New approach to curbing marijuana use among teens: ‘just say no’ gives way to ‘just smoke less’

By Naomi Martin

Zaire Richardson listed healthy alternatives to smoking marijuana at a Charlestown Coalition Youth Group gathering. Barry Chin/Globe Staff

CHARLESTOWN — In a church basement here one recent evening, two dozen teenagers sat in a circle, eating pizza and discussing how they view marijuana.

The teens, most of whom live in nearby public housing, agreed that cannabis could be addictive and expensive. But they also felt it helped them.

“I was using it to get myself up to go to school,” one girl said. Another added: “It helps me in social situations.”

A boy said pot eased his stress, but he didn’t like being dependent: “If you’re having a problem and you can’t get it, you’re all tight like, ‘Damn, I need my weed.’ ”

The adult leaders, from a local health nonprofit, nodded. Recognizing why teenagers use marijuana is the first step of their program to curb problematic pot use.

The program teaches students to try healthy stress relievers like exercise or meditation, before encouraging them to cut back on pot in a realistic way. But the approach stops short of one step: demanding they quit altogether.

A far cry from zero tolerance and “Just Say No,” the Charlestown program — funded by Massachusetts General Hospital’s center for community health improvement — is part of a growing effort around the state to help high schoolers make sound choices about cannabis in an era of marijuana legalization. The new initiatives tend to focus on treatment rather than on abstinence and punishment.

“Scare tactics don’t work — we’ve figured out a way to do something that works,” said Sarah Coughlin, director of the Charlestown Coalition, which runs the youth group in the church and a separate marijuana program for Charlestown High students caught stoned or with pot that lets them avoid suspension. Punishment misses the point, she said, that most teens she sees live in poverty, use marijuana to manage severe trauma and stress, and need healthy alternatives.

“No child is getting high every single day at 7 a.m. and going to school for no reason,” Coughlin added.

But how schools handle teenagers found with marijuana varies widely. At a time when educators largely agree that discipline alone doesn’t work, many schools lack the resources to deal with marijuana issues in any way besides suspensions, which are linked to higher dropout rates and the “school-to-prison pipeline.”

Sarah Coughlin, Director of the Charlestown Coalition Youth Group "Turn It Around", spoke at the group’s gathering. Barry Chin/Globe Staff

Boston Public Schools tries in-school suspensions first, but offers few treatment options unless a student receives an out-of-school suspension. At Brookline High School, students receive one-on-one counseling and are rarely suspended.

At Walpole High School, meanwhile, the principal suspends students for a few days and ensures their parents send them to therapy, though this year the school started a vaping-cessation course.

Massachusetts lawmakers, aiming to keep troubled students in class, enacted a discipline overhaul, effective in 2014. Since then, marijuana suspensions fell 20 percent, to 1,628 last year. Other states often arrest students and expel them.

More addictive products

High school students have long experimented with marijuana, but educators say they now contend with a dramatically different landscape.

Several schools have seen upticks in students with life-disrupting marijuana issues. Researchers say that change is likely linked to new high-potency pot products such as vapes and wax-like extracts called “dabs” that are odorless and popular in legal and illicit markets. 

Overall marijuana use among young people has held steady.

Medical specialists say the new products are more addictive and pose higher risks of harm to the developing brain, including on learning ability, cognitive functioning, and mental health. Vaping can also carry physical health risks; federal officials said a nationwide outbreak of deadly lung injuries this year was linked to an additive used mostly in illicit marijuana vapes.

 

“Even in the context of a flat level of overall use, the shift in the way that kids are using should make us all alarmed,” said Randi Schuster, a Harvard Medical School psychiatry professor. She found a 25-fold increase since 2015 in the portion of local pot-using high schoolers who primarily vaped. That mirrors nationwide trends.

Zaire Richardson listed healthy alternatives to smoking marijuana.Barry Chin/Globe Staff

For the first time, marijuana surpassed opiates in 2019 as the top drug among students struggling with addictions at William J. Ostiguy High School, a recovery school in Boston. Now, 38 percent have marijuana problems, compared to 18 percent three years ago.

“It is impacting their lives where they can’t function on a daily basis,” said Principal Roger Oser.

Many local educators blame legalization for the changes, noting parents and students increasingly see pot as harmless. However, teen marijuana vaping is up nationwide. And other studies show that youth pot use did not increase after legalization in Colorado or Washington.

Fatima Fontes (left) and Zaire Richardson attended the Charlestown Coalition Youth Group gathering.Barry Chin/Globe Staff

The Charlestown High program, which partners with the Gavin Foundation and uses a motivational-enhancement treatment developed by the US Substance Abuse and Mental Health Services Administration, has seen success since 2014 in reducing students’ pot use and school suspensions. Medical specialists praised the program, saying teenagers would benefit from reducing their usage, though abstinence would be best.

Zaire Richardson, 19, said without the program she likely would’ve dropped out. She used to get suspended and spent those days getting high.

 

In the program, she examined why she smoked — marijuana helped her sleep, enjoy school, and cope with her best friend’s death. 

She also realized the downsides of her habit — spending money she needed for college and hurting her brain’s ability to be naturally happy. She learned to substitute aromatherapy, exercise, and music.

Now graduated and working, she still smokes cannabis, but less.

“I wouldn’t have had the tools to figure out how to break the habit” without the program, she said. “I would’ve just been an angry girl that was high all the time.”

‘A huge need’

Other city schools would love such a program but lack the money, staff, or know-how. A charity-run substance abuse program at Boston Public Schools shuttered in 2018 due to a lack of funding.

Since then, Coughlin and other educators said at least 10 public high schools have reached out to her — and many to the recovery high School, too — for help handling marijuana issues.

“Schools are frustrated because they don’t know what to do with students — they don’t want to suspend them,” Coughlin said. “There’s a huge need. The problem is there’s not a whole lot of resources.”

The district said it prioritizes treatment and sends suspended students — 98 last year — to substance abuse programs.

 

Youth advocates say Boston Mayor Martin J. Walsh’s office of recovery services issued a comprehensive plan in 2018 that acknowledged critical needs, but it lacked sufficient financial backing. The office said it is implementing the multi-year plan, has trained educators on marijuana, and is improving interventions.

In theory, there should be money for programs from taxes on the state’s booming cannabis industry, which brought in nearly $400 million of sales its first year. Under state law, part of the 10.75-percent excise tax on recreational pot should fund youth substance programs.

This year, the Legislature gave nearly $84 million of those taxes to the Department of Public Health’s substance services bureau, but the budget does not require that it fund youth programs statewide.

