USA: Opioid Addiction Needs Serious Recovery Focus

Opioid addiction isn’t going away and it will continue to grow for several years

The etiology of the current opioid epidemic can be traced to a series of events which began around 2000. The perfect storm. First, pain pills became stronger, impacting the neurobiology of the brain significantly. Second, the pressure was placed on physicians to treat pain as one would treat an abnormal vital sign (rating of pain became a common question).

Third, pain clinics opened to better treat pain but just made patients more addicted to the opioids being prescribed. By 2013-2014 in Tennessee, where I see patients, there were 333 pain clinics and more than 8.5 million prescriptions written for pills such as oxycodone, hydrocodone, and oxymorphone.

The United States was the leading user of oxycodone, and this placed Tennessee as one of the prominent users of oxycodone in the world. Against this backdrop of pill availability, was an unawareness by many providers that opioids could be as addictive as they are.

One of the most significant problems that currently exists is a lack of access to care. Opioid addiction is a chronic condition that does not respond to short-term treatment. It requires long-term, recovery-oriented services. The occurrence of withdrawal from opioids, as well as the triggers to use opioids, are so severe that relapse is typical in an individual who tries to maintain abstinence.

It is for this reason that medication is used as a maintenance treatment to prevent withdrawal, keep engagement and allow the individual to participate in behavioral therapies to build on strengths and address needs. This life course perspective changes the treatment concept from a short stay and discharges to a more integrated long-term recovery.

It is this need for long-term recovery management that makes opioid addiction comparable to other chronic primary health disorders. Recovery over a lifetime must be maintained, and to do so requires a high standard of quality of care and engagement in behavioral counseling and medication-assisted treatment (MAT). To accomplish this requires more access to care that is committed to sustained recovery.

For complete story


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USA: Online Giants – Purging Pot?

Cannabis cleanse? Why big tech is giving pot businesses the boot

YouTube and others are erasing the accounts of marijuana brands, limiting their ability to advertise themselves

Neither Google nor Facebook, the two most important internet companies, accepts marijuana advertising and both have been known to erase cannabis-related accounts without warning. Both companies say they want to allow discussions around the drug but not facilitate commerce. While attitudes about cannabis have been changing, it remains illegal almost everywhere they reach.

That approach has created problems for the marijuana companies trying to get their brand out.

Instagram, which is owned by Facebook, is the dominant platform in the cannabis world. It’s where aficionados go to discover the latest pipes, the dankest crops and endless memes of cartoon characters getting high. For those in the know, Instagram can also be a place to search for unsanctioned cannabis markets.

Facebook and the cannabis industry have more or less reached a detente where companies can post but not advertise. But there are exceptions, and enforcement can be spotty or arbitrary. A Facebook spokesperson said the company has been cracking down on opiate sales, which has probably resulted in a “shadow ban” that can make cannabis-related pages harder to find through Facebook searches, including those from mainstream media sources and government agencies.

The lack of receptiveness from Facebook and Google is a serious concern for pot companies, which are limited in their access to traditional advertising through print media, radio, television and billboards.

For complete article


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GLOBAL: S.A.M. News Update

News Roundup

August 2018
We hope you had an amazing Labor Day weekend!
Thank you all for the great work you are doing to defend public health and safety. Here is a brief rundown of what we have been up to over the last month.

New Report: Colorado Tests Thousands of Drivers for Pot, Two-Thirds are Positive Phillip Morris Execs Admit They Are “Looking Into” Expanding Into the Marijuana Industry
In one of the most concerning developments to date, a published report by the state of Colorado found that in 2016,  73% of some 4,000 drivers charged with driving under the influence tested positive for marijuana. The report, by the Division of Criminal Justice, also revealed that half of the drivers who tested positive were over the legal limit of THC in their blood. And  53 percent admit they smoked marijuana within two hours of getting behind the wheel .
“I have read thousands of research reports over the last 25 years – and this one is one of the most alarming.To make matters worse, marijuana impairment is most likely underrepresented in data due to the fact that it is so hard to gauge. Other states considering legalization must pump the breaks and take note of such damning reports.”
During an interview with Barclays Investments on September 5, 2018, tobacco industry executives from Altria (the parent company of tobacco giant Philip Morris) indicated their interest in taking advantage of marijuana as a new product line:
Q: “ Were it (marijuana) legalized, is there any reason to believe that you would have a competitive advantage in the cannabis business, say, relative to a booze company?”

