The Seattle Weekly May 1, 1992 JUST SAY YES AND NO HOW PAST DRUG USE MAY (AND MAY NOT) HAVE ADDLED YOUR BRAIN. by Rose Pike Copyright 1992, The Seattle Weekly. Elaine took her first toke of marijuana as a 15-year-old high-school student -- "We got it from older hippies," she says -- and went on to use acid, peyote, alcohol, and other substances, natural and chemical, from the late 1960s to the early 1970s. "I was going to do it forever," she remembers, "I thought my kids would, too. I was going to be real mellow. What was the slogan? Turn on, tune in, drop out?" She had some bad trips, but continued down the flower- child path because "I thought it would make me part of something." Now a counselor in a drug-abuse program, Elaine says she wonders "what I would be like if I hadn't done it." She attributes her later drinking problems (she is now a recovering alcoholic) to youthful use of illegal substances, and contends that her memory and learning ability were adversely affected. "In the real world", she believes, "you'll see people who are fried on acid right and left, just not all there." A quarter-century after the Summer of Love, Elaine and some other erstwhile flower-children look back on their early chemical indiscretions with worry and regret, both for themselves and their kids. They didn't pay much attention at the time, but now recall the old cautions and link them to present physical and emotional problems. The predictions _were_ scary. GENETICISTS WARN OF LSD PERIL TO CHROMOSOMES, blared a typical 1967 headline. The article, a report on a March of Dimes conference, went on to say that "a panel of experts in human genetics advised that no one in his or her reproductive years should take . . . LSD unless there was a very good medical reason for doing so." Similarly, a New York physician claimed that "chromosome damage has been unequivocally demonstrated on those who tried LSD, even in some who have only had one dose." That same year, an official of the Federal Bureau of Narcotics asserted that his agency's files were "punctuated with murders and atrocities committed under the influence of marijuana." In addition, the bureau maintained that "evidence shows that the drug is dangerous, that many heroin addicts began by smoking marijuana." According to a Greek researcher, two marijuana joints a day meant almost certain "adverse personality changes . . . and damage to the brain and other organs." Some of the scare stories turned out to be all sound and fury, laughable in retrospect. Remember the federal investigation into "mellow yellow" -- smokable dried banana peels -- following a _Berkeley_Barb_ story touting the fruit's euphoric potential? Bananas turned out to be neither a natural hallucinogenic panacea nor a menace to the national morality. The threat to human genetics was also much overblown, in part because the field of human genetics was in its infancy and scientists did not clearly understand some of the microscopic abnormalities they were seeing. "To this day," says March of Dimes national spokesman David Leavitt, "we get questions from women about whether their own or their husband's past LSD and marijuana use carries any risk for their present pregnancy." That idea may persist in popular lore, but the specter of LSD-linked chromosomal damage was long ago laid to rest by science. Leavitt now tells callers with confidence, "There is no known risk." And although it's true that chronic pot-smoking can dampen male fertility, for those who stop smoking, sperm counts usually return to normal. Several studies in the past decade seem to show a link between birth defects and marijuana smoking during pregnancy -- a fetal drug syndrome similar to fetal alcohol syndrome -- but even that connection remains tenuous and controversial, says Leavitt. According to University of Washington pharmacologist Lawrence Halpern, who frequently testifies in trials in which crimes are held to be drug-related, "In terms of clinical syndromes, we haven't seen anything like longtime adverse effects from LSD. The drug police were out [in the 1960s] and you couldn't believe a word they said." Similarly, drug-enforcement professionals still frequently cite the so-called "gateway" or "steppingstone" effect -- that experiment- ation with MJ will inexorably lead to harder stuff and addiction -- even though research has shown that not to be the case for the majority of users. But in a study presented at a 1983 meeting of the American Psychiatric Association, researchers from the University of Kansas reported that approximately one in nine marijuana users develops a dependency on the drug -- about the same rate as for alcohol. Indeed, negative medical and psychological repercussions of that era have turned out to be subtle and difficult to attribute with certainty to any particular factor. There's a tendency among baby- boom patients, say some who specialize in the treatment of chemical dependency, to attribute a variety of present emotional problems to past use of illicit pharmaceuticals. "I encounter people who feel that the somehow broke their brains in the '60s," says University of Washington professor and psychiatrist Albert Carlin, but he's skeptical of the connection. "The notion of the person who fried his brain tends not to be borne out clinically," he says, though he hastens to add that "of course, anyone who was reduced to a raving maniac as a result of drug use