Marijuana use has become more socially acceptable lately, with many states legalizing it for medical and, increasingly, for recreational use. There is a distinction. Medical marijuana must be recommended by a physician and obtained from state-regulated outlets. In Maryland, medical marijuana is legal but recreational marijuana is not. However, a law passed in 2014 decriminalized the possession of 10 grams or less of marijuana, making it a civil infraction, similar to a traffic ticket.
The movement to legalize marijuana is a big change from the past, and although proponents make some good arguments, there are many unknowns. The major question is, is marijuana really harmless?
Although marijuana – like alcohol and nicotine – is often called a “gateway drug,” the fact is that the majority of people who have tried or habitually use any of these substances do not go on to abuse “harder” drugs, such as heroin and cocaine. However, the vast majority of those who do become addicted to more harmful substances began their drug careers only after using these starter substances. Alcohol, nicotine, and marijuana “prime the brain for a heightened response to other drugs,” according to the NIH. But is this the only reason to avoid “soft” drug use?
A Cardiologist Speaks
Jerald Insel, MD, FACC, FSCAI, a member of our community, is a Clinical Assistant Professor at the University of Maryland and head of Chest Pain at Sinai Hospital. He was kind enough to share his views on the medical and societal effects that marijuana (and other “soft” drugs) can bring. It is an issue that is close to his heart.
“There is no question in my mind that marijuana is a gateway drug, just as alcohol is. Obviously, substance abuse of any type is not good for many different reasons,” he states. Dr. Insel warns that “medically, it is clear-cut that people who smoke marijuana regularly double their risk of having a stroke or congestive heart failure.”
But it is not only the older generation that needs to be aware of heart damage risks. Dr. Insel has seen a clear association between marijuana use and myocarditis in young people. Myocarditis is an inflammation of the heart that can lead to sudden death. In his own practice, he has seen three cases of this within the last year-and-a-half alone, and other cases have been reported. Ten to twenty percent of sudden cardiac deaths in young people are due to myocarditis, he explains.
Dr. Insel believes there have been more cases of myocarditis and sudden death related to marijuana use, but people don’t want to delve into the data. He feels that these cases, as well as other health issues, are not being focused on by the government because there’s a lot of money to be made through taxation of the drug. The Journal of the American Medical Association (JAMA) concurs. In a 2016 article, it states, “Despite limited research on the effects of smoked cannabis, states appear to be motivated to legalize marijuana use for financial gain.”
The state governments, of course, aren’t the only ones making money. A quick online search of medical marijuana dispensaries in the Baltimore area revealed that appointments with doctors who are authorized to dispense marijuana are rarely, if ever, covered by insurance. These visits generally cost about $200 for the initial visit with renewal visits costing either the same amount or somewhat less. That, of course, does not account for the actual costs of the drugs.
Not Just the Heart
It’s not just your heart you need to worry about. “Marijuana can damage your lungs and cause chronic bronchitis,” Dr. Insel warns. An NIH article concerning tobacco and marijuana use states, “When there’s smoke there’s harm…Marijuana smoke reduces respiratory function.”
How ironic is it that young people, who are among the most concerned with important environmental issues such as air pollution, do not give a second thought to absorbing foreign substances into their lungs by smoking or vaping marijuana or other chemicals?
Yet, when it comes to young people, heart damage and respiratory function – as serious as they might be – are not the chief health issue of marijuana. According to Dr. Insel, “The brain is still forming during adolescence and into the mid- to late twenties. In terms of psychological development, there is no question that marijuana impairs neural connectivity in areas of the brain that are involved in higher level thinking, especially for those who are chronic cannabis users. The data show that frequent use of marijuana during this stage is associated with a decline in IQ in adulthood,” continues Dr. Insel. “We know that substance abuse is a potential risk factor for mental health disorders. There is also a statistically significant association with marijuana use and psychosis in later life, particularly if the drug was used before the age of fifteen.