Murray Garnick (Altria):
“Well, it’s a hypothetical and actually we’re exploring our options. There’s nothing more… I can’t really go beyond that. We’re exploring our options. We’re studying and evaluating market opportunities. And obviously, that question is one of the questions we’re looking at.”


September is  National Recovery Month. We at SAM celebrate this month with the whole country. It is a time to remind everyone that marijuana use disorder is real, and recovery happens.
In order to help you join in the discussion of the importance of recovery from drug addiction, SAM has put together a toolkit full of helpful links to studies highlighting marijuana addiction, inspirational stories and blog posts discussing recovery from addiction, examples of letters to the editors and opinion pieces, one-pages on drugged driving and the link between marijuana use and opioids, and even sample tweets and facebook posts.
For some inspiration, click here to view “On the Road to Recovery” by Ben Cort or here to view #MyTruth by Justin Luke Riley.
Click here to check out the comprehensive toolkit packed with material to keep you informed and active in the discussion all month long.  Please use this information to promote the message that marijuana use is on the rise, and recovery is possible with the right tools.

SAM Founder Sits Down With CBC in Canada

“ When most people talk about Canada’s impending legalization of marijuana, they talk about the future. When Kevin Sabet talks about it, he worries about history repeating.
“There are huge misconceptions, I often feel like we’re living in 1918, not 2018,” he said.”When I say 1918, I mean 1918 for tobacco when everyone thought that smoking cigarettes was no problem and we had a new industry that was just starting.”
“We hadn’t had tobacco related deaths before the 20th century because we hadn’t had a lot of cigarettes, which actually gave us the most deadly form of tobacco we’ve ever seen. I feel like we’re like that with marijuana.”
To read the full story and watch the interview, please click here.

Op-ed in Washington Examiner: Beware of Increasingly Common Drugged Driving on Labor Day
A new report on marijuana production, distribution and consumption in Oregon is finding major problems since the legalization of the drug. The Idaho/Oregon High Intensity Drug Trafficking Area (HIDTA) report finds there is so much pot in circulation, it’s being shipped to more than half the states in the nation. The study also discovered many illicit growth sites are in impoverished counties that could one day see their economy collapse due to falling pot prices.
“The effects of commercialization on Oregon are painfully clear: more use, more advertising, and more Big Tobacco playbook tactics. There is no potency limit on pot in Oregon, and Big Marijuana is already producing multiple times the demand for pot, which is fueling a massive black market. It’s time we held the industry accountable for its actions.”
SAM president and founder, Dr. Kevin Sabet recently penned an oped in the
Washington Examiner warning Americans to be alert and aware to the dangers of drugged driving over the Labor Day weekend.
Large increases in DUI cases often coincide with holiday weekends, and drugged driving is becoming more and more common — particularly in states that have legalized marijuana.
“In Colorado, the first state to legalize marijuana, the number of drivers under the influence of pot involved in fatal crashes increased 88 percent since legalization. Also, collision claims in Colorado are 14 percent higher than in nearby states that have not legalized pot.”

American Academy of Pediatrics Urges Pregnant and Nursing Mothers to Avoid Marijuana Use
I n response to growing evidence that more pregnant and breastfeeding women are using marijuana and concerns about the potential risks to developing fetuses and infants, the American Academy of Pediatrics (A.A.P.) released a
recommendation recently that women avoid the drug altogether when they are pregnant or breast-feeding.
“We applaud the American Academy of Pediatrics’ decision to shed light on the dangerous implications of marijuana use during pregnancy. This sends a clear message to the Big Marijuana industry that the scientific community and others will not fall for the blatant falsehoods and misinformation used to suggest that marijuana is safe.
“As research grows and the painful lessons are being learned from states that have legalized marijuana, more and more are moving to reject pot. Lawmakers in Vermont, Rhode Island, Connecticut, and New Hampshire have said no to legalization and commercialization bills so far this year…”