DPH said it will support more youth interventions. Schools can apply for grants, a spokeswoman said, though none are available now.

Changing times, new approaches

While educators and addiction specialists believe abstinence from cannabis is ideal until the brain fully develops, typically around age 25, they see value in teens reducing the frequency, potency, or amount of use.

“If a student walked in and I said, ‘You should never smoke pot again,’ they might walk out the door,” said Mary Minott, a longtime substance abuse counselor at Brookline High.

Minott counsels students who decide they want help or are referred by an adult. Last year, she said, referrals doubled, with most needing help with vaping marijuana, nicotine, or both. She talks to teens about why they use — often college anxiety, stress, and partying — and sets goals. Students are rarely suspended for pot, she said, unless they’re caught selling it.

At Walpole High, principal Stephen Imbusch was alarmed by a rise in vaping last year, so he sent his school nurse to learn how to run a cessation program. This year, he offered all students the chance to enroll, promising they wouldn’t get in trouble. A dozen signed up.

The school still suspends students for marijuana but sets a hearing within three days to craft a treatment plan, usually involving a private therapist, and now, the cessation course.

“Discipline on its own wasn’t really working,” Imbusch said. “I think more and more schools are going to be doing this kind of thing.”

At the church in Charlestown, the teenagers listed healthy alternatives to cannabis they pledged to try: sports, reading, sleeping, getting lost in nature.

“I’m trying to figure out how can I make myself happy again without using a drug,” Richardson said. “In the next five years, I don’t see myself smoking.”

Recent study reveals adverse effects of smoking marijuana while pregnant

By Mark Hernandez

Warnings against drinking alcohol and smoking cigarettes while pregnant are everywhere, but scientists — including some from UNLV — are just catching up on the consequences of a prospective mother using marijuana.

In a study published this fall in The Journal of Maternal-Fetal and Neonatal Medicine, researchers reviewed the sonogram data of 450 pregnant women who reported smoking marijuana daily. The study shows a link between marijuana use while pregnant and delayed fetal growth, which in extreme cases can lead to a stillbirth.

“Recent data from JAMA (The Journal of the American Medical Association) indicates that marijuana use in pregnancy has doubled over the last 15 years and what’s more alarming is that 70 percent of women believe there is minimal or no harm from using marijuana in pregnancy,” Dr. Bobby Brar of the UNLV School of Medicine, one of the two lead authors of the study, said in a press release.

“Our findings contribute to the growing body of evidence that fetal marijuana exposure may not be as safe as people think.”

A woman’s daily use of marijuana while pregnant was shown to cause multiple health problems for her infant, such as an increased risk of low birth weight, low resistance to infections, and decreased oxygen levels.

One of the key findings of the study found that there was an increase in placental vascular resistance in the second and third trimesters — in other words, the flow of oxygen through the placenta is disrupted and leads to delayed growth.

“Anecdotally speaking, many of my patients tell me that they don’t think that there’s anything wrong with smoking marijuana in pregnancy and they’re not aware of any risks that are present to the fetus,” said Brar in an interview with The Nevada Independent. 

 “There’s been a prior study that shows that 70 percent of women believed that there’s either minimal or no harm from using marijuana in pregnancy.”

One reason there is little to no information on the risks of marijuana during pregnancy is the fact that it is illegal on a federal level. Many types of studies use federal funds and grants to conduct research and that funding is not available when you work with an illegal substance.

“I would advise that all pregnant patients abstain from using any amount of marijuana in pregnancy,” Brar said. “Our recommendation is always that there is no known safe amount of alcohol exposure in pregnancy and I tend to have that same approach when it comes to cigarette smoke and now when it comes to marijuana, the only difference is that we’re still learning about what the extent of that marijuana might be.”

According to the report, an estimated 16 percent of pregnant women engage in daily marijuana use.

“I do think that given how much [is] sort of unknown with regards to marijuana use on long term health, specifically in our field, ‘house of the fetus,’ I think that this is an area that we’re going to see more and more research in,” Brar said. “I think, and I hope over the next 10 to 20 years that we’re able to fully elucidate the effect of marijuana, not only on the fetus in utero but also at five to 10 years of age.”

The study was a retrospective cohort study where self-identified daily marijuana users who were pregnant were compared to control subjects. The study focused on comparing maternal demographics, fetal biometry, and umbilical artery dopplers, which measure the blood flow through the umbilical cord.

With decades of evidence from the effects of smoking tobacco while pregnant, the Center for Disease Control and Prevention (CDC) warns of health risks such as birth defects, preterm birth, and an increased risk of sudden infant death syndrome (SIDS) if a mother smokes. There have been many campaigns to educate pregnant women about the dangers of tobacco, including warnings on cigarette cartons and helplines for quitting smoking.

Just as with cigarettes, alcohol use while pregnant has also been widely studied and found to be dangerous for infants and mothers alike. Warnings on alcohol containers and in restaurants inform women about the dangers of drinking while pregnant.

With recreational marijuana legal in 11 states and medical marijuana legal in 33, more research into the effects of cannabis is expected.

And awareness campaigns are already underway: In Nevada and California, there are billboards along roadsides with the warning “Just because it is legal doesn’t mean it’s safe.”

What to watch for in the cannabis industry in 2020

Jenni Avins

 

 

 

By Jenni Avins

It’s been a brutal year for weed. The six largest publicly traded cannabis companies lost a collective $25 billion in market value since late March—a bloodletting Kevin Murphy, chairman and CEO of Acreage Holdings, compared to “2008 for the cannabis industry.”

The Marijuana Index, which tracks the stocks of the 45 leading North American cannabis stocks plummeted 63% percent after April 1, as investors fled a sector rocked by new regulations slowing rollouts in mega-markets such as California and Canada.

“There was a bit of a shock to the most of the industry,” says Bethany Gomez, director of research at the Brightfield Group, a Chicago-based cannabis market research firm.

“The investor’s honeymoon is over.”

“The investor’s honeymoon is over,” Gomez says. Now, investors are treating cannabis companies like any other business, looking for solid fundamentals, high-quality products, and—oh yeah—profitability. “People still buy the dream. They still want to buy into the industry because they see longer term potential. But ‘one day maybe’ isn’t good enough for investors anymore.” 

Troy Dayton, CEO of the Arcview Group, a cannabis investment and research firm in San Francisco, agrees.

