By Dr. Christine Miller, Ph.D, originally published by Poppot on October 29, 2014Myth #1. It is rare for marijuana users to experience psychotic symptoms like paranoia.
In fact, about 15% of all users and a much higher percentage of heavy users will experience psychotic symptoms.1 Half of those individuals will become chronically schizophrenic if they don’t stop using.2 Fortunately, some do stop using because psychosis is not pleasant and they wisely recognize that pot caused their problems.
Attached is a list of medical articles that document medical warnings against marijuana that are running in newspapers throughout the country, to warn in advance of participation in 420 events.
Average flower is 17.1% in one state with legal sales of recreational marijuana, Colorado, much higher than the national average (HIDTA, 2017), and as high as 30% THC in some samples (NBC News report). It should be noted that variation in testing results is quite high between laboratories (Jikomes and Zoroob, 2018).
Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf
Processed cannabis reaches up to 90% THC
Jikomes N, Zoorob M. The Cannabinoid Content of Legal Cannabis in Washington State Varies Systematically Across Testing Facilities and Popular Consumer Products. Sci Rep. 2018 Mar 14;8(1):4519. doi: 10.1038/s41598-018-22755-2. https://www.nature.com/articles/s41598-018-22755-2.pdf
Marijuana is the Number 1 substance now found in Colorado suicides, 10-19 years old, 2014-2016
Causes mental illness, and is associated with onset of schizophrenia and other psychotic disorders such as bipolar disorder with psychosis
Association with schizophrenia and other psychotic disorders such as bipolar and schizophrenia. (Miller, 2017; Cougle et al., 2015), completed suicides and suicide attempts (Arendt et al., 2013; Silins et al., 2014; Clarke et al., 2014) and violence towards others (Arseneault et al., 2000; Dugre et al., 2017; Harford et al., 2018) particularly in those who develop marijuana-induced psychosis.
Arseneault L, Moffitt TE, Caspi A, Taylor PJ, Silva PA. Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Arch Gen Psychiatry. 2000;57(10):979-86.
Arendt M, Munk-Jørgensen P, Sher L, Jensen SO. Mortality following treatment for cannabis use disorders: predictors and causes. J Subst Abuse Treat. 2013;44(4):400-6.
Clarke MC, Coughlan H, Harley M, Connor D, Power E, Lynch F, Fitzpatrick C, Cannon M. The impact of adolescent cannabis use, mood disorder and lack of education on attempted suicide in young adulthood. World Psychiatry. 2014;13(3):322-3.
Cougle JR et al. (2015). Quality of life and risk of psychiatric disorders among regular users of alcohol, nicotine, and cannabis: An analysis of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). J Psychiatr Res., 66-67, 135-141
Di Forti M, et al. Proportion of patients in South London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry. 2015;2(3):233-8.
Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res. 2018;262:384-392.
Silins E, Horwood LJ, Patton GC, Fergusson DM, Olsson CA, Hutchinson DM, Spry E, Toumbourou JW, Degenhardt L, Swift W, Coffey C, Tait RJ, Letcher P, Copeland J, Mattick RP, for the Cannabis Cohorts Research Consortium. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry 2014; 1(4): 245-318.
Starzer MSK, Nordentoft M, Hjorthøj C. (2018) Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis. Am J Psychiatry,175(4), 343-350
Harm to unborn, nursing babies
Marijuana harms unborn children (Jenkins et al., 2007; Trezza et al., 2012; Tortoriello et al., 2014; Grewen et al., 2015; Zumbrun et al., 2015; Leemaqz et al., 2016; Benevenuto et al., 2017), and may concentrate in breast milk if used repeatedly (Perez-Reyes and Wall, 1982; Grotenhermen, 2003), with consequences for the developing neonate (Astley and Little, 1990).
Astley SJ, Little RE. Maternal marijuana use during lactation and infant development at one year. Neurotoxicol Teratol. 1990 Mar-Apr;12(2):161-8.
