Cannabis Discourse Facts and Opinions in Context

Home , Boiling Points, Cannabis ruderalis, NORML New Zealand, Outline of cannabis, Reefer Madness, Spots (cannabis)

Jacob Levine

First published 2018

All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the author.

Note: This book is written for educational purposes only. It is illegal to grow, possess, transport, and consume cannabis in most countries; these activities may result in arrest and criminal conviction. This book does not encourage or promote any illegal activities in any form.

To purchase the paperback or Kindle version from Amazon, click here: https://amzn.to/2L0FUGd

Contact [email protected]

LinkedIn: Jacob Levine https://www.linkedin.com/in/jacob-levine-cannabis/

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Much love to family and friends

Contents INTRODUCTION ------7 TERMS TO UNDERSTAND------10 CANNABIS ANATOMY ------17

PART 1 ------19

WHAT IS CANNABIS? ------19

1 HOW CANNABIS GROWS ------20 SEEDS ------20

VEGETATION STAGE ------21 FLOWERING STAGE ------21 CURING STAGE ------22 FINAL PRODUCT------22

CONCLUSION ------23 2 CANNABIS PRODUCTS ------24 INTRODUCTION ------24 BUDS ------24 CONCENTRATES ------24 SOLVENT AND SOLVENTLESS CONCENTRATES ------24 EDIBLES ------28 CONCLUSION ------29 3 ADMINISTRATION OF CANNABIS ------30

SMOKING ------30

VAPORIZING ------30 INGESTION ------31 SUBLINGUAL ------31 TOPICALS ------31 CONCLUSION ------32 4 USES OF CANNABIS ------33 INTRODUCTION ------33 SPIRITUAL USE ------33 MEDICAL USE ------33 RECREATIONAL USE ------34

PART 2 ------35

A BRIEF HISTORY ------35

5 HISTORY OF MARIJUANA PROHIBITION ------36 INTRODUCTION ------36 1839 – W.B. O’SHAUGHNESSY ------36 1893–1894 – INDIAN HEMP DRUGS COMMISSION ------38 1914 – HARRISON NARCOTICS TAX ACT------39 HARRY JACOB ANSLINGER ------41 RACISM ------43 1937 – MARIHUANA TAX ACT 1937 ------45 1944 – THE LA GUARDIA COMMITTEE ------48 1951–1956 – BOGGS ACT AND NARCOTICS CONTROL ACT49 1961 – SINGLE CONVENTION ON NARCOTIC DRUGS ------49 CONCLUSION ------49

PART 3 ------51

HOW TO READ BETWEEN THE LINES ------51

6 HOW TO READ BETWEEN THE LINES ------52 INTRODUCTION ------52

Jacob Levine

CONFIRMATION BIAS ------52 HEADLINES ------52 TREATMENT OR CURE? ------53 AGENDA ------54 SCIENTIFIC RESEARCH ------54 SIMPLISTIC CONNECTIONS ------57 AMBIGUOUS TERMS ------57 DISCLAIMERS ------58 COUNTER STATEMENTS ------58 HOW MUCH WEED ARE WE TALKING ABOUT? ------59

CORRELATION VS. CAUSALITY ------60 STATISTICS ------61 CONCLUSION ------61

PART 4 ------63

CANNABIS DISCOURSE ------63

7 THE GATEWAY DRUG THEORY ------64 THE INTRODUCTION ARGUMENT ------64 THE GATEWAY DRUG THEORY ------65 CONCLUSION ------78 8 CANNABIS ADDICTION ------80 INTRODUCTION ------80 BACKGROUND AND CANNABIS USE DISORDER ------80 DEFINITION OF ADDICTION ------81 CONFUSION REGARDING THE TERM “DEPENDENCE” ------81

CANNABIS WITHDRAWAL ------82 GAMBLING, A SUBSTANCE USE DISORDER? ------82 PRO AND ANTI ARGUMENTS ------83 CONCLUSION ------86

9 ADOLESCENT CANNABIS USE ------87

INTRODUCTION ------87 STUDIES ------87 LEGALIZATION OF CANNABIS AND ADOLESCENTS------88 DRUG PREVENTION ------91 CHILDREN ------94 10 MEDICAL MARIJUANA ------96 WHAT IS MEDICAL MARIJUANA? ------96 HISTORY OF MEDICAL MARIJUANA ------96 WHY IS MEDICAL MARIJUANA SUCH A BIG DEAL? ------97 ILLEGALITY OF MARIJUANA HINDERS RESEARCH ------98

MEDICAL USES ------100 CONCLUSION ------112 11 CANNABIS LEGALIZATION ------114 DRUG CLASSIFICATION SYSTEMS ------114

FROM SEED TO CONSUMPTION ------114 MINORITY INCARCERATION ------117 THE FINANCIAL ASPECT ------118 LEGALIZE POT, THEN HARDER DRUGS BECOME LEGAL --- 120

MARIJUANA USE AND CRIME------121 CONCLUSION OF THE BOOK ------123 RESOURCES ------124

INTRODUCTION

We are entering an era when the legalization of marijuana is gaining ground, with the US leading the way. Today, artists are smoking weed in music videos, politicians are advocating for legalization, we’re celebrating 4/20, scientists are studying cannabis, fields of marijuana are being harvested, fields are being destroyed, criminal organizations are growing tons of weed, cannabis dispensaries are cropping up, cannabis university programs are being established, potheads are rising to the surface, the legal marijuana economy is growing fast, weed plants are more potent than ever, thousands of cannabis strains have been hybridized, cannabis competitions and fairs are on the rise,

Jacob Levine edibles are coming in all shapes and sizes, marijuana is taking the world by storm. As a writer for cannabis websites, I’ve had an opportunity to observe and involve myself in discussions surrounding the plant’s anatomy, growth characteristics, effects, history, legalization, politics, and culture. I define the cannabis discourse as all of the discussions, beliefs, arguments, and actual occurrences surrounding cannabis. I’ve come to the conclusion that discussions surrounding cannabis are focused on a number of specific topics such as, in no particular order: physiological effects of cannabis, the gateway drug theory, medical marijuana, the link between cannabis and schizophrenia, cannabis addiction, and the legalization of marijuana. I’ve also come to the conclusion that our understanding of cannabis’s physiological and societal effects is extremely limited, and this extremely superficial understanding is often directly expressed and mediated by entities that refuse to involve any further critical thought. Some believe that cannabis is the ultimate remedy for any ailment, while others believe it’s poison. In this book, I aim to present the main points made by each side in the current discourse, as well as the logic and history of the arguments. I can muster arguments that will convince you of virtually anything I wish in regards to the effects of cannabis. I could do this by selectively picking literature sources which support either point I would wish to make. I can quote Harvard-educated doctors and provide government statistics to convince you that cannabis consumption is extremely dangerous. I can also use equally credible sources to convince you that cannabis is the best and safest substance on the face of the earth. I could sprinkle these statistics and sources with manipulation techniques that will mediate my message as the ultimate truth, which those on either side of the debate have done countless times. Even when scientific discoveries are presented “objectively,” they may not be presented objectively. One can present the same statistic in a variety of different ways; for example: “The increase of marijuana overdoses doubled over the last year, according to ER visit statistics” or “from all ER visits, those for marijuana overdoses increased from 0.00001% to 0.00002%.” The frame in which facts are presented determines the weight we attach to them. Scientific discoveries and statistics are tools, which are used by us imperfect biased humans, for better or worse. Even though facts can be presented objectively, there are many ways of contextualizing and presenting these facts, which can be extremely biased. During my career in writing about cannabis, I have learned that pro- and anti-marijuana advocates claim an objective stance when they’re clearly biased and pursue a certain agenda. Some quote advanced cancer research to

Cannabis Discourse convince people of the miracle properties of cannabis, but the underlying agenda might be: “I want weed to be legal, because I want to get baked without legal repercussions.” The same goes for anti-marijuana advocates, who hand- pick all the relevant research statistics to convince the audience that marijuana should remain illegal. However, their underlying agenda may be: “I grew up in a culture where marijuana use was completely unacceptable, and I’m uncomfortable with people thinking that smoking marijuana is cool and acceptable.” As humans, we tend to cover our biases and agendas with an objective facade to get what we want. Initially, my purpose in writing this book was to promote the amazing properties of cannabis and argue why we should legalize its use. However, after doing thorough research, I uncovered certain inconsistencies in my arguments and learned that everything about cannabis legalization isn’t as straightforward as I initially perceived. In today’s politically polarized world, where ideas surrounding cannabis are charged with intense emotions, it’s easy to lose track of rational thinking. So, instead of persevering with my original idea which consisted of writing a book-long version of the chant “legalize pot!” I decided to present arguments from all sides of the spectrum to generate a rational discussion. If you’re looking for a book that rants: “Legalize pot!” you're reading the wrong book. If you're looking for a book that rants: “Drug prohibition is great!” you’re reading the wrong book. If you want to find out about the discussion itself, then you can get comfortable, and read on. My aim is to encourage a rational and logical approach to formulating future drug policies by providing an entire spectrum of today’s views surrounding marijuana. It is beyond my knowledge to suggest how exactly our drug policies should change. On a deeper level, my aim is to encourage rational thinking in a world where extremely polarized and reactionary views are clouding our judgment. Therefore, my intent is to make you think, rather than convince you of my own personal opinions. The sources used to gather information for this book comprise hundreds of articles and blogs, as well as debates, books, short videos, and news. Today, the US is the epicenter of the cannabis discourse, which people from all around the world interested in cannabis topics are following (except perhaps, in North Korea). The focus of the book will stay mostly on the US, because today, the US has the liveliest discussions about cannabis due to the recent legalization of medical and recreational use in several states, and because the country greatly affects the world’s perception of cannabis. Also, from a historical perspective, today’s marijuana discourse is deeply rooted in the US’s marijuana prohibition dating to the 1930s.

Jacob Levine

To clarify the terminology from the beginning, cannabis goes by many names, the most popular ones being, marijuana, pot, weed, ganja, Mary Jane, and herb. I will mostly use the term “cannabis” because it’s the official name of the plant, as in “Cannabis sativa” or “Cannabis indica,” and is the name commonly used by the legal cannabis industry in the US. It’s important to note, that the theme of this book mainly covers the psychoactive cannabis plant and products derived from it. Cannabis plants that are not psychoactive will be generally referred to as “hemp.” Different terms for cannabis will be used throughout this book, to better suit the context. In the discussions of the history of prohibition and of the popular understanding of the drug during the mid- twentieth century, for example, I use the name “marijuana,” to suit that discursive context. Here’s a quick overview of this book. First, I will succinctly describe frequently used terms to aid the understanding of the cannabis discourse and the terminology used throughout the book. To understand what cannabis actually is, I will outline its growth patterns and products such as concentrates and edibles. The next chapter goes through the history of marijuana prohibition which helps to explain the origins and fundamentals of today’s cannabis discourse. Afterward, I include a chapter specifically dedicated to help you read between the lines and think critically about how claims are made about cannabis. After this chapter, we’ll jump right into the discourse. The main discussions, beliefs, and arguments will be presented. At the end, I provide a few websites and organizations you can follow in order to keep up to date. There’s much more to the cannabis discourse, but for the sake of brevity, here’s the big picture of what’s going on. That’s it, let’s jump right in!

Terms to Understand To have a greater understanding of the content in this book and the discourse around cannabis in general, this chapter should not be skipped. It's important to understand and be able to explain the following terms, because many misunderstandings and misconceptions stem from not knowing the basics. This chapter is organized so that everything makes sense along the way; therefore, it should be read from beginning to end. All of the definitions of these terms are greatly simplified, although the general explanation will do for the purpose of this book. Pro-marijuana and Anti-marijuana In this book, the terms such as “pro-marijuana” or “anti-marijuana” strictly refer to being for or against legalization or decriminalization of marijuana. Terms such as pro-advocates, or the anti-movement, refer to the same concept.

Cannabis Discourse

Endocannabinoid System (ECS) The endocannabinoid system (ECS) comprises cannabinoid receptors, which are located throughout our body. There are two main cannabinoid receptors, CB1 receptors, which are mostly located in the central nervous system (CNS) and the brain, and CB2 receptors, located throughout the body. The functions of these receptors are “unlocked” after interacting with endocannabinoids1 and/or phytocannabinoids.2 These functions regulate our sleep, pain, motor functions, memory, immune system, pleasure and reward centers, digestion, appetite, reproduction, fertility, and more. Our body naturally produces endocannabinoids such as “anandamide.” Phytocannabinoids, found in cannabis, mimic the structure of endocannabinoids such as anandamide, and therefore can unlock the function of cannabinoid receptors.3 Cannabinoids Phytocannabinoids, colloquially referred to as “cannabinoids”, are chemical compounds present in cannabis. The most prevalent cannabinoid found in most cannabis strains is THC (tetrahydrocannabinol). The second most prominent cannabinoid is CBD (cannabidiol). It’s generally understood that more than 85 cannabinoids4 have been identified in cannabis plants including CBN, THCV, CBDV, and CBG; however, the number often fluctuates depending on the source. Scientists have barely scratched the surface of finding all the interactions between cannabinoids and our body. It’s important to note that all cannabis strains differ in their chemical profile; some may comprise 23% THC and 0.3% CBD, while other may comprise 15% CBD and 2% THC. All strains contain different levels of cannabinoids because they have different chemical profiles. It’s important to note that not everybody is affected identically when in contact with the same cannabinoids. Let’s go into the most prevalent cannabinoids, which are the most prominently discussed: THC and CBD.

1 “Endo” translates into “within”; endocannabinoids are cannabinoids naturally occurring within the body. 2 “Phyto” translates into “plant”; phytocannabinoids are cannabinoids deriving from plants, such as cannabis. 3 Anna Wilcox, “The Endocannabinoid System for Dummies (We’ve Made It Easy for You),” Herb, 28 Jul. 2016, http://herb.co/2016/07/28/endocannabinoid-system-dummies/. Accessed 12 Jun. 2017. 4 Bailey Rahn, “Cannabinoids 101: What Makes Cannabis Medicine?” Leafly, 22 Jan. 2014, https://www.leafly.com/news/cannabis-101/cannabinoids-101-what-makes-cannabis-medicine. Accessed 28 Mar. 2018.

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THC Tetrahydrocannabinol, abbreviated THC, is the main psychoactive cannabinoid and is the main chemical responsible for the “high.” When THC molecules enter the body, they bind to CB1 receptors.5 Today it’s generally understood that out of the many effects reported from this binding, these are some of the main ones: psychoactive effects, spiritual experiences, increased appetite, decrease in nausea, pain alleviation, alleviation of asthma symptoms, alleviation of glaucoma symptoms, and decreased insomnia.6 There’s a general understanding that THC can generate feelings of anxiety and paranoia if taken in too large doses.7 CBD According to “Project CBD,” cannabidiol, or CBD, works together with CB1 and CB2 receptors and can manifest other functions in the body.8 Unlike THC, CBD is a non-psychoactive cannabinoid, hence it doesn’t get the consumer “high.” It is generally understood by scientists that CBD can decrease the negative feelings experienced from consuming elevated amounts of THC.9 Many studies have been conducted on the medicinal efficacy of CBD that, according to “Project CBD,” show promising possibilities for medical conditions such as, anxiety, depression, cancer, OCD, Alzheimer’s disease, inflammation, nausea, stress, MS, diabetes, obesity, asthma, the list is long.10 Terpenes Cannabis contains other chemical compounds, among which are terpenes. Terpenes provide fruits, vegetables, and other plants with their unique flavors and aromas. Many claim that terpenes influence the high experienced from consuming cannabis. The most common terpenes found in cannabis are Alpha-Pinene, Beta-Pinene, Limonene, Myrcene, Caryophyllene, Linalool,

5 “Cannabinoid receptor type 1 (IPR000810),” InterPro, http://www.ebi.ac.uk/interpro/entry/IPR000810. Accessed 13 Jun. 2017. 6 “What Are the Medical Benefits of Marijuana?” Leaf Science, 13 Oct. 2017, http://www.leafscience.com/2014/07/22/7-proven-medical-benefits-thc/. Accessed 12 Jun. 2017. 7 Bailey Rahn, “Why Does Cannabis Cause Paranoia in Some but Helps Anxiety in Others?” Leafly, 30 Oct. 2015, https://www.leafly.com/news/cannabis-101/why-does-cannabis-cause- paranoia-and-anxiety. Accessed 12 Jun. 2017. 8 “How CBD Works,” Project CBD, https://www.projectcbd.org/science/cannabis- pharmacology/how-cbd-works. Accessed 28 Mar. 2018. 9 Ibid. 10 “Conditions,” Project CBD, https://www.projectcbd.org/guidance/conditions. Accessed 28 Mar. 2018.

Cannabis Discourse

Borneol, and Eucalyptol. Many marijuana and health blogs state that these terpenes have shown great medicinal potential for humans.11 Decarboxylation Cannabis in its raw form comprises THCA (tetrahydrocannabinolic acid), which is THC with a carboxylic acid attached to it. THCA is a non-psychoactive compound, while THC is psychoactive. When heat is applied, the carboxylic acid detaches from THCA, leaving the psychoactive THC, in a process called decarboxylation, which can also be referred to as “activating.” Or, over time, the herb naturally decarboxylates, leaving the THC molecule.12 CBD also goes through the decarboxylation process, because it originates as CBDA (cannabidiolic acid). Cannabis Species So far, three species of cannabis have been identified, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Consider these species as archetypes, because in reality they generally don’t exist in their “pure form,” unless they’re “landrace strains” untouched by cannabis genetics from other regions. These landrace strains have coevolved with humans over thousands of years of cultivation. Species should not be confused with strains, which refer to thousands of different hybrids resulting from the hybridization of various cannabis plants. Let’s look into what these species are all about. Cannabis Sativa This species of cannabis was first classified by Carl Linnaeus in 1753,13 although the records of its use date back thousands of years.14 It’s rare to find unanimous agreement as to the earliest records of Cannabis sativa use; the dates range anywhere between 1000 to 10,000 BCE. According to the documentary “The Magic Weed – History of Marijuana,”15 the ancient Chinese

11 Bailey Rahn, “What Are Cannabis Terpenes and What Do They Do?” Leafly, 12 Feb. 2014. https://www.leafly.com/news/cannabis-101/terpenes-the-flavors-of-cannabis-aromatherapy. Accessed 16 Jun. 2017. 12 Patrick Bennett, “What Is Decarboxylation, and Why Does Your Cannabis Need It?” Leafly, 30 Apr. 2016, https://www.leafly.com/news/cannabis-101/what-is-decarboxylation. Accessed 28 Mar. 2018. 13 Geoff Watts, “Science commentary: Cannabis confusions,” BMJ 2006, 332. doi: https://doi.org/10.1136/bmj.332.7534.175. Accessed 17 Oct. 2017.

14 Xiaozhai Lu and Robert C. Clarke, “The Cultivation and Use of Hemp (Cannabis sativa L.) in Ancient China,” DrugLibrary.Org, http://www.druglibrary.org/olsen/hemp/iha/iha02111.html. Accessed 13 Jun. 2017. 15 “The Magic Weed – History of Marijuana,” YouTube, 14 May. 2015, https://www.youtube.com/watch?v=XF19DvTkHc8. Accessed 13 Jun. 2017.

Jacob Levine used Cannabis sativa for food, to develop paper, clothes, fishing nets, and textiles, among approximately 5,000 different products. This species thrives in tropical climates like Cambodia, Thailand, Congo, and Colombia. Cannabis sativa plants reach approximately 150–400 cm in height. The entire plant is very resilient to tropical climates because of its narrow leaf fingers, fluffy buds, and stretched out internodal areas, which allow the plant to respire with ease, a great asset in climates with intense heat and humidity levels. Some of the most prominent sativa-dominant strains on the market are Jack Herer, Durban, Super Silver Haze, Amnesia Haze, Chocolope, Maui Waui, Sour Diesel, Tangie, and Amnesia. Difference Between Sativa and Hemp It’s important to make a distinction between “sativa” and “hemp,” at least as these terms are commonly used today. Whenever someone uses the term “sativa,” they’re referring to a sativa-dominant cannabis strain, which produces psychoactive effects. “Hemp” on the other hand, is used today16 to describe the non-psychoactive cannabis plants that are mainly used for industrial purposes and as a food source. “Hemp” and “sativa” both derive from the same species, Cannabis sativa. The “sativa” contains substantial amounts of THC, making it by law in many countries a “psychotropic drug” or an “illegal substance” (according to EU laws, if the THC levels of the plants stay below 0.2%, they’re allowed as long as they’re grown for fiber).17 On the other hand, “hemp” lacks the psychotropic amounts of THC (generally having less than 0.2% THC), due to different breeding selections throughout the years. Hemp is used for industrial use such as textiles, but recently hemp is being cultivated for CBD extractions, which are used medicinally,18 while the sativa strains are also used for medicinal purposes, as well as psychotropic use. The highs experienced from sativa strains are generally considered as energizing, uplifting, happy, focused, confidence boosting, social, euphoric, and spiritual.

16 The term “hemp” was used to describe the psychoactive plant decades and centuries ago. An example can be found in literature spanning back to the 1893–1894 Indian Hemp Drugs Commission Report. 17 “Cannabis Legislation in Europe: An overview,” European Monitoring Centre for Drugs and Drug Addiction, http://www.emcdda.europa.eu/system/files/publications/4135/TD0217210ENN.pdf/. Accessed 28 Mar. 2018. 18 Lane Tr, “What's the Difference Between Hemp and Cannabis,” Herb, 27 Nov. 2015, http://herb.co/2015/11/27/whats-the-difference-between-hemp-and-cannabis/. Accessed 13 Jun. 2017.

Cannabis Discourse

Cannabis Indica In 1785, Jean-Baptiste Lamarck made a distinction between the Cannabis sativa present at the time, and strains from India, which he classified as Cannabis indica.19 There’s a general consensus that the growth patterns and characteristics of Cannabis indica differ significantly from those of Cannabis sativa. Just like the term “sativa,” the term “indica” is used to describe psychoactive Cannabis indica plants, which derive from mountainous areas of Hindu Kush, around Pakistan, Afghanistan, and Northern India. These plants adapted to harsh environments. The growth of Cannabis indica is more protective by nature. The buds are dense, the leaf fingers are relatively wide, the flowering cycle is shorter than that of Cannabis sativa, and the plants reach shorter heights. There’s a general consensus that indica strains induce more physically stoned and sedating effects. Some of the most prominent indica- dominant strains are OG Kush, Purple Kush, Master Kush, Afghan Kush, Black Domina, Blueberry, and Northern Lights. Cannabis Ruderalis This species of cannabis is quite unique. In 1924, D.E. Janischevisky coined it Cannabis ruderalis.20 This variety is native to Northern Asia, Northern/Central Europe, and Russia.21 Cannabis ruderalis adapted to cold climates by having a short flowering cycle, which allows it to drop seeds before the frost kicks in, which can be as early as beginning of September in northern climates. The leaves of Cannabis ruderalis are differently shaped than those of indica and sativa, with the middle three leaf fingers being wide while the two on the sides are miniscule. Cannabis ruderalis plants reach around 50–100 cm in stature and contain very little THC, while the CBD levels can often be more pronounced.22 Cannabis ruderalis is the key ingredient of autoflowering strains. Autoflowering Strains Cannabis ruderalis plants adapted to the short summers by developing autoflowering characteristics, meaning that they don't require diminished light

19 Geoff Watts, “Science commentary: Cannabis confusions” BMJ 2006, 332. doi: https://doi.org/10.1136/bmj.332.7534.175. Accessed 13 Jun. 2017. 20 Agata Blaszczak-Boxe, “Marijuana's History: How One Plant Spread Through the World,” Live Science, 17 Oct. 2014, https://www.livescience.com/48337-marijuana-history-how-cannabis- travelled-world.html. Accessed 13 Jun. 2017. 21 Will Hyde, “What Is Cannabis Ruderalis?” Leafly, 4 Jun. 2015, https://www.leafly.com/news/cannabis-101/what-is-cannabis-ruderalis. Accessed 28 Mar. 2018. 22 “Cannabis Ruderalis: The Rugged Weed,” Royal Queen Seeds, 24 Nov. 2016, https://www.royalqueenseeds.com/blog-cannabis-ruderalis-the-rugged-weed-n380. Accessed 13 Jun. 2017.

Jacob Levine hours to kickstart the flowering process. In other words, they are not photoperiod plants, or photoperiod dependent like Cannabis sativa and Cannabis indica, which flower only when exposed to diminished hours of light, which naturally occurs during the fall season. Breeders were experimenting in the 1970s by hybridizing ruderalis plants with indica and sativa varieties.23 The purpose was to create unique strains by mixing autoflowering characteristics with significant amounts of THC of photoperiod plants, which Cannabis ruderalis plants don’t naturally contain. The autoflowering characteristics are quite unstable when hybridized with photoperiod plants, however, so the desired results were quite difficult to obtain. But once they were, the first autoflowering strains came to light and were coined as Lowryder.24 Autoflowering strains are quite short and finish their lifecycle in around 60 days, from seed to harvest. The THC levels are generally lower than their photoperiod counterparts, although today's autoflowering strains can contain very high THC levels, in comparison with the ones developed in the 1970s. Strains with the word “Auto,” “Automatic,” or “Autoflowering” will have the autoflowering characteristics.

23 “History of Autoflowering Seeds,” Dinafem Seeds, 25 Jan. 2012, https://www.dinafem.org/en/blog/history-of-autoflowering-seeds/. Accessed 21 Mar. 2018. 24 Ibid.

Cannabis Discourse

Cannabis Anatomy

Artist: Yodidit

Jacob Levine

Male calyx - Cannabis plants are either male or female. Male plants develop male calyxes, also referred to as “pollen sacks,” which contain pollen that fertilizes the female flowers. Pistil - A part of the female plant that catches the pollen from the male flowers and transports it to the female calyx. Calyx - The flower of the female plant where the seeds develop. Trichomes - The plants produce trichomes as a part of their defense mechanism against insects and rough climates. Trichomes contain a significant amount of cannabinoids and terpenes. Bud - The bud is simply a bundle of calyxes, pistils, trichomes, and some leaves. Node - The nodal areas are where the buds develop and where new branches grow. Fan leaves - These are big leaves that capture a lot of energy from the light.

Cannabis Discourse

Part 1

What Is Cannabis?

Jacob Levine

1 HOW CANNABIS GROWS

Understanding the basics of cannabis growth will uncover the plant we’re dealing with. The physiological effects of cannabis greatly depend on how, where, and when it grows, as well as how the plants are treated during their lifespan. The growth patterns of cannabis also determine certain regulatory and legal aspects, which will be briefly mentioned in the conclusion of this chapter. Even though cannabis grows relatively easily in nature, growers who wish to develop high-grade cannabis are dealing with a complex science with hundreds of factors to consider. Cannabis can be grown in various grow mediums; the plants can be grown outdoors, indoors, and in greenhouses; autoflowering and photoperiod plants will receive different treatment. The buds can be cured, or directly turned into concentrates; indica, sativa, and autoflowering varieties grow differently; there are layers upon layers in the science of growing cannabis. This chapter goes through the plants’ life cycle, from beginning to end.25

Seeds The growth begins with a tiny seed. Cannabis seeds can be purchased online from seedbanks, which specialize in breeding psychotropic strains. Some of the most popular seedbanks are Barney’s Farm, Sensi Seeds, Green House Seed Company, Dutch Passion, and Dinafem. Since Dutch seedbanks have been breeding, selecting, and improving cannabis genetics for decades now, they’re considered ahead of the game. These seeds are stored in cold and dry environments before they’re germinated. It’s virtually impossible to distinguish between strains based on the seed’s appearance. Germination Germination is not necessary, but the majority of growers prefer to go through this process. Germination refers to exposing the seed to a moist environment until it sprouts, after which it is planted in a grow medium. The germination allows the grower to separate sterile and healthy seeds from each other, because if they’re all planted directly in the grow medium, some seeds will not sprout, which leads to logistical problems. All plants should be growing at the same time, because of their unique requirements depending on the stage they’re in. There are many creative ways of germinating cannabis seeds, which usually involve a wet kitchen towel and a dark space. When the seeds have

25 These websites have a lot of information about the growth of cannabis: http://www.growweedeasy.com/, http://www.ilovegrowingmarijuana.com/, https://howtogrowmarijuana.com/. Accessed 25 Oct. 2017.

Cannabis Discourse popped, after around three to five days, they can be planted in the grow medium of choice. Seedlings About seven days after the seeds have been planted, the tiny green seedlings will rise to the surface. These tiny seedlings require a lot of moisture and humidity, and therefore the soil is kept very moist during at least these consecutive two weeks.

