Blog & Announcements

Every year, the National Survey on Drug Use and Health (NSDUH) provides the most recently available information on tobacco, alcohol, and other substance use, mental health, and other health-related issues in the United States.

The NSDUH began in 1971 and is conducted annually in all 50 states and the District of Columbia. Approximately 70,000 people were interviewed for this important study.

Information from the NSDUH is used to support prevention and treatment programs, monitor substance use trends, estimate the need for treatment, and inform public health policy.

17 PERCENT HAVE SUBSTANCE USE DISORDER

In 2024, nearly 50 million Americans, 16.8 percent of people 12 years or older, met the diagnostic criteria for a substance use disorder (SUD) in the past year. Of these individuals, 27.9 million had an alcohol use disorder, and 28.2 million had an SUD involving drugs.

About one in six people with a past year substance use disorder (16.0 percent or 7.7 million people) had both an alcohol use disorder and a “drug use disorder” in the past year. Cannabis (marijuana) use disorder (CUD) was the most common drug use disorder (20.6 million), followed by opioid use disorder (4.8 million), and a central nervous system stimulant use disorder (4.3 million).

“With the ready availability of illicitly made fentanyl and other potent synthetic opioids such as nitazenes, the emergence of substances like xylazine, medetomidine, and illicit benzodiazepines, and increasing polysubstance use, Americans face an illicit drug supply that is more toxic, unpredictable, and dangerous than ever,” wrote Art Kleinschmidt, Ph., MBA, Principal Deputy Assistant Secretary, Substance Abuse and Mental Health Services Administration in a press release. “In addition, the proliferation of social media and other technology that is inundating America’s young people, coupled with other social stressors in homes and communities across the Nation, has contributed to declining mental health and well-being and rising rates of suicide in the past two decades.”

MAJOR TRENDS

The 2024 NSDUH identifies “areas of progress” and “trends heading in the wrong direction.”  

“Americans are binge drinking and smoking tobacco less but consuming marijuana significantly more,” summarized Lev Facher in the findings of the new federal survey on STAT News.

“On the progress front, we see from the NSDUH that the percentage of people 12 years or older reporting use of most substances either decreased or remained stable between 2021 and 2024, with decreases in past month use of tobacco, cigarettes, binge and heavy drinking as well as decreases in past year use of cocaine, misuse of prescription opioids, and past year alcohol use disorder,” reported Dr. Kleinschmidt.

Heading in the wrong direction, however, are trends that include past year illicit drug use, marijuana use, and hallucinogen use, and past year drug use disorder and cannabis use disorder. “Among adults, we also saw that the percentage of people 18 or older [who] reported making a suicide plan increased between 2021 and 2024.”

Dr. Kleinschmidt points out that “the increases in past-year illicit drug use and past-year drug use disorders are largely driven by increases in marijuana use and [cannabis] use disorder among adults 26 years or older. Although marijuana use and [CUD] trends remained stable among adolescents and young adults between 2021 and 2024, the increase in adult use is important to inform prevention and treatment activities given changing attitudes around marijuana use and the shifting state policy landscape which has increased risk for marijuana use and use disorder among young people, and enabled the ready availability of high-potency marijuana products linked to negative health impacts in communities across the country.”

MENTAL HEALTH AND SUBSTANCE MISUSE

The NSDUH highlights the “substantial overlap” between substance use and mental health. “Although mental health and substance use funding and treatment systems have historically often been separate, the NSDUH clearly demonstrates that in reality, people with substance use disorders and those with mental health challenges often have co-occurring conditions.”

For the first time in 2024, the NSDUH included the Generalized Anxiety Disorder (GAD-7) scale, a validated self-report measure to screen for and assess symptoms of GAD in the past two weeks.

Among adults 18 years or older in the US, 7.4 percent had moderate or severe symptoms of anxiety and 14.3 percent had mild symptoms. Moderate to severe symptoms were more common among 18 to 25-year-olds (14.5 percent) compared to 26 to 49-year-olds (9.0 percent) and adults 50 years or older (3.9 percent).

TREATMENT NEEDS NOT MET

According to the NSDUH, “approximately one in five people (19.3 percent) who needed substance use treatment actually received treatment in the past year. Treatment receipt was highest among adolescents aged 12 to 17 years (30.2 percent of those needing treatment reported receiving treatment in the past year), followed by those 26 years or older (20.5 percent) and those 18 to 25 years old (11.3 percent).”

Modern, evidence-based addiction treatment needs to be trauma-informed and dual diagnosis capable, addressing the needs of the patient as a whole person, including their life experiences, and going far beyond simply suppressing powerful cravings to use drugs and alcohol.

Every patient with addiction deserves the best medical care. When it comes to behavioral healthcare, the ability of your treatment provider to understand your needs, provide effective therapies, and identify the specific resources that will help you maintain health and recovery after treatment is vital to your success.

FOUNDRY FRONT RANGE TREATS CANNABIS USE DISORDER

NRT Behavioral Health Managing Partner Ben Cort has written two books on the problems associated with today’s high-potency cannabis products and their effects. Growing evidence demonstrates that consuming highly concentrated cannabis poses significant health risks, from anxiety and depression to cardiac problems and suicidal ideation.

A minority of cannabis users will develop cannabis use disorder and its serious effects. However, those who are impacted, and their family members and loved ones, face significant challenges and the same risks associated with other forms of substance use disorder.

NRT Behavioral Health programs, including Foundry Steamboat, Foundry Front Range, and its intensive outpatient program, have specialized expertise in treating cannabis use disorder. With some of the most experienced clinicians, modern and well-equipped clinical facilities, and leading experts in addiction medicine, Foundry Steamboat and Foundry Front Range represent an appropriate treatment option for people experiencing cannabis use disorder.

If you or a loved one needs help or to learn more about our comprehensive addiction treatment program, visit www.foundryfrontrange.com  or call (720) 807-7867.

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New research has revealed problematic cardiac changes in patients with both cocaine and alcohol use disorders. This raises concerns about the effects of cocaine and alcohol use on the heart, even after treatment and abstinence.

“Cocaine use is a well-established cardiovascular risk factor, further enhanced by concurrent alcohol use. However, cardiovascular risk is poorly managed in individuals with cocaine use disorder,” wrote Porras-Perales, Segovia-Reyes, et al. in their cross-sectional case-control study on cardiac troponin alterations in patients with cocaine and alcohol use disorders.  

People with substance use disorder (SUD) frequently misuse more than one addictive drug, which is known as polysubstance use. This includes taking two or more together or within a short period, either intentionally or unintentionally.