is not around to study." In the '70s, Carlin worked on a project that sought to determine if certain illegal drugs caused brain damage. "The ultimate answer," he recalls, "was yes and no. In a group of multiple-, heavy-drug users, a significant portion were impaired, but we couldn't pin down drugs as the specific cause. When we began to look at childhood and other social factors, it wasn't so clear." He also cites the "cracked vase" phenomenon, meaning that there were "people who were vulnerable already and whose vulnerability was highlighted by drugs." Paradoxically, Carlin points out, some studies of marijuana use have shown a higher level of overall functioning in those who smoked than in those who didn't. BEYOND THE SUMMER OF LOVE Much of the movement away from the drug culture came as the result of uncommon, though sometimes severe and tragic, drug reactions, rather than from any fear instilled by the drug nay-sayers. Before those losses of health and life occurred, the nation -- at least that part of it that was the baby-boom bulge -- had fallen under the spell of Haight Ashbury's mellow hippies. Every city had a drug- laced rock-and-roll scene. Grass was smoked and acid savored in an atmosphere etched with adolescent rebellion and fearlessness and with an intensely naive spiritual and intellectual curiosity. For a while, it seemed that chemical euphoria might provide an answer to the dilemmas of our post-assassination, Vietnam War-era lives. As the scene degenerated, a flurry of perilous chemicals hit the streets and sent casualties to emergency rooms: PCP (phencyclidine, an animal tranquilizer also called "angel dust", "crystal", and "peace pill"); the amphetamine DOM, known on the streets as STP (Serenity, Tranquility, Peace), guaranteed to produce a three-day high; and DMT, the so-called "half-hour" hallucinogen. The Summer of Love segued into a season of bad trips and came to an abrupt and sobering end with the tag line "Speed kills." LSD also killed, by triggering suicides in a small number of people (the well-publicized delusional leaps from windows or high places). Also for a few, acid was the spark that ignited full-blown schizo- phrenia, though the consensus among psychiatrists is that some other substance or event would have done the trick sooner or later in susceptible individuals. Even in the highest of high times it was clear that those who strayed from dope-smoking or an occasional, sacramental hit of acid to shooting up were at much greater risk. "The vector for getting into trouble," recalls a participant in the '60s scene who also ran a drug-crisis clinic, "was speed rather than marijuana or acid. It was the speed freaks who got into difficulty, especially the ones who crossed the line of putting needles into their veins." In fact, the connection between past use and present impairment is clearer for street-manufactured amphetamines than for any other illegal drug. Speed was perilous -- still is -- and it left some victims permanently panicked and paranoid. "Certainly," says Dr. Peter Roy-Byrne, of the University of Washington's Anxiety Disorders Program, "long-term amphetamine use had been reliably associated with paranoia. The same is true for cocaine." Both types of drugs produce "a 'kindling' phenomenon in the brain. The brain becomes more sensitive over time to smaller doses." Dr. Roy Clark, a clinician who specializes in the treatment of chemically dependent patients who've failed in other programs, reports another ampheta- mine-related difficulty: "We are beginning to see a number of individuals who were involved with speed on its initial run and are now seeking treatment for chronic depression." CHRONIC POT USE Marijuana, of course, was the most widely used and at the time the mildest of the illegal substances; to date, 68 million Americans are said to have tried marijuana, as compared with 10 million who've tried LSD. Like those who stopped smoking cigarettes years ago, people who gave up pot or became moderate, occasional tokers are probably off the hook in terms of health effects. The biggest single problem associated with past pot use, however, is that some people never stopped, and at some juncture realized they couldn't. According to Roger Roffman, a University of Washington psychologist who is well known for his studies of chronic marijuana users, "Many people come into our program saying, 'If only I could take it or leave it the way I used to.' They find that if they have access to it, they smoke grass compulsively and get very anxious if there's none around." Some chronic dopers have been smoking every day for 20 or 30 years and have difficulties much like those of the problem drinker. The average person in Roffman's program is male (three-quarters of those enrolled), middle-class, employed, and in their 30s or 40s. Many of those who applied to be part of the latest round of studies were dependent on more than one drug concurrently -- alcohol and pot, for example. Marijuana (and hashish, another derivative of the _Cannabis_sativa_ plant) has been used recreationally in various cultures for centuries. But it was not until the mid '60s that scientists in Israel were able to isolate Delta-9 THC, the ingredient that produces a high. Just three years ago, National Institutes of Mental Health scientists described the was in which cannabis receptors work in the brain (though the treatment or policy implications