“We saw a big run-up, and we also saw a huge market correction,” Dayton says.  And because stock prices took such a dive, Dayton says potential investors see value opportunities now. “A lot of investors were staying out of this market because they felt like it was in the middle of a hype cycle,” he says. “People that have dry powder to invest in the [private cannabis] sector are really excited about deploying it right now.”

Canadian cannabis 2.0

Many of the cannabis industry’s titans are based in Canada, where they enjoy nation-wide legalization and access to US investors.

Unlike US cannabis companies, they’re not breaking US federal laws, and so can list publicly on US stock markets. Deloitte projects Canada’s legal cannabis sales in 2019 could reach up to $4 billion—and the market is about to get a big boost as new products come online. In Canada’s first year of legal cannabis, sales were essentially limited to cannabis plants, its flower, and oils. Now, Canada’s licensed producers will also be able to sell edibles, beverages, vapes, and topicals, such as lotions and balms. Canada opened up applications for these products in October with 60-day notice period, so the first products are just hitting shelves now.

The new products “will completely change the landscape of the market in Canada, and really push it a lot closer to a consumer-packaged goods model,” says Gomez, emphasizing that brands will be better able to differentiate their identities and products in this more diverse marketplace. “There will be a ton of new products coming to market that have been years in the making.”

Leading the charge should be Canopy, the behemoth Ontario-based cannabis producer which received a $4 billion investment from the booze giant Constellation Brands—parent of Corona beer, Modelo lager, and Robert Mondavi wines, among other brands—in 2018 in exchange for a 38% stake in the company. (Former Canopy CEO Bruce Linton blamed his ousting in August on Constellation’s influence.)

“If you have billions of dollars in R&D and a partnership with one of the largest alcohol manufacturers in the world,” says Gomez, of Canopy “you should be able to develop a pretty fantastic cannabis-infused drink.”

Other beverage companies, such as AB InBev and Molson Coors Canada, have entered into partnerships with Canadian cannabis companies (Tilray and Hexo, respectively), but as the largest among them, Canopy is the bellwether—and an indicator of the edge that these partnerships can give a cannabis company.

US cannabis policy in 2020

Stateside, the US continues its messy, uneven, and incremental march toward cannabis legalization.

At the federal level, the Secure and Fair Enforcement Banking, or SAFE, Act and the Marijuana Opportunity Reinvestment and Expungement, or MORE, Act are making their way through the House and Senate.

The SAFE Act, which passed a House vote in September, would allow cannabis companies to access banking and financial services they currently cannot due to federal prohibition. “That’s a real lifeline for the industry,” says Gomez, pointing out that new cannabis companies would gain access to business loans, rather than having to dole out equity in exchange for private investment. Dayton points out that while the impeachment process has slowed progress, it has also given lobbyists more time to win over potential support from Senate republicans.

The MORE Act would decriminalize the plant, and offer an avenue for people charged with or convicted of some cannabis-related crimes to expunge their records and avoid further penalties—but it stands little chance in a GOP-controlled Senate.

Of course, if either piece of legislation got past Senate Majority Leader Mitch McConnell—who opposes legalization—they would have to also get the signature of president Donald Trump. Trump has opposed legalization legislation in the past but in an election year, that may change.

In lieu of legalization or a more cohesive federal framework,  states continue to take matters into their own hands.

States legalizing cannabis

Come January 1, Illinois—the sixth most populous US state—will follow Michigan to become the 12th state where recreational cannabis can legally sold, in addition to the 33 states where its medical use is legal.

Illinois is also significant because it is the first state to legalize weed through its legislature, rather than ballot measure. Arcview’s Dayton sees this as an indication of real political progress on the issue. A recent Pew Survey found that fewer than one in 10 Americans support keeping cannabis illegal.

“It’s almost like cannabis may be the one issue in America that’s bringing people together,” says Dayton, adding that Major League Baseball’s decision to treat cannabis use by its players more like alcohol than an illegal drug could spark similar changes in the National Football League. “What’s more American than baseball?” he asks. “And nobody was upset about that!”

In 2020, keep an eye on the east coast too. In the New York state legislature lawmakers promised to push for legal recreational use in 2020, after legalization efforts fell apart over disagreements about regulation policy in June. After similar struggles to craft policies that accounted for decades of racially disproportionate drug policing, New Jersey will put the question of legalization to voters in November 2020. The governors of those two states convened with those of Rhode Island, Connecticut, and Pennsylvania in October, in an effort to come up with coherent and cohesive policies on taxing, social equity, public safety, and regulation. The meeting indicates a serious intention to move forward, but also hints these leaders won’t be in favor of rash or sudden moves.

“Once there’s consensus that they want to do something, that’s often when the fighting begins,” says Dayton.

Notable changes to weed’s legal status may also be afoot in New Mexico, Vermont, Arizona, Florida, and Montana, all states where legalization is being advanced in the legislature or by ballot measure.

Speaking of 2020

Oh yeah! A presidential election is planned. What happens there is anyone’s guess, but here’s where some of the current front-running dems stand. Senators Elizabeth Warren and Bernie Sanders are in favor of legalization and co-sponsors of legislation of the Marijuana Justice Act, a bill that fellow senator and 2020 candidate Cory Booker introduced to end cannabis prohibition, expunge criminal records, and reinvest in communities harmed by the war on drugs.

Mayor Pete Buttigieg is also for cannabis legalization and has outlined intentions to reduce drug sentencing, eliminate mandatory minimums, expunge prior cannabis convictions, and develop entrepreneurship programs for people affected by cannabis convictions.

Former vice-president Joe Biden is the odd man out here. In November, he told the audience at a town hall event that he was wary of cannabis, which he said may be a “gateway drug.” Instead of legalizing, Biden advocates reclassifying the plant’s status as a controlled substance to schedule II, opening the door for more research. He says he is in favor of decriminalization, but it’s worth noting that other schedule II drugs include cocaine and methamphetamine.

CBD and the FDA 

Some fun facts: A recent Gallup Poll found that one in seven Americans say they use cannabidiol, also known as CBD, and according to the Grocery Manufacturers Association, three of four Americans believe the Food & Drug Administration (FDA) is regulating CBD. 

Surprise: it’s not!

This time last year, after the Farm Bill effectively removed hemp (which is just cannabis containing less than 0.3% THC) and its derivatives including CBD from schedule I—where the Drug Enforcement Administration (DEA) classified it as having “no currently accepted medical use and a high potential for abuse.” The FDA has continued to emphasize the agency has yet to evaluate or regulate CBD products aside from a single approved drug, Epidiolex, to treat epilepsy in children. The FDA recently made an announcement about potential health risks of CBD and held a public hearing to gather information about it in May. It seems a regulatory framework should be imminent, but then, that’s what we thought a year ago. Until then, all those CBD tinctures, topicals, and treats are unregulated, so buyer beware.

