Alcohol and Marijuana Use Epidemiology

Dec 14 2009 Published by under Alcohol, Cannabis, Drug Abuse Science

A recent survey suggested that a majority of US respondents support the legalization of marijuana. The press release version from Angus-Reid Global Monitor is here. I've taken the liberty of graphing the data because something strikes me as funny.
AngusReidLegalizeSurvey.jpg It is very odd to me that the public view on drug harms seems to exist in a sort of good/bad binary state that does not appear to be graded with anything resembling a specific measure of "harmfulness" whatever that may be. If we may take the public willingness for legalization as a reflection of some global harm evaluation, that is. Some of the more philosophically defensible arguments, along the line of libertarian civil liberties and what not, would seem to be entirely independent of drug identity, right? So it must be something about the level of harm. The public appear to feel that there is a categorical distinction between marijuana and some other popular drugs but I just don't see where it is supported in terms of any given harmful outcome including risk of dependence, interference with ability to function when acutely intoxicated, acute risk of death, risk of toxicity to brain or other major organ with repeated use, etc.
Unfortunately, I was distracted by something shiny in my researches so we're going off on a bit of a tangent today...

SAMHSU08-F71.jpg

These data come from the US National Survey on Drug Use and Health for 2008. They make the point that alcohol accounts for a very large swath of our abuse and dependence problem (defined by diagnostic criteria, as always, not necessarily reflective of what you consider a subjective drug problem). And as we all know, the majority of people who sample a given drug are never going to end up with drug dependence. Nevertheless data such as these illustrate a point I like to make about base rate. Namely that when considering the public health impact of legalization of recreational drugs we have to go beyond the rate of harm X and multiply that against the exposed population to end up with an estimate of eventual harm.

However, the much greater population prevalence of alcohol (91.5%) or cannabis (46.3%) in comparison with heroin (1.5%) means that the fraction of the entire population that is dependent on heroin (0.3%) is miniscule in comparison with the fraction dependent on cannabis (4%) or alcohol (14%).

To belabor my prior point, one of the reasons that a low harm rate drug like alcohol is such a big problem is that closing in on all of the population has sampled the drug in their lifetime. Some 96% of the US population have tried alcohol by age 27-28 and this reaches 98% by age 50 according to the current Volume II of the Monitoring the Future survey.
Mtf08-alcpatterns.jpg Shifting to more-proximal estimate of exposure, these data represent the fraction of the population (by age range) which claims to have had alcohol at least once in the past year, 30-days or daily over the past 30 days. Although not specifically shown here, the numbers for abuse and dependence are small enough to very likely be a small subset for most drugs. After this it gets tricky to evaluate from broad survey data like this. We'd want to know more about specific patterns of daily use and the history of those patterns if we were to attempt a finer grained prediction about risk for dependence. Nevertheless, I wanted to contrast these relationships for those for marijuana.
MtF08-MJpatterns.jpg
Note first the change in scale. (Normally I don't like to do that but for the sake of illustrating the point with low-res web graphics I caved in.) Many fewer people in the US population sample marijuana in a given 12-mo interval than sample alcohol. So the first point is that there is a lot of room for more people to sample marijuana under a change in access. Such as might be brought about by legalization such as was the subject of the survey I started the post with. This is the first untested (as yet) hypothesis. The second question is how the 12-mo / 30-day / daily and dependence rates scale up under such a scenario. If we compare to the legal substance alcohol, we might predict an under-predictive uptick in those who smoke cannabis on daily basis. OTOH, on face these data suggest a larger fraction of those who smoke cannabis on an annual or monthly basis smoke cannabis daily. Does this tell us cannabis is "more addictive" than alcohol given a particular rate of use? Or does it tell us that the untroubled user population represented clearly in the alcohol stats simply fails to smoke dope out of psychopharmacological preference or legal concerns?
I should point out that near daily cannabis smoking seems to be commonly associated with dependence, based on my chats with those who do research studies on human cannabis smokers. I also note that in at least one treatment seeking population of cannabis smokers, the mean was 25 days per month (Hathaway et al, 2009). I say this not because it rules in/out dependence for an individual but more to point out that there are people who smoke cannabis daily. This is news to some of my acquaintances who think cannabis is no big deal based on their college peer experiences.
I'll close with the lifetime stats for cannabis. As I said above, alcohol reaches about 98% of the middle adult population and the graph shows that about 65% have a drink at least once per month. The lifetime/monthly gradient for cannabis seems a bit steeper, does it not?

MtF08-MJtrends copy.jpg

Mtf08-Cigpatterns.pngUPDATE 12/15/09: The first comment, from bsci, asked about cigarettes

Perhaps a better comparison would be nicotine, which doesn't have as long a cultural history as alcohol and currently has a great taboo regarding usage, even if it is legal.

so I'll graph those data as well. N.b., the survey includes an additional category for those that smoke a half a pack of cigarettes per day or more. Interestingly, it may be the case that only about 60% of those that smoke at least half a pack (or 10 cig) per day will meet dependence criteria (Donny and Dierker 2007). As you can see from these data some 83-89% of those who smoke cigarettes monthly, smoke daily. Similar numbers are 28-42% for marijuana and 8-17% for alcohol. The commenter bsci argues essentially that the casual use population is smaller for cigarettes because of social pressure, thus the prediction for marijuana should track these numbers. I'd argue that the difference between alcohol and cigarettes has more to do with perception of harm as it applies to self and accordingly, marijuana rates are not well predicted by the cigarette rates.
__
Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2009). Monitoring the Future national survey results on drug use, 1975-2008. Volume II: College students and adults ages 19-50 (NIH Publication No. 09-7403). Bethesda, MD: National Institute on Drug Abuse, 305 pp. [pdf]
Substance Abuse and Mental Health Services Administration. (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD. [pdf]
Cannabis dependence as a primary drug use-related problem: the case for harm reduction-oriented treatment options. Hathaway AD, Callaghan RC, Macdonald S, Erickson PG. Subst Use Misuse. 2009;44(7):990-1008.

88 responses so far

  • bsci says:

    You've posted similar trains of thought before. One thing I'm curious about is that part of the reason so much of the population uses alcohol is that it has such a long cultural and even religious history. Despite a relatively short-spanning temperance movement and a few religions, alcohol consumption is widely tolerated and even promoted by some religions.
    This is not the case for marijuana. Perhaps a better comparison would be nicotine, which doesn't have as long a cultural history as alcohol and currently has a great taboo regarding usage, even if it is legal. Based on no specialized scientific understanding, I'd look towards nicotine to find maximum potential base usage rates for legalized marijuana rather than alcohol. Any idea where to find those rates?