Oped in CalMatters: One Last Drink for the Road?
SAM’s Will Jones Debates Author of Bill to Legalize Marijuana in Illinois
“One last drink for the road,” once a widely-used phrase, is thankfully out of vogue now, as we have learned the painful lessons of drinking and driving.
And though science has shown that another intoxicant – marijuana – should be added to the list of no-nos while driving, not everyone has gotten the message.  State Controller Betty Yee and her husband were unfortunate victims of California’s lax attitude toward pot.
They were rear-ended on July 13 by a driver who allegedly was high on marijuana. Although everyone survived, this incident brings into focus the facts of marijuana-impaired driving.
A recent study out of Washington state found that almost 17 percent of marijuana users admit to using the substance every day. More than half of daily users aged 15 to 20 believe marijuana made them better drivers. Science says otherwise
At an event in Chicago, SAM’s Outreach Associate Will Jones debated Illinois State Senator Heather Steans on the merits of marijuana legalization. Senator Steans is the author of the bill to legalize the drug in the state.
Will raised serious concerns over the impact legalization would have on communities of color:
“The closest store to my house is a liquor store. The next closest stores are convenience stores so plastered over with signs for cigarettes and beer that you can’t see inside,” Jones said.
“Maybe you heard we should regulate marijuana like liquor. And perhaps if you live in another neighborhood that’s not mine, that might sound like a good idea.”

New Study on Marijuana Use by Children Uses Data From Before Legalization

The Healthy Kids California Survey purported to find that teen use of marijuana in California was down in recent years. Pro-marijuana talking heads were quick to pronounce that this supported their claims that legalization does not lead to increased youth use of the drug.
“The reality is the majority of the data presented in this study were collected at a time when recreational marijuana use was not legal, let alone retail sales (which did not begin in limited locations until the first of this year).
“The report itself states: ‘Data on important correlates of [substance] use, perceived harm, availability, and personal, peer, and parental disapproval of use, were mixed.’ This means the raw data doesn’t back up the spin from the pot industry.”

Contemporary Health Issues on Marijuana :
New Book Co-Edited by Dr. Kevin Sabet Available Now

Hot off the presses of Oxford University, Contemporary Health Issues on Marijuana  is now available for purchase.
This new book, co-edited by Drs. Kevin A. Sabet and Ken C. Winters, comprises chapters by other experts hailing from a wide range of fields including psychology, epidemiology, medicine, and criminal justice. It is a balanced, data-driven volume highlighting new theory and clinical evidence pertaining to marijuana.
The volume features a comprehensive review of research into marijuana’s impact on public health, including how it affects cognitive and neurological functioning, its medical effects, suggested treatment approaches for marijuana use disorders, marijuana smoking and lung function, and marijuana-impaired driving.
Supplies are limited, so place your order today!


Big Marijuana is borrowing the playbook of Big Tobacco in search of the same deep profits at the expense of addicted users. It is time to combat their game with the facts! To help you do so, Smart Approaches to Marijuana (SAM) has partnered with Communities for Alcohol and Drug Free Youth (CADY) to offer a comprehensive media campaign prevention toolkit.

As always, thank you for being a SAM supporter. If you can, please chip-in with a small donation by clicking here.

If you can’t chip-in, then at the very least,  and help grow the SAM community.

In Health,

Colton Grace

Communications Associate

Smart Approaches to Marijuana

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Canada: Great to go after one drug, but actively promote another, hmm?

B.C. files lawsuit against opioid makers and distributors for deceptive marketing



OxyContin pills are arranged for a photo at a pharmacy in Montpelier, Vt. The B.C. government has announced a lawsuit against Purdue and dozens of other companies for their role in fuelling Canada’s opioid epidemic.


British Columbia is suing Purdue Pharma and dozens of other opioid manufacturers for what the government alleges was “corporate corruption and negligence” that fuelled the overdose crisis, killing thousands of Canadians.

The lawsuit, first reported by The Globe and Mail, is the first case against opioid manufacturers filed by a government in Canada. Attorney-General David Eby said he would be asking other provinces to join.

The lawsuit targets 40 manufactures and distributors, including Purdue, whose OxyContin pain pill has been implicated in triggering Canada’s opioid epidemic. The list of defendants includes brand-name and generic manufacturers and alleges they deceptively marketed opioids as both being less addictive than actually known and for conditions they were not effective in treating.

