By Alliance President Terry Gips
Marijuana is safe to use, right? Isn’t that why more and more states are legalizing it and it has become a $33 billion industry?
That’s what I thought until I read an explosive exposé by the New York Times that challenged many myths. It also pointed to mounting evidence that there is a very dark side for daily users of the new, much more potent, ultra-high level THC marijuana products. This is leading to a growing public health crisis in the US.
Marijuana has been an invaluable, positive relief for millions of Americans dealing with a wide variety of physical and mental health conditions. However, more than 18 million regular daily users of high level THC products are experiencing previously undisclosed, significant and deleterious health impacts referred to as “cannabis use disorder.” Many are facing addiction, nausea, vomiting and pain. And a small number are experiencing temporary psychosis and chronic psychotic disorders.
Meanwhile, states are continuing to legalize its use with few restrictions on THC levels or warnings about the possible dangers. And there is limited tracking of the health effects due to a lack of medical codes and little research on the effects of the higher THC levels.
The New York Times did such a great job of clearly documenting the evidence that I have selected the key highlights and done some rearranging but feel it’s important to allow their voice:
As marijuana legalization has accelerated across the country, doctors are contending with the effects of an explosion in the use of the drug and its intensity. A $33 billion industry has taken root, turning out an ever-expanding range of cannabis products so intoxicating they bear little resemblance to the marijuana available a generation ago. Tens of millions of Americans use the drug, for medical or recreational purposes — most of them without problems.
But with more people consuming more potent cannabis more often, a growing number, mostly chronic users, are enduring serious health consequences.
The accumulating harm is broader and more severe than previously reported. And gaps in state regulations, limited public health messaging and federal restraints on research have left many consumers, government officials and even medical practitioners in the dark about such outcomes.
Again and again, the New York Times found dangerous misconceptions. Many users believe, for instance, that people cannot become addicted to cannabis. But millions do.
About 18 million people — nearly a third of all users ages 18 and up — have reported symptoms of cannabis use disorder, according to estimates from a unique data analysis conducted for The Times by a Columbia University epidemiologist. That would mean they continue to use the drug despite significant negative effects on their lives. Of those, about three million people are considered addicted.
The estimates are based on responses to the 2022 US National Drug Use Survey from people who reported any cannabis consumption within the previous year. The results are especially stark among 18- to 25-year-olds: More than 4.5 million use the drug daily or near daily, according to the estimates, and 81% of those users meet the criteria for the disorder.
That means almost everybody that uses it every day is reporting problems with it,” said Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse, who was not involved in the analysis. “That is a very clear warning sign.”
People are considered to have cannabis use disorder if they meet two of 11 criteria, which include craving the drug, building up tolerance and continuing to use it even when it interferes with work and social activities. People who meet six criteria are considered addicted.
Last year, the federal government’s National Survey on Drug Use and Health found that the rate of cannabis use disorder among people ages 18 to 25 was 16.6%. It has caught up to the rate of alcohol use disorder, 15.1%.
Marijuana is known for soothing nausea. But for some users, it has the opposite effect.
Cannabinoid hyperemesis syndrome (CHS), a condition caused by heavy cannabis use and marked by nausea, vomiting and pain. It can lead to extreme dehydration, seizures, kidney failure and cardiac arrest. In rare cases, it has caused deaths — at least eight in the United States, including some newly identified by The NY Times.
Since the syndrome was first documented in 2004, doctors say they have observed a sharp rise in cases. Because it is not recorded consistently in medical records, the condition is nearly impossible to track precisely. But researchers have estimated that as many as one-third of near-daily cannabis users in the United States could have symptoms of the syndrome, ranging from mild to severe. That works out to roughly six million people.
Meanwhile, as more people turn to marijuana for help with anxiety, depression and other mental health issues, few know that it can cause temporary psychosis and is increasingly associated with the development of chronic psychotic disorders.
Many physicians said that they have seen growing numbers of patients with cannabis-induced temporary psychosis — lasting hours, days or even months. While it is more common among younger consumers, it can afflict people of all ages, whether heavy or first-time users, and with or without a family history or other risk factors for psychosis.
Dr. Levy and other physicians have also seen a rise in chronic psychotic disorders, such as schizophrenia, in which they believe cannabis was a contributing factor.
While chronic psychotic disorders are rare, affecting 1% to 3% of the population, they are among the most debilitating mental illnesses.
A study in 11 sites across Europe found that people who regularly consumed marijuana with at least 10% THC were nearly five times as likely to develop a psychotic disorder as those who never used it. A study in Ontario found that the risk of developing one was 11 times as high for teenage users compared with nonusers. And researchers estimated that as many as 30% of cases of schizophrenia among men in Denmark ages 21 to 30 could be attributed to cannabis use disorder.
“There’s a difference in legalizing the original cannabis on the planet and the products that exist today.” – Yasmin Hurd, a neuroscientist, said the medical field has fallen behind in its understanding of the rapidly changing drug.
The marijuana smoked in the 1990s, typically containing about 5% THC, was transformed. Companies turned out inconspicuous vape pens, fast-acting edibles, pre-rolled joints infused with potency enhancers and concentrates with as much as 99% THC. (These are different from concentrates of CBD, a nonintoxicating component of the cannabis plant that is also widely seen as therapeutic and has gained in popularity.)
In 2017, the National Academies of Sciences, Engineering and Medicine published a review of research on the health effects of cannabis and warned that the lack of evidence-based information posed a public health risk. Last month, the organization issued another report, criticizing the nation’s disjointed cannabis policies and calling for urgent action by the federal and state governments.
Even without psychosis or cannabinoid hyperemesis syndrome, cannabis can disrupt lives.
While the drug can assist the endocannabinoid system, alleviate some symptoms of disease and otherwise make people feel good, regular heavy doses of it can also throw the system off balance. People must continue escalating their use to get the same effect. And quitting can cause anxiety, depression and other signs of withdrawal.
Quitting marijuana can be rocky. People with cannabinoid hyperemesis syndrome typically experience the most difficulties, including physical pain similar to withdrawal from harder drugs, but others also struggle to eat, sleep and otherwise function. People who turned to the drug to help ease anxiety or depression find that those underlying issues worsen at first without the cannabis.
While opioid users can get some relief with medicines to help break their addiction, there are no FDA-approved drugs to help people quit marijuana.