Too late to nip in the bud
As Australia debates drugs, legal cannabis is raising health fears in the US.
Alex Berenson gave up investigative journalism the best part of a decade ago. A former New York Times muckraker, he moved on to writing successful thriller novels and has rarely looked back.
Until one day, that is, when he disagreed with his wife, Jacqueline, a psychiatrist who works with mentally ill criminals. When discussing a case in bed one night, she pointed out that the criminal was “of course” a cannabis user.
“What do you mean ‘of course’?” he asked. “They all smoke,” she replied, positing a link between schizophrenia and cannabis consumption.
Berenson scoffed. His wife told him to go and do some reading and come back. So he did.
Now he has written an explosive book, which argues that cannabis is a key factor in psychosis, schizophrenia and the violent crimes they often trigger.
“You should never argue with your wife,” he says.
Psychiatrists, Berenson says, are the canaries in the coalmine, much as lung surgeons were the ones to spot the perils of cigarette smoking.
“We know surprisingly little about the mechanisms by which marijuana might hurt the brain,” he says.
He argues that America is sleepwalking into an epic health crisis, similar to that experienced before the true dangers of tobacco became known or, indeed, the opioid crisis currently claiming more than 100 lives a day.
Yet the weed industry is on a roll. About a quarter of Americans live in states where cannabis is legal, including California and Massachusetts. Most other states have medicinal marijuana systems that provide easy access.
Last week New York Governor Andrew Cuomo unveiled a plan to legalise cannabis for the state’s 20 million inhabitants. He long resisted legalisation and called cannabis a “gateway drug” as recently as 2017 but now has caved in.
Cannabis lobbying is powerful because it aligns progressive pressure groups that chafe against puritanical drug laws and their impact on black communities, along with business interests hungry for a huge payday from the nation’s estimated $US50 billion ($70bn) weed industry.
To call cannabis mainstream in the US is to undersell it. Last month, Altria, parent company of tobacco giant Philip Morris, which made its name with Marlboro cigarettes, announced a $US1.8bn investment in the marijuana industry.
John Boehner, a staunch conservative and former Republican Speaker of the House of Representatives, is now on the board of a cannabis company.
As the debate over legalisation gains steam around the world — and Australia debates drug reforms such as pill testing at music festivals — countries would do well to pay attention to the path being forged in the US, which may well follow Canada into full legalisation within a decade. But even as the momentum behind legalisation becomes seemingly unstoppable, a backlash is mounting and dissenting voices such as Berenson’s are growing in volume.
“Full legalisation is a mistake,” he says.
“It creates a business community that is going to market the drug heavily. It also creates the perception that we’ve decided the drug is safe, which is clearly untrue for a lot of people.”
The real nature of the links between marijuana and mental health have yet to be fully proven either way. Because cannabis has been illegal for so long, research into its effects has been inhibited and the overall picture remains murky. A report released in 2017 by the National Academy of Medicine emphasised how much remains unknown about the drug.
On the subject of pain relief, for example, the report stated that while there is evidence that marijuana can help with pain, “little is known about the efficacy, dose, routes of administration or side effects of commonly used and commercially available cannabis products in the United States”.
Peter Bach, a healthcare expert, is more strident.
“Legalise marijuana but don’t pretend it’s therapeutic,” was the heading in a column he wrote last week in The Wall Street Journal.
“Actual medicines have research behind them, enumerating their benefits, characterising their harms and ensuring the former supersedes the latter.
“Marijuana doesn’t. It’s a toxin, not a medicine. It impairs judgment and driving. It increases the risk of psychosis and schizophrenia … If weed is a pain reliever, so is Budweiser.”
Berenson goes even further. “Marijuana causes paranoia and psychosis. That fact is now beyond dispute,” he writes. “Paranoia and psychosis cause violence.”
He points to a 50 per cent increase in schizophrenia admissions in the US since 2006 and talks to psychiatrists, who place partial blame for this on the fact marijuana consumption has doubled in the country in the past 20 years.
He also cites a 2013 study of 12,000 school pupils that found those who consumed marijuana were three times likelier to be aggressive.
In Washington state, which in July 2014 became one of the first in the US to start selling the drug legally, he found that the murder rate rose 44 per cent between 2013 and 2017 — more than double the national average.
Berenson’s case is not conclusive, though. Marijuana advocates retort that the link between mental illness and weed is correlated, not causal; many who are suffering from or susceptible to mental illnesses will opt to use cannabis.
“It’s possible that cannabis may exacerbate pre-existing conditions,” says Morgan Fox, of the National Cannabis Industry Association. “But no research proves a causal link between cannabis consumption and mental illness.”
Sceptics have dismissed Berenson’s book as an outbreak of “reefer madness”, a reference to a lurid 1930s film in which school pupils embark on a violent marijuana-driven bender.
But if one finds his position paranoid, even those who are strongly pro-legalisation may be troubled by the pro-cannabis narrative that has quickly emerged in the US.
