This book could have been longer.
The mental-health dangers of cannabis don’t stop with psychosis. At a time when the suicide rate in the United States is rising, growing evidence links cannabis to depression and suicide. The Dunedin research also suggests that marijuana may lower overall intelligence, though other studies disagree with that finding.
A strong link between cannabis and dangerous driving is also emerging. The number of drivers in fatal accidents in Colorado and Washington who test positive for marijuana has soared since legalization. As with the marijuana-violence link, controlled laboratory research doesn’t seem to capture the true risk.
An even broader question is whether persistent cannabis use decreases motivation and ultimately discourages users from working and having successful lives. Wayne Hall, the Australian drug abuse expert, is hardly a cannabis alarmist. He notes that alcohol is far more physically toxic. Yet marijuana can subtly enmesh itself in the lives of users in ways that alcohol does not, he notes.
Those heavy users tend to be at a societal disadvantage already, and cannabis worsens it. Hall points to a New Zealand study—not Dunedin—that showed that people who used heavily into their late twenties generally had not married or found steady work. “They just didn’t have much of a life, basically,” Hall said. “That’s one of the concerns that I would have about the social equity effects of legalization.”
All these issues are important. But to me, at least, they are all secondary to marijuana’s link to psychosis and violence—because the evidence is so strong, the issue so misunderstood, and the consequences so severe.
Now the time for guesswork is over. The federal government needs to step up with serious and well-funded research on marijuana’s effects. Not on psychosis. That debate is over. By any reasonable standard, the connection has been proven.
But we need to know about the relationship between marijuana and other drug use. The advocacy community made a brilliant tactical move when it promoted marijuana as a solution for the opiate crisis. In the very unlikely event marijuana can help people avoid opiate addiction, we should know, so we can encourage its use.
And in the far more likely event that marijuana is in fact a gateway drug, we should know—so that we don’t push people who are at high risk for opiate addiction to use it.
We also need much more research into the marijuana-violence connection, to discover if marijuana causes as much violence as its link to psychosis and the emerging data suggests.
At the same time, the government should drop its barriers to researching cannabis for medical purposes. The reason is not that marijuana is likely to prove a miracle cure for cancer—or anything else. It’s precisely the opposite. Let’s put unfounded claims to rest, permanently.
If and when we do, I hope media outlets will pay as much attention to the negative findings as they have to the very slim positive ones so far. Journalists need to be far more skeptical when they discuss cannabis—both its risks and its potential benefits.
Marijuana is not medicine. Marijuana and THC-extract products—whether eaten or smoked—are intoxicants and mild pain relievers, like alcohol. They have serious side effects, like alcohol. Serious journalists don’t pretend alcohol is medicine. They need to stop extending that false courtesy to marijuana.
(Yes, CBD is medicine, in the traditional sense. It has won FDA approval to treat a medical condition. But CBD is not marijuana. It is a single chemical compound derived from marijuana. It has less to do with cannabis than morphine has to do with the poppy plant. Morphine effectively concentrates the natural ability of poppy flowers to produce pain relief and euphoria, while CBD has none of the psychoactive properties that cause people to use marijuana and THC recreationally.)
Further, the civil rights issues around marijuana legalization are far more complicated than the media or politicians would like them to be. Yes, marijuana arrests disproportionately fall on minorities, especially the black community.
But marijuana’s harms also disproportionately fall on the black community. Black people are more likely to develop cannabis use disorder. They are also more likely to develop schizophrenia—and much more likely to be perpetrators and victims of violence. Given marijuana’s connection with mental illness and violence, it is reasonable to wonder whether the drug is partly responsible for those differentials.
In general, the reporting around marijuana and legalization has been ridiculously lopsided. The media owes us all a more thoughtful understanding of the risks and benefits.
• • •
Time is running short.
