Month: December 2019

It’s time to acknowledge “marijuana’s” racism-steeped past by transitioning back from “marijuana” to “cannabis”.

1930’s…

It was always cannabis. In plant taxonomy terms, Cannabis sativa is a plant that has been used for the strength of its fibers and medicinal properties for thousands of years. Even into the early 1930’s, cannabis was being consumed regularly for the treatment of migraine, nausea, and other ailments.

But in 1934, Harry Anslinger took over the Federal Bureau of Narcotics and made it his mission to criminalize marijuana possession. His strategy: scare the American public by associating it with Mexican immigrants, and make it evil. After all, Mexican immigrants were using cannabis recreationally. But they called it marijuana.

The term “marijuana” was introduced to the US by Mexican immigrants who came to the US during the Mexican Revolution, a period of great political turmoil between 1910 and 1920. One of the most common versions of the famous La Cucharacha, sung by soldiers and civilians supporting Pancho Villa included marijuana in its lyrics:

Spanish	English
La cucaracha, la cucaracha,	The cockroach, the cockroach,
ya no puede caminar	can’t walk anymore
porque no tiene, porque le falta	because it doesn’t have, because it’s lacking
marihuana que fumar.	marijuana to smoke.

When Anslinger went on the attack against cannabis, he didn’t call it cannabis. It was a deliberate strategy to avoid using the words “cannabis” or “hemp”, two innocent and soft sounding words, in favor of the unknown and harsher sounding “marijuana”. It gave him the opportunity to make the fresh association to the American public: marijuana and immigrants were linked. And not only that, it made them dangerous.

William Randolph Hearst, media mogul and father of yellow journalism, was Anslinger’s megaphone. Through Hearst, Anslinger generated fear in this alien drug called marijuana. It was turning good people evil; it created thieves, and killers; it made Mexicans and African Americans lust for white women. Marijuana was at the heart of immigrant crime.

And it worked. By 1937, Anslinger was in front of Congress to support a bill that would criminalize the possession of “marijuana” (the Marijuana Tax Act essentially criminalized its possession by creating unreasonably high tariffs on its possession). Despite claims by a representative from the American Medical Association that 1) marijuana has not been proven to be harmful in the ways claimed by Anslinger, and 2) most physicians didn’t even know marijuana and cannabis were the same thing, the bill overwhelmingly gained approval.

Today… 

The number of cannabis-related arrests are vastly weighted towards minority populations despite ubiquitous use patterns throughout the population. Many have died because of cannabis, not through overdose or its harmful impacts on the body, but in gang-related killings in the cannabis drug trade. Simple possession charges have broken families, disproportionately affecting African Americans and minority men, in part a holdover from cannabis’ racially-tinged history over the last 80 years.

And the negative social stigma has been pervasive. Nancy Regan’s Just Say No campaign solidified marijuana’s stigma in a new generation of Americans; cannabis’ medicinal abilities were of course never discussed. Many are surprised to learn about cannabis treatment for pain, migraine, nausea. But our American ancestors at the turn of the 20th century would be surprised that cannabis is no longer associated with medicine, and instead, it’s considered dangerous to the same order of magnitude (be federal government definition) as heroin, quaaludes, and LSD.

Does this stigma impact its treatment potential? Work by prominent UCLA Psychiatrist, Dr. Thomas J. Ungerleider, described how important “set” and “setting” are in cannabis’ effects in his commentary of his career’s work in Marijuana: A Signal of Misunderstanding (1999). It extends what we know about the importance of expectation in medicine; our brains are powerful regulators of drug success.

Even though cannabis has been repeatedly demonstrated to be therapeutically effective for a host of disorders and ailments in rodents (presumably with no expectation), children (little to no expectation), and adults, a negative expected outcome based on social stigma and expectation of harm from decades of anti-marijuana campaigns can hinder its success. If a positive expectation can drive treatment success with minimally-effective drugs or placebos, then it stands to reason that one tainted in social stigma could impede maximal treatment outcomes. Indeed, there’s a well-documented medical phenomenon called the “nocebo” effect in which there’s a detrimental effect on health caused by negative expectations. The brain can override some of cannabis’ positive effects, if we let it. We need to wipe away the social stigma attached to medicinal cannabis use.

So let’s start by moving away from marijuana and returning to cannabis.

We can even retain the alliteration! “Medicinal marijuana” sounds nice, but why not “clinical cannabis”? Let’s perpetuate the latter.

