The Association Between Youth Cannabis and Opiate Use: A Split Brain Syndrome?
We live in a postmodernist world where reason and facts often do not apply if they contradict with ideology or public perception. How else can we explain the “Split Brain Syndrome” where the media fails to consider the association between the increase in youth cannabis use and the American opiate use epidemic that has led to an increase in number of cases of lethal overdose? The focus on heroic and lifesaving Narcan administration for opiate overdosing of youth is indeed dramatic and makes headlines. However, this extreme measure does not address the addictive disorder and the possibility of a future overdose.
The trivial questions to be asked are how youth got into abusing opiates and how can we prevent it. The answer is we need to prevent the process of addiction and not address it as an “end game” lifesaving intervention (i.e., event) only.
The media is focusing mainly on adults and, to a large degree, neglecting to address the youth problem. Indeed, a significant percentage of adults who were not drug users in their youth suffer from acute or chronic pain syndrome. They have been prescribed opiates by physicians and became dependent on them. The search for a synthetic opioid without addictive properties continues to be the “Holy Grail” of analgesia and pain medicine. However, adolescents are not “miniature adults”. The vast majority of adolescents who abuse opiates do not suffer from pain. Their journey into the abyss of opiate addiction and lethal ending started first with experimentation of cannabis as a mood altering drug. Marijuana has been identified as a gateway drug for progression to use of other drugs in youth. That explains why some adolescents and young adults were lured by the chase of a “better high” via prescription opiates, which are unfortunately easy to attain. These drugs are stolen from relatives or pharmacies, diverted from legal opiate users or simply purchased in the street. Due to a normative process of delayed brain maturation development until the mid-20s, drug using youth do not appropriately weigh the potential negative consequences against the promise of a new chemically induced mood high. The common narcissistic belief of adolescents that “this is not going to happen to me” has contributed to mortality and morbidity caused by road crashes, drowning, physical and sexual violence, and other deleterious consequences of high-risk behaviors under the influence of drug use.
Cannabis is not a harmless compound. The misleading term “medical marijuana” and the changes in cannabis legal status have contributed to the biased perception of youth that marijuana use is safe. This perception has been correlated with an increase in the prevalence of marijuana use, decrease in age of first onset (every day approximately 4000 American adolescents use cannabis for the first time) and leads to an increase in associated medical, psychiatric, academic and quality of life negative consequences in the last ten years.
In conclusion: an increase in awareness, resources and prevention efforts as early as 4th grade would reduce the number of first time cannabis users. It would eventually decrease the number of adolescents who would become dependent on marijuana and later abuse prescription opiates and heroin with potential lethal consequences.
Dr. Kaminer is a Professor of Psychiatry in the Department of Psychiatry & The Alcohol Research Center, University of Connecticut Health Center, Farmington, CT. He has a joint appointment as Professor at the Department of Pediatrics, where he is involved in research of youth high-risk driving and suicidal behavior at the Injury Prevention Center of the Connecticut Children’s Medical Center (CCMC), Hartford.