every forty two seconds somebody is arrested for can 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 in the head of the continuing medical education department at the princeton health care system that's correct though i should note that in this capacity i don't represents  so i was very impressed with that that was actually i have to give credit to one of my colleagues for actually having come up with that particular speaker but i agree that he was great and speaking about about the state of the science yeah i mean those rea of but and i don't know if things have changed now but i can tell you that as a medical student as a resident there isn't really a whole lot that's taught about the end of can happen and system and in the defensive medical education i think some of that was just because there wasn't the perceived need but i think it's also interesting lee the nature of the plant that because it itself does not serve any life sustaining sustaining functions the toxicity of it  is less of a concern which i think is is one of the issues that brings me here is the lack of tough toxicity and you know in the position that i have on the that is that that's a good thing you know we did the research  well there was research done actually by david allen dr david allen from california who said that on only fourteen percent of the medical schools in the united states even mention the endo can have a system and here you have a system that regulates so many processes and lobbying absolutely laws that we see absolutely and i can i certainly can't claim never to have accepted anything other than the usual pens and such back in the day before i really thought about such issues i would go to dinners and i would  tend functions that were paid for by drug companies i would give a talk on a subject of my choice and be paid an honorarium by the drug companies the change really came both from an awakening of the ethical issues involved in that and also the fact that as the continuing medical education director i wanted to wanted it to be clear that i was not being influenced by any corporate interest in trying to educate other physicians when i think that's really extremely admirable  expertise but i can say that that as far as physician education goes there's a reason that so much money is spent by pharmaceutical companies on physician education  and communications with physicians and they would be doing it if it wasn't in some way profitable now not to say that you can't get some good education through the events that are sponsored by them for example when a new drug comes out it's important physicians learn about it and it's not a terrible idea to learn about it from the from the corporate interests that actually produces it at the same time i don't think that doctors choices should be guided by who most recently came to their office and gave them the biggest smile end of two thousand and nine after years of seeing lives ruined by marijuana not so much by the drug itself i treat only adults and of the adults that i would treat i saw lives devastated by marijuana again not by the drug but by the legal system who was using a sledgehammer to kill a weed and i was really increasingly angry about the ways that our laws were counterproductive that they not only didn't serve the public interest and public health but they actually were harmful to our nation and eventually got to the point where i felt like i had to speak up and so i wrote an opinion piece that was run in the wall street journal thinking that ok i'll just lend my voice to the many of that if spoken up from the physician community on this issue only to find out once the article had run that not that many physicians have really spoken up and while it's been gradually over the years that i've gotten more involved in this movement it was quite a surprise to me that my voice was not often heard or the point of view that i was a spouse was not often heard now that's changing i would say that part of the reason i was surprised was that in private conversations with other physicians all the time we would share with each other that yeah it's ridiculous that marijuana is against the law because we as physicians who treat substance misuse we see of course terrible problems with alcohol we see we see problems with heroin cocaine methamphetamine and all the drugs that we imagine to be really devastating to two individuals lives but marijuana wasn't generally all now now with the coffee out that i don't treat kids  among adults there is very little harm that's done by that drug among occasional users and that's not to say that it's harm less of course to individuals who are predisposed to psychiatric disorders that can actually either trigger an episode for example of a psychotic disorder in unusual circumstances not common but it happens and it can also exacerbate a mood or anxiety disorder of course you'll also hear individuals tell you that actually improve their mood or anxiety disorder and as i'm sure your audience knows it's increasingly being used used in post traumatic stress disorder especially by veterans and the main issue in marijuana legalization the main concern that physicians should have whether or not they do or not is a matter of individual choice but but the real concern should be creating a distinction in use between children and adults and i'm talking about personal use not medical use you know medical use for children with refractory seizures seizures that aren't being well treated by other medications ok they are kids for whom marijuana use may may be appropriate but for personal or you could say recreational use  creating a distinction between adults and a somewhat arbitrary number of twenty one years or older verses minors is a very important distinction so when our society is making no distinction between adult and under age use when it's illegal for everybody the message that we're sending is