Benevenuto SG et al., Recreational use of marijuana during pregnancy and negative gestational and fetal outcomes: An experimental study in mice. Toxicology. 2017 Feb 1;376:94-101
Grewen K, Salzwedel AP, Gao W. Functional Connectivity Disruption in Neonates with Prenatal Marijuana Exposure. Front Hum Neurosci. 2015;9:601.
Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-60. Review.
Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL; American Heart Association Council on Cardiovascular Disease in the Young. Non-inherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation. 2007 Jun 12;115(23):2995-3014.
Leemaqz SY et al. Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol. 2016;62:77-86.
Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med. 1982;307(13):819-20.
Tortoriello G, et al. Miswiring the brain: Δ9-tetrahydrocannabinol disrupts cortical development by inducing an SCG10/stathmin-2 degradation pathway. EMBO J. 2014;33(7):668-85.
Trezza,V. et al. Altering endocannabinoid neurotransmission at critical developmental ages: impact on rodent emotionality and cognitive performance. Front Behav Neurosci. 2012; 6: 02. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265033/
Zumbrun EE et al. Epigenetic Regulation of Immunological Alterations Following Prenatal Exposure to Marijuana Cannabinoids and its Long Term Consequences in Offspring. J Neuroimmune Pharmacol. 2015; 10(2):245-54.
Marijuana causes cyclic vomiting
Sorensen CJ, DeSanto K, Borgelt L, Phillips KT, Monte AA. Cannabinoid Hyperemesis Syndrome: Diagnosis, Pathophysiology, and Treatment-a Systematic Review. J Med Toxicol. 2017;13(1):71-87. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330965/
Alaniz VI, Liss J, Metz TD, Stickrath E. Cannabinoid hyperemesis syndrome: a cause of refractory nausea and vomiting in pregnancy. Obstet Gynecol. 2015 Jun;125(6):1484-6.
Marijuana can trigger violence in those with PTSD and make PTSD worse
Wilkinson ST, Stefanovics E, Rosenheck RA. Marijuana use is associated with worse outcomes in symptom severity and violent behavior in patients with posttraumatic stress disorder. J Clin Psychiatry. 2015 Sep;76(9):1174-80.
Friedman A, Glassman K, Terras A Violent Behavior as Related to Marijuana and Other Drugs, by Albert Journal of Addictive Diseases, Vol 20(1), 2001,pp. 49-72. Marijuana users nearly as likely to engage in violent behaviors as crack users.
Marijuana is linked to increased driving fatalities
Staples JA, Redelmeier, DA, The April 20 Cannabis Celebration and Fatal Traffic Crashes in the United States. JAMA Intern Med. 2018;178(4):569-572. doi:10.1001/jamainternmed.2017.8298 Rate of traffic fatalities go up 12% after 4/20 festivities, in comparison to one week before and one week after.
Bosker WM, Kuypers KP, Theunissen EL, et al. Medicinal Δ9-tetrahydrocannabinol (dronabinol) impairs on-the-road driving performance of occasional and heavy cannabis users but is not detected in standard field sobriety tests. Addiction. 2012;107(10):1837-1844.
Compton WN, Volkow Nd, Lopez MF. Medical marijuana laws and cannabis use: intersections of health and policy, JAMA Psychiatry. 2017: 74 (6): 559-560
Del Balzo G, Gottardo R, Mengozzi S, Dorizzi RM, Bortolotti F, Appolonova S, Tagliaro F, “Positive” urine testing for Cannabis is associated with increased risk of traffic crashes, Journal of Pharmaceutical and Biomedical Analysis. https://doi.org/10.1016/j.jpba.2017.12.059
Ramaekers JG, Kauert G, van Ruitenbeek P, Theunissen EL, Schneider E and Manfred R Moeller, High-Potency Marijuana Impairs Executive Function and Inhibitory Motor Control. Amer Col of Neuropsychopharmacology (2006) 31, 2296–2303.
Raemakers, JG Driving Under the Influence of Cannabis: An Increasing Public Health Concern. JAMA published online March 26, 2018 Regular cannabis users wrongfully believe that cannabis does not affect their driving performance or that they can compensate for cannabis-associated impairment. Raemakers_2018 JAMA driving editorial.pdf
World Health Organization. Drug Use and Road Safety: A Policy Brief. Geneva, Switzerland: World Health Organization; 2016.
