Breaking Through

Cannabis legalization is a growing reality: 20 states permit medical marijuana use, and Colorado and Washington have legalized it for all adults. But as more states line up — and more people light up — Columbia researchers wonder: what’s on the other side?

by Paul Hond Published Spring 2014
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Predictably, Hasin found a higher rate of use in states with medical marijuana, and a higher rate of disorders, too. “You could interpret that in different ways,” she says. “You could say, these laws are causing people to use more and be at higher risk. Or you could say, the laws are just reflecting what’s going on in the states: the states with more permissive attitudes have higher use.”

That was for adults. Next, Hasin wanted to learn about kids. Using another data set, she and her team did an analysis of twelve-to-seventeen-year-olds in medical-marijuana states. There, too, the data showed a higher level of use — though again, it didn’t say what came first, the elevated rate or the law. To figure that out, Hasin is now studying a larger sample — a yearly survey of 45,000 eighth, tenth, and twelfth graders from 1991 to the present. She wants to see what was going on in states before and after they passed a medical-marijuana law, and compare that to trends in states without any law. (California was the first to legalize medical marijuana, in 1996.)

“There are many variables that we need to incorporate before we can understand the results,” Hasin says. “There are differences in laws, in how states handle dispensaries, and in attitudes within a state. How risky do people think it is? How OK is it to use? We built those variables into the analysis, because we wanted to see: does passing a law result in a change in attitudes as well as a change in use?

“Medical marijuana aside, marijuana use has been creeping up in adolescents and adults since 2007. The proportion of the population that sees it as risky has been going down. There is a debate about cannabis: on the one hand, market forces are perking up at legalization. On the other, there is a public-health perspective. In the two states that have legalized marijuana, we’re seeing that the systems they’re implementing aren’t taking public health into account the way they could.

“Not every user is harmed,” says Hasin, “but there are harms from using cannabis. And it seems likely that legalization will increase the amount of harm.” 

Czar Power

What are those harms, exactly?

Let’s visit Herbert Kleber, the director of the Division on Substance Abuse at Columbia’s College of Physicians and Surgeons and the New York State Psychiatric Institute. From 1989 to 1992, Kleber, now seventy-nine, was deputy drug czar under President George H. W. Bush. His official title was deputy director for demand reduction. He’s a treatment guy, a mild-mannered, good-humored professor of psychiatry who is not high on marijuana, in any sense.

Kleber’s office is a barricade of books and stacked peer-reviewed papers and framed photos of himself with colleagues and personages. Prominently displayed is a letter of thanks from the president he served. Kleber, a dapper, white-haired man with wireframe glasses, sits in his desk chair, dwarfed by the monuments of his achievements.

“Dr. Kleber,” we begin. “You’ve spent your career trying to reduce the demand for cannabis. Now things are moving in the opposite direction. How do you understand this?”

Kleber reflects for a moment. “I gave a talk over a decade ago on marijuana entitled, ‘The Grass Makes the Other Side of the Hill Look Greener.’” He grins at the pun. “Meaning that there are a lot of people who enjoy marijuana’s effects.” This remark sounds almost tolerant, a concession to the pursuit of happiness. Kleber then qualifies it. “We’re going through a difficult time in this country, in terms of jobs, stress, a dysfunctional Congress, and a dysfunctional government. I think a lot of people are looking for escape. And the marijuana today is a very different creature than it was in the 1960s, when John Lennon called it ‘a harmless giggle.’ Then, it was about 2 percent THC. Now, the THC level of the average DEA seizure is about 12 percent. At the dispensaries in California and Colorado, it’s 15 to 30 percent.” Kleber lowers his voice. “It’s a very different drug. A very, very powerful drug.”

In a 2009 CBS News op-ed on marijuana, Kleber wrote, “There are a number of very serious side-effects including increased likelihood of cancer, impaired immune system, and increased chance of other drug problems, such as addiction to opiates. Some studies disagree on these. Recently, substantial evidence has been published linking marijuana use to earlier onset of schizophrenia and other psychoses.”


“Dr. Kleber, is it really true? About psychosis?”

“Yes.” Kleber stands up, goes over to a table heaped with papers and indicates two thick folders. “It’s all marijuana,” he says. “Marijuana and psychosis.” Kleber proffers a folder for inspection. “These articles are all on marijuana and psychosis.”

When we politely invoke Reefer Madness, in a delicate “some might say” formulation, Kleber says, “No. These are careful scientists who have studied this, both in the US and in England.”

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