Years ago, I sat in D.A.R.E. class as teachers warned of the harm of cannabis. Not only would it destroy your brain, but it would lead to harder and more dangerous drugs (side note: I find it funny that cannabis is listed as a Schedule I drug in part out of fear that it would lead to the use of Schedule 2 drugs, like cocaine and morphine). Is this true? Does cannabis itself alter the brain in such a way that makes users more likely to graduate to other drugs?

Well, no.

The political history

Cannabis is not a “gateway drug”. Even those who toiled to make it illegal admitted that it was not the gateway to heroin. The Federal Bureau of Narcotics chief, Harry Anslinger, made it his mission to prohibit cannabis (which he deliberately called “marijuana” to associate it with Mexican immigrants). Throughout the 1930s, he cajoled newspapers, Hollywood, and politicians in a grand effort to make cannabis illegal. His efforts culminated with the passing of the 1937 Tax Act, which essentially made cannabis illegal to possess. In these hearings before the Committee on Ways and Means (75th Congress, 1st Session: House Marijuana Hearings), Anslinger was was asked if cannabis users graduate to heroin or cocaine.

“No sir,” he responded. “I have not heard of a case of that kind. I think it is an entirely different class. The marijuana addict does not go in that direction.”

12 years later, as the Cold War was heating up, Anslinger changed his view. He likened cannabis to a falling domino stating that cannabis addicts graduate to heroin once the thrill of weed is gone. This resonated with people of the era who were familiar with the idea of Communism toppling one country after the other, like a domino.

The idea stuck and persisted through the Nancy Reagan, “Just Say No” era.

What does the science say? 

The science in unclear, at best. On one hand, studies show that cannabis use precedes other drug use. But this by no means indicates that cannabis causes other drug use. Instead, it is commonly believed that the reason cannabis precedes other drug use is that it is more easily accessible. Under this reasoning, nicotine, tobacco, and alcohol would also be considered “gateway drugs”. It’s clear that accessibility plays a major role individual use patterns.

Of concern is the impact of cannabis (mainly THC-rich cannabis) on the developing brain. Adolescent exposure to THC impairs dopamine signaling in the brain in response to other rewards. This affects the strength of drug-associated reward, and hypothetically, lead to the use of harder drugs in order to achieve a strong high. Consistent with this idea, rats exposed to large amounts of THC (or just their parents!) are more likely to seek heroin in adulthood.

But this doesn’t mean people behave like this in the real world. For one, we’re given more choices for how to live our lives than rats in a cage. And just because there may be some shift in brain chemistry, it’s unlikely to sufficiently alter reward perception to the point that heroin is the only means of living a pleasurable life.

To date, there haven’t been any studies linking adolescent cannabis use to harder drug use that aren’t confounded by genetic, environmental, or socio-economic factors. So given our current level of scientific and political understanding, the simplest answer to the question, is cannabis a gateway drug? is NO. The main reasons being: 1) an historical perspective reveals that this stance was taken for political reasons, and not based on science; 2) confirmational bias leads us to confirm our belief that cannabis is a gateway drug because “hard drug” is often preceded by cannabis, even though cannabis is merely the more easily accessible and economic choice.

Original posting date: February 17, 2018

A recent article published in the journal, Addiction, looked at the impact of adolescent alcohol and cannabis use on brain structural characteristics. The scientists used a brain imaging technique called MRI (yes, the same thing used to diagnose your torn ACL) and looked at numerous characteristics relating to number of brain cells and how they connect across different brain areas.

To the excitement of the cannabis community, alcohol use was associated with numerous abnormal structural characteristics, while cannabis appeared to have no effect. “See, cannabis is safe!” I read on numerous cannabis sites. I got emails, “what do you think of this? Exciting, huh?”

Let’s pump the breaks. Yes, adolescent alcohol exposure is bad. That’s not surprising. Not only does alcohol perturb normal brain function when it’s in the system, leading to shifts in the way brain cells act, but it also increases inflammation in the brain leading to a host of long-term consequences such as the changes in brain structure reported in this article. But THC, the high-inducing chemical in cannabis, is known to cause detrimental effects on the developing brain even in the absence of overt structural changes.

THC has been shown in numerous studies to affect the manner in which brain cells connect to one another and synchronize their activity. This shift in what’s known as “functional connectivity” can lead to long-term consequences on cognitive function and psychology health. Adolescent THC exposure is also associated with increased risk for developing schizophrenia. THC can cause 1) an acute psychotic episode, 2) one that persists beyond THC’s action in the brain, and 3) long lasting psychosis that requires clinical intervention.