“Whether intentional or not, mixing drugs is never safe because the effects from combining drugs may be stronger and more unpredictable than one drug alone, and even deadly,” explains a CDC webpage.

“While research indicates combined use of cocaine and alcohol poses [a] greater threat than either substance alone, there may be different mechanisms of injury,” explained Mark Gold, MD, in Psychology Today.

Researchers studied 84 participants with substance use. “Highly sensitive cardiac troponin T (cTnT) blood levels were measured. Cardiac troponin levels are markers for heart attack and other heart abnormalities. CTnT is a substance released into the bloodstream with damage to heart muscle. It includes troponin I (cTnI), a protein in heart muscle cells that regulates muscle contraction. The research showed distinct cardiac troponin blood alterations in cocaine addicts.”

When heart muscle is damaged during a myocardial infarction (heart attack), cTnI releases into the bloodstream. The major research finding was that cocaine use disorder patients showed significantly elevated cTnT levels relative to controls. In addition, patients with alcohol use disorder exhibited elevated cTnI levels relative to controls.

“This suggests possible subclinical myocardial injury caused by cocaine distinct from alcohol’s effects,” wrote Dr. Gold. “Sadly, even with abstinence and without overt cardiovascular disease, substance use disorders (especially cocaine) are associated with detectable and important heart and injury signals.”

The new study is a reminder that among drug combinations, cocaine (and methamphetamine) is a well-established cardiovascular risk factor. “The combined use of methamphetamine/cocaine plus alcohol may cause cardiovascular disease (CVD) problems so often that when addiction treatment begins in early abstinence, physicians should consider a cardiovascular risk assessment,” explained Dr. Gold.

“Chronic heavy alcohol use has a direct negative effect on the heart, referred to as myocardial toxicity. This causes cardiomyopathy, arrhythmias, and hypertension. In the Porras‑Perales et al. study described at the beginning of this post, researchers found that alcohol use was associated with elevated cTnI, suggesting subclinical injury.”

Chronic alcohol use contributes to dilated cardiomyopathy, atrial fibrillation, left ventricular dysfunction, and increased heart failure risk.

NRT Behavioral Health programs take a comprehensive approach to treating Substance Use Disorder.

Our programs provide modern, evidence-based addiction treatment and integrated addiction medicine to address the needs of the patient as a whole person. Many individuals suffering from prolonged substance use disorder and who use multiple substances have increased risks for complex medical problems, such as heart conditions.

Our experienced medical team members are experienced at identifying comorbid health conditions accompanying long-term substance misuse and can refer clients to appropriate specialized treatment. Treating comorbidities is crucial for maintaining lasting health and promoting recovery. Unless chronic conditions are treated, people may experience a range of debilitating symptoms that prevent them from feeling well and sustaining their recovery.

NRT Behavioral Health residential treatment programs, Foundry Front Range, and Foundry Steamboat provide the level of comprehensive assessment and treatment needed to successfully diagnose and create treatment plans to find and treat heart problems and other healthcare problems associated with substance use disorders.

If you or a loved one needs help, please get in touch with our informed admissions team at (720) 807-7867.

This article mentions suicide. If you or someone you know is in crisis, please call, text, or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.

“The frequent use of cannabis is associated with a plethora of negative health and social consequences,” wrote Langlois, Potvin, Khullar, and Tourjman in their 2021 study regarding depression and cannabis.

“There is a growing body of evidence pointing to the co-occurrence of cannabis use and depression,” confirmed  Feingold and Weinstein in the same year. “There is also some evidence that the use of cannabis may lead to the onset of depression; however, strong evidence points to the inverse association, i.e., that depression may lead to the onset or increase in cannabis use frequency.”

New research has now raised more concerns about cannabis use, especially for young users.

“Cannabis use has become increasingly normalized in the United States, and at least half the states have 'medical marijuana' laws,”  wrote Mark Gold, MD, in Psychology Today in July. “This reversed criminalization, but rather than following FDA-like testing and approval, cannabis was suddenly ‘a medicine.’ Access to cannabis or its intoxicant THC has never been greater. Adolescents may not legally purchase cannabis; however, their access has increased.”

Alarmingly, there appears to be a strong relationship between cannabis use and suicidal thinking that can only partly be explained by depression.

“Cannabis is largely unstudied or has failed rigorous medication trials, so its impact on mental health is mostly unknown,” warned Dr. Gold. “However, new findings indicate distressing results, causing experts to call for a reassessment of the risks and benefits of cannabis, as nearly 30 percent of users develop cannabis use disorder (CUD). For adolescent users, risks for addiction are twice that of adults, and after four years, one in five adolescents develop problematic use. Disturbingly, new studies suggest elevated cannabis risks for depression and suicidal thoughts and behaviors, especially in adolescents and young adults.”

Gold pointed to a new review and meta-analysis by Maviel, Somma, et al. that found “a clear relationship between cannabis use and suicidal behaviors.” After adjusting for depression, adolescent cannabis use was significantly associated with increased risks for thinking about suicide and more than double the risk for suicide attempts. Among adolescents, cannabis use was linked to a 1.85 times higher likelihood of attempting suicide.

“Depression may contribute to the relationship between cannabis use and suicidality, but doesn’t fully explain it, suggesting cannabis use poses independent risks for suicidal thoughts and behaviors,” explained Dr. Gold. “Cannabis may act as a catalyst, accelerating depressive processes.’

Recent high-quality studies have reinforced findings that cannabis use during adolescence can predict increases in depressive symptoms and suicidal ideation. Gobbi, Atkin, et  al. reported in JAMA Psychiatry that “adolescent cannabis consumption was associated with increased risk of developing depression and suicidal behavior later in life, even in the absence of a premorbid condition.” Cannabis use in adolescence was associated with an increased risk for major depression and suicidal ideation (about 1.5 times greater), and adolescent cannabis use was associated with suicide attempts in young adulthood (3.4 times greater).

A major study in Proceedings of the National Academy of Sciences compared a large sample of hospitalized adolescents with cannabis use disorder (CUD) vs. those without CUD and controlled for depression. Adolescents with CUD had substantially increased odds of suicide attempts and self-harm; the presence of comorbid depression more than doubled risks.

The authors concluded that their study “provides evidence for the association between CUD and suicide risk among hospitalized adolescents and underscores the importance of recognizing and addressing co-occurring mental and substance use disorders along with CUD to mitigate suicide risk.”

A study in Frontiers in Public Health found cannabis use associated with higher risks of major depressive disorder, as well as suicidality. “Another study demonstrated that adolescents with cannabis use disorder (CUD) symptoms were more severely ill than adults, suggesting a developmental vulnerability,” Gold wrote. “Experts concluded youth cannabis use likely fuels depression and suicide in young people.”