Cannabis science in 2020: the next CBD

One immediate effect of the Farm Bill, however, was that it cleared the way for research into hemp-derived CBD and the countless symptoms we are trying to treat with it.

Ziva Cooper, research director of the Cannabis Research Initiative at the University of California Los Angeles, says because of the “exploding interest,” she expects to see more “more rigorous, double-blind, placebo-controlled studies” of CBD for different diseases and symptoms in 2020. And that’s just the beginning.

CBD is just one of hundreds of naturally occurring chemicals in the cannabis plant, and the US National Institutes of Health (NIH) announced a series of grants in September to support the research of other lesser-known cannabis-borne compounds for treating symptoms such as arthritic pain and inflammation. Already, marketers and the media are talking about the “next CBD,” and these researchers may help to prove their efficacy.

“Everyone wants to know what’s coming down the pike,” says Cooper, rattling off other cannabinoids: “CBN, CBC, THCV. Some of that research has been percolating for the last decade or so, but it’s been very minimal. But now with this more public attention to it, I think that research is going to really blossom.”

Cooper also predicts an intensified focus on risk and safety, following the rash of vape-related respiratory illness in 2019, and more research on the effects of cannabis on specific demographics, whether growing teens, aging seniors, or pregnant women.

For her own part, Cooper has been focused on how cannabis could relate to another US health crisis—the opioid epidemic—and how chemicals from the plant might help patients reduce reliance on opioids when it comes to pain relief.

“Looking at cannabinoids as a therapeutic alternative to opioids is really important,” says Cooper, citing a 2019 study that showed promise for using CBD to break the cycle of heroin addiction. “We’ll see a lot of that in 2020.”

Cannabis-related psychosis, addiction, ER visits: For young users, marijuana can be a dangerous game

by Rita Giordano

Not long ago when Joseph Garbely, chief medical officer for the Caron Foundation, reviewed younger patients starting drug or alcohol treatment on his unit, he usually saw people shaking, sick, and seizing from alcohol or opioid withdrawal. Marijuana was seldom what put them in those medical beds.

That has changed.

“A few years ago, it was rare to see a young person enter Caron with marijuana-induced psychosis,” said Garbely. “Now we see it on a regular basis. Older teens and young adults — approximately ages 18 to 26 — are the most impacted. We see a significant misperception about the safety and efficacy of marijuana among our teen and young adult patient population.”

Marijuana, legal for medical uses in well over half the states in the country and as a recreational substance in ever more states, is generating increasing concern as a dependency-causing drug capable of serious impairment and harm, particularly among its youngest users. New Jersey voters will get to decide in 2020 whether to legalize marijuana for recreational use for people age 21 and over.

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While it was once doubted as an addictive substance, treatment professionals now say they are seeing more adolescents and young adults with cannabis use disorder. Often starting in their early teens, many graduate to daily use.

“The majority of cases we see of substance use disorder are marijuana,” said Ned Campbell, medical director of Rehab After School, an intensive out-patient program for adolescents in southeastern Pennsylvania, including the Philadelphia area.

In-patient admissions have increased as well.

At Caron, patients who were admitted with a primary diagnosis of cannabis use disorder increased over 22% from 2014 to 2019. In those five years, people admitted to treatment for marijuana addiction rose from over 27% of Caron’s total admissions to nearly 40%.

 

Independence Blue Cross, the region’s largest health insurer, has seen claims for cannabis use disorder treatment rise substantially.

Between 2012 and 2018, there was an 180% increase in marijuana treatment claims. That included a 100% claim rise for patients ages 19 to 25. Claims for adolescents requiring treatment went up 25% during the same period.

Terri L. Randall, medical director of Children’s Hospital of Philadelphia’s Substance Use Disorder Clinic, said it has become more common for young patients to experience bad reactions like extreme anxiety and even detachment from reality from cannabis use — and continue using.

“The fact that kids continue to use, even despite an adverse experience or unpleasant experience with marijuana, is really concerning to me,” Randall said. “Not only are they having difficult consequences of their use, but they also are finding themselves using more and are unable to control their use. That really is at the heart of the diagnosis of addiction.”

The extremes aren’t only showing up in treatment offices.

“We’re certainly seeing a lot more emergency department visits due to marijuana,” said Kevin Osterhoudt, medical director of Children’s Hospital of Philadelphia’s poison control center. ”We’re seeing more people with paranoid delusions. We’re seeing a lot more people with signs of acute psychosis.”

A more potent drug

Today’s marijuana is not the reefer of the Woodstock generation or even the weed of the Grunge era. Over the decades, the amount of THC — the psychoactive compound in cannabis — has soared.

“The nature of what’s being consumed has changed dramatically,” said Itai Danovitch, an American Society of Addiction Medicine fellow and psychiatry chairman at Cedars-Sinai Medical Center in Los Angeles.

In the 1990s, THC concentrations were still in the single digits. Now, the THC percentage in a marijuana cigarette can range from the teens to as high 30% with some strains.

“And then when people use extractions — oils and waxes — they can easily get 80% to 90%,” Danovitch said.

Some research has suggested that for new or infrequent users, vaping cannabis produces stronger effects than smoking. In this year’s mysterious rash of vaping-related lung injuries — which has accounted for 52 confirmed deaths in 26 states, according to the Centers for Disease Control and Prevention — many involved vaping THC products. While the CDC has identified vitamin E acetate as “a chemical of concern” in these cases, it’s just one of many substances present in vaping oils and liquids. The CDC has said the mystery of these illnesses is far from solved and has recommended people not use any THC-containing e-cigarette products.

Regular marijuana use may not have the crash-and-burn effect of other drugs, but it can limit a young person’s social, academic and personal development.

“For many of them, there is a grieving process,” said Jason Whitney, program coordinator of the Penn State Collegiate Recovery Community. “They’re so much behind where they want to be.”

Jason Whitney, program coordinator of the Penn State Collegiate Recovery Community, with Marguerite, a member of the community, on Penn State's University Park campus.

Impact on developing brains

Especially concerning to medical and treatment providers is what today’s increasingly potent strains may be doing to young, developing brains.