“Instead of living with normal tension and a normal desire to learn, kids who use marijuana (or other drugs) are basically sedated, which is getting them nowhere and blocking the development of the brain. People who are chronic, habitual abusers of marijuana or alcohol do not end up with successful, healthy lives. It lowers achievement. The old Marlboro Man, who smoked two packs of cigarettes and drank three bottles of whiskey a day and, at 99 years old, rode off into the sunset, really doesn’t happen,” says Dr. Insel.
Other Dangers
So far, we have only been speaking of the “good stuff,” pure marijuana. “Unfortunately,” says Dr. Insel, “most of the marijuana sold on the street is adulterated, which is even more dangerous. You never know what you are getting. Imagine going to some guy on the street and asking for a flu shot! Could this be as safe as getting one from your doctor or pharmacy?”
One might think that synthetic marijuana would be safer to ingest. One would be wrong. “In Chicago,” continues Dr. Insel, “there have been many hospitalizations and several deaths in the last six or seven months due to the use of ‘K2,’ a so-called synthetic marijuana.” There have been several hundred overdoses and hospitalizations from K2 in the Maryland and Washington, D.C. area as well.
“There’s no way of knowing exactly what is in K2, also known as ‘spice.’ K2 is actually a drug that is ‘pasted’ to leaves that look like marijuana. At times, one compound of this paste has included chemical blood thinners used in rat poisoning, similar to the drug Coumadin.”
Proponents of legalizing marijuana make the point that legalizing recreational marijuana would make it safer as buyers would at least know that what they were ingesting came from a reliable source. (However, because marijuana has a status of a Schedule 1 drug, and lacks FDA approval, there are no strict standards even for the legal recreational stuff.) Dr. Insel does not agree with legalizing marijuana recreationally. It could have many negative impacts, he says. Direct health issues are not the only danger of marijuana use. Another important health risk is the much higher incidence of car accidents and traffic fatalities when driving under the influence. “If you look at Colorado, where marijuana is legal, you can see that,” he notes. Dr. Insel feels the number of traffic accidents there has been downplayed because the additional money made in taxing marijuana blinds the government’s eyes.
Any Benefits?
What about the supposed health benefits of medical marijuana? “JAMA did a good review on research into medical marijuana and concluded there may be some medical conditions for which some cannabinoids could possibly help,” Dr. Insel said. “There are over 400 chemical compounds in cannabis. Researchers are trying to separate the hallucinogenic substances from some of the other chemicals, which may potentially be good for pain or have other benefits. But the hallucinogenic portion (THC) has not been shown to have any benefit for pain.”
(It is interesting to note that one online listing for marijuana doctors advertises itself as a “New Kind of HealTHCare,” with the emphasis on THC, touting pain relief as a major benefit.)
The FDA has not approved marijuana as a safe and effective drug for any indication, and Dr. Insel is opposed to marijuana’s medical use as a general “cure-all for what ails you,” as many of its proponents seem to push. However, he says, “In cases where we know what the various cannabinoids are good for – such as pain and other issues – then it might be beneficial to prescribe, with appropriate regulation. If you separate THC, the substance primarily responsible for the psychoactive effects of cannabis, from other cannabinoids, there is the potential for a great scientific benefit in terms of pain, but this must be prescribed by a legitimate physician. People who have serious chronic pain syndromes may benefit from marijuana. Those are not the young kids. But even in the older age group, there is a significant amount of abuse.
“You have to be very careful. If you go to a place like Florida, which has medical marijuana, it turns out that the highest number of medical marijuana users are between the ages of 18 and 26. Basically, the drug is being pushed, and many of the operators are not legitimate,” says Dr. Insel. “There are too many phonies who are opening clinics for the sole purpose of making money. The government would prefer not to look too closely, since they are making money off of them.”
