Advocates for the legalization of medical and retail marijuana are quick to point out all the possible benefits that a community might see from such a venture. These include increased jobs, increased tax revenue, possible medical benefits and they advertise it as “safe” and “healthy” and “organic.” Many people who have voted for legalization thought they were talking about the marijuana of the 1960s to 1980s when the THC content was less than two percent. However, without any clear guidelines or regulations from government officials, the cannabis industry has taken a page from the tobacco and alcohol industries’ playbook and developed strains of marijuana and concentrated marijuana products with much higher concentrations of THC, the psychoactive component that causes addiction. The more potent a drug is, the stronger the possibility of addiction and the more likely the person will continue to purchase and use the product.
From less than two percent the THC content grew to four percent in the 1990s, and between 1995 and 2015 there was a 212 percent increase in THC content in the marijuana flower. In 2017 the most popular strains found in dispensaries in Colorado had a range of THC content from 17-28 percent such as found in the popular strain named “Girl Scout Cookie.” Sadly these plants producing high levels of THC are incapable of producing much CBD, the protective component of the plant, so these strains have minimal CBD. For example, the Girl Scout Cookie strain has only 0.09-0.2 percent CBD. Concentrated THC products such as oil, shatter, dab and edibles have been able to get the THC concentration upwards of 95 percent. There is absolutely no research that indicates a concentration of THC greater than 10 percent is beneficial for any medical condition. The purpose of these products is to produce a high, and the increased potency makes them potentially more dangerous and more likely to result in addiction.
According to the 2014 Monitoring the Future Study, marijuana is by far the number one drug abused by 8th and 12th graders. Since legalization in Colorado, marijuana use in adolescents and those 18-25 has steadily climbed, well outpacing the national average. Colorado leads the nation in first-time marijuana use by those aged 12-17, representing a 65 percent increase in adolescent use since legalization. There is significantly less perception of harm by marijuana primarily because Colorado has normalized it as a society and allowed the perception that it is “organic” and “healthy” and that there is nothing wrong with it.
There are significant consequences of long-term or heavy marijuana use beginning in adolescence. Many studies demonstrate the negative effect on cognition and IQ in people who are exposed to marijuana beginning in utero through adolescence. In spite of this, nearly 70 percent of dispensaries in Colorado recommend cannabis products to treat nausea in the first trimester of pregnancy. This is basically bud-tenders practicing medicine without a license.
The marijuana of old used to be classified as a hallucinogen and was thought to not cause addiction because there was no identified withdrawal syndrome. This has changed. And with the increased potency of THC there is a definite recognized withdrawal syndrome which includes increased anger, irritability, depression, restlessness, headache, loss of appetite, insomnia and severe cravings for marijuana. It has been reported that nine percent of those who experiment with marijuana will become addicted, 17 percent of those who start using marijuana as teenagers will become addicted and 25-50 percent of those who use daily will become addicted. A 2015 study carried out in the U.K. found that high-potency cannabis use is associated with increased severity of dependence, especially in young people. This is further supported by a 16-year observational study from the Netherlands, published in 2018, demonstrating a direct correlation between increasing THC potency and first-time cannabis admissions to drug treatment.
Marijuana use is also correlated with creating or worsening many mental health problems including anxiety, depression, psychosis, and suicidal ideation. Numerous studies have demonstrated that using cannabis prior to the age of 15-18 significantly increases the risk of developing psychotic symptoms. The risk is dose dependent and increases with greater frequency of use and with higher potency THC. A landmark study in the U.K. analyzed 780 adults, ages 18-65, 410 with their first psychotic episode versus 370 matched healthy controls. They found that use of high potency THC >15 percent resulted in a three-times increased risk of psychosis, and if the use was daily there was a five-times increased risk. Those using hash with <5 percent THC did not exhibit psychotic symptoms.
There is no evidence that marijuana successfully treats PTSD, and there is evidence that it can make it worse. All it does is provide temporary relief by numbing the individual and disconnecting them from the traumatic emotion. It does not resolve the trauma, and they have to continue to use multiple times a day in order to continue with the benefit. This can lead to increased addiction potential and withdrawal symptoms, cognitive impairment, a-motivational syndrome and the potential for psychosis or worsening psychosis from the PTSD.
Multiple studies have documented a relationship between cannabis use and suicidality. A large, longitudinal study in Australia and New Zealand, published in 2014, of over 2000 adolescents and maximum frequency of marijuana use, found almost a seven-fold increase in suicide attempts in daily marijuana users compared with non-users. According to the Colorado Department of Public Health and Environment, marijuana is by far the most frequently encountered drug on toxicology screens of suicides among adolescents ages 10-19 and has been increasing over the last eight years.
If states continue to commercialize marijuana as has been done in Colorado we are destined to see many more people requiring treatment for addiction, depression, anxiety, suicidal ideation, and psychosis. We need to continually educate every one of the risks and increase prevention efforts to prevent children and adolescents from initiating marijuana use.
Libby Stuyt is a psychiatrist. A version of this article appeared in Missouri Medicine.
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