The National Institute on Drug Abuse cites research that suggests between 9% and 30% of people who use marijuana may develop use disorder, and the risk increases the younger someone starts using. Individuals who begin using cannabis before age 18 are four to seven times more likely than adults to develop marijuana use disorder. And the likelihood is that more young people will be impacted; two studies published earlier this month in the Journal of the American Medical Association found more teenagers are vaping cannabis than ever before.

There’s also evidence that people who start using cannabis as teenagers risk suffering impaired memory, attention and cognitive function that may not improve with time.

A long-term study by an international research team that included Duke University found that people who began regular, persistent marijuana use as teenagers that continued into adulthood showed an average decline in IQ of eight points.

Episodes of acute psychosis seem to go away if the user stays off the drug. But adolescents who use especially high potency marijuana may be at increased risk for developing a chronic psychotic disorder such as schizophrenia, particularly if they had a genetic predisposition. A recent article in the journal The Lancet said at least 12% of new cases of psychosis could be eliminated if high potency marijuana wasn’t available.

“They found both the frequency of use and potency was associated with increased incidents of psychotic disorders,” said ASAM’s Danovitch.

Unlike other drugs, there is no record of death by cannabis overdose.

“The toxicity is certainly less. And the severity of the substance use disorder tends to be less severe than what you can do to yourself with alcohol and heroin,” Danovitch said. “However, that doesn’t mean it’s safe.”

A voice of recovery

Marguerite, 21, a Pennsylvania State University psychology major and member of the campus recovery community, learned the hard way that marijuana is not the innocuous substance she thought.

“I definitely think it’s an addictive drug. I don’t think it’s harmless,” said Marguerite, who asked her full name not be used because of the stigma associated with marijuana use disorder. “I absolutely got addicted to it mentally and physically, and I couldn’t go a day without smoking.”

She started smoking marijuana early in high school. The initial relaxed high it gave her turned to anxiety and paranoia, but she wanted the good feeling back, so she stuck with it. By her junior year, she was using cannabis before and after school, before dinner, after dinner, to do homework. She said she needed marijuana just to “feel normal.”

“It was like something I needed to do really anything. I probably smoked at least six times a day,” she said. “And if I wasn’t smoking it, I was eating it. I tried all the different ways you could do it. I got an oil pen so I could get more THC.”

When she didn’t have enough of her own money for the drug, she’d steal from her parents. “I’ve stolen jewelry from my mom and pawned it.”

Eventually she started trying other drugs, too, including LSD.

Marguerite believes she was in psychosis not long after graduating high school. She ended up hospitalized a few days, diagnosed with an anxiety disorder. The hospital sent her home with Xanax and told her to go to substance use outpatient treatment. She did briefly, but went back to marijuana and alcohol. She continued to use until she ran out of money. Then her family sent her to Caron in 2016.

“I was still in a psychosis when I went there,” Marguerite said.

It took about a month and a half before her intense cravings went away. She was in treatment with Caron about three months. For at least a year, she had trouble with her short-term memory. She thinks it has for the most part returned.

After Caron, Marguerite attended Marymount University in Virginia before transferring to Penn State in 2018 because of its recovery community. She’s in ROAR House, Residence of Addiction Recovery. She goes to 12 step meetings. She enjoys the support.

“I’m a lot happier now,” she said, ”that I’m able to function as a normal human being.”

Did Newborn Die From Mom's Marijuana Use?

Diagnosis of exclusion leads to answer of... probably

by Kate Kneisel,

An 11-day-old white female neonate is brought to hospital shortly after being found unresponsive at home. Clinicians pronounce her dead. She is said to have been found face-up and on her back – thus there is no suspicion that the baby died of suffocation due to unsafe sleep position or conditions.

The infant was born at 36.5 weeks to a 20-year-old and seemed healthy at the time of delivery. Hospital clinicians order a complete autopsy and full investigation. The mother is thought to have a history of marijuana use.

Macroscopic examination notes extensive hemorrhage of both adrenals, petechial hemorrhage of the entire liver (Figure 1), and focal hemorrhage of the thymus. The infant has no X-ray evidence of any bone fractures or other trauma.

Newborn screening of inborn errors of metabolism, and post-mortem neo-nate blood toxicology test results are both negative.

The newborn drug screen of umbilical cord homogenate reveals 528 pg/g carboxy-THC (screen cutoff at 50 pg/g). Microscopic examination shows extensive necrosis and hemorrhage of the liver and adrenals, and focal hemorrhage of the thymus.

Case Follow-up
There is nothing unusual found on microscopic examination of the other major organs and no evidence of congenital disease or infection. The cause of death is extensive necrosis and hemorrhage of the liver and adrenals; the cause is considered to be marijuana toxicity, based on the mother's blood marijuana concentration and pattern of marijuana use prior to and during pregnancy (currently confidential due to legal circumstances).

Discussion
Clinicians reporting this case of fatal marijuana toxicity in a neonate write that the growing use of marijuana and the near impossibility of conducting prospective case control studies during pregnancy make retrospective case reports such as this one vital to help clinicians identify acute marijuana toxicity in newborn health or death.

They add that the last 5 years have seen increasing hospital use of the newborn drug screen of umbilical cord homogenate.

Marijuana is one of the most widely available and used drugs across the world; its use at least once over a lifetime is reported by up to 4% of the global adult population, and by 11% of adults in the U.S.

As well, marijuana and its derivatives are increasingly used for therapeutic purposes, and have been evaluated for conditions including pain, anorexia, side effects of chemotherapy, multiple sclerosis, and muscle spasms.

Recently, case authors note, the therapeutic and health effects of cannabis and cannabinoids as studied in more than 24,000 articles and 10,700 abstracts were reviewed by a National Academies of Sciences, Engineering, and Medicine committee. It graded the support for therapeutic effects as follows:

Conclusive evidence or substantial effect:

• Chronic pain
• Chemotherapy-induced nausea and vomiting
• Multiple sclerosis-related spasticity

Moderate evidence:

• Sleep disturbance

Limited evidence:

• Appetite and weight gain
• Post-traumatic stress disorder
• Anxiety
• Tourette syndrome

Insufficient evidence:

• Cancer
• Epilepsy
• Neurodegenerative disorders
• Irritable bowel syndrome

While marijuana use has been implicated as an indirect cause of death due to motor-vehicle accidents, falls or other personal injuries, or suicidal behavior, this may be the first reported death directly caused by acute marijuana toxicity, reporting clinicians suggest.

There is no increased risk of human death caused by acute marijuana toxicity even for high levels of marijuana use compared to non-users, case authors write, and inconclusive evidence of its chronic effect on mental health, lung cancer, cardiorespiratory diseases, or cognitive impairment.