“While much attention has been focused on the effects of street drugs contaminated by illicit fentanyl and carfentanil, there is another side of this crisis,” Mr. Eby said Wednesday outside the Supreme Court of British Columbia. “We allege that Purdue was not alone in their illegal actions to drive profits.”

The allegations have not been proven in court and the companies have not yet filed statements of defence.

For complete article


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Global: Cannabis Use Disorder – tougher to shift than you think!


  1. Full remission from cannabis-related problems is possible and probable (67-90% rates in short-term and lifetime rates).
  2. CUD remission rates are similar for men and women, but women experience a more rapid onset and stabilization of remission than men.
  3. Remission takes time—an average of 32.5 months from CUD onset to one year of remission.
  4. CUD remission styles vary, with some people with CUDs achieving remission through deceleration of the frequency and intensity of cannabis use rather than through total abstinence.
  5. Abstinence styles of CUD remission are more likely to produce greater enhancements in global functioning than non-abstinent remission patterns.
  6. CUD remission can be fragile during its early stages but strengthens over time, suggesting the need for assertive and continuous management, particularly during the first months and years of remission

For more


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Scotland: ‘Medibles’ to utterly Mess up Our Minors!

Drug dealers selling chocolate treats like Mars and Smarties packed with high-strength cannabis to KIDS via Instagram

The so-called ‘medibles’ (Marijuana edibles) are the latest way to package drugs according to detectives and are being sold apparently to school pupils

By Paul Drury August 2018, 

DRUG dealers in Scotland are packing sweet treats like Mars bars and Smarties with high-strength cannabis and selling them to KIDS on Instagram, police have warned.

The so-called “medibles” (Marijuana edibles) are the latest way to package drugs according to detectives and are being sold apparently to school pupils.

The items look like a familiar chocolate treats from giant confectionery brands Mars or Smarties – but are full of high-strength cannabis, called ‘skunk’.

They contain the powerful THC (Tetrahydrocannabinol), the main psychoactive constituent of cannabis.

Sales at the click of the button were uncovered by the Mail on Sunday, which spent hundreds of pounds on test purchases in Glasgow and Perth.

An undercover female reporter was warned the chocolate was “very strong” and only to eat a third of a cake to ensure she was not “knocked out.”

“Make no mistake, this is on our radar and we are actively monitoring social media sites. Anyone caught supplying medible products should know it could result in a prison sentence. It is a controlled drug and will be treated the same way as other controlled drugs

“Some of the dealers are now operating huge operations almost like multinational companies – with managing directors and distributors.”

For more


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Today’s Marijuana

Wednesday, October 3rd, 11:30am-1:00pm
Cable Center at University of Denver
2000 Buchtel Blvd. Denver, CO  80210 

Tickets starting at $125 – Includes Lunch

Table sponsorships are available and greatly appreciated.
Contact for more information.


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Global: Recovery Month – Nanny State and Recovery!

Recovery and the ‘Nanny State’ – A note to the ‘right to recreational drug use’ lobby!

Reprinted with permission!

When elements of a society (most always from the ‘grown-ups’) say, “I don’t want a nanny state, with laws and regulations keeping me from doing what I want”, then ‘movements’ emerge seeking to mandate the removal of prohibitions and prevention on that risky edge. This is no more apparent than with the vociferous minority seeking to normalize illicit drug use in our culture.

Of course, the lesser protections there are in place, the greater the incidences of harm will follow, and invariably for the most vulnerable – our young.

Besides the utter disregard for ‘others’, what is not only incongruent, but breath-takingly hypocritical, is that this decrying of the ‘Nanny State’ interference only works one way for the societal saboteur!

At the commencement of their campaigns, these egocentric self-indulgers demand to be left alone to do what they want but seem to have no repulsion in lining up quickly for free health care, welfare benefits and tax-payer funded reparations when their hedonism eventually fails them.

So, if we are to stop being a Nanny State, then that must work at every level and in all directions, right?  Let us permit all drug use, but also permit that only the user pays for both the harm to themselves and others, and without any burden or impost on society they chose to carelessly ignore!

