Cannabis: Addiction Medicine And Legalization

At the American Society of Addiction Medicine (ASAM) annual meeting in April 2015, it became clear that there is a substantial divide between the addiction medicine doctors practicing in states where marijuana and/or medical marijuana is legal and the states where marijuana is still illegal in any form. The “White Paper on State-Level Proposals to Legalize Marijuana” from ASAM articulates that marijuana in all forms must remain illegal and is supported by the National Institute on Drug Abuse (NIDA) and the federal government. ASAM stresses the increasing rates of use among youth and the increasing incidence of those with marijuana use disorders entering treatment. All addiction medicine physicians agree with these concerns, particularly those who treat adolescent addiction and marijuana dependence.

However, the increase in marijuana use has occurred in all states, including those where marijuana is illegal and enforcement is strict. The white paper emphasizes the public relations campaign in the media to legalize marijuana and its downplaying of the harmful aspects of marijuana, but does not mention the past history of “Reefer Madness” media approaches by the government which overstated the dangers of marijuana and poisoned the information environment for youth who do not now trust current drug education information.

At the ASAM panel on cannabis, Dr. Greg Bunt discussed the difference between legalization and decriminalization, also covered in the white paper: Marijuana decriminalization at the state level generally removes criminal penalties for the possession and use of marijuana while the production and sale of the drug remain illegal. Full legalization, in contrast, embraces the commercialization of production, sale and use of marijuana.

As stressed by ASAM, a medical society treating the negative consequences of psychoactive drugs, marijuana can have many negative health consequences. The psychoactive component in marijuana is THC, and tolerance and dependence on THC can occur with regular heavy use. Particularly with the more potent forms of cannabis, including the rapid delivery systems such as butane hash oil (BHO), intoxication, psychosis and drug-precipitated psychosis are regularly seen in treatment programs such as Muir Wood Adolescent and Family Services, which specializes in treating cannabis-dependent adolescents.

NIDA has summarized the mental health studies showing that age of first use is an important risk factor in the development of mental health problems, including early onset schizophrenia in at-risk youth. In addition, marijuana intoxication causes short-term effects on the brain, including memory and learning. The ASAM white paper, while urging options for increased treatment for those whose lives are terribly impacted by the drug, particularly young people, and continued prohibition, ignores the fact that an ever-growing percentage of the population not only supports cannabis legalization, but is using the drug without noticeable harm. The cat is well out of the bag.

However, the California Society of Addiction Medicine (CSAM), ASAM’s largest state chapter, in its report, “Youth First,” by CSAM Past Presidents Timmen Cermak and Peter Banys, co-chairs of the Marijuana Policy Task Force, acknowledges the negative health problems with marijuana but recommends a different strategy for marijuana policy in California, where marijuana will probably soon be legal, based on current public opinion polls.

Because Cermak and Banys are members of California’s Blue Ribbon Commission on Marijuana Policy and are its Youth Education and Prevention Working Group co-chairs, their position likely will have more impact on California policy than ASAM’s white paper. The core realities stated in “Youth First” are:

Current state law does not effectively regulate marijuana use in California.

Medical marijuana and lessened penalties for possession of small amounts have minimized the legal consequences involved with marijuana use and/or possession since the mid-nineties.

National and local anti-drug campaigns have been largely ineffective.

Forty years of increasingly strict criminal sanctions have had little impact on widespread drug use, while creating conditions that encourage drug trafficking. The Blue Ribbon Commission on Marijuana Policy found that young people in California “have only limited access to quality drug education, counseling or treatment.”

Incarceration of non-violent drug offenders has substantially contributed to California’s prison overcrowding crisis.

Excessive reliance on incarceration places criminal justice in the position of treating what is largely a public health problem.

Marijuana prohibition is not necessary for adult public health protection.

Negative health consequences are generally less severe than those from addiction to alcohol, other illicit drugs, and perhaps even tobacco, except in at-risk youth.

Treatment for substance use disorders works.

Treatment is an effective, efficient, and economical society response to individuals dependent on cannabis, particularly for youth, who are the most vulnerable to marijuana’s effects. Cannabis use when the brain is still maturing increases the risk and onset of developing dependence while also affecting the brain’s structure and cognitive functions.

Adolescents in California have virtually unlimited access to marijuana.

Surveys show that 73% of California 11th-graders say marijuana is “fairly” or “very easy” to obtain.

Children and adolescents are at significantly greater risk from marijuana use than adults.

As Cermak has stated, early onset addiction should be viewed as a pediatric disease as the signs and symptoms occur early in the developmental cycle, well before full-blown addiction surfaces.

Nonetheless, there is barely any system of early intervention and treatment for at risk youth, in part because of lack of funding and emphasis. Even long-standing adolescent programs, such as Thunder Road Adolescent Treatment Centers in Oakland, are facing closure due to withdrawal of funding. The current treatment system is adult-oriented and based on medical necessity rather than early intervention.

Sound drug policy protects public health.

Addiction is a chronic disease. Like other chronic diseases, treatment must be available for those with substance use disorders.

The relentless drive to legalize marijuana would be better served through education that our nation’s current drug policy is a failure and requires a better public health strategy, rather than providing a platform to promote marijuana as benign for youth. It is clear that addiction medicine is divided on what drug policy would be most effective and whether final decisions will be based on medical evidence or public hysteria.


American Society of Addiction Medicine (ASAM). (2012). White Paper on State-Level Proposals to Legalize Marijuana. Retrieved from

Garofoli, J. (2015) “Legal pot’s big issue: What about schoolkids?” San Francisco Chronicle, May 20, 2015.
Marijuana Policy Task Force. (2011). Youth first: Reconstructing drug policy, regulating marijuana, and increasing access to treatment in

California. A Report to the California Society of Addiction Medicine. Retrieved from