Given the growing popularity of marijuana in the U.S., authors see an urgent need to better understand the potential repercussions of marijuana use on maternal and fetal health during pregnancy.

With estimated rates of marijuana use during pregnancy from 2% to 11% of gravidae, current data are limited by self-reporting data collection, recall bias, and confounding risk factors. Research efforts are now focusing on identifying how marijuana may influence pregnancy outcomes.

Furthermore, only 6.7% of women with a positive umbilical cord homogenate for marijuana use actually reported using marijuana, according to a recent epidemiology study.

Many epidemiologic studies of maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity return inconclusive results, in part due to difficulty in separating indirect maternal physical or mental effects on the fetus from direct toxicity of marijuana on the fetus or newborn neonate.

Thus, no explanations have been proposed regarding a mechanism of acute marijuana toxicity on fetal or neonatal death.

Authors note that the current social and cultural environment makes it almost impossible to conduct prospective case control studies on adverse effects of marijuana use on maternal and fetal health during pregnancy, and even animal experiments on this topic are difficult.

Data most relevant to human physiology is from a 1987 study on fetal disposition of marijuana during late pregnancy in the rhesus monkey. This research found that marijuana rapidly crosses the placenta and enters the fetus, where it is concentrated in the liver/bile, adrenals, and thymus, as compared to the placenta, plasma, spleen, testes, lungs, brain, and kidneys.

Diagnosis of exclusion
The cause of death in this case was a "diagnosis of exclusion." The neonate was unremarkable at delivery, and no congenital, metabolic, or infectious disease or trauma were identified. Positive findings include necrosis and hemorrhage of the liver and adrenals, as well as focal hemorrhage of the thymus.

Case authors write that maternal high-dose marijuana use in late pregnancy was evident based on the presence of marijuana in the umbilical cord. As well, the observed necrosis and hemorrhage of the liver and adrenals are consistent with animal data that show the concentration of marijuana in the liver/bile and adrenals after rapidly crossing the placenta, they write.

In contrast, the thymus consists of mostly lymphoid tissues, which may resist necrosis and only show hemorrhage even with high-dose marijuana distribution.

This case is unique in that other possible causes of death can be eliminated – since there was no confounding evidence of substances other than marijuana in the umbilical cord, or congenital, metabolic, or infectious disease.

Investigation of an in utero fetal demise could be confounded by potential maternal or placental factors, even with positive findings of marijuana in the umbilical cord, authors observe. In most autopsies of still-born fetuses, the internal organs are autolyzed, and it is difficult for pathologists to identify necrosis in the liver and adrenals.

Clinicians reporting this case conclude that forensic pathologists have professional obligation to report these cases in peer-reviewed publications, to inform the public for their "informed decisions" about marijuana use.

Marijuana use may severely effect your heart, study reveals

The researchers found that people who used marijuana regularly had an enlarged left ventricle along with early signs of impaired heart function 

By Samhati Bhattacharjya

A new study, published in the journal JACC Cardiovascular Imaging, has revealed that marijuana use may damage the structure of the heart. This comes just as when marijuana was about to get legalised in several places for being deemed harmless.

A team of researchers from the United Kingdom analysed the heart scans of about 3,407 people, who never had any heart disease, with an average age of 62 years collected as part of the UK Biobank study.

Early signs of impaired heart function

Pixabay

Out of 3,407 people, 47 people were regular marijuana users, while 105 had regularly used cannabis five or more years before. The rest of them had never used marijuana.

The researchers found that people who used marijuana regularly had an enlarged left ventricle along with early signs of impaired heart function. Dr Mohammed Khanji, Senior Clinical Lecturer at Queen Mary, said, "We believe this is the first study to systematically report changes in heart structure and function associated with recreational cannabis using cardiac MRI, which is a very sensitive imaging tool and the current reference standard for assessing cardiac chambers."

"The World Health Organization has warned about the potentially harmful health effects of non-medical cannabis use and called for more research specifically around the cardiac impact," the lead author of the study added.

Limitations of the study

However, the researchers said that there are several limitations to this study. They stated 96 percent of the research participants were white and they themselves had reported about their cannabis habits. In addition, the total number of marijuana users was quite small and thus the study could detect only a few subtle changes.

But, the researchers believe that this study will play an important role for further studies involving the drug, especially considering that marijuana may soon be legalized in several places.

Dr Khanji said, "We urgently need systematic research to identify the long-term implications of regular consumption of cannabis on the heart and blood vessels. This would allow health professionals and policymakers to improve advice to patients and the wider public." 

Will New York legalize recreational marijuana in 2020? These obstacles stand in the way

David Robinson

 

A renewed push for recreational marijuana in New York next year faces threats spanning from deadly vaping-related illnesses to entrenched opposition led by doctors, educators and law enforcement.

Amid thousands of lung injuries tied to marijuana vaping and mounting state budget gaps, lawmakers and advocates are bracing for a political brawl over legalizing cannabis use for adults in 2020, after a similar bid failed earlier this year.

Some doctors, parents and anti-marijuana groups suggested the outbreak of vaping-related illnesses this year underscored cannabis risks, adding to their long-standing concerns about legal weed fueling drugged driving and youth marijuana use.

The Coalition for Medical Marijuana of New Jersey host a rally in front of the New Jersey statehouse to bring attention to marijuana legalization on the unofficial 420 holiday. Vyacheslav Rabinovitch of New Brunswick smokes in front of the statehouse.

Doug Hood 

 

“What they’re doing is inviting a great social experiment at a time when it’s a risk to public health,” said Dr. Arthur Fougner, president of the Medical Society of the State of New York. “On balance the risks outweigh the good.”

Marijuana supporters, however, noted many of the lung illnesses have been linked to black-market vaping products and asserted it is a reason to create a tightly regulated legal cannabis marketplace.

“We really want to make sure we’re putting illegal markets out of business,” said state Sen. Liz Krueger, D-Manhattan, who has championed New York’s legal weed bill.

“We don’t want people buying products in back alleys before they’re of age; or if they don’t know what is in it, or if it’s brought in by dangerous cartels.”

Further, the upcoming political fight over a $6 billion state budget gap threatens to overshadow many other issues during the next Legislature session that begins in January.

“It depends on how much of a priority this (marijuana bill) is for leadership in both houses of the Legislature and how much of a priority is this of the governor,” said state Sen. Peter Harckham, D-South Salem, one of the key lawmakers who derailed legal weed this year.

“The budget looks like it is going to be very ugly.”