Even the oft quoted anti-nanny state libertarian and 19th Century social commentator, John Stuart Mills insists some lines be drawn in society, and when it comes to drug use, his following statements couldn’t be more relevant or poignant.

“No person is an entirely isolated being; it is impossible for a person to do anything seriously or permanently hurtful to himself without mischief reaching at least to his near connections, and often far beyond them.” And, “If he deteriorates his bodily or mental faculties, he not only brings evil upon all who depended upon him for any portion of their happiness, but disqualifies himself for rendering the services which he owes to his fellow creatures generally, perhaps becomes a burden on their affection or benevolence; and if such conduct were very frequent hardly any offense that is committed would detract more from the general sum of good.

And even (it will be added) if the consequences of misconduct could be confined to the vicious or thoughtless individual, ought society to abandon to their own guidance those who are manifestly unfit for it? If protection against themselves is confessedly due to children and persons under age, is not society equally bound to afford it to persons of mature years who are equally incapable of self-government? If gambling, or drunkenness [we would add drug use, of course]… are as injurious to happiness, and as great a hindrance to improvement, as many or most of the acts prohibited by law, why (it may be asked) should not law, so far as is consistent with practicability and social convenience, endeavor to repress these also? …There is no question here (it may be said) about restricting individuality or impeding the trial of new and original experiments in living. The only things it is sought to prevent are things which have been tried and condemned from the beginning of the world until now; things which experience has shown not to be useful or suitable to any person’s individuality. There must be some length of time and amount of experience, after which a moral or prudential truth may be regarded as established, and it is merely desired to prevent generation after generation from falling over the same precipice which has been fatal to their predecessors.1

Of course, not all current drug users are of this epicurean ilk, and many are trapped in the tyranny of addiction and need support, care and empowerment to recover. However, make no mistake, the current lobby is all about engagement with illicit drugs for anything but trauma alleviation!

Drug use exiting recovery is best practice for the well-being and restoration of those currently living with the consequences of decisions to enter the world of drug use – motivators/invitations from everything from uninvited trauma, to the careless and reckless decisions ‘to smash as many drugs as I can and party hard!’. This Recovery Month we encourage all in such situations to seek out and at least commence that journey to drug use exiting recovery.

However, the adage remains irrevocably true – “Prevention is ALWAYS better than cure!” When it comes to illicit drug use, and the misuse of the legal and most damaging drug, Alcohol, please think not only of yourself, but of those nearest to you. The life you enrich may not just be your own!

L’chaim – To life, not instead of it!

Shane Varcoe – The Dalgarno Institute.

  1. 1. Mill J.S.  (1859) On Liberty London: Parker & Son, West Strand  Ch 4 Of the limits to the authority of society over the individual:


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September is National Recovery Month. We at SAM celebrate this month with the whole country. It is a time to remind everyone that marijuana use disorder is real, and recovery happens.
SAM is proud to release this toolkit to help in your work.
Some key facts to share on social media:
  • Big Pharma is eyeing marijuana- The former CEO of the drug companybehind OxyContin is now a co-founder of a medical marijuana company based in Canada.
  • Pot use is exploding- A recent study finds college-age people are using marijuana more now than in the last 30 years.
  • Invisible addicts are everywhere- The Atlantic reported that the drug is becoming so commonplace and so abused the reporter of the story said: “users lost jobs, lost marriages, lost houses, lost money, lost time…foreclosures and divorces… weight gain and mental-health problems.”
Stories of recovery to share:
Here is an inspirational blog post written by Justin Luke Riley, who heads up the Marijuana Accountability Coalition:…ustin-luke-riley/