Vegetation Stage The vegetation stage is defined by the period between the surfacing of the seedlings and the beginning of the flowering stage. During the vegetation stage, indoor growers usually set the light schedule on 18 hours of light and 6 hours of darkness. The 18 hours of light ensure that the cannabis plants are on a spring/summer-time cycle, which prevents the plants from flowering too early. Outdoor growers simply plant the seeds in the beginning of spring/summer. The autoflowering varieties are more flexible regarding light schedules, because they flower independently of the changes in the light cycle. It’s generally understood that the ultimate temperature for cannabis plants during the vegetation stage should hover around 25°C with 50% relative humidity (RH). While watering the plants, the water temperature should be around 20°C; the roots appreciate cooler temperatures and an abundance of oxygen. The water needs to be pH regulated, because the pH determines which nutrients the roots will absorb. There’s a great difference in how strains grow during the vegetation stage based on their genetics. As a rule of thumb, autoflowering varieties grow relatively short in size, indicas become slightly taller, while sativas can reach very tall heights. There are many techniques to contain the heights such as topping, low-stress-training (LST), and Screen of Green (ScrOG) which involves training the plants by tying them to a grid, so that they remain short, and all buds are at an optimal distance from the grow lights. During the vegetation stage, the plants should receive a significant amount of nitrogen to keep the leaves green, which helps them with the photosynthesis process. Once the vegetation stage comes to an end, the flowering stage begins.

Flowering Stage Indoor growers initiate the flowering stage by switching to a 12h/12h light cycle, which imitates autumn’s light duration. Outdoor growers time the sowing of the seeds based on seasonal changes, so the desired initiation of the flowering stage falls perfectly with the diminished light hours. The temperatures should be slightly lower during the flowering stage, and should not surpass 26°C, or

Jacob Levine the terpenes will begin to disappear. The feeding should gradually include more phosphorus and potassium. During the maturation of the buds, the trichomes, filled with THC, terpenes, and other compounds,26 begin to change color from translucent, to milky, to amber. Once the trichomes become milky, the buds are ready for harvest. Many articles mention that the effects experienced from the buds depend on the stage of the trichomes when they were harvested. There is a general understanding that when the trichomes are half clear and half cloudy, the highs will be more energetic/uplifting, and if the trichomes are almost all milky with a couple turning amber, the highs will be more sedating and narcotic. One to two weeks before the plants are harvested, they should be “flushed,” meaning that the nutrients are flushed from the grow medium with water and sometimes together with special chemicals, which improves the quality of the final product. At this point, the plants are harvested, and the curing stage begins.

Curing Stage The curing process is necessary to transform the buds into smoking/vaping material. This process reduces the buds’ water content from approximately 75% to 10–15%.27 The harvested buds are stripped from their fan leaves and placed in a curing area. The perfect curing setting includes temperature, humidity, light, and air circulation control. The curing process lasts anywhere between two weeks and two months, depending on the grower's preference. Once the buds have been cured, they’re ready for consumption. The curing stage could be skipped when making cannabutter, cannaoil, and various concentrates.

Final Product Whenever discussing the effects of cannabis, it is important to understand that quality matters. Buds which haven’t been cured properly can develop mold, which can cause undesired effects after consumption. Insects and various pesky undesirables can be present in “street weed,” which can cause problems on their own. It’s generally understood among growers that if the plants are not flushed during the last stages of flowering, the added nutrients can cause headaches and paranoia. Depending on the stage of the trichomes, the highs may differ. Terpenes, which can change the experience of the high, might

26 Bubbleman and Jeremiah Vandermeer, “Inside the Trichome,” Cannabis Culture, 12 Jun. 2009, http://www.cannabisculture.com/content/2009/06/12/inside-trichome. Accessed 18 Jun. 2017. 27 “Drying and Curing of Fresh Cannabis Buds,” Dinafem, 18 Jan. 2012, https://www.dinafem.org/en/blog/drying-and-curing-of-fresh-cannabis-buds/. Accessed 18 Jun. 2017.

Cannabis Discourse disappear during the flowering stage if the buds are exposed to elevated temperatures. If there is insufficient air circulation in the grow room, powdery mildew and mold can disease the buds. If the male plants aren’t separated from the females, the potency of the buds will diminish dramatically, because the female plants will focus their energy on developing seeds instead of trichomes.

Conclusion The growth patterns of cannabis need to be understood to fully grasp the discussions surrounding it. For example, when scientific research was conducted, scrutinizing the effects of smoking marijuana, what was the quality of the marijuana used? When police raided a marijuana growing site, were the plants in the vegetation stage with only trace amount of THC, making the plants possibly permissible by law? How can cannabis be logistically eradicated if a tiny autoflower, 60 cm in stature, can be grown in two months in an open field, in almost any climate? How should home-cultivation of cannabis be regulated, if one plant can produce anything between 3 and 1,200 grams of buds?

Jacob Levine

2 CANNABIS PRODUCTS

Introduction Normally, when it comes to the consumable product, people associate cannabis with the dried buds. However, there are also different cannabis concentrates present on the market, like rosin, BHO, and RSO. In this chapter, you’ll learn about the various forms of cannabis consumed today and get a general overview of the manufacturing processes involved.

Buds Once the curing process is complete, the buds are ready for consumption. They can be ground down and placed into a vaporizer or a joint. The buds look like miniature fir trees that are sticky, crumbly, and ooze with intense aromas. The buds are usually light green and covered in milky trichomes. However, some buds become purple, due to the strain’s genetic profile, and are colloquially referred to as “purps.” The buds can also be decarboxylated and used for various concentrates.

Concentrates All cannabis products besides fresh and cured plant material are considered concentrates. These cannabis concentrates differ greatly from one another, as they are manufactured in various ways, differ in their effects, and are made for distinct application purposes. Concentrates are most commonly known for delivering high THC and/or CBD levels, and in some cases specific terpene profiles. Medical professionals can now precisely isolate cannabis compounds by developing concentrates and removing interfering effects caused by other compounds normally present.

Solvent and Solventless Concentrates Cannabis concentrates can either be made without solvents or with the help of solvents. Solvents such as butane, CO2, ethanol, acetone, and olive oil, can be used to extract the desired compounds from cannabis. Solventless concentrates come from natural, “non-chemical” methods of extraction, resulting in concentrates such as kief, hash, and rosin.28

28 Tyler Terps, “The Difference Between Solvent and Solventless,” Merry Jane, 9 Dec. 2015, https://merryjane.com/culture/the-difference-between-solvent-and-solventless. Accessed 26 Jun. 2017.

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Kief Kief is a potent solventless concentrate (potent here means high in THC levels). Whenever buds are moved around, tiny trichomes detach and together form a light-green powdery material, called kief. “Dry sieve kief” is gathered by moving the dried buds over a screen comprising tiny holes that only trichomes and trace amounts of plant material can penetrate. Kief can also be produced by mixing plant material with dry ice in a mesh bag, then shaking the bag until kief comes out. Kief can be used in a variety of ways. It can be made into hash, rosin, or simply added to a joint. Hash Hash smoking has been taking place for centuries, if not millennia.29 There are various methods of making it. Hash can be made by compacting kief into a solid block. One can use the “water ice” method, where plant material is placed into water mixed with ice, when the mixing of the content will detach the trichomes and some plant material, which is collected through sifting and dried afterwards, creating “bubble hash.” When the plants are being trimmed of their stems and fan leaves, sticky material starts collecting on one’s hands. This sticky substance comprises trichomes and plant material, which is then detached from the fingers making something called “finger hash.” In India, the plants are rubbed with clean hands, which accumulates a coat of hash, which is then removed and rolled into small hash balls, a.k.a. “charas.”30 Hash exudes unique fragrances and is usually more potent than the dried buds, with THC levels around 40%, although the THC concentrations can vary greatly. Hash is commonly associated with more sedating and narcotic sensations. Rosin Rosin31 is a solventless concentrate made by applying heat and pressure to the dry herb, hash, or kief, which extracts the THC, and other cannabis compounds. This concentrate became quite popular because cannabis consumers discovered that rosin can be made at home. All one needs is heat resistant gloves, a hair straightener, parchment paper, and a tool to pick up the sappy, honey-like rosin. It’s a relatively safe method of producing homemade

29 Sam Bass, “Charas: Ancient Hash, Global Culture, A History, and Review,” Herban Indigo, 13 Jul. 2016, http://www.herbanindigo.com/cannabis/p/charas-ancient-hash-global-culture-a- history-and-review. Accessed 21 Mar. 2018. 30 Ibid. 31 Gooey Rabinski, “Resin vs. Live Resin vs. Rosin: What’s the Difference?” Merry Jane, 13 Apr. 2017, https://merryjane.com/culture/resin-live-resin-rosin-whats-the-difference. Accessed 26 Jun. 2017.

Jacob Levine dab material (more on dabbing later). Rosin has high THC levels. The quality greatly depends on the cannabis it is extracted from, as well as the pressure and temperatures applied. Instead of using hair straighteners, commercial extractors use advanced rosin machines.32 Butane Hash Oil (BHO) Butane Hash Oil (BHO) is made by blasting butane through a container filled with cannabis. The butane extracts cannabinoids and other compounds from the plant. The mixture is then poured into a container, often a Pyrex dish, and then heat is applied to evaporate the butane. Once this stage has been completed, only extracted cannabis compounds remain. Depending on the texture and appearance of the final result, the BHOs are called wax, shatter, crumble, budder, or honey oil.33 It looks like a caramel, honey-like substance. There’s controversy surrounding this product because it has been linked to several explosions, which happen when the butane catches fire and explodes, which has resulted in several serious injuries and fatalities.34 Also, if the wrong type of butane is used, which includes other dangerous chemicals, the final product can be dangerous to consume. There’s a general understanding that professionally made BHOs are safer to consume, and the production process is quite safe due to the professional machines used. The effects of consuming BHO are considered very potent because BHOs can contain up to 80% THC. BHO extraction should only be left to certified professionals with the appropriate lab equipment. CO2 Extracts Concentrates can also be made using sc CO2 (supercritical carbon dioxide), which is CO2 that has surpassed its critical temperature and pressure point. All cannabis compounds are released at different temperatures and pressures. Because the temperatures and pressures applied can be precisely controlled with sc CO2 machines, the desired cannabis compounds can be isolated from each other, making this extraction method highly desirable. For example, sc CO2 machines are used to extract CBD from cannabis plants and hemp, without THC getting into the mix. Terpenes can be successfully isolated from cannabinoids, and cannabinoids from terpenes. The extracted cannabis compounds can be mixed with each other to create products with highly

32 “Next Level Dab Making: Rosin Presses,” High Times on YouTube, 10 May. 2016, https://www.youtube.com/watch?v=WXtHoPdKL9M. Accessed 27 Oct. 2017. 33 “Wax, Shatter, and Dabs: What is BHO and Why Is It So Controversial?” Cannabis Education, http://cannabis-education.org/info/what-is-bho-wax-shatter-dabs/. Accessed 26 Jun. 2017. 34 Angus Crawford, “Rise in UK Explosions Linked to Super-strength Cannabis,” BBC News, 5 Aug. 2016, http://www.bbc.com/news/uk-36988316. Accessed 26 Jun. 2017.

Cannabis Discourse controlled content, unlike other concentrate types. Since CO2 has a very low critical temperature of around 31°C, it gives the extractor the ability to retain THCA and CBDA, without decarboxylating the compounds. This extraction method is considered eco-friendly (in comparison with BHO extraction). The terpene profile of CO2 extracts can be relatively high. BHOs usually contain 0.5%–3.5% of terpenes, while CO2 extracts contain 8–10%. Even though this method uses a solvent (sc CO2), it’s very simple to remove it from the final product. CO2 extracts are quite fluid and oily in comparison with BHOs.35 Rick Simpson Oil (RSO) Rick Simpson went to the doctor and was diagnosed with skin cancer. He rubbed some cannabis oil on the cancer spots and covered them up with a bandage. After four days, these spots turned into a healthy pink surface. The skin cancer was gone. Rick had a cannabis farm, and he made his homemade cannabis oil, which he gave away for free to his friends and neighbors with various medical conditions. He was amazed by how many people were being cured of their conditions. Rick’s property was raided several times by the police and he was charged with possession, cultivation, and trafficking. But he persevered with his endeavors and became an icon for the pro-cannabis movement.36 He is the face behind the famous Rick Simpson Oil (RSO). This concentrate is made by mixing buds with high-proof alcohol, which acts as a solvent. Then the mixture is sifted and poured into a rice cooker, which evaporates the alcohol, leaving a thick, black, tar-like oil, or RSO. “Phoenix Tears” is another term used for RSO. It’s important to note that this extraction method can be very dangerous, since alcohol is a very flammable substance.37 Tinctures Cannabis tinctures are one of the oldest solvent-based cannabis concentrates. The first step in making a cannabis tincture is decarboxylating cannabis plant material. Once that’s done, the material is placed in a container with high-proof alcohol such as Everclear. Usually, the mixture is left in a dark and cool place for several weeks, for the cannabinoids to dissolve into the alcohol, although there are techniques to speed up the process. Once the cannabinoids have mixed into the alcohol, the tincture is ready for consumption. Tinctures can be

35 Sirius J, “What is CO2 Oil?” High Times, http://hightimes.com/grow/what-is-co2-oil/. Accessed 26 Jun. 2017. 36 “The Rick Simpson Oil,” Zamnesia, https://www.zamnesia.com/content/352-the-rick-simpson- oil. Accessed 26 Jun. 2017. 37 “Producing the Oil” Phoenix Tears | Rick Simpson, http://phoenixtears.ca/producing-the-oil/. Accessed 26 Jun. 2017.

Jacob Levine consumed sublingually or added to foods.38 Fun fact! Here’s a tincture recipe dating back to 1843, written by W.B. O'Shaughnessy himself (more on him later): The resinous extract is prepared by boiling the rich, adhesive tops of the dried gunjah, in spirit (sp. gr. 835), until all the resin is dissolved. The tincture thus obtained is evaporated to dryness by distillation, or in a vessel placed over a pot of boiling water. The extract softens at a gentle heat, and can be made into pills without any addition. The tincture is prepared by dissolving the extract in Spirit of 835° density.39. As we can see, O’Shaughnessy started by making RSO, and then used the RSO to make the tincture. Live Resin When the flowering period has reached its peak, the plants usually go through the curing process. When making live resin, however, the entire plant is directly frozen after harvest in liquid nitrogen, which drops below –180°C. Live resin is usually made in high-tech cannabis labs. Live resin uses solvents such as sc CO2 to extract the desired compounds from the plant. When the buds are cured by novice growers, the plant material may lose a lot of terpenes. Live resin can solve the problem by containing all of the original terpenes which are present in the plant during harvest. Live resin is the new big thing in the world of cannabis concentrates, because it retains the original chemicals, which are otherwise not present in other concentrate types. The prices of live resin are relatively high, due to the complexity involved in its making.4041

Edibles Cannabis can also be turned into concentrates by using food oils such as butter or olive oil. Cannabis-infused butter is called “cannabutter,” and cannabis- infused food-oil is called “canna-oil.” These cannabis-infused fats can be used

38 Philip Bjorge, “Cannabis Tinctures 101: What Are They, How to Make Them, and How to Use Them,” Leafly, https://www.leafly.com/news/cannabis-101/cannabis-tinctures-101-what-are- they-how-to-make-them-and-how-to. Accessed 26 Jun. 2017. 39 W.B. O’Shaughnessy, “On the Preparations of the Indian Hemp, or Gunjah,” Provincial Medical Journal, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490264/. Accessed 26 Jun. 2017. 40 Gooey Rabinski, “Resin vs. Live Resin vs. Rosin: What's the Difference?” Merry Jane, 13 Apr. 2017, https://merryjane.com/culture/resin-live-resin-rosin-whats-the-difference. Accessed 26 Jun. 2017. 41 “Cannabis Concentrates: What Is Live Resin?” Royal Queen Seeds, 2 Feb. 2016, https://www.royalqueenseeds.com/blog-cannabis-concentrates-what-is-live-resin-n206. Accessed 26 Jun. 2017.

Cannabis Discourse to make “space cakes,” weed brownies, and canna-toasts, and can be used for virtually anything in place of regular butter, fat, or food-oil. Cannabutter is made by placing cannabis material, water, and butter in a pot, and applying heat, which causes decarboxylation and attaches the cannabinoids to fats present in the butter. Similar methods can be used to make canna-oils. Food products infused with cannabis are called “edibles.” These types of concentrates make up the vast majority of concentrates made at home.

Conclusion Since our extraction technologies are getting more sophisticated, we have the ability to generate cannabis concentrates with very specific levels of desired compounds, which drastically changes the concept of what cannabis actually is. Many discussions surrounding cannabis mention the heightened potency of concentrates, the extraction methods used, product quality, chemical content, their attractiveness to kids etc. We’ll use these cannabis products as examples further along the line, because whenever cannabis is discussed, obviously it refers to the plant and its derivatives.

Jacob Levine

3 ADMINISTRATION OF CANNABIS

This chapter will focus on the different administration or consumption methods of cannabis. Just like cannabis products, administration methods differ from each other in terms of the effects they induce. Smoking a joint with tobacco will not result in identical effects as eating an edible. Ingesting 1 gram of decarboxylated BHO will not result in the same effects as vaporizing the same amount of BHO. This chapter is just a short section to describe how people are consuming cannabis, what they’re consuming, and the differences in effects. This will help you further understand the cannabis discourse.

Smoking Smoking refers to heating the herb until it combusts and produces smoke, which is then inhaled. Marijuana can be smoked through some form of a joint, bong, or pipe. Concentrates can also be smoked, with hash being the most popular to consume in this form. The term “dabbing” refers to smoking concentrates through a dab rig by heating the bowl with a torch lighter and dissolving the concentrate in the bowl until smoke is released. There are thousands of ways cannabis can be smoked. Aside from regular pipe and bong paraphernalia, pipes can be engineered out of a bananas, apples, and avocados, and gravity bongs can be made from plastic bottles, plastic bags, and buckets. There are even bongs that burn the weed with a laser.

Vaporizing The temperature to which marijuana is heated determines which chemical compounds are released. Cannabis contains over 400 chemical compounds,42 each being released at a specific temperature. For example, THC is released at 157°C, and CBD at 160–180°C.43 Each of these 400+ compounds in cannabis has different psychotropic and physiological effects, and therefore the temperature at which cannabis is heated greatly determines its effects. Here’s where vaporizers come into the picture. They have emerged as a craze in the past few years. Vaporizing means that marijuana is heated before its combustion point. Desired cannabinoids, terpenes, and other chemical compounds are released at much lower temperatures than in a burning joint. The temperatures of vaporizing span between around 150–230°C, while a joint

42 Cannabis Cannabinoids, https://www.marijuanadoctors.com/resources/cannabinoids/. Accessed 6 Jun. 2018. 43 “Vaporization: CBD & THC Boiling Points,” Project CBD, https://www.projectcbd.org/sobre- cbd/ask-project-cbd/vaporization-cbd-thc-boiling-points. Accessed 19 Oct. 2017.

Cannabis Discourse can burn at more than 700°C.44 When it comes to which method of application is the least harmful, it’s generally understood that vaporizing is better than smoking, because the combustion of plant material releases toxins. Both dry buds and concentrates can be vaporized. There are many types of vaporizers, such as manual and automatic, portable and stationary, and conduction and convection based, all having different designs and functionalities.

Ingestion When decarboxylated cannabis products are ingested, the THC is processed by the liver and turned into 11-hydroxy-THC. Many believe that ingesting edibles results in more intense highs than smoking.45 When it comes to edibles, many have experienced bad trips and ended up in the ER, because it’s very easy to ingest massive amounts of THC. If someone without a built-up tolerance to cannabis eats a regular-sized space brownie, the dosage ingested might be 20x more potent than anticipated. The edibles come in any format imaginable, including sweets, chocolates, cakes, gellies/gummies, popcorn, chocolate spread, you name it.

Sublingual The sublingual administration takes place by administering cannabis products or pharmaceuticals under the tongue. This is not the same as ingesting cannabis because the substance surpasses the first-pass metabolism by the liver.46

Topicals Cannabis-infused creams, salves, dermal patches, sprays, and lotions can be applied to the skin for various medicinal purposes. The skin has CB2 receptors, which are responsible for various functions promoting our health.47

44 R.R. Baker, “Temperature Distribution Inside a Burning Cigarette,” Nature, 8 Feb. 1974, https://www.nature.com/articles/247405a0. Accessed 29 Mar. 2018. 45 “11-Hydroxy-THC - Increased Potency That Explains the Effect of Edibles,” Prof of Pot, 2 Jul. 2016, http://profofpot.com/11-hydroxy-tetrahydrocannabinol-potency-edibles/. Accessed 29 Mar. 2018. 46 Marilyn A. Huestis, “Human Cannabinoid Pharmacokinetics,” Chemistry & Biodiversity 4(8), Aug. 2007, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518/. Accessed 16 Jun. 2018. 47 “Cannabis Cannabinoids,” Marijuana Doctors, https://www.marijuanadoctors.com/resources/cannabinoids/. Accessed 16 Jun. 2018.

Jacob Levine

Conclusion Application methods are important to understand in the context of studies conducted on cannabis. When researchers conducted studies on participants who were smoking cannabis together with tobacco, was the tobacco consumption controlled for? Was there a control group consisting of participants who only vaporize, or ingest marijuana? What are the differences in effects between inhaled and ingested marijuana? Because cannabis has been, and still is, treated as an illegal substance, the research surrounding its physiological effects is very limited. We still have a long way to go before determining with certainty the unique effects of every aforementioned method.

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4 USES OF CANNABIS

Introduction Now that we’ve covered everything from planting the seed to the application of cannabis products, let’s conclude with why people consume cannabis, which is usually divided into three categories: spiritual, medicinal, and recreational. There is no rigid line between these three categories, because there’s no singular understanding of them. Some consider spiritual experiences under cannabis intoxication as cleansing and medicinal, some believe that recreational use of marijuana elevates their spirituality. However, there are some aspects that can be widely accepted as separate from one another.

Spiritual Use Cannabis is well known for its psychoactive effects. Many consider the influence of the herb to temporarily shift the perception of reality, which may be experienced as profound, creative, inspiring, and spiritual. An intensified sense of “now,” or “being present in the moment,” is usually how spiritual cannabis- induced experiences are described. That’s in terms of the effects. Cannabis can also be used as a part of a religious practice. In India, during the Holi festival, many Hindus have a tradition of consuming cannabis-infused drinks and edibles. Rastafarians smoke marijuana to elevate their consciousness to a higher level and speak among themselves in “reasoning sessions” about the Rasta lifestyle, get into a trance-like state, and feel a sense of unity.48

Medical Use Cannabis use for its medicinal properties is nothing new. It was used for centuries if not millennia to alleviate various medical conditions and their symptoms. Today, an increasing number of people advocate for using cannabis for medical purposes, because of positive personal experiences and the abundance of research now available in various media. The term “medical,” in the cannabis industry, can imply a certain legal status, since many countries and states have legalized “medical marijuana,” where cannabis can be purchased with a doctor’s prescription. An entire chapter is included later in the book about medical marijuana, due to its immense prevalence in the cannabis discourse.

48 Emily Dufton, “The Use of Marijuana in the Rastafari Religion,” Points: The Blog of Drugs & Alcohol History Society, 11 Jun. 2015, https://pointsadhsblog.wordpress.com/2015/06/11/the- use-of-marijuana-in-the-rastafari-religion/. Accessed 22 Oct. 2017.

Jacob Levine

Recreational Use Recreational use of cannabis is usually defined as anything that’s not considered spiritual or medicinal use. For example, going to a park and smoking marijuana with some friends to pass the time, having a space cake before watching a movie to intensify the experience, or simply to make daily tasks feel more enjoyable, falls under the recreational use umbrella. The term “recreational” can imply a certain legal status, because several states in the US have legalized cannabis for “recreational use.”

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Part 2

A Brief History

Jacob Levine

5 HISTORY OF MARIJUANA PROHIBITION

“If you don't know history, then you don't know anything. You are a leaf that doesn't know it is part of a tree.” - Michael Crichton

Introduction Our convictions, beliefs, opinions, and prejudices are a part of a historical continuum. Today, a person may be convinced that cannabis barely poses any danger to our health, whereas several decades ago, the same person could have considered it extremely dangerous, and several centuries ago completely harmless. To understand today’s cannabis discourse, one needs to look at it in the context of its history. Today, it’s very popular to parrot conspiracy theories surrounding marijuana’s prohibition, involving big corporations, crooked government officials, and dirty money. This chapter will not focus on alleged “dark corners” of history. Instead of trying to resolve some historical mystery, this chapter will simply layer important events that have greatly shaped today’s cannabis discourse. In order to briefly present the history of the marijuana prohibition, the timeline will be limited, and many events and facts will be excluded. The focus will mostly fall on the US, due to the country’s immense impact on the worldwide prohibition. Cannabis was not always illegal. The beginning of this chapter will briefly describe important events before the prohibition.

1839 – W.B. O’Shaughnessy William Brooke O’Shaughnessy (1809–1889) is considered a pioneer in the field of cannabis research. He was involved in many projects, which have greatly contributed to the world of science. One of these contributions was the construction of an expanded telegraph system in India, for which he was knighted by Queen Victoria in 1856. During his stay in India, he became fascinated by the indigenous use of hemp, which led him to extensively research the subject.49 The word hemp in those days referred to the psychoactive plants as well.

49 Brian Houlihan, “Sir. William Brooke O'Shaughnessy - Medical Cannabis Pioneer,” Medium, 12 Jun. 2016, https://medium.com/@dubhempmuseum/sir-william-brooke-oshaughnessy- medical-cannabis-pioneer-c94798fd7722. Accessed 8 Jun. 2017.

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Based on his research, he was amazed at hemp’s medicinal properties. All the following quotes from O’Shaughnessy derive from the Provincial Medical Journal, published February 4th 1843:5051 “In action it [hemp] resembles opium and wine, but is much more certain than these remedies. I have no hesitation in saying that in the cases in which opium treatment is applicable, hemp will be found far more effectual.” In the journal, he included several cases of treating medical conditions with hemp. One of these cases involved patients suffering from rheumatism. A hemp tincture was applied while O’Shaughnessy documented the effects: In several cases of acute and chronic rheumatism admitted about this time, half-grain doses of the resin were given, with closely analogous effects; alleviation of pain in most, remarkable increase of appetite in all, unequivocal aphrodisia, and great mental cheerfulness. In no one case did these effects proceed to delirium, or was there any tendency to quarrelling. The effects of hemp on convulsions amazed O’Shaughnessy altogether, which he expressed in the “Case of Infantile Convulsions” section of the journal. Many traditional methods including leeches, opiates, and purgatives were applied to the 60-day-old baby. These methods showed no improvement to the baby’s health. O’Shaughnessy applied his hemp tinctures in several stages, at specific time intervals, and was surprised at the effects it had on reducing convulsions and improving the baby’s state. After approximately 75 days of treating the baby, O’Shaughnessy noted, “The child is now … in the enjoyment of robust health, and has regained her natural plump and happy appearance.” He didn't claim that hemp was the only agent which healed the baby, but he noted its undeniable efficacy during the treatment. Apart from his research on medical conditions, O’Shaughnessy was also interested in documenting the behavior of a person intoxicated with the hemp

50 W.B. O’Shaughnessy, “On the Preparation of the Indian Hemp, or Gunjah,” Provincial Medical Journal - NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2490264/pdf/provmedsurgj00865-0001.pdf. Accessed 8 Jun. 2017. 51 O’Shaughnessy’s first comprehensive report on cannabis had been published in 1839. Four years later, he wrote a short article on cannabis, which was included in the Provincial Medical Journal, 4 February 1843. The reason I chose to quote the latter article, is simply because it was written four years later, and it is my opinion that he gained more knowledge regarding cannabis between 1839 and 1843, based on the following quote from his article: “I have only further to add, that since the substance of the preceding memoir was first published, numerous cases have come to my knowledge in which the churrus, or resin prepared by the natives for smoking, has been used with little effect.” (According to the article, he believed that cannabis tinctures were much more effective.)