  • Alex says:

    It is very true that we need to consider the likely increase in usage as a result of policy changes. However, we should also consider two other things that might change if policy changes:
    1) Will patterns of use change? For instance, original recipe coca cola, with a low dose of cocaine, probably posed different (and lesser) harms than snorting a line of cocaine.
    Also, just as there is a difference between moderate social drinking in an open setting and getting drunk alone every night (the later is far more likely to be harmful) it is likely that patterns of moderate, social use in low doses might emerge for some substance. These sorts of things need to be factored into an analysis.
    2) Will harms be easier to address if policy changes? Does pursuing a habit in secret exacerbate some of the harms? Do black market prices lead some users into theft and other pathological behaviors? Does fear of the law make it harder to reach out to some addicts? And while you've made good points before about how certain drugs are harmful on their own despite folklore about additives being "the real problem", control over labeling and purity would at least make these issues easier to address. Not to mention the benefits of diverting money into rehab and away from fighting violent cartels (which would largely evaporate after a policy change).
    So if we're going to make predictions of the possible effects of a policy change, we need to look at the entire picture.

  • Alex says:

    As long as we're talking about public health effects, while violence caused by abuse would obviously have to go on the negative side of the ledger for any proposed policy change, reductions in violence due to a weakened black market should go on the positive side of the ledger.

  • Ryan says:

    FYI, I'm pretty sure OTOH is not a common abbrev, it took a while for me to figure it out.

  • becca says:

    "Also, just as there is a difference between moderate social drinking in an open setting and getting drunk alone every night (the later is far more likely to be harmful)"
    Hmm. That might depend on what you mean by harmful, and if your "open setting" requires transportation home or not.
    Ryan- IMO, I'm pretty sure if the first hit of Google gives you the answer, it's legit to use without defining. Which would not, come to think of it, justify IMO.
    "in at least one treatment seeking population of cannabis smokers, the mean was 25 days per month "
    Hey DM, do you happen to have the average # of days of consumption per month of treatment seeking alcohol users?

  • Steve Clay says:

    I see where you're going, but nearly all marijuana consumers are law-breaking or at the very least norm-breaking, so you have quite a bit of selection bias to wade through when trying to compare them to alcohol users. If you could isolate the data within CA (and just counties where MMJ dispensaries are very accessible) you'd be able to say more, but even then you'd be limiting your sample to people who mostly don't work in jobs that require drug testing.

  • Pete Guither says:

    For reasons that others have stated above, it appears to me that the rough formula you postulate -- paraphrased: rate of harm X times exposed population equals eventual harm -- is missing some critical variables. I find it extremely hard to believe that the rate of harm under a regulated system would be even a significant fraction of the rate of harm under a prohibition system, and that's without even including the additional harms specific to prohibition.

  • Alex says:

    becca-
    Good point. This just shows how complex the issue of harm is, and how much it depends on variables beyond "How much did the person ingest?" Decisions made in the context of use and the cultural factors that influence those decisions (e.g. once upon a time being drunk was actually considered a valid excuse for driving poorly, now the designated driver is a societal norm) matter at least as much.
    I still think that some occasional moderate drinking with friends (if one of them is a designated driver) is very different from going home and getting loaded every night.

  • Alex says:

    Anyway, I'll repeat something that I said before, because it reinforces the complexity of harm and the social context of use: Violence is a potential harm of use that harms more people than just the user, and those hurt by a violent user need to be included in estimating the public health costs of a policy. By the same token, violence in an underground market also needs to be considered, and if a policy reduces the violence associated with an underground market then that reduction in violence must be factored into a public health cost-benefit analysis.
    One complication is that some of the reduction in violence may not be local. We can only act locally, but we should think globally here. A policy that reduces violence in Afghanistan or northern Mexico won't register in the statistics compiled by your local public health authorities in City Hall, but a person deciding whether a policy change was a net positive or net negative should factor that into the analysis nonetheless.

  • denbee says:

    I find it interesting the extent "good people" will go to try to make you live your life according to their grand plan. They think their laws are justified and so they arrest us, fine us, even kill us in the pursuit of a better drug free society. Yet we have no better society, only disrespect and loathing for the law and those who enforce it. The damage to millions of people by this law far exceeds any damage they did to themselves or society by using cannabis. When 50 million people choose to ignore the law regardless of the risk and our lawmakers continue to support cannabis prohibition regardless of the futility of it we need to vote the old fogies out of office. The tides are changing and those who fail to reconize the change that is coming will find themselves alone and out of office. A recent Angus poll puts support for legalization at 53% and rising! Next year it will be 63%!

  • DrugMonkey says:

    A recent Angus poll puts support for legalization at 53% and rising! Next year it will be 63%!
    Really? Where'd you find that? Hook us up dude!

  • lunchstealer says:

    To what extent would problem MJ use cannibalize alcohol users? Is the predilection for dependency substance-specific, or would some potential alcohol-abusers end up abusing MJ instead of alcohol? Essentially, is there a possibility that addicition in this case may be closer to a zero-sum game?
    My gut reaction would be that it's probably not true zero-sum, but there might nonetheless be a drop in alcohol-abuse rates in favor of MJ abuse, even if the total abuse between the two went up somewhat.

  • Alex says:

    DrugMonkey,
    We've talked about this before, but I continue to find it endlessly fascinating that while you have some sort of interest in and knowledge of matters related to drugs, and while you clearly have a strong interest in issues of diversity and privilege, you studiously avoid linking the two subjects and noting that the Drug War is a policy with a massive disparate impact on ethnic minorities and the under-privileged in the US, as well as countless poor people in other countries. One would think that such a proud ally of the under-privileged might note at some point that drug prohibition has a massive disparate impact on young minorities, particularly via incarceration. One would think that such a proud ally of the under-privileged might note the violence that the drug war brings to poor people in northern Mexico, the Andes, Afghanistan, and numerous other places.
    It is, of course, your prerogative to blog about what you like to blog about, but it is fascinating how the links between these two topics of interest are never explored. Moreover, consider the recent Dawkins debacle: The "I merely included the writings that I happened to like, and I saw no need to consider any angles relevant to diversity, privilege, under-representation, or role models" excuse didn't fly, and for good reason.
    But your take on the legalization issue seems to be "Why should I consider the racial and economic angles of this issue? I merely want to consider a few health angles in isolation, and mock anybody concerned with the bigger picture. Why must I take notice of ways in which this policy disparately impacts minorities? Anyway, I'm a great ally."

  • J sub D says:

    It is hardly surprising that the War on Liberty has a disparate impact on minorities when one looks at the racist ramblings of Henry Anslinger, the first spear carrier for the war.

    There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos and entertainers. Their Satanic music, jazz and swing, result from marijuana usage. This marijuana causes white women to seek sexual relations with Negroes, entertainers and any others.

    …the primary reason to outlaw marijuana is its effect on the degenerate races.

    and my favorite -

    Reefer makes darkies think they're as good as white men.

    Prohibition was founded in racism and the effcts are still seen today

  • Alex says:

    Another interesting passage:
    http://ftp.resource.org/courts.gov/c/F1/0026/0026.f1.0512.pdf

    But smoking opium is not our vice, and therefore we are more likely to go to extremes in our desire to suppress it, or to vex those who practice it. Indeed, it is well understood that this legislation, however right in the abstract, is not so much the result of a desire on our part to reform the "Heathen Chinee" as to annoy him.