FOUNDRY FRONT RANGE TREATS CANNABIS USE DISORDER

NRT Behavioral Health Managing Partner Ben Cort has written two books on the problems associated with today’s high-potency THC products and their effects. Growing evidence demonstrates that consuming today’s highly concentrated cannabis poses significant health risks, from anxiety and depression to cardiac problems to suicidal ideation. A minority of cannabis users will develop cannabis use disorder and its serious effects. However, those who are impacted, and their family members and loved ones, face significant challenges and the same risks associated with other forms of substance use disorder.

NRT Behavioral Health programs, including Foundry Steamboat, Foundry Front Range, and its Intensive Outpatient Program, have specialized expertise in treating cannabis use disorder. Cannabis, which is stored in fat cells, can remain in the body and cause psychoactive effects long after a person stops consuming it. This can lead to residual effects of cannabis that must be stabilized before clients are ready to engage in treatment programming. Specialized medical attention may also be required to help people experiencing severe side effects of cannabis use disorder, like cannabis-induced hyperemesis or psychosis, feel stable and comfortable before entering treatment.

With some of the most experienced clinicians, modern and well-equipped clinical facilities, and leading experts in addiction medicine, Foundry Steamboat represents a good treatment option for people experiencing Cannabis Use Disorder (CUD). To learn more, call us at (844) 955-1066.

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Fentanyl deaths in Colorado dropped last year, but still inflicted a severe economic toll, says a new report by the Common Sense Institute (CSI), a free-enterprise think tank.

Fentanyl-related deaths in Colorado “dropped from 1,184 in December 2023 to 801 in November 2024, a 32.4 percent reduction, but that’s still well above death rates before 2020,” reported Derek Draplin in the Kiowa County Press.

CSI estimates that “the total cost of fentanyl-related overdose deaths in Colorado is on par with 2022 at $13.1 billion in 2024 – approximately $2,220 per Coloradan.”

Though last year’s overdose rates and their associated economic impacts are trending downward, “they are still highly elevated compared to any point before 2020. This mirrors the development of Colorado’s crime rate generally, which has recently improved from 2022 but remains far above the norm set in the previous decade.”

OTHER KEY FINDINGS

Fentanyl-related overdose deaths have declined since the passage of HB22-1326, the Fentanyl Accountability and Prevention Act. The legislation was a response to rising fentanyl overdose deaths in the state.

Colorado’s Drug Overdose Competitive Index is still higher (30th) than it has been since 2015. This is due to increased drug overdose per capita in Colorado and improvements in other states.

CSI recommends that policymakers consider reverting to the effective drug laws that imposed stronger criminal penalties for the possession of any amount of drugs like methamphetamine, cocaine, and heroin. “While the state made some strides in strengthening fentanyl possession laws with the passage of HB22-1326, the law fails to address other hard drugs that often contribute to overdoses,” the report says. The authorities should be “proactive in anticipating whatever drug will eventually replace fentanyl,” and “adopt a robust public health strategy with rigorous tracking criteria aimed at reducing fentanyl-related overdoses.”

Fentanyl is a powerful synthetic opioid that is up to fifty times stronger than heroin and one hundred times stronger than morphine. Its misuse is a major contributor to fatal and nonfatal overdoses in the United States. As the CSI report explains, “fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Even in small doses, it can be deadly. Over 150 people die every day [nationally] from overdoses related to synthetic opioids like fentanyl.”

According to the latest data from the Colorado Department of Public Health and Environment, there were 222 fentanyl-related deaths in 2019, 540 in 2020, 912 in 2021, 920 in 2022, and 1,097 in 2023. The total number of drug overdose deaths decreased 15.7 percent from 1,935 in November 2023 to 1,631 in November 2024.

OPIOID USE DISORDER

Opioids such as fentanyl and heroin can produce feelings of euphoria that make it more likely that people will continue to misuse opioids, despite severe negative consequences such as addiction and death. Opioid use disorder (OUD) is a serious condition requiring treatment.

NRT Behavioral Health treatment programs, including Foundry Front Range and Foundry Steamboat, strive to make addiction treatment as accessible as possible. Every person with addiction deserves effective medical care. When it comes to behavioral healthcare, the ability of your treatment provider to understand your needs, provide effective therapies, and identify the specific resources that will help you maintain health and recovery after treatment is vital to your success.

If you or a loved one needs help, please contact us at (720) 807-7867.

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Nearly 19 million children in the United States have at least one parent with a substance use disorder (SUD), according to a new study published in JAMA Pediatrics on May 12. A significant number of those children have a parent whose SUD is moderate or severe as opposed to mild, the study finds.

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Witnessing a parent misusing drugs and alcohol as a child is considered an "adverse childhood experience" (ACE) that can have long-term negative impacts on health and well-being. ACEs are common. About 64 percent of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six adults reported they had experienced four or more types of ACEs.

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"Children exposed to parental SUD are more likely to develop adverse health outcomes than their peers without parental SUD exposure, including early substance use initiation, substance-related problems, and mental health disorders," wrote study authors Sean Esteban McCabe, Vita McCabe, and Ty Schepis. "We aimed to estimate the number of US children living in the same household as at least one parent or primary caregiver with a DSM-5-defined SUD."

As Rhitu Chatterjee reported on NPR, "the new study used data from the 2023 National Survey on Drug Use and Health, a federal survey that estimated the prevalence of substance use and mental health disorders based on the most updated criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). The national survey is managed by the Substance Abuse and Mental Health Services Administration, but the team in charge of the survey was let go as part of the recent reduction in force. It is unclear how the cuts will affect the future of the survey."

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"If one-quarter of kids in the US have a parent with a substance use disorder, that tells us that every day in our clinics we are encountering many, if not dozens of families that are affected by substance use disorders," Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital told NPR. "We need to be poised and ready to help support those families."

"The study's main finding is significantly higher than previous estimates (7 million in a study originally published in 2022), which had relied on diagnostic criteria from the DSM-IV," reported Chatterjee. "The new study also estimated how many children have a parent with a moderate or severe addiction as opposed to mild."

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McCabe and his team found that 7.6 million US children have a parent with a moderate or severe SUD, and 3.4 million live with a parent dealing with multiple substance use disorders. The authors also found that more than 6 million children have a parent dealing with both a substance use disorder and a co-occurring mental health condition.

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"These estimates are incredibly important to understand the scope of parental substance use disorder in the United States," Davida Schiff, a pediatrician and addiction physician at Massachusetts General Hospital, told NPR. Dr. Schiff pointed out that a majority of the parents (12 million) had alcohol use disorder. "While alcohol is more socially acceptable in our society, the study points to a need to pay greater attention to a rising number of children exposed to parental alcohol use disorder."

