More and more Americans are reporting near-constant cannabis use, as legalization forges ahead.
The
proliferation of retail boutiques in California did not really bother
him, Evan told me, but the billboards did. Advertisements for delivery,
advertisements promoting the substance for relaxation, for fun, for
health. “Shop. It’s legal.” “Hello marijuana, goodbye hangover.” “It’s
not a trigger,” he told me. “But it is in your face.”
When
we spoke, he had been sober for a hard-fought seven weeks: seven weeks
of sleepless nights, intermittent nausea, irritability, trouble
focusing, and psychological turmoil. There were upsides, he said, in
terms of reduced mental fog, a fatter wallet, and a growing sense of
confidence that he could quit. “I don’t think it’s a ‘can’ as much as a
‘must,’” he said.
Evan,
who asked that his full name not be used for fear of professional
repercussions, has a self-described cannabis-use disorder. If not
necessarily because of legalization, but alongside legalization, such
problems are becoming more common: The share of adults with one has doubled since the early aughts, as the share of cannabis users who consume it daily or near-daily has jumped nearly 50 percent—all
“in the context of increasingly permissive cannabis legislation,
attitudes, and lower risk perception,” as the National Institutes of
Health put it.
Public-health
experts worry about the increasingly potent options available, and the
striking number of constant users. “Cannabis is potentially a real
public-health problem,” said Mark A. R. Kleiman, a professor of public
policy at New York University. “It wasn’t obvious to me 25 years ago,
when 9 percent of self-reported cannabis users over the last month
reported daily or near-daily use. I always was prepared to say, ‘No,
it’s not a very abusable drug. Nine percent of anybody will do something
stupid.’ But that number is now [something like] 40 percent.” They
argue that state and local governments are setting up legal regimes
without sufficient public-health protection, with some even warning that
the country is replacing one form of reefer madness with another,
careening from treating cannabis as if it were as dangerous as heroin to
treating it as if it were as benign as kombucha.
But
cannabis is not benign, even if it is relatively benign, compared with
alcohol, opiates, and cigarettes, among other substances. Thousands of
Americans are finding their own use problematic in a climate where pot
products are getting more potent, more socially acceptable to use, and
yet easier to come by, not that it was particularly hard before.
For
Keith Humphreys, a professor of psychiatry and behavioral sciences at
Stanford University, the most compelling evidence of the deleterious
effects comes from users themselves. “In large national surveys, about
one in 10 people who smoke it say they have a lot of problems. They say
things like, ‘I have trouble quitting. I think a lot about quitting and I
can’t do it. I smoked more than I intended to.
I neglect
responsibilities.’ There are plenty of people who have problems with it,
in terms of things like concentration, short-term memory, and
motivation,” he said. “People will say, ‘Oh, that’s just you fuddy-duddy
doctors.’ Actually, no. It’s millions of people who use the drug who
say that it causes problems.”
Users
or former users I spoke with described lost jobs, lost marriages, lost
houses, lost money, lost time. Foreclosures and divorces. Weight gain
and mental-health problems. And one other thing: the problem of
convincing other people that what they were experiencing was real. A few
mentioned jokes about Doritos, and comments implying that the real
issue was that they were lazy stoners.
Others mentioned the common
belief that you can be “psychologically” addicted to pot, but not
“physically” or “really” addicted. The condition remains misunderstood,
discounted, and strangely invisible, even as legalization and
white-marketization pitches ahead.
The
country is in the midst of a volte-face on marijuana. The federal
government still classifies cannabis as a Schedule I drug, with no
accepted medical use. (Meth and PCP, among other drugs, are Schedule
II.) Politicians still argue it is a gateway to the use of things like
heroin and cocaine. The country still spends billions of dollars
fighting it in a bloody and futile drug war, and still arrests more
people for offenses related to cannabis than it does for all violent crimes combined.
