I am traveling today and have turned my column over to James Puterbaugh, M.D. Dr. Puterbaugh has been a Portland physician for over thirty years. He is a 1973 graduate of the University of California at Los Angeles Medical School who did his residency at Oregon Health Sciences University. He specializes in Internal Medicine and has been board certified since 1977. Dr. Puterbaugh has been previously published in medical journals and this constitutes his first published foray into applying medical information to observed public behavior.
Marijuana and President Obama
by James Puterbaugh, MD
Along with the recent legalization of marijuana in two states, America also has, for the first time, a President who not only used marijuana, but used it heavily, and is open about this use. The President has also made statements that marijuana is no more dangerous than alcohol, (although, even if true, is not a winning recommendation as alcohol is the third leading cause of death in America). These have all bent the public perception of marijuana use towards acceptance with discussions centering on drug cartels and finances with almost no consideration of long-term effects. However, behind the scenes in the smaller world of medical research, long-term effects have provided a fertile ground for new research and findings that marijuana use causes abnormal brain development, especially if used by the young, has bent perceptions towards caution. This article is to open this smaller world, explain why caution is needed, and as more and more questions are being asked about Mr. Obama’s seeming disengagement from the world’s difficulties, to see if these findings relate to our current leadership.
Married to any discussion about negative effects of marijuana use is the “vexing… discrepancy between the ‘benefits’ of cannabis reported by users, and the negative consequences…observed by clinicians“(Marijuana and Madness, 2nd ed.) creating a strong emotional climate which taxes reasonable discussions. Also, the recent burst in information about the neurologic consequences of use, particularly by adolescent and young adults, is relatively new. It has not penetrated well into the emotional world where strong opinions coopt facts. However, “facts are stubborn things…whatever may be our wishes, our inclination, or the dictates of our passion“* Medical literature is usually hesitant to make strong conclusive statements, so it helps to read a few to understand how serious the problems seem to be with the newer findings:
” However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life” ( Lancet, 2007)
“Our findings indicate long-term cannabis use is hazardous to the white matter of the developing brain” (Brain, 2012)
“Chronic cannabis use may alter brain structure and function in adult and adolescent population”(PLOS 2013)
There is little doubt our President used marijuana heavily through his adolescence and into his twenties. He was a member of the “Choom gang” in high school, during which he authored what he termed “TA” or total absorption in marijuana, and his own description of his drug use as “enthusiastic”. There is also little doubt this use could have serious consequences, which, to understand, requires some background in marijuana research.
The history of research on marijuana is one of gradually pulling open the shades. At first, research couldn’t be done because of the legal aspect of investigating an illegal drug. There was also a shortage of grant money, but by the 1980’s some studies were being done which helped understand the drug’s properties. Inhaled marijuana smoke contains up to 60 cannabinoids, but the main one is tetrahydrocannabinol, or THC. THC is a complicated molecule which has some interesting properties relevant to this discussion. Most drugs have a “half-life”, or a time which takes the body to eliminate one-half of the drug. THC has a serum (in the blood) half-life of three or more days. But THC is also fat-soluble and is taken up and stored all over the body, and this tissue half-life is about seven days. Research has amped up recently because there are cannabinoid receptors, called CB-1 and CB-2 receptors in most tissues, and other THC receptors. There has also been the discovery and better understanding of an endogenous cannabinoid system which THC plays a major role in modifying. Storage of THC and its metabolites in the brain, and its actions especially if present in the developing brain are a major source of current research. This research has also benefitted by newer and better scanning techniques plus other advances in molecular biology. The result is a number of remarkable studies on brain development which make it clear that THC presents significant risk to the developing, and perhaps the developed, brain.
The stimulus for such studies was the Dunedin Longitudinal Study, initiated in New Zealand in 1972-3, which studied over 1000 people from infancy to adulthood, and which has generated over 1000 publications. The lead author, a Dr. Meier, reported, “…persistent cannabis use was associated with neuropsychological decline broadly across domains of functioning” and “…impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline.” Also, these functional declines did not seem to diminish with limited use of cannabis in adulthood.
Recent studies have clarified these findings as THC causes miswiring of the brain. Not only are the normal pathways of connection disrupted but also there is decreased “neural connectivity” (fewer fibers) in specific areas of the brain. These include the precuneus, which is a key node for functions which require a high level of integration, and the prefrontal areas, which control what are called “executive functions.” Executive functions include the ability to exhibit flexible adaptive behavior, use appropriate problem-solving strategies, and the capacity to monitor the consequences of actions. Also, executive functions include being able to use prior knowledge to correctly interpret future events. In addition, cortical, subcortical, cerebellar and hippocampal areas are affected. These control a broad spectrum of neurological functions, from memory to habits, and the effect of THC on these areas seems to result in a gradual decline in IQ.
The effects of marijuana on emotional regulation are more complex, and involve not only the prefrontal cortex but also areas called the amygdala and the subcortex. Changes to these areas can cause absent and inappropriate emotional responses particularly to stressful situations.
The consequences relating to Mr. Obama would be emotional disengagement, such as seen with reactions to very distant events or occurrences unrelated to our lives, or absence of emotions, because the neural connections simply don’t exist. But whether it is disengagement or absence, there is little question his emotional responses have raised some eyebrows and seem abnormal, such as his going to a fundraiser the day after the Benghazi crisis, playing golf after the beheading of the American journalist, and the taking of a “selfie” during the funeral of Nelson Mandela.
Marijuana use apparently does not interfere with fact retention but does interfere with the integration of facts into the above mentioned executive functions. Thus, Mr. Obama’s seeming difficulty with problems requiring organization and interpretation of complex information, but then having the ability to shine in situations where recall is important. His “cautious approach” may actually be indecisiveness caused by this lack of problem-solving capabilities. It may have been manifest with his inability to write the original law paper required of someone voted to head the Harvard Law Review. It might leave someone who votes “present” rather than get involved with the intricacies of political life. This inability to perform complex integrative functions leaves a tendency for repetition of simpler tasks, such as fundraisers, public forums which stay in the superficial coatings of the world such as night-time television, partisan political speeches, and the repelling or avoidance of the dizzying array of demands of his office by simple withdrawal to play golf.
Whether it is neurocognitive deficit, emotions lacking or inappropriate, or the inability to develop appropriate reactive strategies, any evaluation of our President’s present performance may be closely tied to his past.