Sample tweets:
  • Marijuana addiction is real. Let’s put public health over profit.
  • More kids are in treatment for pot today than all drugs combined. #TheMoreYouKnow #PeopleBeforeProfit
  • As we celebrate recovery month, a reminder that pot addiction is real.
  • For recovery month, a reminder that pot addiction often accompanies psychiatric disorders.
Sample Facebook post:
  • As we celebrate National Recovery Month, let us not ignore the fact that marijuana addiction is real. More youth today are in recovery for marijuana than all other drugs combined. It is time to put public health over the profits of the next Big Tobacco.
Today’s genetically bred weed is nothing like the days of Woodstock. In many cases, pot is made up of more than 99 percent  THC, the compound that makes the user high.
Big Pot is employing the playbook of Big Tobacco- the last addiction-for-profit industry we had to contend with. The use of  gummies, candies, and sodascolorfully packaged attracts youth, while  dispensaries are set up in low-income  neighborhoods in an effort to lure unsuspecting populations.
The message they send is that marijuana is safe, fun, and harmless. Millions of people in recovery know that isn’t true.
Please use the above information to promote the message that marijuana use is on the rise, and recovery is possible with the right tools.
About SAM
Smart Approaches to Marijuana (SAM) is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. SAM has affiliates in more than 30 states. For more information about marijuana use and its effects, visit


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USA: America’s Invisible Pot Addicts – Business Profiting Off Addiction!

