A new group is forging a way to communicate about marijuana’s adverse health effects as the perception of risk plummets among youth and use increases. Marijuana policy expert Kevin Sabet, Ph.D. (formerly of the White House Office of National Drug Control Policy as a political appointee under both the George W. Bush and Obama administrations), former Democratic Congressman Patrick Kennedy and former George W. Bush presidential advisor and speechwriter Republican David Frum are joining forces to launch “Project SAM — Smart Approaches to Marijuana.”

The purpose of the project, announced January 10 in Washington, is to “educate lawmakers and the public about the science regarding marijuana use and policy,” said Sabet last week. In addition, Sabet, who has increasingly been critical of the viewpoint that there is an “either-or” proposition for marijuana — either legalization or incarceration — wants to convey the message that while people should not be arrested and prosecuted for possession of marijuana, they should get treatment. “Unfortunately, the debate in the United States has devolved to that stark choice, and the result has been a simplistic discussion marred by slogans instead of substance,” said Sabet, who is director of the Drug Policy Institute and assistant professor at the University of Florida.

The Monitoring the Future survey released by the National Institute on Drug Abuse last year clearly shows a link between decreased perception of risk and increased use of marijuana, especially daily use, by youth (see ADAW, December 24, 2012).

Experience with tobacco, alcohol and prescription drugs shows that when drugs are legally available and normalized, the health consequences can be very harmful, Sabet told ADAW. “Alcohol is the leading killer on the roads. Prescription drugs are the number-one killer in America. These aren’t good examples for legalization,” he said.

Sabet’s first goal is for SAM to “change the national conversation,” he said. “The two choices for marijuana — legalization or incarceration — that is not grounded in reality,” he said. “We want to reduce marijuana use, but we don’t want to saddle people with a criminal record.”

The alcohol industry, like the tobacco industry, has been prominent in terms of use, said Sabet. “We want to prevent the marijuana industry from having this much influence,” he said.

The impetus for the initiative came in a phone call from Kennedy after the November ballot initiatives legalizing marijuana in Colorado and Washington, recalled Sabet. “I got a call from Patrick the day after the election in November, saying, ‘What are we going to do? This is going to increase problems for people who are in recovery.’” In the days following, Sabet asked Frum and medical experts, including Sharon J. Levy, M.D., director of the substance abuse program at Boston Children’s Hospital, to join.

Addiction

Much of the campaign for legalization has been based on misinformation, Levy told ADAW. “The conversation has been led by people who don’t necessarily know a lot about marijuana,” she said. The analogy with tobacco is apt, because it took so long after smoking was perceived to be risky — causing lung cancer and death — for the messaging to get across, she said. She is afraid the same thing will happen with marijuana, because, like tobacco, the negative consequences, including a drop in IQ and mental illness, can take years to develop.

There is also no question that marijuana is addictive, she said, even though it doesn’t fit the typical tolerance profile. “It’s fat soluble, so you don’t have withdrawal — the body will auto taper,” she said. “You can’t quit cold turkey.” Addiction to marijuana, instead, is characterized by compulsive use and an inability to stop using. “Marijuana produces a pleasant feeling, and people get a little chatty, and they feel lazy,” she said. “But as we understand more of the biology of addiction, we know that it affects the nucleus accumbens, the pleasure and reward system in the brain.” Changes in the nucleus accumbens also occur with heroin and alcohol, she said. And changes in that part of the brain are linked to addiction.

“In my estimation, we’re losing the public health message with marijuana,” said Levy. “We lost it with cigarettes in the 1950s, and in the 1970s we got it back,” she said. “We’ve been able to control smoking.” In fact, many of the children she treats use both tobacco and marijuana, and they do want to stop smoking tobacco, she said. “Very few are willing to stop smoking marijuana,” she said.

New voices

The initiative has the full support of prevention advocates. “I think it is a very important new initiative that is sorely needed to change the conversation to be science-based,” said Sue Thau, public policy consultant for Community Anti-Drug Coalitions of America. She added that SAM will “really raise awareness about cost consequences and approaches that work and to show that legalization is bad policy, through new voices and partners who have not previously been spokespeople on this issue.”

Levy expects the American Academy of Pediatrics to come out with a similar policy to SAM’s. “We don’t think people should be thrown in jail for marijuana use, but we think they should get an evaluation,” she said.

“Right now we’re doing this blindly with no funding,” said Sabet. “We want to work with treatment providers, state legislatures and the FDA,” he said. “We’re treading a new path. We want to educate the American public, many of them rushing out to legalization, that this could create another tobacco industry that we will be fighting for generations.”