Addiction: A New Treatment Paradigm

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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As the herb Cannabis becomes legalized in the United States, and other countries, as it was prior to 1970 in the United States and most of the world, throughout history, we continue to debate whether this is an addictive drug. Of course, as the science now tells us, almost anything is addictive, and the problem lies primarily with the individual and the brain, not with the substance, activity or ideology that we are addicted to. With Cannabis, still called marijuana, (which by the way, we still don't understand why we use this term, other than it was a Mexican slang term for Cannabis popularized by a single person with a campaign against the growing of hemp in the 1930's, Harry J. Anslinger), scientific study has shown us repeatedly that this herb is neither remarkably addictive, or harmful. Harry Anslinger, a former railroad investigator who apparently disliked Mexican immigrant workers riding the rail during the Great Depression, married the niece of the rich and influential Andrew W. Mellon, and was appointed to be the first head of the U.S. Treasury Department's Federal Bureau of Narcotics after serving on the U.S. Bureau of Prohibition (of alcohol). Around the turn of the twentieth century, we tried to get Cannabis listed as a narcotic, but international panels of experts found this herb to be have no qualities of opiate narcotics. In 1925, the U.S. once again supported regulation of Cannabis as a narcotic, but once again, the International Opium Convention showed that scientifically Cannabis was not an addictive or harmful drug, and not a narcotic. The Treasury Department, working with many state governments, enacted the Marijuana Tax Act of 1937 to place a tax on the sale of Cannabis, or marijuana, as it was officially but so unscientifically called, because Henry Anslinger couldn't prove scientifically that the herb was an addictive and harmful drug that could be classified as a narcotic.

Obviously, the subject of Cannabis had become a sociopolitical issue, not a scientific or medical issue. This history of sociopolitical criminalization, or attempts to criminalize, continued through the 1970s, which was revealed in a 1974 interview with the top Nixon advisor John Ehrlichman finally published in Harper's Bazaar in 2016. In this interview, Ehrlichman is quoted as stating that: "We knew that we couldn't make it illegal to be either against the (Vietman) war or (be) black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt these communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did." This lying about Cannabis for sociopolitical reasons began much earlier, though, and is stuck in our consciousness ubiquitously, even in the minds of scientific researchers today. After over a century of such debate, Cannabis is finally getting a fair hearing and being declared safe and legal. The medical benefits of the herb, used for medical benefit for thousands of years around the whole planet, are also finally being again realized.

Henry Anslinger could not find proof of Cannabis as a harmful drug or narcotic, and instead wrote the Marihuana Tax Act of 1937, with the support of three giants of industry, his father-in-law Andrew Mellon, William Randolph Hearst, and the DuPont Family, all of whom had commercial interests in limiting the growing of hemp (cannabis), since it was a cheap and useful crop that could be made into a variety of products, such as paper, clothing and building materials, like it had in the past. These three rich and influential interests were great friends with President Franklin Delano Roosevelt, who supported their wishes with the Marihuana Tax Act. Hemp was staging a comeback as a crop in 1934, after production had fallen to about 500 tons per year by 1933. With hemp as an inexpensive and natural source for paper, competing with DuPont nylon and rayon, and useful as a building material, with new technologies again improving these hemp products, this Tax Act all but ended the development of this product, hemp, effectively eliminating competition for Hearst, with his large lumber holdings and paper mills, Dupont for his synthetic fabrics, and Mellon, reportedly the third richest individual in the United States at the time, with his huge investment in construction and building materials. An inexpensive and easy to grow product like hemp was indeed a threat to the rising growth of new industrial products that were patented and required large investment backing. To stop a hemp industrial comeback, the propaganda against Cannabis, largely driven by this one man, Henry Anslinger, continued unabated. In 1939, though, to settle the controversy, New York Mayor Fiorello La Guardia, created a commission to scientifically study the effects of Cannabis, employing the most respected medical researchers in New York. The La Guardia Committee, as it was called, found to their surprise, that all of the claims that Cannabis was an addictive and harmful drug were indeed wrong, testing both animals and humans extensively, and finding almost no signs or symptoms that were deleterious to the health or to the mind, and indeed finding Cannabis to have some medical usefulness. Today, as legal scientific study of Cannabis is finally allowed, we are indeed finding an amazing array of medical benefits with Cannabis and specific active chemicals in the herb. If this type of study were allowed decades earlier, many thousands of patients could have been helped in the treatment of a variety of difficult diseases, for a very low cost.

