades, from less than 4 percent in the early 1990s to about 15 percent now. Smoking of extracts and resins from the marijuana plant, which have 3 to 5 times more THC than the plant itself, is also increasing. Vaping of marijuana is on the rise among high school seniors and college students, a dangerous trend because users tend

to vape a higher concentration of THC than they would smoke. Meanwhile, eating food, such as cookies and brownies, infused with marijuana is also on the rise, posing added dangers. A 2019 study of emergency room visits in Colorado found that edibles were more likely than inhaled pot to cause severe intoxication, acute psychiatric symptoms in people with no history of psychiatric illness, and cardiovascular problems. So-called “marijuana concentrates,” which contain extraordinarily high THC levels and can deliver it to the body quickly, may also be contaminated with toxic substances, raising the risks to unwary users. For adolescents, these concentrates may be throwing important development processes out of balance. Looking Ahead President-elect Joe Biden, who during his Senate career was considered a hard-line supporter of punitive anti-drug laws, softened his stance in comments during the campaign. He favors decriminalizing marijuana and expunging the convictions of low-level users so that there would be no permanent criminal record. He would allow states to set their own marijuana policies, but he does not favor federal legalization because he doesn’t believe there have been sufficient studies of its health effects. He favors changing the status of marijuana under federal law from a tightly controlled status that prohibits virtually all uses to a category that would makes it easier to conduct research on marijuana’s health effects. He has also suggested that people convicted of low- level drug offenses should be forced into mandatory rehab programs in lieu of jail. He will need to ensure that whatever compulsion he tries to exert does not infringe on civil liberties. Some advocacy groups believe Mr. Biden should push for complete legalization of marijuana and removal of virtually all federal controls on its use. For now, his measured approach seems reasonable for a substance about which much remains unknown. And it seems more likely to gain bipartisan political support. But no matter what direction the political winds blow concerning legalization, the criminal justice system, and the influx of new marketing strategies for new and stronger product, we owe it to our children to study the effects of marijuana on their brain health and step up our efforts to protect them. l Phil Boffey is former deputy editor of the New York Times Editorial Board and editorial page writer, primarily focusing on the impacts of science and health on society. He was also editor of Science Times and a member of two teams that won Pulitzer Prizes. The views and opinions expressed are those of the author and do not imply endorsement by the Dana Foundation.

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