Appendix B:

The following is from Dr. Nora Volkow’s government blog. Dr. Volkow is the Director of the National Institute for Drug Abuse. I think it is the most educational exchange that I have ever seen on the topic of substance use and addiction. Those who are engaged in drug use may well be jarred to their senses on seeing this video. Those engaged in treating individuals caught up in drug-taking behavior stand to gain enormous insight into the process of becoming addicted and into ways of helping individual escape the trap of addiction and the initiative and will power that is so readily undermined by drug use. The excerpt is from
http://www.drugabuse.gov/about-nida/noras-blog/2013/11/talking-to-dalai-lama-about-addiction-science

Talking to the Dalai Lama about Addiction Science

November 12, 2013

Recently, I had the privilege of visiting Dharamsala, India, for a dialogue with His Holiness the Dalai Lama about addiction science, as part of a five-day conference at his Mind and Life Institute. I was very impressed at the Tibetan Buddhist leader’s personal interest in the brain, and in his desire to convene a small group of scientists from around the world along with Buddhist contemplatives and other scholars to discuss the topic of craving, desire, and addiction.

For Buddhists, craving is the source of human suffering; the misery of those ruled by extreme cravings for drugs is just an extreme form of the attachment to material things that compromises any person’s happiness. The Dalai Lama was interested to learn what I had to say about dopamine and the addicted brain, and the loss of self-control that comes when drugs change crucial brain circuits involved in emotion, pleasure, memory, and judgment.

The Dalai Lama put these brain changes in terms of the “action cycle” of karma in Buddhist belief: Once you make a choice to use drugs, consequences are unavoidable. The powerful changes that occur with the abuse of drugs reinforced the Dalai Lama’s belief that it is necessary to “put up the barrier before the floods come”—that is, to focus as much as possible on prevention. His feeling is that education is central to preventing drug use.

He stressed that education must create an environment in which children will have the opportunity to develop themselves, and young people should be taught in such a way that their brains can achieve their full capacities. The environment should also instill a sense of purpose and connectedness, rather than the materialistic values that, he says, cannot produce happiness. “We must bring to children a sense of wonderment about the world, rather than so much negativity,” he said. “And we must bring more simplicity.”

The Dalai Lama said that Buddhism can help best with this goal of preventing drug abuse, both through training the brain to balance emotions and self-restraint (for instance through meditation) and through promoting education and working to create a less materialistic society. He acknowledged that once a person becomes addicted, Buddhism may have less to offer, and said that medical science may be the best solution to treating their disease.

It was gratifying to see the powerful common ground between the Buddhist approach to suffering and addiction science. Both perspectives agree that prevention is critically important and that the emotional part of the brain is crucial to understanding what can go wrong. It led me to think about what we might learn from a discipline like Buddhism about training the brain—particularly given recent research showing benefits of meditation in smoking reduction—as well as how we might devise new neuroscience-based technologies to assist in strengthening self-control circuits.

Whether coming from the perspective of neuroscience or meditation, our aim is to understand how we can encourage self-control, manage our emotions, and offer children a purposeful life that will prevent substance abuse.

This leaves us as a society with the question: What to do about the recreational use of marijuana. It would seem to be magical and distorted thinking (ironically, an effect of marijuana use) to assume that the use of marijuana could be widely legally sanctioned and that its use would not spread by leaps and bounds throughout society. The presenter concurs with the authors of the 2012 Report of Organization of American States on “The Drug Problem in the Americas” when they discuss the profound implications of legalization and recognize that

….Even with relatively restrictive regulation, the result of le­galization is likely to be expanded use and dependency (p. 94).

A simple alternative to legalization if a society values the social and public health of its citizenry is to keep marijuana use illegal and use the justice system to remand users to “in lieu of prosecution” programs such as drug court programs and other counselling, educational, and treatment-oriented programs.  It such programs were completed and if individuals remained drug free, any criminal record and for drug use would remain permanently expunged.  By reorienting and refocusing efforts on discouraging drug taking behavior, both the individual and society would be the beneficiaries and the future viability of the nation would be far more certain.

I hope you find the material cited and quoted here and the material that is on this website and other websites referenced in this Open Letter of value to you and yours.