    This is a court finding that an early opium law was written with the goal of producing disparate impacts on under-privileged ethnic minorities.

  • jojo says:

    These data are weird. They seem to be saying that daily usage (drinking/smoking EVERY SINGLE DAY) = dependence, and any amount less than that (drinking

  • jojo says:

    Sorry for the repost - it kicked off half of my 2nd paragraph.
    These data are weird. They seem to be saying that daily usage (drinking/smoking EVERY SINGLE DAY) = dependence, and any amount less than that (drinking

  • jojo says:

    argh, I obviously need to use the preview option. Please delete the repeats if you like.
    These data are weird. They seem to be saying that daily usage (drinking/smoking EVERY SINGLE DAY) equals dependence, and any amount less than that (drinking less than 29 of the last 30 days) equals not dependent? This seems wrong.

  • Josh says:

    I'd like to point out that recovery time for marijuana is basiclly zero compared to the rate of recovery from a hard nights drinking. Might that have something to do with the higher frequency of cannabis use?

  • Matthew says:

    I don't buy the premise that frequent use = dependence = harm. I agree with the general hypothesis that views on legalization reflect views of relative harm, but you need another definition of harm. Use isn't the same thing as harm. Look at rates of hospitalization, overdose, etc.
    Alternatively, I think that there may be a threshold of frequency of use that becomes a tipping point for views on legalization. If a lot of your friends and family are using a particular drug, you're more likely to support its legalization.

  • DrugMonkey says:

    @#20- I don't think I drew that equivalence and certainly not with the implied inevitability and directionality.
    My comments about the difference between meeting DSM style criteria and a subjective drug-problem address your second equality.
    @#20, 16-18- With respect to frequent use / dependence I also make it pretty clear that these can be distinct populations. There was coverage on the old blog of a paper on a surprising lack of even DSM dependence criteria.
    jojo- DSM-IV diagnostic criteria can be found many places with a simple google. in the general substance abuse category, dependence requires meeting 3 or more of these in a 12 month interval

    Tolerance (marked increase in amount; marked decrease in effect)
    Characteristic withdrawal symptoms; substance taken to relieve withdrawal
    Substance taken in larger amount and for longer period than intended
    Persistent desire or repeated unsuccessful attempt to quit
    Much time/activity to obtain, use, recover
    Important social, occupational, or recreational activities given up or reduced
    Use continues despite knowledge of adverse consequences (e.g., failure to fulfill role obligation, use when physically hazardous)

    As always, it is an error to try to use these yourself to diagnose others (or self). It requires clinical expertise.

  • antipodean says:

    DM
    With all due respect that's not epidemiology. It's online political pollery from a biased sample that is not going to be representative of "American Voters".

  • DrugMonkey says:

    It is, of course, your prerogative to blog about what you like to blog about, ...
    Do you really believe that? It seems as though you do not. This is not different from people who claim to respect, say, the Constitution of the US and then go immediately on to demonstrate that they do not in fact subscribe to the principles contained therein. Which is it going to be?
    But your take on the legalization issue seems to be "Why should I consider the racial and economic angles of this issue? I merely want to consider a few health angles in isolation, and mock anybody concerned with the bigger picture. Why must I take notice of ways in which this policy disparately impacts minorities? Anyway, I'm a great ally."
    You have no idea what my take is on the "legalization issue" precisely because I do not address it in this particular venue. In this particular venue and particular topic I ally myself mostly with the science of substance abuse.
    One would think that such a proud ally of the under-privileged
    When did I call myself such?
    Speaking of endlessly fascinating, I find it endlessly fascinating that you all drug legalization fans are categorically* unable to discuss scientific findings other then to reject them out of hand because they do not accord with your public policy goals.
    __
    *DuWayne, yes you are the exception that proves the rule...

  • DrugMonkey says:

    antipodean, pray tell why the MtF and NSDUH are not epidemiological in nature?

  • Alex says:

    1) I believe that it is your prerogative to blog about what you want to blog about, but I also believe that omissions are worthy of commentary. Likewise, Richard Dawkins can put whatever he wants into an anthology and label it whatever he wants, but omissions from such an anthology are also worthy of commentary.
    2) I specifically did address issues of science in comments 2 and 3, when I commented on factors that should be included in an analysis of the public health impact of a policy. Moreover, in comment 2 I specifically addressed a scientific topic that you've commented on before (that some substances are harmful on their own, despite folklore about additives being "the real problem") and suggested that this topic might be easier to address in the public arena under a system with better control over labeling and consumer information. I also suggested that the context of behavior needs to be accounted for in an analysis of harm and public health impacts, and I suggested that violence is a topic relevant to public health and that violence should be addressed when considering the public health impacts of a policy change.
    So, yes, I do want to talk about matters of science and public health.

  • WMDKitty says:

    Ugh. Just legalize it, already -- prohibition is causing far more harm than cannabis ever could.

  • Eric the .5b says:

    Do you really believe that? It seems as though you do not.

    This complaint seems "not different" from those who cry censorship when people merely criticize them.

  • Matthew says:

    DM,
    "I should point out that near daily cannabis smoking seems to be commonly associated with dependence, based on my chats with those who do research studies on human cannabis smokers."
    I didn't mean to imply directionality between frequency of use, dependence and harm either, but you certainly do use frequency of use to indicate, if not equivocate dependence. I just disagree that this is a accurate assumption.
    On another subject, I also don't understand the urge to jump from a DSM diagnosis to legislation... even if legislation does decrease the frequency of diagnosis. Legislation is certainly a larger issue that mere addiction or public health. Is it possible that people grasp some of the nuances of drug law enforcement beyond drugs = bad?

  • MattXIV says:

    DM,
    There are several reasons marijuana is treated differently than other common drugs in public opinion.
    First, contra your statement that the acute risks are comparable, the ratio of an acutely toxic dose (which is larger than any practical dose by the normal administration means) to a typical recreational dose threshold for marijuana is higher than any of the other drugs you have on the graph. Acute toxicity is scarier to people because of the whole "one bad decision can kill you" thing and delayed consequences get discounted via time preferences. The message that it only takes one dose of cocaine or heroin to kill has been hammered into the public's mind for quite some time with well-known examples of fatal overdoses available to the public (Len Bias and cocaine, various musicians and heroin) yet there's not a single prominent example (or any example to my knowledge) of acute toxicity related to cannabis.
    Second, more people know someone who has used marijuana or have used it personally without devastating consequences, so their attitudes are likely to be softened compared to other drugs for whom the users are abstractions created by over-the-top anti-drug propaganda.
    Finally, the usage * average harm equation isn't how people look at drug policy - there are various reasons for this, most of them good. First, usage rates do not simply follow from public policy in linear manner - marijuana, like alcohol, is fairly easy to produce illicitly within the US, which makes interdiction harder than . Second, the concentration of negative side effects in a few users can be worse due to threshold effects - one person who drinks 10 beers a day will cause more alcohol related car accidents on average than 10 people who drink a beer a day; a group of 200 people who spend $100 a month on drugs is likely to commit fewer crimes to cover their drug consumption's cost than 10 people who are spending $2000 a month; etc. Finally, people generall believe that there is a certain threshold that must be crossed in terms of a particular person's obnoxiousness before it should become a matter of law - the average marijuana user doesn't cross that threshold for as many people as the average meth user does.

