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Alex
Bere
JANUARY 2019 | VOLUME 48, ISSUE 1 nson
is a
graduate of Yale
University with
Marijuana, Mental degrees in history
and economics. He
Illness, and Violence began his career in
journalism in 1994
Alex Berenson as a business
reporter for the
Author, Tell Your Children: The Truth About Marijuana, Denver Post, joined Mental Illness, and Violence the financial news
website
TheStreet.com. in
1996, and worked as
an investigative
reporter for The New
York Times from
1999 to 2010, during
The following is adapted from a speech delivered on which time he also January 15, 2019, at Hillsdale College's Allan P. Kirby, Jr. served two stints as Center for Constitutional Studies and Citizenship in an Iraq War correspondent. In
Washington, D.C. 2006 he published
The Faithful Spy,
Seventy miles northwest of New York City is a which won the 2007 Edgar Award for best
hospital that looks like a prison, its drab brick first novel from the buildings wrapped in layers of fencing and barbed Mystery Writers of wire. This grim facility is called the Mid-Hudson America. He has Forensic Psychiatric Institute. It's one of three places published ten additional novels
the state of New York sends the criminally mentally and two nonfiction ill —defendants judged not guilty by reason of books, The Number:
insanity. How the Drive for
Quarterly Earnings
Corrupted Wall Street
Until recently, my wife Jackie-Dr. Jacqueline and Corporate Berenson—was a senior psychiatrist there. Many of America and Tell Your Children: The
Mid-Hudson's 300 patients are killers and arsonists. Truth About At least one is a cannibal. Most have been diagnosed Marijuana, Mental • Illness, and Violence.
with psychotic disorders like schizophrenia that
provoked them to violence against family members
or strangers.
Imprimis (im-pri-mis), (Latin): in the first place
TESTOR ARE DIRECTOR
Douglas A. Jeffrey Shanna Cote
A couple of years ago, Jackie was telling me about a Matthew D. Bell Lucinda Grimm Timothy W. Caspar STAFF ASSISTANTS
Samantha Strayer Carrie Moore
patient. In passing, she said something like, Of course Markie Repp Copyright © 2023 Rifisdale Cologe. To request permission to he'd been smoking pot his whole life. reprint, email impremis @nEsdie edu of cal (800) 437 2748 ISSN 0277-8452
Of course? I said.
SEARCH...
Yes, they all smoke.
ARCHIVED
So marijuana causes schizophrenia?
IMPRIMIS
ISSUES
I was surprised, to say the least. I tended to be a
Select Year
libertarian on drugs. Years before, I'd covered the
pharmaceutical industry for The New York Times. I
was aware of the claims about marijuana as
CONTRIBUTORS
medicine, and I'd watched the slow spread of
legalized cannabis without much interest. Select Author...
Jackie would have been within her rights to say, I
know what I'm talking about, unlike you. Instead she
offered something neutral like, I think that's what the big studies say. You should read them. American
Foreign Policy-
Then and Not
So I did. The big studies, the little ones, and all the FREE ONLINE COURSE ENROLL TODAY! rest. I read everything I could find. I talked to every psychiatrist and brain scientist who would talk to
me. And I soon realized that in all my years as a
journalist I had never seen a story where the gap
between insider and outsider knowledge was so
great, or the stakes so high.
I began to wonder why—with the stocks of cannabis
companies soaring and politicians promoting
legalization as a low-risk way to raise tax revenue
and reduce crime-I had never heard the truth about
marijuana, mental illness, and violence.
***
Over the last 30 years, psychiatrists and
epidemiologists have turned speculation about
marijuana's dangers into science. Yet over the same
period, a shrewd and expensive lobbying campaign
has pushed public attitudes about marijuana the
other way. And the effects are now becoming
apparent.
Almost everything you think you know about the
health effects of cannabis, almost everything
advocates and the media have told you for a
generation, is wrong.
They've told you marijuana has many different
medical uses. In reality marijuana and THC, its
active ingredient, have been shown to work only in a
few narrow conditions. They are most commonly
prescribed for pain relief. But they are rarely tested
against other pain relief drugs like ibuprofen—and
in July, a large four-year study of patients with
chronic pain in Australia showed cannabis use was
associated with greater pain over time.
They've told you cannabis can stem opioid use
_ "Two new studies show how marijuana can help
fight the opioid epidemic," according to Wonkblog, a
Washington Post website, in April 2018— and that
marijuana's effects as a painkiller make it a potential substitute for opiates. In reality, like alcohol,
marijuana is too weak as a painkiller to work for
most people who truly need opiates, such as terminal
cancer patients. Even cannabis advocates, like Rob
Kampia, the co-founder of the Marijuana Policy
Project, acknowledge that they have always viewed
medical marijuana laws primarily as a way to protect
recreational users.
