Just How Addictive is Cannabis? 

I always remind people when they say that cannabis is addictive, that it lowers IQ, and makes you amotivational, that Carl Sagan, one of the most prolific scientists of our era, was a noted user. One of the most gifted singer/songwriters of our era, the late Amy Winehouse, was also a big fan of marijuana. Which of course doesn’t prove anything but it’s a good counterargument showing the same associations that our experts love to make. Aside from my humble opinion, there exists plenty of new and old data that trumps much of the caterwauling on addiction.

From the website [ref]http://clinicalcannabisincontext.tumblr.com/[/ref] of Ian Mitchell, MD, a noted expert in marijuana matters. He reminds us of some of the cannabis benefits he pulled from the enlightened Vancouver city council:

  1. As a substitute for more harmful drugs (e.g. alcohol, tobacco, prescription opiates and some illegal drugs such as heroin or cocaine)
  2. As a means to reduce the rates of opioid overdose deaths and opioid-related morbidity
  3. To relieve withdrawal symptoms during detox and to increase retention rates during treatment [Emphasis mine]

These are all excellent points that clinicians need to be aware of when discussing the addiction potential of cannabis. It is safer than heroin. It is far superior to anything else in helping to relieve opiate withdrawal symptoms. Therefore, trading a major addiction for a minor one is good, ethical medicine.

Even if pot is addicting, many authorities are not impressed. Research shows that most patients could kick a cannabis addiction as easily as a heavy coffee drinker going cold turkey. Well, actually it’s probably easier than quitting coffee.

Part of the problem within the literature is that many of our trusted experts know surprisingly little in regards to the true nature of pot. For example, we have experts that apparently don’t know the difference between CBD and THC. An article entitled Cannabis and the maturing brain: Role in psychosis development, by Crocker and Tibbo, (no, they’re not from Miami Vice) mentions the peril involved when treating epilepsy:

In cases such as epilepsy, where medical cannabis may be used in children, we do not yet know all the implications on adult outcomes, though we have discussed a potentially severe problem in this article.

The authors lose credibility here. These “experts” display an amazing lack of clinical knowledge on what components of cannabis are used in treating epilepsy. Again Dr Mitchell:

While there are cases of children being treated for epilepsy with cannabis, the active ingredient that is sought after and used is an isolated extract of [marijuana called] cannabidiol, a non-psychoactive cannabinoid that has shown great promise. Cannabidiol has not been linked to psychosis and has actually shown anti-psychotic properties. The authors have no basis for suggesting that cannabidiol can lead to schizophrenia. Another aspect of treating adolescents has to do with the concept of risk vs benefit. Rather than focusing entirely on risk, clinicians have to weigh risk compared to benefit.

If the same experts can be this misinformed regarding THC and CBD, why should we trust their opinion regarding addiction?

RISK VERSUS BENEFITS

An important concept was introduced above. It’s called risk versus benefit ratio. An astonishing lack of honesty is often employed when clinicians comment on marijuana use in treating diseases. For example, in treating seizure disorders many of the drugs used carry moderate to severe risks of harms which are titanic compared to marijuana’s side effects. I mentioned one such disfiguring risk previously in another publication: gingival hyperplasia from the use of phenytoin.

But that doesn’t stop one from prescribing it. It should be the same for marijuana. If it is addicting you still need weigh its beneficial role FIRST for the patient, then decide if habit forming is worse than the disease. Under these circumstances, cannabis usually prevails.

As America and the rest of the free world mobilize to completely legalize cannabis for medical and recreational use, the notion of addiction storms to the forefront.

Like a thunderhead looming in the distance, detractors will insist that marijuana is highly addictive and urge caution by not legalizing it. Others feel that cannabis, if it is addicting, is very mild, and probably better or at least no worse than food addictions, sex addictions, gambling or a 2 pot-a-day coffee habit.

In a Time magazine publication in 2010 the issues of addiction were raised in Is Marijuana Addictive? It Depends How You Define Addiction. By Maia Szalavitz.

By the book [DSM IV], addiction is the compulsive use of a substance despite ongoing negative consequences, which may lead to tolerance or withdrawal symptoms when the substance is stopped. By this definition, about 10% of people who smoke marijuana become addicted to it.

One of the unique aspects of cannabis addiction is that there are virtually no physical side effects from withdrawal, that it’s a psychological addiction, a craving for the high without many systemic manifestations. It’s quite unlike heroin withdrawal, the classic addiction, which can generate unbearable physical anguish. That’s indeed true but modern medicine no longer separates psychological from physical addiction (DSM V see below).

How addicting is it? Maia Szalavitz:

So the question is, how does marijuana compare to these classically addictive drugs? Estimates vary, but compared with tobacco, which hooks about 20% to 30% of smokers, marijuana is much less addictive, coming in at 9% to 10%. In contrast, 23% to 25% of heroin users get addicted, along with 15% of alcohol users and 15% to 20% of those who use cocaine.

Marijuana is the most heavily used drug in the country — by their 20s, 56% of Americans have tried it — but only 16% of people who are in addiction treatment report that marijuana is their primary drug. In contrast, just 2% of young adults have ever tried heroin, but heroin addicts make up 14% of treatment admissions.

The experts agree that cannabis is addicting in some ways. But is that necessarily bad?

Dr Carl Hart was interviewed for the above feature. He’s an associate professor of clinical neuroscience at Columbia University, who has studied marijuana withdrawal. His take on it:

You can actually die from alcohol withdrawal. Heroin withdrawal you can’t really die from; it’s more like the flu. Marijuana withdrawal is annoying, but it isn’t life threatening.

You might see anxiety, mood disturbances, irritability and a decrease in food intake in addition to other effects like insomnia. But they are clearly much milder than even tobacco withdrawal.

Furthermore, since marijuana has active metabolites that reside in the fatty compartment of your body they tend to leech out slowly over several weeks. This provides a smoothing out of any potential withdrawal effects.

Dr Peele makes a very important point regarding cannabis addiction. Even if it is addicting it makes little difference since its side effects are scant. According to Stanton Peele, author of the classic book Love and Addiction,[ref](http://healthland.time.com/2010/10/19/is-marijuana-addictive-it-depends-how-you-define-addiction/) 07/15/2015[/ref] he remarks:

Marijuana is addictive — so what? How harmful is this addiction compared to other addictions? It can be disruptive to people’s lives; I have a treatment center, and some people end up there because of marijuana. On the other hand, in terms of physical assaults to your body, it’s better than smoking and better than alcohol.

Perhaps it compares favorably to coffee addiction. Heavy coffee drinkers suffer intractable headaches and a craving for a steaming cup that rivals a lion’s bloodlust. But that’s about it.

The article finishes making the point that with the new DSM V manual many unconventional addictions are now listed including gambling, sex, food and shopping. So even these habits are considered addictive now along with cannabis.