To counter the scientific studies of the La Guardia Committee, Henry Anslinger started publishing stories in magazines, describing supposedly real life crime stories where kids smoked Cannabis and then committed gruesome axe murders, raped young girls and so on, especially noting that Cannabis incited negroes to these crimes, and described how Mexicans were importing many tons of marijuana into the states to wreck our society. Anslinger also noted in these magazine and newspaper articles that many famous negro jazz musicians, such as Billie Holiday and Charlie Parker, were addicted to heroin, and got there because they first used marijuana. He failed to note that these famous black artists talked extensively of how they struggled to even make a living despite their popularity, though, just because they were black, and how this depressing situation led to alcoholism and heroin abuse, not smoking Cannabis. He failed to note how Billie Holiday was denied a cabaret license in New York City after her song Strange Fruit, depicting lynching, was published, not on her label Columbia, who refused, but on Commodore. We should also note that one of Anslinger's backers, William Randolph Hearst, was a publishing magnate, controlling a host of influential newspapers and magazines that these stories were published in. Despite this history, we still have a very wide belief that Cannabis is a very addictive drug that has adverse physiological effects, and destroys mental function. We still, in an age of proof of medical benefit finally, and legalization both as a medicine and a safe recreational herb, still have a constant reference to Cannabis as an addictive and harmful drug. During this period of the Anslinger campaign against this "Mexican" scourge, and after the scientific findings of the La Guardia Committee, we also, unfortunately, had a legal ban on the further scientific study of Cannabis, again enacted by Henry Anslinger. Why we should not study the science concerning Cannabis if the La Guardia Committee findings were indeed, as Anslinger stated, "unscientific", is hard to reason.

The La Guardia Committee, headed by the New York Academy of Medicine, stated unequivocably the "the practice of smoking marihuana does not lead to addiction in the medical sense of the word". Prior to this La Guardia Committee study, the scientific literature had little published findings of Cannabis, especially after extensive study of this herb in 1894 by the Indian Hemp Drugs Commission of British India, as it gathered data concerning the dangers of the growing worldwide use of opiates. This Indian Hemp Drugs Commission also found no scientific evidence of harm or addiction from the use of Cannabis. The La Guardia Committee studied the effects of Cannabis for 5 years, and completely discounted the belief, which contradicted the Indian Hemp Commission findings, that Cannabis was a "gateway" drug to other drugs that were potentially harmful, that Cannabis was used by the population extensively, that it was medically addictive, or that it somehow led to delinquency or crime. In response, Henry Anslinger personally commissioned the American Medical Association (AMA) to publish a counter report on Cannabis, but this report did not contain any new scientific findings, and made strange conjectures regarding the racial aspect of Cannabis use, incorrectly reporting that almost all of the test subjects of the La Guardia Committee were black, and that there was evidence that marijuana use in the military made black soldiers disrespectful to their white superior officers.

Only in 1972 did the American Medical Association finally admit that the 1945 assertions that Cannabis was a dangerous drug were "largely false", and that "with careful consideration of the documentation there is no confirmation of the existence of a causal relationship between marijuana use and the possible use of heroin". This was in response to the Controlled Substances Act of 1970, where Cannabis was classified as a Schedule One Narcotic and finally officially made illegal by the Federal Government. Prior to this, many state and local governments had laws against marijuana use, sale and possession, often selectively enforced, but not the federal government, and by 1970 public smoking of marijuana was widely accepted in many communities in the United States. The definition of a Schedule One Controlled Substance included the complete lack of medical use in treatment, a high potential for drug abuse, and a lack of accepted safety for the substance under medical supervision. We see that Cannabis does not meet these qualifications, yet was still called a Schedule One Substance, and still is. This history is obviously full of false beliefs and completely unscientific, almost religious in scope.