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Adverse childhood experiences and other lifetime traumas are regularly encountered by addiction professionals. The strong correlation between addiction and trauma, especially childhood trauma, is well known.

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Addiction is truly a family problem.

NRT Behavioral Health Chief Clinical Advisor Dr. Michael Barnes is a foremost expert in family system disorders and trauma. The Trauma-Integrated Care Model, developed by Dr. Barnes and used at NRT Behavioral Health treatment programs, emphasizes the importance of identifying trauma and substance use in family systems. Because parental substance use disorder exposes children to physical and psychological danger and increases their risk of developing SUD in later life, addressing the effects of these problems on all family members is key to stopping generational cycles of behavioral health disorders. Family programming is a central part of treatment at NRT Behavioral Health programs. It focuses on educating clients and family members and helps families create recovery-supportive lifestyles and home environments.

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Recognizing how families experience, normalize, and perpetuate substance use is vital to reducing high rates of SUD in America's rural communities. Close-knit families that spend more time together and are more isolated from other community members can inadvertently create an internal culture that makes using substances to self-medicate mental health disorders more acceptable. Ensuring that rural community members can access high-quality treatment is one way to address this problem. Helping individuals address anxiety, depression, loneliness, and other psychological problems through therapy and psychiatric medications can reduce their perceived reliance on alcohol and substances to reduce their symptoms. Sometimes, when one family member gets help, other members become more willing to accept help and to change their relationship with substances. 

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If you or a loved one is experiencing problematic drinking or drug use, we may be able to help. Please call us for a free and confidential conversation at (720) 807-7867.

Marijuana causes heart problems — A new study led by UC San Francisco researchers has found that chronic cannabis use, whether smoked or consumed in edible form, is associated with significant cardiovascular risks.

The report, published in JAMA Cardiology, found that people who regularly used marijuana in either form had reduced blood vessel function comparable to tobacco smokers. Vascular function in those who used cannabis by either means was reduced roughly by half compared to those who did not use it.

Decreased vascular function is associated with a greater risk of heart attack, hypertension, and other cardiovascular conditions.

"There is a popular belief that marijuana smoke is harmless," wrote Mohammadi, Navabzadeh, Jiménez-Téllez, et al. in their study. "However, marijuana smoke contains many of the thousands of chemicals contained in tobacco smoke, along with fine particles that contribute to cardiovascular morbidity and mortality. As cannabis legalization increases, it is crucial to understand the public health and clinical implications of marijuana use."

The researchers recruited 55 people between October 2021 and August 2024 who were outwardly healthy and either regularly smoked marijuana or consumed edibles containing tetrahydrocannabinol (THC), the primary psychoactive compound found in cannabis.

Along with decreased vascular function, marijuana smokers had changes in their blood serum that were harmful to endothelial cells, which form the inner lining of all blood and lymphatic vessels. Those who took edibles containing THC, however, did not display these changes in blood serum. It's unclear how THC damages blood vessels.

"This study enhances the understanding of the potential risks to vascular health linked to cannabis use and provides more evidence that cannabis use is not benign," the researchers concluded.

THE RISE OF HIGH-POTENCY THC

Cardiovascular issues are not the only risks associated with cannabis use, of course. Many well-meaning Americans have internalized the propaganda of the well-organized cannabis industry, suggesting that cannabis products can cause no harm and may even mitigate specific health problems such as glaucoma or anxiety disorders, despite a distinct lack of scientific evidence for such claims. In an astonishing turnaround, cannabis went from a dangerous gateway drug to a wellness product in a matter of decades.

Foundry Front Range Managing Partner Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his 2017 book Weed, Inc., he 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 average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," he wrote in Weed, Inc. In other words, cannabis products have been weaponized. Cort's 2024 follow-up book, "Weed Inked," contains further evidence that high-potency THC products are harmful to personal and public health.

Chronic cannabis use is associated with an increased risk of developing a substance use disorder (SUD) and can induce psychosis.

Cannabis Use Disorder (CUD) is a growing problem nationwide. Studies indicate increasing rates of cannabis use disorder following the legalization and commercialization of cannabis in recent years. Cannabis use disorder poses specific health challenges, including hyperemesis, psychosis, paranoia, and—as the UCSF study confirms—heart health risks.

FOUNDRY FRONT RANGE TREATS CANNABIS USE DISORDER

Foundry Front Range has specialized expertise in treating cannabis use disorder. Cannabis, which is stored in fat cells, can remain in the body and cause psychoactive effects long after a person stops consuming it. This can lead to residual effects of cannabis that must be stabilized before clients are ready to engage in treatment programming. Specialized medical attention may also be required to help people experiencing severe CUD side effects, like nausea or psychosis, feel stable and comfortable.

Because 58-plus percent of people with SUD have more than one substance use disorder, treating the effects of cannabis use disorder can be even more complex. Patients with cannabis use and at least one other substance use disorder are more likely to need more clinical attention and medical resources. They may also have home environments or relationships that make substance use seem permissible or supported, requiring family programming and education about how to build recovery-supportive environments.

Continuing care planning, which ensures that individuals have a specific ongoing care plan after completing treatment, is crucial for allowing them to navigate the fragile period of early recovery safely. As this article suggests, cannabis use disorder and other substance use disorders increase the potential for chronic health problems. With growing evidence that cannabis can affect the heart and blood flow, cardiological assessment may be advisable during and after substance use disorder treatment.

With some of the most experienced clinicians, a modern and well-equipped clinical facility, and leading experts in addiction medicine, Foundry Front Range represents a good treatment option for people experiencing Cannabis Use Disorder. To learn more, visit www.foundryfrontrange.com or call (720) 807-7867.

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“A strange thing has happened on the path to marijuana legalization. Users across all ages and experience levels are noticing that a drug they once turned to for fun and relaxation now triggers existential dread and paranoia,” wrote Malcolm Ferguson, an assistant editor at The Atlantic, in August. Like other journalists, Ferguson is beginning to realize what many addiction professionals have known for many years. Cannabis products in the United States have been weaponized on an industrial scale.

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“In 2022, the federal government reported that, in samples seized by the Drug Enforcement Administration, average levels of tetrahydrocannabinol, or THC—the psychoactive compound in weed that makes you feel high—had more than tripled compared with 25 years earlier, from 5 to 16 percent. That may understate how strong weed has gotten. Walk into any dispensary in the country, legal or not, and you’ll be hard-pressed to find a single product advertising such a low THC level. Most strains claim to be at least 20 to 30 percent THC by weight; concentrated weed products designed for vaping can be labeled as up to 90 percent.”

