Why More Potent Cannabis and More Frequent Use Are Contributing to Higher Rates of Psychosis

Some federal scientists have reportedly concluded that "marijuana is neither as risky nor as prone to abuse as other tightly controlled substances and has potential medical benefits, and therefore should be removed from the nation's most restrictive category of drugs."

This astounding recommendation is contained in a 250-page scientific review "provided to Matthew Zorn, a Texas lawyer who sued Health and Human Services officials for its release and published it online," Christina Jewett and Noah Weiland reported for The New York Times in January. An HHS official reportedly confirmed the authenticity of the document.

It looks like federal health officials could soon follow the example of many states and legalize cannabis products for "medical" and recreational use. This momentous volte-face has been expected for quite some time now.

Since the 1970s, marijuana has been considered a Schedule I drug, a category for substances like heroin and cocaine that have no medical use and a high potential for misuse and addiction. Despite this prohibition, proponents of legalized cannabis use have been pushing unproven medical benefits of marijuana use for various ailments.

"Empirical and clinical studies clearly demonstrate significant adverse effects of cannabis smoking on physical and mental health as well as its interference with social and occupational functioning," wrote Svrakic, Lustman, et al. in "Legalization, Decriminalization & Medicinal Use of Cannabis" in 2012. "These negative data far outweigh a few documented benefits for a limited set of medical indications, for which safe and effective alternative treatments are readily available. If there is any medical role for cannabinoid drugs, it lies with chemically defined compounds, not with [the] unprocessed cannabis plant. Legalization or medical use of smoked cannabis is likely to impose significant public health risks, including an increased risk of schizophrenia, psychosis, and other forms of substance use disorders."

According to The New York Times article, the new federal "documents show that scientists at the Food and Drug Administration and the National Institute on Drug Abuse have recommended that the Drug Enforcement Administration make marijuana a Schedule III drug, alongside the likes of ketamine and testosterone, which are available by prescription."

At the same time, the review noted that marijuana misuse does lead to "physical dependence" and "some people develop a psychological dependence." Nevertheless, the review concluded, "the likelihood of serious outcomes is low."

Many addiction experts disagree. "They note that any long-running study of marijuana that the federal authorities have reviewed may not account for the escalating strength and increasingly frequent use of marijuana, which has been tied to psychiatric problems and chronic vomiting among users in recent years," wrote Jewett and Weiland.

For years, there was the promise—ultimately unmet—that marijuana could be used to combat opioid abuse or treat mental health problems, Keith Humphreys, a Stanford health policy professor and a former federal drug policy official, told The Times. "As the science has gotten better in the intervening decades, most of the therapeutic claims about cannabis have been debunked," he said.

A recent article by Julie Wernau in the Wall Street Journal made the same point. "More frequent use of marijuana that is many times as potent as strains common three decades ago is leading to more psychotic episodes, according to doctors and recent research," she wrote.  

Few people know that the legalization is largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. Foundry Treatment Center Steamboat CEO Ben Cort has been raising awareness of these issues for years. In a recent webinar, Cort explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the "weed" people smoked in the 1970s. The reason is the extreme THC (delta9-tetrahydrocannabinol) content of today's cannabis products.

The Cannabis sativa plant has over 480 constituents, with THC being the main psychoactive ingredient. "The average cannabis product sold in Colorado in 2016 had a THC content of 63 percent," Cort said. He doesn't like to talk about the plant anymore because the people treated at Foundry Treatment Center Steamboat for cannabis use disorder (CUD) have not been smoking the pot passed around in the 1970s; they are using high-potency commercially produced cannabis-based products.

The average THC content of cannabis products seized by the Drug Enforcement Administration was 15 percent in 2021, up from just four percent in 1995. However, many commercial cannabis products now advertise THC concentrations of up to 99 percent. The potency of the plant is irrelevant because the plant is being converted into products not used on its own. According to Cort, "Rarely, if ever, do we treat an individual who is only using cannabis in anything like its natural form; they use highly concentrated THC produced by extracting THC from the plant."

"There are now users who consume several grams of this unnaturally potent THC daily," says Ben Cort. "I know that because we treat such patients here at our program." The result of the widespread use of these powerful concentrates: "Addiction rates are considerably higher, the higher the potency goes as are negative psychiatric complication."

According to healthcare analytics company Truveta, rates of diagnoses for cannabis-induced disorders were more than 50 percent higher at the end of November than in 2019, "The trend is contributing to the broader burden of caring for people who developed mental health and addiction problems during the pandemic," Wernau reported.

Symptoms of serious mental disorders, including schizophrenia, often emerge in adolescence. While cannabis cannot be definitively isolated yet as the only culprit in any particular case, a growing body of evidence seems to support this conclusion. Large studies show a clear link between frequent and more potent cannabis use and higher rates of psychosis, particularly in young users, Yale University psychiatrist Deepak D'Souza told the Wall Street Journal.

Even one psychotic episode following cannabis use was associated with a 47 percent chance of developing schizophrenia or bipolar disorder, a 2017 study published in the American Journal of Psychiatry showed. The risk was highest for people 16 to 25 years old and higher than for substances such as amphetamines, hallucinogens, opioids, and alcohol.

The Wall Street Journal cited the example of Dr. Karen Randall, who moved to Pueblo, Colorado, for a job in an emergency room more than a decade ago after working in Detroit for 18 years. She thought it would be like retiring early. She bought a ranch where she could ride horses in an area locals now call the Napa Valley of Cannabis. "I see more psychotic people here than I did in Detroit," she told the Wall Street Journal. "We're just making this huge population of people who we can no longer fix." Dr. Randall is right, we can 'no longer fix' these issues in an acute setting like an emergency department. Individuals affected by the type of THC-induced psychosis she sees need long-term care.

Cannabis use disorder (CUD) is a potentially serious condition frequently requiring treatment. Sadly, people presenting with CUD do not enjoy the same support from society as people with other substance use disorders, explained Cort. "If you ask your doctor for help because you drink too much alcohol or because you can't stop using opioids, you can typically expect encouraging words, immediate action, and specialist referrals. If you ask your doctor for help because you are concerned that you are using too much THC, you may only get a shrug or a simple recommendation to cut down." Many doctors, especially those who have not graduated recently from medical school or received new training in cannabis use disorder, think that cannabis use is relatively harmless or poses few risks. Some doctors believe that cannabis may be less harmful than using alcohol or medications to cope with stress symptoms and anxiety.

"At Foundry Steamboat, we treat patients whose cannabis use disorder had been dismissed as 'only weed' because our society does not recognize cannabis as an addictive substance even though it is objectively demonstratable as such," Cort said. In treatment, Foundry Steamboat has to prepare clients for a trigger-rich environment with ubiquitous "pot shops," billboards advertising cannabis products, and family systems and friend groups in which cannabis use is considered normal.

Foundry Treatment Center Steamboat offers men's residential treatment and telehealth for adults of all genders experiencing substance use and mental health disorders and offers specialized treatment for cannabis use disorder. Treating cannabis addiction can be complex and prolonged compared to the treatment for other types of substance use disorders. Some people presenting with a cannabis addiction experience lengthy periods of psychosis and hyperemesis syndrome, which may require lengthy periods of supervised stabilization before clients are mentally and physically able to safely engage in treatment.

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