  • DrugMonkey says:

    you certainly do use frequency of use to indicate, if not equivocate dependence
    There is an association. In humans it cannot be proven (because of lack of random assignment) that frequency causes dependence. In animal models this has been demonstrated repeatedly so long as you understand that this is science, which entails variability and only approximations of the Truth. I go way out of my way to remind everyone in these discussions that not everyone who is exposed to drug will become dependent. This does not mean that the aforementioned association is false.
    Is it possible that people grasp some of the nuances of drug law enforcement beyond drugs = bad?
    Of course. What is apparently not possible is for some firm fans of cannabis to admit that addiction is a bad thing and is an inherent feature (on a population level) of smoking cannabis.

  • Alex says:

    Addiction is a bad thing and a certain amount of addiction is an inherent feature (on a population level) of drug use.
    Will you admit that markets controlled by criminals and disparate impacts of enforcement are bad things and are inherent features of driving certain activities underground?

  • Alex says:

    Oh, and contrary to your characterization above I am not a "fan of cannabis." I've never touched the stuff. I don't even drink alcohol. I'm from a family with a few addicts and alcoholics. I just despise mobsters, gangsters, cartels, the Taliban, and everyone else involved in this underground market, and I want to drive them into bankruptcy.

  • ildi says:

    Speaking of endlessly fascinating, I find it endlessly fascinating that you all drug legalization fans are categorically* unable to discuss scientific findings other then to reject them out of hand because they do not accord with your public policy goals.

    Like the following?

    I should point out that near daily cannabis smoking seems to be commonly associated with dependence, based on my chats with those who do research studies on human cannabis smokers.

    (My friends all say...)

  • DrugMonkey says:

    (My friends all say...)
    Except in this case my "friend" are scientists who conduct and publish actual studies. And I've provided at least one reference to get you started if you wish to verify this assertion for yourself by familiarizing yourself with relevant literature. What's your point?

  • antipodean says:

    Bollocks. Sorry DM. I was referring to the first figure/study that you referred to. Not the rest of the data you cited in favour of your argument.

  • ildi says:

    Oh, you mean this?

    I also note that in at least one treatment seeking population of cannabis smokers, the mean was 25 days per month (Hathaway et al, 2009).

    You mean treatment-seeking population? Versus daily cannibis smokers who do not seek treatment? Because, you know, you forgot to include the first part of the dependence definition from the DSM-IV diagnostic criteria:

    A maladaptive pattern of substance use, leading to clinically significant impairment or distress

    Oh, and from the very study you cite (I can only access the abstract):

    There are more similarities than differences between groups, with DAST and DSM scores showing high rates of “dependence” and reported symptoms of “abuse.” However, cannabis consistently scored lower on these items, supporting the idea of a continuum of risk on which its rank compared with other potentially misused drugs holds across a wide range of symptoms of impairment.

    That's my point.

  • Joe says:

    DM-
    I think you may have addressed this somewhat in your post, but I didn't see it directly. The comparison between casual/daily usage in marijuana vs. alcohol or cigarettes does not seem like a very useful comparison for drawing any conclusions at this point (which I think you hinted at). Because marijuana is currently illegal, it would make sense that the population of users is going to be more frequent users due to the very nature of how the drug is obtained. It requires concerted effort to obtain marijuana, and simple possession entails much more risk than either other substance. This is drastically different from alcohol, which is available with very little effort required for obtainment, and which is available in many more situations with opportunity for casual usage.
    It seems like Amsterdam is the poster child for looking at social behaviors in regards legalized marijuana. Are there any studies of this kind that have looked at the casual/daily usage there, perhaps in comparison with the same data for alcohol usage?

  • Isabel says:

    "acute risk of death, risk of toxicity to brain or other major organ with repeated use, etc. "
    You don't see a difference here? Really?
    ???????????????????????????????????????????????????????????????
    DM you are such a goddamn tool.
    "on so much of the population uses alcohol is that it has such a long cultural and even religious history. Despite a relatively short-spanning temperance movement and a few religions, alcohol consumption is widely tolerated and even promoted by some religions.
    This is not the case for marijuana. "
    ??????????????????????????????????????????????????????????????????????????????????????????
    What an incredibly ignorant remark! Cannabis has a LONGER religious and cultural history.
    "(My friends all say...)
    Except in this case my "friend" are scientists who conduct and publish actual studies. "
    tools like you.
    "at least one treatment seeking population of cannabis smokers"
    The majority of whom are FORCED to seek "treatment" by employers or law enforcement. Who base their sicko policies on the recommendations of people like you and your nerdy friends. What a fucking waste of tax dollars!

  • Joe says:

    "...acute risk of death, risk of toxicity to brain or other major organ with repeated use, etc."
    Yeah, I didn't even really notice that before. You can't really be serious that you don't see a difference in those specific harmful outcomes, right? The graph was comparing marijuana to ecstasy, cocaine, heroin, and meth. There is most definitely a difference in the risk of acute death and toxicity. To suggest otherwise is not an attempt to be careful about the data, it's just being disingenuous.

  • DrugMonkey says:

    Isabel, Joe- the point is that those risks vary across the illicit drugs listed and despite what you'd like to believe cannabis does entail acute risk- trauma due to acute intoxication. Shall we get into the auto and workplace data to give you some more facts to try to deny?
    Isabel you are incorrect, in many if not all cases, about research subjects. The projects I am most familiar with do not draw from court-mandated populations. The one judge I know who handles a huge drug case load does not consider a research study for mandating treatment. There is a big diff between studies that use the treatment seeking population for studies not directly related to treating, those that are evaluating novel therapy and a straight-up treatment program.

  • Matthew says:

    #30, 31 DM & Alex, ditto. That's my point. Of course there is risk associated with the use of any drug. It would seem that - to a large percentage of the population - the cost of prohibition outweighs the risk associated with the use of cannabis. And, to address DM's point, I would add that in the case of cannabis, the association between frequency of use, dependence and harm seems to be weaker than the case may be with other drugs, even alcohol. Even with alcohol, most people still agree that the consequences of prohibition outweigh the risks associated with use. This isn't because people don't understand the risk associated with alcohol consumption, it's because the consequences of prohibition are so great.