Jacob Levine tincture. Dinonath Dhur, a pupil of “excellent habits” stepped up to the challenge: [H]e entered on discussions on religious, scientific, and political topics, with astonishing eloquence, and disclosed an extent of knowledge, reading, and a ready apposite wit, which those who knew him best were altogether unprepared for… It terminated nearly as suddenly as it commenced, and no headache, sickness, or other unpleasant symptom followed the innocent excess. O’Shaughnessy was a skeptic who felt the obligation to prematurely publish his results so other scientists might also explore hemp’s possibilities: Entertaining this conviction, be it true or false, I deem it my duty to publish it [article] without any avoidable delay, in order that the most extensive and speediest trial may be given to the proposed remedy [hemp]. I repeat what I have already stated in the previous paper – that were mere reputation my object, I would let years pass by, and hundreds of cases accumulate before publication. My object is to have it [hemp] extensively and exactly tested without favor or prejudice, for the experience of four years has established the conviction in my mind, that we possess no remedy at all equal to this in anti-convulsive and anti-neuralgic power. Due to O’Shaughnessy’s contribution, between approximately the 1840s and the 1930s, Western medicine cabinets were filled with medicines containing Cannabis indica, used for numerous medical conditions.52 It’s approximated that during this period, at least 2,000 medicines containing cannabis were produced by more than 280 manufacturers.53 From today’s perspective, many of his discoveries were rediscovered and put into practice, such as using cannabis as an analgesic and an anti-convulsive medicine.

1893–1894 – Indian Hemp Drugs Commission During the late 19th century, the British colonial powers wanted to regulate the use of hemp in India, and as a result, they decided to create a commission to investigate hemp’s effects, to fully understand the situation. After scrutinizing hemp’s effects on individuals, speaking with local police officials, and going through criminal records, in 1893–94, the commission produced the 3,281-

52 “Medical Cannabis – A Short Graphical History - Its Golden Age,” Antique Cannabis Book, http://antiquecannabisbook.com/chap2B/GoldenAge/GoldenAge.htm. Accessed 8 Jun. 2017. 53 Robert S. Goldsmith et al., “Medical Marijuana in the Workplace,” Journal of Occupational and Environmental Medicine 57(5), 8 May. 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410963/. Accessed 8 Jun. 2017.

Cannabis Discourse page “The Indian Hemp Drugs Commission Report.” It was the first extensive research conducted on hemp’s effects.54 Here are some statements from the report that are often used in various blogs and articles: In regard to the physicall effects, the Commision have come to the conclusion that the moderate use of hemp drugs is practically attended by no evil results at all. In respect to the alleged mental effects of the drugs, the Commision have come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind. In regard to the moral effects of the drugs, the Commission are of opinion that their moderate use produces no moral injury whatever. There is no adequate ground for believing that it injuriously affects the character of the consumer.55 The injury done by the excessive use is, however, confined almost exclusively to the consumer himself; the effects on wider society is rarely appreciable.56

1914 – Harrison Narcotics Tax Act In the US, the Harrison Narcotics Tax Act was passed on 17 December 1914.57 This Act marks the breaking point from which our modern perception of drugs emerged. This Act could be said to mark the beginning of the “war on drugs.” Before the Harrison Tax Act, during the late 19th century, opium and cocaine were largely acceptable to use. A series of events culminated in the 1912 Hague International Opium Convention, which was created to control the opium, morphine, cocaine, and heroin trade.58 In 1914, the US passed the

54 Tod H. Mikuriya, MD, “Physical, Mental, and Moral Effects of Marijuana: The Indian Hemp Drugs Commission Report,” DrugLibrary, http://www.druglibrary.org/schaffer/library/effects.htm. Accessed 8 Jun. 2017. 55 “(297) Page 263 - India Papers > Medicine - Drugs ... - Digital gallery,” Medical History of British India, http://digital.nls.uk/indiapapers/browse/pageturner.cfm?id=74574660. Accessed 8 Jun. 2017. 56 “(298) Page 264 - India Papers > Medicine - Drugs ... - Digital gallery,” Medical History of British India, http://digital.nls.uk/indiapapers/browse/pageturner.cfm?id=74574662&mode=zoom. Accessed 8 Jun. 2017. 57 “Harrison Narcotics Tax Act, 1914 – Full Text,” DrugLibrary, http://www.druglibrary.org/schaffer/history/e1910/harrisonact.htm. Accessed 8 Jun. 2017. 58 “The 1912 Hague International Opium Convention,” United Nations Office on Drugs and Crime, https://www.unodc.org/unodc/en/frontpage/the-1912-hague-international-opium- convention.html. Accessed 8 Jun. 2017.

Jacob Levine

Harrison Narcotics Tax Act to comply with international standards placed on these drugs. The main purpose of the Harrison Narcotics Tax Act was not to criminalize drug users, but merely to control the use of drugs, the transport, and revenue gathered from the sales. With special licenses, medical professionals and pharmacists were still able to legally prescribe the aforementioned drugs to their patients. However, the government agencies acted upon a sentence in the act, which states that medical professionals could prescribe the drugs “in the course of his professional practice only.” At the time, drug addiction was not considered a medical condition, and hence was outside of “his professional practice.” Because of this clause, many medical professionals and pharmacists lost their jobs and reputations, and many were imprisoned for illegally prescribing drugs included in the Act.59 As we now know, drug addiction is a powerful condition which makes people go to great lengths to get their fix. After the passing of the Harrison Tax Act, drugs generally couldn’t be obtained from pharmacists or medical professionals anymore, so people turned to the black market situated mostly in big cities like New York and San Francisco.60 The drugs on the black market were much more expensive than the pharmacy drugs. Heroin, morphine, cocaine, and opium addicts resorted to violence, robbery, and prostitution to support their expensive habits. Criminal activity and drug addiction went hand in hand. To deal with this problem, the idea was to crack down hard, and hope it would deter people from dealing or becoming addicted to drugs. The Heroin Act was passed in 1924, making heroin completely illegal, even for medical purposes.61 The laws were getting stricter and the persecution and stigmatization of drug users and dealers was on the rise. Pharmacists and medical professionals feared anything involving prescribing illegal and stigmatized drugs. Basically, medical professionals couldn’t prescribe opium, morphine, heroin and cocaine, and people addicted to these substances had to resort in crime to obtain the drugs from the black market, which increased the stigmatization of these drugs, which led to medical professionals to further distance themselves from these drugs and people who needed help to beat their addiction, which spiraled this vicious cycle into full descent. After 1914, many crimes were connected to the newly established population of drug addicts. The fundamentals behind these drug crimes wasn’t

59 “The Harrison Narcotic Act (1914),” DrugLibrary, http://www.druglibrary.org/schaffer/library/studies/cu/cu8.html. Accessed 30 Oct. 2017. 60 “The Harrison Narcotic Act (1914),” DrugLibrary, http://www.druglibrary.org/schaffer/library/studies/cu/cu8.html. Accessed 1 Apr. 2018. 61 “A History of Opiate Laws in the United States,” NAABT, 9 Sep. 2016, https://www.naabt.org/laws.cfm. Accessed 1 Apr. 2018.

Cannabis Discourse scrutinized; rather, drug addicts were evil, and that was that. Struggling addicts – thin, unwell, not maintained – were seen as pests of society, and treated as such. Black market dealers were getting richer from the restrictions by welcoming drug addicts to the predicament of the underground. The Harrison Narcotics Tax Act was created to control the drug market, which, ironically, led to almost zero control over the flow of heroin, opium, cocaine, and morphine, and no taxes were being collected from the black market.62

Harry Jacob Anslinger Harry Jacob Anslinger (1892–1975)63 was a prominent figure in the “war on drugs.” He waged a vicious campaign, which intentionally misinformed the public about the effects of marijuana and drugs in general. He intensified the negative perception of drugs, which boosted the already present stigmatization of drug use. His contributions greatly shaped the repressive drug policies of the entire world. Anslinger was born to an immigrant Swiss family. At the age of 12, he witnessed a drug addict screaming for her morphine, which he was asked to buy from a pharmacy. This event horrified Anslinger and greatly influenced his outlook on drugs from a very young age. He was very ambitious. Anslinger managed to enter Pennsylvania State College for a two-year engineering and business program, without a high-school diploma. During WW1, in 1917, he worked as an assistant to the Chief of Inspection of Equipment in the US Army. The Harrison Act (1914) and Volstead Act (1919), had been already established to tax and control the supply of drugs and alcohol. In 1926, Anslinger became US consul in Nassau, British Bahamas, the notorious storage location for alcohol during Prohibition. He was praised for persuading the British to cooperate with the US’s prohibition measures. In 1930, the Bureau of Narcotics was established. Their first commissioner? Anslinger. At the time Anslinger became Commissioner of the Bureau of Narcotics, the alcohol prohibition was coming to an end. The engine that drove the prohibitive measures against alcohol suddenly shifted onto other drugs, with “marihuana”64 becoming the number one target. The demonization of

62 “The Harrison Narcotic Act (1914),” DrugLibrary, http://www.druglibrary.org/schaffer/library/studies/cu/cu8.html. Accessed 8 Jun. 2017. 63 “Anslinger, Harry Jacob, and US Drug Policy,” Encyclopedia.com, http://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and- maps/anslinger-harry-jacob-and-us-drug-policy. Accessed 8 Jun. 2017. 64 I use the spelling “marihuana” in this context instead of the common spelling “marijuana,” because the former spelling was used in the infamous propaganda film “Reefer Madness 1936,” and it is the spelling used in the “Marihuana Tax Act 1937.”

Jacob Levine

“marihuana” use arose before Anslinger became Commissioner, but he greatly intensified the pursuit. People were generally unaware of what this “marihuana” was, so the Bureau of Narcotics felt the moral responsibility to educate the public. During this time in the US, the general public knew that hemp and Cannabis indica were widely used to make various products and medicine. When the word “marihuana” appeared on various posters and propaganda films, the public was unaware that it was the same thing. This new “marihuana” was represented in the media as a demonic substance. Stories about vicious crimes committed under the influence of marihuana were appearing in the newspapers, radio, and television. Words such as murder, rape, insanity, prostitution, evil, vice, and scourge were all associated with marihuana through clever and persistent campaigns. During the 1930s, lies about marihuana were absolutely believable, because the anti-drug propaganda was already established. Anti-marihuana sentiments were on the rise. Anslinger was a big fan of punitive measures and was cracking down, hard.65 Between 1930 and 1937, the evils of marihuana spread as a nationwide “phenomenon.” “Reefer Madness,”66 directed by Louis J. Gasnier and released in 1936, is the most notorious anti-marijuana propaganda film ever created.67 To summarize the plot of the film: a bunch of white teenagers are lured by peddlers to smoke marihuana. They become insane, reckless, violent, stupid, suicidal, promiscuous rapists. Imagine all the propaganda techniques in the playbook – they’re all present. Even though this film can be found humorous from today’s perspective, parents were terrified that this could happen to their children. In the introduction of the film, a letter from the Narcotics Bureau (when Anslinger was Commissioner) is recited, which explains how the “deadly narcotic” marihuana must be wiped out. Here’s a segment of the letter: Recently a huge supply of heroin was taken. It was concealed in an apparently harmless shipment of thirty-five barrels of olive oil. The deadly drug was burned in the incinerator of the Bureau of Engraving and Printing.

65 “Anslinger, Harry Jacob, and US Drug Policy,” Encyclopedia.com, http://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and- maps/anslinger-harry-jacob-and-us-drug-policy. Accessed 8 Jun. 2017. 66 “Reefer Madness” (1936) IMDb, http://www.imdb.com/title/tt0028346/. Accessed 8 Jun. 2017. 67 Raul Duke, “Mini Thesis – The Smear Campaign Against Cannabis U.S.A 1930s,” 2 May. 2011, https://raoulduke1989.wordpress.com/2011/05/02/mini-thesis-the-smear-campaign- against-cannabis-u-s-a-1930s/. Accessed 8 Jun. 2017.

Cannabis Discourse

And more vicious, more deadly even than these soul-destroying drugs, is the menace of marihuana! No doubt, many of you do not believe that these things do happen, that they cannot happen to you. You may also believe that the facts have been exaggerated. Let me tell you of something that happened right here, in our own city.68 After the letter is recited, the narrative fades into the story. First, this segment presents the involvement of the Bureau of Narcotics in the movie script. Second, it shows the intensity of danger and persecution associated with marihuana by coining it more deadly than heroin (during the time when Reefer Madness was released, heroin was completely illegal in the US, as mentioned previously). “Reefer Madness” wasn’t the only propaganda film demonizing marijuana. “Marihuana”69 (1936) and “Assassin of Youth”70 (1937) also contributed with virtually the same message. During the year 1937, the public and government officials were greatly convinced of the truth and efficacy of Anslinger’s measures, while they may, in blissful ignorance, have had Cannabis indica medicines lying in their medicine cabinets.

Racism Before jumping into the Marihuana Tax Act 1937, it’s important to mention racist attitudes during the 1920s–30s. Generally, the pro-legalization movement considers racism as one of the main aspects behind the marijuana prohibition and use it as a tool not only to promote their arguments for the legalization of marijuana but also to present a larger picture of minority discrimination. The next segment will present the evidence which strongly suggests that racist attitudes were used at the Marihuana Tax Act 1937 hearing to catalyze its passing. Mexicans During 1910–1920, many Mexicans were escaping the Mexican Revolution by immigrating to the US. They brought with them marijuana, which name was

68 Screenplay: “Reefer Madness” 1936 movie script, Drug News Bot. http://drugpolicycentral.com/bot/pg/propaganda/reefer_madness_movie_script.htm. Accessed 30 Oct. 2017. 69 “Marihuana” (1936), IMDb, http://www.imdb.com/title/tt0026683/. Accessed 1 Apr. 2018. 70 “Assassin of Youth” (1937) IMDb, http://www.imdb.com/title/tt0028589/. Accessed 8 Jun. 2017.

Jacob Levine included in the famous revolutionary tune “La Cucaracha.”7172 Industries in the southwestern states welcomed Mexicans, who were willing to work for pennies. During the 20s, 50,000–100,000 Mexican immigrants were entering per year. During the Cristero War of 1927–1929, a new wave of Mexican refugees immigrated to the US, who, according to historian Julia Young, were also politicized because of the war’s dynamics, and mass protests were taking place within Mexican communities in the US.73 At the end of the Cristero War, the Great Depression emerged, leaving many in the US impoverished. The need for Mexican workers diminished, and consequently tens of thousands voluntarily returned to Mexico, while hundreds of thousands were deported.74 However, many remained in the US, still working for pennies. During the Depression, people were hungry and angry, and under such conditions, the anger toward Mexicans was on the rise because of the now-familiar mantras: “they steal our jobs” and “there isn’t enough to go around.”75 Blacks Simultaneously, “suggestive” jazz music was emerging, and there was a strong connection between Black entertainers and weed, among other drugs. The herb made its way to Storyville, New Orleans, a red-light district and the birthplace of jazz. Louis Armstrong, Bessie Smith, Billie Holiday, Fats Waller, Thelonious Monk, and Duke Ellington, among plenty of other talented musicians, were cannabis consumers. White elites weren’t fond of Blacks gaining self-confidence that was expressed through their music.76 Of course, there’s more to racism present at the time, but the point here is that the negative attributes of marihuana were being associated with blacks.

71 Anna Wilcox, “The Origin & History of the Word ‘Marijuana’,” Leafly, https://www.leafly.com/news/cannabis-101/where-did-the-word-marijuana-come-from-anyway- 01fb. Accessed 8 Jun. 2017. 72 “The Version of ‘La Cucaracha’ Referencing Marijuana,” Leafly, https://www.leafly.com/news/pop-culture/la-cucaracha-references-marijuana. Accessed 8 Jun. 2017. 73 Jason Steinhauer, “The History of Mexican Immigration to the US in the Early 20th Century,” 11 Mar. 2015, https://blogs.loc.gov/kluge/2015/03/the-history-of-mexican-immigration-to-the-u- s-in-the-early-20th-century/. Accessed 31 Oct. 2017. 74 Ibid. 75 “Depression and the Struggle for Survival,” Library of Congress, https://www.loc.gov/teachers/classroommaterials/presentationsandactivities/presentations/imm igration/mexican6.html. Accessed 8 Jun. 2017. 76 Sebastian Marincolo, “Vipers, Muggles, and the Evolution of Jazz,” High Perspectives, 24 Mar. 2015, http://marijuana-insights.com/vipers-muggles-and-the-evolution-of-jazz/. Accessed 8 Jun. 2017.

Cannabis Discourse

1937 – Marihuana Tax Act 1937 The passing of the Marihuana Tax Act 1937 initiated the federal prohibition of marijuana in the US. Marijuana didn’t become “illegal,” as it was legal to grow, possess, and prescribe it, if the correct “tax stamp”77 was obtained from the Treasury Department. However, applying for this tax stamp would put the person or institution under higher scrutiny or surveillance, or would automatically incriminate the applicant if illegal activities were detected. In this sense, marijuana became effectually federally illegal after the passage of the act. During the Marihuana Tax Act 1937 hearing,78 Anslinger presented his case, and at the end of the hearing, he was granted the permission to present additional statements from various sources.79 These additional statements, which are excerpted below, present frightening incidents which allegedly occurred under the influence of marihuana. A case in point is that of a young man, an intelligent high school student, now confined to an institution for the mentally diseased. His experience is entirely the result of acquiring the habit of smoking marihuana cigarettes. —Dr. Frank R. Gomila, commissioner of public safety, and Miss Madeline C. Gomila, assistant city chemist A man under the influence of marihuana actually decapitated his best friend; and then, coming out of the effects of the drug, was as horrified as80 anyone over what he had done. —Dr. Frank R. Gomila, commissioner of public safety, and Miss Madeline C. Gomila, assistant city chemist A young boy who had become addicted to smoking marihuana cigarettes, in a fit of frenzy because, as he stated while still under the marihuana influence, a number of people were trying to cut off his arms and legs, seized an axe and killed his father, mother, two brothers and a sister, wiping out the entire family except himself.

77 “The Marihuana Tax Act of 1937 - Full Text of the Act,” DrugLibrary.org, http://www.druglibrary.org/schaffer/hemp/taxact/mjtaxact.htm. Accessed 8 Jun. 2017. 78 “Statement of Harry J. Anslinger,” DrugLibrary.org, http://www.druglibrary.org/schaffer/hemp/taxact/anslng1.htm. Accessed 8 Jun. 2017. 79 “Additional Statement of Harry J. Anslinger,” DrugLibrary.org, http://www.druglibrary.org/schaffer/hemp/taxact/t10a.htm. Accessed 8 Jun. 2017. 80 Corrected the spelling from “aas” to “as.”

Jacob Levine

—Dr. Frank R. Gomila, commissioner of public safety, and Miss Madeline C. Gomila, assistant city chemist Two weeks ago a sex-mad degenerate, named Lee Fernandez, brutally attacked a young Alamosa girl. He was convicted of assault with intent to rape and sentenced to 10 to 14 years in the state penitentiary. Police officers here know definitely that Fernandez was under the influence of marihuana. —Floyd K. Baskette, city editor, The Alamosa Daily Courier In the last quote, a Mexican sounding name was presented, Lee Fernandez, while the majority of other examples during the hearing simply present the terms “a man” or “a boy.” This is just one example of why today people believe that racism was used to make marijuana illegal. The following statements mediate much more clearly racist attitudes of the times, which were used to strengthen the case for the prohibition of marijuana. I wish I could show you what a small marihuana cigaret can do to one of our degenerate Spanish-speaking residents. That’s why our problem is so great; the greatest percentage of our population is composed of Spanish-speaking persons, most of who are low mentally, because of social and racial conditions. —Floyd K. Baskette, city editor, The Alamosa Daily Courier This [marihuana] the Mexicans make into cigarettes, which they sell at two for 25 cents, mostly to white high school students. —Dr. Frank R. Gomila, commissioner of public safety, and Miss Madeline C. Gomila, assistant city chemist The following statement is one of many that can’t be proven per se to contain racial prejudice, as opposed to the previous ones. However, the implications are there, and are important to present because all racist comments during the hearing weren’t explicit. In Mexico and in America, the plants are permitted to grow together indiscriminately, without separating the male and female plants, so that the potency of the female plant is lessened by the admixture of the male element —Eugene Stanley, district attorney, parish of Orleans, New Orleans, LA This statement could be interpreted as: Mexicans and Whites coexist together indiscriminately without any racial separation, which leads to inter-racial sex,

Cannabis Discourse which leads to lowered “potency” of the female when “pollinated” by the male element. It’s interesting to note that during the hearing, Anslinger avoided using racist claims himself. He simply used other people’s statements to promote his ideas. Now, the following statements are based on Marco Polo’s story. This first statement is made by Anslinger himself: In Persia, a thousand years before Christ,81 there was a religious and military order founded which was called the Assassins and they derived their name from the drug called hashish which is now known in this country as marihuana. They were noted for their acts of cruelty, and the word ‘assassin’ very aptly describes the drug. —H.J. Anslinger The origin of this drug is very ancient. In the year 1090 A.D., the religious and military order or sect of the Assassins was founded in Persia and the numerous acts of cruelty of this sect were known not only in Asia, but in Europe as well. This branch of the Shiite sect, known as Ismalites, was called Hashishan, derived from hashish, of the confection of hemp leaves ‘marihuana.’ In fact, from the Arabic Hasishan we have the English word “assassin.” —Eugene Stanley, district attorney, parish of Orleans, New Orleans, LA The story behind these Ismalite assassins originates from Marco Polo’s story about the “Old Man of the Mountain,”82 who made his servants obey his commands to any extent he wished. He sedated his servants to sleep, woke them up in a breathtaking garden with delicious foods, drinks, and beautiful women. After the “paradise” was experienced, the servants were sedated to sleep again, waking up in the original place. The Old Man of the Mountain told his servants that they just experienced “paradise,” and to return, they had to obey his commands. The drinks given in “paradise” were interpreted as being infused with marijuana. And finally, the following statement sounds very similar to the “Reefer Madness” introduction:

81 Anslinger was inaccurate by two thousand years as to the existence of these “assassins.” 82 Marco Polo, The Travels of Marco Polo, 1845, https://play.google.com/books/reader?id=SypYS7GO6UEC&printsec=frontcover&output=reade r&hl=en&pg=GBS.PA227.

Jacob Levine

But here we have drug [sic] that is not like opium. Opium has all of the good of Dr. Jekyll and all the evil of Mr. Hyde. This drug is entirely the monster Hyde, the harmful effect of which cannot be measured. —H.J. Anslinger Based on the hearing, and additional statements provided by Anslinger, Marihuana Tax Act 1937 was passed, signed by President Franklin D. Roosevelt, and went into effect on 1 October 1937.

1944 – The La Guardia Committee Cannabis was now federally illegal to possess, use, sell, transport, and manufacture. Fiorello LaGuardia (1882–1947), the mayor of New York, created a committee in 1939 to investigate, in depth, the physiological and societal effects of marijuana. La Guardia initiated this study based on the concern surrounding this “marihuana,” and wished to investigate the matter extensively. The final report of the committee was released in 1944. Here are a couple of conclusions from the sociological study conducted by the committee:83 ● The majority of marihuana smokers are Negroes and Latin-Americans. ● The consensus among marihuana smokers is that the use of the drug creates a definite feeling of adequacy. ● The practice of smoking marihuana does not lead to addiction in the medical sense of the word. ● The sale and distribution of marihuana is not under the control of any single organized group. ● The use of marihuana does not lead to morphine or heroin or cocaine addiction and no effort is made to create a market for these narcotics by stimulating the practice of marihuana smoking. ● Marihuana is not the determining factor in the commission of major crimes. ● Marihuana smoking is not widespread among school children. ● Juvenile delinquency is not associated with the practice of smoking marihuana. ● The publicity concerning the catastrophic effects of marihuana smoking in New York City is unfounded.

83 “LaGuardia Committee Report Sociological Study,” DrugLibrary.org. http://www.druglibrary.org/schaffer/library/studies/lag/conc1.htm. Accessed 9 Jun. 2017.

Cannabis Discourse

Anslinger included in “The Murderers: The Shocking Story of the Narcotic Gangs” book,84 that the La Guardia report was extremely dangerous to the public, and that the methods used to produce the report were completely unscientific. This is to show that even during the time of extreme stigmatization of marihuana use, not everybody was onboard.

1951–1956 – Boggs Act and Narcotics Control Act Anslinger intensified the war on drugs by convincing Congress to pass the Boggs Act in 1951. This led to marijuana being synonymous with heroin in terms of its prosecution. The passing of the Narcotics Control Act 1956 further intensified the penalties for drug crimes.85

1961 – Single Convention on Narcotic Drugs The intense anti-marihuana witch hunt culminated in the inclusion of cannabis, as an illegal substance, in the United Nations Single Convention on Narcotic Drugs 1961. Seventy-three countries were represented during this decision, and the convention came into effect on 13 December 1964, after more than the minimum requirement of 40 countries agreed to its passing.86 This is the reason why the overwhelming majority of countries in the world made cannabis illegal. According to the United Nations Office on Drugs and Crime (UNODC): This Convention aims to combat drug abuse by coordinated international action. There are two forms of intervention and control that work together. First, it seeks to limit the possession, use, trade in, distribution, import, export, manufacture and production of drugs exclusively to medical and scientific purposes. Second, it combats drug trafficking through international cooperation to deter and discourage drug traffickers.87

Conclusion The Controlled Substances Act, passed by the Nixon administration and put into effect in 1971, created the scheduling system of drugs in the US, placing

84 Harry Anslinger, “Hemp Around Their Necks,” from The Murderers, Schaffer Library of Drug Policy, http://druglibrary.net/schaffer/History/murd3.htm. Accessed 1 Nov. 2017. 85 “History of Marihuana Legislation – Tightening the Law,” DrugLibrary.org, http://www.druglibrary.org/schaffer/library/studies/nc/nc2_7.htm. Accessed 9 Jun. 2017. 86 David Bewley-Taylor and Martin Jelsma, “Fifty Years of the 1961 Single Convention on Narcotic Drugs: A Reinterpretation,” 12 Mar. 2011, https://www.tni.org/files/download/dlr12.pdf. Accessed 9 Jun. 2017. 87 “Single Convention on Narcotic Drugs,” United Nations Office on Drugs and Crime, https://www.unodc.org/unodc/en/treaties/single-convention.html. Accessed 9 Jun. 2017.

Jacob Levine marijuana as a Schedule 1 substance along with heroin and cocaine. In the US and other countries, from the 70s until the present day, the propaganda messages of the “Reefer Madness” days have been slowly but steadily shifting toward scientifically based and anecdotal evidence. This chapter skipped many events that took place between 1970 and the present day, because the point here is to uncover the history behind the prohibition of marijuana, and the beliefs and opinions that led to it. Let’s conclude with a thought. In Japan, hemp was an important part of the culture for thousands of years. At the end of WW2, in 1945, Japan surrendered to the US authorities which took over with their already established marijuana prohibition. In 1948, the Cannabis Control Act was passed making marijuana illegal to this day in Japan. Many Japanese hold negative views against the use of marijuana,88 as if history didn't exist.

88 Jon Mitchell, “The Secret History of Cannabis in Japan,” The Asia-Pacific Journal – Japan Focus, 12(49), 5 Dec. 2014, http://apjjf.org/2014/12/49/Jon-Mitchell/4231.html. Accessed 2 Nov. 2017.

Cannabis Discourse

Part 3

How to Read Between the Lines

Jacob Levine

6 HOW TO READ BETWEEN THE LINES

Introduction Headlines are exaggerated to welcome visitors to one’s blog; statistics are handpicked and presented in a particular manner to convince the reader of one’s message; the amount of marijuana used in scientific research can be underplayed or exaggerated; quotes from scientific research are taken out of context; there’s a world of difference between correlation and causality; writers include ambiguous terms to omit responsibility; blogs, articles, videos, are filled with flawed arguments. It’s important to learn how to read between the lines of cannabis discourse to have a greater understanding of the facts. This chapter presents the tools to help you focus on the important details, and sift through the nonsense.

Confirmation Bias The internet, where we get most of our information about marijuana these days, functions as a mirror. When a query is written into a search engine, it creates a market, and websites meet the demand with content. Therefore, if one pursues an idea to confirm one’s conviction, such as “cannabis definitely cures cancer,” there’s content out there that will make money from confirming one’s belief, independent of whether the content is true or false. When searching for content that will support one’s conviction, the internet grants that wish, which perpetuates one’s conviction, a classic example of the confirmation bias. The point here is that one needs to read between the lines of one’s own subjectivity.

Headlines When using a search engine, the first thing that catches one’s attention is the headline, which aims at being clicked on. Twenty-four hours from now, millions of blogs will be published,89 hundreds of millions of photos will be posted on Facebook,90 and hundreds of thousands of hours of video content uploaded on YouTube.91 Needless to say, content competition is fierce. Very often, the message of the headlines is intensified to create an emotional response, which functions as an attractiveness factor, and doesn’t reflect true facts. We

89 “Blogging Statistics,” Worldometers, http://www.worldometers.info/blogs/. Accessed 3 Nov. 2017. 90 “47 Incredible Facebook Statistics and Facts for 2016,” Brandwatch. 12 May. 2016, https://www.brandwatch.com/blog/47-facebook-statistics-2016/. Accessed 3 Nov. 2017. 91 “160 Amazing YouTube Statistics and Facts,” Expanded Ramblings, 28 Oct. 2017, https://expandedramblings.com/index.php/youtube-statistics/. Accessed 3 Nov. 2017.