Paula D. Gordon

Appendices to the Open Letter:

Appendix A: An abstract of the article from the April 16, 2014 Journal of Neuroscience:
​http://jn.sfn.org/press/April-16-2014-Issue/zns01614005529.pdf

Neurobiology of Disease

Cannabis Use is Quantitatively Associated with Nucleus

Accumbens and Amygdala Abnormalities in Young Adult

Recreational Users

Jodi M. Gilman, 1,4,5 ; John K. Kuster,1,2 ;* Sang Lee, 1,6 ; * Myung Joo Lee, 1,6 ; * Byoung Woo Kim, 1,6 ; Nikos Makris, 3,5 ; Andre van der Kouwe, 4,5;

Anne J. Blood, 1,2,4,5  † and Hans C. Breiter 1,2,4,6 ;

†

1. Laboratory of Neuroimaging and Genetics, Department of Psychiatry,

2. Mood and Motor Control Laboratory,

3. Center for Morphometric Analysis,

Department of Psychiatry, and

4. Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital,

Charlestown, Massachusetts 02129,

5. Harvard Medical School, Boston, Massachusetts 02115, and

6. Warren Wright Adolescent Center, Department of

Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 06011

Marijuana is the most commonly used illicit drug in the United States, but little is known about its effects on the human brain, particularly on reward/aversion regions implicated in addiction, such as the nucleus accumbens and amygdala. Animal studies show structural changes in brain regions such as the nucleus accumbens after exposure to 9-tetrahydrocannabinol,but less is known about cannabis use and brain morphometry in these regions in humans. We collected high-resolution MRI scans on young adult recreational marijuana users and non-using controls and conducted three independent analyses of morphometry in these structures:

1. gray matter density using voxel-based morphometry,

2. volume (total brain and regional volumes), and

3. shape (surface morphometry).

Gray matter density analyses revealed greater gray matter density in marijuana users than in control participants in the left nucleus accumbens extending to subcallosal cortex, hypothalamus, sublenticular extended amygdala, and left amygdala, even after controlling for age, sex, alcohol use, and cigarette smoking. Trend-level effects were observed for a volume increase in the left nucleus accumbens only. Significant shape differences were detected in the left nucleus accumbens and right amygdala. The left nucleus accumbens showed salient exposure-dependent alterations across all three measures and an altered multimodal relationship across measures in the marijuana group. These data suggest that marijuana exposure, even in young recreational users, is associated with exposure-dependent alterations of the neural matrix of core reward structures and is consistent with animal studies of changes in dendritic arborization.

Governor Jerry Brown has summed up the seriousness of the implications of the spreading use of marijuana for the nation.  In theNational Journal (3-8-14, p. 44), he is quoted as saying the following:

“How many people can get stoned and still have a great state or a great nation?  The world’s a pretty dangerous, very competitive. I think we need to stay alert, if not 24 hours a day, more than some of the
​potheads might be able to put together.”

First Legalization, Then Lawsuits ~ Can marijuana retailers survive the tort bar? May 26, 2014, Vol. 19, No. 35 • By JOHN P. WALTERS and TOM RILEY

…With the open sale of formerly illegal drugs, the number of users will grow. Some advocates expect legalization to destroy criminal markets by providing cheaper drugs, which should boost sales. If the legal market does not produce discounts, however, the black market will continue to operate in parallel with the new higher-end market—a kind of “fast-food” network persisting alongside the new “gourmet” outlets. Either way, the result is increased use and increased profits.

But communities are not helpless before this onslaught. Even when the criminal law has been compromised at the state level, resort to civil procedure might offer protection. Legal or illegal, marijuana injures users—researchers call it a “neurotoxin”—and those who distribute it for profit are liable for its known effects. Its production and distribution, after all, are still federal crimes. America’s tort attorneys could respond by suing drug retailers for the harm done by their product to particular addicts, then collecting damages for the clients and legal fees for themselves.

This approach would not depend on the president or federal, state, or local government policy. It would require only a victim, a drug trafficker, a capable lawyer, and a sympathetic jury. Some law firms could afford to take such cases as a pro bono service to families. They already see for themselves that growing drug addiction makes their communities unattractive to legitimate businesses. Philanthropies concerned about the disadvantaged could also push this initiative forward.