Yet
dozens of states have pushed ahead with legalization for medical or
recreational purposes, given that for decades physicians have argued
that marijuana’s health risks have been overstated and its medical uses
overlooked; activists have stressed prohibition’s tremendous fiscal cost
and far worse human cost; and researchers have convincingly argued that
cannabis is far less dangerous than alcohol. A solid majority of
Americans support legalization nowadays.
Academics
and public-health officials, though, have raised the concern that
cannabis’s real risks have been overlooked or underplayed—perhaps as
part of a counter-reaction to federal prohibition, and perhaps because
millions and millions of cannabis users have no problems controlling
their use.
“Part of how legalization was sold was with this assumption
that there was no harm, in reaction to the message that everyone has
smoked marijuana was going to ruin their whole life,” Humphreys told me.
It was a point Kleiman agreed with. “I do think that not legalization,
but the legalization movement, does have a lot on its conscience now,”
he said. “The mantra about how this is a harmless, natural, and
non-addictive substance—it’s now known by everybody. And it’s a lie.”
Thousands
of businesses, as well as local governments earning tax money off of
sales, are now literally invested in that lie. “The liquor companies are
salivating,” Matt Karnes of GreenWave Advisors told me. “They can’t
wait to come in full force.” He added that Big Pharma was targeting the
medical market, with Wall Street, Silicon Valley, food businesses, and
tobacco companies aiming at the recreational market.
Sellers
are targeting broad swaths of the consumer market—soccer moms, recent
retirees, folks looking to replace their nightly glass of chardonnay
with a precisely dosed, low-calorie, and hangover-free mint. Many have
consciously played up cannabis as a lifestyle product, a gift to give
yourself, like a nice crystal or an antioxidant face cream. “This is not
about marijuana,” one executive at the California retailer MedMen recently argued.
“This is about the people who use cannabis for all the reasons people
have used cannabis for hundreds of years. Yes, for recreation, just like
alcohol, but also for wellness.”
Evan
started off smoking with his friends when they were playing sports or
video games, lighting up to chill out after his nine-to-five as a
paralegal at a law office. But that soon became couch-lock, and he lost
interest in working out, going out, doing anything with his roommates.
Then came a lack of motivation and the slow erosion of ambition, and law
school moving further out of reach. He started smoking before work and
after work. Eventually, he realized it was impossible to get through the
day without it. “I was smoking anytime I had to do anything boring, and
it took a long time before I realized that I wasn’t doing anything
without getting stoned,” he said.
His
first attempts to reduce his use went miserably, as the consequences on
his health and his life piled up. He gained nearly 40 pounds, he said,
when he stopped working out and cooking his own food at home. He
recognized that he was just barely getting by at work, and was
continually worried about getting fired. Worse, his friends were
unsympathetic to the idea that he was struggling and needed help. “[You
have to] try to convince someone that something that is hurting you is
hurting you,” he said.
Other
people who found their use problematic or had managed to quit, none of
whom wanted to use their names, described similar struggles and
consequences. “I was running two companies at the time, and fitting
smoking in between running those companies. Then, we sold those
companies and I had a whole lot of time on my hands,” one other former
cannabis user told me. “I just started sitting around smoking all the time. And things just came to a halt. I was in terrible shape. I was depressed.”
Lax
regulatory standards and aggressive commercialization in some states
have compounded some existing public-health risks, raised new ones, and
failed to tamp down on others, experts argue.
In terms of compounding
risks, many cite the availability of hyper-potent marijuana products.
“We’re seeing these increases in the strength of cannabis, as we are
also seeing an emergence of new types of products,” such as edibles,
tinctures, vape pens, sublingual sprays, and concentrates, Ziva Cooper,
an associate professor of clinical neurobiology in the Department of
Psychiatry at Columbia University Medical Center, told me. “A lot of
these concentrates can have up to 90 percent THC,” she said, whereas the
kind of flower you could get 30 years ago was far, far weaker.
