The legalization of medical and recreational marijuana is bringing with it many issues: DUIs for pot, how to reliably test for it, reports of increased use by adolescents and the impression it is not harmful, and various health issues. Adderall stories continue with a new study saying use of these kind of drugs by young people DOES lead to a greater likelihood of cocaine or meth use and abuse later, not the opposite, has as been the popular wisdom. The studies saying that were often done by doctors on the payrolls of big pharma companies, which has been common practice. Some drug companies are now saying they will no longer pay doctors to promote their drugs, but will still engage them to do research. And new reports noting e-cigarettes and their connection to heart disease.
Transcript (edited):
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard LaMere. We have a variety of stories once again this week several on marijuana, more continuing stories on ADHD medication and the alarming rise of Adderal prescriptions along with, prescription pain killers. A couple of stories about e-cigarettes and a number of stories in the last week or two about big pharma and doctors. Some of the big companies are going to stop paying doctors to promote their medicines, but not going to stop paying them to do research and I was just saying, we could do a whole series on this topic but lets just start from the top, shall we Darryl? Many stories on marijuana which one do you think is top of the pops?
DARRYL: Well they all are very important now that Washington and Colorado rolled out recreational approval of marijuana and states like Oregon and Hawaii are considering it, many other states have proposals for legislation that legalize recreational use. A lot of attention is of course on whats happening in those states where its recreational and there are some positives and negatives. And as usual, were getting a mixed bag of reports and a lot of different studies on both sides of the fence claiming good things and bad things. So its really kind of hard to weed through all this, but I think I agree, that there has been a great increase in marijuana use amongst 12-graders and young people, although laws in both states restrict recreational use to young adults, 18 or over. I think as we would have predicted, there is a great increase in adolescent marijuana use, not only in those states but a lot of other states. Surveys like the annual survey on drug use and health in the United States are continuing to show that the perception especially amongst young people that marijuana is a harmful drug continues to decline and any time that happens, the use of a drug is going to increase and its use especially amongst adolescents is increasing and with that there are a lot more reports about the concerns this is raising. The laws grant young adults, not adolescents immunity of use.
The adolescent brain is still in development from birth until about 6 years old, the brain develops more white matter so the mylineation can be more effective in its communication. Also the brain develops back to front , so more cognitive abilities and more discretion, more of the executive functioning and decision making parts of the brain are just getting hard-wired and that takes time. When young people are exposed to a drug like marijuana, it affects those areas of the brain. A lot of reports state that there are actual changes in the brain, areas shrink the way that we see in schizophrenics and some reports a lot of reports…believe that marijuana is linked to thought disorder and schizophrenia. Some researchers also believe other areas that are important in memory the hippocampus – are also being impacted by early and chronic heavy marijuana use and an MRI can show damage to those parts of the brain. There is a concern regarding how the damage will affect peoples lifelong abilities. A report from Smart Alternatives/Smart Approaches to Marijuana show a great increase in DUI arrests and DUI detentions from marijuana in Washington anyway. Since the legislation approved recreational marijuana in that state it increased 50%. Of course we expected that because people feel freer to smoke, but unlike alcohol which is a 0 order rate of metabolism, marijuana metabolizes very, very slowly. So with alcohol use there was a well-defined logarithm that says if you drink so much an hour, you’re going to have this level of the alcohol in your blood and we know that 0.08 or more is going to impair your abilities. Well, I don’t think that has ever been analyzed with marijuana use so if a person smokes recreationally at a party and that party may have been a week or two ago, there will still be marijuana in that person’s system.
HOWARD: Right, so how do you tell?
DARRYL: You can’t.
HOWARD: So that makes it real hard.