Some clever attorneys might partner directly with treatment providers for referrals. Others might advertise on billboards, buses, television, and radio. They might find that YouTube and sites on the Internet are a vast repository of self-incrimination.

In addition, the retailers of marijuana as medicine—whether for smoking or eating in baked goods, candy, and ice cream—should be easy targets of legal action. There is scant evidence of legitimate medical efficacy and much evidence that “medical marijuana” is a calculated fraud producing large profits. Far from approving it, the FDA has written a letter denying that smoked marijuana is medicine.

If you think trial lawyers made a windfall on tobacco, just wait until they get a handle on marijuana. The scientific and medical evidence against marijuana now dwarfs what we knew about tobacco at the time of the surgeon general’s report of 1964. No warning label in the world could shield marijuana growers and sellers from the tsunami of tort liability they should face from distributing a product with so many known harmful effects.

Everyone loves the tale of Robin Hood because it is a story of justice—taking from oppressors and giving to the oppressed. That story is about to be reenacted with a drug-dealing-retailer near you. The rule of law is a beautiful thing; it can protect our democracy in times of danger even when national leaders and government institutions fail.

  • There are those who assume that the recreational use of marijuana has no deleterious effects spiritually. There are, however, no legitimate religious leaders, gurus, or masters who can be found in the world today who would agree. For the views of those who have insight into the spiritual harmfulness of marijuana use, see http://SpiritualHarmofMarijuana.com. Luminaries from the Ayurvedic community who are among those quoted on that website even underscore the negative karmic consequences not only of using marijuana and promoting its use, but of legalizing the substance as well.

Finally, there is the concern for the impact that the recreational use of marijuana has for citizens in a free society, a republic that depends upon an informed electorate to maintain a viable representational form of government.  I concur with Governor Jerry Brown that no state or nation can be great whose citizens are stoned.

The following excerpt is from
http://www.weeklystandard.com/articles/first-legalization-then-lawsuits_792870.html?nopager=1.

Highlights added.

The Presidency Goes to Pot ~ Irresponsible Obama.  The Weekly Standard, Feb 3, 2014, Vol. 19, No. 20

…… Obama clearly suggests that the racial and socioeconomic disparity in enforcement discredits drug laws and those who defend them. He has not faced the fact that there are racial and socioeconomic disparities in crime and punishment, but they are not caused by drug laws, and they will almost certainly get worse as drug use expands. The pervasive, willful denial of all this is a powerful driver of the moral argument for legalization.

An even stronger driver of legalization may be the simple inability of former users to admit to themselves and to others that what they did was wrong and dangerous, even if they were lucky to avoid serious harm. It is just not cool to say such things, and certainly from the point of view of the many users who were not harmed, marijuana seems harmless. To speak of the harms as a public figure is to criticize many who are just like you and who feel the risks are really not so great. This is a tricky business of denial, however. Virtually everyone has a loved one who has been a victim of substance abuse. We have all watched celebrities and public figures destroy themselves and pass in and out of treatment. We also know of or live in parts of our country that have been devastated by drugs and crime.

Antidrug liberalism has been based on protecting the vulnerable from victimization, but it has lost its way in substituting demographics for moral principle and character. Antidrug conservatism also sought to protect the vulnerable and to preserve individual freedom from addiction and self-destruction. Today some conservatives confuse the institutions and laws needed to preserve freedom with the threats to freedom—they equate willfulness with freedom.

American democracy has always needed leaders who know the truth and have the courage and skill to bring the truth to our public deliberations. That need is greater today than it has been in some time.

  • Litigation by those directly and indirectly affected by harmful effects of marijuana can be expected.  Such litigation may will rival the litigation by smokers of cigarettes and their families.   The legal sale of marijuana that has begun in Colorado and the state of Washington, may be greeted by wave upon wave of law suits, similar to, if not surpassing, the multimillion dollar law suits that followed in the wake of the acceptance of validity of the research on the harmful effects of tobacco.  Smoking marijuana, of course, has all the problems associated with smoking tobacco.  In addition, the use of marijuana has scores of other effects, including effects on embryos conceived by users of marijuana.  Such effects have been noted in the literature and have included miscarriages, stillbirths, and even birth defects such as anencephaly.  Brain anomalies will be readily provable in law suits with the widespread use of brain scans.  The first multi-million dollar law suits are sure to slow if not stultify the potential growth of “Big Marijuana” and serve to make more lucrative the production and sale of marijuana in an unregulated, untaxed, parallel black market universe. The following excerpt is from an article by John P. Walters and Tom Riley concerning lawsuits that can be expected.   While Walters and Riley do not note the research findings that exist on the kinds of extremely harmful effects that have been noted in this Open Letter, such effects are certainly among those that will be the subject of litigation.