  • Spartan says:

    DM, I think your posts on marijuana have been very informative concerning it's harms and risks, and I agree that there are many who inaccurately think that using it is almost harmless. Even though you are very careful in what you say, I think people assume that you must be against legalization when you say things like, "there is a categorical distinction between marijuana and some other popular drugs but I just don't see where it is supported", but I agree that's a non sequitur. I guess I'm unclear on how you are measuring the harm: are you determining it's harmfulness by taking an aggregate of all the harm it causes across the population and comparing it to the smaller population of people using the other, I'd say 'more dangerous', drugs in the chart? Meth is more harmful than marijuana but the larger population of pot users equates to a more even 'harm' to the overall population. Put another way, do you really think that an individual is assuming an equal risk of harm if they were to smoke a joint versus doing any of those other drugs?

    Shall we get into the auto and workplace data to give you some more facts to try to deny?

    Depending on how you want to slice it, I don't doubt that that data does support your conclusion. It doesn't however address the, "risk of toxicity to brain or other major organ with repeated use". You don't see a difference between pot and tooth-rotting meth for instance on that measure?
    I have friends too who are doctors and nurses, a couple who have worked in emergency rooms. None that I've talked to have ever had anyone come in with serious physical problems linked to their marijuana use, yet have story after story for all the other drugs you've listed above. Yes, they do have examples of someone getting in an accident from being impaired from smoking pot, but do you feel that the other drugs above do not cause equal or greater impairment? Yea yea, it's just anecdote, but I'd be surprised if their experience is not somewhat representative.

  • Joe says:

    DM- I'm not attempting to deny anything. Are you saying that the risks vary as some sort of continuous or comparable spectrum? There is likely a very discrete jump in risks between marijuana and the other drugs listed. It seems by what you're implying, that cell phone usage could rank up there as quite a high risk category in relation to automobiles, and just imagine the daily usage statistics on those 😉 And has marijuana itself really been shown to result in workplace issues, or have there been controls for overall deviant behaviour to look at non-deviant marijuana users? Due to its legal status, of course many users are going to show deviant personalities.
    Pertaining to my first post, do you know of any data looking at casual usage where the laws are different than in the US?

  • DrugMonkey says:

    @42,43,
    Why is this so unclear. There are a variety of harms associated with drugs of abuse. The specific drugs vary in terms of how much risk they entail for specific harm categories. Cannabis is by no means unique or comes with a "discrete jump".
    Example one, cannabis is addictive but comes somewhere in the low-middle range. Going by the much cited Anthony et al paper I discussed before the rate of lifetime dependence given lifetime use. 9% for cannabis, 15% for alc, 17% for cocaine, 23% for heroin, 32% for tobacco. BUT, only 3.7% for inhalants and 5% for hallucinogens. Although this is but one way to generate the relationships, different approaches give similar results. Dependence (or compulsive use or treatment seeking or what have you) for cannabis is much higher than for some drugs that people feel are very risky like LSD.
    Trauma- behavioral data from acutely intoxicated research subjects tells us pretty clearly that reaction time under changing conditions is okay or enhanced with the stimulants. Impaired by cannabis. So if you have a kid entering the street, risk from the DUImj is higher than from DUIcoc.
    The only way you get to the survey results in the first figure is by (highly) selective evaluation of which potential harms concern you. Under a broad acting principle like general legalization of marijuana, I fail to see where it is at all reasonable to exclude any particular harm category.
    I guess I'm unclear on how you are measuring the harm: are you determining it's harmfulness by taking an aggregate of all the harm it causes across the population and comparing it to the smaller population of people using the other, I'd say 'more dangerous', drugs in the chart?
    This is an additional part of the calculation, yes.
    This isn't because people don't understand the risk associated with alcohol consumption, it's because the consequences of prohibition are so great.
    You realize that this undercuts your point, right? You are basically arguing that if we have prohibition of a substance that this is because the consequences have been judged to be appropriate given the risks of consumption. You are arguing that status quo is the one true and right way to go. It is idiotic in my view to think that *any* political decision on recreational drug legal status has ever been made with a sober evaluation of extant evidence driving the outcome. It will not escape you that this is one reason I don't offer too much in the way of policy views.

  • Spartan says:

    The only reason it's unclear is because of this assertion, or just the way you phrased it:

    The public appear to feel that there is a categorical distinction between marijuana and some other popular drugs but I just don't see where it is supported in terms of any given harmful outcome including risk of dependence, interference with ability to function when acutely intoxicated, acute risk of death, risk of toxicity to brain or other major organ with repeated use, etc.

    Death due to overdose is a given harmful outcome, and is nearly impossible to achieve using cannabis. Isn't that a 'discrete jump' as I think you are using that phrase? You say the results don't reflect any apparent measure of harmfulness; doesn't the physical harm component alone of the above drugs explain the chart?

    The only way you get to the survey results in the first figure is by (highly) selective evaluation of which potential harms concern you. Under a broad acting principle like general legalization of marijuana, I fail to see where it is at all reasonable to exclude any particular harm category.

    I agree that no harms should be excluded, but aren't you also employing a selective evaluation and weighing of harms to come to the conclusion that these results are odd? I don't disagree that cannabis involves harms that many people ignore in response to a survey like this, like dependence and impairment that you rightly bring up. I would guess that in many people's minds, alcohol's harm provides some sort of threshold for legalization, and many people who know about pot also believe, very justifiably in my view, that at the worst pot is no more harmful and no more impairing than alcohol.
    It would be interesting, and maybe you've posted it previously, to see how the scores in all these harm categories for the drugs above really compare. Cannabis' impairment seems to me the greatest harm you've listed; from a harm standpoint rates of dependence would have to take into account the effects of dependence obviously, which I don't think are as great for pot vs the others. Wouldn't nearly everyone, if forced to choose the least harmful drug in that list to become addicted to, choose pot, and for good reason? Don't those reasons explain the survey results?

  • DrugMonkey says:

    If you focus on chance of dying sitting in your living room from a "typical recreational dose" (whatever that might be) then yes, you might say MJ is somewhat unique of the listed compounds.
    OTOH, other drugs, like Ecstasy and the classic hallucinogens for example, seem to have a much lower chance of developing repetitive, compulsive use and dependence. So there you might say MJ is not unique and the only way you get to unique status is by ignoring dependence. (or acute intoxication trauma of certain categories)
    Is my weighting off? I dunno, you seem to think that dependence is no big deal. I think it is. Among other reasons because it drives more use under more circumstances. That multiplies the acute intoxication harm as well. Of course, you seem to be undervaluing the acute intoxication harm as well when you come to your gestalt harm index.

  • Spartan says:

    I dunno, you seem to think that dependence is no big deal.

    It's not that it's not a big deal, and I don't think I need to assign a unique status to MJ; we are comparing different levels of harm. At the very least, I think there are some very good arguments to be made that the harm caused by the dependence on pot is less than the harm caused by the dependence of the other drugs mentioned. The drug I think that is closest might be Ecstasy, for the very reason you mentioned, that pot has a higher risk of dependence; to what extent that is balanced by the physical impact taking Ecstasy has compared to pot, as you say, I dunno.
    If you just look at physical harm, acute intoxication harm, and dependence for the index, which would not seem to favor cannabis, and we try to balance them equally somehow in weight, I think you still have MJ and Ecstasy at the bottom. I don't know much about the physical damage caused by ecstasy and whether that's accurate. Dependence also multiplies the physical harm, on which MJ, relative to the above, is negligible; I don't know if any of the above has a comparatively negligible acute intoxication harm. Point taken, it's complicated; the survey looks about right to me using that index when comparing to meth and heroin though, but not so much, I don't think, compared to ecstasy.