Marijuana associated with lung disease, cancer
Marijuana smoke is associated with lung disease (Tan et al., 2009; Tashkin, 2015) and the development of some cancers (Efird et al., 2004; Lackson et al., 2012). High levels of the cannabinoid receptor that is preferentially activated by THC (CB1) correspond to shorter survival in many cancers (Michalski et al., 2008; Carpi et al., 2015; Suk et al., 2016)
Carpi S, Fogli S, Polini B, Montagnani V, Podestà A, Breschi MC, Romanini A, Stecca B, Nieri P. Tumor-promoting effects of cannabinoid receptor type 1 in human melanoma cells. Toxicol In Vitro. 2017 Apr;40:272-279. doi: 10.1016/j.tiv.2017.01.018. Epub 2017 Jan 26
Efird JT, Friedman GD, Sidney S, Klatsky A, Habel LA, Udaltsova NV, Van den Eeden S, Nelson LM. The risk for malignant primary adult-onset glioma in a large, multiethnic, managed-care cohort: cigarette smoking and other lifestyle behaviors. J Neurooncol. 2004 May;68(1):57-69.
Lackson et al., 2012, Population-based case-control study of recreational drug use and testis cancer risk confirms an association between marijuana use and nonseminoma risk. Cancer 188:5374-83
Michalski CW, Oti FE, Erkan M, Sauliunaite D, Bergmann F, Pacher P, Batkai S, Müller MW, Giese NA, Friess H, Kleeff J. Cannabinoids in pancreatic cancer: correlation with survival and pain. Int J Cancer. 2008;122(4):742-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225529/pdf/nihms38106.pdf
Suk KT, Mederacke I, Gwak GY, Cho SW, Adeyemi A, Friedman R, Schwabe RF. Opposite roles of cannabinoid receptors 1 and 2 in hepatocarcinogenesis. Gut. 2016;65(10):1721-32. http://gut.bmj.com/content/gutjnl/65/10/1721.full.pdf
Tan WC, et al. Marijuana and chronic obstructive lung disease: a population-based study. CMAJ. 2009;180(8):814-20
Tashkin DP. The respiratory health benefits of quitting cannabis use. Eur Respir J. 2015;46(1):1-4
Legal marijuana increases youth use (Cerda et al., 2017) and is associated with youth switching to more potent marijuana products (Borodovsky et al., 2017)
Use by youth in 8th and 10th grades has gone up significantly in Washington State (Cerda et al., JAMA Pediatrics ). School districts with the highest density of legal dispensaries in Colorado have a 30% higher rate of use in students by the time they reach their senior year of high school (Healthy Kids Colorado Survey, 2015: Adolescent Health); and to compile data on density of dispensaries for each school district https://weedmaps.com/dispensaries/in/united-states/colorado)
The percentage of youth on probation testing positive for marijuana has increased steadily since 2012 (DPS, 2017)
Borodovsky JT, Lee DC, Crosier BS, Gabrielli JL, Sargent JD, Budney AJ. U.S. cannabis legalization and use of vaping and edible products among youth. Drug Alcohol Depend. 2017; 177:299-306. https://www.ncbi.nlm.nih.gov/pubmed/28662974
Cerdá M, Wall M, Feng T, Keyes KM, Sarvet A, Schulenberg J, O’Malley PM, Pacula RL, Galea S, Hasin DS. Association of State Recreational Marijuana Laws With Adolescent Marijuana Use. JAMA Pediatr. 2017;171(2):142-149. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5365078/
Marijuana decreases IQ in those who begin their use young
Meier MH, Caspi A, Ambler A, Harrington H, Houts R, Keefe RS, McDonald K, Ward A, Poulton R, Moffitt TE. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci U S A. 2012 Oct 2;109(40):E2657-64. doi: 10.1073/pnas.1206820109
Mj harms developing adolescent and young adult brains.
