The Public Health Crisis That Wasn't

One of our favorite journalists, Annie Lowrey, recently wrote an article titled, "America's Invisible Pot Addicts".  While she is clearly no friend of cannabis prohibition and in fact has repeatedly gone on the record supporting legalization, in this article the author addresses head-on the issue that many (but not all) legalization advocates have heretofore been loath to discuss at all:  cannabis addiction and its apparently growing trend in this country.

As she quotes various self-styled experts on the matter, we seem to get several different answers on the size of the problem and especially how to handle it.  But some facts are undeniable regardless of who says them:

• Some people can indeed become dependent on cannabis, to one degree or another.  And while cannabis is significantly less addictive than alcohol, tobacco, hard drugs, prescription painkillers and sedatives, and even caffeine, it can still become quite habit-forming when used too frequently and heavily.
• While cannabis addiction is usually not as severe as most other addictions, it can be for some people.  Cannabis may be relatively harmless for most of its users, but that does not make it completely safe for everyone.  Some may find that it can have quite a dark side when seriously abused.
• Since the early to mid-1990s and especially since the early 2000s, rates of "cannabis use disorder" (abuse, dependence, or both) as defined by DSM-IV criteria have increased markedly, as have the percentage of daily or near-daily (DND) users of cannabis (about half of whom are dependent).
• While some of those who technically meet DSM-IV criteria for abuse or dependence are pseudoaddicts or an artifact of social stigma and prohibition, others are indeed genuine addicts, and the exact proportion is not entirely clear.
• Likewise, many DND users are truly medical or quasi-medical users, but many are clearly not.
• These trends in heavy and/or dependent use began long before recreational legalization and even before medical legalization in most states, and there is no unambiguously prospective link between legalization and such trends.
• These trends have occurred primarily among adults rather than teenagers.
• Regardless, none of the above facts constitute a real public health crisis at this time, and all of this truly pales in comparison to the opioid epidemic as well as the "pink elephant in the room" that is America's alcohol problem.

So yes, Virginia, there really is a "there", there, but contrary to what some commentators may fear, it is unlikely that legalization is really anything to fear in terms of making it worse.  After all, prohibition clearly couldn't stop it from rising over the past quarter-century.  And us legalization advocates would do wise to stop the denials and face the problem head-on, without fear that it would weaken our movement one bit.  Do not fall into the trap of ceding the moral high ground to the anti- side.  At the same time, we must also tackle head-on the "tyranny of the weaker brother" that really has no place in a free society.

The message really needs to be that spending the majority of one's waking hours under the influence of any psychoactive substance is probably not a wise idea, unless of course one truly needs it for medical reasons.   Saying that cannabis is the safer choice is NOT the same as saying that it is absolutely safe for everyone.  Besides, when you are stoned all the time, it basically loses its fun eventually, and isn't the whole point of recreational use by definition to have fun in the first place?  As Dr. Andrew Weil notes, if it stops being fun or effective, the worst thing one can do is smoke even more weed or seek out stronger strains.  And if you're at the point where you can't even enjoy video games without being stoned, that is definitely a warning sign that you need to at least take a break or cut back significantly, if not quit completely.

It is utterly important to first name and define the problem before discussing it further, to avoid inadvertently reinforcing the lies and half-truths on either side of the debate. We are talking about problematic, chronic, heavy, very heavy, and ultra-heavy use of cannabis here, at ANY age.  We are NOT talking about casual use, use per se by people below some arbitrarily high age limit, or about the roundly debunked "gateway theory" either.   Toking up, say,  once a week (or less) is really NOT the problem here, it's more like toking up every day or nearly so, especially multiple times a day, and/or in very large quantities, that is the real problem.  And while slopes may be slipperier than they appear as one approaches heavier and heavier use, the vast majority of cannabis users still do NOT become chronic heavy users.  And among those who do, it doesn't usually last very long, though for some it unfortunately does.

Likewise, while there currently is no hard scientific evidence (and not for lack of trying to find it) that using cannabis at 18 is really any worse in practice than using it at 21, 25, or even 30 for that matter, there is nevertheless some evidence that using before 18 and especially before 15 may indeed be riskier overall, both in terms of potential harm as well as addiction potential.  It is quite nuanced and the studies still need to be fleshed out, for sure.  But we should note that the aforementioned chronic, heavy users that represent the real problem typically started toking before 15 and/or transitioned to heavy use before 18 as a rule.  And many, if not most, of those users have also used alcohol and/or tobacco at an early age as well, again especially before 15.

As for public policy within the framework of legalization, Lowrey notes that probably one of the best--if not the best--measures that policymakers can take is to raise the taxes on cannabis.  That would, by definition, hit the heaviest users the hardest, while casual users would barely even notice the resulting price hike.  Of course, it would be best to keep the taxes very low at first in order to destroy the black market, and then gradually but sharply raise them beginning a year or two after legal recreational sales begin in a given state.  Lowrey also notes other ideas as well, such as capping THC levels in products, dispensing public health information, and restricting advertising, which are likely good ideas.  But excise taxes, especially if they are proportional to THC content (and perhaps inversely proportional to CBD content as well), would probably have the largest effect size of all in terms of reducing cannabis-related problems.  As for the fear that higher cannabis taxes would drive users back to alcohol, well, we all know by now how to prevent that hypothetical from happening:  simply raise the taxes on alcohol as well.

In other words, freedom has nothing to fear from the truth.  That, and don't fear the reefer--but DO treat it with the respect it deserves nonetheless.