  • djlactin says:

    duuuude. got not idea what your point is

  • Isabel says:

    "Shall we get into the auto "
    Cannabis users are AWARE of their impairment and drive more cautiously, so as far as accident data, it is a wash.
    The evidence has shown this time and time again.
    DM, where has the fact that humans crave some type of altered state of consciousness and that they generally find it using one plant product or another figured into all your scientific calculations?
    This is what I mean about you and your NIDA associates being dweebs.
    I'm still waiting for someone to name a single drug, including OTC's, that is as safe as Cannabis. That your child, for example, could ingest several thousand doses of, throw up from the volume of plant material at worst, and be perfectly fine after a good night's sleep.
    And that a lifetime of regular use will result in no organ damage.
    Please name one drug DM I am still waiting!
    The only people on earth who do not use plant intoxicants are traditional Inuits. Which apparently is the "norm" we should all be striving for.
    because according to the NIDA website, the very first time a person uses Cannabis, they are "abusing" the drug.

  • VikingMoose says:

    meh - as a non user, still think it should be legalized at some level. Can anything be turned into something big pharma might like, etc.
    Alex - excellent arguments, btw

  • Isabel says:

    Please just state your case. I don't follow blind links. If what you say is interesting, I may follow the link, but you should be able to summarize your point on a thread like this.

  • cashmoney says:

    You are one paranoid nutter, I'll grant you that. Hardly 'blind' links, geez.
    Emergency Room visits featuring marijuana intoxication. Your behavioral adjustment theory is just plain nonsense. Even if attempted it fails to compensate for the impairment, at the population level anyway.

  • bsci says:

    cashmoney, just remember Isabel is the same person (comment 38) who implied that marijuana has a large and more significant cultural history than alcohol!
    I'm also not sure where she came to the conclusion that a single use of MJ is abuse according to NIDA. If anything their page for teens says the opposite. http://www.nida.nih.gov/MarijBroch/teenpg13-14.html#addicted
    Long-term marijuana use leads to addiction in some people. The only use of the word "abuse" on the page is regarding people's listed drug when they seek treatment. That seems to be a fairly accurate use of the word.
    Finally anyone who thinks Inuits don't have altered states hasn't seen Atanarjua (The Fast Runner)

  • Matthew says:

    DM: "You are basically arguing that if we have prohibition of a substance that this is because the consequences have been judged to be appropriate given the risks of consumption. You are arguing that status quo is the one true and right way to go. It is idiotic in my view to think that *any* political decision on recreational drug legal status has ever been made with a sober evaluation of extant evidence driving the outcome."
    You are being obtuse. First let me outline what I am not claiming. I'm not arguing for status quo at all (on the contrary, in my personal opinion, a change of legislation is warranted). I didn't say anything about what is or is not "appropriate." I'm also not saying any one way is "right" or another is wrong.
    Now, what I am saying is that your assumption of 'frequency of use correlates with harm' is - at least - not helpful if not wholly inaccurate when discussing risk and harm associated with cannabis. Again, that is not to say that there is no risk involved with cannabis, just that the association with frequency of use isn't sufficiently correlated in this case. If you think it is, then demonstrate a statistical correlation to a measurable harm (other than "dependence" as defined by frequent use... that's what we call a circular argument).
    Getting back to the complexity of the issue, I speculate that popular opinion of marijuana prohibition is as much a commentary on US law enforcement and judicial systems as may be on any perceived harm (or lack of) associated with cannabis. That is to say, there may be an evaluation of risks/harms and for cannabis. The harm of prohibition may outweigh the harm of cannabis to a growing % of Americans, not merely that there is *no* harm associated with cannabis.

  • DrugMonkey says:

    just that the association with frequency of use isn't sufficiently correlated in this case. If you think it is, then demonstrate a statistical correlation to a measurable harm (other than "dependence" as defined by frequent use... that's what we call a circular argument)
    Wait, let me be clear here. You are seriously denying that there is a positive association between frequency of marijuana consumption and dependence? Between frequency of use and acute traumatic harm? Really? That's the point of contention here? And you are not confused over the difference between a *perfect* correlation and a positive correlation, right?

  • Matthew says:

    Yes. I'm making the point that there are a lot of people who smoke a lot of pot that never exhibit signs of harm other than their frequent use... relative to other drugs.

  • DrugMonkey says:

    Right, Matthew, so you don't understand the difference between a regular old (significant) correlation and a perfect correlation.
    The latter is a one to one correspondence which is rarely found in biology up to and including whole organism and even social behavior.
    The former reflects a general, albeit imperfect, tendency for two things to be predictive of each other.
    When I say an association exists or that there is a correlation, I'm referring to the regular old version which accepts variability. Not a perfect correlation. Is that clearer?

  • Isabel says:

    well, I meant 'unexplained' links. I don't know why I wrote blind, but you're an asshole.
    "Your behavioral adjustment theory is just plain nonsense"
    my what?
    And you are linking to some gov. propaganda, should have known....
    ER visits for what? Paranoid reactions. No harm done. And I wasn't talking about teens intentionally using.
    Very poor rebuttal, if that's all you've got.
    "cashmoney, just remember Isabel is the same person (comment 38) who implied that marijuana has a large and more significant cultural history than alcohol!"
    It's true, jerk.
    "I'm also not sure where she came to the conclusion that a single use of MJ is abuse according to NIDA"
    This was stated by the 'new' director, in a letter on the opening page, not on the teen site. Have no idea if it's still there, but I did cite it on a former DM thread. Jerk.
    "Finally anyone who thinks Inuits don't have altered states hasn't seen Atanarjua (The Fast Runner)"
    I said they didn't use plant intoxicants. What plant intoxicants do they use, smartypants?
    And you've just strengthened my point, thanks.

  • bsci says:

    Isabel,
    NIDA has had the same director since 2003. Not sure which "new" director you're talking about. Perhaps you're confusing NIDA with one of the law enforcement agencies?
    You really think large-scale marijuana use is older than alcohol, which has evidence of wide use since at least the start of non-nomadic communities?
    It's really not worth linking to any actual information for you since you seem to decide anything you disagree with is propaganda and lies. Oh well.

  • Matthew says:

    DM,
    I understand. Association is a sliding scale. I'm saying that the association between frequency of use and harm caused by cannabis is probably much, much less than the association for any other recreational drug on the list in the original post. So much so, that I don't think frequency of use is a fair surrogate for harm in this case (not that it's entirely uncorrelated, again I understand correlation) but it's definitely invalid when you're trying to explain differences in perceived harm for those drugs. On the sliding scale of association between frequency of use and harm, cannabis and meth are probably on opposite ends of the spectrum, and alcohol probably sits somewhere between the two and caffeine is probably off the scale on the cannabis end. That's why you can't use frequency of use to approximate harm when comparing between drugs. If we want to talk about harm then lets talk about emergency room admissions, automobile accidents, etc. and not a surrogate that may be or may not be correlated to a greater or lesser extent to the actual harm you're trying to address.
    Does that make sense? If not, are you equally perplexed at the legal status of caffeine?