Even as I wrote this book, the evidence that cannabis causes mental illness and violence is becoming stronger. New studies and new data have emerged. And yet even as I wrote this book, marijuana’s move toward legalization in the United States gained momentum. In a single week in June 2018, voters in Oklahoma approved medical marijuana, Charles Schumer, a US senator from New York, introduced federal decriminalization legislation, and Canada became the second country to legalize marijuana fully. (The first, Uruguay, began retail sales in the fall of 2017; in the first six months of 2018, murders in Uruguay rose 64 percent compared to the same period in 2017. Coincidence, no doubt.)
Eventually these two trends must collide. But how many people will become psychotic or violent before politicians and the advocacy community admit the risks of legalization? And full legalization will draw billions of dollars in new investment into cannabis businesses, making restrictions even more difficult.
When I told people I was writing this book, they inevitably asked whether I thought marijuana should be legal. Like Robin Murray, I usually dodged the question. Legalization appeared certain, and I simply wanted people to understand the risks, I said.
But the truth is: No. Of course, it shouldn’t.
The best reason to legalize marijuana is not a good one. It’s that alcohol is legal, and alcohol is responsible for significant violence and death. But alcohol is far more ingrained in American society than marijuana. Criminalizing it would be impossible, as Prohibition proved. Over half of Americans have had a drink in the last month.
Despite what its backers claim, marijuana is still a relatively marginal drug. Half of Americans have never used it. Eighty-five percent have not done so in the past year. As you’ve seen, its consumption is concentrated among a vocal minority of heavy users.
Alcohol is certainly more physically harmful than marijuana, but marijuana is more neurotoxic. Alcohol rarely causes psychosis except in late-stage drinkers. And the kind of violence that alcohol causes is very different—and, yes, less severe—than the violence that marijuana causes.
There are no victims, cops sometimes say. What they mean is that violence victims are rarely completely innocent. The person who winds up dead after a bar fight or a gang shooting might easily have been the killer.
But marijuana’s madness makes its victims exceptions. They are children, wives, parents, even strangers, people whose only crime was being near someone in the grip of psychosis. That risk—not racism—is the reason that societies have always been wary of marijuana. And the new high-THC products worsen it. Why on earth would we want to encourage people to use this drug?
The direct economic benefits of legalization also appear to be vastly overstated. In the first states to legalize, sales are already peaking. In May 2018, Colorado quietly hit a milestone that the cannabis industry didn’t publicize. For the first time, overall year-over-year retail sales fell. Counting medical and recreational dispensaries, marijuana sales were $122.9 million, compared to $123.5 million in May 2017. (Overall consumption probably is still rising slightly, but because of oversupply, prices are falling.)
Colorado’s retail market is about $1.5 billion, and the state collected about $250 million in taxes in 2017—both rounding errors compared to the state’s overall economy of $300 billion and budget of $29 billion. Considering that hospitalizing a patient with psychosis for a single ten-day inpatient stay costs more than $10,000—and that few of those patients have private insurance—it is possible that the costs of marijuana psychosis and violence alone already outweigh the taxes the industry pays in Colorado. (That comparison takes no account of any other costs associated with marijuana.)
Decriminalization is a reasonable compromise. People shouldn’t be arrested or sent to jail for possessing marijuana. If they’re dumb enough to smoke in public, the police should take their joints and ticket them. If they’re dumb enough to be caught smoking while they’re on parole, they should be sent back to prison. But if they want to use in the privacy of their own homes, so be it.
But legalization is very different, which is exactly why marijuana’s backers are pushing so hard for it. Legalization creates an entrenched business community that can promote its product. Legalization encourages investment and drives down the price of cannabis. In states that haven’t legalized, an ounce of pot usually costs in the range of $300—as much as six times the price in states like Oregon. (And as you’ve seen, the home cultivation allowed under legalization feeds a black market with even lower prices.)
Most of all, legalization signals that marijuana is not dangerous and encourages teen use. The states with the highest rates of youth marijuana use all allow legalized recreational sales or medical sales with very loose conditions.