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NRT Behavioral Health™ managing partner Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his 2017 book Weed, Inc., he 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 average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," he wrote in Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." “Weed Inked,” Cort’s recently published “Weed, Inc.” follow-up, discusses how many of the predictions about the harmful effects of high-potency THC product commercialization and industrialization have come to pass.

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The consequences of making this largely unregulated psychoactive product available through legalization and commercialization have been devastating. 

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“In the past few years, reports have swelled of people, especially teens, experiencing short- and long-term ‘marijuana-induced psychosis,’ with consequences including hospitalizations for chronic vomiting and auditory hallucinations of talking birds,” reported Ferguson. “Multiple studies have drawn a link between heavy use of high-potency marijuana, in particular, and the development of psychological disorders, including schizophrenia, although a causal connection hasn’t been proved.”

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The wider public remains largely unaware of these significant risks. In May, the number of Americans who use cannabis daily was reported to have surpassed the number who drink alcohol that frequently for the first time in the history of the United States. As the Associated Press reported, it is “a shift some 40 years in the making as recreational cannabis use became more mainstream and legal in nearly half of US states.”

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In 2022, an estimated 17.7 million people reported using marijuana daily or near-daily compared to 14.7 million daily or near-daily drinkers, according to an analysis of national survey data. In 1992, when daily cannabis use hit a low point, fewer than one million people said they used marijuana nearly every day.

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“Cannabis is in and alcohol is out”—a preference change likely driven by Gen Z, Nikki Battiste reported for CBS News in May. The cannabis industry has mostly succeeded in convincing large numbers of Americans—particularly young people—that their potent products are harmless if not beneficial for their well-being. As a consequence, millennials and Gen Z tend to think of alcohol as harmful and marijuana as healthy. 

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After years of promoting cannabis as "medication" (although the evidence for its efficacy is mostly anecdotal) and downplaying the risks of marijuana use, the cannabis industry is close to achieving another goal. In May, the federal Justice Department proposed reclassifying the drug, saying the change would recognize marijuana’s “medical” uses and suggesting it had less potential for abuse than other illicit drugs. 

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For now, however, the federal government continues to classify cannabis as a Schedule I controlled substance with “no currently accepted medical use and a high potential for abuse.” Any reclassification is not expected before the November election. 

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Meanwhile, the National Institute on Drug Abuse (NIDA)—one of 27 institutes and centers comprising the National Institutes of Health, which is part of the US Department of Health and Human Services—informs the public on its website that “marijuana use can lead to the development of a substance use disorder, a medical illness in which the person is unable to stop using even though it's causing health and social problems in their life.” A severe cannabis use disorder (CUD) is considered an addiction. “Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder.”

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Cannabis products—especially those with dangerously high THC concentrations—also affect brain development. When people begin using these weaponized THC products as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. 

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A 2022 review study found that higher THC concentrations are now causing more people to become addicted to cannabis. “One of the highest quality studies included in our publication found that use of high potency cannabis, compared to low potency cannabis, was linked to a four-fold increased risk of addiction,” study coauthor Tom Freeman told CNN.

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Foundry Treatment Center Steamboat, part of NRT Behavioral Health, developed a specific treatment track for people affected by cannabis use disorder because the condition poses particular challenges. In 2000, Cort co-authored the first published best practices on treating CUD alongside Dr. LaTisha Bader in a medical text and reference book entitled Cannabis In Medicine and Evidence-Based Approach. He has spent the years since working to educate clinicians and medical professionals in our field on these practices. Many people experiencing cannabis use disorder suffer from extended periods of cannabis-induced psychosis and must be safely housed and medically supervised until their symptoms subside enough for them to engage in treatment programming successfully. Cannabis use disorder treatment is also an area of specialty offered by Foundry Front Range, a comprehensive residential addiction treatment program opened by NRT in August. 

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It is a move that has been expected for a long time. After years of promoting cannabis as "medication" and downplaying the risks of marijuana use, the cannabis industry is about to score another victory.

On April 30, US Attorney General Merrick Garland recommended loosening the restrictions on marijuana, a historic shift in federal drug policy that could broaden access to the drug for "medicinal" and recreational use even further and boost the cannabis industries in states where it is already legal.

"Today, the Attorney General circulated a proposal to reclassify marijuana from Schedule I to Schedule III," the Justice Department said in a statement. "Once published by the Federal Register, it will initiate a formal rule-making process as prescribed by Congress in the Controlled Substances Act." On May 13, the Drug Enforcement Administration added its support for reclassification.

The proposal, which the White House has one to three months to review, would recognize the unproven "medical" uses of cannabis and acknowledge it has less potential for abuse than some of the nation's most dangerous drugs. However, it would not legalize marijuana outright for recreational use on a federal level. 

The proposed change could nevertheless increase the profits of the cannabis industry dramatically. Unsurprisingly, industry leaders believe that declassifying cannabis altogether, as opposed to reclassifying it, would be even better.

The FDA has approved just one drug, the epileptic seizure treatment Epidiolex, that contains CBD derived from cannabis plants. It has also approved three drugs containing synthetic THC compounds to treat nausea associated with cancer treatment and reduce wasting associated with HIV/AIDS. Like all prescription drugs, these FDA-approved medications are prescribed by doctors to treat very specific medical conditions. 

By contrast, “medical” cannabis can only be recommended by doctors to address a range of ailments. Research on other claimed medical and health benefits of marijuana is scant to non-existent, while the negative effects of mass consumption are becoming more and more evident in states that have legalized cannabis. One of those states is Colorado, where Chuck Smith, who leads an alliance of cannabis business executives, described rescheduling as progress.

"The HHS rescheduling recommendation marks a historic step toward federal cannabis policy reform," Smith said. "For over a decade, Colorado has been demonstrating states' ability to effectively regulate cannabis for medical and broader adult use, and it's time for federal law to reflect that reality. State-legal cannabis businesses that create jobs, pay taxes, and provide adults and medical patients with safe and legal access to cannabis deserve to be treated fairly, and this would be a big step in that direction."

Legalization in states across the nation has fueled rapid growth of the marijuana industry, with an estimated worth of nearly $30 billion. Rescheduling cannabis could reduce the tax burden by allowing deductions unavailable for a Schedule I substance. There are fears that rescheduling cannabis could now open the door for large pharmaceutical companies and other major corporations to take over the industry.

NRT Behavioral Health™ President Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his book Weed, Inc., 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 dangerously high THC content of today's cannabis products.

THC (delta9-tetrahydrocannabinol) is the main psychoactive ingredient in marijuana, and THC levels in cannabis products have dramatically increased in the last few decades from less than one percent THC in the seventies to well beyond 15 percent in recent years. And that's just the plants—concentrates can reach much higher levels of THC. 