As the full weight of corporate marketing swings behind the drug, it is now being heavily advertised as a panacea for any number of ailments, from anxiety and depression to cancer and chronic pain, often on a hazy scientific basis.
What is indisputable is that the cannabis being sold on the streets is vastly more potent than the joints passed around during the 1960s when weed first blazed a path into popular culture. Studies have shown that the average concentration of THC — tetrahydrocannabinol, the drug’s psychoactive ingredient — has risen in the US from about 4 per cent in 1995 to closer to 20 per cent now.
The weed of today is incomparable to that experienced by our baby-boomer parents during the “Summer of Love”, when life was about getting stoned, listening to rock music and bad-mouthing your country.
The relationship between modern weed and the grass of yesteryear is akin to that between a glass of beer and shot of vodka. They are entirely different beasts yet, as the US legalises, there is little serious discussion about limiting the potency of weed.
Super-strong weed is now sold in snazzy, polished outlets along much of the US west coast, coming in the form of flapjacks, massage oil, biscuits and vitamin drinks. There really is nothing that cannabis can’t solve, if the sales guff is to be believed. Period pains? Try some cannabis cream. Want smoother sex? Apply some marijuana lube.
“Mental health issues are strongly associated with this increase in potency,” says Ken Finn, a pain expert who sits on Colorado’s Medical Marijuana Scientific Advisory Council. “More potent, more problems.”
For Sally Schindel, a mother from Prescott, Arizona, seeing powerful weed become packaged up and sold is an intensely painful experience. In 2014 her son, Andy, took his life after years of battling with psychosis. His suicide note read: “My soul is already dead. Marijuana killed my soul + ruined my brain.”
“Andy was a great kid,” says Schindel. “So full of happiness and joy.” Her son served with the 82nd Airborne Division, including in Iraq, and returned home at 21 to go to college. “He had so much potential, so many plans,” she recalls.
Andy went to university but soon started having mental health issues, becoming psychotic. During one of his terrifying incidents, Schindel discovered Andy had become a heavy weed smoker.
“Cannabis was his drug of choice,” she says. “I was just so shocked at the effects. I didn’t know it could be so addictive.”
Although her son did see active service in Iraq, Schindel does not believe he had post-traumatic stress disorder and sees marijuana as the cause, not a symptom, of his breakdown.
“I blame marijuana,” she says. “For us to be selling and promoting a drug that causes mental illness is just tragic. We all should have known this a long time ago.”
Schindel is part of a committed network of campaigners who have been adversely affected by marijuana. Another is Corinne Gasper from Columbus, Ohio, who campaigns about the effects of driving while high. Her 22-year-old daughter, Jennifer, was killed in 2012 by a man driving under the influence of cannabis. “The pain I live with is terrible,” says Gasper. “But the worst part is she had her life snatched away from her.”
Activists such as Gasper point to the fact in Colorado the overall number of road fatalities that involved a positive test for marijuana has nearly doubled since legalisation in January 2014, from 75 that year to 139 last year. Marijuana advocates say the police are now far more rigorous about testing for cannabis.
The arguments for legalisation remain strong. Criminalising cannabis has created a huge black market, with violent cartels fighting over territory and using profits to fund more illicit activities. It also has created tens of thousands of criminal records where they might otherwise not have existed, blighting the lives of many from poorer communities and using police resources that might otherwise have been deployed elsewhere.
Libertarian advocates point out that tobacco and alcohol both have enormous, proven and chronically adverse health effects on our society. But we manage them, educating people as to their effects and then giving them the freedom to choose.
Legalisation ought to mean that weed is carefully tested, that people know what they are buying and can be much more precise about dosage.
The potential tax revenue from cannabis is considerable: Cuomo projects that New York state will rake in $US300 million in the first three years of legalisation, money that can go towards schools and hospitals instead of into drug dealers’ pockets.
There is a legitimate medical argument being made for cannabis, too. Sanjay Gupta, chief medical correspondent for TV network CNN, was a long-time opponent of marijuana. Like Berenson, he eventually decided to do his research. And he changed his mind the other way.
“It doesn’t have a high potential for abuse,” he wrote. “And there are very legitimate medical applications. Sometimes, marijuana is the only thing that works.
“Take the case of Charlotte Figi, who I met in Colorado. She started having seizures soon after birth. By age three she was having 300 a week, despite being on seven different medications. Medical marijuana has calmed her brain, limiting her seizures to two or three per month.”
Even Berenson says he believes marijuana should be heavily decriminalised, but he baulks at the idea of allowing it to become fully legal. “Growing your own weed is a lot easier than making your own alcohol,” he argues. “So even when you legalise it, the black market remains. You get the worst of all worlds.”
What about the fact alcohol and tobacco are legal? “This is not a zero-sum game,” he replies. “I’m not sure the solution to that is to create another industry whose success can blight people’s lives.”
Many will take Berenson’s views with a healthy dose of scepticism but, until the science is more settled, legalisation remains a leap into the unknown.
The Times