In thinking about substance use it is important to recognize the close relationship between substance use disorder and mental health issues. According to the Substance Abuse and Mental Health Services Administration, at least fifty percent of those involved in substance use also struggle with mental illness, and vice-versa.
Professionals in mental health and addiction services refer to this as comorbidity. Comorbidity refers to the presence of more than one disorder in the same person. There can be comorbidity or overlap with diabetes and heart disease, or infectious diseases and dementia. Mental disorders that tend to show comorbidity include substance abuse, eating and anxiety disorders. Comorbidity is often associated with more complex treatment requirements, more negative health consequences, and increased healthcare costs. In comorbidity the interactions between the illnesses make them both worse.
Mental illness and substance abuse have many of the same risk factors. Trauma is often associated with both. People with mental health issues are more likely to self medicate with illicit substances as a coping strategy. They often use substances to reduce anxiety, avoid dealing with past trauma and mask its consequences. Although some drugs may temporarily reduce the symptoms of mental illness, they can also make symptoms worse and actually contribute to the progression of the illness.
Both mental illness and substance use can cause changes to the brain, making an individual more vulnerable to increased substance use. Both can affect the reward center of the brain, decrease awareness of consequences for behavior, decrease impulse control, and increase drug cravings. Substance use can also change the structures of the brain that can contribute to mental illness.
Substance use and mental health issues are often treated by different treatment providers. It can be difficult to find a facility or provider that integrates all of these needs. Those with comorbidity are less likely to follow their treatment plan and drop out of treatment more frequently than those with only one of the factors. People with this comorbidity often use more than one substance, further complicating treatment
Those with both mental illness and substance abuse issues tend to have the most difficulties with life in general. They tend to have higher rates of interpersonal problems, homelessness, unemployment, arrest, and medical need. It is important to connect them to community agencies to help secure housing, food, health care, job training and legal support.
Progress is being made in research and development of effective integrated treatment. Treatment providers are recognizing the complexities of this comorbidity and programs for treatment continue to be developed. . Increasing interpersonal skills and coping skills that support motivation and further recovery has been helpful in treating comorbidities of substance use disorder and mental illness. Even in these challenging situations, there is hope. Treatment works. Recovery is possible. If you or someone you know is struggling with substance abuse, please call to talk to a live person: 765-490-0381.
#48 marijuana and opioids
One of the arguments for legalizing recreational cannabis is that it would improve the opioid/substance use crisis. Can marijuana help with the treatment of more harmful addictions? Will marijuana increase overall rates of substance use disorder? I know and respect people who are passionate on both sides of this debate, and each perspective is represented in this article.
There is a mother whose child has struggled with various forms of addiction for many years. She sees legalization as a ray of hope for those struggling with addiction. She is certain that safe, legalized marijuana would allow her child to maintain recovery and avoid additional legal issues. She believes that cannabis will help with the discomfort and cravings of withdrawal. As a Pro Cannabis advocate, she emphasizes the benefits of natural health, the medical history that cannabis had before prohibition, and the natural endocannabinoid system in our bodies. She states that cannabis is better medically assisted treatment for opioids than the current practice of using suboxone, buprenorphine or methadone.
On the other hand, a friend in recovery is convinced that legalizing recreational marijuana is the worst thing that could happen for those involved in substance use. He believes that legalization could lead to increased addiction and abuse. He argues that alcohol and pot reduce impulse control and inhibition, and those under the influence are more likely to take risks that they would not take if sober. He points out that legalization of opioids and alcohol have only legitimized their use and created more abusers.
Pro-legalization supporters argue that no one has ever died of a marijuana overdose. The two sides quote differing research on whether or not legalization has increased or decreased opioid overdose fatalities in states with legalized use.
Opponents of legalization claim that legalizing marijuana increases the rates of addiction to harder drugs, such as heroin and meth. Pro-cannabis advocates claim that just because users of heroin or cocaine are likely to have used marijuana earlier in life doesn’t mean that cannabis was the catalyst for their later drug use. A person in recovery told me, “I know many people who use recreational marijuana and have not gone on to harder drugs. But every person I know who is using harder drugs, started with marijuana and alcohol.” Another person responded that cannabis might help people treat addiction to harder drugs “until they want a better high.”
Anecdotal stories do not reflect scientific research, but there is little consensus in the research. As with many controversial topics, both sides cite studies supporting their position and reasons to invalidate research by their opponents. Passionate people on both sides are often unconvinced by the arguments of the other side. The “truth” continues to be evasive and clear answers are few. The jury is still out on how legalization will affect many aspects of our society, as the debate continues.
In this series of articles on the legalization of cannabis or marijuana, we have looked at the complexity of drug schedules. Today we will look at arguments for and against.
As with many controversial topics, the loudest voices on both sides of legalization of marijuana tend to paint the issue as black and white. Finding a balanced voice that does not sensationalize the issue can be difficult. When examining a point/counter point comparison of each position, both sides cite research supporting their arguments. It is difficult for the average reader to discern anecdotal evidence from scientific, peer reviewed studies.