"The average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," Cort wrote in Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." 

The National Academies of Science pointed out that despite a growing acceptance of marijuana in many states, "evidence regarding the short- and long-term health effects of cannabis use remains elusive" and that "no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively."

A 2020 letter from the director of the National Institute on Drug Abuse said, "Marijuana impairs short-term memory and judgment and distorts perception" and, as a result, "can impair performance in school or at work and make it dangerous to drive."

Although it is illegal for Coloradans under 21 to buy, have, or use retail marijuana, and it is a felony for anyone to give, sell, or share marijuana with anyone under 21, teenage consumption and addiction are on the rise. 

A 2021 systematic review found that past-year cannabis vaping nearly doubled from 2017 to 2020 in adolescents - jumping from 7.2 percent to 13.2 percent," warned Ty Schepis, a professor of psychology at Texas State University, in a recent article for The Conversation. "A more recent study in five northeastern US states found that 12.8 percent of adolescents vaped cannabis in the past 30 days, a more narrow time frame that suggests potential increases in use. In addition, a 2020 study found that one-third of adolescents who vape do so with cannabis concentrates."

The notion that Colorado is effectively regulating the medical adult use of cannabis seems to provide a partial view of cannabis use within the state by not also acknowledging widely accepted concerns about the negative effects of use and increased underage use. However, the state may only be providing minimal resources when it comes to regulating adult cannabis use, according to Ben Cort’s forthcoming sequel to “Weed, Inc.” The book also talks about how the state’s Marijuana Enforcement Division (MED), which is tasked with regulating commercial cannabis, seems primarily to be a recruiting apparatus to help grow Colorado’s commercial THC industry.

Cannabis misuse by adolescents is dangerous because it can alter the way their brains develop, explained Schepis. "Research shows that the brains of adolescents who use cannabis are less primed to change in response to new experiences, which is a key part of adolescent development. Adolescents who use cannabis are also more likely to experience symptoms of schizophrenia, struggle more in school, and engage in other risky behaviors."

Smart Approaches to Marijuana (SAM) President Kevin Sabet, a former White House drug policy advisor to Presidents Obama, Bush, and Clinton, issued the following statement:

"Politics and industry influence have loomed over this decision from the very beginning. [...] Now, against the recommendations of prior Attorneys General, the medical community, and law enforcement, the Administration unilaterally reversed decades of precedent despite volumes of data confirming marijuana's harmfulness. Moreover, a drug can be taken off Schedule I only if it has accepted medical use—raw, crude marijuana has never passed safety and efficacy protocols. A drug isn't medicine because it's popular."

"Medical and scientific studies, as well as government data, have conclusively linked THC drugs with addiction, psychosis, schizophrenia, depression, anxiety, suicidality, and IQ loss, among other impacts," Dr. Sabet wrote. "The Administration's effort to push through this action in an election year could be perceived as a thinly veiled attempt to reverse polling trends with the principal targets of the pot industry, namely young people."

Ben Cort also believes that the decision is “a reflection of politics rather than medical science. I’ve had several conversations with the nation’s thought leaders and researchers since this recommendation was leaked. They all agreed that there is no science to support the decision, while there are a lot of scientific indicators encouraging a much more careful and deliberate approach.” 

“This is a tight election year and somebody did the math on how many swing votes this might pull for the current administration,” says Cort. “We still haven’t learned our lesson as a nation that thoughtless engagement with psychoactive intoxicants doesn’t end well. We still haven’t understood that bad things happen when corporations sell things that have addictive potential.”  While groups promoting the purchase and use of THC products continue to get their way, across-the-board decriminalization of drug possession and use has seen some pushback lately. 

Marijuana use can lead to the development of cannabis use disorder (CUD), which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use THC products may have some degree of marijuana use disorder. People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.

At a time when growing evidence suggests that cannabis legalization and commercialization are making potentially dangerous products more available, increasing accidental THC poisonings and other adverse health events, and are not resulting in the promised financial boons to cannabis business owners or states where cannabis is legal, rescheduling could exacerbate these problems. 

Regardless of whether rescheduling cannabis changes the way it is sold, the move is likely to reduce further the perceived dangers associated with cannabis use. Research suggests that young adults are more likely to use cannabis after it is legalized because they perceive it as less dangerous. 

Rescheduling cannabis could send an even more significant signal to people that cannabis is not harmful, which may further increase its use. The same study suggests that increased use by adolescents and young adults could stimulate cannabis use disorder while making it less likely that they seek treatment. 

The behavioral healthcare field is seeing more patients presenting with cannabis use disorder and complex cases linked to high-potency THC use that are difficult to treat. Rescheduling could result in more people than ever before believing that cannabis use is without risks while THC products are more potent than ever, a situation that may lead to more problematic cannabis use with implications for individuals, families, and communities nationwide. 

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It was supposed to be the panacea for the opioid epidemic. If you decriminalize drug possession and get people with substance use disorder (SUD) into treatment, the crisis will go away. Except, it didn’t.

“When Oregon embarked on a landmark plan three years ago to decriminalize hard drugs, it wagered that a focus on treatment over punishment would create a new model for drug policy around the country,” Mike Baker reported for The New York Times earlier this month. “But after a deluge of overdose deaths and frequent chaos in the streets of Portland, Gov. Tina Kotek signed into law […] a measure to restore criminal penalties for drug possession.”

The new law rolls back a 2020 voter-approved measure by making so-called personal use possession a misdemeanor punishable by up to six months in jail. It also establishes ways for treatment to be offered as an alternative to criminal penalties by encouraging law enforcement agencies to create deflection programs that would divert people to treatment services instead of the criminal justice system.

Measure 110, approved by voters with 58 percent support in 2020, made the personal use possession of illicit drugs such as heroin, cocaine, and methamphetamine only punishable by a ticket and a maximum fine of $100. Supporters said treatment is more effective than jail in helping people overcome addiction and that the decades-long approach of arresting people for possessing and using drugs hasn’t worked.

Farther north, British Columbia became the first province in Canada last year to decriminalize the use of hard drugs as part of its efforts to tackle its deadly opioid crisis. But there, too, the policy is now facing pushback, leaving its future uncertain.

Portugal was the trailblazer for this approach, but the European country has also had second thoughts lately. “Portugal decriminalized all drug use, including marijuana, cocaine, and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime,” reported Anthony Faiola and Catarina Fernandes Martins in The Washington Post last year.

“Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but [...] some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades and the state-funded nongovernmental organizations that have largely taken over responding to the people with addiction seem less concerned with treatment than affirming that lifetime drug use should be seen as a human right.”

Clearly, decriminalization has not ended Portugal’s drug problem. Overdose rates hit 12-year highs and almost doubled in Lisbon from 2019 to 2023. Sewage samples in Lisbon show cocaine and ketamine detection is now among the highest in Europe.

It seems that in all three places—Portugal, British Columbia, and Oregon—decriminalization primarily brought drug use out in the open without actually curbing it. So, why didn’t it work?

“Measure 110 did not reduce Oregon’s drug problems,” wrote Keith Humphreys and Rob Bovett in a recent analysis piece in The Atlantic. “The drug overdose death rate increased by 43 percent in 2021, its first year of implementation—and then kept rising. The latest CDC data show that in the 12 months ending in September 2023, deaths by overdose grew by 41.6 percent, versus 2.1 percent nationwide. No other state saw a higher rise in deaths. Only one state, Vermont, ranks higher in its rate of illicit drug use.”

It appears the notion that decriminalization will induce a flood of help-seeking from people with addiction was hopelessly naive. “The replacement for criminal penalties, a $100 ticket for drug possession with the fine waived if the individual called a toll-free number for a health assessment, with the aim of encouraging treatment, failed completely,” wrote Humphreys and Bovett. “More than 95 percent of people ignored the ticket, for which—in keeping with the spirit of Measure 110—there was no consequence.”

Humphreys and Bovett have spent the better part of their careers studying and working on drug policy and were not surprised that “trivial pressure” to seek treatment proved ineffective. “Fentanyl and meth addiction are not like depression, chronic pain, or cancer, conditions for which people are typically motivated to seek treatment. Even as it destroys a person’s life, addictive drug use by definition feels good in the short term, and most addicted people resist or are ambivalent about giving that up. Withdrawal, meanwhile, is wrenchingly difficult. As a result, most addicted people who come to treatment do so not spontaneously but through pressure from family, friends, employers, health professionals, and, yes, the law.”

The reporters contend that Oregon didn’t even need Measure 110 as “a rebuke to the War on Drugs” because Oregon “had never fought such a war.” The state had the country’s “lowest rate of imprisonment for nonviolent crimes. Short local jail sentences for drug possession were permitted, but diversion programs, including drug courts and community supervision with drug testing, were widely used. However, after Measure 110 was passed and the threat of jail time eliminated, the flow of people into these programs slowed.”

Humphreys and Bovett do not advocate a return to severe crackdowns by the justice system. “Many states are far more punitive toward drug users than Oregon was before Measure 110 passed. They overemphasize incarceration of people who use drugs, they do not provide adequate, publicly funded health treatment and health insurance, and they do not use criminal justice productively to discourage drug use (for instance, by using arrests and probations as leverage to get people into drug courts and treatment).”

If these states could be persuaded to dial down their overly harsh criminal-justice approach to approximate what Oregon had before Measure 110, “except with adequately funded, evidence-based prevention and treatment, substantial gains in public health and safety would likely follow,” they feel. “The future of successful drug-policy reform is not greater laxity in states that are already quite progressive in their approach to drug use; it is using criminal justice and public health together in a balanced, pragmatic fashion, as Oregon is now poised to do.”

While the decriminalization of heroin, cocaine, and meth was based on naive assumptions about addiction, at least proponents have not attempted to declare these substances to be harmless or even good for your health. In the case of the legalization and commercialization of cannabis, that is exactly what happened.

In Colorado, cannabis has been legal for “medical” use since 2000 and for recreational use since late 2012. On November 7, 2000, 54 percent of Colorado voters approved Amendment 20, which amended the state constitution to allow the use of marijuana in the state for approved “patients” with written “medical consent.” Twelve years later, that medical figleaf was dropped with Amendment 64, which led to full recreational legalization in December 2012 and state-licensed retail sales in January 2014.  

The impact has been widespread and negative. Few people are aware that marijuana legalization is largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. Foundry Treatment Center Steamboat Managing Partner Ben Cort has been raising awareness of these issues for years. In a webinar last year, 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 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 2023 than in 2019. It has been estimated that approximately three in ten people who use marijuana have a cannabis use disorder.

Despite the addiction risk, Colorado is still expanding the availability of cannabis. Since January, retail marijuana stores have been allowed to accept payment for products ordered online. Online ordering became legal in Colorado late last year, but customers still had to pay for their orders in person.

American Heart Association warned last year that marijuana use is linked with an increased risk of heart attack and heart failure. “As more people across the US use marijuana, [...] two new studies suggest its regular intake may damage heart and brain health. In one study, daily use of marijuana raised the risk of developing heart failure by about one-third, even after considering other factors, compared to people who reported never using marijuana. In a second study, older people with any combination of Type 2 diabetes, high blood pressure, and high cholesterol who used marijuana, significantly increased their risk for a major acute heart or brain event while hospitalized, compared to those who reported not using marijuana.”

Legalizing dangerous substances like cannabis because people bought into claims of unproven medical benefits or tolerating the illegal use of heroin and cocaine in the hope that people addicted to these drugs will simply come forward asking for treatment without any encouragement is a path fraught with dangers as it turned out. Addiction is a complex bio-psycho-social disease characterized by the continued use of psychoactive substances or the continuation of addictive behaviors despite negative consequences.

Addiction is frequently driven by underlying trauma and depression, and simply decriminalizing maladaptive attempts to self-medicate such underlying conditions does nothing to address them. Treating a severe substance use disorder often requires the concerted efforts of the affected individuals, their families, and a team of treatment professionals addressing the root causes of the SUD.

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Many Americans are not aware of the grave dangers cannabis use can entail. Ever since the nationwide—if not international—movement to promote marijuana as a healthy substance or even as a medication succeeded beyond its wildest expectations, the risk awareness connected to the use of THC (delta9-tetrahydrocannabinol), the main psychoactive ingredient in cannabis, has been steadily eroded.

Twenty-four states (plus Guam, the Northern Mariana Islands, the US Virgin Islands, and the District of Columbia) now allow the recreational use of cannabis, and around a dozen states, plus Puerto Rico, allow the "medical" use of cannabis products. However, the federal government continues to categorize marijuana as 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. As of this writing, the recommendation of federal scientists and associated reporting indicate that cannabis may be rescheduled to a lower schedule, a move that could further relax cannabis prohibitions.

Addiction—a severe cannabis use disorder—is not the only risk. Marijuana use can also result in acute psychosis and violent behavior with devastating consequences.

In January, Los Angeles television station KTLA reported on a manslaughter case in which a man was stabbed to death by a Ventura County woman after both used cannabis together.
In May 2018, 32-year-old Bryn Spejcher killed 26-year-old Chad O'Melia after taking several hits from a bong filled with marijuana. Spejcher reportedly experienced an adverse reaction resulting in a cannabis-induced psychotic episode. During that psychotic break, she stabbed O'Melia multiple times, eventually killing him. She also stabbed herself repeatedly, officials said.
According to KTLA, police officers arrived the next morning at O'Melia's apartment to find him "in a pool of blood and Spejcher screaming hysterically while still holding a knife in her hands. As officers tried to disarm her, Spejcher plunged the knife into her neck, authorities said."
Officers had to use "a taser and several baton blows before they were able to finally disarm Spejcher," police said. "A long-serrated bread knife was taken from her hands." Spejcher, who had been dating the victim for a few weeks, was found to have stabbed O'Melia 108 times with three different knives.  

On January 23, a judge sentenced Spejcher to two years of felony probation and no prison time. She had been out on bail since the 2018 slaying. She had faced up to four years in prison along with sentence enhancements. However, the judge cited evidence and expert testimony, saying the defendant did not know marijuana would have this type of effect on her when she smoked with the victim that night.

Family members of Chad O'Melia expressed outrage at the leniency of the sentence and said they were worried about the broader impact of this ruling.  

NOT YOUR PARENTS’ WEED
The core of the problem is that most people don't know that today's cannabis products are largely unregulated and extremely potent. They don't believe that marijuana use can result in psychosis or violent behavior, and they have uncritically absorbed the claims promoted by the cannabis industry of unproven medical benefits of marijuana use for various ailments. Hence, the excuse that a defendant cannot know marijuana would have a murderous effect.  
The effect is well known, however. "Cannabis is involved in approximately 50 percent of psychosis, schizophrenia, and schizophreniform psychosis cases," wrote Shrivastava, Johnston, et al. in a 2014 study on the neurobiology of cannabis and psychosis.

A recent article in the Wall Street Journal pointed out that "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."  

Foundry Treatment Center Steamboat CEO Ben Cort has been warning for years that the legalization of cannabis has been largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. "The average cannabis product sold in Colorado in 2016 had a THC content of 63 percent," he explained in a webinar last year. In the 1970s, "weed" contained roughly 1–3 percent THC.

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

CANNABIS AND VIOLENT BEHAVIOR
"According to research studies, marijuana use causes aggressive behavior, causes or exacerbates psychosis, and produces paranoia," wrote Miller, Ipeku, and Oberbarnscheidt in a 2020 study on marijuana use and violence. They, too, noted that marijuana products are far more potent in THC concentrations than they used to be. "Accordingly, and demonstrated in direct studies, more potent marijuana results in a greater risk for paranoid thinking and psychosis. In turn, paranoid behavior increases the risk for paranoid behaviors and predictably associated with aggressive and violent behaviors."

In their study, Miller et al. presented many case examples, one of which pertained to Nikolas Cruz, who killed 17 students and staff at the Marjory Stoneman Douglas High School in Parkland, Florida, in 2018. "Cruz was diagnosed as developmentally delayed at age three and had numerous disciplinary issues dating to middle school. From a young age, he started consuming marijuana heavily." He would "frequently 'hear demon voices' and would consume large amounts of marijuana to try and silence those voices. He also attempted suicide. During an interview after his mass shooting, he stated that he used a lot of marijuana as well as [the] prescription tranquilizer Xanax."

In May 2017, Richard Rojas purposely drove a car along three blocks of pavement in New York's Times Square, killing a teenager and injuring 22 other people. "Evidence indicates that Rojas was a heavy marijuana user. He admitted to the consumption of spiced-up marijuana right before committing the attack," reported Miller et al. in their study.

The year before, Arcan Cetin carried out a mass shooting that killed five people and injured many others at the Cascade Mall in Washington, DC. "Evidence indicates that Cetin was a heavy marijuana consumer. Further, he had a past of violent behavior, with some incidents including the consumption of marijuana."

Twenty-one-year-old white supremacist Dylan Roof murdered nine black people who were attending a prayer service in Charleston, South Carolina, in 2015. His declared intention was to start a race war. His acts were preceded by years of substance misuse. Reports revealed that Roof's drug use started at the age of twelve when he would smoke marijuana three times a day.
Dzhokhar Tsarnaev and his brother Tamerlan, who killed three people and injured more than 250 in the 2013 Boston Marathon bombing, were heavy marijuana users since they were young teenagers.

In the cases presented by the authors, "one of the recurring conditions that most likely led perpetrators to commit violence was paranoia… It is very likely that marijuana played an active role in these people's paranoia, considering that the chemical composition of the drug has compounds that alter a person's perception of reality."

The authors note that "marijuana intoxication results in panic reactions and paranoid feelings whose symptoms lead to violence. The sense of fear, loss of control, and panic are associated with violence. Also, marijuana use increases heart rate, which may be associated with violent behavior."

When people stop using marijuana, they may experience a variety of withdrawal symptoms, including sleep disturbance, irritability or restlessness, loss of appetite, anxiety, and sweating. "Experiencing any of these symptoms can make a person angry, ranging from mild irritation to violent rage," explained Miller, Ipeku, and Oberbarnscheidt. "Marijuana withdrawal can lead to intimidating violent or bullying behavior, endangering the perpetrator or other people and property."

In the case of Bryn Spejcher and Chad O'Melia, the use of high-potency THC sadly also resulted in a psychotic break and the death of a human being. "We now have concentrated THC products such as oil, shatter, dab, and edibles that have been able to get the THC concentration upwards of 95 percent. There is absolutely no research that indicates this level of THC 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," wrote Elizabeth Stuyt, MD, in "The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist."

Foundry Treatment Center Steamboat treats adults experiencing cannabis use disorders and other substance use and co-occurring mental health disorders. While cannabis has long been one of the substances used by people suffering from substance use disorders, Foundry Steamboat clinicians have seen significant increases in the acuity of symptoms arising from problematic cannabis use. High-potency THC products, like other psychoactive substances, pose unique health risks, including the potential to cause or exacerbate paranoia, psychosis, hyperemesis, anxiety disorder, and more. While violence and severe adverse mental health impacts resulting from cannabis use affect a small percentage of cannabis users, it seems that these potential harms should be better known. It is also worth noting that treating cannabis use disorder and its co-occurring mental health disorders can be especially challenging. Patients experiencing psychosis, paranoia, or heightened anxiety related to cannabis use may require more treatment than people not experiencing these conditions.

Despite growing evidence that today's high-potency THC products pose specific health risks, reporting indicates increasing rates of adolescent and teen consumption, and states and the federal government seem likely to reduce further cannabis restrictions to expand commercial access.

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