Cannabis Discourse consciously and unconsciously consume headlines as if they’re facts in their own right, which needs to be considered to fully understand the cannabis discourse. Here’s an example. Sensationalist headlines such as “Over 100 Scientific Studies Agree: Cannabis Annihilates Cancer,”92 should be read as “we are using this sensationalist headline to catch your attention, independent of whether its message is true or false, or the consequences that might arise from using it. We’ll write an article on the subject of possible benefits of using cannabis as treatment for cancer patients; however the headline ‘possible benefits of using cannabis as treatment for cancer patients’ will not spark as much interest, hence not get many clicks, hence bad for our business.” Now, we read these headlines without going into the details of its content, and believe that cannabis annihilates cancer. Websites that are highly ranked on search engines will be more likely to attract an audience. The quality of the content is independent of where the links are placed on the search engine results. If one searches on Google for “marijuana causes schizophrenia,” and the headline of the first result reads “marijuana definitely causes schizophrenia” it does not mean that the information is more valid than the second result which is titled “marijuana doesn’t cause schizophrenia.” Of course, there’s more to the topic of how headlines affect our opinions. The message here is simply that one should take headlines with a grain of salt, and understand that they’re powerful tools that greatly shape public perceptions of cannabis.

Treatment or Cure? There’s a difference between a treatment and a cure. Here’s a perfect definition: The term “cure” means that, after medical treatment, the patient no longer has that particular condition anymore. Some diseases can be cured. Others, like hepatitis B, have no cure. The person will always have the condition, but medical treatments can help to manage the disease.93

92 “Over 100 Scientific Studies Agree: Cannabis Annihilates Cancer,” 26 Sep. 2017, https://dailyhealthpost.com/cannabis-cancer-studies/. Accessed 3 Nov. 2017. 93 “Expert Answers on…,” KidsHealth, https://kidshealth.org/en/teens/curable.html. Accessed 2 Apr. 2018.

Jacob Levine

People often confuse cannabis treatments with cures for specific medical conditions. Additionally, content creators are confused about these terms, which leads to many misconceptions about cannabis’s medicinal properties.

Agenda In many cases, the agenda of the writer or the website is supported if the content makes the reader believe its message. This agenda needs to be understood. For example, the drugfreeworld.org94 site, as the name suggests, wants a drug-free world. Their content about marijuana needs to be read from the perspective that it’s not in their interest to present marijuana’s benefits. A vast number of websites benefit financially from selling the idea that cannabis is the ultimate medicine. For example, the website cureyourowncancer.org95 includes an article titled, “How Cannabis Oil Works to Kill Cancer Cells.”96 They sell CBD oils, hemp products and much more. It’s not in their financial interest to criticize the alleged benefits of cannabis. It’s crucial to mention that just because the content creator or website has a specific agenda does not automatically mean that the information is false. The point here is to understand the content creators’ or website’s interest behind presenting information about cannabis, and take that into account.

Scientific Research Scientific research is often used to make one’s claims seem more legitimate. In regard to cannabis, research can be used to support both extremes. For example, some articles quote research to present the positive effects of cannabis on the respiratory system,97 and some articles quote research to present how marijuana smoking is worse for your lungs than cigarettes.98 In many cases, complex scientific research is quoted by non-scientists. Here’s a realistic scenario: Casper has an assignment to write an article about the positive effects of marijuana on various types of cancer. Casper doesn’t have a science background. He only gets paid $50 for the article, so there’s no

94 “Drug-Free World,” Foundation for a Drug-Free World, http://www.drugfreeworld.org/. Accessed 5 Nov. 2017. 95 “Cure Your Own Cancer,” https://www.cureyourowncancer.org/. Accessed 5 Nov. 2017. 96 Dennis Hill, “How Cannabis Oil Works to Kill Cancer Cells,” CureYourOwnCancer.org, https://www.cureyourowncancer.org/how-cannabis-oil-works.html. Accessed 6 Nov. 2017. 97 Anna Wilcox, “You Need to Know How Weed Helps Keep Your Lungs Healthy,” Herb, 8 Aug. 2016, https://herb.co/2016/08/08/lungs-healthy-weed/. Accessed 5 Nov. 2017. 98 Jenny Hope, “Why Cannabis Is a Greater Cancer Risk than Tobacco,” Daily Mail Online, http://www.dailymail.co.uk/news/article-146853/Why-cannabis-greater-cancer-risk- tobacco.html. Accessed 5 Nov. 2017.

Cannabis Discourse time for thorough research. The scientific study which he wants to quote comprises complex and incomprehensible sentences, and is quite long to read. However, he finds a sentence which can easily be interpreted as marijuana having cancer-killing properties. Jackpot. Casper uses that quote to make the message of the article seem more legitimate, and gets a pat on the back from his editor. Here’s an example of how scientific research is taken out of context. An article in Herb, “You Need to Know How Weed Helps Keep Your Lungs Healthy,”99 includes the following claim supported by research: Though the cannabis and lung health debate persists, two pieces of recent research have really shaken things up. The first came out in 2012, from researchers working on a long-term study on the risks of cardiovascular disease. During their 20-year study, the scientists tested the lungs of 5115 young adults. Their findings were a bit astonishing. Tobacco use was associated with lung decline. But, moderate marijuana smokers had positive results on lung function. Specifically, cannabis-lovers had an increased lung capacity. (Emphasis added.) This last part is based on the following sentence from the study: “A recent longitudinal study, which demonstrated significantly higher FVC100 and total lung capacity with marijuana exposure, strongly supports this notion, as does our study.”101 (Emphasis added.) Now, here’s another part from the same study which includes other explanations behind the results which haven’t been included in the Herb article: These findings suggest that marijuana smoking could influence pulmonary function via multiple mechanisms. To explain the higher FVC previously observed in marijuana smokers, some investigators have proposed that the deep inspiratory maneuvers practiced by marijuana smokers could stretch the lungs, resulting in larger lung volumes. Another speculative possibility is strengthening of chest wall

99 Anna Wilcox, “You Need to Know How Weed Helps Keep Your Lungs Healthy,” Herb, 8 Aug. 2016, https://herb.co/2016/08/08/lungs-healthy-weed/. Accessed 5 Nov. 2017. 100 Forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath. Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test. “Forced Expiratory Volume and Forced Vital Capacity-Topic Overview,” https://www.webmd.com/lung/tc/forced-expiratory-volume-and-forced-vital-capacity- topic-overview. Accessed 5 Nov. 2017. 101 Mark J. Pletcher et al., “Association Between Marijuana Exposure and Pulmonary Function over 20 Years,” JAMA Network, 11 Jan. 2012, https://jamanetwork.com/journals/jama/fullarticle/1104848. Accessed 5 Nov. 2017.

Jacob Levine

musculature or another “training” effect that allows marijuana users to inspire more fully (closer to total lung capacity) on spirometry testing. This is a perfect example of how scientific research is often cherry-picked and taken out of context, whether deliberately or not. That’s not to say that cannabis does not have properties which may increase pulmonary capacity or function. Rather, this example is presented to show why cannabis articles, videos, and blogs quoting scientific studies need to be taken with a grain of salt. Not only can the quotes be taken out of context, but the important details can be completely modified or erased. A Live Science article, “Marijuana Science: Why Pot Heads Are Slackers,”102 makes the point that since cannabis can lower dopamine functioning, this can turn the consumer into a “slacker,” because dopamine is necessary in motivation and reward-seeking behavior. To support their case, the article quotes Michael Bloomfield’s study103 and mentions the number of participants involved in the study as “19 regular marijuana users, and 19 nonusers of the same sex and age.” However, the direct quote from the study itself is: “19 regular cannabis users who experienced psychotic-like symptoms when they consumed cannabis with 19 nonuser sex- and age-matched control subjects.” (Emphasis added.) Bloomfield’s study mentions in the background section that “substance dependence and schizophrenia are both associated with dopaminergic dysfunction.” Therefore, the alteration of the quote is not insignificant, because perhaps those cannabis users who experienced psychotic-like symptoms already had a dopaminergic dysfunction, which may have been independent of their cannabis use. Additionally, Bloomfield’s research studied the link between cannabis use and psychotic symptoms, not reward-seeking and motivation. The author of the Live Science article made a simplistic connection (which will be described in the next section). Again, the point here isn’t to scrutinize Bloomfield’s study or shed light on whether cannabis does or does not cause schizophrenia or lower motivation; it’s simply to show how scientific studies are being manipulated to support one’s message.

102 Denise Chow, “Marijuana Science: Why Pot Heads Are Slackers,” Live Science, 1 Jul. 2013, https://www.livescience.com/37889-marijuana-users-lack-motivation.html. Accessed 5 Nov. 2017. A similar example can also be found in "Long-term Cannabis Use May Blunt the Brain’s Motivation System,” ScienceDaily, 1 Jul. 2013, https://www.sciencedaily.com/releases/2013/07/130701081053.htm. Accessed 8 Nov. 2017.

103 Michael A.P. Bloomfield et al., “Dopaminergic Function in Cannabis Users and Its Relationship to Cannabis-Induced Psychotic Symptoms,” Biological Psychiatry, 1 Jul. 2013, http://www.biologicalpsychiatryjournal.com/article/S0006-3223(13)00502-7/abstract. Accessed 5 Nov. 2017.

Cannabis Discourse

Therefore, it’s important to read statements such as “this study conducted by a Harvard educated scientist proves that…” with a critical mindset. Research is often taken out of context, quotes are modified, and the message can be seriously misinterpreted. Even when a professional scientist makes statements about marijuana, they need to be taken with a grain of salt, because the scientist’s authority might be used as a tool to pursue a specific agenda.

Simplistic Connections Very often there are simplistic connections made to prove why cannabis causes certain effects. Here’s an example: Medical Jane’s article, “Taking Care of Business: The Effects of Marijuana on Productivity,”104 states, “when cannabinoids and THC inhibit GABA, the brain releases more dopamine as a result. This increase in dopamine causes people to feel more calm, focused, and can even boost their overall creativity.” The implication is that cannabis consumption releases more dopamine, which leads to the mentioned effects. These types of arguments are usually not made by neuroscientists. They’re constructed by content creators who simply read the “dictionary.com” definition of marijuana, and dopamine, and make the connection by themselves. How dopamine affects our mood and behavior is a complex topic, and therefore, one must be aware of these simplistic connections. That’s not to say that the connection presented in the example is not true, but one could also use another simplistic connection arguing that marijuana consumption releases more dopamine, and there are links between increased dopamine levels and schizophrenia,105 therefore marijuana causes schizophrenia.

Ambiguous Terms The best way to present claims without taking responsibility for their factual truth is to use conditional words such as possibly, may, probably, suggest, allegedly, potentially, seem, etc. The use of these words doesn’t tie the content creator to the facts presented, which is a great way to evade responsibility, while simultaneously convincing the reader that the claims are true.

104 Chloe Cohen, “Taking Care of Business: The Effects of Marijuana on Productivity,” Medical Jane, 4 Dec. 2014, https://www.medicaljane.com/2014/12/04/taking-care-of-business-the- effects-of-marijuana-on-productivity/. Accessed 5 Nov. 2017. 105 J.P. Kesby, “Dopamine, Psychosis and Schizophrenia: The Widening Gap between Basic and Clinical Neuroscience,” Nature, 31 Jan. 2018, https://www.nature.com/articles/s41398-017- 0071-9. Accessed 3 Apr. 2018.

Jacob Levine

For example, Herb’s headline reads “Science Proves That Mental Health May Be Improved With CBD.”106 However, what the headline means is: “scientific research suggests CBD can improve mental health; however, more research is needed to evaluate whether the positive effects of CBD on mental health can be stated as a fact.” Using the phrase “science proves” leads the reader to assume that whatever follows is indisputable, while using the word may covers the writer and website if this scientifically “indisputable” fact is disputed. The writer gets the message across that CBD improves mental health, while simultaneously deflecting any responsibility. That’s not to say that the opposite is true, that CBD doesn’t have any positive effects on mental health. And of course, these terms are not used solely to manipulate the audience. However, if one wishes to do so, they come in handy.

Disclaimers Disclaimers are made with the intention to release the person or entity making the claim from certain legal responsibilities. At the bottom of the article “How Cannabis Oil Works to Kill Cancer Cells,” there is a disclaimer that reads: The statements on this site have not been evaluated by the FDA and are not intended to diagnose, treat, cure or prevent any disease. Individual results may vary. Always consult with your doctor before starting any treatment. Content on this site is no way to be considered professional medical advice; they are opinions. Unless otherwise stated, none of the authors are valid medical professionals. This site is for educational purposes only! We encourage you to use the information and links on this site with your doctor. The article basically says, “Cannabis oil works to kill cancer cells, but that’s merely our opinion, and in no way should be considered as professional medical advice.” Again, that’s not to say the opposite is true, that cannabis oils don’t have medicinal value for cancer patients, or that the oils should be dismissed as a medicine in general. The point is that content creators are often legally covered (or think that they’re covered) from giving potentially dangerous advice.

Counter Statements Another technique used by content creators is to begin with “in-your-face” statements, and then use tactics to evade responsibility throughout the

106 Tiffany King, “Science Proves that Mental Health May Be Improved with CBD,” Herb, 31 Aug. 2017, https://herb.co/2017/08/31/mental-health-cbd/. Accessed 6 Nov. 2017.

Cannabis Discourse content. For example, the aforementioned article, “Marijuana Science: Why Pot Heads Are Slackers,”107 begins with “The stereotype of pot smokers as lackadaisical loafers is supported by new research: People who smoke marijuana regularly over long periods of time tend to produce less of a chemical in the brain that is linked to motivation, a new study finds.” However, further on in the article the following statements are included: “But the new results suggest more research is needed to understand the potential links between chronic marijuana use and mental illnesses” and “although further study is needed to better understand the link, the researchers said.” These types of statements function similarly to disclaimers. One could write anything about the effects of marijuana, back it up with scientific research, and write “although further study is needed.” Also, any information that may compromise the message of the article is rarely presented at the beginning. This technique is often used to prime the reader with the intended message and then throw in relevant counter statements, which are largely ignored because of priming,108 and simply because we tend not to read or watch through the entire piece of content.109

How Much Weed Are We Talking About? There’s a difference between occasional, moderate, regular, and heavy use of cannabis. These terms determine the amount and frequency of cannabis use in question. Not being aware of these differences leaves the reader susceptible to believing virtually anything about the physiological effects of cannabis. The exact definition of these terms differs between sources; however, the general understanding is that occasional use refers to smoking a joint maybe once a month or once a week, moderate use refers to several times a week, regular use refers to daily consumption, and heavy use refers to daily consumption in large doses. As an example of why this is important to understand, here’s a passage from the “Safety First” document,110 written by Marsha Rosenbaum, PhD:

107 Denise Chow, “Marijuana Science: Why Pot Heads Are Slackers,” Live Science, 1 Jul. 2013, https://www.livescience.com/37889-marijuana-users-lack-motivation.html. Accessed 5 Nov. 2017. 108 Jayson DeMers, “59 Percent Of You Will Share This Article Without Even Reading It,” Forbes, 8 Aug. 2016, https://www.forbes.com/sites/jaysondemers/2016/08/08/59-percent-of-you-will- share-this-article-without-even-reading-it/. Accessed 3 Apr. 2018. 109 Victoria Hoffman, “13 Reading Stats that Prove Nobody Is Reading Your Content,” Uberflip, 2 Sep. 2015, https://hub.uberflip.com/blog/13-stats-that-prove-that-nobody-is-reading-your- content-and-what-you-can-do-about-it. Accessed 3 Apr. 2018. 110 Marsha Rosenbaum, PhD, “Safety First: A Reality-Based Approach to Teens and Drugs,” Drug Policy Alliance, 7 Sep. 1998,

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Questions have also been raised about the possible impact of heavy marijuana use on IQ. One New Zealand study claimed that 38 of 1,000 users (3.8%), who were physically dependent before the age of 18, showed an 8 point drop in IQ twenty years later. More recent research, however, including a 2014 study of 2,600 young people, has found that when taking into account socioeconomic factors such as environment, poverty, poor nutrition, parenting style, mental health, and alcohol use, the association between moderate marijuana use and IQ largely disappears. (Emphasis added.) The first study presented refers to heavy marijuana use. The second study, which is clearly supposed to override the former one by presenting it as more recent and taking into account additional factors, is based on moderate marijuana use. In this case, to make a solid comparison one would need to compare research results based on the same amount and frequency of use with one another.

Correlation vs. Causality The battle between correlation and causality will be mentioned throughout the book, because there’s often a misunderstanding about whether marijuana use causes a certain effect, or if there’s simply a correlation between the two measurements, without them being necessarily interconnected. Kandel (1984), for example, found that only 7% of American youth who had never used cannabis reported using another illicit drug. This figure increased to 33% among those who had used cannabis, and to 84% among current daily cannabis users.111 Does this mean that cannabis consumption directly caused the higher consumption rates of another illicit drug, or does this simply show a correlation that can be explained by the fact that cannabis users are more predisposed to using other illicit drugs independent of their cannabis use? Presenting correlations as causal links is a classic play in the cannabis discourse, and is used by both sides. Also, the term correlation is often used as an antonym to causality, which is false because researchers can potentially determine that the correlation between the measurements in question is causal.

https://www.drugpolicy.org/sites/default/files/DPA_SafetyFirst_2014_0.pdf. Accessed 9 Nov. 2017. 111 W.D. Hall and M. Lynskey, “Is Cannabis a Gateway Drug?” Drug & Alcohol Review 24(1), Jan. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16191720. Accessed 8 Nov. 2017.

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Statistics A statistic can be presented and interpreted in various ways. Let’s take a look at the following graph referring to marijuana use by 6–12th graders in Colorado.112113

One could assert that after Colorado legalized recreational marijuana use in 2014, there has been an increase in marijuana use. Not only did the number of students who tried marijuana increase, but the downward trend from 2009 has been reversed, hence the rise is much higher than 0.5%. On the other hand, one could assert that after the legalization, marijuana use has decreased 5% since 2009 when it was illegal. This is just a simple example of how the same statistic can be presented and interpreted in various ways.

Conclusion There are many more things to consider as to different techniques to convince the public of one’s message. However, this chapter mentions the ones that are most often repeated in the cannabis discourse. The important take is to remain skeptical and be aware of the aforementioned details. In the study that claims negative effects on the lungs from smoking marijuana, how much did the participants smoke? What is the agenda of the website? When was the study conducted and published? Am I basing my opinion on a headline I read two weeks ago? Is there a causal link between these statistics? All these aspects

112 “Marijuana Use Among Youth in Colorado,” infographic, Healthy Kids for Colorado Survey 2015, https://www.colorado.gov/pacific/sites/default/files/PF_Youth_MJ-Infographic-Digital.pdf. Accessed 8 Nov. 2017. 113 Healthy Kids Colorado Survey, https://www.colorado.gov/pacific/cdphe/hkcs, Accessed 9 Jun. 2018.

Jacob Levine need to be kept in mind, not only to remain critical of one’s opinions, but to understand the workings within the cannabis discourse itself.

Cannabis Discourse

Part 4

Cannabis Discourse

Jacob Levine

7 THE GATEWAY DRUG THEORY

The Introduction Argument Before we jump into the gateway drug theory, let’s go through the introduction argument, which is an important aspect of anti-legalization arguments within the cannabis discourse. This argument claims that legalizing marijuana will increase the consumption rates, by introducing the drug to the legal market. The introduction argument is based on three hypothetical routes through which the increased consumption occurs. The deterrence route: “the illegal status of marijuana deters people from consuming the drug, legalizing marijuana will alleviate the deterrence factor, which will lead to increased consumption rates.” The availability route: “legalization of marijuana will make the drug more available and widespread; people consume drugs that are more available and widespread in comparison with drugs that are not; therefore, legalization of marijuana will lead to increased consumption rates.” The marketing route: “legalization of marijuana will permit predatory marketing techniques to get people to smoke marijuana, this will increase the consumption rates, therefore we shouldn’t legalize marijuana.” The main argument used by the pro-legalization movement against the deterrence route, is that people are not deterred from using marijuana, or any other drug for that matter, under extremely punitive laws. Additionally, the pro- movement use the forbidden fruit argument, which goes, “many people consume marijuana because it’s illegal, and making it legal will take the thrill out of it, hence legalizing marijuana will discourage many from consuming the drug.” The main argument used by the pro-legalization movement against the availability route is that marijuana is and was widely available to everyone under an illegal mandate, and legalization will simply shift the market into a legal sphere, hence the consumption rates are unlikely to be affected. When it comes to the marketing route, the pro-movement is generally aware that this needs to be controlled and regulated. However, many cannabis businesses or people affiliated with cannabis business are often trying to keep the reality of this route under the carpet, because of the idea that their business will be strongly affected by heavy sanctions on marketing. The introduction argument in particular is the foundation of most arguments against marijuana legalization. For example, here are two common narratives: “smoking marijuana kills brain cells, therefore we shouldn’t legalize

Cannabis Discourse it, because that will lead to increased consumption rates, which will collectively kill more brain cells” or “marijuana is a gateway drug, therefore we shouldn’t legalize marijuana, because that will lead to increased consumption rates, which will lead to increased consumption rates of harder drugs” (the gateway drug theory will be explained shortly). Both Sides of the Argument In terms of the consumption rates rising, staying the same, or falling after legalization, both sides present statistics to support their point. For example, the anti-movement presents the increased consumption rates among people aged 26+ in states that have legalized medical marijuana,114 and the pro- movement presents statistics to prove that the consumption rates have decreased among teenagers in states that have legalized recreational marijuana.115 These statistics can be tailored to present both extremes by selecting a framework, timeframe, and location where recreational and/or medical marijuana has been legalized.

The Gateway Drug Theory Introduction Whenever debates are waged surrounding the dangers of marijuana, the gateway drug theory virtually always comes up. Before we begin with presenting the definition of the theory, it’s important to note that terms such as legal, illegal, and hard drugs, have different connotations and definitions depending on their setting. For example, if a research paper mentions the term “illegal substances” when alcohol was classified as an illegal substance, the term probably includes alcohol. Another example: in the US marijuana is federally classified as a Schedule 1 drug, the most illegal classification for a substance possible. However, whenever mentioning a strictly illegal substance, marijuana rarely comes to mind. How we compartmentalize drugs based on their legal status, enforcement of the legal status, subjective understanding of the drugs’ effects, and their actual effects, are not in sync with one another. Fentanyl is a synthetic opioid that leads to tens of thousands of

114 Christine M. Mauro et al., “Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004–2013,” Prevention Science, https://link.springer.com/article/10.1007/s11121-017-0848-3. Accessed 19 Mar. 2018. 115 Tom Angell, “Teen Marijuana Use Down in Most Legalized States, Federal Data Says,” Marijuana Moment, 11 Dec. 2017, https://www.marijuanamoment.net/teen-marijuana-use- legalized-states-federal-data-says/. Accessed 19 Mar. 2018.

Jacob Levine overdose deaths each year, with an estimated lethal dose of 2mg for humans116 (the estimated lethal dose of heroin is 200mg117). Under US federal law, fentanyl is a Schedule II drug, while marijuana, which according to the European Monitoring Centre for Drugs and Drug Addiction rarely causes any fatalities,118 is classified as a more illegal drug.119 From a subjective understanding, cannabis may be perceived as more dangerous than alcohol; however, these perceptions don’t translate to actual statistics of their physiological and societal dangers.120 That being covered, let’s get into the definition. Theory Definition The gateway drug theory can also be referred to as the stepping stone theory, escalation hypothesis, or progression hypothesis.121 The gateway drug theory is based on the definition of what “gateway drugs” are, which is: “drugs whose use pharmacologically causes the use of later drugs in the sequence.”122 This definition is not necessarily the “official” one, but it makes the most sense in terms of all the aspects surrounding the gateway drug theory in today’s discourse. Today, in the US and other Western countries, “the sequence” is commonly understood as running in the order of, first alcohol and tobacco, then marijuana, then legal pills, then cocaine, methamphetamine, and heroin. However, among various cultures, and time frames, this sequence might take a different shape. Whenever the gateway drug theory is included throughout the book, it always refers to the progression from marijuana to the “hard” later

116 “Fentanyl drug profile,” EMCDDA, 8 Jan. 2015, http://www.emcdda.europa.eu/publications/drug-profiles/fentanyl. Accessed 28 Nov. 2017. 117 “Heroin profile,” EMCDDA, 8 Jan. 2015, http://www.emcdda.europa.eu/publications/drug- profiles/heroin. Accessed 28 Nov. 2017. 118 The exact quote is “fatalities directly attributable to cannabis are rare.” “Cannabis profile, EMCDDA, 8 Jan. 2015, http://www.emcdda.europa.eu/publications/drug-profiles/cannabis. Accessed 28 Nov. 2017. 119 “Drug Schedules,” Drug Enforcement Administration, https://www.dea.gov/druginfo/ds.shtml. Accessed 28 Nov. 2017. 120 David J. Nutt, Leslie A. King, and Laurence D. Phillips, “Drug Harms in the UK: A Multicriteria Decision Analysis,” The Lancet, 1 Nov. 2010, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61462-6/fulltext. Accessed 5 Dec. 2017. 121 “Gateway Drug Theory,” Wikipedia, https://en.wikipedia.org/wiki/Gateway_drug_theory. Accessed 27 Jul. 2017. 122 W.D. Hall and M. Lynskey, “Is Cannabis a Gateway Drug?” Drug Alcohol Review, 24(1) Jan. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16191720. Accessed 26 Jul. 2017. The definition from the Hall and Lynskey states, “drugs whose use in some unspecified way is a cause of the use of later drugs in the sequence” (emphasis added). However, I changed it to make it more specific as to the difference between the hypotheses explained further along in the chapter.