The following is excerpted from an article by John P. Walters in the Weekly Standard:
http://www.weeklystandard.com/articles/presidency-goes-pot_775329.html?nopager=1

Highlights added.

It is very sad to know that so many are either unaware of the research findings concerning marijuana or have succumbed to groupthink, social pressure, and denial regarding the many harmful effects of the recreational use of marijuana.  It is particularly disheartening to know that so few are aware of the most significant research on marijuana that has been published over the past fifty years.  Even the ground breaking research findings on marijuana and its effects on the functioning of the brain that have been published in the past two years, including the research published in April 16, 2014 in the Journal of Neuroscience, are all but unknown to the vast majority of proponents of the recreational use of marijuana.  (Several hundred references to the research concerning the widest imaginable array of harmful effects of marijuana use can be found here at http://GordonDrugAbusePrevention.com. An selected working list of references and resources is posted here and will be updated periodically.)

If you follow the reports on the damage that the use of marijuana has already done in Colorado, I think that you might well have second thoughts about the nature of the effects of the “recreational” use of marijuana. The following excerpt is from a “report card” created by the organization known as “Smart Approaches to Marijuana” (SAM). The report are being issued on an ongoing basis concerning what has been happening in Colorado since the first of 2014. The organization responsible for the reports was co-founded by Kevin A. Sabet, Ph.D., author of Reefer Sanity: Seven Great Myths about Marijuana and former Congressman Patrick Kennedy.  The report is dated 4/29/2014 and recounts some impacts that marijuana legalization has had in Colorado already. The following is from http://learnaboutsam.com/wp-content/uploads/2014/04/CO-420-doc-final.pdf : “The City of Denver now surpasses  all US states for teen marijuana use, and car crashes  with  drivers  testing  positive  for  marijuana  have  almost  tripled”. Use has spread among school age children. There have also been significant increases in the numbers of those of all ages seeking treatment as a result of marijuana use. Two deaths have been attributed to the use of marijuana. Even small children have gotten hold of marijuana edibles and experienced negative effects as a result.

The following is a litany of things that one should be aware of concerning the THC content and the effects of the marijuana that is widely available today.  Not only is the general public and the media largely unaware of these facts, those in public roles of responsibility including the President, appear to be unaware of these facts as well:

