Cannabis Update: Five Years After Legalization
• April 2021 •
From Juan Navarro, Executive Director
Los Angeles Centers for Alcohol and Drug Abuse
Cannabis Update: Five Years After Legalization
It’s been five years since California voters overwhelmingly passed Proposition 64: The Control, Regulate, and Tax Adult Use of Marijuana Act. Not everything has gone according to plan.
For one thing, retail sales were supposed to generate hundreds of millions in taxes; some of which could be used for behavioral health treatment (every project sold includes a 40% tax). We also expected a high number of jobs to be created within the “canna-biz” industry. Unfortunately, tax revenues and new jobs have fallen far short of expectations due to difficulties with dispensary licensing. One unintended consequence is the flourishing illegal sale of (untaxed) pot in California.
Another expectation with the legalization of marijuana was the civic obligation to adjust cultural standards, social values, and beliefs in order to identify and discourage harmful use. Unfortunately, California still has no systems, processes, and collective wisdom for how cannabis can be used in a legal and responsible way. Like cannabis, alcohol is a drug, but almost 70% of American adults believe alcohol is more harmful to health than marijuana. Let’s look at that.
First, the similarities. Both alcohol and weed have addiction potential. It’s possible to develop an emotional and/or physical dependence to both substances. In fact, the current data suggests that 30% of people who use weed may have some degree of “marijuana use disorder.” And while being intoxicated with weed feels different than being intoxicated with alcohol, the two have roughly the same effect on our cognitive abilities, reflexes, and judgment.
Now the differences. Science knows much more about alcohol than it does about weed — there’s a lack of large, long-term studies on the effects of marijuana. Weed may appear to be safer than alcohol simply because we aren’t yet aware of all the risks. Yes, it’s true that high-intensity drinking can be deadly and very few people overdose on cannabis products. Plus, alcohol abuse can also cause serious health complications, including problems for the heart, liver, pancreas, and nervous system. For cannabis, one thing we do know is that vaping puts teens at a greater risk for developing symptoms of lung injury than just smoking cigarettes or marijuana. New findings show that adolescents who vape marijuana were about twice as likely to report wheezing or whistling in the chest than those who used e-cigarettes or smoked.
Before we judge pot as consequence-free, we still have a lot to learn.
Find out how: Marijuana Affects the Young Brain.
“I absolutely thought that you can’t get addicted to pot — marijuana is a natural, legal herb. I have bipolar disorder and pot helped me calm down and manage my manic periods, stress, depression, anger, whatever. Plus, pot is easier to get than alcohol when you’re underage, so in my mind here I am using a safe, legal thing. No problem. But my boyfriend started to say that I was addicted to it. He’s an athlete, so he’s into healthy things and I wasn’t. The more he said I was addicted, the more I used pot to chill out. When he asked me to try and quit for one week, just one week. I said I would — just to prove he was wrong. But I couldn’t even go one day without it. I tried over and over again. At the same time, I was starting to have some hallucinations and my mental health was getting worse. I finally went to a counselor for help, and got into recovery treatment. The most important thing I learned in recovery is that I am stronger than I think. Now with a year clean, I’m as into healthy things as my boyfriend. More!”
SPOTLIGHT – THE EVIDENCE IS IN:
Cannabis Use Disorders
Treatment for marijuana dependence begins with a comprehensive psychiatric assessment, including collateral information from family, friends, coworkers, and previous treatment providers. For cannabis use disorder, clinicians primarily assess patterns of substance use (both marijuana and other substances) and patient reasoning for what they find useful and problematic about these patterns.
In general, best practices in addiction treatment emphasize a chronic management model in the outpatient setting, rather than residential rehabilitation or inpatient hospitalization. Although some patients with severe cannabis use disorder may not be able to stabilize their use without being removed from their home environment, the outpatient setting is often the most appropriate level of care.
We know that patients who are dependent on pot often acknowledge spending an excessive amount of time or money on cannabis. They may also express a desire to reduce or stop use despite an ongoing attachment to the drug and a preference for how they feel while using. Starting with the initial assessment, the clinician can work to clean vocabulary, patient perspectives, and priorities that will subsequently allow for motivational work to reinforce patients’ “change talk” using a motivational interviewing framework.
A goal to immediately stop cannabis completely is unrealistic for the great majority of patients with a diagnosis of moderate to severe cannabis use disorder. Instead, frequent visits with intensive management for reducing frequency and amount of use in the direction of eventual abstinence is more effective for this patient population. The use of cognitive-behavioral therapy, motivational interviewing, and motivational enhancements are the most frequently used interventions for cannabis use disorders.
Find out more about evidence-based treatment for: Marijuana Use Disorder