of that finding aren't clear at this point). Unlike LSD, marijuana has grown more potent over the years; street pot not contains about five percent THC (although this figure can go as high as 20 percent), compared with the one percent average of 25 years ago. As a result, some chronic dope-smokers are finding it more difficult than ever to moderate their intake, and it's possible, say some experts, that the new breed of dope may rope in a higher percentage of chronic users. Back in the '60s, even before the discovery of THC, scientists observed that heavy hashish users sometimes experienced an amotivational syndrome, becoming the classic picture of the stuporous, slow-moving hash head. A version of that syndrome is not commonly seen in low-dose, chronic marijuana users; Roffman describes people in his program who worry about "procrastination, feeling out of control, wishing they had better thinking and memory capacity." While some chemical-dependence professionals tend to write off complaints of memory loss due to drug abuse in the distant past as "aging hippie syndrome" (we all have a tendency toward forgetfulness as middle age creeps up), a report in the British medical journal the _Lancet_ in 1989 outlined evidence that chronic cannabis use seems to cause short-term memory deficits. Another hazard for chronic, heavy dopers is lung damage. "The net respiratory burden of particulates was approximately four times greater during marijuana smoking than during pot smoking," wrote a UCLA research team in the _New_England_Journal_of_Medicine a couple of years ago. Though a person would have to smoke an unlikely four joints a day to equal the harm caused by one pack of cigarettes, the finding nonetheless is significant for those who indulge in both tobacco and pot or those with a predisposition to chronic lung diseases such as asthma and bronchitis. Perhaps more troubling is a recent finding that the world's finest cannabis may contain significant amounts of mercury. "The best- quality marijuana," according to a study done at the University of Hawaii and reported in the journal _Bioscience_, "appears to come from areas known to have rich mercuriferous soils, such as Hawaii, California, and parts of Mexico." Mercury inhaled through the lungs in pot smoke is absorbed at a rate 10 times higher than mercury traveling through the digestive tract in food. Bio-accumulated mercury, moreover, is known to precipitate many of the same neurological symptoms associated with chronic marijuana or hashish use: forgetfulness, irritability, tremors, and paranoia. LSD AND LONG-TERM RISKS Compared with the brain damage that some scientists now believe a small minority of LSD users may have incurred, the signs and symptoms associated with chronic cannabis use are relatively easy to discern. Impairment related to pas LSD use may be so subtle -- on the level of biochemical "scarring" -- that we don't yet have tools sophisticated enough to measure it. Recent research using electronic devices such as the BEAM system (the Brain Electrical Activity map, which creates colored "virtual" maps of brain centers), seems to be breaking through the mystery of lysergic acid diethylamide, a substance that has been the subject of fascination since its debut, in the 1940s. Originally manufactured by Sandoz, the Swiss pharmaceutical company, LSD (the initials come from the German chemical name) first captured the attention of the medical community as the world's most powerful hallucination-inducing compound. A byproduct of ergot, a fungus that grows on rye, LSD was thought to have potential as a treatment for mental disorders, but that promise was never realized. According to UCLA neuropsychiatrist Lewis West, who has studied the drug since the 1950s and once took a hit as part of his training, "It was going to be the royal road to the unconscious, like having patients dream while they were awake." But despite LSD's auspicious pedigree as a legal drug and our considerably greater understanding of brain chemistry 50 years after its discovery, "we still don't know how LSD works," says West. "There's a change in the brain chemistry that's reversable in most people, but not in others." Dr. Henry Abraham, a Harvard research psychiatrist who works out of Boston's St. Elizabeth Hospital, investigates LSD's neurological sequelae in both past and present users. Acid's complications fit into three categories, he explains: bad trips, flashbacks or "free trips", and the relatively rare phenomenon of prolonged psychosis. The bad trip -- acute panic or temporary psychosis soon after ingestion -- usually goes away with time and treatment, though there is speculation that some LSD users eventually develop chronic panic disorder related to the original bad trip. If so, Abraham and his colleagues suspect that the mechanism that triggers panic attacks is similar to the kindling effect associated with other stimulants. So far, brain abnormalities that might cause an LSD kindling effect aren't nearly as well documented as those associated with flashbacks. A few years ago, Abraham identified a syndrome called post-hallucinogen sensory disorder, in which patients see "continuous visual disturbances of an abstract nature, such as flashes of light, auras, patterns of dots vibrating in the air, trailing, after-imagery. These things can go on forever. Post hallucinogen syndrome occupies a spectrum -- some people react