that marijuana is bad for everyone and kids my kids i have a fifteen and eleven year old  two children they know that there's a big difference mainly because i've taught that to them and they've heard me speak on the subject and they understand that what is a generally safe activity for adults is neither safe nor legal nor should it be legal for minors and by creating that distinction we will for the first time in decades for nearly one hundred years send the message that what is a safe and acceptable activity for adults is neither safe nor acceptable for minors right now the system that we have the system of prohibition tries to to  send the message that it's bad for everyone and kids know that's not true you know you know we wonder how much sense it really sounds really makes when you say minors should not use marijuana but adults should not use marijuana you know is not a reasonable regulation that's just a blanket prohibition that americans are pretty much fed up with right and the polls reflect that of course and the media reflects that when you see light hearted discussions about adult use of marijuana in the media either in the news as is increasingly happening or in entertainment what you're seeing is the realization by adults that come on we really we know it's not that bad let we can agree on that that for example alcohol is a more dangerous and more harmful drug across populations we know that it may not make that distinction between adult use and childhood use though  kids watching this will certainly learn that for dulce it's not that big a deal and if we try to convince them that nobody should be using it for personal use that doing so i bad enough that we should put people in prison for that kids know we're lying to them and they're not going to listen to us and they're not going to listen to us when we tell them they shouldn't use it either i think they i think they've stopped listening to us already well sure i mean the statistic that is really most impressive to me is that the government's own statistics the national institute on drug abuse for decades has been gathering data on eighteen year  olds and their use of various drugs and their access to various drugs and what that has shown is that for decades over eighty percent and generally closer to ninety percent of of minors eighteen year olds report that marijuana is either fairly easy or very easy to obtain if they want it and you know i kind of wanted to cross check this against some anecdotal evidence so i asked my niece who at the time was probably fifteen or sixteen years old very sweet young girl who by her very candid description has i tend to believe her when she says that she's never tried the stuff i least hope that's the case  but she has a pretty straight laced kid i asked her could you get it if you wanted it and she lives in a in a fairly crime free be drug free  community and i asked her that question in her answer was she kind of chuckled and she said yes uncle david i could get marijuana if i wanted marijuana and i asked her how would that compare to alcohol and she said well marijuana is easier to get because marijuana is sold illegally and so you know kids can get it the same way adults can as opposed to alcohol where you have to have some form of id which you know less kids fake id than they're not in license facilities correct yeah i know absolutely i feel very strongly about that and you know as a physician i'm not advocating the use of marijuana in adults or kids certainly not in kids and in adults occasional use i think is not so bad it's probably not as bad as alcohol but if we want to take this problem of under aged you seriously then what we need to do is get it out of the parks and off of the street corners and out of the hands of illegal dealers who will sell to anybody they're not asking for id they're already breaking the law so they don't really make a distinction between customers who are adults versus customers who are minors and then put it behind the counter with somebody who is regulated by the government whose livelihood depends upon their compliance with the law and they will check for id and indeed when they've done studies in colorado what they found is very few almost no incidence of  sales to two undercover officers posing as minors who don't provide sufficient id it virtually never happens and that's not surprising  really i've seen arguments from people who oppose the legalization of marijuana where they say we're sending the wrong message to teens by legalizing it and first of all as as i was just explaining i think that the wrong message that it's harmful adult for equally for adults and kids and that's why the same law applies to both i think that's very harmful to make that case because because you're supporting something the kids simply will not believe and that aside since when have kids listen to and i told you so argument about something where they have evidence to the contrary so if the message that they want to send is that you shouldn't use it why because we told you so because it's because that's the law certainly we should respect the law but when there are laws that aren't worthy of respect i don't think you're going to get a lot of enthusiasm from children and from teens about following that law and that's why the law needs to change you know on it i find it ironic to the to these laws are made to protect children what do we do with people who break the laws you  disproportionately impact areas community for other than other communities and you know if there was a straw that broke the camel's back in my speaking up about this and not being willing to keep silent anymore and not being willing to have these private conversations with friends and family and colleagues about this but actually in a sense putting my reputation on the line about this issue and feeling that certain about the need to legalize it it was hearing from