Dear friend,
Annie Lowrey wrote the illuminating piece below in the Atlantic that highlights the growing marijuana problem we face in our country- and how Big Pot puts profit over public health. I wanted to make sure you got the chance to read it.  If there’s one piece on this issue you read all year, this should be it.
Dr. Kevin Sabet
President and Founder
Smart Approaches to Marijuana
The proliferation of retail boutiques in California did not really bother him, Evan told me, but the billboards did. Advertisements for delivery, advertisements promoting the substance for relaxation, for fun, for health. “Shop. It’s legal.” “Hello marijuana, goodbye hangover.” “It’s not a trigger,” he told me. “But it is in your face.”
When we spoke, he had been sober for a hard-fought seven weeks: seven weeks of sleepless nights, intermittent nausea, irritability, trouble focusing, and psychological turmoil. There were upsides, he said, in terms of reduced mental fog, a fatter wallet, and a growing sense of confidence that he could quit. “I don’t think it’s a ‘can’ as much as a ‘must,’” he said.
Evan, who asked that his full name not be used for fear of the professional repercussions, has a self-described cannabis-use disorder. If not necessarily because of legalization, but alongside legalization, such problems are becoming more common: The share of adults with one has doubled since the early aughts, as the share of cannabis users who consume it daily or near-daily has jumped nearly 50 percent-all “in the context of increasingly permissive cannabis legislation, attitudes, and lower risk perception,” as the National Institutes of Health put it.
Public-health experts worry about the increasingly potent options available, and the striking number of constant users. “Cannabis is potentially a real public-health problem,” said Mark A. R. Kleiman, a professor of public policy at New York University. “It wasn’t obvious to me 25 years ago, when 9 percent of self-reported cannabis users over the last month reported daily or near-daily use. I always was prepared to say, ‘No, it’s not a very abusable drug. Nine percent of anybody will do something stupid.’ But that number is now [something like] 40 percent.” They argue that state and local governments are setting up legal regimes without sufficient public-health protection, with some even warning that the country is replacing one form of reefer madness with another, careening from treating cannabis as if it were as dangerous as heroin to treating it as if it were as benign as kombucha.
But cannabis is not benign, even if it is relatively benign, compared with alcohol, opiates, and cigarettes, among other substances. Thousands of Americans are finding their own use problematic-in a climate where pot products are getting more potent, more socially acceptable to use, and yet easier to come by, not that it was particularly hard before.
For Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, the most compelling evidence of the deleterious effects comes from users themselves. “In large national surveys, about one in 10 people who smoke it say they have a lot of problems. They say things like, ‘I have trouble quitting. I think a lot about quitting and I can’t do it. I smoked more than I intended to. I neglect responsibilities.’ There are plenty of people who have problems with it, in terms of things like concentration, short-term memory, and motivation,” he said. “People will say, ‘Oh, that’s just you fuddy-duddy doctors.’ Actually, no. It’s millions of people who use the drug who say that it causes problems.”
Users or former users I spoke with described lost jobs, lost marriages, lost houses, lost money, lost time. Foreclosures and divorces. Weight gain and mental-health problems. And one other thing: the problem of convincing other people that what they were experiencing was real. A few mentioned jokes about Doritos, and comments implying that the real issue was that they were lazy stoners. Others mentioned the common belief that you can be “psychologically” addicted to pot, but not “physically” or “really” addicted. The condition remains misunderstood, discounted, and strangely invisible, even as legalization and white-marketization pitches ahead.
The country is in the midst of a volte-face on marijuana. The federal government still classifies cannabis as Schedule I drug, with no accepted medical use. (Meth and PCP, among other drugs, are Schedule II.) Politicians still argue it is a gateway to the use of things like heroin and cocaine. The country still spends billions of dollars fighting it in a bloody and futile drug war, and still arrests more people for offenses related to cannabis than it does for all violent crimes combined.
Yet dozens of states have pushed ahead with legalization for medical or recreational purposes, given that for decades physicians have argued that marijuana’s health risks have been overstated and its medical uses overlooked; activists have stressed prohibition’s tremendous fiscal cost and far worse human cost; and researchers have convincingly argued that cannabis is far less dangerous than alcohol. A solid majority of Americans support legalization nowadays.
Academics and public-health officials, though, have raised the concern that cannabis’s real risks have been overlooked or underplayed-perhaps as part of a counter-reaction to federal prohibition, and perhaps because millions and millions cannabis users have no problems controlling their use. “Part of how legalization was sold was with this assumption that there was no harm, in reaction to the message that everyone has smoked marijuana was going to ruin their whole life,” Humphreys told me. It was a point Kleiman agreed with. “I do think that not legalization, but the legalization movement, does have a lot on its conscience now,” he said. “The mantra about how this is a harmless, natural, and non-addictive substance-it’s now known by everybody. And it’s a lie.”
Thousands of businesses, as well as local governments earning tax money off of sales, are now literally invested in that lie. “The liquor companies are salivating,” Matt Karnes of GreenWave Advisors told me. “They can’t wait to come in full force.” He added that Big Pharma was targeting the medical market, with Wall Street, Silicon Valley, food businesses, and tobacco companies aiming at the recreational market.
Sellers are targeting broad swaths of the consumer market-soccer moms, recent retirees, folks looking to replace their nightly glass of chardonnay with a precisely dosed, low-calorie, and hangover-free mint. Many have consciously played up cannabis as a lifestyle product, a gift to give yourself, like a nice crystal or an antioxidant face cream. “This is not about marijuana,” one executive at the California retailer MedMen recently argued. “This is about the people who use cannabis for all the reasons people have used cannabis for hundreds of years. Yes for recreation, just like alcohol, but also for wellness.”