Cannabis Discourse drugs in the sequence according to the aforementioned understanding of them; if any exceptions come to light, they’ll be defined. The gateway drug theory doesn’t separate between regular use of drugs and one-time occurrences. If someone smokes marijuana and later tries cocaine once in their life, they’ll fall on the gateway drug spectrum, just as the frequent cocaine user might. This factor is often omitted by anti-marijuana advocates that simply present marijuana as a gateway drug without differentiating the amounts consumed. The pro-movement is likely to mention the difference between occasional, regular, and heavy use of any drug in this context. This chapter is mostly based on the study by Hall and Lynskey, which summarizes the gateway drug theory.123 Correlation Vs Causality The following three correlations between marijuana and hard drugs are a part of the engine pushing the gateway drug theory into today’s discourse. Cross-sectional surveys of adolescent drug use in the United States and elsewhere have consistently shown three types of association between cannabis use and the use of other illicit drugs, such as, heroin and cocaine.124 First, American adolescents during the 1970s and 1980s showed a typical sequence of involvement with licit and illicit drugs in which almost all who tried cocaine and heroin had first used alcohol, tobacco and cannabis.125 Second, during the same period there was a strong relationship between regular cannabis use and the later use of heroin and cocaine. Kandel (1984), for example, found that only 7% of American youth who had never used cannabis reported using another illicit drug. This figure increased to 33% among those who had used cannabis, and to 84% among current daily cannabis users126. The same relationships have been observed in surveys of drug use in Australia.127

123 Ibid. 124 Ibid. 125 Ibid. 126 Ibid. 127 Ibid.

Jacob Levine

Third, the earlier the age at which any drug was first used, the more likely the user was to use the next drug in the sequence. So those who begin to use alcohol and tobacco at an early age were the most likely to use cannabis; early cannabis users, in turn, were more likely to use hallucinogens and ‘pills’ (amphetamines and tranquillisers); and early users of ‘pills’ were, in turn, the ones most likely to use cocaine and heroin.128 The battle over whether cannabis is, or is not, a gateway drug, is waged between correlation and causality. The correlations between cannabis use and harder drug use are virtually undeniable and accepted by all parties. However, these correlations are not synonymous with a causal relationship. For example, according to the study by Fergusson and Horwood (2000),129 those who used cannabis once or twice were 2.7 times more likely to later use other illicit drugs, while those who used cannabis 50+ times were 59.2 times more likely. This suggests regular cannabis use is much more predictive of the escalation to harder drugs than occasional cannabis use. This generates the narrative that if cannabis were not used, the chances of escalating to harder drugs would drastically diminish, and therefore cannabis “is” a gateway drug. However, just because there is a correlation, doesn’t prove that cannabis pharmacologically causes an escalation to harder drugs, and just because a causal relationship is not established, doesn’t mean that it doesn’t exist. This leads to the next part. Three Hypotheses The gateway drug theory comprises three hypotheses: • Social environmental hypothesis: claims there is an escalation from cannabis to hard drugs due to the workings of society, culture, and the black market. This is a non-causal hypothesis. • Predisposition hypothesis: claims the individual’s predispositions lead from marijuana use to hard drugs. This is a non-causal hypothesis. • Pharmacological hypothesis: claims the consumption of marijuana drives the user to harder drugs, due to physiological changes caused by its effects. This is a causal hypothesis.130

128 Ibid. 129 Ibid. 130 Ibid. Before this quote, the research reads: “MacCoun has provided a detailed typology of explanations of the gateway patterns of cannabis use [23] but for the sake of simplicity we classify these into three types of explanation.” I summarized these three types of explanations to avoid repetition and to simplify the message, and to clearly identify which hypotheses are causal and which are not. The source Hall and Lynskey refer to is MacCoun R. “In what sense

Cannabis Discourse

The pharmacological hypothesis is the only hypothesis which can prove whether or not cannabis is a gateway drug, because it’s the only one that can directly explain causation. If scientists prove in well-researched studies that cannabis by itself changes something in the brain which directly leads us to escalate to harder drugs, then cannabis becomes by definition a gateway drug. The social environmental hypothesis and predisposition hypothesis both assign cannabis use as a function rather than a substance. Only by studying cannabis as a substance can one potentially determine whether it is a gateway drug, because scientists can establish a clear causal link. If it’s viewed as a function, the explanation of the escalation could always fall on predispositions to using and escalating drug use rather than on the substance itself. The following segments will show clear examples of the difference between substance and function. The anti-marijuana movement implies causation by presenting the social environmental and predisposition hypotheses as causal, but these hypotheses don’t explain causation. The pro-marijuana movement has a better picture of what causation entails in the gateway drug theory, because they use the social environmental and predisposition hypotheses as a means to defend cannabis from being defined as a gateway drug. However, the pro-movement often plays down the importance of the social environmental hypothesis. The following segments will cover these hypotheses in more detail. Predisposition Hypothesis The predisposition hypothesis claims that some individuals are predisposed to seek stronger highs or use drugs in general. Based on today’s cannabis discourse, this drive is divided into genetic and internalized factors. The genetic factors are the qualities one is born with; many blogs and articles mention that addiction to drugs and drug seeking is something that can be inherited genetically.131 The internalized factors refer to incorporated changes based on the individual’s life experiences. Internalized factors can include socioeconomic status, parental conflict and divorce, childhood sexual abuse, parental punishment, etc.132 The predisposition hypothesis is generally accepted as true by all parties. The World Health Organization document on

(if any) is marijuana a gateway drug?” FAS Drug Policy Annual Bulletin, 1998. Accessed 26 Jul. 2017. 131 “Say What? ‘Epigenetics,’” National Institute on Drug Abuse (NIDA) for Teens, https://teens.drugabuse.gov/blog/post/say-what-epigenetics. Accessed 9 Apr. 2018. 132 W.D. Hall and M. Lynskey, “Is Cannabis a Gateway Drug?” Drug & Alcohol Review, 24(1) Jan. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16191720. Accessed 26 Jul. 2017.

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“Neuroscience of psychoactive substance use and dependence” covers predispositions to drug use as a fact.133 There’s a famous experiment conducted by Bruce K. Alexander during the 70s,134 which is often cited whenever the topic of predisposition to use drugs arises. Kurzgesagt released a video explaining this experiment on YouTube, and it received millions of views.135 A rat was placed alone in a cage with two bottles, one containing pure water, and the other containing heroin-laced water. When the rat was alone in the cage it would take the heroin water until it died. On the other hand, when several rats were put in a “rat park,” where they could have sex and play around, the rats wouldn’t touch the heroin water. This experiment was based on a previous experiment136 that didn’t compare the lonely rats in a cage with several rats in “rat park,” which led many to believe that addiction stems solely from taking the drug. In addition to disproving this belief, Bruce Alexander also placed the lonely drug-addicted rat into the rat park, and its addiction would eventually completely disappear. Kurzgesagt connects the rat park experiment to another experiment conducted on soldiers who were addicted to morphine in Vietnam, and after returning to the US to their friends and families, the majority abandoned the drug. This experiment presents the classic substance versus function debate. It was believed that heroin, the substance itself, caused the rat to take more drugs. Although, the conclusion of the “rat park” experiment was that the rat was isolated and alone in the cage, and used the heroin laced water as a function to achieve alleviation. Social Environmental Hypothesis The social environmental hypothesis claims that using marijuana opens the gates to certain social dynamics, which lead to using harder drugs. This hypothesis describes the “outside” evidence of the escalation, rather than uncovering the individual’s drive to use drugs. Basically, it only accounts for all the aspects surrounding the gateway drug theory, from “outside” of the individual, without scrutinizing internal psychological and physiological aspects

133 “Neuroscience of Psychoactive Substance Use and Dependence.” World Health Organization, 19 Jan. 2004, http://www.who.int/substance_abuse/publications/en/Neuroscience.pdf. Accessed 26 Jul. 2017. 134 B.K. Alexander, R.B. Coambs, P.F. Hadaway, “The Effect of Housing and Gender on Morphine Self-Administration in Rats,” Psychopharmacology 58(2), 175–179 (1978), https://link.springer.com/article/10.1007/BF00426903. Accessed 12 Dec. 2017. 135 “Kurzgesagt – In a Nutshell Addiction.” https://www.youtube.com/watch?v=ao8L- 0nSYzg&t=218s . Accessed 12 Dec. 2017. 136 B.K. Alexander, “The Myth of Drug-Induced Addiction,” Senate of Canada, https://sencanada.ca/content/sen/committee/371/ille/presentation/alexender-e.htm. Accessed 5 Apr. 2018.

Cannabis Discourse of the escalation. There are three main routes in the frame of this hypothesis in today’s discourse, the black market route, the peer pressure route, and the availability leads to escalation route. The black market route: This route is based on the idea that marijuana users escalate to harder drugs through the black market. Here’s an example: Sara starts smoking marijuana. She enjoys it a lot. Her dealer sells marijuana among other drugs like heroin. The dealer offers Sara some heroin. She decides to try it. This narrative led the Dutch government to permit the establishment of coffeeshops to separate marijuana from the black market filled with hard drugs. During the 70s the Netherlands were in the midst of a heroin epidemic, and the worry was that many marijuana users were getting involved with dealers that pushed heroin onto their customers. When it comes to the outcome of this policy, according to the Hall and Lynskey study, “the lack of rigorous testing of its effects represents a lost opportunity to evaluate the effects of a widely advocated harm reduction measure.”137 The pro-advocates often push this decision as a smart choice in terms of its logic, and not so much in terms of its outcome, which is not clearly established. The peer pressure route: This route explains how the drug use patterns of friends, acquaintances and family members fuel the escalation. Here’s an example: Sara meets some “cool” people who smoke marijuana. To fit into the group, she needs to smoke marijuana. She starts smoking marijuana and socializes with her fellow smokers, who also use harder drugs like LSD. Sara blends into the crowd and uses LSD. Sara meets people who use LSD among harder drugs such as cocaine. She decides to try it. The D.A.R.E and Nancy Reagan’s “Just Say No!” campaigns are mostly based on this route, which claim that the gateway to hard drugs often begins with socializing with people who smoke marijuana, and the peer and social pressures lead the person to escalate their drug use. These campaigns and drug prevention programs will be discussed later in the book. The availability leads to escalation route: This route is based on the following argument: the more readily available marijuana is, the more it will be consumed, and if it’s consumed more, it will increase the consumption of harder drugs because marijuana is a gateway drug. Here’s how this is often portrayed by anti-advocates: Johnny walks out of school and sees a dispensary. The dispensary is using enticing marketing techniques to lure

137 W.D. Hall and M. Lynskey, “Is Cannabis a Gateway Drug?” Drug & Alcohol Review, 24(1) Jan. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16191720. Accessed 26 Jul. 2017.

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Johnny into the store. Johnny is not afraid to consume marijuana because it’s legal now. He purchases marijuana cookies which he enjoys, and after a while starts doing harder drugs. He would never have started with the hard drugs if this marijuana dispensary wasn’t there, the marketing of marijuana wasn’t allowed, and if marijuana remained illegal. This argument sounds a lot like the introduction argument; however, it’s independent of marijuana’s legal status, because the availability leads to escalation route, encompasses all forms of marijuana availability, even under an illegal status. For example, marijuana is illegal, marijuana is available in people’s homes, making it more available to consume, which will lead to an escalation to hard drugs. Based on the Hall and Lynskey study, there’s statistical evidence that people who use cannabis are more likely to accept an offer to use hard drugs. These statistics fuel the idea that if the opportunity to use cannabis increases, it will consecutively increase the opportunity to use hard drugs. According to Hall and Lynskey: Wagner and Anthony also found that opportunities to use cocaine were strongly related to cannabis, alcohol and tobacco use. Only 13% of young people who had not used alcohol, tobacco or cannabis reported an opportunity to use cocaine. This compared with 26% of alcohol and tobacco users, 51% of cannabis only users; and 75% of those who had used alcohol, tobacco and cannabis. Those who had used cannabis were 15 times more likely to accept an offer to use cocaine than those who had not. These relationships did not change when young people who used cocaine within a year of their first opportunity to use were excluded from the analysis. This provides the most direct evidence to date that drug use influences the opportunity to use and the likelihood of accepting the opportunity presumably provided within one’s peer group.138 (Emphasis added) Two examples mentioned in the study show that African American communities used cocaine and heroin before hallucinogens and “pills” because of the widespread availability,139 and that American soldiers in Vietnam used heroin before alcohol because it was more available.140 These examples show that the commonly understood escalation sequence doesn’t follow the classic pattern mentioned in the beginning of this chapter. This strengthens the case that cannabis could be replaced by another drug if it disappeared, basically

138 W.D. Hall and M. Lynskey, “Is Cannabis a Gateway Drug?” Drug & Alcohol Review, 24(1) Jan. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16191720. Accessed 26 Jul. 2017. 139 Ibid. 140 Ibid.

Cannabis Discourse presenting cannabis as a function in the escalation, rather than a substance that caused it. However, this doesn’t mean that today’s route from cannabis to hard drugs is irrelevant. In these examples, harder drugs were used before hallucinogens or alcohol because they were more available, while in most Western countries today, cannabis is much more available than cocaine which in turn becomes more available after consuming cannabis. So, the African American and Vietnam examples are used to show how the social environmental hypothesis is non-causal, but strengthens the relevance of the social environmental hypothesis based on the availability of drugs. Let’s look at an important statement in the study to understand the limitations of the social environmental hypothesis: “Because no measures of propensity to use illicit drugs were included these data do not enable personal characteristics to be excluded as an explanation of the associations.”141. This describes the social environmental hypothesis in a nutshell. We can see that cannabis users are more likely than non-users to use harder drugs through social interactions, although the predispositions to drug use are excluded from the equation. Pharmacological Hypothesis In the gateway drug theory, the battle over what drives the escalation of drug use is waged between the predisposition hypothesis and pharmacological hypothesis – in other words, between our inherent drive to escalate to hard drugs, or whether cannabis pharmacologically causes that escalation. The social environmental hypothesis is simply an outside view of the escalation, independent of what drives it. Now, that being said, there are suggestions that even after statistically controlling for predisposition factors, the predispositions don’t fully explain the link between cannabis and hard drugs: Yamaguchi (1984), for example, found that the relationship between cannabis use and ‘harder’’ illicit drug use was reduced but it still persisted after statistically controlling for pre-existing adolescent behaviours and attitudes, interpersonal factors, and the age of initiation into drug use. They interpreted this as evidence that the relationship between cannabis use and the use of other illicit drugs was causal. The same finding has emerged in other studies.142 In the cannabis discourse, whenever a study shows that predispositions don’t fully explain the escalation to hard drugs, the common interpretation of the conclusion is that the pharmacological hypothesis is strengthened, which

141 Ibid. 142 Ibid.

Jacob Levine strengthens the idea that cannabis is a gateway drug. This form of logic is not flawed per se. These studies narrow in on the pharmacological causality, but they don’t prove it, as there may be factors behind the escalation which were not accounted for. The predispositions to drug use is a very complex matter to isolate. That being said, let’s go through four correlations which suggest the pharmacological causation of the escalation: First, animal studies indicate that common neural pathways underlie the rewarding effects of cannabis, cocaine, heroin and nicotine. All of these drugs act on the dopaminergic neurotransmitter systems that are involved in the ‘reward centres’ in the midbrain, the nucleus accumbens. Second, animal studies indicate that the cannabinioid [sic] and opioid systems in the brain interact with each other, influencing each others’ analgesic and euphoric effects, and producing similar effects on dopaminergic systems in the midbrain. Third, mutant mice in which the CB1 cannabinoid receptor had been knocked out found opioids less rewarding than rats with CB1 receptors. Fourth, studies indicate that the corticotropin-releasing factor which is involved in producing withdrawal symptoms from alcohol, opioids, and cocaine is also released when rats trained to self-administer cannabinoids are treated with a cannabinoid antagonist.143 The same section of the study includes criticism of the research which supports the pharmacological hypothesis. The following part is often used by pro- advocates in some form: There are a number of uncertainties about the relevance of these studies to gateway patterns of adolescent drug use. First, these effects were produced by injecting high doses of cannabinoids whereas most adolescents smoke cannabis. They may be most relevant to the minority of adolescents who use cannabis very heavily; this group would expose themselves to similar doses of THC. Second, the cross- sensitisation between cannabinoids and opioids was symmetrical: that is, animals who were administered opioids were cross-sensitive to cannabinoids and vice versa. This suggests that if opioids were more readily available than cannabis, then opioids would be a gateway to cannabis use.144

143 Ibid. Author changed format to simplify reading. 144 Ibid.

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To conclude, the Hall and Lynskey study suggests that to further investigate the gateway drug theory, we need to conduct: 1. animal tests of pharmacological hypotheses provided that these can be done under conditions that plausibly resemble patterns of cannabis use among young adults; 2. large, well designed intervention studies which test whether preventing or delaying the onset of cannabis use reduces the use of other illicit drugs; 3. more behaviour genetic studies using the discordant twin design to test the roles of shared genes and environment as explanations of the co-occurrence of cannabis and other types of illicit drug use; 4. more rigorous tests (using discordant twin designs and longitudinal epidemiological studies) of the effects that Netherlands drug policy has had on the association between regular cannabis use and the use of other illicit drugs.145 Now that we’ve covered the hypotheses which construct the gateway drug theory, let’s jump into aspects surrounding it. Early Initiation and Regular Use The Hall and Lynskey study sheds light on common misconceptions surrounding the gateway drug theory: One feature of these patterns needs to be stressed: cannabis use per se is not a strong predictor of the use of other drugs. It is the early initiation and regular use of cannabis that are most strongly predictive of the use of other illicit drugs. These facts have implications for two common misinterpretations of the evidence. First, it is mistaken to believe (as the media is wont to do) that a young person who has experimented with cannabis on a small number of occasions is at high risk of using other illicit drugs. Second, contrary to many sceptics, the gateway hypothesis is not refuted by pointing out (as is true) that most cannabis users do not use other illicit drugs.146 (Emphasis added.) This part is based on the popular narrative used by the anti-marijuana and pro-marijuana advocates. Anti-marijuana advocates often play down or avoid mentioning altogether the amount of marijuana used before the escalation to harder drugs. For example, a short opinion piece in the New York Times,

145 Ibid. 146 Ibid.

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“Marijuana Has Proven to Be a Gateway Drug,”147 does not include the amount of marijuana used. It merely assumes the truth of the narrative that any marijuana use is a potential gateway to harder drugs based on the social environmental hypothesis which, as mentioned before, does not claim a causal link. Pro-marijuana advocates very often use the argument “marijuana is not a gateway drug, because most people that consume marijuana don’t escalate to hard drugs.” That, of course, is a bad argument. For example, maybe marijuana pharmacologically caused 1% of marijuana smokers to use hard drugs, which they wouldn’t use without smoking marijuana. Just because the majority doesn’t escalate to hard drugs, doesn’t mean that marijuana can be dismissed as a gateway drug. The Reverse Gateway Drug Theory The reverse gateway drug theory suggests that users of hard drugs, especially opioids, could go on to use a safer alternative, cannabis. The discussion surrounding this theory has been intensified in the midst of today’s opioid crisis taking place in the US. According to the National Institute of Drug Abuse (NIDA), there has been a 2.8-fold increase in opioid overdose deaths from 2002 to 2015. Fentanyl and fentanyl analogue overdose deaths increased from approximately 1,000 to 20,000 between 2000 and 2016.148 On 26 October 2017, President Donald Trump declared the opioid crisis a public health emergency.149 Overdose deaths from other drugs such as cocaine and methamphetamine are also on the rise.150 The graph shown on the following page, also from NIDA, illustrates the severity of this problem.

147 Robert L. DuPont, “Marijuana Has Proven to Be a Gateway Drug,” New York Times, 26 Apr. 2016, https://www.nytimes.com/roomfordebate/2016/04/26/is-marijuana-a-gateway- drug/marijuana-has-proven-to-be-a-gateway-drug. Accessed 26 Nov. 2017. 148 “Overdose Death Rates,” National Institute on Drug Abuse (NIDA), https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed 26 Nov. 2017. 149 J. Johnson and J. Wagner, "Trump Declares the Opioid Crisis a Public Health Emergency,” Washington Post, 26 Oct. 2017, https://www.washingtonpost.com/news/post- politics/wp/2017/10/26/trump-plans-to-declare-the-opioid-crisis-a-public-health-emergency/. Accessed 26 Nov. 2017. 150 “Overdose Death Rates,” National Institute on Drug Abuse (NIDA), https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. Accessed 26 Nov. 2017.

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This is where cannabis enters. The opioid crisis requires creative ways to combat the increasing number of overdose deaths. Yuyan Shi, a professor of public health at the University of California, San Diego, “analyzed hospitalization records from 1997 through 2014 for 27 states, nine of which implemented medical marijuana policies. Her study was the fifth to show declines in opioid use or deaths in states that allow medical cannabis.”151 The same article states, “In a 2014 study, Dr. Marcus Bachhuber found deaths from

151 “Legalized Marijuana Could Help Curb the Opioid Epidemic, Study Finds,” NBC News, 27 Mar. 2017, https://www.nbcnews.com/health/health-news/legalized-marijuana-could-help-curb- opioid-epidemic-study-finds-n739301. Accessed 26 Nov. 2017.

Jacob Levine opioid overdoses fell by 25 percent in states that legalized medical marijuana.” These types of statistics are used by pro-advocates. There are also institutions and individuals opposed to the notion that cannabis should be legalized in order to reduce the opioid crisis. US Attorney General Jeff Sessions, the man behind the famous quote “good people don’t smoke marijuana,” declared for the law enforcement in Virginia, March 15, 2017: I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana – so people can trade one life-wrecking dependency for another that’s only slightly less awful. Our nation needs to say clearly once again that using drugs will destroy your life.152 Robert L. DuPont, president of the Institute for Behavior and Health stated in the New York Times: Legalizing marijuana will have lasting negative effects on future generations. The currently legal drugs, alcohol and tobacco, are two of the leading causes of preventable illness and death in the country. Establishing marijuana as a third legal drug will increase the national drug abuse problem, including expanding the opioid epidemic.153 (Emphasis added.) It’s ironic how one side argues for the legalization of marijuana on the basis of decreasing the opioid epidemic, and the other side is opposed to legalization on the basis that marijuana will increase the opioid epidemic.

Conclusion In the various discussions surrounding this topic, all parties presuppose that there is a common understanding of what constitutes a gateway drug, even though their definitions of it greatly differ. This chapter provides the tools for future discussions surrounding the gateway drug theory, because it separates the three hypotheses from each other, allowing a clear compartmentalization. Take the actual facts included with a pinch of salt. To repeat the aim of this book, it presents what’s going on in today’s cannabis discourse, gives the tools to better understand the topics, and makes you think outside the box of the common narratives surrounding cannabis. Whether cannabis is, or is not, a

152 “Attorney General Jeff Sessions Delivers Remarks…,” Justice News, 15 Mar. 2017, https://www.justice.gov/opa/speech/attorney-general-jeff-sessions-delivers-remarks-efforts- combat-violent-crime-and-restore. Accessed 30 Nov. 2017. 153 Robert L. DuPont, “Marijuana Has Proven to Be a Gateway Drug,” New York Times, 26 Apr. 2016, https://www.nytimes.com/roomfordebate/2016/04/26/is-marijuana-a-gateway- drug/marijuana-has-proven-to-be-a-gateway-drug. Accessed 26 Nov. 2017.

Cannabis Discourse gateway drug (or a reverse gateway drug) has not been fully established. We need more research.

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8 CANNABIS ADDICTION

Introduction There’s a lively debate around the topic of cannabis addiction. Some claim that cannabis addiction is a myth perpetuated by prohibitionists, and some claim that cannabis is as addictive as heroin. For clarity, this chapter is called “cannabis addiction” instead of “marijuana addiction,” because of the official term “cannabis use disorder” established in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Let’s go through the current discussion surrounding cannabis addiction.

Background and Cannabis Use Disorder Now, let’s go through an important piece of background. Before the fifth edition of the DSM, which was released in 2013, individuals with substance use problems fell either into the substance abuse or substance dependence category. Substance dependence was considered a more serious condition than substance abuse. When the DSM-5 was published, the “substance abuse” and “substance dependence” categories merged under the substance use disorder (SUD) blanket.154 Additionally, withdrawal symptoms were added as a criterion for identifying a SUD, and importantly, cannabis was added to the list of substances which can create withdrawal symptoms. The following criteria need to be covered for the patient to be diagnosed with a “cannabis use disorder.” When two to three criteria are met, the cannabis use disorder is considered mild, when four to five are met, it’s considered moderate, and 6+ is considered severe. There is more to the diagnosis than simply checking off these criteria, but they are presented to give a rough picture of what the disorder entails. This section cites a Medscape article,155 that summarizes cannabis use disorder as it is described in DSM-5: Cannabis use disorder, a cannabis-related disorder coded as 305.20 for mild or 304.30 for moderate or severe, is defined by DSM-5 as the following:

154 “Highlights of Changes from DSM-IV-TR to DSM-5,” APA, https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Changes_fr om_DSM-IV-TR_-to_DSM-5.pdf. Accessed 4 Dec. 2017. 155 Lawrence Genen et al., “Cannabis-Related Disorders Clinical Presentation,” Medscape, 23 Mar. 2017, http://emedicine.medscape.com/article/286661-clinical. Accessed 4 Dec. 2017.

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A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12-month period: - Cannabis is often taken in larger amounts or over a longer period than was intended. - There is a persistent desire or unsuccessful efforts to cut down or control cannabis use. - A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects. - Craving, or a strong desire or urge to use cannabis. - Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home. - Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis. - Important social, occupational, or recreational activities are given up or reduced because of cannabis use. - Recurrent cannabis use in situations in which it is physically hazardous. - Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis. - Tolerance, as defined by either a (1) need for markedly increased cannabis to achieve intoxication or desired effect or (2) markedly diminished effect with continued use of the same amount of the substance. - Withdrawal, as manifested by either (1) the characteristic withdrawal syndrome for cannabis or (2) cannabis is taken to relieve or avoid withdrawal symptoms.

Definition of Addiction Today’s general understanding of the term “addiction” in relation to drugs is: a condition where an individual is unable to stop using the drug when confronted with negative consequences resulting from its use. Basically, the difference between an addict and a non-addict is the ability to cease using the drug when confronted with negative consequences from its use.

Confusion Regarding the Term “Dependence” Today, in the context of cannabis, the term “dependence” generally refers to the physiological dependence on cannabis. According to drugabuse.com:

Jacob Levine

In medical terms, dependence specifically refers to a physical condition in which the body has adapted to the presence of a drug. If an individual with drug dependence stops taking that drug suddenly, that person will experience predictable and measurable symptoms, known as a withdrawal syndrome.156 Prior to the establishment of DSM-5, being “dependent” on a drug was synonymous with being (somewhere on the scale of) today’s SUD. Having a substance use disorder and being physiologically dependent on the drug are two separate things. For example, when a patient receives morphine in the hospital as an analgesic for the pain resulting from bone fractures, the patient may become physiologically dependent on the drug, but after leaving the hospital, the patient might stop taking morphine altogether while going through the withdrawal symptoms. Therefore, the patient may be dependent on the drug, but not have a SUD, or be addicted.

Cannabis Withdrawal The withdrawal symptoms resulting from abstaining from cannabis are controversial among the pro-movement, because for many decades now, cannabis has been put on a pedestal of drugs that don’t have the potential of causing physiological dependence. However, the inclusion of cannabis withdrawal symptoms in DSM-5 greatly challenges that belief. According to Medscape, DSM-5 provided the following criteria for cannabis withdrawal: • Irritability, anger or aggression • Nervousness or anxiety • Sleep difficulty (i.e., insomnia, disturbing dreams) • Decreased appetite or weight loss • Restlessness • Depressed mood • At least one of the following physical symptoms causing significant discomfort: abdominal pain, shakiness/tremors, sweating, fever, chills, or headache157

Gambling, A Substance Use Disorder? An interesting development has taken place in recent years: pathological gambling was renamed gambling disorder and was moved from the “Impulse

156 “Understanding Tolerance, Dependence, and Addiction,” Drugabuse.com, https://drugabuse.com/library/tolerance-dependence-addiction/. Accessed 16 Jun. 2018. 157 Lawrence Genen et al., “Cannabis-Related Disorders Clinical Presentation,” Medscape, 23 Mar. 2017, http://emedicine.medscape.com/article/286661-clinical. Accessed 4 Dec. 2017.

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Control Disorders Not Elsewhere Classified” category in DSM-IV to the “Substance-Related and Addictive Disorders” section in DSM-5.158 The rationale behind the move is that gambling disorder shares many similarities with SUDs. In a blog post on the topic of the change, the National Center for Responsible Gaming writes: According to Dr. Charles O’Brien, chair of the Substance-Related Disorders Work Group for DSM-5, brain imaging studies and neurochemical tests have made a “strong case that [gambling] activates the reward system in much the same way that a drug does.” Pathological gamblers report cravings and highs in response to their stimulus of choice; it also runs in families, often alongside other addictions. Neuroscience and genetics research has played a key role in these determinations.159 The rationale behind moving gambling disorder to the “Substance-Related and Addictive Disorders” section could possibly, in the future, be applied to other behaviors. One can imagine adrenaline junkies who can’t stop putting themselves in dangerous situations as having a SUD. Sex addicts may fall under the SUD spectrum. The line between certain behaviors and SUDs may become more and more ambiguous. The rationale of placing gambling disorder in the substance category greatly reflects today’s arguments used by the pro- movement. Let’s go through the arguments used by pro and anti-marijuana advocates, in regard to cannabis addiction.

Pro and Anti Arguments Pro Side Very often, pro-advocates would compare cannabis with alcohol, claiming that cannabis is not as dangerous because it doesn’t cause withdrawal symptoms, hence has a low potential for addiction. Pro-advocates often separated between physiological and psychological dependence, claiming that cannabis can only be correlated with psychological dependence, without any potential of causing physiological dependence. Since withdrawal symptoms resulting from cannabis abstinence were added to the DSM-5, it’s hard to argue that cannabis

158 C.J. Rash, J. Weinstock, and R. Van Patten, “A Review of Gambling Disorder and Substance Use Disorders,” Substance Abuse and Rehabilitation, 7, 17 Mar. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803266/. Accessed 6 Dec. 2017. 159 “The Evolving Definition of Pathological Gambling in the DSM-5,” National Center for Responsible Gaming, 19 May. 2013, http://blog.ncrg.org/blog/2013/05/evolving-definition- pathological-gambling-dsm-5. Accessed 6 Dec. 2017.