Some of the negative effects of cannabis on the developing brain are thought to result from perturbation to the connections between the brain’s cortex, which controls everything from decision making to sensory perception, and the thalamus, which acts as an important relay station in the brain. By impairing the connections between the cortex and the thalamus, cannabis can lead to impairments in cognitive and executive functioning, and disorganized thinking associated with schizophrenia. It’s noted however that this particular mechanism is up for debate.

There are numerous disorders that often don’t have overt structural signatures including depression, anxiety, and PTSD. Instead, many symptoms result an imbalance in the chemicals brain cells use to communicate, called neurotransmitters. Shifts in neurotransmitters levels, and the sensitivity of their receptors, can be altered by cannabis exposure. This effect has long-term consequences in the developing brain of an adolescent.

While we can be excited about cannabis’ wide scope of therapeutic benefits, let’s not let that cloud the reality of its potential risk. THC-rich cannabis may not have as detrimental effects on the developing brain as alcohol, but it’s not accurate to say that it’s safe. For both drugs, it’s best to wait until the brain is fully developed to mitigate any long-term adverse consequences.

In 1971, Congress created the National Commission on Marijuana and Drug Abuse, now called the Schaffer Commission. A reluctant President Richard Nixon appointed 13 members to the group that consisted of senators, congressmen, and physicians. One of these members, Dr. Thomas Ungerleider was a psychiatrist and researcher at UCLA. Nearly 30 years after the commission was formed, Dr. Ungerleider reflected on the experience in a paper titled: Marijuana: Still a “Signal of Misunderstanding”. This title alludes to the title of their first year’s report: “Marijuana, Signal of Misunderstanding”, in which the commission unanimously recommended that cannabis be decriminalized. Notably, they did not recommend legalization, but they felt strongly that possession should not be grounds for imprisonment. In the end, the commission’s recommendation was opposed in Congress, and the Nixon administration failed to implement its recommendations. Consequently, 25 years after the report was issued, there were still nearly 600,000 arrests for personal possession.

One of the commission’s task’s was to travel around the world to study cannabis laws and use patterns in various countries. These experiences revealed the global pervasiveness of the United State’s anti-marijuana agenda. The United States had a major influence in the 1961 Single Convention on Narcotic Drugs, which established an international treaty for outlawing specific drugs, including cannabis.

Adhering to the treaty’s policy against cannabis exposed a country’s bias against certain ethnic and socioeconomic groups. Just as the United States justified cannabis’ illegality by tying its use to crime among immigrant populations, Dr. Ungerledier recalls several instances in which the stated justification for a country’s cannabis policy diverged from the truth. These stories were divulged to members of the commission in unofficial meetings and social events, often after the consumption of “free-flowing use of alcohol”.

Global reach

In India, there were two types of cannabis: 1) the stronger smoked cannabis (called charas), which was illegal, and 2) the legal weaker cannabis beverage (called bhang). The official reason charas was illegal was because it was reported to be more like heroin, whereas bhang was like coffee. But Dr. Ungerleider reports that the real reason charas was illegal was because it was used mainly by the lower class while bhang was commonly used by the upper class. By making charas illegal, India complied with the international treaty established at the Single Convention on Narcotic Drugs that was strongly supported by the US, while preserving its use among the upper class.

In South Africa, marijuana, or dagga as it was called, was illegal for the official reason that it harmed the nation’s youth. But dagga was mainly used by the Bantu natives suppressed by the apartheid regime. After centuries of use by the Bantu, there was a growing market for dagga among the white middle class. It was feared that the money used to purchase dagga from the Bantu would be used to buy weapons to overthrow apartheid. This fear was revealed to the commission in unofficial meetings with government officials, adding to the number of countries that used cannabis laws to suppress minorities and the lower classes.

Iran adopted a policy of capital punishment for cannabis smuggling. Of the 160 smugglers who were executed, all were Afghans, thereby preserving the cannabis smuggling operation for Iranians citizens.

Dr. Ungerleider recalls heavy skepticism of the commissioners wherever they visited. Some foreign agents assumed they were on a secret mission with the CIA, or investigating other drugs like heroin or cocaine. Most couldn’t fathom that the United States would invest resources towards the study of cannabis alone. He remembers statements like, “You are not really a marijuana commission; no one would appoint a commission to study just marijuana. How gullible do you think we are?”

The commission was not on a mission for the CIA, nor were they secretly investigating other drugs, but they did discover ways in which a US-led international drug treaty was used to suppress minorities, immigrants, and the lower-class. What they couldn’t find was the serious harm their own government claimed cannabis caused. Instead, cannabis’ greatest harm seemed to stem from the way it was handled by the governments themselves.

Note: this was originally published on May 3, 2018 by Josh Kaplan