Camchong J, Lim KO, Kumra S. Adverse Effects of Cannabis on Adolescent Brain Development: A Longitudinal Study. Cereb Cortex. 2017 Mar 1;27(3):1922-1930. doi: 10.1093/cercor/bhw015. https://academic.oup.com/cercor/article/27/3/1922/3056289
Allan GM Simplified guideline for prescribing medical cannabinoids in primary care Canadian Family Physicians Vol 64: February 2018 2018 Cannabis Prescribing Guidelines.pdf.
Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up. https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413
Olfson M, Wall M Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States, American J Psychiatry. Cannabis use, even among adults with moderate to severe pain, was associated with a substantially increased risk of nonmedical prescription opioid use at 3-year follow-up. https://doi-org.proxy.hsi.ucdenver.edu/10.1176/appi.ajp.2017.17040413
Ron Coppola’s testimony gives insight into how today’s marijuana changes brains and becomes a factor in the development of schizophrenia. “It’s not what I smoked, ” he explained.
“Marijuana flipped a switch in his son. ” he said. Of this dilemma, he warned, “Anyone who deals with mental illness realizes it’s a black hole.”
Here’s one story. As personal and painful as it is to relate, I write this account hoping that efforts to legalize the use of recreational marijuana will be defeated.
My second son, Chris, had an outstanding secondary school career. As the youngest student in a class of 315 students, he was the valedictorian. At spring honors day, he received the American
History prize, the best peace essay, a state and national scholastic writing award, the best student in mathematics award, AP Calculus award for the highest score and the Student Leadership award. But he was no nerd. He was President of the Student Council and Co-captain of the wrestling team. He had a ton of friends and he loved to backpack, kayak and rock climb. My only worry about him was his lack of fear in tackling any physical challenge.
On a holiday break in his first year at Stanford, he came home and went out with some of his friends. About a half hour later, he came running back home in a state of absolute panic. This fearless kid was terrified and in a state I hardly recognized. He thought the woods were surrounded by FBI agents and that a high school football star was trying to rape him. It turned out that the kids who picked him up were smoking marijuana. Evidently, this was not Chris’ first time. With all his accomplishments, he always tried to be one of the boys and smoking weed was what they did. I felt a tremendous sense of guilt because I hadn’t thought that it was necessary to talk about drug use with my own boys.
That night was a marker for his steady mental decline which continued even after he ceased using marijuana. Within two years, he was exhibiting full-blown schizophrenia. In his first of six hospitalizations, the doctor told us that he had a severe case and we should expect his mental acuity and his social affect to decline. The positive news according to the doctor was that Chris was high functioning enough that the decline could be tolerated. He was wrong.
The next ten years were not pretty. This thoughtful, intelligent, winsome child became extremely paranoid and sometimes violent. He heard voices continually and his thoughts became completely disordered. Once a promising writer, his journals show a steady progression from cogent essays to paragraphs and sentences that don’t make sense to jumbles of meaningless word combinations. Hospitalizations and attempts to medicate him had no effect.
At the age of 28, perhaps in a moment of lucidity recognizing what had become of him, he took his life. Although there will never be any proof that marijuana was the cause of his schizophrenia, I believe that the first panic episode I witnessed was a precursor and initiator of his illness. This is certainly consistent with the scientific studies which suggest the correlation between early marijuana use and schizophrenia.
Proposition 205 would imprint on young people that recreational marijuana use is without risk. No wonder that so many social agencies, medical professionals, state officials and business groups oppose its passage.
I am sure that many people smoke marijuana on a limited basis with no apparent ill effects. However, there is ample scientific evidence that marijuana use by teenagers whose brains are in the developmental stage are at risk for psychotic events which may be long term. There is also evidence that long-term use by adults can also lead to mental impairment issues. For anyone who is interested, I can share a bibliography of over 60 scientific articles addressing the risks that early marijuana use poses.
Editor’s Note: It is a public health failure that we have not warned young people they are at risk for psychosis and other mental illnesses from marijuana. But as this author remarks, risks remain for those who start using marijuana as adults. Our recent article summarizes the dangers of marijuana, and why it cannot be consumed safely by anyone.