Jacob Levine use doesn’t cause physiological dependence. Pro-advocates who adopted the changes made in DSM-5, who believe that cannabis has a potential for developing physiological dependence and addiction compare cannabis to other legal substances and activities. Here’s the classic narrative of this argument: “We can eat addictive cheeseburgers, and wash them down with addictive soft drinks. We can watch addictive TV series, before taking our addictive sleeping pills. We go to casinos and immerse ourselves in addictive gambling, while ordering addictive alcoholic drinks. We engage in addictive sex, we jump from airplanes to get our adrenaline fix, after which we smoke an addictive cigarette to cool down the nerves, but cannabis, which has never caused any overdose deaths is illegal because it’s an addictive substance?” The point is that these potentially addictive substances and activities are legal, and they can be much more dangerous for the individual and society than cannabis addiction. Here are some real-life examples of people using this argument: People say “Well you can abuse marijuana.” Well shit you can abuse cheeseburgers too. Ya know, you don’t go around closing Burger King because you can abuse something. I can take a fuckin’ fork and jam it in my eyeball. Does that mean forks should be illegal? Ya know, I could jump off a bridge, should we outlaw bridges?160 —Joe Rogan You can’t compare cannabis with opiates or alcohol. Especially the alcohol addicts can have severe withdrawal symptoms. But you will not have those with marijuana.161 —Dr. Lester Grinspoon We now know that while estimates vary, marijuana leads to dependence in around 9 to 10% of its adult users. By comparison, cocaine, a schedule 2 substance “with less abuse potential than schedule 1 drugs” hooks 20% of those who use it. Around 25% of heroin users become addicted. The worst is tobacco, where the number

160 Joe Rogan in “The Culture High” (2014), IMDb, http://www.imdb.com/title/tt1778338/. Accessed 5 Dec. 2017. 161 Quoted in Patrick Dewals, “Marijuana, Reconsidered: Dr. Lester Grinspoon on 45 Years of Cannabis Science,” 25 Sep. 2015, Mint Press News, http://www.mintpressnews.com/MyMPN/marijuana-reconsidered-an-interview-with-doctor- lester-grinspoon/. Accessed 5 Dec. 2017.

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is closer to 30% of smokers, many of whom go on to die because of their addiction.162 —Dr. Sanjay Gupta Anti Side The anti-legalization movement rarely compares cannabis addiction directly to alcohol and tobacco because these substances are considered more addictive and are currently legal. The comparison is often made with illegal drugs like heroin or cocaine, or cannabis addiction is simply presented in its own right. If the comparison with tobacco and alcohol is unavoidable, the arguments of the anti-movement fall on the introduction argument “yes alcohol and tobacco are addictive and dangerous, but why should we introduce an additional dangerous drug on the market?” Also, the gateway drug theory is layered on the introduction argument: “maybe cannabis addiction is not as dangerous as alcohol and tobacco addiction; however, cannabis is a gateway drug to opioids such as morphine and heroin (basing it on the social environmental hypothesis).” As US Attorney General Jeff Sessions put it: “And I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana – so people can trade one life-wrecking dependency for another that’s only slightly less awful.”163 Another argument often used by the anti-movement, is that today’s marijuana is much more potent compared with the marijuana grown a few decades ago. This potency shift is used to promote the idea that marijuana is much more addictive now: As weed gets stronger, the body is exposed to higher levels of THC that can cause stronger effects. Negative side effects are amplified as well. Since THC is stored in fat tissues, stronger weed stores more THC in fat tissues per gram smoked than the stuff from 20 or 30 years ago. Many researchers agree that the more potent a strain is the more apt to becoming addicted a person is.164

162 Dr. Sanjay Gupta, “Why I Changed My Mind on Weed,” CNN, 8 Aug. 2013, http://www.cnn.com/2013/08/08/health/gupta-changed-mind-marijuana/index.html. Accessed 5 Dec. 2017. 163 “Attorney General Jeff Sessions Delivers Remarks…,” Justice News, 15 Mar. 2017, https://www.justice.gov/opa/speech/attorney-general-jeff-sessions-delivers-remarks-efforts- combat-violent-crime-and-restore. Accessed 30 Nov. 2017. 164 Jon McKee, "Is Weed Getting Stronger and More Addictive?” QuitMarijuana.org, 30 Jan. 2015, http://quitmarijuana.org/blog/weed-stronger-addictive/. Accessed 8 Dec. 2017.

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Conclusion The roots of the discussion surrounding cannabis addiction stem from the historical comparison between cannabis and harder drugs like cocaine and heroin. The propaganda first used in the 1930s greatly contributed to this comparison, as well as the language itself. Marijuana is called a drug, just like heroin, and being under the influence of marijuana is called being “high,” just as with heroin. Therefore, the “nature” of this discussion of whether cannabis is addictive or not, and what problems this addiction may present, needs to be seen from the perspective of how cannabis is tied by its policy history and semantics with hard drugs, independent of its physiological effects. In the coming years, our perception of substance abuse in general may shift considering that Gambling Disorder made its way into the “Substance- Related and Addictive Disorders.” Perhaps this will catalyze the comparison between addictive substances and addictive behaviors, and generate a more encompassing and rational discussion.

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9 ADOLESCENT CANNABIS USE

Introduction Discussing adolescent cannabis use is clearly a sensitive topic. Parents fear that with the growing popularity and legalization of cannabis, the consumption rates will increase. These fears arise in part from an abundance of blogs and articles, celebrities and politicians, who say that cannabis is virtually harmless. Even though all parties agree that adolescent cannabis use needs to be prevented, there is disagreement over the approach to tackling this issue. In this chapter, the zero-tolerance approach and more progressive prevention programs will be presented. Additionally, the question of preventing accidental ingestion of cannabis by infants and children will be covered.

Studies Many studies are cited on the effects of cannabis on adolescents, and these citations can be twisted in either direction. However, in this case, all sides agree that cannabis use should be prevented or at least delayed until the adolescent brain reaches full maturity. Nobody cites studies to support a claim that cannabis is harmless for adolescents, because it would be extremely controversial in today’s political climate, and based on today’s consensus among scientists, it would be untrue. A study conducted in New Zealand by M.H. Meier with colleagues,165 published in 2012, is considered the most thorough study conducted on the long-term effects of cannabis use on the adolescent brain. The researchers studied 1,037 participants born between 1972 and 1973. From the age of 13 until 38, the participants’ IQ was systematically assessed together with cannabis use patterns. The drop of IQ amounted to “an average of 8 points for those who met criteria for cannabis dependence.”166 A study conducted by Ole Rogeberg criticizes the “New Zealand” study for not considering the socio-economic status (SES) of the participants.167 This

165 M.H. Meier et al., “Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife,” Proceedings of the National Academy of Sciences 109(40), 2 Oct. 2012, https://www.ncbi.nlm.nih.gov/pubmed/22927402. Accessed 10 Apr. 2018. 166 Nora D. Volkow, “Marijuana's Lasting Effects on the Brain,” National Institute on Drug Abuse, 10 Sep. 2012, https://www.drugabuse.gov/about-nida/directors-page/messages- director/2012/09/marijuanas-lasting-effects-brain. Accessed 18 Sep. 2017. 167 Ole Rogeberg, “Correlations between Cannabis Use and IQ Change in the Dunedin Cohort Are Consistent with Confounding from Socioeconomic Status,” Proceedings of the National Academy of Sciences 110(11), 12 Mar. 2013, http://www.pnas.org/content/110/11/4251.abstract. Accessed 18 Sep. 2017.

Jacob Levine study, in turn, was criticized by PNAS in a letter published in 2013,168 on the basis that SES does not stand as a confounding variable, “because adolescent cannabis use was not more prevalent in populations with lower SES.”169 This shows that depending on one’s agenda, the appropriate citation from the relevant research can be used. The following example from the Safety First document by Marsha Rosenbaum was included in the previous chapter, but let’s look at it from a different perspective. She states: More recent research, however, including a 2014 study of 2,600 young people, has found that when taking into account socioeconomic factors such as environment, poverty, poor nutrition, parenting style, mental health, and alcohol use, the association between moderate marijuana use and IQ largely disappears.170 (Emphasis added.) This quote responds to the common anti-marijuana message that any teenage cannabis use will result in a drop of up to 8 IQ points, by presenting that moderate use does not result in the same deleterious effects.

Legalization of Cannabis and Adolescents Let’s go through the most common pro and anti-legalization arguments presented in today’s discourse surrounding adolescent cannabis use. The weight of the sources should be seen here as irrelevant, as the following examples simply present the common arguments and narratives. Anti-Legalization Arguments If cannabis consumption becomes legal, it will show adolescents that there is nothing wrong with smoking pot, which will increase consumption rates. A Feb. 25 study published in the International Journal of Drug Policy171 found that about 10 percent of high school students who would otherwise be at a low risk for picking up a pot-smoking habit – which includes those who don’t smoke cigarettes, students with strong

168 T. Moffitt, et al., “Reply to Rogeberg and Daly,” Proceedings of the National Academy of Sciences, 110(11), 12 Mar. 2013, http://www.pnas.org/content/110/11/E980.full.pdf. Accessed 18 Sep. 2017. 169 Nora D. Volkow, “Marijuana's Lasting Effects on the Brain,” National Institute on Drug Abuse, Mar. 2013, https://www.drugabuse.gov/about-nida/directors-page/messages- director/2012/09/marijuanas-lasting-effects-brain. Accessed 18 Sep. 2017. 170 Marsha Rosenbaum, “Safety First A Reality-Based Approach to Teens and Drugs,” 2014, http://www.drugpolicy.org/sites/default/files/DPA_SafetyFirst_2014_0.pdf. 171 “International Journal of Drug Policy - Elsevier.” https://www.journals.elsevier.com/international-journal-of-drug-policy/. Accessed 14 Dec. 2017.

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religious beliefs and those with non-marijuana smoking friends – say they would use marijuana if it was legal.172 If cannabis consumption becomes legal, vicious marketing campaigns will target teenagers to purchase cannabis products, which will increase consumption rates. Opponents of legalization cite a number of concerns specifically about youth and young adults. For example, there is significant concern that the legalization of marijuana will open the floodgates of marketing, with much of that being subtle marketing toward youth, even though any such legalization laws would be expected to apply only to adults older than either 18 or 21 years. The experience with the alcohol and tobacco industries, which use subtle and creative messaging directed at youth, has been cited as one of the reasons that alcohol and tobacco are used at such high rates by adolescents and young adults, and it is feared that similar marketing strategies would contribute to increased rates of use and dependence by adolescents.173 The statistics show that cannabis use has increased among youth in states where marijuana has been legalized. The safety of young people has been severely compromised, not just in Colorado, but any state that legalizes recreational or medicinal marijuana has higher youth use rates than states that don’t, we’ve seen an overall increase in youth use rates in Colorado since medicinal and recreational marijuana have been legalized. We’re still number one or number two, depending on the study you look at, for youth use rates in the country by nearly every measure.174 Pro-Legalization Arguments Adolescents already have almost unlimited opportunities to get hold of cannabis even under strict prohibition, hence the consumption rates are unlikely to rise.

172 Michele Castillo, “Will Legalization Lead to More Teens Smoking Pot?” CBS News, 26 Feb. 2014, https://www.cbsnews.com/news/marijuana-legalization-may-lead-more-teens-to-smoke- pot/. Accessed 14 Dec. 2017. 173 Seth Ammerman et al., “The Impact of Marijuana Policies on Youth: Clinical Research and Legal Update,” Pediatrics 135(3), Mar. 2015, http://pediatrics.aappublications.org/content/135/3/e769. Accessed 14 Dec. 2017. 174 Jeff Hunt, quoted in “Marijuana Symposium Debate – Centennial Institute,” – YouTube, 6 Oct. 2017, https://www.youtube.com/watch?v=N2wNQst4pFs. Accessed 14 Dec. 2017.

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There’s a simple reason why legalization may not be having much of an effect on teen marijuana use – adolescents already report that marijuana is widely available. Nationally, roughly 80 percent of 12th- graders say that pot is easy to get. The kids who want to smoke weed are probably already doing so – and legalization would do little to change that.175 The prohibition harms teenagers because criminal records pose serious future problems. Hundreds of thousands of youth have been arrested or put in jail for using marijuana. Having a criminal record can make it hard or impossible to get college loans, financial aid, housing, and certain kinds of jobs.176 Enforcing the marijuana prohibition costs fortunes and prevents the vast resources to be accumulated, which could be used for drug prevention programs for teenagers. In 2016, the state [of Colorado] raised an additional $117 million through the rest of its pot revenue, made up of marijuana license and application fees, sales taxes, and the excise tax. That other money was allocated to the Marijuana Tax Cash Fund, which is largely used for health care, education, drug treatment, drug prevention.177 Statistically, marijuana use has dropped among adolescents since legalization. In 2016, rates of marijuana use among the nation’s 12- to 17-year-olds dropped to their lowest level in more than two decades, according to federal survey data released this week. Last year, 6.5 percent of adolescents used marijuana on a monthly basis, according to the latest National Survey on Drug Use and Health. That represents a statistically significant drop from 2014, when the nation’s first recreational marijuana shops opened in Washington state and Colorado.178

175 Christopher Ingraham, “Now We Know What Happens to Teens When You Make Pot Legal,” Washington Post, 21 Jun. 2016, https://www.washingtonpost.com/news/wonk/wp/2016/06/21/colorado-survey-shows-what- marijuana-legalization-will-do-to-your-kids/. Accessed 14 Dec. 2017. 176 Claire McCarthy, “Legalizing Marijuana Not Good for Kids: AAP Policy Explained,” HealthyChildren.org, 26 Jan. 2015, https://www.healthychildren.org/English/ages- stages/teen/substance-abuse/Pages/legalizing-marijuana.aspx. Accessed 16 Dec. 2017. 177 German Lopez, “Marijuana Taxes are Giving Colorado a Pot of Money to Rebuild its Crumbling Schools,” Vox, 12 Jul. 2017, https://www.vox.com/policy-and- politics/2017/7/12/15956742/colorado-marijuana-taxes-schools. Accessed 16 Dec. 2017. 178 Christopher Ingraham (The Washington Post) “Teen Marijuana Use Falls to 22-Year Low, Federal Report Says,” reprinted in The Cannabist, 7 Sep. 2017,

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Countries where marijuana is legal, like in the Netherlands, show that adolescents won’t go crazy for marijuana after it becomes legalized. The Dutch have about 700 adults-only clubs that sell 50 to 150 metric tons of cannabis per year, yet Dutch teens report lower levels of weed usage and availability than youth in the United States.179

Drug Prevention After the Harrison Tax Act and the Marihuana Tax Act were established, the main prevention tactic targeting the demand side was the zero-tolerance mandate, which commands adolescents to “just say no” to drugs. The zero- tolerance message is “drugs are evil, using drugs will make you an addict, you’ll drop out of school, become mad, insane, stupid, lazy, you’ll become a crackhead in no time, you’ll go broke, eat from dirty trash cans, if someone offers you drugs, just say no!” This approach escalated during the 80s with Nancy Reagan’s “Just Say No” campaign, and D.A.R.E (Drug Abuse Resistance Education) created in 1983 by the Los Angeles Police Department.180 These programs were mostly targeted toward teenagers and kids. The zero-tolerance approach is criticized for being ineffective and even dangerous. According to the American Psychological Association: Zero tolerance has not been shown to improve school climate or school safety. Its application in suspension and expulsion has not proven an effective means of improving student behavior. It has not resolved, and indeed may have exacerbated, minority overrepresentation in school punishments. Zero tolerance policies as applied appear to run counter to our best knowledge of child development.181 Marsha Rosenbaum writes, “The abstinence-only mandate puts adults in the unenviable position of having nothing to say to the young people we need most

http://www.thecannabist.co/2017/09/07/teen-marijuana-use-decline/87535/. Accessed 16 Dec. 2017. 179 David Downs, “Going Dutch: Teen Marijuana Use in the US vs. Netherlands,” East Bay Express, 22 Sep. 2011, https://www.eastbayexpress.com/LegalizationNation/archives/2011/09/22/going-dutch-teen- marijuana-use-in-the-us-vs-netherlands-the-full-interview-with-cal-professor-robert-maccoun. Accessed 24 Dec. 2017. 180 “D.A.R.E. America,” https://www.dare.org/. Accessed 24 Sep. 2017. 181 American Psychological Association Zero Tolerance Task Force, “Are Zero Tolerance Policies Effective in the Schools?” American Psychological Association, https://www.apa.org/pubs/info/reports/zero-tolerance.pdf. Accessed 26 Dec. 2017.

Jacob Levine to reach.”182 What she meant by this quote, is that by telling young people to simply abstain from drugs, the conversation ends there, which prevents a dialogue and ignores the reality of young people who are surrounded by drugs. For example, if a teenager asks an adult “what is the lethal dose of MDMA?” and the adult says, “just say no to MDMA,” the teenager will not know the lethal dosage of MDMA with which the teenager wants to experiment, regardless of the adult’s command not to use it. More progressive programs are rising to the surface, and they have the following assumptions: while we strictly don’t want teenagers to use drugs, the reality is that some teenagers will use drugs whether their loved ones approve of it or not, drugs are everywhere, zero-tolerance campaigns do more harm than good, and therefore we need to minimize the harms of drug use by using a reality-based harm-reduction approach. To illustrate the typical themes of progressive drug prevention programs, let’s go through a letter written by Marsha Rosenbaum for her son, Johnny: Dear Johnny, This fall you will be entering high school and, like most American teenagers, you’ll have to navigate drugs. As most parents, I would prefer that you not use drugs. However, I realize, that despite my wishes, you might experiment. I will not use scare tactics to deter you. Instead, having spent the past 25 years researching drug use, abuse and policy, I will tell you a little about what I have learned, hoping this will lead you to make wise choices. My only concern is your health and safety. When people talk about “drugs,” they are generally referring to illegal substances such as marijuana, cocaine, methamphetamine (speed), psychedelic drugs (LSD, Ecstasy, “Shrooms”) and heroin. These are not the only drugs that make you high. Alcohol, cigarettes and many other substances (like glue) cause intoxication of some sort. The fact that one drug or another is illegal does not mean one is better or worse for you. All of them temporarily change the way you perceive things and the way you think. Some people will tell you that drugs feel good, and that’s why they use them. But drugs are not always fun. Cocaine and methamphetamine speed up your heart; LSD can make you feel disoriented; alcohol intoxication impairs driving; cigarette smoking leads to addiction and

182 Marsha Rosenbaum, “Safety First A Reality-Based Approach to Teens and Drugs,” 2014, http://www.drugpolicy.org/sites/default/files/DPA_SafetyFirst_2014_0.pdf.

Cannabis Discourse sometimes lung cancer; and people sometimes die suddenly from taking heroin. Marijuana does not often lead to physical dependence or overdose, but it does alter the way people think, behave and react. I have tried to give you a short description of the drugs you might encounter. I choose not to try to scare you by distorting information because I want you to have confidence in what I tell you. Although I won’t lie to you about their effects, there are many reasons for a person your age not to use drugs or alcohol. First, being high on marijuana or any other drug often interferes with normal life. It is difficult to retain information while high, so using it, especially daily, affects your ability to learn. Second, if you think you might try marijuana, please wait until you are older. Adults with drug problems often started using at a very early age. Finally, your father and I don’t want you to get into trouble. Drug and alcohol use is illegal for you, and the consequences of being caught are huge. Here in the United States, the number of arrests for possession of marijuana has more than doubled in the past six years. Adults are serious about “zero tolerance.” If caught, you could be arrested, expelled from school, barred from playing sports, lose your driver’s license, denied a college loan and/or rejected from college. Despite my advice to abstain, you may one day choose to experiment. I will say again that this is not a good idea, but if you do, I urge you to learn as much as you can, and use common sense. There are many excellent books and references, including the Internet, that give you credible information about drugs. You can, of course, always talk to me. If I don’t know the answers to your questions, I will try to help you find them. If you are offered drugs, be cautious. Watch how people behave, but understand that everyone responds differently even to the same substance. If you do decide to experiment, be sure you are surrounded by people you can count upon. Plan your transportation and under no circumstances drive or get into a car with anyone else who has been using alcohol or other drugs. Call us or any of our close friends any time, day or night, and we will pick you up, no questions asked and no consequences. And please, Johnny, use moderation. It is impossible to know what is contained in illegal drugs because they are not regulated. The majority

Jacob Levine

of fatal overdoses occur because young people do not know the strength of the drugs they consume, or how they combine with other drugs. Please do not participate in drinking contests, which have killed too many young people. Whereas marijuana by itself is not fatal, too much can cause you to become disoriented and sometimes paranoid. And of course, smoking can hurt your lungs, later in life and now. Johnny, as your father and I have always told you about a range of activities (including sex), think about the consequences of your actions before you act. Drugs are no different. Be skeptical and, most of all, be safe. Love, Mom183 The main argument against the progressive prevention approach, and the institutions that create and support these programs, is that they enable and justify drug use. The International Task Force on Strategic Drug Policy document, presents under the section “Two Major Global Threats to Reducing Drug Demand Identified” the classic counter-argument against the progressive harm-reduction prevention programs: A multi-million-dollar lobby seeking to accommodate drug use through political advocacy for so-called “harm reduction” and/or drug legalization policies. Task Force members declare it a gross violation of human rights and individual dignity to adopt policies that accept, encourage and/or enable illegal drug use.184

Children When it comes to children and infants, the main concern is the attractiveness and appeal of edibles. The main statistics used to present this problem are the ER visits resulting from children ingesting edibles. Here are two quotes from “Unintentional Pediatric Exposures to Marijuana in Colorado, 2009–2015” study, which is often used by the anti-legalization movement. Annual RPC pediatric marijuana cases increased more than 5-fold from 2009 to 2015.

183 Marsha Rosenbaum, “A Mother’s Advice About Drugs,” San Francisco Chronicle, September 7, 1998, https://www.sfgate.com/opinion/openforum/article/A-Mother-s-Advice-About-Drugs- 2991952.php. Accessed 24 Sep. 2017. 184 International Task Force on Strategic Drug Policy, “A New Approach to Reduce Drug Demand,” Feb. 2005, https://dfaf.org/assets/docs/A%20New%20Approach%20to%20Reduce.pdf. Accessed 2 Jan. 2018.

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Pharmaceuticals and household products still account for most toddler exposures because they are much more common and available in the household. However, as marijuana becomes more available, exposures may continue to increase.185 It’s generally understood that we don’t want to attract children and teenagers to cannabis products. Therefore, regulations are being put forward in Colorado, and other legal states, to decrease the attractiveness factor of cannabis products. This includes prohibiting the sale of strains with names such as “Cinderella 99,” “Girl Scout Cookies,” and “Candyland.”186 Additionally, edibles should not have the shape, color, and smell which is considered attractive to kids. Sam Méndez, Executive Director, Cannabis Law & Policy Project, created a report187 for the Washington State Liquor and Cannabis Board that suggests which edibles children might be attracted to, with the aim of preventing any accidents.

185 G.S. Wang, M-C. Le Lait, and S.J. Deakyne, “Unintentional Pediatric Exposures to Marijuana in Colorado, 2009–2015,” JAMA Pediatrics 170(9) 6 Sep. 2016, https://jamanetwork.com/journals/jamapediatrics/fullarticle/2534480. Accessed 2 Jan. 2018. 186 “OLCC Deems Strain Names Unsuitable for Children,” Mrs. Nice Guy, 25 Oct. 2016, http://www.mrsniceguy.com/olcc-deems-strain-names-unsuitable-children/. Accessed 25 Sep. 2017. 187 S. O’Connor and S. Méndez, “Concerning Cannabis-Infused Edibles: Factors That Attract Children to Foods,” Cannabis Law and Policy Project, University of Washington School of Law, 28 Jun. 2016, https://lcb.wa.gov/publications/Marijuana/Concerning-MJ-Infused-Edibles- Factors-That-Attract-Children.pdf. Accessed 25 Sep. 2017.

Jacob Levine

10 MEDICAL MARIJUANA

Cannabis is currently being used to alleviate various medical symptoms like nausea, pain, anxiety, lack of appetite, and depression. Scientists and physicians are coming around and questioning the stigma against cannabis that has dominated for nearly a century. Countries such as Germany, The Netherlands, Spain, and many others prescribe cannabis and its extracts for various ailments. The media discussion surrounding the topic of medical marijuana is absolutely enormous. This chapter aims to summarize some of the most prevalent medical conditions discussed in connection with marijuana.

What Is Medical Marijuana? There are several interpretations of the term “medical marijuana,” which describes cannabis used with the intention of alleviating medical conditions and symptoms. It can also refer to very potent marijuana, cannabis products, and synthetic cannabis, developed by companies with special pharma licenses. It can also mean “cannabis prescribed by the doctor.” This chapter will mostly deal with the first definition, because it includes all types of cannabis and extracts used for medical purposes.

History of Medical Marijuana Today, we can find medical marijuana in dispensaries, coffeeshops, cannabis clubs, pharmacies, and on the black market. Currently, the medical marijuana market is growing exponentially, because products containing CBD are being heavily marketed, and laws surrounding cannabis use are loosening throughout the US and other countries as well. GW Pharmaceuticals are developing pharmaceutical cannabis extracts for patients; CBD-infused lollipops, gummies, and teas can be found on shelves of dispensaries; a growing number of websites feel permitted to spread information about cannabis’s healing powers; even black market dealers are beginning to sell specific cannabis products for specific ailments. But how did this medical marijuana revolution emerge after decades of intense prohibition? In terms of the earliest documentation of medical marijuana, many blogs and articles reference an ancient Chinese emperor, Shen Nung (circa 2698 BCE), who allegedly used the word ma (Chinese for hemp) in the original Chinese pharmacological book. Even though this origin in particular is often disputed, it’s generally accepted that medical marijuana goes back to ancient China. Medical marijuana is nothing new. People were using it for centuries if not millennia to alleviate various medical symptoms.

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O’Shaughnessy is considered the pioneer of modern medical marijuana research. As mentioned previously, he extensively researched the effects of marijuana on various conditions during the 1830s, which resulted in the introduction of cannabis-based medicines in the West. More than a century later, a scientific breakthrough took place at the Hebrew University in 1964, which is retrospectively of immense importance, when Dr. Raphael Mechoulam and his colleague Dr. Yechiel Gaoni were the first to extract THC from cannabis.188 After the first THC extract was made, scientists were able to identify its effects. In 1988, William Devane, Allyn Howlett, and co-researchers, discovered that THC binds to certain receptors in rats’ brains. These receptors were coined as cannabinoid receptors. In 1990, Lisa Matsuda announced that together with her co-workers, they pinpointed the DNA sequence which produces these cannabinoid receptors. Based on this scientific breakthrough, scientists were able to clone cannabinoid receptors and sculpt molecules that would “lock into” these receptors. Also, scientists were now able to remove the cannabinoid receptors from rats’ brains, allowing a more targeted evaluation of the function of these receptors.189 Now, the question arose: something needs to be naturally produced in the body that binds to these receptors; otherwise, they wouldn’t be there, so what is it?190 That’s when Mechoulam, in collaboration with William Devane and Dr. Lumir Hanus, discovered the first endocannabinoid which was named “anandamide,” after the word “ananda” which means “bliss” in Sanskrit texts.191 This led to the discovery of our endocannabinoid system, which is beginning to be widely researched and studied. The International Cannabinoid Research Society192 publish news on a regular basis on the discoveries surrounding the endocannabinoid system.

Why Is Medical Marijuana Such a Big Deal? Why is medical marijuana such a big deal in today’s discourse in comparison with other plant-derived remedies or pharmaceuticals? From the medical and

188 M.A. Lee, “The Discovery of the Endocannabinoid System,” BeyondTHC, http://www.beyondthc.com/wp-content/uploads/2012/07/eCBSystemLee.pdf. Accessed 25 Feb. 2018. 189 W.A. Devane et al., “Determination and Characterization of a Cannabinoid Receptor in Rat Brain,” Molecular Pharmacology 34(5) Nov. 1988, https://www.ncbi.nlm.nih.gov/pubmed/2848184. Accessed 4 Feb. 2018. 190 “Science Explains How Cannabis Kills Cancer Cells,” CBD-Healthcare News, https://www.youtube.com/watch?v=5RtRil2ND-E&t=242s Accessed 14 Jan. 2018. 191 M.A. Lee, “The Discovery of the Endocannabinoid System,” BeyondTHC, http://www.beyondthc.com/wp-content/uploads/2012/07/eCBSystemLee.pdf. Accessed 25 Feb. 2018. 192 “International Cannabinoid Research Society,” http://icrs.co/. Accessed 13 Jan. 2018.

