“Has the World Gone to Pot?”
That was the title of the lead article by pioneering psychiatrist Joel Fort, MD, in the first “marijuana”-themed issue of this journal. The concerns in his and other contributions therein included trends in marijuana use, how dangerous that use might be, what approaches were best to minimize any harms, how best to treat overuse, what public policies are likely to be the most beneficial, and so on—in 1968. The same issues—with the notable addition of “medical” marijuana issues—were extensively explored in the Journal of Psychoactive Drug’s second such issue, “Marijuana at the Millennium,” published in 2000.
Fifteen fast years later, and here we are with a third theme issue on marijuana. No one who follows the general topic of marijuana science and “politics” will be surprised that the issues have not changed very much. In fact, most of them have become more contentious, even as knowledge increases. With recent surveys showing a notable rise in cannabis use in both adults and adolescents, the issues are heightened even further. There must be no substance in the addiction field that elicits such diverse and strong opinions, allegedly based upon similar “data.” This third edition of the aperiodic Journal of Psychoactive Drugs Marijuana Series is our attempt to consolidate and advance some of those debates.
The science of cannabis’ impacts on the human mind and body—especially our brains—is central to the debate, and thus the old catchphrase “What about the children?” comes to mind, for better or worse. The theme of the developing brain has received increasing attention in the past decade, with evidence building that, as with alcohol and other drugs, young brains are more vulnerable to adverse impacts of cannabis exposure. Thus, many of the following articles explore neuroscience, toxicology, and prevention in young populations.
Professional clinical opinion is likewise founded on scientific knowledge, but conflicts persist. The medical specialty of addiction medicine would seem the logical place for expert opinion, but even here we find conflict. The American Society of Addiction Medicine (ASAM) has developed policies on the controversial cannabis issues that might be seen as more “conservative” than that of its California chapter; but we see this as a question of the “middle right” vs. the “middle left,” rather than one of conflicting extremes. Perhaps these internal debates will eventually come together as science and policy evidence advances, but it is a slow process. In any event, we can also note that this “state vs. national” conflict is reflected in the broader medical world, with the California Medical Association issuing a detailed call for rescheduling and decriminalization of cannabis a few years ago, but the American Medical Association holding firm in opposing such proposals.
As for California, home state of this journal, one dynamic that has changed is that mainstream elected officials are increasingly willing to speak out in favor of pot policies that would have been anathema in such circles not long ago. Thus, California Lt. Governor Gavin Newsom convened a statewide commission (disclosure: one of us, SH, served on this panel) to study and address the increasing perception that prohibitionist policies do not serve the goals of reducing use and harm. In this theme issue of the Journal, we are fortunate to have some of the expertise from his panel, namely Drs. Cermak, Banys, and Rosenbaum, represented among contributors.
The “medical marijuana” issue is not addressed specifically among articles included in this theme issue. Suffice it to say that California now has almost two decades of experience with legalized medical cannabis, and it is a decidedly mixed experience. Opinions range from regarding this as a landmark human rights advance granting access to a miracle medication, to one of a disastrous, anarchic profiteering sham. In an attempt to rein in abuses, Governor Jerry Brown signed new regulations in October 2015 on the medical cannabis industry that may, or may not, satisfy at least some critics on various sides.
“As California goes, so goes the nation” is an old slogan, true in some instances, less so in others. With respect to cannabis policies in our state—where it does seem that our “medical” laws have spread nationwide—perhaps some manner of “tipping point” is on the horizon. Watching states such as Colorado, where “recreational” use has been legalized since 2014, yields informative, if mixed, lessons thus far. As some wag once quipped, marijuana can indeed induce insanity—but mainly in politicians. We hope the contents of this issue of the Journal of Psychoactive Drugs serve as something of a preventative medicine for that.