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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Kandel’s theory was widely accepted. Perhaps its most fervent advocate was an Egyptian-born Columbia anesthesiologist named Gabriel Nahas.

One day in 1928, Nahas, then eight years old, took a walk with his father through the streets of Alexandria. Ragged beggars were everywhere. Nahas asked his father what was wrong with these men. His father had a simple answer: hashish. (Hashish is made of cannabis resin.) Nahas moved with his family to Paris a year later, but the imprint of human desolation in Alexandria stayed with him. Those memories, together with fatherhood, spurred Nahas to a crusade against cannabis that lasted from 1969 until his death in 2012. Nahas wrote more than a hundred papers on marijuana in the 1970s and ’80s, making controversial claims for the drug’s negative effects on the brain, the immune system, fetal growth, and testosterone and sperm production. His books Marihuana, Deceptive Weed (1972) and Keep Off the Grass (1976), though criticized within the medical community, were embraced by the antidrug movement, and Nahas became known as “Nancy Reagan’s favorite scientist.”

“Nahas loved my stuff,” Kandel says. “I wasn’t too crazy about that. He was really extreme.” 

On the Couch

John Mariani is an assistant professor of clinical psychiatry and the director of Columbia’s Substance Treatment and Research Service, which provides free substance-abuse treatment in a research setting.

“Most people using marijuana probably don’t experience significant problems,” says Mariani. “But there is a subset of people who do.”

Mariani explains the nature of the problems by way of contrast.

“With alcohol,” he says, “you might have a blackout, or get in a fight, or have sex with people you wouldn’t have sex with otherwise. With heroin you could have an overdose, or get hepatitis or an HIV infection. With crack you could have a seizure. With crystal meth, you could get psychotic. Marijuana is not really like that.

“Marijuana problems tend to be less dramatic — you’re not as ambitious, you perform less well. You probably stay home, watch TV, and eat ice cream. The disorder is about the absence of things — what doesn’t happen. Part of the problem is that because the problems are subtle, it’s never an emergency to stop. With other substances, if you’ve had a near overdose, or a DUI, it can be a wake-up call: ‘Wow, I need to get this under control.’ With marijuana, there are no overdose deaths. If there’s a crisis, it’s from someone else, like a spouse. The wife’s pregnant, and she’s not OK with her husband smoking anymore. So it often takes longer to appreciate the consequences.”

According to Mariani, no medications have been proved effective for cannabis use disorder.

Lost Highway?

While others focus on mental health, Guohua Li has his eyes on the road. With a grant from the National Institute on Drug Abuse, Li, the director of the Center for Injury Epidemiology and Prevention at the Mailman School, is studying cannabis and traffic accidents. Vehicular collisions are the biggest killer of Americans under forty-five.

“First of all,” Li says, “the use of marijuana doubles the risk of being involved in a crash. The risk is not as great as with alcohol, which increases crash risk thirteen-fold. But when a driver uses alcohol and marijuana, the risk of a fatal crash increases about twenty-four-fold. So marijuana in combination with alcohol doubles the risk.” In another study, Li looked at the trends of alcohol and drug involvement in traffic fatalities from 1999 to 2010. Alcohol involvement remained high but stable, at about 40 percent, but marijuana involvement tripled over that time, from 4 percent to 12 percent.

This raises a question.

“Dr. Li, since cannabis stays in the blood for days and weeks after use, how do you know if a person was high at the time of the crash?”

“We cannot say for certain,” Li says. “But based on the blood-test results, it’s definitely an indication that the driver used marijuana pretty recently.”

True. Maybe we should ask the more obvious question.

“Dr. Li, if marijuana is no more dangerous than alcohol — and a lot of people say it’s less dangerous — then why shouldn’t it be legal?”

“I don’t buy that argument,” Li says. “It’s as flawed as the argument you make in traffic court: ‘The drivers in front of me were going even faster and they weren’t ticketed, so why should I be ticketed?’ The reasoning is flawed. If you argue that because alcohol is worse than marijuana (and I think that statement is debatable), then marijuana should be legalized, that’s a race to the bottom, rather than a race to the top.”

What really matters in policymaking, Li says, is the risk-benefit ratio of the substance.

“Moderate alcohol consumption has a proven benefit in reducing cardiovascular disease, whereas marijuana has no proven health benefits.”

Li, too, sees medical marijuana as a “stepping stone to the goal of legalizing marijuana.” Ideally, he would like to see marijuana offenders treated in substance-abuse programs rather than going through the criminal-justice system. But he draws a line at legalization.

“I don’t think we should surrender to the drugs,” he says. “The legalization of marijuana is open surrender.” 

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