DARRYL: Well, there are field sobriety tests that are very accurate….if you’re over 50, you’re going to fail a field sobriety test just for being over 50 because they aren’t meant to allow you to pass. If its cold outside, if you are a diabetic or if you have any kind of a balance disorder or anything, you’re going to fail these tests. They’re meant for people to fail. If for any reason you have a backup light thats out, or you don’t signal before you change lanes. they’re going to stop you and you’re going to fail and then they’re going to test you and if you happened to smoke marijuana a month ago and you happen to be a heavy user or a binge user but haven’t used in 2 weeks or a month your test will be positive and you’ll be convicted. And so thats one side of it. The other side of it is marijuana does greatly impair some functions it impairs tasks that require memory and require a lot of random of functions necessary to achieve a goal. Drivers must watch their speed, they must hold their foot on the gas or break, pay attention to the gauges, check the rear view mirror… do all of these multiple tasks at the same time and marijuana does impair that. Theres no doubt about it. And so there is a greater potential for an accident. People get so paranoid when they smoke marijuana, they drive 5 miles an hour down a 30 mile an hour street. So, marijuana does impair driving and nobody has, I think, really thought about that. The states and the city governments haven’t figured out how to police that and how they’re going to pay for it. On the other hand, the citizens who wanted it and voted for it are now going to find themselves facing the stigma, all the costs, all the fines and that come with being convicted of DUI, so thats a real concern.
HOWARD: Like you said we knew that there were going to be ramifications to this, but the extent is still to be determined.
DARRYL: I had a concern about some of the studies reporting that although the use of marijuana has increased, there is a decrease in the use of illicit drugs in both of these statesIm not sure I agree with that, so I would like to really scrutinize those studies. Historically, if the view of illicit drug use like marijuana goes up, use of all illicit drugs goes up. This might be the honeymoon hey, marijuana is legal so everybody is using, but pretty soon they may get bored, and although its not a gateway drug in and of itself – any drug that is addictive or psychoactive is a gateway drug. There is a decreased belief that marijuana is harmful. An increase in its use and an increase in all other drug use is what I believe to be coming about. Another concern was a recent study that says marijuana has been linked to increased stillborn deaths and that there are reports that women who smoke marijuana during their pregnancy have a much greater chance of stillborn and also a much greater chance of SID (Sudden Infant Crib Death).
HOWARD: I think part of this has to do with the perception of medicine and we all know that marijuana has become accepted as a therapy in about of the states now. The ongoing rise in prescription drug use and abuse, both pain medication and now ADHD drugs Adderal, Ritalin, but there is a perception in all these cases that they are useful therapeutically and thus not so dangerous.
DARRYL: Absolutely and unfortunately there are multiple facets to that story. For the life of me I still cant understand why our nation and especially street people and people who are using for medical purposes, do not understand the difference between medical marijuana and rolling up shake or rolling up bush and smoking it. I think they are 2 separate things and there are prescription medications that contain the extracts and have been purified and are much healthier. We have products that people can eat. But right now, the growing understanding in medicine is that of the 400 chemicals or so that are physiologically active and the 60 that are psychoactive in the cannabis plant, its really the cannabidiol, CBD, that contains a wealth of very healthy medical properties with very little psychoactive properties. Today we have something called Charlottes Web and other hybrid marijuanas that have less of the psychoactive THC which is addicting and more CBD which is healthy and that’s medical marijuana. Before, we thought medical marijuana – and I still believe this – was a smoke screen to get recreational marijuana approved. But now we have recreational marijuana approved in states and so there should be a distinction about what is medical and what is not medical but even in those states, the healthier forms of marijuana the good ones are being shunned or avoided and people who really need it medically continue to roll up shake and roll up bush and expose themselves to more health hazards than benefits. So its a real concern of mine. As societies and governments approve marijuana as a medicine, it gets sucked into this whole medical thing where people think well, if its medicine and my doctor is prescribing it and approving it, its got to be healthy there can’t be anything wrong here.
HOWARD: All things have side effects.
DARRYL: Every one. And the best we get out of any medication is about 50% effective medicine. We use the shotgun approach until we find something that is effective and a lot of people suffer side effects, adverse effects, toxic effects, bad reactions from medications – so just because a drug is prescribable and given to you by a doctor, doesn’t mean in and of itself is a safe and effect drug.
HOWARD: Is there anything more to add you’ve got that new study there about the Adderal increase?