Drugs and the Jews
Drug and alcohol use among Jews is not particularly new, but neither is it “traditional.” In 1982, Rabbi Isaac N. Trainen wrote an article in the book entitled Addictions in the Jewish Community. He relates the following: Late in 1952, in an attempt to bring down the price of kosher dinners in major New York hotels, he approached the banquet managers. They all complained to him that they made less money off Jews because “You Jews don’t drink.” By the early 1970s, things had changed, and banquet managers began soliciting him. He was now told, “You Jews drink like everyone else.”
Behavior patterns may have been evolving, but the frum community still did not have a major problem with boys and girls in yeshivas and day schools tuning off to school and into drugs. “Many years ago, when I was in high school in Brooklyn, New York,” Dr. Insel recalls, “some kids were better learners than others, but the vast majority of kids stayed religious – not only religious but also good people, because they learned the basic values of respecting and helping others. Before 1960, substance abuse was unheard of. Deaths from drugs was basically non-existent in the religious Jewish community. The concept of yeshiva boys getting drunk on Shabbos did not exist.”
Dr. Insel believes that a big part of why youth are turning to drugs is that they don’t feel valued as students or as community members. “In my day, the rebbes’ attitude was, people will have different paths in life, but they are all Jews and all valued. It’s not just the smart kids or the good learners who count. Every single kid counts.
“We have to realize that every single person is a tzelem Elokim and recognize their intrinsic worth. If kids have problems with the school or their family, they may feel there is no place for them in the community. The next thing they do is turn to drugs as an escape.”
“As a Jewish community,” he says, “we have a greater responsibility. We shouldn’t just be looking in our own homes or to the rich and prominent. We need to show concern for our neighbors down the street, who may have issues or may not have a stable family structure, and help them. We need to teach our kids to act like mentschen – teach them proper behavior so they don’t ostracize or bully people.”
Despite Dr. Insel’s opposition to marijuana use, he has empathy for those who are caught up in it. “We cannot afford to lose anybody in our community. When we have an epidemic of people dying from drug overdoses and other issues, we as a community need to realize that it has to stop. Kids growing up need to learn to deal with the natural stresses (including social issues) of life rather than try to escape, But we can’t just criticize people who turn to marijuana or other drugs. We have to offer an alternative – show people their intrinsic value and give them reasons not to get high,” he concludes.
Judge Freier
Dr. Insel’s opinions were reminiscent of those expressed by the Orthodox New York judge, Ruchie Freier, before Tisha B’Av, 2017. Following the overdose death of Malky Klein, Judge Freier wrote an article called “Reflecting from the Bench on Judging our Children.”
Describing how Malky Klein began her tragic downward spiral after feeling rejected by schools that demanded high achievement, Judge Freier looked back on an earlier time, when she was growing up and attitudes toward academic achievement and acceptance were different.
“I had classmates from a variety of backgrounds and we all got along. Our teachers valued each student and encouraged us to reach greater heights in our connection to Hashem. Some girls in my class had learning disabilities, but in those years, we didn’t know it; we just knew they failed most of their tests.” She notes that during those decades, the term “off the derech” didn’t yet exist and no one she knew left Yiddishkeit. Just as Dr. Insel stated, she wrote, “We valued life and knew that, while we had our differences, each of us was created with a tzelem Elokim and had a purpose.”
According to Judge Freier, unique qualities of each individual must be nurtured and allowed to flourish. She quotes a Times of Israel article by Devir Kahan, who wrote, “We mistakenly confuse achdus (unity) with achidus (uiformity). While we aspire to harmony, we mistakenly demand conformity and stunt creative individuality and inhibit growth.”
As Dr. Insel says, “We, as Jews, need to respect one another and our children. All Jewish children are our children and need to be valued.”
It is our responsibility as a community to develop a more inclusive outlook, treat others with more understanding and kindness, and make sure we share these values with our children. If they could all only grow up knowing their own importance, purpose, and value, there would most likely be little need to write about the dangers of drugs in our publications. It is our
