The July/August 2008 issue carried an article in which author Aaron Norton wrote in reference to marijuana that “the potential accumulated risks can be very severe, up to and including death.” Since the statement is not qualified in any way, I read it to intend a meaning that in some cases marijuana is sufficiently dangerous or toxic that it can be the direct cause of a person's death. Subsequent e-mail exchanges with the author provided qualification that he meant the statement to encompass marijuana use as a contributing factor to someone's death (i.e., chronic obstructive pulmonary disease, an automobile crash while intoxicated, etc.).
I believe that when we write for publication or speak in public, precision in language is important and that it is our job as addiction professionals to characterize the harms from drug use accurately and without editorial shading or personal bias. This is especially true for discussions about marijuana in which the harms associated with its use have been exaggerated in order to fit current drug war ideology.
So, to clarify, heroin overdoses kill. Acute alcohol intoxication can be fatal. Cocaine can cause heart failure in some individuals (Len Bias). There are lots of reasons not to use marijuana, but fear of death is not one of them.
John de Miranda, EdM, Chief Executive Officer, Stepping Stone of San Diego
Aaron Norton replies:
Thank you for your dialogue on this important issue. I agree with the perspective that addiction professionals should be careful in their use of language. In the two introductory paragraphs of my article, I compared marijuana to tobacco in the sense that both are highly unlikely to “result in salient, acute negative consequences (e.g., overdose, hallucinations, blackouts, hangovers).” Given that context, I think it was clear that I was not suggesting that marijuana is “toxic” in the sense that people can overdose from it.
That being said, I do not agree that “fear of death” is not a valid reason for not using marijuana. Toxicity/overdose is only one of many ways that substance use can be fatal. In-depth examples of how marijuana can be lethal would have extended beyond the scope of my article on marijuana and sleep. The Drug Abuse Warning Network (DAWN) mortality report (http://dawninfo.samhsa.gov/pubs/mepubs) documents instances of marijuana-related deaths.
In my practice, I have worked with clients whose marijuana use put them at risk for serious bodily harm and death, such as from a serious motor vehicle accident. I also have worked with clients who continued to smoke marijuana regularly against medical advice, despite diagnoses of life-threatening respiratory conditions. If we can't say that smoking marijuana is potentially fatal simply because it is unlikely or impossible to overdose from it, then I'm not sure we can say that tobacco use can be fatal either.
Marijuana use might not be as likely to result in death as use of other substances is, but I think that a responsible, honest, and thorough dialogue aimed at helping clients make informed decisions about their use should not ignore the fact that marijuana use can be lethal.