every forty two seconds somebody is arrested for can the mission of our organization to educate the public about the benefits of marijuana marijuana is a safe and inexpensive therapeutic for a wide variety of diseases symptoms and condition no patient should suffer needlessly without it and no patient should ever go to jail for following the advice of a doctor joining us and learn more about the exciting science of medical marijuana welcome to c n n in j t v i'm ken waltz executive director of the coalition for medical marijuana new jersey i'm here in the prince n community t v studios today with dr david nathan from princeton university from princeton so welcome thank you don't you bring the nation so you're a psychiatry and you have a private practice here in princeton that's correct  and you're also with the head of education from princeton health care system young the head of the continuing medical education department at the princeton health care system that's correct marijuana is commonly used it is the most commonly used illegal drug and also it is a reasonably benign drug so that's part of what contributes to to the fact that it's commonly used in its most commonly used illegal drug if you don't consider alcohol and tobacco illegal that's right minors oh good point actually good point right and so of course it's an illegal use by minors in either case so let's set aside that word illegal is a point of contention is to how we should be cracking down on drugs generally among young people what should we be doing to try to keep them off drugs should we be using the criminal justice system or should we be using preventive education and treatment when needed but if you set aside the question of what drugs are legal and which are illegal of course people who use heroin also first used alcohol they probably also at some point tried to back oh whether or not they use it and you know what i would say though i haven't seen the statistics an overwhelming number have probably tried milk and applesauce at some point in their lives now most people who use milk in applesauce do not go on to use heroin we know that right that kind of goes without saying well the fact is that hundreds of millions of americans have used marijuana virtually none of them when you look at the percentage compared to people who haven't used marijuana the percentages of the use of hard drugs is not that different and the great majority of people who try marijuana never go on to use any harder drugs and and if you ignore that fact then you might start thinking about correlation but if you consider the fact that the great majority of people who try marijuana never have a problem with hard drugs that right there seems to refute the gateway hypothesis now there is one way in which marijuana is a gateway to harder drugs a people are now listening intently to know what is that one way while the one way is very simple and that is that the aforementioned illegal drug dealer who is selling marijuana to children is also selling heroin cocaine methamphetamine i have a patient who his significant other like marijuana and he worked in new york and he would get her marijuana he himself had had a problem with cocaine but he had finally kicked it years before and the dealer who would sell a marijuana kept saying you know i'm happy to comp you a little bit of cocaine if you won you know you've been such a good customer i'm happy to just give you a little if you want and he kept saying no no no and occasionally he would take it and give it to someone else which i think must've required an amazing amount of willpower eventually he we can do ok i'll try it and he was right back to the races and that's when he came to see me was when he had started developing a new problem with cocaine that he had gotten courtesy of a marijuana dealer it's also a gateway to the criminal justice system that's right there are so many marijuana possession of us live there twenty four thousand the last count in per year in new jersey so this is an entry into the this whole system you know  collateral consequences that we talked about before and for people with limited resources who can afford to make the records go away to hire good lawyers to make the charges go away you know they they suffer disproportionately sure and you i mean we all have been hearing at least i hope everybody listening has been hearing about the racial disparities in marijuana arrests between blacks who in new jersey a almost three times more likely to be arrested for marijuana offenses compared to whites despite similar usage rates we also don't consider the the socio economic bias against individuals who can't defend their way out of a marijuana charge so in an affluent family if one of the members of the family is caught with marijuana it will cost them a lot of money but they'll make the problem go away and in most cases in poor families they have no recourse they're going to suffer the consequences of that arrest  and that's an injustice that needs to be corrected nineteen somewhere in the one nine hundred ninety those working as a nurse supervisor at new jersey state prison or trenton and i was talking to one of the inmates about eighty six percent of the racist and it's been the result because of because of the incredibly high percentage of blacks and hispanics and in the prison system and he said no he didn't think it was racism thought it was classes and interesting and i thought that was very interesting he said you know you don't see poor people here in this prison to me it's that is interesting and whether or not you can tease apart apart those two because of course we have an african american underclass essentially in america after after so many decades and centuries of bias that is the case maybe we can't separate those two but we shouldn't need to because when you're talking about marijuana you're talking about the wrong drug and the fact that so many of those individuals who are in prison are imprisoned or prosecuted or wind up on the wrong track because of a marijuana arrest that itself should not be happening in and some months ago i was in a forum where i was debating against kevin sabet who is a respected individual in the opposition to  marijuana legalization we were talking about the experience of colorado which had an incredibly high racial disparity in arrests before the legalization of marijuana and  sabet point professor i guess about had pointed out that that that racial disparity still existed after the legalization and then i it occurred to me that well that may be so and maybe we still have a problem there but if you're not arresting people for marijuana use then there is then then that racial disparity is much less important it was and while you may still be mown the existence of