As for the marijuana-reduces-opiate-use theory, it is
based largely on a single paper comparing overdose
deaths by state before 2010 to the spread of medical
marijuana laws— and the paper's finding is probably
a result of simple geographic coincidence. The opiate
epidemic began in Appalachia, while the first states
to legalize medical marijuana were in the West.
Since 2010, as both the epidemic and medical
marijuana laws have spread nationally, the finding
has vanished. And the United States, the Western
country with the most cannabis use, also has by far
the worst problem with opioids.
Research on individual users—a better way to trace
cause and effect than looking at aggregate state-level
data—consistently shows that marijuana use leads to
other drug use. For example, a January 2018 paper in
the American Journal of Psychiatry showed that people
who used cannabis in 2001 were almost three times
as likely to use opiates three years later, even after
adjusting for other potential risks.
Most of all, advocates have told you that marijuana is
not just safe for people with psychiatric problems
like depression, but that it is a potential treatment
for those patients. On its website, the cannabis
delivery service Eaze offers the "Best Marijuana
Strains and Products for Treating Anxiety." "How
Does Cannabis Help Depression?" is the topic of an
article on Leafly, the largest cannabis website. But a
mountain of peer-reviewed research in top medical
journals shows that marijuana can cause or worsen
severe mental illness, especially psychosis, the
medical term for a break from reality. Teenagers
who smoke marijuana regularly are about three
times as likely to develop schizophrenia, the most
devastating psychotic disorder.
After an exhaustive review, the National Academy of
Medicine found in 2017 that "cannabis use is likely to
increase the risk of developing schizophrenia and
other psychoses; the higher the use, the greater the
risk." Also that "regular cannabis use is likely to
increase the risk for developing social anxiety
disorder."
***
Over the past decade, as legalization has spread,
patterns of marijuana use—and the drug itself—have
changed in dangerous ways.
Legalization has not led to a huge increase in people
using the drug casually. About 15 percent of
Americans used cannabis at least once in 2017, up
from ten percent in 2006, according to a large
federal study called the National Survey on Drug Use
and Health. (By contrast, about 65 percent of
Americans had a drink in the last year.) But the
number of Americans who use cannabis heavily is
soaring. In 2006, about three million Americans
reported using cannabis at least 300 times a year, the
standard for daily use. By 2017, that number had
nearly tripled, to eight million, approaching the
twelve million Americans who drank alcohol every
day. Put another way, one in 15 drinkers consumed
alcohol daily; about one in five marijuana users used
cannabis that often.
Cannabis users today are also consuming a drug that
is far more potent than ever before, as measured by
the amount of THC-delta-9-tetrahydrocannabinol,
the chemical in cannabis responsible for its
psychoactive effects—it contains. In the 1970s, the
last time this many Americans used cannabis, most
marijuana contained less than two percent THC.
Today, marijuana routinely contains 20 to 25 percent
THC, thanks to sophisticated farming and cloning
techniques—as well as to a demand by users for
cannabis that produces a stronger high more quickly.
In states where cannabis is legal, many users prefer
extracts that are nearly pure THC. Think of the
difference between near-beer and a martini, or even
grain alcohol, to understand the difference.
These new patterns of use have caused problems
with the drug to soar. In 2014, people who had
diagnosable cannabis use disorder, the medical term
for marijuana abuse or addiction, made up about 1.5
percent of Americans. But they accounted for eleven
percent of all the psychosis cases in emergency
rooms—90,000 cases, 250 a day, triple the number
in 2006. In states like Colorado, emergency room
physicians have become experts on dealing with
cannabis-induced psychosis.
Cannabis advocates often argue that the drug can't
be as neurotoxic as studies suggest, because
otherwise Western countries would have seen
population-wide increases in psychosis alongside
rising use. In reality, accurately tracking psychosis
cases is impossible in the United States. The
government carefully tracks diseases like cancer with
central registries, but no such registry exists for
schizophrenia or other severe mental illnesses.
On the other hand, research from Finland and
Denmark, two countries that track mental illness
more comprehensively, shows a significant increase
in psychosis since 2000, following an increase in
cannabis use. And in September of last year, a large
federal survey found a rise in serious mental illness
in the United States as well, especially among young
adults, the heaviest users of cannabis.