Jacob Levine financial stance, cannabis could potentially replace a gargantuan chunk of the pharmaceutical market. That’s because an increasing number of people consider medical marijuana a safer alternative than many of the currently prescribed drugs. Cannabis contains analgesic (pain relieving) properties. Analgesics are prescribed for pain resulting from chemotherapy, broken bones, muscle pain, nerve pain, migraines, etc. It’s estimated that around 91.8 million Americans used prescription opioids, which function as analgesics, in 2015.193 Today, it’s rarely disputed that cannabis, the use of which results in virtually no overdose deaths,194 is a safer alternative to opioids. This is huge, especially for the US which is in the midst of an opioid crisis, which as mentioned previously, may help fuel the legalization of marijuana. Additionally, cannabis and its extracts are currently being prescribed for epilepsy; to help alleviate the nausea that comes with chemotherapy; to increase appetite for AIDS patients; to treat different types of anxiety problems; for PTSD patients to minimize the amount of prescribed medicines; and for depression, which is a big deal considering that according to the National Center for Health Statistics, between 2011–2014, 12.7% of people aged over 12 have used an antidepressant during the previous month.195 Additionally, there’s an entire discussion surrounding cannabis's effects on cancer and chemotherapy, which is a huge discussion in its own right. There are also other medical conditions and symptoms for which cannabis is being used, like Crohn’s disease, arthritis, MS, and many others.

Illegality of Marijuana Hinders Research Since marijuana falls in the Schedule I category, it has “no currently accepted medical use” under federal law,196 which hinders scientists from conducting research on the compound. There’s a general consensus that rescheduling cannabis down to at least the Schedule II category will provide a green light for scientists to research the plant’s medical efficacy. Currently, in the US, scientists need to go through a lengthy process to obtain federally legal cannabis by filing for a special license from the Drug Enforcement

193 B. Han et al., “Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults,” Annals of Internal Medicine, 5 Sep. 2017, http://annals.org/aim/article-abstract/2646632/prescription- opioid-use-misuse-use-disorders-u-s-adults-2015. Accessed 13 Jan. 2018. 194 The exact quote is “fatalities directly attributable to cannabis are rare.” “Cannabis drug profile,” European Monitoring Centre for Drugs and Drug Addiction, 8 Jan. 2015, http://www.emcdda.europa.eu/publications/drug-profiles/cannabis. Accessed 28 Nov. 2017. 195 L.A. Pratt et al., “Antidepressant Use Among Persons Aged 12 and Over: United States, 2011–2014,” National Center for Health Statistics, 15 Aug. 2017, https://www.cdc.gov/nchs/products/databriefs/db283.htm. Accessed 4 Feb. 2018. 196 “Drug Scheduling,” Drug Enforcement Administration, https://www.dea.gov/druginfo/ds.shtml. Accessed 4 Feb. 2018.

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Administration (DEA).197 When this license is obtained, applicants receive powdered cannabis produced at the University of Mississippi. According to Susan Sisley MD, the quality of this powdered cannabis barely mimics the product consumed in the real world.198 The reason pro-marijuana advocates from across the world focus on the US scheduling system, is because there’s an understanding that the US has the framework to revolutionize medical marijuana research, which will then catalyze research around the world. Synthetic Cannabis We’ve already covered phytocannabinoids and endocannabinoids, but there’s also a third category, synthetic cannabinoids, which are lab-designed cannabinoids that interact with our cannabinoid receptors. Cesamet (Nabilone) and Marinol (Dronabinol) are synthetic cannabinoid pharmaceuticals, used for scientific research and medical use. There are also phytocannabinoid pharmaceuticals extracted from the plant itself, such as Sativex199 which contains a mix of THC and CBD, and Epidiolex which contains only CBD.200201 Natural vs. Pharmaceutical Cannabis There’s a debate between the use of “pharmaceutical cannabis” and “natural cannabis” for medical purposes. The argument for “pharmaceutical cannabis” is that it’s crucial to only use FDA approved, pharmaceutical grade cannabis, because it can be identically replicated, making research on its effects much more consistent. Cannabis plants differ from one another in their cannabinoid and terpene profiles. Even when the plants are cloned, containing the same genotype, divergent environmental conditions may produce unique chemical profiles, which is not something that researchers want. Let’s say that the White Widow strain worked wonders for subject A, but not subject B; what was the chemical composition of that strain, and if determined, how can it be exactly

197 “Marijuana Research,” University of Mississippi School of Pharmacy, https://pharmacy.olemiss.edu/marijuana/. Accessed 25 Feb. 2018. 198 7:50 “Science and Medicine of Cannabis: Coping with PTSD,” MJIC Media, YouTube, 17 Feb. 2017, https://www.youtube.com/watch?v=1RZ1IRCTV7g. Accessed 25 Feb. 2018. 199 “Sativex (delta-9-tetrahydrocannabinol and cannabidiol),” GW Pharmaceuticals, https://www.gwpharm.com/products-pipeline/sativex-delta-9-tetrahydrocannabinol-and- cannabidiol. Accessed 24 Jan. 2018. 200 “For Patients: GW’s Epidiolex® Clinical Program,” GW Pharmaceuticals, https://www.gwpharm.com/epilepsy-patients-caregivers/patients. Accessed 28 Jan. 2018. 201 The main difference between cannabis pharmaceuticals and regular cannabis extracts, like BHO or RSO, is that the former is controlled by pharmaceutical companies, can be identically replicated, and are intended solely for medical purposes. Regular cannabis extracts tend to vary from batch to batch in their chemical makeup and are used for both recreational and medical use.

Jacob Levine replicated? Pharmaceutical grade THC and CBD, whether plant-derived or synthetic, are often used in research because their contents and dosage can be controlled, which will provide more valid readings of their efficacy. The argument for using “natural cannabis” is that the plants’ medical efficacy comes from the interaction between myriad cannabinoids, terpenes, and other compounds, which produce the “entourage effect.” Therefore, simply isolating THC and/or CBD may lead to false conclusions about the efficacy of cannabis in medical treatments. There’s a famous YouTube clip of a woman who got herself injected with pure THC, which resulted in anxiety and paranoia, but when injected with THC mixed with another cannabinoid, most likely CBD, she felt great and was giggling a lot.202 Now, let’s go through various medical conditions for which medical cannabis is being used as a treatment. The main narratives and discussions surrounding each condition will be presented, which by no means covers the entire topic and connections between cannabis and the respective condition.

Medical Uses Cancer Let’s begin with the most prevalent topic on the list, the connection between cannabis and cancer. This topic has gained much momentum with scientists like Dr. Donald Tashkin,203 Dr. Prakash Nagarkatti,204 Dr. Manuel Guzmán,205 and Dr. Christina Sanchez,206 who have suggested that cannabis contains anticancer properties. Additionally, many former cancer patients, like Rick Simpson, claim that cannabis itself cured their cancer.207

202 “Intravenous THC & CBD Experiment,” YouTube, 12 May. 2012, https://www.youtube.com/watch?v=T2cAFRAX3Gs. Accessed 24 Jan. 2018. 203 “Dr. Donald Tashkin - The Anticancer Activity of Cannabinoids,” Decriminalise It, Jersey, YouTube, 9 Mar. 2015, https://www.youtube.com/watch?v=Adcouhq6-6o. Accessed 5 Feb. 2018. 204 “Prakash Nagarkatti, Ph.D. Testifies at South Carolina Statehouse,” SC Compassionate Care Alliance, YouTube, 26 Oct. 2017, https://www.youtube.com/watch?v=NLdmcidTVWA. Accessed 5 Feb. 2018. 205 “Dr. Manuel Guzman speaks for how cannabis cures cancer,” YouTube, 9 Dec. 2015, https://www.youtube.com/watch?v=ur3ZAZSI3yc. Accessed 5 Feb. 2018. 206 “Dr.Christina Sanchez explains how cannabis kills cancer,” YouTube, 25 Mar. 2014, https://herb.co/marijuana/news/dr-christina-sanchez-cannabis-cancer. Accessed 17 Apr. 2018. 207 “Cannabis Oil Testimonials,” Cure Your Own Cancer, https://www.cureyourowncancer.org/testimonials.html. Accessed 5 Feb. 2018.

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There are suggestions that cannabis may comprise the following properties: • Proapoptotic – makes cancer cells commit suicide • Antiproliferative – prevents the cancer cells from reproducing • Antimetastatic – suppresses or eliminates the spreading of cancer cells • Antiangiogenic – cuts off the blood supply for cancer cells Concerns Surrounding “Cannabis Cures Cancer” Claims There is general concern over websites, articles, and blogs claiming that cannabis is a cure for cancer. Scientists who have presented cannabis’s anticancer properties almost never take an absolute stance, but instead generally state that “research strongly suggests” that cannabis comprises anti-cancer properties of some sort. The following statement from Cancer Research UK perfectly pinpoints the main concerns: Based on the arguments presented on these kinds of websites, it’s impossible to tell whether these patients have been “cured” by cannabis or not. We know nothing about their medical diagnosis, stage of disease or outlook. We don’t know what other cancer treatments they had. We don’t know about the chemical composition of the treatment they got. And we only hear about the success stories – what about the people who have tried cannabis and not been cured? People who make these bold claims for cannabis only pick their best cases, without presenting the full picture.”208 Only a small percentage of research studying the interaction between cannabis and cancer cells is conducted on humans.209 Most research is conducted either on lab-grown cancer cells in Petri dishes or various animal models. This is important to understand because cannabis showing possible cancer-killing effects in Petri-dishes does not necessarily mean it will work on humans. Alleviates Symptoms For the time being, we haven’t discovered a 100% effective cure for cancer. Various cannabis products and synthetic cannabinoids are currently used to reduce the symptoms of chemotherapy, such as nausea, pain, and skin irritation. Cannabis is also used to increase appetite, improve sleep, minimize

208 “Cannabis, Cannabinoids and Cancer – The Evidence So Far,” Cancer Research UK, 25 Jul. 2012, http://scienceblog.cancerresearchuk.org/2012/07/25/cannabis-cannabinoids-and-cancer- the-evidence-so-far/. Accessed 14 Jan. 2018. 209 Ibid.

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Jacob Levine chronic fatigue, and improve the physical and mental well-being of cancer patients.210 In 2014, authors of a WebMD survey shared their results showing that of 1,566 oncologists and hematologists, 82% were in favor of cancer patients having access to cannabis.211212 The Business of Cancer According to the National Cancer Institute, 8.2 million people worldwide died from cancer in 2012,213 and according to IMS Institute for Healthcare Informatics, approximately $107 billion was spent worldwide on cancer therapeutics and medicines in 2015.214 There’s clearly a lot of money involved in treating cancer. There’s a conspiracy theory circulating in the media that “Big Pharma” is hindering scientists from finding a cure for cancer because that would ruin a billion-dollar industry. The narrative goes: “Big Pharma” can’t patent cannabis plants, therefore they can’t capitalize on cannabis, legalization of cannabis will shift people from using pharmaceuticals to using cannabis for their cancer, therefore “Big Pharma” are keeping cannabis illegal. This conspiracy theory is also associated with other conditions and medications in today’s discourse, but it’s very prevalent in connection with cancer. Huge pharmaceutical companies like Valeant have increased the prices of patented medicines significantly, putting those who need the medication to survive in situations where they need to pay whatever the pharmaceutical company asks – therefore this conspiracy is not baseless. Now, to take a step back, the denouncing of “Big Pharma” on the basis of making billions and keeping cannabis illegal for cancer patients, is often predicated on the idea that cannabis can cure cancer, which, as mentioned, has not been proven. This debate is very heated, comprising many different points of view.

210 Anna Wilcox, “10 Powerful Ways Cannabis Can Benefit Cancer Patients,” Herb, 15 Aug. 2017, https://herb.co/marijuana/news/cannabis-cancer-patients. Accessed 5 Feb. 2018. 211 D.I. Abrams, “Integrating Cannabis into Clinical Cancer Care,” Current Oncology, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791148/#b2-conc-23-s8. Accessed 26 Feb. 2018. 212 R.S. Rappold, “Legalize Medical Marijuana, Doctors Say in Survey,” WebMD, 25 Mar. 2014, https://www.webmd.com/pain-management/news/20140225/webmd-marijuana-survey-web. Accessed 26 Feb. 2018. 213 “Cancer Statistics,” National Cancer Institute, 22 Mar. 2017, https://www.cancer.gov/about- cancer/understanding/statistics. Accessed 14 Jan. 2018. 214 “Global Oncology Trend Report,” IMS Institute for Healthcare Informatics, 1 Jun. 2016, https://morningconsult.com/wp-content/uploads/2016/06/IMS-Institute-Global-Oncology- Report-05.31.16.pdf. Accessed 14 Jan. 2018.

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PTSD In various states and countries, medical marijuana is currently prescribed as an alternative medicine for people suffering from PTSD (Posttraumatic Stress Disorder). PTSD is a mental health problem which develops in individuals who experienced or witnessed a traumatic event or events, such as sexual violence, war, combat, a natural disaster, personal assault, or a serious accident in any form.215 PTSD does not develop in everyone who has experienced or witnessed trauma. Usually the symptoms associated with traumatic events pass, but for some individuals, they persist for a longer period of time, if not a lifetime. According to the American Psychiatric Association216 there are four main symptoms of PTSD: • Intrusive thoughts – flashbacks, nightmares, “re-living” the traumatic experience • Avoiding reminders – avoiding situations and places that are reminiscent of the traumatic event • Negative thoughts and feelings – negative feelings about oneself, low self-esteem • Arousal and reactive symptoms – hyper-vigilance, in a constant state of being “on edge” War Veterans Today’s discourse surrounding the use of medical marijuana by PTSD patients overwhelmingly focuses on the realities of war veterans. There’s definitely a sense of underrepresentation among patients who have experienced other non-combat related traumas. The main narrative of using the PTSD of war veterans to legalize marijuana is: people who are serving to protect our country are suffering, we need to take care of them, as they took care of us. According to a Vice News documentary “there’s a growing sense that the voice of veterans might be the best way to change the federal policy on medical marijuana.”217 Suzanne Sisley, MD is a renowned scientist in the field of researching the connection between medical marijuana and PTSD.218 She was fired from her position at the University of Arizona due to her research on cannabis. In 2016, she received a license from the DEA to conduct research

215 “What Is Posttraumatic Stress Disorder?” American Psychiatric Association, https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd. Accessed 11 Feb. 2018. 216 Ibid. 217 “Veterans Fighting to Smoke Weed for PTSD (HBO),” YouTube, 24 Aug. 2017, https://www.youtube.com/watch?v=HJEUIPfaXnM. Accessed 14 Jan. 2018. 218 “CannaTech 2016: The Healing Power of Cannabis for Post Trauma Patients,” YouTube, 5 May 2016, https://www.youtube.com/watch?v=eLR-wPNJgsY. Accessed 20 Feb. 2018.

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Jacob Levine on the efficacy of medical marijuana on war veterans suffering from PTSD. Suzanne Sisley is definitely the scientist to follow in terms of medical marijuana for PTSD patients. Marijuana Alleviations People with PTSD find that cannabis improves sleep, reduces feelings of paranoia, anxiety, stress, and hyper-vigilance, and generally improves their physical and mental wellbeing. According to Fabian Henry, an Afghanistan war veteran, co-founder of Marijuana for Trauma,219 it’s important to note that there’s no “cure” for PTSD, and medical marijuana works well as a band-aid for the symptoms. Peer support, neurofeedback, psychotherapy, and family- peer support should be included in the process. Replacing Pharmaceuticals There’s a common understanding that various pharmaceuticals used to treat PTSD symptoms can make the patient feel like a “zombie” – dissociated, numb, unenthusiastic, etc. An important benefit of medical cannabis according to some PTSD patients is that it allows them to reduce or completely replace the current pharmaceuticals such as Zoloft, Paxil, and Prozac,220 which come with a wide array of side-effects, such as sexual dysfunction, weight-gain, and depression. The Power of Forgetting According to Raphael Mechoulam, people with PTSD may benefit from medical marijuana, because cannabinoids help us forget.221 We often speak about forgetting as something “bad,” but remembering all the faces at the supermarket, all the product designs, where and how they’re placed on the shelves, all the smells and sounds, would drive us mad. Now, the research suggests that the endocannabinoid system is involved in our internal disposal of information. Remembering the traumatic event, every single detail of it, and all the baggage that comes along with it, is something that PTSD patients need to endure during a significant portion of their waking life. According to a Project CBD article, research has been conducted on participants who were near the World Trade Center during 9/11. The ones who suffered from PTSD had lower

219 “Veterans Use Marijuana for PTSD,” Funker Tactical, YouTube, 8 May. 2015, https://www.youtube.com/watch?v=rWTMYSDoWoc. Accessed 11 Feb. 2018. 220 R. Dryden-Edwards, “Posttraumatic Stress Disorder: Read Up on PTSD,” MedicineNet, https://www.medicinenet.com/posttraumatic_stress_disorder/article.htm. Accessed 11 Feb. 2018. 221 “The Endocannabinoid System: A Look Back and Ahead,” 37:45, Institute of Cannabis Research, YouTube, 16 May. 2017, https://www.youtube.com/watch?v=cvGSSv5cIgc. Accessed 11 Feb. 2018.

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Cannabis Discourse anandamide levels than participants without PTSD who also experienced the event. According to the same article, scientists have determined that CB1 receptors are a crucial component in forgetting and fear extinction.222 The specifics surrounding the interaction between marijuana and PTSD are yet to be uncovered. Epilepsy Epilepsy is seizure disorder that produces recurrent seizures, which diverge in their strength, duration, and recurrence rates among patients.223 The manifestation of epilepsy arises due to various medical conditions like the Dravet syndrome, or the Lennox Gastaut Syndrome (LGS). Charlotte Figi Charlotte Figi, born 18 October 2006, was suffering from approximately 300 Dravet seizures a week. The pharmaceuticals prescribed by doctors didn’t help. When her parents resorted to CBD, Charlotte’s seizures decreased to almost zero a week. The story broke out in 2013, which presented the medical potential of CBD in front of scientists and the mainstream public.224 CBD- abundant cannabis strains and extracts began to crowd the market after 2013. According to Orrin Devinsky, MD, Director of the NYU Comprehensive Epilepsy Center, research suggests that CBD has significant anticonvulsant properties; however, it’s not something that should be used for epilepsy without consulting with an epileptologist first.225 CBD Medicines There are several types of CBD medicines available on the market. The most prevalent pharmaceutical CBD medicine is Epidiolex, manufactured by GW Pharmaceuticals.226 The homemade CBD extracts, also referred to as “artisanal CBD extracts,” which are made by various individuals and

222 M.A. Lee, “Cannabinoid Science Sheds New Light on the Darkness of PTSD,” Project CBD, https://www.projectcbd.org/about/cannabis-pharmacology/cannabinoid-science-sheds-new- light-darkness-ptsd. Accessed 20 Feb. 2018. 223 “What Is Epilepsy?” Epilepsy Foundation, https://www.epilepsy.com/learn/about-epilepsy- basics/what-epilepsy. Accessed 21 Jan. 2018. 224 Saundra Young, “Marijuana Stops Child’s Severe Seizures,” CNN, 7 Aug. 2013, http://www.cnn.com/2013/08/07/health/charlotte-child-medical-marijuana/index.html. Accessed 13 Jun. 2017. 225 “Medical Marijuana and Epilepsy,” Epilepsy Foundation, https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/other-treatment- approaches/medical-marijuana-and-epilepsy. Accessed 20 Feb. 2018. 226 “For Patients,” GW Pharmaceuticals, https://www.gwpharm.com/epilepsy-patients- caregivers/patients. Accessed 21 Jan. 2018.

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Jacob Levine companies that mostly extract the CBD from industrial hemp plants. There are also cannabis strains that contain high levels of CBD, which are not considered industrial hemp, such as Charlotte’s Web (named after Charlotte Figi), AC/DC, and Juanita La Lagrimosa. Currently, these strains are federally illegal, because their THC-levels are often above the legal limit. Problems with CBD and Epilepsy It’s generally understood by scientists that CBD does not cure epilepsy but may in some cases prevent seizures. Medical professionals have problems with videos and blogs that claim that CBD cures epilepsy, or that CBD is a miracle treatment. During the conclusion of a Child Neurology Foundation webinar,227 Nicole Villas, who serves on the Board of Directors for the Dravet Syndrome Foundation, said that she would like to have known that CBD medications might not have worked for her son, in which case she would have tried other medications and options earlier. Also, Dr. Jacobsen mentioned in the webinar that she wishes that she didn’t trust the dispensaries, who said that CBD can treat her son’s epilepsy. Both Villas’s and Dr. Jacobsen’s comments reflect today’s craze over CBD, which is marketed as the ultimate healer medicine that can cure epilepsy, cancer, and various other conditions. That’s not to say that CBD doesn’t have medicinal properties; however, in the media space, the positive effects of CBD are greatly exaggerated. The artisanal CBD extracts sold through the internet or dispensaries are not FDA regulated and rarely contain the CBD levels written on the container. Many CBD medicines claim that they’re THC-free, but many products tested positive for THC, as well as yeast and mold.228 This may not pose any significant problems for healthy individuals; however, people with epilepsy need to have a quality-controlled and consistent dose to know which dosage works, when, and how. Not to mention that unregulated products can worsen the seizures for some patients.229 Exact dosing and controlled ingredients are very important for medical specialists to identify the effects of CBD on the seizures. This is why pharmaceuticals like Epidiolex show much promise.

227 “Child Neurology Foundation Webinar,” 1:10:00 YouTube, (Nicole Valles and Dr. Jacobsen comment during the same time frame) https://www.youtube.com/watch?time_continue=2&v=GzQU9YAWmLs . Accessed 20 Feb. 2018. 228 “Child Neurology Foundation Webinar,” 30:31, YouTube, https://www.youtube.com/watch?time_continue=2&v=GzQU9YAWmLs . Accessed 20 Feb. 2018. 229 “Medical Marijuana and Epilepsy,” Epilepsy Foundation, https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/other-treatment- approaches/medical-marijuana-and-epilepsy. Accessed 2 Mar. 2018.

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Anxiety Anxiety is a feeling of unease, distress, or worry that something bad might happen, which can increase the heart rate, blood pressure, and generally put the individual “on edge.” It’s correlated to our fight-or-flight response; whenever we sense danger, a rush of adrenaline pumps through the body which increases our vigilance of the surroundings as a part of our defense mechanism.230 When this feeling occurs, very often it can debilitate the person from leading a healthy life. If feelings of anxiety interfere with daily functioning, one could be diagnosed with an anxiety disorder such as obsessive compulsive disorder (OCD), social anxiety disorder, generalized anxiety disorder, or panic disorder. There’s a general understanding in today’s media, based on abundance of anecdotal evidence, that cannabis can induce relaxing sensations, which are found to be beneficial by people suffering from anxiety. On the flip side, there’s also a general understanding that cannabis can induce anxiety. THC and Anxiety It’s common to feel anxious after consuming marijuana, this fact is rarely disputed by anyone. It’s generally acknowledged that elevated amounts of THC, specifically, can cause anxiety. Stories about people eating massive space-cakes and feeling anxious about their surroundings and existence are abundant. THC acts mostly on CB1 receptors, which “are known to exert a ‘biphasic’ effect when it comes to anxiety and depression,”231 meaning that in high doses, THC can trigger anxiety, but in lower doses it can function as an anxiolytic.232 There’s a general understanding among the pro-movement, that CBD counteracts the negative effects of THC, which is often used as a selling point for artisanal CBD medicines and CBD-rich strains. Terpenes Another addition to the “entourage effect” are the terpenes, which many claim induce anxiolytic effects. Many blogs and articles quote scientific discoveries which suggest that β-caryophyllene, a terpene present in cannabis, contains anxiolytic and antidepressant qualities by acting on cannabinoid receptors. β-

230 “Anxiety: Causes, Symptoms, and Treatments,” Medical News Today, 12 Dec. 2017, https://www.medicalnewstoday.com/info/anxiety. Accessed 5 Mar. 2018. 231 “β-Caryophyllene: A Terpene for Anxiety and Depression?,” Medical Cannabis Dispensary, https://www.medicalcannabisdispensary.co.za/%CE%B2-caryophyllene-a-terpene-for-anxiety- and-depression/. Accessed 17 Apr. 2018. 232 A medicine that inhibits anxiety, “Anxiolytic,” Wikipedia, https://en.wikipedia.org/wiki/Anxiolytic. Accessed 18 Apr. 2018.

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Jacob Levine caryophyllene can also be found in black pepper, cinnamon, and oregano.233 There are also many other terpenes present in cannabis with unique effects on the body. Today, many cannabis terpene products are presenting themselves on the market, claiming that the highs will be better, using the “entourage effect” as a selling point. The terpenes present in cannabis are also present in fruits, vegetables, and spices. For now, claims about the positive effects of terpenes on anxiety, or any other condition for that matter, should be taken with a grain of salt. Strains There’s a general consensus among cannabis consumers that indica strains are preferred over sativa strains in reducing anxiety, because indica strains are more sedating and relaxing, while sativa strains can be more energizing and cerebral, which may trigger anxiety. On websites like Leafly.com certain strains are noted to comprise anxiolytic effects based on anecdotal data provided by the consumers. “Set and Setting” The term “set and setting” is often used whenever searching for advice about lowering anxious feelings during a high. The “set” describes the “current mindset of the consumer” and “setting” is “the physical environment where the consumer will spend his/her high.” If the consumer is already feeling anxious about something before the high, and is going to consume cannabis with people they’re uncomfortable with, it’s not recommended to consume cannabis in that instance according to the “set and setting” advice. How to Relax During a Bad Trip There are various tips and tricks presented by blogs and articles to alleviate anxiety during a cannabis high, such as: meditation techniques; indulging in something one enjoys, delicious foods, a nice walk, relaxed music, etc.; understanding that the anxiety is something induced by the drug itself and that it shall pass; instead of trying to run away from anxiety, one should embrace its reality with a peaceful mindset. Of course, anxiety, and anxiety disorders, are quite complex, so all information about how to reduce anxiety during a high should be taken with a pinch of salt. Schizophrenia According to Mental Health America,

233 J. Gertsch et al., “Beta-caryophyllene Is a Dietary Cannabinoid,” 105(26), 23 Jun. 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449371/. Accessed 2 Oct. 2017.

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Schizophrenia is a serious disorder which affects how a person thinks, feels and acts. Someone with schizophrenia may have difficulty distinguishing between what is real and what is imaginary; may be unresponsive or withdrawn; and may have difficulty expressing normal emotions in social situations.234 Schizophrenia is stereotypically depicted as the manifestation of hallucinations and voices in one’s head; however, people diagnosed with schizophrenia can display an array of symptoms. This condition is not synonymous with multiple personality disorder, and the vast majority of people with this condition don’t pose any danger to others.235 History of the Connection Between Schizophrenia and Cannabis The connection between cannabis and schizophrenia definitely raises concern and heats the discussion. It all started with the aforementioned propaganda film “Reefer Madness,” where one of the characters, Ralph, goes crazy and starts killing people under the influence of marihuana. Since then, we saw an abundance of propaganda connecting marijuana with schizophrenia such as the “Above the Influence” ad236 where Lindsey, under the influence of marijuana, hears her dog speak to her, or the “Simon” ad237 where Simon is having a crazy party in his head while high. These types of ads are found humorous by many cannabis users, because of their exaggerated format. Of course, many scientists agree that cannabis can have negative effects on people already suffering from schizophrenia (more on that in this chapter). The widespread belief that cannabis causes schizophrenia catalyzed scientists to conduct studies on the link between cannabis and schizophrenia. Causation or Correlation to Schizophrenia The general consensus among scientists is that people with schizophrenia are more likely to consume cannabis than people without the condition.238 This leads to the correlation vs. causality debate. Are individuals with schizophrenia more likely to use cannabis, or are cannabis users more likely to develop

234 “Schizophrenia,” Mental Health America, http://www.mentalhealthamerica.net/conditions/schizophrenia. Accessed 5 Oct. 2017. 235 Ibid. 236 “Anti Weed Commercial. Talking Dog. Original,” YouTube, 4 Apr. 2011, https://www.youtube.com/watch?v=5aRjEXazXd4. Accessed 5 Oct. 2017. 237 “FRANK: Cannabis Side Effects,” YouTube, 26 Feb. 2009, https://www.youtube.com/watch?v=5ASKyLdSa_E. Accessed 5 Oct. 2017. 238 Mark Weiser and Shlomo Noy, “Interpreting the Association between Cannabis Use and Increased Risk for Schizophrenia,” Dialogues in Clinical Neuroscience 7(1), Mar. 2005. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181719/. Accessed 16 Jun. 2018.