Evan started off smoking with his friends when they were playing sports or video games, lighting up to chill out after his nine-to-five as a paralegal at a law office. But that soon became couch-lock, and he lost interest in working out, going out, doing anything with his roommates. Then came a lack of motivation and the slow erosion of ambition, and law school moving further out of reach. He started smoking before work and after work. Eventually, he realized it was impossible to get through the day without it. “I was smoking anytime I had to do anything boring, and it took a long time before I realized that I wasn’t doing anything without getting stoned,” he said.
His first attempts to reduce his use went miserably, as the consequences on his health and his life piled up. He gained nearly 40 pounds, he said, when he stopped working out and cooking his own food at home. He recognized that he was just barely getting by at work, and was continually worried about getting fired. Worse, his friends were unsympathetic to the idea that he was struggling and needed help. “[You have to] try to convince someone that something that is hurting you is hurting you,” he said.
Other people who found their use problematic or had managed to quit, none of whom wanted to use their names, described similar struggles and consequences. “I was running two companies at the time, and fitting smoking in between running those companies. Then, we sold those companies and I had a whole lot of time on my hands,” one other former cannabis user told me. “I just started sitting around smoking all the time. And things just came to a halt. I was in terrible shape. I was depressed.”
Lax regulatory standards and aggressive commercialization in some states have compounded some existing public-health risks, raised new ones, and failed to tamp down on others, experts argue. In terms of compounding risks, many cite the availability of hyper-potent marijuana products. “We’re seeing these increases in the strength of cannabis, as we are also seeing an emergence of new types of products,” such as edibles, tinctures, vape pens, sublingual sprays, and concentrates, Ziva Cooper, an associate professor of clinical neurobiology in the Department of Psychiatry at Columbia University Medical Center, told me. “A lot of these concentrates can have up to 90 percent THC,” she said, whereas the kind of flower you could get 30 years ago was far, far weaker. Scientists are not sure how such high-octane products affect people’s bodies, she said, but worry that they might have more potential for raising tolerance, introducing brain damage, and inculcating dependence.
As for new risks: In many stores, budtenders are providing medical advice with no licensing or training whatsoever. “I’m most scared of the advice to smoke marijuana during pregnancy for cramps,” said Humphreys, arguing that sellers were providing recommendations with no scientific backing, good or bad, at all.
In terms of long-standing risks, the lack of federal involvement in legalization has meant that marijuana products are not being safety-tested like pharmaceuticals; measured and dosed like food products; subjected to agricultural-safety and pesticide standards like crops; and held to labeling standards like alcohol. (Different states have different rules and testing regimes, complicating things further.)
Health experts also cited an uncomfortable truth about allowing a vice product to be widely available, loosely regulated, and fully commercialized: Heavy users will make up a huge share of sales, with businesses wanting them to buy more and spend more and use more, despite any health consequences.
“The reckless way that we are legalizing marijuana so far is mind-boggling from a public-health perspective,” Kevin Sabet, an Obama administration official and a founder of the nonprofit Smart Approaches to Marijuana, told me. “The issue now is that we have lobbyists, special interests, and people whose motivation is to make money that are writing all of these laws and taking control of the conversation.”
This is not to say that prohibition is a more attractive policy, or that legalization has proven a public-health disaster. “The big-picture view is that the vast majority of people who use cannabis are not going to be problematic users,” said Jolene Forman, an attorney at the Drug Policy Alliance. “They’re not going to have a cannabis-use disorder. They’re going to have a healthy relationship with it. And criminalization actually increases the harms related to cannabis, and so having like a strictly regulated market where there can be limits on advertising, where only adults can purchase cannabis, and where you’re going to get a wide variety of products makes sense.”
Still, strictly regulated might mean more strictly regulated than today, at least in some places, drug-policy experts argue. “Here, what we’ve done is we’ve copied the alcohol industry fully formed, and then on steroids with very minimal regulation,” Humphreys said. “The oversight boards of a number of states are the industry themselves. We’ve learned enough about capitalism to know that’s very dangerous.”
A number of policy reforms might tamp down on problem use and protect consumers, without quashing the legal market or pivoting back to prohibition and all its harms. One extreme option would be to require markets to be noncommercial: The District of Columbia, for instance, does not allow recreational sales, but does allow home cultivation and the gifting of marijuana products among adults. “If I got to pick a policy, that would probably be it,” Kleiman told me. “That would be a fine place to be if we were starting from prohibition, but we are starting from patchwork legalization. As the Vermont farmer says, I don’t think you can get there from here. I fear its time has passed. It’s generally true that the drug warriors have never missed an opportunity to miss an opportunity.”
There’s no shortage of other reasonable proposals, many already in place or under consideration in some states. The government could run marijuana stores, as in Canada. States could require budtenders to have some training or to refrain from making medical claims. They could ask users to set a monthly THC purchase cap and remain under it. They could cap the amount of THC in products, and bar producers from making edibles that are attractive to kids, like candies. A ban or limits on marijuana advertising are also options, as is requiring cannabis dispensaries to post public-health information.
Then, there are THC taxes, designed to hit heavy users the hardest. Some drug-policy experts argue that such levies would just push people from marijuana to alcohol, with dangerous health consequences. “It would be like saying, ‘Let’s let the beef and pork industries market and do whatever they wish, but let’s have much tougher restrictions on tofu and seitan,’” said Mason Tvert of the Marijuana Policy Project. “In light of the current system, where alcohol is so prevalent and is a more harmful substance, it is bad policy to steer people toward that.” Yet reducing the commercial appeal of all vice products-cigarettes, alcohol, marijuana-is an option, if not necessarily a popular one.
Perhaps most important might be reintroducing some reasonable skepticism about cannabis, especially until scientists have a better sense of the health effects of high-potency products, used frequently. Until then, listening to and believing the hundreds of thousands of users who argue marijuana is not always benign might be a good start.
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