occasionally, some every few seconds." Imagine viewing the world as a sort of psychedelic Georges Seurat painting from which you can't turn away, or seeing a perpetual migraine-type aura around everything. One post-hallucinogen sufferer endures a light like a flash bulb that goes off in front of his eyes every few seconds; another notices auras around objects only occasionally, for example, when he's tired at the end of a day. The syndrome, which can also involve greater sensitivity to glare, is treatable in some (with Valium and related drugs), not in others. Using the BEAM method, says Abraham, "we've done brain-mapping and found that these people have visual-field disturbances in the temporal lobes." The maps show abnormalities similar to those found in temporal-lobe epilepsy, a malady that also causes visual and auditory hallucinations and personality changes (unlike people with epilepsy, post-hallucinogen sufferers don't have seizures). The temporal lobes are instrumental in the processing of visual, aural, and tactile data, and they also play a part in the synthesis of emotion and memory. It's possible, then, that some past users of LSD might have damaged these segments of the brain in such a way that, as one researcher put it, they may be "seeing sound and hearing color". The other long-term acid complication that concerns Abraham is the prolonged psychotic reaction that strikes about one user in 1000. "These people can be very sick, they can be daunting. We're reviewing the old data on psychotic breaks. The common story is the kid who tripped once and enjoyed it, the second time got into more trouble, and by the third time had permanent problems." In addition to pursuing the temporal-lobe/LSD connection, Abraham and his colleagues are looking at LSD-experiment data (including the notorious US government experiments) from the '50s and '60s for clues to acid-related syndromes that might have been overlooked by past researchers. As far as currently non-using veterans of '60s drug culture are concerned, Abraham says, "I don't think we're looking at a generation of brain-damaged individuals". Nonetheless, he frets about the current resurgence of interest in acid (which, incidentally, is consumed today in much lower doses -- 100 micrograms as opposed to the 250 micrograms or more in the '60s). "There are folks who can eat this stuff like popcorn and stay out of trouble," says Abraham. "They should count their lucky stars they're not one of the wounded. Then there are people who are biochemically vulnerable, and for them it's like having Scud missiles in your head." TODAY'S GENERATION: NEW DANGERS So it would seem that except for those few who permanently rewired or disconnected segments of their brains, the vast majority who participated in the drug culture of a quarter of a century ago escaped unscathed. In fact, many fortysomethings wax wistful about their acid trips or the first time they tried hash in a bar in Amsterdam, in much the same tone as an ex-jock might boast about a championship season in the distant past. What's genuinely confusing for many middle-age former drug users, who ran the gauntlet and emerged whole, is how they should regard illegal-drug use now. As a new generation stumbles upon LSD and marijuana, Drug Enforcement Administration officials report that acid confiscations in the District of Columbia alone rose from 14 doses in 1990 to 5600 in 1991 (due in part to a more concerted effort by the agency). But there are differences in the current drug scene. Acid is weaker now, pot packs a wallop more like hashish used to (and costs 10 times what it used to), and the average age of first drug use is dropping almost into the single digits. "For someone who's 25, to smoke dope periodically is not all that toxic," Ries says, "but you take the same exposure with someone who's 12 and it has a very different effect. Your brain is not developed and you quickly get in trouble with thinking." Unlike the mostly college-age group that experimented with drugs in the Vietnam War era, many of the kids trying LSD today are in junior high or high school and have not yet reached physical maturity. Crack, too, with its terrible legacy of permanently addicted babies born of addicted mothers, is often used by very young teenagers. Indeed, the drug problems that draw our attention in the '90s differ dramatically from those of the '60s. What _hasn't_ changed is our addiction to scare tactics as a means to abate the "epidemic" of the moment. The "reefer madness" of the 1920s and '30s became the "genetic peril" of the '60s. For the past decade or so, we've been assaulted with the latest version. "This is drugs," begins the public-service announcement, showing smoking butter in a hot skillet. "This is your brain on drugs," is the famous follow-up line as an egg is broken into the pan, where it fries furiously. But reefer madness never happened, genetic peril remains unsubstantiated, and that fried-egg line probably wouldn't deter a genuinely troubled teenager from jumping into the frying pan. Scare stories about drugs, especially when the old ones are regularly debunked, didn't work back then to stop young people from testing the limits, and they still don't work today. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - For more information on prescription and nonprescription drugs, visit OnHealth.com, the leading consumer health site on the Internet.