DARRYL: Yes, Adderal.since 2003 to 2012, the number of prescriptions for Adderal has just dramatically increased. If I was looking at it on a percentage basis, its probably tripled or quadrupled and thats of deep concern. The majority of doctors who treat attention deficit disorder and attention hyperactivity disorder continue to try and convince me that all the studies show that the use of Adderal or Concerta or Ritalin or any of these stimulants, actually promotes less drug abuse and less addiction to stimulants. these are decent people and I respect them, but as you pointed out, they’re quoting studies conducted by doctors who are paid by the pharmaceutical companies that are manufacturing these stimulants. And as we pointed out last week or 2 weeks ago, a new Boston University study costing 2.5 million dollars paid for by the government with no pharmaceutical involvement – found the exact opposite and may be pulling the plug on all of this because they find a direct correlation between early prescription of these types of stimulants to young children for ADHD that results in future cocaine, methamphetamine, and stimulant abuse which is the exact opposite of what weve been told. And so thats prompted a lot of pushback on drug companies and has us wondering, as we should, what are their practices? How do they promote these things? And Glaxo, I think, is the first company to say okay were no longer going to pay doctors to promote drugs. Were not going to have them offer testimonials or go out on the speaking circuit to say our drug is good or whatever because its not an unbiased opinion. But as you point out, they’re not stopping doctors from doing the research. Somebody has to do the research on it and it calls for more scrutiny, more control.
HOWARD: It should be independent and the same goes for the approval process wherein the drug companies themselves are in charge of the studies and the submissions that are submitted to the FDA. Thats kind of like the fox in the chicken house if you ask me!
DARRYL: The FDA has definitely a very expensive and very rigorous approval process – the problem is if you are honest and are just trying to do a very, very objective and non-biased study, you probably don’t have the money to get it through the FDA process. But the company that stopped doctors from promoting their drugs is also doing an interesting thing and Im interested to see how that works. A job being a drug salesman for any of these companies – boy, its a plush job. You get an expense account, you get all these goodies to hand out, you go to all these conventions, you have these wonderful display things and you’re always somebody’s friend. You go to doctors offices, you hold lunches and you bring in experts and you do all these things to promote your drugs and .back in the 60s, I knew some who were reprimanded if they didn’t spend their expense account if they didn’t spend so many thousands of dollars a week, the company didn’t think they were working very hard….. they weren’t doing what they were supposed to do. But the big issue was that they were given targets. The company wanted to see so many prescriptions being written in the sales person’s territory for the drug they’re supposed to be promoting if they don’t meet those targets – they’re fired or they’re replaced and they’re thought to be non-effective. Well, Glaxo-Smith-Kline.is going to scrap that. they say they re not going to hold these marketing targets up to their drug representatives as being so important to them. Im not sure if thats going to fly or Im not sure thats a truthful thing. Im sure they’re going to find some other ways to make sure that their products are being pushed to the forefront.
HOWARD: It seems like we could develop some kind of system where the pharmaceutical companies paid into a blind trust and that way there was no, or less direct connection between the doctors conducting the research and the pharmaceutical companies.
DARRYL: Boy, thats a brilliant idea. You know, I don’t know how it would fly in a capitalistic society and we believe in free enterprise and all that, but you know we tax everything else. Why don’t we tax pharmaceutical companies for the development of new drugs?
HOWARD: They seem to have a lot of money.
DARRYL: They spend 300, 400 million dollars to develop a drug like buprenorphine or Naltrexone and Vivitrol and all the other medications for addiction, but its because if it is approved and it is available they make billions every year so they make their investment and then some. Well, maybe it would be a good idea to say, okay, your’e making billions every year, we see what you’re paying your stockholders, put a certain percentage into a fund but thats the problem though say it goes into the government fund and the government decides to take the money and determine who gets it for research and what the research is conducted for – and even though a company put money in to the fund – the research may or may not be done on that company’s drug. That might rub some pharmaceutical companies the wrong way…make them wonder if they are paying for a competitors drug to be developed. But the other scary part of that is weve seen what the government does with these kinds of funds and Im not sure we can trust them to be objective.
HOWARD: Yes or they’ll take and do something else with it!
DARRYL: Exactly!
HOWARD: But not fix the potholes in the road!
DARRYL: Exactly …we have trouble funding our government, there is this deficit, and the budget balance has gone wrong and so there is the possibility that money would be reallocated towards the general fund to be spent on …. potholes or whatever …and nobody has any say in it. So, I have concerns on both ways.