Proponents of legalizing recreational marijuana say it will add billions to the economy, create hundreds of thousands of jobs, free up scarce police resources, and stop the huge racial disparities in marijuana enforcement. They contend that regulating marijuana will lower street crime, take business away from the drug cartels, and make marijuana use safer through required testing, labeling, and child-proof packaging. They say marijuana is less harmful than alcohol, and that adults should have a right to use it if they wish.
Opponents of legalizing recreational marijuana say it will increase teen use and lead to more medical emergencies including traffic deaths from driving while high. They contend that revenue from legalization falls far short of the costs in increased hospital visits, addiction treatment, environmental damage, crime, workplace accidents, and lost productivity. They say that marijuana use harms the user physically and mentally, and that its use should be strongly discouraged, not legalized.
Proponents of legalization compare current criminalization of cannabis to the failure of Alcohol Prohibition in the 1920s. Opponents compare the legalization camp to ‘Big Tobacco’ tactics of luring youth and exploiting people for profit.
Both sides are concerned with protecting children. Opponents state legalization will allow increased access to youth, and there is emerging evidence that heavy marijuana use by teens can negatively impact their IQs later in life and increase the occurrence of schizophrenia and violence. Proponents state that proper regulation of legalized cannabis will protect youth from risks and allow adults to use safely.
According to Gallup polls in 2018 and 2019, a record-high sixty-six percent Americans support legalizing marijuana, up from twelve percent in 1969. Popular opinion is shifting to a more pro-cannabis stance. However, medical and public health organizations such as the American Medical Association, the American Cancer Society, and the American Academy of Pediatrics do not advocate for legalization of marijuana, stating marijuana needs to be subject to the same rigorous clinical testing as other medical treatment and “should not be decided by ballot initiatives decided by individuals who are not qualified to make such decisions.”
Perhaps the most important question in the marijuana debate is whether we have enough unbiased information to hold an opinion at all.
#46 drug schedules
This is the first in a series of articles about legalizing marijuana. Legalization of marijuana is a complex issue with many influencing factors and potential consequences. One often-overlooked factor is how drug schedules are developed by the Drug Enforcement Administration (DEA).
Drug scheduling is the way the United States government classifies drugs, based on their medical value, safety, and potential for abuse or addiction. Drugs and substances are divided into five categories, or schedules. Schedule 1 drugs have a high potential for addiction and abuse, with no recognized medical value in the United States. On the other end of the scale, Schedule 5 drugs have low potential for addiction and misuse, and are generally accepted as safe for medical use. In general, the higher a drug is classified, the more federal restrictions and the more severe the criminal penalties for possessing it. Any drug listed on the DEA schedule is considered a controlled substance.
If a drug is classified as a Schedule 1 or 2 drug, there are severe regulatory restrictions on its research, supply and access. The main difference between a Schedule 1 and 2 drug is that Schedule 1 drugs are considered to have no medical value while Schedule 2 drugs have some medical value. For example, schedule 1 drugs include heroin, LSD, marijuana, ecstasy, and peyote; Schedule 2 drugs include Vicodin, cocaine, methamphetamine, methadone, Dilaudid, Demerol, OxyContin, fentanyl, Dexedrine, Adderall, and Ritalin; Schedule 3 drugs include codeine, ketamine, anabolic steroids, and testosterone; Schedule 4 drugs include Lorcaserin, Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, and Tramadol; and Schedule 5 drugs include Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin.
Many are surprised to find that marijuana is a Schedule 1 drug and methamphetamine (meth) is a Schedule 2 drug.
A frustration of those in favor of medical marijuana is that having a schedule 1 classification limits the amount of research that can be done to substantiate its medical value. This becomes a Catch-22, as proving a drug has medical value requires large-scale controlled clinical trials, which are limited for marijuana due to its Schedule 1 status.
Others, including Mark Kleiman, believe that under the current scheduling, alcohol and nicotine would be marked as Schedule 1 substances if they were evaluated today (National Review).
Another difficulty in developing scientific studies of medical use of marijuana is that all marijuana used for research must be obtained from the only approved grow site in the United States at the University of Mississippi (approved through the National Institute of Drug Abuse). Even though medical marijuana is legal in 23 states, marijuana sold legally under state law remains illegal federally, and prohibited for research use under federal guidelines.
Some argue that even if marijuana was moved to Schedule 2, a prescription would be required to legally dispense it and that would complicate state-legal marijuana dispensaries and retail stores already established in states with legalized marijuana.
Recently, H.R.3884 - Marijuana Opportunity Reinvestment and Expungement Act of 2019, a comprehensive marijuana reform law, was introduced to Congress to decriminalize and de-schedule marijuana. At the time of this writing, it was passed by the House Judiciary committee and awaits vote in the House and Senate.
These are only a few of the complexities concerning the legalization of marijuana. Next time we will discuss arguments from both sides of the marijuana debate.
Lynn Saylor is the AmeriCorps member working with the United Against Opioid Abuse Initiative alongside the White County United Way. She is a major facilitator of the United Council on Opioids serving White County and a regular contributor to local media.