29 May 2015

Marijuana and opiates: not as different as you may think

The conversations about legalizing marijuana and the conversations about heroine may seem farther apart than they really are.

How so? To understand this connection, we can first take a moment to challenge the assumptions inherent in various aspects of the argument for legalizing marijuana. Then, we look at the similarities between the marijuana and opiates as business models. This is important because what we know and believe about both plays a significant role in the larger context of what we want for our communities.

Argument One: Marijuana has a medical use, which is to treat pain and anxiety.
This argument makes us think about medicine, first. When we think of “medicine,” we think of something positive, something that gets us from sickness to wellness, and or something that eases pain once that becomes the only possibility. Underlying our idea of medicine is the understanding that it is still a substance (a “medicine”) and should be used selectively. Selective use would imply that there was some mediation between the user and the manufacturer. It would imply that frequent use and recreational use were negative and never intended. The leap the legalization argument makes is directly from “medicine” to “good,” and it gets us there effectively, because when we think of “medicine,” we usually also think “good.”
However, there is a chasm between the two concepts where the “goodness” of medicine is inextricably linked to its indications which are made with a prescribed dosage.  
In states where marijuana has been made legal to sell from dispensaries as a medicinal product, we have seen use among youth skyrocket and illegal trade remain steady and increase. The medical marijuana industry has been unsuccessful at regulating itself and ensuring that use is medicinally administered, and thus its potential benefit as a medicine has been outpaced by its overuse and unintended use.

Argument Two: Drug use and abuse happens more because drugs are illegal and unregulated.
This argument assumes that we have neatly and effectively been able to reduce the harm inflicted by the two substances we do allow because we have allowed them and regulated them. This is not true; the two legal, regulated substances we have now are the most used of all substances. Marijuana is the third most used substance, but still small compared to the rates of use of tobacco and alcohol, use and abuse of which result in 480,000 and 88,000 deaths per year in the United States, respectively. Making something legal makes it saleable in a public market, which means people will sell it in stores the general public will frequent; which means more people will see it and more people will buy it and use it.
This argument also assumes that the industries that sell these products enter into their business hand-in-hand with public health officials, willing to comply with any necessary regulations. As we know, however, this is not true either. The tobacco and alcohol industries have fought vigorously attempts by communities to limit access to their products. Of course they would, since underage and overuse of these substances is the source of most of their profits. It would be na├»ve to think that the marijuana industry will be different, and as we can see in the states where recreational use has been legalized, every effort has been made to limit the ability of communities to regulate it. In Alaska, the legalization put forth by the marijuana industry denied Native communities the ability to deny marijuana sales, even though they are sovereign nations and believe allowing sales will hurt the health of their communities. In Colorado, labeling laws and regulations on edibles—putting marijuana in jolly ranchers, sodas, cookies, etc.—were made nearly impossible under the state’s constitutional amendment that legalized marijuana. Denver, Colorado’s use of marijuana by underage residents is 350% higher than the rest of the country.
Still, underlying this argument is the correct assumption that drug use and abuse is a negative.

Argument Three: Marijuana is “safer” than alcohol.
The logic of this argument falters when one considers that the “product” of using any substance is a chemically-induced altered state of mind. Once a person’s state of mind is compromised by a substance that changes his or her view of what is safe and unsafe, s/he has stepped over into the potentially unsafe realm, introducing artificial risk.
There is no fixed scale of harm potential that rates alcohol on one point and marijuana on another. Fatal car crashes occur with marijuana use just as with alcohol use; accidental poisonings of children occur; overdosing occurs; and over a longer term use, the damage that occurs may be different but devastating from both substances, affecting a person’s ability to learn and grow intellectually and socially. We have seen more people needing rehabilitation treatment for marijuana addiction than any other substance in recent years. The idea that marijuana is “safer” than alcohol makes it sound like there is some sort of checklist of harms that are ranked in terms of scope and that alcohol and marijuana can be scored side-by-side. The other aspect of this argument assumes what we have seen as a result of alcohol is comparable to what we have seen as a result of marijuana, which is not true, because alcohol use and abuse has been much greater and widespread, and therefore the harms associated have been proportionately greater.

The legalization argument moves from agreeing use of marijuana is a negative that we can lessen with legalization to an argument that it might be negative, but at least it is less negative than alcohol. Still, it is a given is that marijuana use is negative.

We the public are being asked to make a large leap and ignore the important information between a medicinal and a recreational substance. The central connection is not that they are the same things inherently, but that the same organizations are driving both medical and recreational marijuana. The overuse and over-prescription of opioids starts to look a lot like how the marijuana industry plans to be profitable in our communities.

Bottom line, no one (perhaps hardly anyone) is trying to say that marijuana and opioid use are blanketly positive.

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In conclusion, one assumption that we can make as community members is that we want the best for our kids, our families, and our seniors, that we want them to be able to live healthy, fully engaged lives. We can move on to answering the question about how to do this based on science and evidence.

For many people who use tobacco, alcohol, and marijuana and other drugs, use is a form of mental pain relief. With this recognition and understanding, we promote healthy coping mechanisms and good overall health; educate people about the effects on their bodies and minds of tobacco, alcohol, marijuana and other substances; cheer and celebrate choices to engage in healthy stress-relief and socialization (like regular exercise, playing recreational sports, playing music with friends, reading, walking, others); and make sure our policies and laws support health. There has been extensive research showing that limiting access to unhealthy coping mechanisms helps keep them from becoming entrenched habits and exacerbating the parts of our lives that are already causing stress and anxiety. Humans are social creatures, and what we see and do and see others doing has a huge impact on our own decisions. We can create healthier communities by making sure what we see and do is more often healthy than not.