Growing support for marijuana in NY

Central to New York’s pot legalization reboot is mounting public support as two-thirds of Americans now say the use of marijuana should be legal, according to a new Pew Research Center survey.

The share of U.S. adults who oppose legalization has fallen from 52% in 2010 to 32% today, a trend closely mirrored in New York, where opposition stood at 36% according to a recent Siena College poll.

A small majority of New Yorkers, 52%, agree that marijuana is basically the same as alcohol and should be treated the same, the poll found.

New York legalized medical marijuana in 2014, and the program now has about 111,000 patients and 2,600 prescribers.

Meanwhile, New York this month expanded its oversight over the legal hemp industry, which has been booming because of the growth in sales of products with CBD oil.

A coalition of 40 pro-marijuana groups has also urged Gov. Andrew Cuomo to hold new listening sessions to better inform the legalization debate, citing potential repercussions in communities hit hardest by racially biased enforcement of marijuana laws.

The proposed meeting sites include cities with the highest numbers of marijuana arrests in upstate New York, such as Rochester and Syracuse, as well as the lower Hudson Valley, such as Mount Vernon, White Plains and Yonkers, according to a Dec. 2 letter to Cuomo.

“Given New York’s history of draconian enforcement, we must be bold and innovative in creating justice and equity within marijuana legalization,” the letter stated.

The coalition includes state and national groups focused on civil rights, legal aid, agriculture and legal marijuana policy.
More: What to know about marijuana arrests, racial bias

Marijuana decriminalization in NY already approved

Legal weed opponents, however, contend New York addressed criminal justice failures when lawmakers in June decriminalized possession of small amounts of pot and expunged prior convictions.

“Once that decriminalization, which was the right thing to do, was off the table, now that leaves you with all the harmful effects of marijuana in our schools and on our children,” said Kyle Belokopitsky, executive director of the state Parent Teacher Association.

Yet some marijuana supporters asserted decriminalization didn't go far enough to address societal damage of racial bias. Krueger, for instance, said portions of legal weed tax revenue should “go in various ways back to the communities that were done the most harm by having a prohibition model of marijuana enforcement that resulted in large numbers of black and brown people getting criminal records.”

Still, some marijuana opponents suggested approving legal weed might be about resolving state budget problems through the additional revenue it would bring in, rather than improving upon decriminalization. “The real driving force for this in New York is we’re looking at this sizable budget deficit, so they’re scrambling around looking for revenue wherever they can find it,” Fougner said.

What happens after Northeast states' weed summit? 

In recent months, Cuomo has pushed a regional approach to legalizing recreational marijuana in New York, New Jersey and Connecticut.

Cuomo said he supports legalizing marijuana, but critics said he didn't do enough to push for the measure's passage during the last legislative session that ended last June.

The regional effort, in many ways, is aimed at stopping people in the three states from traveling to legal weed states like Massachusetts to buy pot. It also could influence how the states try to tax and regulate marijuana.

Connecticut Gov. Ned Lamont, left, speaks as New York Gov. Andrew Cuomo listens during a press conference, Wednesday, Sept. 25, 2019, in Hartford, Conn. The two governors announced a strategic partnership between Connecticut and New York to develop a uniform regional approach to policies on e-cigarettes and legal cannabis.

Susan Haigh, AP 

 

Cuomo broadly outlined the plan during a summit this fall focused on cannabis reforms and cracking down on the dangers of vaping.

New Jersey, however, has already seen its latest push to pass recreational marijuana legislation falter. Instead, legal weed is expected to head to Jersey voters in a pivotal ballot question in the 2020 election.

If voters approve the measure, New Jersey would become the 12th state to legalize marijuana for adult use. All but two of the states — Vermont and Illinois — have legalized weed via ballot measures, which illustrated the complications of pursuing legal weed legislation for several states at once.

“You might as well try to get the federal government to do it, and the punchline is that that’s the reason that the states are going at it alone,” Krueger said, adding she supports interstate collaboration on establishing general cannabis rules and standards. “

We’re not going to build walls between each other’s states and either we’re going to confirm this as people are going to be crossing borders to buy legal marijuana, or you’re going to create a program where it keeps it in state,” she said.

More: New York eyes regional plan for recreational marijuana, vaping with New Jersey and Connecticut

How would marijuana tax revenue be spent in NY?

Kephra Stone, of New York City, standing in line at the NETA marijuana dispensary in Northampton, MA, said New York was losing out on state revenue to Massachusetts.

David McKay Wilson/The Journal News 

 

In the midst of all the weed diplomacy, politically charged battles over marijuana tax revenue remain major factors in New York.

Disagreements over divvying up marijuana tax dollars proved key to the failed legal weed bill this year and could endanger the renewed effort in 2020.

To understand the stakes, consider state officials estimated collecting about $300 million in legal marijuana revenue per year when fully implemented.

Some lawmakers have pushed for using specific percentages of marijuana money for various issues, such as education, addiction treatment and investments in communities hit hardest by biased-pot policing.

“We have a really diverse mix of where we think that money should be spent, but we want it in locked boxes for those purposes,” Krueger said.

In contrast, Cuomo has proposed using unspecified amounts for an array of programs, such as traffic safety, addiction treatment and small-business development, as well as public health education and intervention.

Cuomo also proposed using some of the revenue to fund transit upgrades in New York City and its suburbs.

“My governor, like every governor, would like to have total control of how the money gets used. They always want to have total control over their state money,” Krueger said.

Amplifying the tension between Cuomo and the Legislature is the state budget gap on the horizon, which is largely driven by a $2.9 billion Medicaid deficit.

Details of Cuomo’s 2020 recreational marijuana proposal for New York are expected to be part of the executive budget next month.

New Jersey marijuana taxes complicates NY's debate

Protesters urging legislators to pass Marijuana legislation holds a signs against the senate lobby doors at the state Capitol Wednesday, June 19, 2019, in Albany, N.Y. (AP Photo/Hans Pennink)

Hans Pennink, AP 

 

Another aspect of New Jersey’s pending ballot measure looms large over New York’s upcoming pot debates.

The Jersey plan says legal weed sales would only be subject to its state sales tax. And that 6.625% tax rate would be the lowest marijuana tax in the U.S., which New Jersey lawmakers expect would help push customers away from the black market and into legal marijuana dispensaries.

"One of the things we can try to do to combat and eviscerate the black market is to have the lowest possible tax rate," state Sen.

Nicholas Scutari said. "It'll take a long time to get rid of the black market, but this will help get it done."