  • Isabel says:

    NIDA Intensifies Focus on Marijuana Abuse
    Director's Column
    Vol. 20, No. 1 (August 2005)
    By NIDA Director Nora D. Volkow, M.D.
    More than 96 million Americans have smoked marijuana at least once. Marijuana abuse is particularly prevalent among adolescents: Of the more than 2 million people who abuse the drug for the first time every year, two-thirds are between 12 and 17 years of age.

  • Isabel says:

    "part of the reason so much of the population uses alcohol is that it has such a long cultural and even religious history. Despite a relatively short-spanning temperance movement and a few religions, alcohol consumption is widely tolerated and even promoted by some religions.
    This is not the case for marijuana."
    You are wrong. What is your background anyway?

  • Take a peek at the "Information Is Beautiful" site - http://www.guardian.co.uk/news/datablog/2009/nov/06/drugs-bnp. He has the sources. Notice especially the reported mortality from cannabis - 484% of deaths were reported...

  • bsci says:

    When you say "you are wrong" with no explanation or evidence, this really isn't worth continuing. I am a medical researcher (nothing directly relating to addition) so I'm part of the evil conspiracy anyway and you have no reason to trust anything I say.

  • Isabel says:

    Try google. You didn't ask about cannabis, you stated that it was not true for cannabis. Then you made the bizarre assertion that we should compare cannabis to tobacco.
    If you had asked and not spread misinformation as you did I might feel more like helping you.
    484% of deaths...what?

  • Neuro-conservative says:

    The actress Brittany Murphy died this morning at the age of 32, reportedly due to cardiac arrest.

  • Emergency Room visits featuring marijuana intoxication.

    Featuring?? What the fuck kind of fucking weasel word is that?? Yeah, maybe people show up in the emergency room with other injuries or intoxications and also happen to be high, thus "featuring" marijuana intoxication.
    The only emergency room visit I can think of that could be caused by marijuana intoxication per se goes like this:

    {naive teenager} ZOMFG!!!! I am so fucking high!!11!! {paranoia sets in} ZOMFG!!!11!! I'M GONNA DIE!!!11!!11!! {teenage friends take excessively stoned teenager to emergency room} ZOMFG!!! Our friend smoked some pot and now he says he's GONNA DIE!!!11!! {emergency room doc snickers}

  • DuWayne says:

    While it is not reasonable to say that all people who are daily or almost every daily users have an acute cannabis dependency, there is every reason to believe that the vast majority do. The mere fact that people who are addicted/dependent refuse to objectively look at the harm caused, does not mean there isn't any - it just means they are like a great many addicts. We can play fucking games and equivocate all we want, but if one is using any drug on a near daily basis, the chances are pretty good that they are dependent. If said drug is ostensibly being used for recreational purposes, chances are they are also an addict.
    On the other hand, we have your comparison to alcohol DM, which is more than a little silly. Contrary to Isabel's assertion, alcohol has a very special place in human societies throughout time and space. Alcohol use is firmly enough ingrained that there are populations with a genetic propensity for alcohol addiction. Consider that for a moment - consider exactly what that means. Abuse that has been prevalent enough in certain populations, that a specific propensity for addiction to that substance has been selected for. We are not looking at a particularly reasonable comparison here.

  • DrugMonkey says:

    Not my fault CPP, they actually use the term "mentions" which isn't much better. Very big category and is going to include plenty of situations where being positive for cannabis was entirely irrelevant to the reason for being in the emergency department. You seem, however, to be missing the large category of harms captured under acute trauma because someone did something stupid while high.

  • DrugMonkey says:

    Sorry, N-c, your link got trapped. Yeah, the Twitts were all about the sad tale of Ms. Murphy yesterday. My cynical behind immediately suspects drug involvement, of course. Mode suggests the stimulants but there is a mention of multiple prescription drugs in some reporting. Also sudden weight loss which *might* be consistent with a run of stimulant use- which can screw with the heart, particular valves if I have it right. I have to look into whether anorexia not involving stimulant drugs is also cardiopathic...anyone?

  • I have to look into whether anorexia not involving stimulant drugs is also cardiopathic...anyone?

    Don't know about causing persistent cardiopathy, but the electrolyte imbalances associated with anorexia and--even more so--with bulimia (because of vomiting and/or diuretic and/or laxative use) can cause acute heart failure.

  • Isabel says:

    "Contrary to Isabel's assertion, alcohol has a very special place in human societies throughout time and space."
    WTF is that supposed to mean? Contrary to WHAT assertion??? I said NOTHING about alcohol.
    If you read what I SAID it was that this is true for cannabis also. It aint all about upper middle class American hippies you know. Learn your history before dissing me next time. If someone asks me respectfully, I can give you an overview to help you start your research.
    And DM anyone familiar with your posts can only view your "sadness" over a single recent case as crocodile tears.
    btw I did read the propaganda pdf that was linked to above concerning ER visits. As expected, over half involve other drugs or alcohol; of the rest 60% involve "unexpected reaction" which was unexplained (I guess after four pages of scary-sounding statistics which basically said nothing informative, there was no room to actually define the main reason for actual cannabis-related ER visits, supposedly the subject of the paper). We can safely assume this was paranoia/anxiety attacks of those unfamiliar with the effects of the drug, and that no lasting harm was done. Many of the others, which were, 2, 3% or so each were quite puzzling and also unexplained, such as "dependency" (an ER visit?), overdose (impossible) and so on. Even the 'doing something stupid' evidence is circumstantial at best.
    Please provide stats for your accident claims. People on this thread tend to assume car accidents would increase for example but all the efforts to prove this have been unsuccessful, for the reason I outlined above.

  • Isabel says:

    And no comment on NIDA Director Volkow's belief that first time use is "abuse"? To my mind this really gets to the heart of all the arguments here.

  • DrugMonkey says:

    To my mind this really gets to the heart of all the arguments here.
    Of course it does. Because you cannot seem to distinguish specific comments, orientations and approaches to a topic. You take the unfortunately common approach of lumping all research scientists in with what you see as a vast right-wing prohibitionist conspiracy against your desire to smoke weed legally. To my mind, this gets at the heart of your arguments against anything anyone has to say about cannabis and results of smoking it.
    I do not ever claim first use is "abuse" (and if I have, direct me there because I need to correct the record) and I try to point to or post the DSM criteria now and again so that when I do use the term abuse you know what I mean. I also go out of my way to point out that diagnostic criteria are just that and may not map onto what we think of colloquially or even politically as "a drug problem".