some institutional racism legalizing marijuana does make the problem much less of a problem and certainly diminishes the impact correctly if i could just make another comment about the gateway theory in even the da doesn't believe in the gateway  here in were when they turned down the last petition to reschedule marijuana they discussed the gateway theory and they said they they know that the national academy of sciences institute of medicine report for us said there's there's nothing in marijuana that makes people use marijuana led to the heroin or the heroin led to the marijuana shortage of course though so it's interesting that you know even though we have governor christie still you know he is not on the the gateway theory is reason to oppose marijuana legalization you know even the da doesn't support it anymore right and you know am i the am i the most inspired an infallible doctor out there  maybe but this isn't even close this is not a close call in the consideration of whether marijuana should be legal or not so if we were to put everything under the same light all the different drugs and we see the problems caused by alcohol we see the problems caused by tobacco we see the problems caused by marijuana which of those drugs should be illegal first while i can tell you that marijuana should be number three on that list and some would say well but we're already kind of stuck with alcohol and marijuana sorry alcohol and tobacco and we don't want to make another drug legal but if the harm caused by an illegal drug is clearly less than the harm caused by the legal drugs then we as a society really have no right and certainly no logical leg to stand on to say that that third drug should be illegal the only morally ethically logically consistent argument would be either make all of those legal because it's impractical to make them illegal or see what happens if you try to make all of those illegal what happens well we actually know the answer to that question as far as alcohol is concerned the the prohibition experiment of the one nine hundred twenty s was such an incredible failure that many of the people who supported and pushed for the initiation of alcohol prohibition actually called for its repeal by the end not because it didn't work the fact is that alcohol prohibition did somewhat radically but it diminished alcohol abuse it even diminished domesticity abuse domestic violence but it also created such an incredible problem with organized crime that we're still suffering the consequences of that and  the social consequences of alcohol prohibition were so overwhelming that now eighty years later we still have no appetite to repeat that experiment well for the people listening who haven't haven't been following this so closely consider the fact that we have had a prohibition in effect for seventy eight years and that prohibition is against marijuana and because marijuana initially was not so commonly used and its use increased gradually a lot of people were reasonably unaware of how high of a social and economic toll marijuana prohibition has had i think we're waking up to it i think that the conversation we're having today is a reflection of that greater awareness among average people who themselves have no interest in harming the public good we want to improve the public good well the public good demands that we repeal this prohibition and in a sense a i think it's fair to say it's time to end prohibition again somewhere in my no side so that you dispensary that she worked at over three hundred patients and she saw that a significant percentage of them used marijuana to help them deal with alcohol withdrawal to help them deal with the withdraw from street drugs and from more dangerous the drugs and also from prescription drugs so it was her hypothesis i think that there was that marijuana with its very low addiction potential was far from being a gateway drug it was actually in an exit drug for many of these more harmful substances what are your feelings short i i'm somebody who really wants to stick with the science and i have to admit ignorance about the science on that so i don't know if there is are studies to support that or not  the idea that one might substitute marijuana for alcohol if adults do that that's probably generally a very good thing the question is will they do that it would be nice if they did because marijuana is much less harmful than alcohol in chronic use so even if it's not an exit meaning that they don't stop all substance abuse if they were able to stop alcohol in favor of  marijuana for adults i think that would be a good thing one thing that has been observed and i have seen the data on this is that in states that have medical marijuana laws overdose rates on opiate medications have gone down i'm sorry overdose lethal overdose is over on on on opioid drugs has gone down by twenty five percent this isn't two percent this isn't four percent this isn't on the boundary of statistical significance this is a huge change in those states and i certainly can understand the theoretical basis of that which is that  controlled studies there has there have been studies to show that that substitution does occur and and it's obviously a very positive thing when overdose rates plummet in states with medical marijuana you know salute course new jersey has a medical marijuana law but we were not one of those states they talked about the thirteen states that legalized medical marijuana before new jersey that's where they saw all the significant decline in o death rates and i'd like to comment about new jersey's mit mit disenrolled marijuana law you know i am glad that we have it i think that it certainly has plenty of room for improvement shall we say but in the one case of medicinal marijuana that i have personal experience with because it's a psychiatrist there are no psychiatric indications in the state of new jersey which would lead me to not even bother registering to be a recommender of mid december marijuana in new jersey but i had a patient who had end stage cancer and he couldn't sleep and part of the reason he couldn't sleep is that he was constantly in pain from cancer that had spread all over his body and was also in his lungs and i should note that i have his widow's permission to tell the story which is which is a really sad one so he had insomnia partly as a result of chronic pain all over his body he couldn't eat and when he did he he got it but he had no appetite and so he was losing weight drastically and from the first time i met him when he was already quite ill to the last time i saw him before he died he became a shadow of himself even over a few months and in that time course i kept thinking to myself this is the case of somebody who should be given medical marijuana if