HOWARD: Well, its worth thinking about. Clearly we need to take a look at the way were doing business now because it doesn’t seem like its quite right. Lets see what else was on my list.oh, there were some articles about e-cigarettes. The New York City council did in fact ban e-cigarettes in all public places where cigarette smoking is currently banned and the City of Chicago turned that down, but Mayor Emanuel says the issue is going to come up before the council again soon. Theres a new study reporting a direct link between all nicotine products and heart disease, which is something that I think has been known for quite awhile. It applies to e-cigarettes too, so there is definitely some health concern there.
DARRYL: Well it hearkens back to what we’ve been saying on this podcast, Howard. Either because of the legal and lobbying ability of the big tobacco companies, all the laws and all the controls are written about tobacco rather than nicotine. For years we were told by their experts that nicotine was non-addicting, non-toxic, it was not the issue at all – it was tobacco. So, the FDA doesn’t have restrictions on e-cigarettes because an e-cigarette is not considered a tobacco product, its nicotine. However, big tobacco companies are getting into it. I was at a conference recently and one topic was gambling, because its an addiction. The big casinos are now sponsoring virtual online casinos for people to go online and gamble, they don’t have to dress up, or drive anywhere. The addictive thing is gambling and the addictive thing with an e-cigarette is nicotine and because there are no controls, use will continue to spread. I’ve been on airplanes just this last month and there were people sitting a couple of seats in front of me.sitting there with their e-cigarettes and puffing them proudly into the air as if everything is ok because no studies have been done that show otherwise and there are no restrictions on use. I think a couple of other passengers asked them to put them out and they flipped them off. So, were looking at some desperate situations here. My concern, is that young people will abuse e-cigarettes like they do marijuana even though there are reports by scientists indicating that use by young people impacts specific areas in the brain. We know the brain is still in development during adolescence so early age of drug use – nicotine or marijuana.will have some very, very dangerous effects on addiction and on the development of the brain. Im hoping that somebody can take on big tobacco and lobby to finally control nicotine. I would imagine that big tobacco would be interested because the e-cigarettes were manufactured and introduced by China, and they are making a lot of money and now we see Phillip Morse and other companies developing their own brands of e-cigarettes with specific tastes and flavors. If they all team up and try to control this a little bit better they might just protect their corner of the market and not lose out.
HOWARD: …another ongoing story and we will be talking more about it but we are out of time for today – thanks everyone for listening and if you have comments, questions, or suggestions .stop by the website, cnsproductions.com. and leave us a note. Darryl….one more thing?
DARRYL: Yes. We didn’t mention this – its a weird year where all of our holidays are mid-week and so we didn’t talk yet about the holiday blues and I just want to again put it out there to people who are in recovery or families of recovering people, that this time of year is particularly hard
HOWARD: Its hard on everyone.
DARRYL: its hard on everyone but just imagine if you’re already stressed out, if you’re already kind of depressed and your life is kind of sad.it is much sadder to you. Its the winter solstice – the coldest time of year, its the darkest time of year and its the wettest time or the snowiest time and cultures deal with that by celebrating this time of year. in any country in the northern hemisphere, theres a major religious spiritual event this time of year to bring people out of that mood. To help lift everyone’s mood. And in every one of those societies, right in the midst of most every event , is a psychoactive addictive drug. People ..go to dinner or any social event at Christmas time, New Years . as soon as they open the door for you, it is …”Would you like a drink? Have some wine, eggnog, some hard cider”… or whatever and for somebody in recovery, thats a real challenge. So I put out to them to have a good safety plan in place…. a strategy to deal with those events when they happen. They’e got to make sure they’re among safe people. I know a lot of people in early recovery who are going to do 24 hour 12-step meeting marathons…all day long for about a week because they know if they leave that meeting and go anyplace else, even to a restaurant, somebody is going to offer them something to drink.the restaurant may offer them a free glass of wine because its a holiday! Merry Christmas and thats all it takes, they know, to ruin their lives again. So, its a time of year thats difficult for everybody. Its the holiday blues really. Sometimes we see a lot more suicidal gestures in this time of year, so I wanted to put that warning out there and ask people to take care of themselves and be very considerate to people who are in recovery, or people who are having a difficult time.
HOWARD: Very important, very good advice. It is that time of year so Happy Holidays and be safe, be clear. We will be back soon. Thanks.
DARRYL: Hey, Happy Holidays Howard.
HOWARD: That wraps our pod for today. Thanks for visiting the CNS Podcast. Please check back soon for the next in the series and visit our website, www.cnsproductions.com