When Does Medical Marijuana Use Morph into Full-Blown Addiction?

Despite legalization, experts warn there's no "safe" way to use pot.

In more US states, marijuana is becoming legalized and socially accepted as treatment for a range of illnesses. But, like many medicines, it can lead to misuse and dependence. So, how do you know where to draw the line?

Relief Turns to Habit

Joseph, from Rockford, Illinois, became depressed after a death in the family and turned to marijuana for relief. His pot use turned into a daily habit; he became paranoid, socially isolated, and suffered from malnutrition.

“I always thought (marijuana) would bring down my anxiety, but it just made it that much worse,” he tells the Chicago Tribune.

One day, after a marijuana-induced “freak out,” Joseph, now 19, was taken by his brother to a nearby drug treatment center where he entered an inpatient program. After graduating from high school, he relapsed, and found himself hopeless and suicidal. He re-entered inpatient treatment, joined a 12-step program and is now seven months sober.

Though research suggests that most marijuana users don’t become dependent, Joseph’s story may be more common than you think.

Marijuana Facts

  • A 1994 study by the National Institute on Drug Abuse estimated that about 9 percent of pot users will become dependent, with an even greater likelihood for those who use the drug daily or began as teens.
  • Marijuana is the most popular illicit drug in the U.S.
  • Aside from alcoholism, more people seek treatment for abuse of pot than any other drug.

Legislation Fears

In Illinois, where marijuana is weeks away from being legalized for medical use, some addiction experts fear that legalization will lead to higher rates of abuse and dependence. “I think we’re entering a critical time, because it gives people a license to say, ‘I’m going to use this for a medical reason,'” said Linda Lewaniak, director of the Center for Addiction Medicine for Amita Health at Alexian Brothers Behavioral Health Hospital.

“It opens the door to a lot of potential abuse.”

But many attribute these concerns to misconceptions about pot stemming from the “Reefer Madness” era. Advocates have long pointed out that rates for marijuana dependency are much lower than for alcohol, cocaine, heroin or nicotine,that withdrawal symptoms are less severe, and that death from a pot overdose is nearly impossible.

Mitchell Earleywine, a psychology professor at the University of Albany and chairman of pot advocacy group NORML, challenges the claim that 9 percent of marijuana users become addicted. He says that, in reality, only about half that portion of users experience serious problems related to marijuana use, and those who do become dependent are often successfully treated.

Earleywine also disagrees with the prediction that medical marijuana will increase rates of abuse. A study published earlier this year in The Lancet found no increase in marijuana use by teens in states that have legalized medical marijuana, and a study from the University of Pennsylvania last year found that rates of overdose deaths from prescription painkillers are lower in states with legal medical marijuana, suggesting that pot may be a safer alternative for treating pain.

The Real Dangers of Weed

However, marijuana abuse is not without consequences. Heavy use can impair short-term memory, judgment, thinking and driving, and long-term use has been linked to pulminary issues and cognitive impairment, according to the National Institute on Drug Abuse. Some studies have linked marijuana use with psychosis, though it remains unclear which causes the other. And addiction counselors warn that marijuana use may be particularly risky for teens whose brains are still developing and who are more susceptible to addiction.

Potential signs of a marijuana use disorder include craving the drug, an inability to stop using or cut back, and pot use interfering with relationships, work or other areas of life, according to the American Psychiatric Association.

Another concern is a potential rise in marijuana-related hospitalizations. In states where medical marijuana was legalized, there were significant increases in ER visits involving marijuana between 2007 and 2012, according to according to a study presented last year to the American Academy of Addiction Psychiatry.

Patients who qualify for Illinois’ upcoming medical marijuana program should exercise caution in how much of the drug they consume and their method of consumption, said Dr. Joshua Straus, a psychiatrist and specialist in substance abuse at NorthShore University HealthSystem.

He warned that marijuana strains have become much stronger than they’ve ever been in the past. And pot-infused “edibles” are causing some problems of their own, as the drug’s effects can take longer to set in.

He also expressed concern about the drug not being labeled with warnings of potential side effects and drug interactions, like those required on federally approved drugs’ packaging. “There isn’t an adequate informed consent,” he said. “It’s on every other medication…. It’s a big missing piece.”

But despite his reservations, Dr. Straus said he welcomes the state’s new medical marijuana program. Research has found marijuana to be effective in treating pain and a range of other health conditions with fewer side effects than some pharmaceutical drugs.

Dr. Leslie Mendoza Temple, head of the Illinois Medical Cannabis Advisory Board, recognizes that marijuana may have some potential dangers, but said the risks are worth its potential benefits. She advised doctors to monitor and manage marijuana use by patients, as they would with any other drug prescriptions.

“[Marijuana] does have a low risk of addiction, but the risk is there,” she said. “There are risks to everything we do.”

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