  • DuWayne says:

    Ummm, Isabel - this would be the statement I was referring to...
    What an incredibly ignorant remark! Cannabis has a LONGER religious and cultural history.
    Not exactly sure why you would be arguing that cannabis has a longer cultural history, but it is both self-defeating and flat wrong.

  • Isabel says:

    "Not exactly sure why you would be arguing that cannabis has a longer cultural history, but it is both self-defeating and flat wrong."
    We can quibble about the length of the history if that is what you want to discuss, and it will be interesting to see you prove me 'flat wrong,' but the above quote cannot be the "statement you were referring to." Nowhere do I imply that alcohol does not have "a very special place in human societies throughout time and space" as you suggested I did. Of course it does! And so does cannabis.
    DM, I think the first part of your last comment (#75) revealed a lot about your 'issues' with cannabis policy.
    "I do not ever claim first use is "abuse"
    but don't you think it's troubling that the NIDA Director does?

  • DrugMonkey says:

    don't you think it's troubling that the NIDA Director does?
    Obviously. It is troubling because it supports nutter paranoids going off on tangents when we should be focusing our discussions on things that matter.
    Equally obviously, though, Dr. Volkow sees it differently than I do.
    I think the first part of your last comment (#75) revealed a lot about your 'issues' with cannabis policy.
    Indeed? It is not exactly top sekrit..

  • DuWayne says:

    Obviously. It is troubling because it supports nutter paranoids going off on tangents when we should be focusing our discussions on things that matter.
    More importantly, DM, it also cuts into her credibility in a huge way. And while I do not expect her to talk in positive terms, I do expect her to be realistic about it. Dr. Volkow has a lot backing her ability to functionally perform her job. But absurd comments about first time use equaling abuse are pretty good for negating a lot of those positive attributes.
    We can quibble about the length of the history if that is what you want to discuss, and it will be interesting to see you prove me 'flat wrong,' but the above quote cannot be the "statement you were referring to." Nowhere do I imply that alcohol does not have "a very special place in human societies throughout time and space" as you suggested I did. Of course it does! And so does cannabis.
    Excuse me for not being considerably more clear. Contrary to your ignorant assertion that cannabis has a much longer and stronger cultural history than alcohol, you are full of shit - so full of shit your eyes are floating in it. Is that better? As for the quibble, alcohol has been used by modern humans for as long as they have eaten fruit and noted that overripe fruit makes the head feel a little funny. There is no reason to believe this was limited to modern humans either - it is exceedingly likely that our protohuman ancestors figured that out before the dawn of humankind.
    It would be much easier to engage in these discussions with you, if you would step away from the "cannabis is magical" koolaid and accept that it is good and bad and that comparisons to alcohol and other drugs is simply irrelevant. Don't play the stupid games that people who espouse a pretty solid anti attitude about cannabis want to play. It is a lot more effective to point out that such comparisons are logical fallacies and why. It is a lot more effective to accept the premise that cannabis has it's negative points and point out that this is irrelevant too. Don't fall into the trap that DM is creating here - don't allow the discussion to rest on his framing. When the frame is flawed, attack the flaws instead of playing into it.

  • Isabel says:

    ". Contrary to your ignorant assertion that cannabis has a much longer and stronger cultural history than alcohol,"
    Again, putting words in my mouth. I said longer, not "much" longer.
    And where did "stronger" come from? I didn't say that, though it's perhaps true if you are considering the numbers of people involved (eg the centuries of everyday use by hundreds of millions in India) and the hypothesized and known influence on religion. But again, this could be debated, and I'm certainly no expert.
    I said a "longer religious and cultural history". That's as far as the historical evidence shows anyway. We could argue about what "probably" happened earlier, and which was used first, but it's nonsensical to totally dichotomize the two drugs as far as history and culture go, as was originally suggested here. That was my original point.
    Have no idea what you're going on about as far as the magic and the falling into traps.
    The biggest trap anyone (esp DM) is falling into around here IMO is assuming an ideal goal of no plant intoxicant use. Even if we don't expect to fully reach it, if we act like that would be best, we are way off base from the start.

  • DrugMonkey says:

    The biggest trap anyone (esp DM) is falling into around here IMO is assuming an ideal goal of no plant intoxicant use.
    Who said I assumed any such thing?
    Even if we don't expect to fully reach it, if we act like that would be best, we are way off base from the start.
    Really? How so? We don't expect to fully reach goals of 0% obesity or 0% diabetes or 0% heart disease either...are we off base if we act like we should have that as a target? I think what you really mean is that your answer to the first point (ideal goal 100% plant intoxication, right?) trumps the "Even if" of your second point.

  • MonkeyPox says:

    Jesus fucking christ, Isabel, who gives a fuck how long a history there is? What is important is the evidence for effects on health, positive and negative. When we voluntarily introduce foreign substances into our bodies, we should try to do so with actual knowledge of the effects rather than child-like wishful thinking.
    If people could pull their lips off the bong long enough to look at the evidence they could perhaps note that pot can cause negative health effects and then say, "but I like it and choose to do it with eyes open."

  • cashmoney says:

    C'mon Poxie, next thing you will be objecting to our species' long and hallowed social tradition of hitting people we don't like over the head with a heavy stick. It's our HISTORY, yo.

  • Isabel says:

    "Jesus fucking christ, Isabel, who gives a fuck how long a history there is? "
    Who keeps bringing it up, Asshole? Not me. I was just pointing out that it is ridiculous to assume a long cultural and religious history with alcohol only. Since then people keep arguing with me about it, though I can't imagine why.
    "they could perhaps note that pot can cause negative health effects and then say, "but I like it and choose to do it with eyes open.""
    Most of us did this already. It's stupid to keep saying people say there are no harms or it is magical. Nobody is saying this. You are imagining this.
    And you forgot the part about how we weighed the effects against the effects of other drugs. You're making the same mistake DM is.

  • DrugMonkey says:

    "Denying" harms is not equal to "weighing" harms, Isabel.

  • MonkeyPox says:

    Isabel, if you "didn't bring it up" then why defend the argument? Given the literature, it's hard to deny that marijuana can have significant harms and that dependence is common. As with cigs and EtOH, if you start using the shit with eyes open, well, fine, but when using substances that can cause dependence, it doesn't much matter whether you go in voluntarily or not as it is the leaving that is hard.

  • Isabel says:

    ""Denying" harms"
    This is occuring in your imagination. No one is denying anything.
    You are still a tool, sorry.
    "By NIDA Director Nora D. Volkow, M.D.
    More than 96 million Americans have smoked marijuana at least once."
    You support the criminalization of 1/3 of Americans?
    People want to use, and always have used, plant intoxicants.
    Deal with it. Treat the dependency, and lay off the policy.
    That is all I ask.
    Merry Christmas!

  • todd james says:

    Viewing this data exemplifies the fact that mental disorders and drug abuse often goes hand-in-hand. My client, Silver Hill Hospital excels at Adolescent Dual Diagnosis treatments which often times can be very difficult to detect.

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