All of this weird history has only led to the reinforced belief by a majority of humans that, despite all scientific proof to the opposite, that Cannabis is a dangerous, harmful and addictive drug, despite its use for thousands of years around the world, and much documentation of its use in herbal medicine in many countries. In the United States, this belief was an almost religious fact in most medical schools, despite that fact that in 2002 the United Nations reported that Cannabis was the most widely used illicit substance in world history, both presently and in the past, and a number of studies in the last decade show that a majority of Americans have at least used Cannabis at one time in their life. The societal and scientific attitudes are finally changing.

Research in 1994, by epidemiologist James Anthony of the National Institute of Drug Abuse, found in a large cohort study that about 9 percent of Cannabis users fit the profile of dependence, or addiction, which is about the same for almost any well known substance, activity or belief that we find addictive, and less than estimates of users of nicotine, heroin, cocaine and alcohol. In other words, the most used recreational drug in world history, has a lower rate of addiction than cigarettes and sugar, when analyzed by a conservative voice in the field of drug abuse, with less than 10 percent of users potentially with a dependence (fitting a profile), and that may be addicted. As experts in the field of addiction now note, even with patients with a diagnosed addiction, 90 percent of these addicted individuals are perfectly functional, and can stop using the substance they are addicted to if there is an incentive. The question is not whether Cannabis is addictive, but what are we going to do with the substantial percentage of addictive individuals in society, clarify their problem and fix it, or blame their medical addiction on the substance, activity or ideology that they are addicted to. Blaming the problem on 'marijuana' is not yielding results, and about half of patients that seek treatment for addiction to marijuana go back to smoking, like cigarette smoking. With a more realistic look at the pathophysiology of addiction we might be able to solve this problem.

Instead of treating addiction as a medical problem of the individual patients, more and more effort and investment has been applied to devise more and more elaborate "scientific" means to classify cannabis as an addictive and harmful drug, and this elaborateness is finally being seen as ridiculous by authorities on the subject. For instance, to "measure" the addictiveness of cannabis, still called by its derogatory nickname marijuana in all of these studies, the U.S. National Institute of Mental Health Addiction Research Center, in the early 1960s, constructed a "self report inventory" of addiction using associative word and "sentence completion" questions, and other subjective techniques of nuance, developed on male subjects under drug and no-drug conditions. Thus, "drug-sensitive" questions were devised, with 550 true-false questions developed to differentiate various subjective effects of narcotic drugs, and to differentiate between normal behavioral and cognitive abnormalities, and those that may be more clearly associated with a drug addict. This was called the ARCI, or Addiction Research Center Inventory. Later, a special section of subjective true-false questions was devised for Cannabis as a "class" of these drugs, and various researchers trying to "prove" that Cannabis was an addictive drug narrowed these subjective true-false questions down to as few as 49 selected questions. In 1985, Chait et al developed 4 more true-false questions specific to "marijuana euphoria", and divided the ARCI into 6 scales of subjective "evidence", measuring 1) drug-induced euphoria of morphine and benzendrine drugs, 2) stimulant effects of amphetamines, 3) intellectual efficiency and energy effects of benzedrines, 4) sedation effects of barbituates, 5) dysphoria and somatic effects of LSD, and 6) a special group of effects simply called "marijuana effects".

