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Director of drug abuse institute offers words of caution on marijuana

Dr. Nora D. Volkow, director of the National Institute on Drug Abuse, was in Boston on Thursday to speak at a symposium sponsored by Boston University’s Clinical and Translational Science Institute and Boston Medical Center’s Grayken Center for Addiction. Before her talk, she sat down with the Globe to talk about marijuana legalization and the opioid crisis. Here are edited excerpts:

■ Dispensaries that sell legal marijuana will soon open in Massachusetts. What are your thoughts on pot legalization?

The greatest mortality from drugs comes from legal drugs. The moment you make a drug legal, you’re going to increase the number of people who get exposed to it, and therefore you increase the negative consequences from its use. When you legalize, you create an industry whose purpose is to make money selling those drugs. And how do you sell it? Mostly by enticing people to take them and entice them to take high quantities.

■ But isn’t marijuana much safer than the other legal drugs, alcohol and tobacco? Can you die from marijuana?

You can die from marijuana if you’re intoxicated and driving a car. I don’t know that it is safer. It depends on what stage in your life you are.

For example, if you’re a teenager, marijuana is much more dangerous than nicotine, because it is likely to interfere with the development of your brain. Marijuana dumbs you down. When you’re a teenager and your job in life is to learn, then to slow that down puts you at tremendous jeopardy. Nicotine will not do that. Of course you’ll pay a price when you’re at 60 years of age and you may end up with lung cancer. But how do you determine what is worse? Dropping out of school, when you’re 16 or 17, that’s one of the predictors of poor health outcomes. It’s not as simple as people like to make it.

■ What about the medicinal uses of marijuana?

We have evidence for its benefit for certain conditions, such as the painful muscle contractions that occur with multiple sclerosis. But there is much more work to be done. There hasn’t been a large enough study to determine: Are the effects larger than a placebo, do you become tolerant, and how should you be managing it? When you smoke, it’s very difficult to control how much of the active ingredient you inhale.

We have gone into practices that are not supported by the evidence, like the management of chronic pain. We don’t want to give inadequate solutions to patients. We owe it to them to actually do the studies, in order to understand what may be potential benefits or harms.

■ Why do people become addicted, and how can they recover?

Some individuals have a genetic vulnerability. Others don’t have the vulnerability but they are brought up in an environment that is very, very stressful — the parent is in jail or the mother neglects them. That social deprivation component affects how the brain develops.

We have medications [for opioid addiction] that are very useful, that improve outcomes significantly, but they are vastly underutilized. Medication is a tool that significantly improves the likelihood of that person being able to recover but it will require that there is a change in the system that will allow that person to go back to work or go back to school or to have the social support interactions that are necessary for all of us to succeed.

Unfortunately, we’ve made addiction a very stigmatizing, isolating condition that removes that social support.

■ Do you think addiction will always be with us?

Addiction can be addressed, but that will require that we make significant changes to the social structure. Our culture has one of the highest rates of addiction in the world. It’s telling you that there’s something in the social system, culture, economics, that is driving access to drugs.

More and more states are legalizing marijuana; we’re going to have more people become addicted to cannabis. We have to figure out how do we prevent that from happening.

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