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Jacob Levine schizophrenia? The latter is supported by the famous Swedish study239 including 50,000+ participants, which concludes, “Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation.” On the other hand, renowned scientists Dr. Lester Grinspoon and Dr. Igor Grant, explain in the documentary “Culture High”240 that if schizophrenia is caused by marijuana, the rise of marijuana use since the 60s should correspond to equally rising rates of schizophrenia, which is not the case. Even though the media is dominated by both extreme stances – either marijuana causes schizophrenia or it doesn’t – there are more nuances to the discussion. For example, Prof. David Nutt mentions that marijuana may bring on the development of schizophrenia earlier in people who are prone to the condition, in comparison with non-consumers.241 There are also questions in regards to how exactly marijuana affects people with schizophrenia, and why people with schizophrenia are more likely to consume marijuana if it makes them allegedly worse off.242 Nevertheless, there’s a general consensus among scientists that individuals suffering from schizophrenia should refrain from consuming cannabis, because it can potentially exacerbate the symptoms of the condition.243 Effects During the High Generally speaking, a cannabis high can create feelings and sensations which may indicate some type of “abnormal thinking”; however, after the high has passed, based on anecdotal evidence most individuals return to their normal, sober state. This component is often missing from claims surrounding the connection between marijuana and schizophrenia. The reason it’s important to mention is because often there are claims, that stem from the “Reefer Madness” era, that marijuana causes psychosis. But, is the causation of psychosis temporary, lasting only throughout the duration of the high, or permanent in some degree? This is often not clarified. Also, what exactly are

239 S. Zammit et al., “Self Reported Cannabis Use as a Risk Factor for Schizophrenia in Swedish conscripts of 1969: Historical Cohort Study,” BMJ 325(7374), 23 Nov. 2002, https://www.ncbi.nlm.nih.gov/pubmed/12446534. Accessed 5 Oct. 2017. 240 Here’s the short clip from the movie “The Culture High” (2014): https://www.youtube.com/watch?v=UCggeEoNGCQ, http://www.imdb.com/title/tt1778338/. Accessed 5 Oct. 2017. 241 0:38 https://www.youtube.com/watch?v=UCggeEoNGCQ “The Culture High” (2014), http://www.imdb.com/title/tt1778338/. Accessed 5 Oct. 2017. 242 “What Is the Link Between Marijuana and Schizophrenia?” Leaf Science, 28 Aug. 2017, https://www.leafscience.com/2017/08/28/marijuana-and-schizophrenia/. Accessed 5 Oct. 2017. 243 Rajiv Radhakrishnan, Samuel T. Wilkinson, and Deepak Cyril D’Souza, “Gone to Pot – A Review of the Association between Cannabis and Psychosis,” Front Psychiatry 5(54), 22 May 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033190/. Accessed 17 Jun. 2018.

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Cannabis Discourse the parameters of psychosis or schizophrenia for that matter, considering that they are very complex and ever-changing labels? Can Cannabis Help with Schizophrenia? Many articles and blogs244 claim that CBD could potentially help people with schizophrenia. There is limited research on this topic, although the positive effects of CBD on treating schizophrenia is presented in numerous articles and blogs. The general narrative, whether true or false, is that THC can worsen the symptoms of psychosis, while CBD can ameliorate the negative effects of the condition.245 Depression According to the American Psychiatric Association,246 depression causes symptoms of lethargy, loss of sleep, feelings of sadness, low self-worth, and in severe cases suicidal thoughts and actions. The official term for depression is “major depressive disorder.” According to healthline.com, around 5% of the world’s population suffers from this condition.247 Depression can be a part of another condition such as the bipolar disorder, seasonal affective disorder, and peripartum (postpartum) depression. The treatment for depression usually consists of psychotherapy and pharmaceuticals. Antidepressants vs. Cannabis As mentioned above, in 2011–2014, 12.7% of people aged over 12 have used an antidepressant during the previous month.248 Antidepressants have helped manage people’s depression, however many patients who take antidepressants claim that they feel more depressed than before taking the medication. Many patients suffering from depression are using cannabis as a treatment, because they claim that it doesn’t come with the same side effects

244 Maia Szalavitz, “Marijuana Compound Treats Schizophrenia with Few Side Effects: Clinical Trial,” 30 May. 2012, http://healthland.time.com/2012/05/30/marijuana-compound-treats- schizophrenia-with-few-side-effects-clinical-trial/. Accessed 5 Oct. 2017. 245 A.W. Zuardi et al., “A Critical Review of the Antipsychotic Effects of Cannabidiol: 30 Years of a Translational Investigation,” Current Pharmaceutical Design 18(32), 2012, https://www.ncbi.nlm.nih.gov/pubmed/22716160. Accessed 17 Jun. 2018. 246 “What Is Depression?” American Psychiatric Association, https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed 21 Feb. 2018. 247 “Depression: Facts, Statistics & You,” Healthline, 28 Jan. 2015, https://www.healthline.com/health/depression/facts-statistics-infographic. Accessed 5 Mar. 2018. 248 L.A. Pratt et al., “Antidepressant Use Among Persons Aged 12 and Over: United States, 2011–2014,” National Center for Health Statistics, 15 Aug. 2017, https://www.cdc.gov/nchs/products/databriefs/db283.htm. Accessed 4 Feb. 2018.

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Jacob Levine as pharmaceutical antidepressants. In terms of people with depression replacing pharmaceuticals with cannabis, it’s virtually the same narrative as with PTSD patients. Does Cannabis Work, or Make Things Worse? There are several theories, whether true or false, about the link between cannabis and depression. The most prevalent one goes like this: heavy cannabis use can partially override the functioning of endocannabinoids which release dopamine in our brain; when the cannabis consumption is discontinued, the endocannabinoids will not release at an appropriate rate; dopamine makes us happy, and therefore cannabis can cause depression. This narrative is rarely disputed per se, but the details of it are. The amount of cannabis necessary to develop depression, the duration of consumption, age of initiation, whether it leads to temporary or long-term depression, and other factors, need to be considered. Anecdotal evidence suggests that consuming cannabis can make the consumer feel joyful, uplifted, and generally in a good mood; however, we also know that cannabis can be “couch-locking” and sedating, which might manifest itself in a depressive-like state. Therefore, blogs and articles recommend sativa-dominant strains for depression. However, this should not be taken as professional advice. The general consensus is that more research is needed to determine whether cannabis is a potential medicine to supplement or replace antidepressants. The scientific research on the connection between cannabis and depression seems to be further away than with other conditions like epilepsy. Therefore, more research is needed. However, anecdotally speaking, cannabis is used for depression by many who claim that it helps them in some way. Culture of Depression The very definition and how we formulate depression differs between cultures and also changes over time. Aside from the physiological aspects, there’s also a cultural element to depression, feelings of meaninglessness, existential crises, how we describe depression, and how we deal with depression and problems in general. Cultural considerations like this are often omitted from the cannabis discourse.

Conclusion We only discovered the endocannabinoid system in 1992, and the restrictions on studying cannabis as a medical compound are only beginning to loosen. Still, scientists are finding ways to conduct their research on cannabis which

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11 CANNABIS LEGALIZATION

Let’s go through several main themes of the cannabis discourse from the legal and policy perspective. Mentioning the current legal status in detail of every state and country is pointless, because by the time you read this chapter, the laws are likely to change. This chapter instead presents the main discussions and arguments surrounding this topic.

Drug Classification Systems Most countries have some form of a drug classification system in place, which describes the legal status of various drugs. The drug classification system in most countries is largely influenced by the Single Convention of Narcotic Drugs 1961, and the Controlled Substances Act 1970 which created the scheduling system in the US.249 The majority of countries around the world have been pressured into making cannabis, among other drugs, illegal to comply with the “war on drugs” policies of the US. Even though that’s the case, all countries have their own distinct laws surrounding cannabis. In some countries like Uruguay, marijuana is legal to consume for recreational purposes, while in the UAE one could go to prison for possessing trace amounts. There are also distinct labels assigned to drugs within the classification systems, for example, in Germany cannabis is a “Schedule II” drug,250 in Slovenia a “Group 1” drug, and in the UK a “Class B” drug.251 There’s a general consensus that the legal status of drugs is not synonymous with drugs’ inherent danger to our health or society at large. Cannabis is often classified together with heroin and cocaine, which are found to be much more dangerous.252

From Seed to Consumption Cannabis is often simplistically framed as either legal or illegal. However, this binary split does not make the distinction between the legal status of individual

249 “CSA Schedules,” Drugs.com, 4 May. 2014, https://www.drugs.com/csa-schedule.html. Accessed 7 Mar. 2018. 250 “Country Legal Profiles,” EMCDDA, 19 Mar. 2012, http://www.emcdda.europa.eu/html.cfm/index5174EN.html?pluginMethod=eldd.countryprofiles &country=DE. Accessed 7 Mar. 2018. 251 “United Kingdom – Country Drug Report 2017,” EMCDDA, http://www.emcdda.europa.eu/system/files/publications/4529/TD0116925ENN.pdf. Accessed 7 Mar. 2018. 252 David J. Nutt, Leslie A. King, and Lawrence D. Phillips, “Drug Harms in the UK: A Multicriteria Decision Analysis,” The Lancet, 376(9752), 1 Nov. 2010, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61462-6/fulltext. Accessed 5 Dec. 2017.

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Cannabis Discourse components like the cultivation, transportation, sale, possession, and consumption of cannabis. It may seem logical that if it’s legal to smoke marijuana, everything from cultivation to sales and consumption should be legal and regulated; however, that’s often not the case. Let’s go through the entire process from seed to consumption from the legal standpoint. Cultivation It all begins with a seed. Generally, the laws of various countries consider cannabis seeds either as a product itself, or something that has future potential of becoming a cannabis plant. If the laws consider cannabis seeds a product itself, they’re often legal to purchase and possess because they don’t contain significant levels of THC. If the seeds are considered precursors to cannabis plants, they may be deemed illegal. Many seedbanks sell cannabis seeds not as something that’s intended to produce cannabis, but as “collectors’ items”253 or “luxury bird food.”254 When the seeds sprout, they will often be considered as cannabis plants. The laws surrounding cultivating cannabis for personal use will often be more lenient than cultivating with the intention of selling. The amount of cannabis cultivated also matters, because the law often determines whether the cultivation is for personal or commercial purposes based on the amount cultivated. Now, what exactly is being measured differs between countries. Austria, for example, measures by the total THC content cultivated, meaning that small cannabis plants can be legally sold, because they barely contain THC255; in Colorado, a specific number of plants is permitted under specific circumstances.256 In the US, in states that have legalized cannabis for recreational and/or medical use, there’s usually a license which needs to be obtained to grow cannabis. In the Netherlands, where coffeeshops have been operating for several decades now, the laws in regards to cultivation are somewhat ambiguous; in some cases, one can get a hefty penalty, and extreme cases, imprisonment. Growing for pharmaceutical companies like GW Pharmaceuticals is legal as long as the growers have the appropriate licenses.

253 “Green House Seed Company | Support,” https://shop.greenhouseseeds.nl/support.html. Accessed 8 Mar. 2018. 254 “Brands,” Firestax, https://www.firestax.com/hikashop-menu-for-products-listing. Accessed 8 Mar. 2018. 255 “This Austrian Legal Loophole Is Getting Everyone Lit,” Wide World of Cannabis, YouTube, 28 Mar. 2017, https://www.youtube.com/watch?v=-5LkwcTEJSY. Accessed 15 Mar. 2018. 256 Home Grow Laws, Colorado.gov, https://www.colorado.gov/pacific/marijuana/home-grow- laws, Accessed 8 Mar. 2018.

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Transportation Now that the cannabis plant has been cultivated, and in many cases processed, what are the laws surrounding its transportation? When it comes to legalizing cannabis, either for medical or recreational purposes, the main concern by the governing bodies is identifying the amount shipped, tracking the vehicle, the source and destination of the shipment, and identifying the driver. In the US, many professional transport companies don’t want to take the risk of transporting legal cannabis because it’s still federally illegal; insuring the product is problematic; there’s a fear of getting robbed, and the fear of getting “labeled” as a transporter of marijuana. Transportation across state lines, or countries, is considered trafficking and is a very serious offence, which discourages businesses from being identified as cannabis transport companies. Being caught trafficking cannabis can result in anything from having one’s stash confiscated to being sentenced to death, depending on the country and the nature of the situation. In the Netherlands, according to the country’s policy, purchasing marijuana for personal use from coffeeshops is rarely (if ever) prosecuted, but the policies surrounding the transportation of marijuana to coffeeshops are very ambiguous. The Netherlands, a country that has been selling “legal” marijuana for decades, is still trying to create regulations for transporting marijuana. Sales When it comes to synthetic, or plant-derived pharmaceutical cannabis products, they’re generally sold by pharmacies which need special licenses to sell the medicine on prescription. Patients residing in Germany, Canada, Australia, Chile, Colombia, Denmark, Finland, Israel, or in many US states, have access to medical cannabis on prescription for specific medical conditions.257 In locations where cannabis has been legalized, or at least decriminalized, it can be found in places like dispensaries, coffeeshops, and cannabis clubs. These places usually operate under specific regulations, which include the amount of cannabis that can be sold per person, the amount allowed on the premises, age limits, the marketing strategies used to attract customers, etc. In the US, dispensaries are very careful not to sell to anyone below the age limit, because under federal law, that’s considered “selling illegal drugs to minors,” which is a very severe offense. In the Netherlands, the coffeeshops are not as careful about checking people’s IDs before entering coffeeshops.

257 “Legality of Cannabis by Country,” Wikipedia, https://en.wikipedia.org/wiki/Legality_of_cannabis_by_country. Accessed 12 Mar. 2018.

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Fun fact: in Spain it’s illegal to sell or purchase recreational marijuana under any circumstances. But cannabis clubs circumvent the law by creating “clubs” where its members contribute “members fees” which are used to sustain the club. The marijuana isn’t bought or sold, but it’s given to members for free, as long as the members contribute with these “members fees” to sustain the club, and the club requires the production of marijuana to be sustained, which can then be consumed by the members for free within the premises. Whenever entering a legitimate cannabis club in Spain, they specifically state not to use the terms “buy” and “sell,” as it is illegal to do so. Consumption The regulations surrounding where it is permitted to consume cannabis are very ambiguous at the present moment, and legislators are trying to create an established framework for locations where cannabis has been legalized or decriminalized. Today, in places like Amsterdam and Barcelona, people above a certain age limit can smoke in coffeeshops or cannabis clubs. However, outside of those places, there are certain “unwritten” rules about where one can smoke marijuana. For example, smoking next to a police officer is not a good idea, while smoking marijuana in a park with virtually no one around is more tolerated. When an individual is stopped for possession of cannabis, the law enforcement usually takes into account the person’s age, the amount of cannabis possessed, if the product is for sale (if one has 30 x 5g bags of marijuana, it will likely be considered for sale in many countries), if it’s for personal use, etc. When it comes to being under the influence of cannabis while driving or operating heavy machinery, it will most likely be considered a DUI. Generally speaking, in the US, and in Europe, cultivation, transportation, and sales of marijuana is considered more severe by the governing bodies than possession for personal use. Laws from cultivation to consumption, are usually the most lenient surrounding the consumption part. Now that the entire process from growing to consumption has been covered, the following segments will present discussions surrounding the marijuana legalization.

Minority Incarceration Disproportionate incarceration rates of minorities in the US for marijuana related crimes is a prevalent topic in the cannabis discourse. These disproportionate arrest numbers are mainly mediated by presenting the ACLU report: “it has been found that while black and white Americans smoke marijuana at similar rates, blacks are arrested 3.7 times as frequently for

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Jacob Levine marijuana possession.”258 Today’s problem with mass incarceration rates in the US, is often presented together with disproportionate arrest rates of minorities for marijuana crimes in the cannabis discourse.

The Financial Aspect The financial side of legalization includes three main themes: 1) resources spent on enforcing marijuana laws; 2) the potential revenue stream of an untapped market; 3) shifting the resources from the black market to legitimate businesses. Enforcement Depending on the source of information, the alleged amount spent on enforcing marijuana laws in the US ranges from $3.6 billion259 to $8.7 billion260 per year. These estimates greatly differ from one another because they include different financial costs of drug enforcement – for example, the resources spent on police forces, lost productivity due to prison sentences, resources spent to maintain a prison, lost productivity of the jury, the mental health issues arising from anti-marijuana enforcement and how that translates into lost productivity, etc. The main idea presented by the pro-legalization movement is that legalizing cannabis will cut down these costs dramatically. The counter- argument claims that resources required to enforce policies under a legal cannabis mandate will still exist. The government will still need to enforce laws surrounding the legal market, so that for example dispensaries don’t sell cannabis to children, ensure that people smoke marijuana in designated spots, and that people who grow cannabis don’t sell their product without special licenses, etc. Some even believe that the legalization of cannabis will increase the current enforcement costs, because the legal nature of cannabis will invite illegal activity. Drug traffickers growing cannabis under a legal pretext and trafficking the product over state lines or abroad is a common narrative. A Green Revenue Stream The amount of revenue potentially gathered through a completely legal market for cannabis is equivocal because it’s based on market predictions. In the US,

258 “Report: The War on Marijuana in Black and White,” American Civil Liberties Union, https://www.aclu.org/report/report-war-marijuana-black-and-white. Accessed 21 Mar. 2018. 259 “Report: The War on Marijuana in Black and White,” American Civil Liberties Union, https://www.aclu.org/report/report-war-marijuana-black-and-white. Accessed 9 Mar. 2018. 260 Jeffrey A. Miron and Katherine Waldock, “The Budgetary Impact of Ending Drug Prohibition,” Cato Institute, 2010, https://object.cato.org/pubs/wtpapers/DrugProhibitionWP.pdf. Accessed 12 Mar. 2018.

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Cannabis Discourse there are estimates that the industry will reach anything between $20 billion261 and $50 billion.262 Stating that the additional money from cannabis taxes can be distributed to virtually any sector functions as a great tool to push the cannabis legalization argument forward. According to the Washington State Liquor and Cannabis Board Annual Report of 2017,263 the total taxes acquired from cannabis sales reached $319 million dollars, of which $145.7 million was distributed to fund health care services, and the rest was distributed to other sectors like education and critical state services. Colorado gathered $247 million in 2017, of which millions of dollars were spent on public schools.264 These kinds of statistics are very compelling, in comparison with zero dollars gathered under an illegal mandate. Shifting the Markets One of the main pro-marijuana arguments is that shifting the resources from the black market to the legitimate and regulated market will take away funding from cartels who distribute marijuana across the world. The argument goes: when cannabis becomes legal, people will buy it legally in dispensaries, and it will greatly diminish the existing market for gangsters, which cuts their funding for illegal activities like human trafficking, weapons, and gang violence, while simultaneously creating a legitimate revenue stream for our country. Additionally, as mentioned previously in the “gateway drug” chapter, another related selling point is the separation between the hard drug market, and the marijuana market. Pricing Issue Some claim that the financial incentive for the black market will still exist after legalization, due to the pricing issue. If a dispensary sells marijuana priced at $10/gram, and the street price lays at $3/gram, there will still be an incentive for the black market to perpetuate its operations. Cannabis grows very easily in nature and in people’s apartments. If the black market price is driven down by dispensaries to $1/gram, and a large plant generates 1,000 grams of bud, a dealer could still make $1,000 from a single plant. And since laws

261 Ibid. 262 Jennifer Kaplan, “Cannabis Industry Expected to Be Worth $50 Billion by 2026,” Bloomberg, 12 Sep. 2016, https://www.bloomberg.com/news/articles/2016-09-12/cannabis-industry-to- expand-to-50-billion-by-2026-analysts-say. Accessed 12 Mar. 2018. 263 “Washington State Liquor and Cannabis Board Annual Report,” WA.gov, https://lcb.wa.gov/sites/default/files/publications/annual_report/2017-annual-report-final2- web.pdf. Accessed 19 Apr. 2018. 264 “Marijuana Tax Data,” Colorado Department of Revenue, https://www.colorado.gov/pacific/revenue/colorado-marijuana-tax-data. Accessed 19 Apr. 2018.

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Jacob Levine surrounding cannabis cultivation will most likely become more lenient under a legal framework, it gives an additional incentive for people to grow cannabis and sell it on the black market. In Barcelona, for example, the cannabis clubs raised their prices for marijuana due to a strict regulatory system and an influx of tourists and expats. Today, the prices of marijuana in cannabis clubs range between €7–€20 per gram. Due to the lenient laws surrounding cannabis cultivation in the privacy of one’s home, the black market prices of marijuana lay at approximately €3 per gram, and the black market for marijuana in Barcelona is abundant. In the US, dispensaries need to pay a lot of money for licenses, rent, employees, and various business expenses. Currently, since marijuana is a Schedule 1 drug under federal law, dispensaries are subject to financial obstacles which prohibit them from operating in the same way as other legitimate businesses. Money deposits and banking solutions for dispensaries come with an array of problems. Banks generally don’t want to be involved with businesses that are illegal under federal law. Black market dealers on the other hand, generally don’t pay taxes, and don’t need to pay for various licenses and business expenses, which allows them to drive the price down. Therefore, pro- marijuana advocates want to alleviate financial burdens of dispensaries to reduce the incentive for people to resort to the black market. Also, there are other creative ideas to resolve this issue, like having top-quality product in dispensaries, giving professional advice in dispensaries, tagging the exact cannabinoid profile of the products, and creating a certain “go to dispensary” culture instead of going to street dealers.

Legalize Pot, then Harder Drugs Become Legal Here’s a common anti-argument: when marijuana becomes legalized, drugs such as crack, cocaine, LSD, heroin, speed, and ecstasy will soon be legalized as well, we don’t want these drugs to be legalized, therefore we shouldn’t start the engine by legalizing marijuana. This argument is based on several factors. First, as mentioned, cannabis is associated with hard drugs due to the historical propaganda beginning in the 1930s. Second, in today’s language, substances like marijuana, cocaine, and heroin are placed under the same umbrella term: “drugs.” Whenever substances that cause some kind of intoxication are being described, very often alcohol and tobacco are separated from the word “drugs,” even though they are technically drugs. For example, parents tell children that they should stay away from cigarettes, alcohol, and drugs. Because of the way we compartmentalize substances into their respective categories, the narrative of alcohol being a possible gateway to legalizing harder drugs, is virtually non- existent, because alcohol is not called a “drug,” and getting intoxicated on

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Cannabis Discourse alcohol is called getting “drunk,” not getting “high.” Third, pro-advocates use the same arguments that could be eligible for other illicit substances, for example: “we should legalize marijuana to shift the market from illegal enterprises to legal businesses operating in accordance with the law to increase the tax revenue.” Based on this argument, it would then make sense to legalize heroin or any other illicit substance. There is a disagreement within the pro-legalization movement over whether harder drugs should also undergo some form of legalization or not. The “pro-legalization of all drugs” advocates present virtually the same pro- marijuana arguments to legalize and regulate other drugs. These arguments surround topics such as incarceration rates, resources wasted, elimination of the black market, having uncontaminated drugs, having treatment for people with substance use disorders rather than criminalizing them, etc. The “pro- legalization of marijuana only” advocates don’t feel comfortable with the idea of “hard drugs” being legalized, which is often affected by the aforementioned compartmentalization of crack, cocaine, LSD, heroin, speed, ecstasy, and other substances into a single category. However, it’s generally understood by the majority of pro-marijuana advocates, whether solely pro-marijuana or “pro- all drugs,” that drugs differ from one another in terms of their physiological and societal effects and should be subjected to individually tailored laws and regulations.

Marijuana Use and Crime There’s the question of how the physiological effects of cannabis will affect crime rates after its legalization. Even though “Reefer Madness” propaganda is still hanging in the air, the narrative of marijuana causing violent behavior has been largely abandoned by all parties. The most prevalent discussion surrounding the topic of crime and safety is driving while high. According to NIDA, “Two large European studies found that drivers with THC in their blood were roughly twice as likely to be culpable for a fatal crash than drivers who had not used drugs or alcohol.”265 Based on the introduction argument, this statistic is commonly presented by the anti-movement to keep cannabis illegal. The pro-movement counters this argument by stating that the testing methods for identifying cannabis compounds in the body are flawed, because they can stay in the body for several weeks, long after the intoxication goes away, which can cause statistical errors as to the dangers of cannabis. Another argument is that even if the increased risk is true, alcohol causes a significantly

265 “Does Marijuana Use Affect Driving?” National Institute on Drug Abuse, https://www.drugabuse.gov/publications/research-reports/marijuana/does-marijuana-use- affect-driving. Accessed 15 Mar. 2018.

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Jacob Levine larger number of accidents under the influence, and alcohol is legal.266 This argument focuses more on the hypocrisy surrounding the weight placed on the dangers attributed to cannabis. Both the anti- and pro-movements, in general, don’t promote driving under the influence of cannabis or any other intoxicant. On the flip side, there’s a classic narrative that the crime rates will decrease under cannabis legalization. Many statistics are presented to promote this narrative; for example: Denver saw a 2.2 percent drop in violent crime rates in the year after the first legal recreational cannabis sales in Colorado. Overall property crime dropped by 8.9 percent in the same period there, according to figures from the Drug Policy Alliance. In Washington, violent crime rates dropped by 10 percent from 2011 to 2014.267 The presentation of this argument is largely based on the fact that people associate cannabis with drugs, and drugs with crime. Also, it’s based on the idea that cannabis makes the consumer relaxed and peaceful.

266 R. Andrew Sewell, James Poling, Mehmet Sofuoglu, “The Effect of Cannabis Compared with Alcohol on Driving,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722956/. Accessed 15 Mar. 2018. 267 Alan Pyke, “Sessions: Legal Pot Drives Violent Crime, Statistics Be Damned,” ThinkProgress, 28 Feb. 2017, https://thinkprogress.org/sessions-legal-pot-violent-crime-8640413ca090/. Accessed 15 Mar. 2018.

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CONCLUSION OF THE BOOK

By researching and learning about the arguments, opinions, beliefs, and convictions of all sides of the cannabis discourse, I’ve learned a substantial amount and gained more perspective about the bigger picture of the discourse. My position on whether cannabis should be legalized remains unchanged. I believe that the production, transportation, possession and consumption of cannabis should be legalized and regulated. However, it’s outside of my knowledge and expertise to suggest specific laws and regulations. The main point is for you acquaint yourself with various points of view on the subject, think, and decide for yourself what to believe. Of course, I have many subjective opinions about marijuana and other drugs, but I decided to remain outside of the discourse and present it objectively, to the best of my ability. The only point I will make is that we need to rethink our perception of drugs and substances in general. We humans have always used drugs and will use drugs well into the foreseeable future, whether for medical, recreational, or spiritual purposes. The main issue we have with drugs is not the drugs in and of themselves, but the context of their use. Having a 10mg edible before going to sleep every night is not the same as smoking weed every day and neglecting one’s children. Getting drunk at a wedding and having a blast without causing harm to oneself or others is not the same as getting drunk on a Tuesday morning and driving to work drunk. Getting morphine at a hospital as an analgesic for one’s broken bones is not the same as recreationally shooting up morphine with dirty needles. If we try to look outside the scope of our preconceived ideas about drugs’ physiological and societal effects, and scrutinize the context of where and how drugs can be used, we can begin to have a rational discussion which exists outside of the infamous binary split of whether we should or should not use drugs.

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RESOURCES

NORML – According to their website, “NORML’s mission is to move public opinion sufficiently to legalize the responsible use of marijuana by adults, and to serve as an advocate for consumers to assure they have access to high quality marijuana that is safe, convenient and affordable.” http://norml.org/ MAPS – According to their website, “Founded in 1986, the Multidisciplinary Association for Psychedelic Studies (MAPS) is a non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.” http://www.maps.org/ Leafly – Leafly is one of the most prominent cannabis websites presenting news about cannabis strains, the effects of cannabis, cannabis culture, and much more. https://www.leafly.com/news High Times – According to their website, “High Times is the definitive resource for all things cannabis. From cultivation and legalization, to entertainment and culture, to hard-hitting news exposing the War on Drugs, High Times has been the preeminent source for cannabis information since 1974.” https://hightimes.com/ Medical Marijuana, Inc. – This website offers news in terms of medical marijuana, CBD, medical conditions treated with marijuana, etc. https://www.medicalmarijuanainc.com/news/ Citizens Against Legalizing Marijuana – According to their website, “Citizens Against Legalizing Marijuana (CALM) is an all-volunteer political action committee dedicated to defeating any effort to legalize marijuana.” https://calmca.org National Institute of Drug Abuse (NIDA) – According to their website, “Our mission is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health.” https://www.drugabuse.gov/ The International Cannabinoid Research Society – According to their website, “The ICRS is non-political, non-religious organization dedicated to scientific research in all fields of the cannabinoids, ranging from biochemical,

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Cannabis Discourse chemical and physiological studies of the endogenous cannabinoid system to studies of the abuse potential of recreational cannabis.” http://icrs.co/

Contact [email protected]

LinkedIn: Jacob Levine https://www.linkedin.com/in/jacob-levine-cannabis/

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