nothing else it wasn't going to harm this guy and maybe it would help and it's not even my area i'm not an oncologist is i spoke to his oncologist to to her credit said that she didn't oppose the idea of me trying it but she just didn't have the familiarity with it and the u notion of it made her vaguely uncomfortable because of how she grew up understanding the consequences of marijuana and the kinds of people she  knew who would use it she had very negative ideas about it but she said if you are willing to be the point person on this i'm ok with that is his own colleges and so i registered for new jersey's program that wasn't that hard  registered that patient that took a bit of doing that wasn't it wasn't an easy process it took them a little while to get all the paperwork done and then they went to one of the very few dispensary is in the state of new jersey i told him especially since he had tumors in his long i did not want him smoking it obviously he was coughing as it was and had trouble with his respiration i figured ok you can try inhaling the vapors so  said make sure you get a vaporizer and so they went there and they did everything i said they even got to kind of strain that i did a little research to find out what might be most helpful for him i recommended that he got that strain and he got a vaporizer and that all went very smoothly the problem was that his respiratory status was so compromised it was so bad that he couldn't inhale it and the one time he thought he got enough he felt better for that afternoon evening and overnight he slept better and i can't remember if he ate more but the pain was improved that was the only time he got any relief after that he just couldn't vaporize it he couldn't inhale it and i said well then you should get the edible form turns out and state of new jersey that was not available to him is an option which to me is a tragedy and it certainly was a tragedy for this gentleman who died some weeks later after i did my best to try to help them figure out a way that maybe they could take the marijuana buds that they had purchased they still had it he couldn't consume it and convert that into some kind of edible which i'm not very expert on or even like cooking and the wife was so preoccupied with his care that she could never get around to it and so this gentleman who might have benefited from medical marijuana could not get medical marijuana and that is the kind of case that to me says that while medical marijuana has its place some doctors will argue what exactly is it good for what is it not even the most staunch opponents of legalization will not question and that patient of mine should have had access to it because god bless him let him do what he needed to do i think pretty much all of us would agree on that but if marijuana was legal for personal use i would not be telling you this story he would have been able to get an edible because it would have been regulated by the state he would have had to travel across the state to get it he would have had somewhere closer to home and he could have experienced some relief in the last weeks of his life and he did earlier  he didn't and as for as much as governor christie has claimed to be against the drug war and for as much as he says that he supported our medical marijuana laws this is what we have right now in two thousand and fifteen in the state of new jersey and i'm a personal witness to the failure of our medical marijuana laws in new jersey thank you for that story dr nathan and thank you for your efforts on behalf of the patients and certainly seem to have gone above and beyond the call of duty for marijuana really does help with the dying process and so many different ways it controls pain with that over sedation don't it because you know that it improves the appetite it lives the spirits of dying patients that's right and you know people say well they're just getting high and in a case like that especially so what you know if they can feel better and they can subjectively report that they're better what is it that we use is the ultimate measure of pain management and somebody that you give morphine to well it's the subjective improvement and people who use marijuana for purposes such as this report subjective improvement and i think that we need to acknowledge that and we need to respect those individuals rights to do what they need to do feel better right now absolutely and the most efficient and effective way to meet the needs of so many people who are in the dunk process is to legalize marijuana this the the failures of our in the alternative treatment centers that are supposed to be available couple of years ago for minors at least not that's right olds that's right you know that there's they're still not available some people are taking the study that showed i  itself or whether other factors were involved you know i think that that's still up in the air at any rate what are your thoughts on that my comment on that is that when i look at the data i see that correlation not just with decreasing i q and of course q itself is a controversial subject because of potential ethnic and gender biases and how we measure i q but even setting that aside there are not only with you with under age marijuana use and i q decreases that endure after the use we also see a correlation between early marijuana use and low motivation and i think for parents of kids who have experienced issues or problems with marijuana use or who started at a a surprisingly young age i think that they would not be surprised to hear that it might affect function now what you're pointing out is something that i can't speak authoritatively to because i can't go beyond the data does show a good correlation but my reading of the data which starts to become more about belief than about just science but it is my belief that the younger you start and by young i'm talking about middle schoolers early high schoolers  and the more you do it and i'm talking about daily use so if you start very young and if you start and if you use marijuana very heavily i think that there probably is some effect on neuro psychiatric development so i do believe that that's the case putting that out there i don't think that that changes the argument about the legalization of marijuana for adults if anything all of the other arguments for example the need to make a distinction between adult and under age use those are arguments to legalize the fact that it may be harmful for young people let's focus on those young people let's focus on their education let's focus on prevention of early recreational use let's focus our efforts on preventing the diversion of marijuana from adults to children right now and that's not really the focus so much the focus is on trying to stop