Scientists are not sure how such high-octane products affect people’s
bodies, she said, but worry that they might have more potential for
raising tolerance, introducing brain damage, and inculcating dependence.
As
for new risks: In many stores, budtenders are providing medical advice
with no licensing or training whatsoever. “I’m most scared of the advice
to smoke marijuana during pregnancy for cramps,” said Humphreys,
arguing that sellers were providing recommendations with no scientific
backing, good or bad, at all.
In terms of long-standing
risks, the lack of federal involvement in legalization has meant that
marijuana products are not being safety-tested like pharmaceuticals;
measured and dosed like food products; subjected to agricultural-safety
and pesticide standards like crops; and held to labeling standards like
alcohol. (Different states have different rules and testing regimes,
complicating things further.)
Health experts also cited
an uncomfortable truth about allowing a vice product to be widely
available, loosely regulated, and fully commercialized: Heavy users will
make up a huge share of sales, with businesses wanting them to buy more
and spend more and use more, despite any health consequences.
“The
reckless way that we are legalizing marijuana so far is mind-boggling
from a public-health perspective,” Kevin Sabet, an Obama administration
official and a founder of the nonprofit Smart Approaches to Marijuana,
told me. “The issue now is that we have lobbyists, special interests,
and people whose motivation is to make money that are writing all of
these laws and taking control of the conversation.”
This
is not to say that prohibition is a more attractive policy, or that
legalization has proven to be a public-health disaster. “The big-picture
view is that the vast majority of people who use cannabis are not going
to be problematic users,” said Jolene Forman, an attorney at the Drug
Policy Alliance.
“They’re not going to have a cannabis-use disorder.
They’re going to have a healthy relationship with it. And
criminalization actually increases the harms related to cannabis, and so
having a strictly regulated market where there can be limits on
advertising, where only adults can purchase cannabis, and where you’re
going to get a wide variety of products makes sense.”
Still,
strictly regulated might mean more strictly regulated than today, at
least in some places, drug-policy experts argue. “Here, what we’ve done
is we’ve copied the alcohol industry fully formed, and then on steroids
with very minimal regulation,” Humphreys said. “The oversight boards of a
number of states are the industry themselves. We’ve learned enough
about capitalism to know that’s very dangerous.”
A
number of policy reforms might tamp down on problem use and protect
consumers, without quashing the legal market or pivoting back to
prohibition and all its harms. One extreme option would be to require
markets to be noncommercial: The District of Columbia, for instance,
does not allow recreational sales, but does allow home cultivation and
the gifting of marijuana products among adults. “If I got to pick a
policy, that would probably be it,” Kleiman told me. “That would be a
fine place to be if we were starting from prohibition, but we are
starting from patchwork legalization.
As the Vermont farmer says,
I don’t think you can get there from here. I fear its time has passed.
It’s generally true that the drug warriors have never missed an
opportunity to miss an opportunity.”
There’s
no shortage of other reasonable proposals, many already in place or
under consideration in some states. The government could run marijuana stores,
as in Canada. States could require budtenders to have some training or
to refrain from making medical claims. They could ask users to set a
monthly THC purchase cap and remain under it. They could cap the amount
of THC in products,
and bar producers from making edibles that are attractive to kids, like
candies. A ban or limits on marijuana advertising are also options, as
is requiring cannabis dispensaries to post public-health information.
Then,
there are THC taxes, designed to hit heavy users the hardest. Some
drug-policy experts argue that such levies would just push people from
marijuana to alcohol, with dangerous health consequences. “It would be
like saying, ‘Let’s let the beef and pork industries market and do
whatever they wish, but let’s have much tougher restrictions on tofu and
seitan,’” said Mason Tvert of the Marijuana Policy Project. “In light
of the current system, where alcohol is so prevalent and is a more
harmful substance, it is bad policy to steer people toward that.” Yet
reducing the commercial appeal of all vice products—cigarettes, alcohol,
marijuana—is an option, if not necessarily a popular one.
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