Meanwhile, New York’s plan for collecting $300 million per year in marijuana revenues was based on a 20% state tax and 2% local tax, plus a per-gram tax on growers. It included an analysis of illicit drug dealers’ pot prices in New York.

Now, lawmakers in New York could be forced to consider a lower tax rate to avoid losing legal weed sales to New Jersey.

And infighting between New York state and local officials over carving up marijuana money further complicates the debate.

“State government tends to have a bias that we should be able to keep all the money, and local communities are saying if we’re taking on additional responsibilities we should get money,” Krueger said.

Marijuana politics

Sorting out marijuana taxes is also crucial in changing the vote of a handful of key state senators, mostly in the New York City suburbs and Long Island, who didn’t support legal weed earlier this year.

One is Harckham, who remained undecided but appears to be leaning towards a yes vote in 2020 after a fact-finding trip to a legal weed dispensary last month in Pittsfield, Massachusetts, just over the New York border.

“There is clearly an appetite for this in New York, and people are willing to drive 40 miles to buy recreational cannabis legally,” he said, citing the glut of Empire State license plates in Massachusetts dispensary parking lots.

Dispensaries in Massachusetts recently reported nearly $400 million in legal weed sales during the first year, state data show.

And potential pot profits in New York have prompted cannabis industry leaders to deploy waves of lobbyists amid New York’s marijuana legalization battle, spending millions of dollars a year since 2013.

Yet limiting big cannabis companies' ability to control New York's legal weed marketplace is a top priority for some lawmakers and advocates pushing social equity through cannabis reform.

"We don’t want a situation like we've seen in several other states where four or five major corporations come in and scoop up all the licenses for growing and producing and selling of cannabis, a la big alcohol or big cigarette companies," Krueger said.

While supportive of social equity plans, Harckham's priorities include securing enough of the legal weed tax revenue for addiction treatment, law enforcement and education, as well as strong consumer safety standards.

“The thing about a legal market is you can control purity,” he said. “Even in the smokables, you don’t want pesticides and chemicals in there, and when people buy on the black market they have no idea what’s in there.”

Marijuana vaping

The state Health Department said its lab results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples that may have been leading to lung illnesses from vaping. It said these were some of the products it found with high levels of vitamin E.

New York state Health Department 

 

The outbreak of serious lung injuries this summer revealed how little authorities know about the health risks of vaping in general.

What began with a handful of vaping lung injuries quickly exploded into hundreds. Federal authorities last month declared vitamin E acetate, an additive typically found in illicit marijuana vapes, was the suspected culprit behind about 2,300 vaping illnesses, and 48 deaths.

Investigators at the Centers for Disease Control and Prevention, however, emphasized they are still trying to find out whether other chemicals contributed to the outbreak.

Massachusetts regulators also issued a ban last month on sales of legal weed vaping products, citing concerns about lung injuries linked to the outbreak. It lifted the ban on Dec. 12 after reforming testing standards to prohibit use of contaminants, such as vitamin acetate.

Fougner asserted the ongoing vaping probe, including New York’s 200 lung injuries and two deaths, added to the list of health-related concerns surrounding legal weed.

Everything from mental-health impacts of prolonged use of high-potency pot to cannabis use during pregnancy warrants further medical research before New York considers legal weed, he said.

Kevin Sabet, president of anti-marijuana group Smart Approaches to Marijuana, slammed New York lawmakers for holding a legal weed rally in November, shortly after New York announced its second vaping-related death.

"We must take action to prevent further harms and halt any effort to legalize, commercialize, and promote the use of marijuana.

The risks are too great,” Sabet said in a statement.

Krueger contended legalizing marijuana would limit health risks of New Yorkers’ existing illicit pot use, adding public-health professionals should determine if vaping cannabis poses a threat.

“Our law in New York will leave it up to the Department of Health to set the regulation on what forms of products are legal,” she said.

“Follow the science. If there are certain ways to use that prove more dangerous, then don’t use those.”

Millions of Americans are stoned on the road: Nearly 5% of the population admit that they drove high last year

• Some 12 million Americans drove while high last year 
• Just under one percent, or 2.3 million Americans said they used other drugs then drove, CDC data reveal
• Between 1999 and 2010, the number of fatal car crashes involving marijuana tripled
• As marijuana becomes legal in more states, more people toke and drive and law enforcement are struggling to keep up  

By Natalie Rahhal Deputy 

In 2018, about 12 million Americans drove while high - and willingly admitted it to health officials. 

According to the new data from the Centers for Disease Control and Prevention (CDC), nearly five percent of Americans reported driving after using marijuana last year. 

Just under one percent admitted to driving under the influence of other illegal drugs. 

Though the rate of drunk driving still outpaces drugged driving, marijuana is catching up quickly, and the number of fatal accidents involving the drug has tripled in recent years. 

Some 12 million Americans drove after using marijuana in 2018, new CDC figures reveal 

As marijuana is legalized in more states, more people are taking up toking, vaping and eating the drug. 

It's now legal in 33 states for medical use and can be used recreationally in 11. 

And use it, Americans are. The CDC estimated that even back in 2014, there were 7,000 new users a day. 

Rising rates of marijuana use mean more people are using it more places and overlapping with more activities. 

In 2014, just 3.2 percent of people between ages 16 and 25  - an age demographic with higher general rates of marijuana use than average - drove high.

By 2018, 4.7 percent of all Americans over 16 had gotten behind the wheel of a car while stoned. 

Although it's not quite a direct comparison, that means that nearly 47 percent more people of all driving ages did so while high in 2018 than did the group of Americans most prone to weed smoking in 2014. 

There's a common misconception that driving while high is not dangerous, or at least not as dangerous as drinking while driving. 

In 2018, 10,511 Americans died in drunk driving accidents. 

The CDC has struggled to get a clear estimate of how many driving deaths involved marijuana or other illicit drugs.  

But other studies have found soaring rates of these accidents, particularly in states where marijuana has been legalized and in instances when both marijuana and alcohol were involved. 

'Research has determined that co-use of marijuana or illicit drugs with alcohol increases the risk for driving impairment,' the CDC study authors write. 

'The use of these substances has been associated with impairment of psychomotor and cognitive functions while driving.' 

Marijuana presents a challenge for law enforcement because there is not a reliable way to test blood or saliva for whether someone is high - but many scientists are hard at work to solve this puzzle.   

'Impaired driving is a serious public health concern that needs to be addressed to safeguard the health and safety of all who use the road, including drivers, passengers, pedestrians, bicyclists, and motorcyclists,' the authors wrote.