March 26, 2018

By Dr. Elinore F. McCance-Katz

Each year, SAMHSA holds Prevention Day as an opportunity to share best practices and data with professionals who work day in and day out to end the cycles of substance use disorder sweeping our country. It’s usually a chance to learn what “preventionists” on the front lines are experiencing, and how our priorities at SAMHSA and their realities intersect.

I had the honor of addressing these health professionals this year—starting with a status report on the nation’s opioid crisis, providing updates and ending with a brief examination of the risks of marijuana consumption. As many of you may know, the opioid fentanyl has had a horrific impact on our nation: Its potency and often-stealthy addition to other drugs have caused the surges in fatal overdoses seen in recent years.

Training medical professionals to deliver proven-yet-underutilized treatments for the opioid crisis sweeping our country is important. These professionals are on the front line, serving as medical resources to people who need them. And our Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs rely on their insight and caring.

As SAMHSA trains medical professionals in the evidence-based practices needed to serve people with substance use disorders (SUDs) and serious mental illnesses, we’re also working to combine our resources with experts at the local level. To this end, we recently awarded a $12 million technical assistance grant to the American Academy of Addiction Psychiatry that will put federal resources into the hands of local experts to create community-relevant solutions. This effort is a clear example of SAMHSA working to support communities throughout the nation, moving beyond the valuable work performed by our grantees to assist whoever needs to be trained.

Interestingly, it was the second half of my presentation from Prevention Day that garnered stronger responses from supporters and critics alike. “The Elephant in the Room” dealt with marijuana as a drug that carries risks—risks too seldom discussed.

As a clinical psychiatrist specializing in addiction, as someone committed to treating people with substance use disorders, as a concerned American—I cannot stress enough how understated the risks and consequences tied to marijuana consumption are in our nation’s dialogue about the drug and about states’ respective moves to decriminalize or legalize aspects of consumption.

America has come a long way from the dramatics of “Reefer Madness,” the 1930’s cult film that railed against the use of marijuana. But, sadly, today, warnings about the drug often are dismissed as outdated propaganda. Amid discussions of decriminalization or of legalizing medicinal use, the topic rarely includes factual examinations of the harm that can come with marijuana consumption. Data show Americans have grown to perceive the drug as less harmful than alcohol and other drug use (slide 21).

Also ignored are data that speak to how the drug can adversely affect health (slide 24), can be associated with a decrease in IQ with chronic use, can lead to a number of undesirable social consequences (slide 31) and can reveal a predisposition to serious mental illness (slide 29).

To that last point, a study of the data on the slide “Marijuana-Associated Psychosis” shows the risk of schizophrenia increases as marijuana use increases. The same slide shows a higher risk of schizophrenia-like psychosis is directly related to younger ages of first marijuana use. It’s important to note that there is a distinction between a substance causing psychosis and one revealing a predisposition—the data I present concern the latter.

We know serious mental illness and SUDs often co-occur. And I believe there is room for researching the medical potential of marijuana’s components. But pretending that marijuana is a harmless substance is not the way to help our loved ones. It is time for medical professionals to courageously share what the data say, even if the conclusion is a socially unpopular one. Our people—particularly our young people—are depending on us.

Most important, SAMHSA offers supports for people who grapple with substance use disorders—whether tied to marijuana, alcohol, opioids or other substances. We know that, with appropriate treatment, people recover from SUDs. We’re working tirelessly to not only connect Americans to these resources, but to also get them back on the path toward fulfilling, productive lives.

Dr. Elinore F. McCance-Katz is the Assistant Secretary for Mental Health and Substance Use, and head of SAMHSA.

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