The Truth About Marijuana

Book Review

Marijuana: The Unbiased Truth About the World’s Most Popular Weed

by Kevin P. Hill, MD; Center City, Minn:
Hazelden Publishing; 2015
208 pages • $35 (hardcover)

[[{"type":"media","view_mode":"media_crop","fid":"40458","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_682744333328","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4189","media_crop_rotate":"0","media_crop_scale_h":"200","media_crop_scale_w":"130","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]There really is a drug revolution going on and, frankly, it’s very confusing. There is excitement about the therapeutic potential for hallucinogens, even though they remain Schedule I drugs. And in the world of weed, grass roots folk, once content to “blow smoke” at those who demonize and criminalize pot, are now mobilizing politicians, lobbyists, and advertisers to loosen the naysayers’ grip. The pro-weed camp touts its safety (relative to cigarettes or alcohol); the “high”; and the broad medical benefits in cancer, epilepsy, arthritis, and PTSD. The list of purported benefits is endless. The con-weed camp cites addiction, anxiety, psychosis, and lowered IQ-and reasonably asks, “Where are the data on medical benefits?”

Such polarization has serious repercussions. As many states legalize marijuana, people (mainly African Americans) get criminal records or sit in jail for drug-related offenses. What are we doctors to do? Although states have decided to medicalize, there are no robust clinical trials or FDA approvals. I have been very uncomfortable with it. I don’t see drug users as criminals needing punishment, nor do I feel that the drug (or drugs, given the number of active alkaloids) fulfills criteria as a prescribed medicine.

Author Kevin Hill attempts to straighten this mess out and has written an articulate and nuanced review of the situation. Dr Hill is a Harvard psychiatrist-a clinician and researcher who has made the study of marijuana his career focus. In his book, Marijuana: The Unbiased Truth About the World’s Most Popular Weed, he is thoughtful, measured, and humble, both personally and in his writing style.

The book outlines the interesting history, tackles key myths (such as “it’s not harmful” or “the drug is non-addictive”), and presents the pros and cons of medicalization. Dr Hill explains exactly why early and heavy use is a particular problem. The chapter on decriminalization and legalization gives the floor to each camp. Chapters on treatment include medications, behavioral health, and family approaches, and the book offers avenues for future progress. There are carefully chosen case examples throughout.

Dr Hill summarizes the arguments from both sides of the debate, and then-in a calm and respectful tone-presents a counterpoint and his balanced view. He uses words such as “shocking” and “alarming” to describe the increased use, but his voice is never shrill and calms the usual hysterical gusto. It is a lot to squeeze into 200 pages; it can feel succinct, but never dense, and the reference section points to further reading for those so inclined.

I would have wanted to read more on the interactions of the drug with the stress system. Stress is the lure of the user, the realm of self-medication, and a factor in relapse, perhaps especially for women, and it has to be addressed throughout the treatment process. Cannabinoids modulate the stress system and alter processing of emotional memory in fascinating ways. There is a big story there. Readers might have benefited from more information on the different ways pot is consumed: edibles; vaping; oils; and synthetics, such as K2 and spice.

I am a harm reductionist, and I wanted Dr Hill to be one too. After presenting a lovely and successful case in which he taught moderation, he says that “the goal of treatment is abstinence-zero use of marijuana,” but he never explains why. Perhaps an explanation of why he feels moderation is impossible would help. When discussing the Meier study (showing decreased IQ in heavy, prolonged smokers), he does not emphasize that the IQ drop (although profound) was seen only in those who started using marijuana very early (before age 15 years) and continued throughout their 20s and 30s; instead, he only says that the study is “hotly debated.” It is a subtle point, but it feels to me that he is making an effort to stay in the abstinence-oriented camp.

So who would I recommend this book to? Pretty much anyone, including practicing psychiatrists. My son Toby (age 14 years and not a user) spontaneously picked it up and polished off half of it, which is unusual for him. His report: it was “pretty good,” easy to read, and thought-provoking; indeed we had a great conversation afterward. This is what any parent should hope for.

Active marijuana smokers will learn that things are a lot murkier than DARE depicted in middle school, on the one side, or the Internet relays on the other. Concerned parents on either side will be challenged and may find a framework that helps them talk with their kids rather than tell them what’s right. It is too nuanced and measured to turn anyone certain of his or her opinion, but any clinician would benefit and be reminded to take a balanced, calm, and collaborative approach. Marijuana is a different plant from when we were kids: far more potent, many more varieties, and way more marketed. It is an issue that we will likely all face in our practice and we need to know about it. Dr Hill’s book is an excellent and timely update.

This article was originally posted 6/26/2015 and has since been updated.

Disclosures:

Dr Green is an addiction psychiatrist and owner of The Psych Garden in Belmont, Mass. www.psychgarden.com.