California Cannabis Research Medical Group


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Autumn 2005
Journal of the California Cannabis Research Medical Group

Implications of Early Cannabis Initiation

By Tom O'Connell, MD

I have been conducting an ongoing clinical study of applicants seeking “medical” designations under the aegis of Proposition 215. By encouraging individuals regarded (perhaps even by themselves) as “recreational” users to seek recommendations, Prop 215 created the opportunity for physicians to gather clinical data of a type not previously available.

Over the course of nine months I developed a structured interview that allowed construction of a user “profile” by relating family and school histories to initiations and lifetime experiences with alcohol, tobacco, cannabis and other illegal “drugs of abuse.”

It soon became apparent that the great majority of applicants -whatever visceral or structural lesions they now cited to justify their use of cannabis- had first tried it as adolescents. They had been (often unwittingly) using it over long intervals as safe and effective self-medication for a panoply of emotional symptoms.

Most of their initiations occurred during junior high or high school (i.e., the age period at which federal policy is designed to deter cannabis use).

The relative scarcity of applicants born before 1946 indirectly confirms that older patients who had not initiated cannabis as adolescents are very reluctant to even try it. This holds true even when they are experiencing symptoms known to respond to cannabis (nausea associated with chemotherapy, for example). Because they had come of age before the hippie/Vietnam era, tobacco and alcohol had been their only readily available options for self-medication.

Implications for drug policy
Despite their adverse health and social consequences, alcohol and tobacco have been essentially receiving preferential endorsement from national drug policy. Alcohol and tobacco remain legal while cannabis use is criminalized. Research aimed at exploring medical applications is stifled.

Symptoms being treated by self-medication are variants of anxiety that relate to low self-esteem (often associated with physically or emotionally absent fathers). The aggressive drug initiation patterns exhibited by these patients suggests that repetitive drug use is an unwitting search for relief brought on by low self-esteem.

Symptoms being treated by self-medication are variants of anxiety that relate to low self-esteem

Demographic Notes
Standardized information has now been gathered from approximately 3000 individuals. Chronic cannabis users born before 1946 are very uncommon, compared with early ‘baby boomers born just in time for the Vietnam/hippie era. Chronic cannabis use typically begins after initiation during middle and high school years. The increased availability of cannabis to adolescents over time is manifested by a decline in average age at initiation noted after 1975.

The ‘gateway’ hypothesis —that cannabis somehow leads its youthful initiates to progress to “harder” drugs— was based on limited observations, made during the mid-1970s, on youths born in the late ’40s and early ’50s. Demographic data from that population suggests they were on the leading edge of what would gradually become today’s huge illegal market. Continuing Congressional pique at the size of that market has prompted enactment of “add-on” penalties which apply primarily to adolescents and young adults convicted of marijuana “crimes.”

For updates on Tom O’Connell, MD’s study and his observations on cannabis and applicable policy see

O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.