  • The active principle of marijuana is delta 9 tetrahydrocannabinol (THC). The THC content in the marijuana that is available today is far higher than it was in the ‘60s and ‘70s when the most widely cited reports were written. “Wax”, for instance has an 85% or higher THC content and is readily available in Colorado, among other places in the country. Colorado law makers doubtlessly did not realize that they were in effect legalizing a substance as strong as hashish when they legalized marijuana. Hashish is widely known for producing psychotic effects. For some information on this high potency form of marijuana, see the Smart Approaches to Marijuana website at http://learnaboutsam.com/wp-content/uploads/2014/04/CO-420-doc-final.pdf.
  • The April 16, 2014 research reported on in the Journal of Neuroscience showed that the brain scans of casual users reveal some serious of brain anomalies.  Here again, the law makers and those in roles of public responsibility have been very slow to catch become aware of this research. An abstract of the journal article is below at the end of this Open Letter and can also be found at http://jn.sfn.org/press/April-16-2014-Issue/zns01614005529.pdf Governor Chris Christie is among the first public official who has recognized and has spoken out forcefully concerning the importance of the findings reported on in the Journal of Neuroscience.  See both videos on the top and bottom of the following URL for Governor Christie’s comments putting down Colorado for its legalization of marijuana and quoting from the April 16, 2014 issue Journal of Neuroscience: http://kdvr.com/2014/04/22/colorado-policymakers-fire-back-at-gov-christie-over-pot-comments/
  • Also, a must see is the following video of an exchange between Dr. Nora Volkow, Director of the National Institute on Drug Abuse and the Dalai Lama. This exchange took place in India in the fall of 2013.  Dr. Volkow show brain scans, comparing drugs users and those who are addicted with individuals who are not similarly afflicted, including a Buddhist monk. Extraordinary insights into both psychological and physical addiction to marijuana and other psychoactive substances. The video is posted at http://dalailama.com/webcasts/post/300-mind-and-life-xxvii---craving-desire-and-addiction/4588 (Notes by Nora Volkow from her NIDA blog concerning this exchange with the Dalai Lama are also provided at the end of this Open Letter.)
  • “In Reefer Sanity: Seven Great Myths about Marijuana, Dr. Kevin Sabet considers the consequences of marijuana legalization. He uses a plethora of research – drawn from his almost two decades of work and policymaking in this area – to argue that the United States should not legalize marijuana with all of its attendant social costs, nor damage the future of marijuana smokers by prosecuting and jailing them. Rather, he contends we should shift our emphasis to education about the newly revealed health dangers of marijuana use, as well as focus on intervention and treatment. In short, he argues for trying these evidence-based reforms first.” Dr. Sabet gave a talk on his new book April 30, 2014. See http://www.heritage.org/events/2014/04/reefer-sanity for a most extraordinary overview of the issues and the myths surrounding marijuana and the specter posed by a spreading use that could rival the hold that “Big Tobacco” has had on society.
  • An appearance on 'The O'Reilly Factor' of Christopher Kennedy Lawford and his cousin, Former Congressman Patrick Kennedy is particularly insightful concerning the reasons that marijuana should never be legalized.  Lawford’s book, "What Addicts Know: Ten Lessons from Recovery to Benefit Everyone" published in March of 2014, is also discussed. They underscore the threat of the spread of the use of a third substance of abuse, beyond alcohol and tobacco and the deleterious impact that its use would have on those who are already hardest hit by alcohol and tobacco. See https://www.youtube.com/watch?v=btjSLMzKLMk
  • Civil libertarians have been slow to begin to understand that there are effects of marijuana use that impinge on the civil liberties of non-users. These effects can be particularly unsettling for former users, the segment of mentally ill in society, children, and the infirm. Contact high effects as well as flashback effects are not extensively reported on in the scientific literature. However there have been reports written on such effects. Contact high effects can occur owing in part to the fact that users and former users and other sensitive individuals can “pick up” on another person’s high. Obviously the passive inhalation of marijuana smoke will also trigger a high in others in the environment. In fact drug testing would reveal that those in the environment where marijuana is smoked will show up as having measurable amounts of the active principle in their systems. Flashbacks are another effect. These can be triggered when a person is not using the substance at the time. The explanation in the scientific literature is that that residual amounts of the active principle are retained in the body for days, if not months, or years, after last use. It can be metabolized well after the time of last use. Some of the literature on the contact high and flashback effects can be found in two articles of mine:  a report on passive inhalation of marijuana or tobacco smoke and an article entitled “Resolving the Controversy Surrounding Marijuana…” Both are posted on the http://GordonDrugAbusePrevention.com website. These research reports will be included in an extensive list of references and resources on the topic of the wide array of different kinds of harmful effects that have been shown to result from the use of marijuana.
  • John Walters who formerly headed the Office of National Drug Control Policy has made some notable statements in response to the President’s ill-conceived statements about marijuana in January of 2014.

An Open Letter to Those Who Believe that Marijuana is Either Harmless or
​“Relatively” Harmless to Users and to Those in Their Environment

by Paula D. Gordon, Ph.D.
​May 21, 2014

A May 21, 2014 Open Letter


Additional publications of possible interest including

TABLE OF CONTENTS

1) LISTS OF REFERENCES AND RESOURCES ON MARIJUANA, KEY LEGAL DEVELOPMENTS, PRESENTATIONS,​

TESTIMONY, ARTICLES, REPORTS, AND OPEN LETTERS

End of appendices and excerpted material

You can watch a video of my conversation with the Dalai Lama here:
​http://dalailama.com/webcasts/post/300-mind-and-life-xxvii---craving-desire-and-addiction/4588

GordonDrugAbusePrevention.com


Other Drug Abuse Prevention-Related Articles and Reports by Paula Gordon, including Peer-Reviewed Journal Articles: