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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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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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The USFood and Drug Administration (FDA) has not approved the use of cannabis as a treatment for any medical condition. However, after a long legalization campaign, most states now allow "medical" use of marijuana to treat pain, nausea, and other conditions. Twenty-three states, theDistrict of Columbia, and Guam have fully legalized the drug for recreational use as public support for legalization rose rapidly—despite marijuana being illegal at the federal level.

Cannabis sativa (the marijuana plant) contains many active compounds. The best known aredelta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary ingredient in marijuana that makes people "high."

Today, many Americans believe in the unproven health benefits of cannabis, but few people know about the danger of addiction and other health impacts of marijuana use. The FDA continues to classify cannabis as a Schedule I controlled substance "with no currently accepted medical use and a high potential for abuse." Recent research estimates that approximately three in ten people who use marijuana have cannabis use disorder (CUD). For people who begin using cannabis products before the age of 18, the risk of developing a marijuana addiction is even greater.

Among the many risks and possible side effects of "medical" marijuana, the Mayo Clinic lists  

increased risk of heart attack and stroke, potential for addiction, hallucinations or mental illness, and withdrawal symptoms.

FoundryTreatment Center Steamboat CEO Ben Cort has raised awareness of these health risks for years. In a recent webinar forHarmony Foundation, Cort pointed out that the THC levels in cannabis products have dramatically increased in the last few decades from less than one percentTHC in the seventies to well beyond 40 percent in recent years. And that's just the plants—concentrates and other products can reach 99 percent THC. 

Cort doesn't really want to talk about the plant anymore because the people who are treated at Foundry Treatment Center Steamboat for CUD have not been smoking the pot passed around in the 1970s. "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 his 2017book 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." Cort will publish a new book in 2024 that focuses, in part, on the wide-ranging effects of expanded cannabis commercialization since the release of his first publication.

One group of individuals regularly self-medicating with cannabis is people with anxiety. "Lots of people with anxiety are counting on cannabis's ability to treat their symptoms," wrote Andrea Petersen and Julie Wernau in the Wall Street Journal in October. But "there's a problem: The science shows that it probably doesn't help, and it may make those symptoms worse."

The cannabis industry is promoting its products as helpful for anxiety because it's a very lucrative market. "Anxious consumers have turned to weed and edibles for relief as treatments for their ailments have become harder to find," wrote Petersen and Wernau. "The number of available and affordable therapists badly lags demand, and traditional medications don't work for everyone."

Petersen has personal experience with anxiety issues and cannabis use. In her 2017book On Edge – A Journey Through Anxiety, she used that experience and her expertise as a health reporter to explore the nature of anxiety and its treatment options. 

WhenPetersen smoked marijuana in college, she experienced a psychotic episode and had a panic attack. She didn't try to self-medicate with cannabis again. Sheavoided alcohol, too, realizing that her abstention was not typical. "Many people with anxiety disorder drink to relax, a way of self-medicating."

In OnEdge, Petersen also recalled the example of her friend Mike, who turned toalcohol and drugs to try to ease his anxiety and depression. "For Mike,marijuana and narcotics like Vicodin were a revelation," she wrote."They took away the worrying. They calmed his twitchy body." Itdidn't last, of course. "After a while, the marijuana turned on Mike. Itstarted making him more anxious. His drinking and use of narcotics slid intoaddiction. He went to rehab. He relapsed. He kicked the drugs and alcoholagain." 

Manyusers want to believe that cannabis can make them less anxious, and themarijuana industry is more than happy to accommodate that belief. "Yetlittle independent scientific evidence shows that cannabis is an effectivetreatment for anxiety problems, and some studies have found it can worsensymptoms," wrote Petersen and Wernau. "Researchers say this isparticularly true for products high in THC, the substance responsible formarijuana's intoxicating effects."

"Ihave patients who use it every day. They say it really helps," BethSalcedo, a psychiatrist and medical director of the Ross Center in Washington,DC, who specializes in treating anxiety disorders, told the Wall StreetJournal. "My message is that if it were really working for you, youwouldn't be here with me."

WhenDr. Salcedo talks with patients about what their anxiety was like before cannabis, she said they usually report that their anxiety is unchanged. Any transient relief they feel may be due in part to marijuana's high, she said.

Cannabis is big business. Anxiety is one of the most common symptoms that customers of cannabis dispensaries are looking to address. Several states have made anxiety a qualifying condition to receive a "medical" marijuana card despite there being any supporting evidence to support this. 

"Two recent studies show the potential problems with treating anxiety with cannabis," explained Petersen and Wernau. "Cannabis use was significantly associated with increased odds of developing anxiety conditions, according to a review of research published in 2020 in the Canadian Journal ofPsychiatry. Recent cannabis use was associated with more severe symptoms in people with anxiety and mood disorders, according to another review published in 2018 in the Journal of Clinical Psychiatry."

Unsurprisingly, the marijuana industry has funded its own studies. In some surveys, cannabis users have reported that they have felt relief from anxiety symptoms after consuming cannabis. "There is some evidence that cannabidiol, or CBD, which is a nonintoxicating substance derived from cannabis, may relieve anxiety symptoms," reported Petersen and Wernau. However, the science is limited and does not support the use of THC to relieve symptoms. 

While the benefits are questionable, the risks are clear. "Using cannabis regularly comes with a significant risk of addiction," wrote the WallStreet Journal reporters. "Marijuana use can become a disorder when people need to use an increasing amount to get the same effect and when the use interferes with work and relationships, among other symptoms."

Marijuana users also run a higher risk of psychosis. "Research has shown that cannabis use is associated with an increased risk for an earlier onset of psychotic disorders (such as schizophrenia) in people with other risk factors, such as family history," according to the National Institute on Drug Abuse(NIDA). "Cannabis intoxication can also induce a temporary psychotic episode in some individuals, especially at high doses. Experiencing such an episode may be linked with a risk of later developing a psychotic disorder."

Cannabis use disorder is a potentially serious condition frequently requiring treatment. "At Foundry Treatment Center Steamboat, we treat patients whose CUD was dismissed as 'only weed' because much of our society does not recognize cannabis as an addictive substance," says Cort. "One of the most pernicious effects of the cannabis industry's strategy of positioning the drug as medicine is that people generally believe that it is safe or poses no significant health risks. This extends to perpetuating the long-held belief that cannabis can provide a form of mental and physical relaxation. While this may be the case for some users, others have the opposite experience, and it can lead to very real and serious medical and mental health problems. The problem with allowing those profiting from the sale to define its uses is that they will always only tell one side of the story unless compelled to tell the entire story. Without considering negative, potentially negative, and unknown effects, it's like telling the story of Jack and The Beanstalk without the giant,"says Cort.

FoundryTreatment Center Steamboat developed a specific treatment track for people affected by cannabis use disorder (CUD) because the condition poses specific challenges. In 2000, Ben 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 start treatment programming.

“More Americans than ever are dying fromfentanyl overdoses as the fourth wave of the opioid epidemic crashes throughevery community, in every corner of the country,” reported Nadine Yousif on BBC News in September.

A recent study by researchers at theUniversity of California, Los Angeles, outlined the four waves: “The UnitedStates overdose crisis has escalated in an exponential fashion for over fourdecades, yet with a shifting profile of drugs implicated in each successive ‘wave’of the crisis. The first wave of the overdose crisis is typically argued tohave begun in the late 1990s or early 2000s with the rise of deaths involvingprescription opioids, the second wave beginning in 2010 driven by a shift toheroin, and the third wave beginning in 2013 driven by illicit fentanylanalogs. Recently, scholars have argued that the ‘fourth wave’ of the USoverdose crisis has begun, in recognition of rapidly rising polysubstanceoverdose deaths involving illicitly manufactured fentanyl, with stimulantsplaying a key role.”

In 2018, in a rare moment of bipartisanship,Republicans, Democrats, and former President Trump came together aroundlegislation that dedicated $20 billion to the treatment and prevention of andrecovery from drug addiction. Five years later, the SUPPORT Act has lapseddespite the fact that the number of Americans dying from drug overdoses hasincreased by more than 60 percent in those five years—largely driven by thepowerful synthetic opioid fentanyl.

“We are in the middle of a crisis ofproportions we couldn’t have imagined even five years ago when the originalSUPPORT Act was passed,” Libby Jones, program director of the OverdosePrevention Initiative at the Global Health Advocacy Incubator, told Politico. “If they can’t pass this, it’sreally sad.”

“Community-based organizations are on thefrontlines of the overdose crisis, and the SUPPORT Act delivers crucial fundingand resources, allowing them to continue providing hands-on overdose preventioncare,” Libby Jones, the program director of the Overdose Prevention Initiativeat the Global Health Advocacy Incubator explained on a Johns Hopkins webpage. “Some of the originalprovisions in the 2018 SUPPORT Act saw modest increases, while others sawsizeable expansion of funding.”

Highlights of the SUPPORT Act include:

●     Funding for communities ofrecovery was raised by $11 million each year (from $5 million to $16 millionfor each of the fiscal years 2024 through 2028).

●     Residential treatment programs forpregnant and postpartum people saw an increase in funding of $9 million yearly(from $29,931,000 to $38,931,000 for each of the fiscal years 2024 through2028).

A few days ago, the 2018 SUPPORT Act expired,and it doesn’t look like Congress is coming to the rescue any time soon. TheHouse just restarted legislating after emerging from 22 days without a speaker.“Despite its dysfunction, the House is further along legislatively than theDemocratic-controlled Senate,” wrote Carmen Paun on Politico. “The House Energy andCommerce Committee unanimously approved a new SUPPORT Act in July. But thatmeasure’s limited ambition suggests a reason for the lack of urgency to passit.”

A bipartisan group of representatives focusedon mental health and substance use has proposed more than 70 bills to fight theoverdose crisis. Still, there hasn’t been the sense of urgency lawmakersdisplayed five years ago.

While some have hailed the SUPPORT Act as asignificant accomplishment, it has barely made a dent in the drug overdoseepidemic. “Over 100,000 deaths is not a success in this country. It’s not apolicy success,” Regina LaBelle, a former White House Office of National DrugControl Policy acting director, told Politico.

Addiction is an extremely complex diseasedriven by complicated bio-psycho-social aspects. Allocating funds to a fewgroups and organizations can only be a small part of the solution.

“When addiction epidemics strike, we want toknow why,” wrote psychiatry professor Carl Erik Fisher in his sweeping 2022analysis of the addiction crisis, The Urge. But a complex situation with amultitude of factors is too often reduced to a simplistic scenario. “What isnecessarily a complex web of intersecting forces is too often reduced to onesimplistic story: trauma, brain disease, an evil and unstoppable drug, a badpill-mill doctor, a hereditary taint, or a weak will, or poor morals.”

While certain pharmaceutical, alcohol,cannabis, and tobacco industries cannot exactly be viewed as blameless—Fisherregards many such companies as “addiction supply industries”—they are only partof the problem. “Epidemics are never caused solely by an inherent power of thedrugs themselves or the efforts of the addiction supply industries; there isoften if not always, social wounding underneath, driving the substance use.”

The combination of social disconnection,anxiety, depression, and substance misuse can expose individuals to seriousphysical and mental health risks. People with substance use disorder needcomprehensive treatment to address all relevant concerns.

Foundry Treatment Center Steamboat ChiefOperating Officer Tom Walker is well-versed in the effects of governmentpolicies and funding on population health. “Our legislators need to prioritizethe continuation of the SUPPORT Act or legislation like it to ensure thatresources exist to fight the nation’s leading cause of preventable death. Ourelected officials and government departments responsible for allocating fundsshould look carefully at the social determinants of health that lead to theastonishingly high and deeply troubling rates of mental and behavioral healthdisorders we are facing. Funding treatment is important, but understanding andstemming the underlying factors contributing to intensifying and rampantanxiety, depression, trauma, hopelessness, homelessness, and family systemdysfunction is also critical,” says Walker.

Foundry Treatment Center Steamboat operates aspecialized treatment program for men experiencing substance use andco-occurring mental health disorders. Its parent company, NRT Behavioral Health^TM,also operates intensive outpatient and telehealth services for adults inColorado and Wyoming. These programs focus on helping individuals and familiesidentify the root causes that lead to the development of substance use andco-occurring mental health disorders, learn ways to manage these issues, andreduce the stressors that perpetuate a perceived need to use substances to feelnormal or escape overwhelming distress and pain.

This article includes the topic of 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.

Suicides in the US reached an all-time high in 2022, according to new data provided by the Centers for Disease Control and Prevention (CDC). According to provisional findings from death certificates, about 49,449 people took their own lives last year, an estimated 3 percent increase compared to 2021.

KFF, an independent source for health policy research, notes that “Increases in the number of suicide deaths follow high levels of mental health symptoms during COVID, rising financial stressors, and longstanding difficulty accessing needed mental health care—particularly for some populations. Total suicide numbers may be undercounted, as some research suggests that suicides may be misclassified as drug overdose deaths since it can be difficult to determine whether drug overdoses are intentional.”

“The largest increases were seen in older adults,” reported NBC. Deaths rose nearly seven percent in people ages 45 to 64 and more than eight percent in people 65 and older. White men, in particular, have very high rates, the CDC reported. The suicide rate among males in 2021 was approximately four times higher than the rate among females. Males make up about half of the US population but nearly 80 percent of suicides.

As we reported on this blog, men are also much more prone to drug overdose deaths than women, and the fatalities are not always accidental. Another important factor is the wide availability of firearms. According to an analysis by the Johns Hopkins Bloomberg School of Public Health, “Gun suicides continued to reach all-time highs, increasing 1.6 percent from a previous record in 2021; 26,993 people died by gun suicide in 2022.”

“While the increase in gun homicides has gained public awareness, less attention has been paid to the growing epidemic of gun suicides—which historically make up the majority of gun deaths. The gun suicide rate has steadily increased, nearly uninterrupted, since 2006. In 2021 it reached the highest level since the CDC began recording such data in 1968; and this past year, in 2022, it surpassed that record,” the JHU researchers wrote.

The current epidemic of suicides by white, middle-aged men is correlated with an epidemic of loneliness. Approximately one in five American men say they do not have a close friend, according to the Survey Center on American Life's May 2021 American Perspectives Survey. “Only 30 percent of men reported having a private conversation with a close friend when they divulged personal emotions in the past week,” wrote psychiatry professor Charles Hebert in Newsweek in 2022.

Earlier this year, US Surgeon General Vivek Murthy issued an advisory on the “healing effects of social connection,” in which he warned that “about one-in-two adults in America reported experiencing loneliness” in recent years. “Loneliness is far more than just a bad feeling—it harms both individual and societal health,” Dr. Murthy wrote. “It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day and even greater than that associated with obesity and physical inactivity.”

Loneliness, social disconnection, anxiety, depression, and other stressors can lead to substance misuse and, ultimately, suicide. “There is considerable evidence from population-based and clinical studies supporting a positive association between psychosocial adversity, negative affect, and chronic distress, and addiction vulnerability,” stated Rajita Sinha in a 2009 study entitled “Chronic Stress, Drug Use, and Vulnerability to Addiction.”

Addressing social isolation and chronic distress usually requires people to seek help — an act that some men see as a weakness. “Men are socialized to not ask for help or be vulnerable—and they can be penalized when they challenge this notion,” wrote David Mayer in Harvard Business Review in 2018. “An informative set of studies from 2015 finds that when male (but not female) leaders ask for help, they are viewed as less competent, capable, and confident. And when men make themselves vulnerable by disclosing a weakness at work, they are perceived to have lower status. This is problematic, as not seeking help when you need it or admitting areas for improvement inevitably leads to mistakes and less development.”

The combination of social disconnection, anxiety, depression, and substance misuse can expose individuals identifying as male to serious physical and mental health risks. Men with substance use disorder need comprehensive treatment to address all relevant concerns.

Foundry Treatment Center Steamboat operates a specialized men’s treatment program for adult males experiencing substance use and co-occurring mental health disorders. The program regularly treats men struggling with feelings of isolation, loss, trauma, and hopelessness. As previously reported by Foundry Steamboat, many of the men the program serves perceive a lack of purpose and meaning, which can contribute to relationship problems and depression.

“Living with active substance use disorder — even before someone knows that they have a problem — can cause extreme isolation and loneliness. Addiction destroys relationships and separates people from the very people best positioned to help them. Men with addiction are at especially high risk of suicidal ideation and suicide attempts for numerous reasons. We regularly use symptom rating scales to assess client depression and suicidality to ensure that they are getting the clinical and psychiatric help they need to feel better while they pursue recovery. We also build strong therapeutic relationships with clients and get to know them and their situations,” says Foundry Steamboat Chief Clinical Officer Michael Barnes, Ph.D.

“The need to assure that men feel a sense of belonging and know that they have peers with whom they can have a conversation about how they are feeling is a central reason for our alumni program and why we encourage clients to find a community-based support group that suits them. Suicide is very often preventable if people feel authentically connected and are able to self-regulate their emotions, and it is a problem directly related to addiction that requires vigilance and study.”

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Unions and the leadership responsible for protecting the health and wellness of their members can play essential roles in addressing America’s addiction epidemic and changing public perception about the disease. Since its inception, organized labor has empowered workers to negotiate better wages, insurance benefits, paid leave, and safety standards. In recent years, unions have also begun to tackle one of America’s most formidable health problems — addiction.

The National Labor Relations Act of 1935 legalized unions in the United States. Union density, the percentage of union employees, peaked at 35 percent in 1954, and more than 20 million Americans belonged to a union in 1979. Today, union workers account for just 10.1 percent of workers, representing roughly a twenty percent decline since the early 1980s.

While total union membership has waned, more people are joining, and the desire to unionize is significantly growing. According to the Economic Policy Institute, union petitions increased by 53 percent between 2021 and 2022, and more than 60 million people wanted to join unions but could not do so. It is no secret that some of America’s largest private employers oppose unionization. A May New York Times article detailed efforts by Apple, Trader Joe’s, Starbucks, and REI to stop unionization and their potential use of retaliatory practices and firings to suppress unionization support.

The Writers Guild of America strike (in its third month at the time of this writing) is using its member’s notoriety to draw attention to the stark pay inequity between the front-line workers who produce entertainment and the corporations who reap the lion’s share of the profits. What seems clear is that more people see the benefits of union membership to offset growing income inequality, slow wage growth, reduced paid leave, more costly or limited health benefits, and other workplace challenges.

Organized labor represents more than collective bargaining power. Unions offer a form of community, identity, and safety net. At a time when mental health disorders, substance use disorders, and deaths of despair are at record levels, belonging to an organization that provides a degree of fellowship, protection, and resources may seem more meaningful than ever.

Chris Carlough, a national labor leader, educator, and mental health advocate, comes from a long line of union members. To Carlough, the appeal of unions is fundamentally unchanged — greater negotiating power leads to better contracts, better wages, and a more level playing field. What is new, however, is the ability of unions to make a vital resource available to millions of Americans in need — mental and behavioral healthcare.

“Growing up, I remember my grandfather telling us, ‘Never trust a man who doesn’t drink,’ and that was a message that stuck with me during my formative years,” says Carlough. “The idea that using alcohol or other substances to cope with physical or psychological pain is deeply ingrained in some workplace cultures.” Carlough points to high rates of substance use disorder among some industries with high union representation. The Substance Abuse and Mental Health Administration reports that 17.5 percent of miners and 16.5 percent of construction workers have heavy alcohol consumption or alcohol use disorder. “There is a culture of acceptance, and it is a means of coping with the physical pain that comes with the job and emotional pain that comes from childhood or other trauma picked up along the way. These are careers in which injury is fairly common. Someone may fall from a ladder, for example, and the unspoken response from co-workers is ‘this is a no-pain zone’ or ‘rub some dirt on it’ and get back to work,” says Carlough. “This is exactly the kind of thinking and behavior that leads to substance abuse. People have been injured but feel like they would be considered weak if they saw a doctor. So, they drink, misuse prescription medicines, or take illicit drugs to cope with the pain. But they have not treated with the underlying injury, and the pain persists, and so does the substance use.”

Injury is one of many factors that can lead to substance use and mental health disorders. Many workers are exposed to various stressors, including job insecurity, fear of being replaced by technology or automation, the need to be retrained for new jobs, an inability to save adequately for retirement or to fund daily life and childcare, and more. People are even reporting more anxiety about existential issues like climate change and societal ones like political unrest. Many factors are converging to exacerbate stress and anxiety, leading more people to seek relief through substances or unhealthy behaviors.

Today, Carlough and his colleagues are working to change how union members think about mental health and substance use disorders and improve access to high-quality care. Carlough is the coordinator of the SMOHIT SMART MAP program, a mental health awareness, and peer-led action program that highlights the issues associated with all mental health issues with a particular focus on substance use disorder and suicide prevention and trains union members to help fellow members and their families in need to access those resources. Carlough travels the country, providing education and training and spending time with union leaders and members to dispel old thinking, reduce stigma, and normalize treatment. Another focus is overcoming some remnants of toxic masculinity that can still be found throughout the workforce, which can make it harder for people to admit that they are struggling and seek help. “It helps when I tell people, ‘Me too,’ as in I have struggled with mental health issues, and I share some of that vulnerability relating to my own alcoholism and addiction and how I got the help I needed, so maybe they can too.”

The SMART MAP Peer training takes trusted, respected, and empathetic union workers, from apprentices to long-standing journey-level tradespeople who want to help and enlist them into this service. “Your union brother and sister can make the difference. Part of what we do is train our members to simply ask people how they’re doing and not take someone’s first answer at face value. We want them to dig a little deeper to elicit an authentic response. If someone can feel safe and comfortable telling you that they are feeling down, are in pain, or are having other problems, that is the first step toward getting them help — help that might save their lives and the lives of their family members. We also work to ensure that everyone from peer support to company owners and union representatives are aware of all available resources and how to access them to get people into treatment. Not only can this help people feel that reaching out for help is normal, but that they are supported compassionately throughout the entire process.”

Carlough also connects unions with high-quality treatment providers and employee assistance programs (EAPs) to ensure union members receive the quality and range of services needed. “Not all treatment providers are the same, and people may need access to multiple levels and types of care. Unions control significant health plan funding, and this can be used to create beneficial relationships with the best medical providers. We want to ensure that when members feel comfortable getting help, they get the excellent, evidence-based treatment from experienced caregivers all workers deserve. We need effective treatment that addresses root causes and helps people access the continuum of services and resources they need to get the mental healthcare they need or to enter and stay in recovery.”

When Carlough wanted to increase education efforts for union members, he tapped long-time friend and Foundry Steamboat CEO Ben Cort. Cort and Carlough have collaborated to develop education and find appropriate treatment partnerships for organized labor unions nationwide. Now, Cort is interested in ensuring that Foundry Steamboat’s trauma-integrated care is available to union members who could benefit from it. “Unions are a vital part of this country’s labor force and are lifelines for millions of American families. Union members, including first responders, are at risk for witnessing or experiencing physical and psychological trauma and need appropriate treatment to be easily accessible. I want to ensure that in addition to educating unions about how to connect members to excellent treatment resources, we are doing all we can to make our unique trauma-integrated care model available and accessible to as many union members as possible.”

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While the rates of deaths and devastation wrought by ongoing addiction and mental health crises are unprecedented, these problems have always been with us.

Despite estimated one-trillion-dollar productivity losses from depression and anxiety and $215 billion productivity losses from addiction annually, treatment resources are vastly outweighed by the need. A major problem is too few people are becoming behavioral health professionals. According to the Commonwealth Fund, “In 2021, fewer than half of people with a mental illness were able to access timely care; those with substance use disorders were even less likely.” Workforce shortages are cited as the primary cause of treatment inaccessibility. The Association of American Medical Colleges reported in 2022 that the country will soon”...be short between 14,280 and 31,109 psychiatrists, psychologists, social workers, and others…”

Behavioral healthcare careers can be very challenging. Frontline workers, like psychologists, psychotherapists, and psychiatrists, experience high rates of burnout. In 2022, 46 percent of psychologists felt unable to meet the demand for care, and 45 percent felt burned out, according to the American Psychological Association. Compassion fatigue, heavy administrative paperwork requirements, compliance-related issues, insurance claim management, and even hard-to-use electronic health record systems make a tough job even harder. Almost 60 percent of therapists stay in the same job for less than two years.

High-quality treatment provider organizations, and even smaller private practices, recognize the need to support clinicians and other team members to create workplaces and teams that reduce fatigue and increase longevity. Treatment providers committed to maintaining long-term employees and building expertise are committed to developing healthy and supportive cultures and fostering safety, openness, and personal wellness. Treatment organizations also do well to remember that many healthcare workers feel a calling to this work that helps them endure its inherent challenges. Designing practices and procedures that honor and protect this sense of calling can reduce stress and create client-centered environments in which practitioners feel supported and able to do high-quality work.

Direct caregivers are one behavioral healthcare role among many. Many treatment provider organizations, but especially those operating extended care residential and intensive outpatient levels of care, require numerous positions, including managers and directors, case managers, compliance and insurance utilization specialists, outreach and admissions professionals, wellness experts, nutritionists and chefs, recovery coaches and recovery peer support specialists, and more. Every member of these teams is vital to supporting the program’s treatment mission and creating a therapeutically-centered environment conducive to client success and clinical excellence.

Foundry Treatment Center Steamboat is led by experienced professionals who have gained experience at some of the nation’s leading behavioral healthcare institutions. When acquiring the program and planning its expansion, this team knew that creating a clinically-focused and supportive environment was crucial to clinician longevity and client outcomes.

“The trauma-integrated care model developed by Dr. Barnes requires an operation completed organized around the goals of reducing retraumatization and supporting perceived safety. We must put this theory into practice for clinicians as well as clients. To be effective at treatment, we also must treat one another well,” says Chief Operating Officer Tom Walker.

“We offer very competitive pay and benefits, pay for continuing education and personal development, provide ample vacation and paid leave time, offer free access to wellness services, and generally create an open environment where our team members feel open about sharing and feeling supported,” says Human Resource Manager Amanda Lacey.

Other Foundry Steamboat team members recognize the benefits of working with colleagues who support their aspirations. Outreach & Special Projects Manager Amber King felt supported to spearhead a novel initiative rooted in a personal passion. “When Amanda and I proposed organizing treatment providers in rural communities, the team was immediately receptive and supportive. Our personal passions drive this project to bring resources to communities like the ones we grew up in, and that lack adequate care. Not many employers would be so open to allocating the time and resources, and fewer would realize that supporting this project is actually supporting and rewarding us by doing something we love.”

Access to leading experts and training is another advantage of working at Foundry Steamboat and other high-caliber providers. Foundry Steamboat provides internship opportunities for rising healthcare professionals. It is a place where leading thinkers and practitioners with decades of experience share their insights and help others learn and grow.

Behavioral healthcare is a demanding job but a deeply helpful profession. Some of the most rewarding aspects of this work are seeing individual lives saved and families salvaged, clients celebrating recovery anniversaries, and the future prospects of generations changed.

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