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GAZETTE: What constitutes heavy use?

Date February 24, 2020

By Alvin Powell Harvard Staff Writer

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HILL: The myths have been disproven. Unfortunately, the loudest voices in the cannabis debate often are people who have political or financial skin in the game, and the two sides are entrenched. Pro-cannabis people will say that cannabis is the greatest medication ever, and harmless. Others — often in the same field that I’m in, people who treat patients, people who do research with cannabis — will at times misrepresent the facts as well. They will go into a room of 100 or 200 high schoolers and relay the message that cannabis is as dangerous as fentanyl. That’s not true either. These camps seem to feel that even a single shred of evidence that runs counter to their narrative hurts them. So at the end of the day, a lot of what people hear about cannabis is either incomplete or flat-out wrong because both sides are promoting polar opposite views of cannabis.

Jon Chase/Harvard Staff Photographer

HILL: They are. When someone’s sitting in my office, if you redacted some of the details of their story, it’d be hard to tell who’s got which problem: alcohol versus opioids versus cannabis. The onset — what will bring you into my office — is different. People who are using cannabis are not going to knock off a CVS to fuel their habit. If somebody’s using fentanyl, they may overdose and that could be potentially fatal. That’s not going to happen with cannabis. But when you talk to them, other details are often the same. “My wife said I gotta come talk to you or she’s gonna kick me out.” And that can happen to somebody who’s drinking, that could happen to somebody using opioids. It’s not as dramatic if cannabis is the drug of choice, but once somebody meets the criteria for a cannabis-use disorder or alcohol-use disorder or opioid-use disorder, there are a lot of similarities, more similarities than differences, frankly. One unique thing about cannabis is that on the same day, I may have somebody who is 26, smoking four times a day, graduated from a local elite university, and not making it like they want to be making it. Then, the next hour, I may see a 70-year-old woman who has chronic back issues and tried multiple medications, multiple injections, and wants to use cannabis for her pain. There aren’t a lot of doctors who see both of these patients and that is one of the reasons why people take really strong positions, when in fact many of the answers on cannabis are down the middle. There are a lot of things we don’t know, and a lot of answers we wouldn’t have expected. I’ve done studies myself where I hypothesized one thing, and something else comes out. Are you going to dismiss that or let that new information shape what you think about cannabis? You have to be open-minded in an area that is continuing to evolve. If you aren’t open-minded and willing to have a sensible conversation about cannabis, you won’t be able to reach your patients. A lot of times patients don’t tell their primary care doctor about their cannabis use, their use of CBD, because they think their physician won’t approve of their use. That’s another major problem. If you’re using CBD to treat a given medical condition and your doctor doesn’t know it and you’ve got six other medications, that could be a major issue.

HILL: It’s less addictive than alcohol, less addictive than opioids, but just because it’s less addictive doesn’t mean that it’s not addictive. There’s a subset of people — whom I treat frequently — who are using cannabis to the detriment of work, school, and relationships. It’s hard for the majority of people — who may use once a month or once every six months, or they tried it in Vegas because it’s legal there — to recognize the reality that there are many people who are using and losing in key areas of their lives. I’ve had patients who have lost multimillion-dollar careers. It’s hard for people to understand that that can happen. I often compare cannabis to alcohol. They’re very similar in that most people who use never need to see somebody like me. But the difference is that we all recognize the dangers of alcohol. If you go into a room of 200 high school kids, they know it’s dangerous and binge drinking among high schoolers is way down. But if you ask that same group about cannabis, you’re going to get all different answers. Data that suggests that although cannabis use among young people is flat — that’s another misrepresentation, that it’s going up — the perception of risk among those young people is going down. So, while everyone’s talking about it, and stores are opening in Brookline, in Leicester, and all over the state, adults and young people are not clear about the risks.

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A study published in 2012 in The Journal of the American Medical Association (JAMA) had some good news for people who smoke marijuana: smoking at a rate of one joint a day for as long as seven years doesn’t seem to affect lung function adversely.

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