The United States should not legalize cannabis nationally; it should move to discourage more states from legalizing, and it should consider pressuring those that have already done so to reverse course. Theoretically middle-ground alternatives to reduce the risk of legalized cannabis, such as regulating its THC content or imposing high taxes, won’t work in practice. They will simply lead to a black market in potent, untaxed marijuana.
• • •
But Robin Murray is right that the precise legal status of marijuana is less important than public understanding of the risks. Most people who smoke cigarettes don’t die of lung cancer, but we say that cigarettes cause cancer, full stop. We make sure anyone who smokes knows the risk. Most people who drink and drive don’t have accidents, but we highlight the cases of those who do. Most people who smoke marijuana will not develop psychosis or commit violence, but we need to make sure that everyone who smokes knows the reality of the connection.
Only adults—preferably over 25—should use cannabis. And they should use only if they are psychiatrically healthy. Instead, at the moment, cannabis advocates are encouraging the most dangerous type of use—long-term use of THC as an antidepressant or antianxiety drug, by people as young as 18, whose brains are still developing.
And so we are in the worst of all possible worlds. Marijuana is legal in some states, illegal in others, becoming steadily more potent, and sold without warnings everywhere. We have nearly ended youth cigarette smoking with pointed, well-funded advertising campaigns. Between 2002 and 2014, the rate of tobacco use among adolescents fell from 13 percent to under 5 percent. Teens are now more likely to use cannabis than cigarettes.
If we do nothing else, we need to commit to discouraging young people from using marijuana just as we do with tobacco. The personal and societal costs of psychosis are just too high.
Twenty years ago, the United States moved to allow or encourage wider use of two drugs: cannabis and opiates. In both cases, we ignored hundreds of years of warnings. We decided that we knew better, that we could outsmart the drug and somehow have its benefits without its costs.
We were wrong. Opiates are far riskier, of course, and the overdose deaths they cause more obvious, and so we have focused on those. But soon enough the mental illness and violence that marijuana use causes will be too widespread to ignore.
Writing this book was a depressing exercise, as you might imagine. Every day I read about marijuana, violence, and psychosis—and every day I read the cheery tales told by cannabis advocates. But when I got too down, I reminded myself that the situation now isn’t unlike the late 1970s, the last time that cannabis was so widely used in the United States.
Then, like now, many advocates believed that the United States was moving inevitably toward legalization. In the 1970s, more teenagers were using, so more parents could see marijuana’s negative effects firsthand—but, on the other hand, the drug was far less potent, so its neurotoxicity wasn’t so obvious. And in the late 1970s, once enough people experienced marijuana’s impacts up close, the tide shifted almost instantly.
Even now, despite the daily bombardment of pro-cannabis messages, hints that marijuana’s popularity may be peaking are emerging. Alongside the Colorado sales peak and the Oregon supply glut, sales in California in 2018 are falling short of industry forecasts. A drug that regularly causes paranoia and psychosis may be less appealing than its backers think.
And a non-governmental lobbying group is now fighting cannabis legalization nationally. In 2013, Kevin Sabet, a former advisor in the Office of National Drug Control Policy, founded Smart Approaches to Marijuana to advocate for policies to discourage use of the drug. The pro-legalization groups still dwarf it in size and influence, but SAM has grown to a $2 million annual budget—with no money coming from opioid, alcohol, or tobacco companies—and affiliates in almost every state.
Still, I am old enough to understand how difficult a task I have set myself with this book. If you are an average American, you believe both medical and recreational marijuana should be legal. I’m trying to change your mind. And changing someone’s mind is next to impossible. I mean anyone’s mind, of anything. People think what they think. So, this book all by itself may not do much.
But I hope at the least it will make you skeptical of the pro-marijuana arguments that advocates have sold you for twenty-five years. More, I hope it will open your eyes to the mental illness and violence that marijuana causes in your community, whether that community is Bellingham or Burlington, Five Points in Denver or Little Five Points in Atlanta, Park Slope or Pacific Heights. Nothing is more powerful than personal experience.
Open your eyes.
See the truth.
Tell your children.