This ARCI is still used to show "proof" of the addictiveness of Cannabis, which is not what it was intended for, and obviously does not measure any objective evidence, and in fact designs subjective questions purely to create an apriori outcome. A sizable number of such measures were developed to provide proof of Cannabis as an addictive and harmful drug. Using such measures, the University of Chicago, the University of New York, and The American Institute for Cognitive Therapy, in 2003, studied the effects of straight THC (tetrahydrocannibinol) on behavioral measures of impulsivity in recreational Cannabis users, measuring 4 tasks, 1) the time it takes to stop a task or motor response, 2) a go or no-go response, 3) a delay discounting task that measures the value of uncertain reinforcers, and 4) a time elimination task, which measures the alterations in subjective time perception. THC was found to increase impulsive responding on the time it takes to stop a task, but not on the go or no-go response or the delay discounting task, and only affected the subjective time perception in short time intervals, and not in longer time intervals. Of course, the outcome of these randomized controlled human clinical trials was that THC may increase impulse behavior and that the impulsivity "is an assemblage of distinct components rather than a unitary process". The trial also confirmed the ARCI euphoria and "marijuana scales" (Neurophsyopharmacology 2003 (28): 1356-65). If such tests are the scientific measure of the addictive quality of Cannabis, no wonder the herb is being legalized. Once again, though, all of this type of study just pulls us further and further from the fact that we know with real objective scientific study that addiction itself is a state of disease that almost any behavior or consumed product can create and reinforce. We must finally treat the disease, and not spend all of our resources in trying harder and harder to confirm that such products as Cannabis are addictive drugs by elaborate study designs. We are missing the point, and may continue to keep missing the point.

By 2016, as scientists and institutions desperate to finally prove that Cannabis is addictive as more and more states in the U.S. are legalizing use, even recreational use, we see some confusing emerging 'evidence' once again. A single past study in Europe of just a handful of subjects purported that there was an association between Cannabis users who started a heavy habit at the age of 10-13 years of age, and a slightly higher incidence later in life of a psychiatric illness such as schizophrenia. Now, in such a study, we have to depend on the reporting of such use at an unusually early age by the patient with a diagnosed psychological disorder than includes delusional thinking, and we have to also assume that these patients did not just use Cannabis and other drugs to try to alleviate a condition that is still poorly treated and almost always onsets in childhood. There is much to questioned here, yet most publications in the media reported this conclusion of proof of Cannabis as potentially causing schizophrenia to be a fact. In 2016, the Columbia University Medical Center posted a study that was curiously unauthored, with a lead researcher specializing only in psychiatric radiology, Dr. Anissa Abi-Dargham, that showed in a study of just 11 patients that heavy Cannabis use actually decreases the level of dopamine in key areas of the brain, such as the striatum. Now, since dopamine increase is associated with increased addictive desire and a the trigger of reinforcement, the supposition that a decrease in dopamine release would confirm an addictive potential seems absurd. This study also purported that lowered dopamine in this area of the brain was associated with lowered cognitive performance and working memory, but the heavy Cannabis users did not score lower than control subjects in this regard. Surely, the deduction is that the Cannabis use perhaps led to a decreased need for dopamine, and that this did not equate with a condition of poor dopaminergic physiology and the consequent side effects seen in such diseases, such as Parkinsonism. Funding for this tiny study and monetary grants to the radiologist were provided by Insys Theraputics, Lifeloc Technologies, Aelis Farma, Health Advances, and Amgen. In 2016, 2 former employees of Insys were arrested for kickback schemes involving doctors prescribing the company's main drug, Subsys, which contains the narcotic Fentanyl! Subsys was approved only for end-stage cancer patients with pain, but has been promoted heavily for minor conditions, such as migraines, neck and back pain, against FDA guidelines. Lifeloc is a company that specializes in testing equipment for alcohol and drugs. Aelis Farma specializes in therapeutic drugs to treat Cannabis abuse! Health Advances is a company that provides career training in the addiction recovery business! Amgen is a pharmaceutical company that specializes in drugs that Cannabis would compete with! OMG! The mere publishing of a tiny study whose results make no sense and was obviously paid for by the industry which has a stake in the arena of medical Cannabis use is enough, though, for most media to tout this new 'evidence' of the addictive potential of Cannabis! This is ridiculous!