a patient who was on his way to college and because of a marijuana arrest last a scholarship and lost you know had a criminal record after that and his life went in a very different direction and his life could have been quite different had he not been arrested for that and had the law not come down as hard on him as it had collateral consequences of civil civil penalties loss of driver's license fines lots of scholarships as you point out which has nothing to do with the personal use of a of a reasonably nontoxic substance you know maybe it's not good for you but it's not that bad for you expel your entire family from public housing you know that's right you know it's just devastating and i don't know you know i think a lot of the people who are opposed to marijuana were form realize the devastation that's caused by marijuana laws and how much more harm is done by the laws than could ever be done by marijuana use you know it's not only an effective years ago soley for medical marijuana we have come in the last year to endorse legalization right now no one so and i imagine i mean you can tell me if it's otherwise but if i were sitting where you're sitting  thought would be that you know given how there has been difficulty with access to marijuana and people have been arguing which indication would qualify and which form it could be sold in certainly in the state of new jersey the the laws have been restrictive in counterproductive a lot of these problems go away once you have full legalization and absolutely you know you don't situation when they're really on a spectrum of some kind of mental or emotional disorder and and they find that marijuana is is helpful in helping them to cope with their life struggles and yet yet they would never have a diagnosis that would qualify and certainly in new jersey right that's correct and you know to to give the fullness of my opinion i would say that for patients with psychiatric  disorders as i mentioned before the use of marijuana can cut both ways i don't think that it's certainly don't think it's a panacea and whether it has psychiatric indications or not there are certainly cases of people who should not  smoke marijuana and honestly the ones for whom that's true they generally figure it out and they stop and the reason that they stop is that as we know it's not nearly as physiologically addicting is other recreational drugs such as  alcohol or tobacco and it's not even his physiologically habit forming it's caffeine right now but let's talk about that a little bit now you say that marijuana well and i'd like to address that because i have colleagues who assert that that's a very serious question you know if that is the case that it causes schizophrenia that's a that's a different thing the evidence really isn't there i mean there is evidence you know there have been studies to suggest that maybe it does contribute to the risk of schizophrenia there's also evidence to suggest that there is no risk just like with lung cancer you know this is a bit of an aside but with lung cancer there was the question of whether caused lung cancer well a very large study that was done at u c l a seemed to even have a negative correlation between marijuana use and lung cancer which is not to say that inhaled smoke which is the form in which they were studying it is good for your lungs that's that's not the point but the point is that sometimes what you're expecting to find what seems like the obvious answer is not obvious at all with the case of schizophrenia what we might be seeing when we think that that marijuana use is causing schizophrenia is that the same age at which that at which people start experimenting with drugs is the age at which they're at risk for developing schizophrenia and if there is as i think there is some evidence to show if there is support for the for the notion that it can trigger an episode of psychosis well if you are prone to getting schizophrenia and you are using marijuana usually more than once or twice but a significant amount that's where you might i see a correlation whether it's causative or not is another story and we can talk about the difference between correlation and causation but even if it is a trigger and there is some evidence to support that there is not the evidence to support the notion that it causes schizophrenia very well i mean can't many things be a trigger for schizophrenia oh absolutely not the whole alcohol could be breaking up with a girlfriend exactly yes stresses stresses on the system of any kind precipitate all manner of psychiatric problems that you might have been prone to getting anyway you know and so you know how can you possibly legislate against all the things that could possibly precipitate absolutely i mean we're not legislating against skydiving we don't legislate against football although some people are suggesting we should one of them but we and by correlation you cannot make illegal an activity that first of all people who are intelligent and have good judgment are choosing to engage in anyway and that's a significant part portion of the american population and of course nearly half of all americans have tried marijuana and if we were really being diligent about prosecuting everyone imagine what would be like in that situation  t you you cannot prohibit your way out of the use of a drug like marijuana and to me the strongest argument against any cause effect relationship between marijuana countries that have greater or lesser use you're not seeing a difference in the percentage of individuals who use it i imagine you would ask about the gateway hypothesis that's often something that comes up  opposition to marijuana legalization is that the use of marijuana in some way causes people to use wrong or right more dangerous drug for more information about the coalition for medical marijuana new currently join us and our public meeting on the second tuesday of