According to this latter study, 7.5 percent of adults
age 18-25 met the criteria for serious mental illness
in 2017, double the rate in 2008. What's especially
striking is that adolescents age 12-17 don't show
these increases in cannabis use and severe mental
illness.
A caveat: this federal survey doesn't count individual
cases, and it lumps psychosis with other severe
mental illness. So it isn't as accurate as the Finnish or Danish studies. Nor do any of these studies prove that
rising cannabis use has caused population-wide
increases in psychosis or other mental illness. The
most that can be said is that they offer intriguing
evidence of a link.
***
Advocates for people with mental illness do not like
discussing the link between schizophrenia and
crime. They fear it will stigmatize people with the
disease. "Most people with mental illness are not
violent," the National Alliance on Mental Illness
(NAMI) explains on its website. But wishing away
the link can't make it disappear. In truth, psychosis is a shockingly high risk factor for violence. The best
analysis came in a 2009 paper in PLOS Medicine by
Dr. Seena Fazel, an Oxford University psychiatrist
and epidemiologist. Drawing on earlier studies, the
paper found that people with schizophrenia are five
times as likely to commit violent crimes as healthy
people, and almost 20 times as likely to commit
homicide.
NAMI's statement that most people with mental
illness are not violent is of course accurate, given
that "most" simply means "more than half"; but it is
deeply misleading. Schizophrenia is rare. But people
with the disorder commit an appreciable fraction of
all murders, in the range of six to nine percent.
"The best way to deal with the stigma is to reduce
the violence," says Dr. Sheilagh Hodgins, a professor
at the University of Montreal who has studied
mental illness and violence for more than 30 years.
The marijuana-psychosis-violence connection is
even stronger than those figures suggest. People
with schizophrenia are only moderately more likely
to become violent than healthy people when they are
taking antipsychotic medicine and avoiding
recreational drugs. But when they use drugs, their
risk of violence skyrockets. "You don't just have an
increased risk of one thing—these things occur in
clusters," Dr. Fazel told me.
Along with alcohol, the drug that psychotic patients
use more than any other is cannabis: a 2010 review
of earlier studies in Schizophrenia Bulletin found that 27 percent of people with schizophrenia had been
diagnosed with cannabis use disorder in their lives.
And unfortunately-despite its reputation for
making users relaxed and calm—cannabis appears to
provoke many of them to violence.
A Swiss study of 265 psychotic patients published in
Frontiers of Forensic Psychiatry last June found that
over a three-year period, young men with psychosis
who used cannabis had a 50 percent chance of
becoming violent. That risk was four times higher
than for those with psychosis who didn't use, even
after adjusting for factors such as alcohol use. Other
researchers have produced similar findings. A 2013
paper in an Italian psychiatric journal examined
almost 1,600 psychiatric patients in southern Italy
and found that cannabis use was associated with a
ten-fold increase in violence.
The most obvious way that cannabis fuels violence
in psychotic people is through its tendency to cause
paranoia-something even cannabis advocates
acknowledge the drug can cause. The risk is so
obvious that users joke about it and dispensaries
advertise certain strains as less likely to induce
paranoia. And for people with psychotic disorders,
paranoia can fuel extreme violence. A 2007 paper in
the Medical Journal of Australia on 88 defendants who
had committed homicide during psychotic episodes
found that most believed they were in danger from
the victim, and almost two-thirds reported misusing
cannabis—more than alcohol and amphetamines
combined.
Yet the link between marijuana and violence doesn't
appear limited to people with preexisting psychosis.
Researchers have studied alcohol and violence for
generations, proving that alcohol is a risk factor for
domestic abuse, assault, and even murder. Far less
work has been done on marijuana, in part because
advocates have stigmatized anyone who raises the
issue. But studies showing that marijuana use is a
significant risk factor for violence have quietly piled up. Many of them weren't even designed to catch the
link, but they did. Dozens of such studies exist,
covering everything from bullying by high school
students to fighting among vacationers in Spain.
In most cases, studies find that the risk is at least as significant as with alcohol. A 2012 paper in the
Journal of Interpersonal Violence examined a federal
survey of more than 9,000 adolescents and found
that marijuana use was associated with a doubling of
domestic violence; a 2017 paper in Social Psychiatry
and Psychiatric Epidemiology examined drivers of
violence among 6,000 British and Chinese men and
found that drug use—the drug nearly always being
cannabis-translated into a five-fold increase in
violence.
Today that risk is translating into real-world
impacts. Before states legalized recreational
cannabis, advocates said that legalization would let
police focus on hardened criminals rather than
marijuana smokers and thus reduce violent crime.
Some advocates go so far as to claim that legalization
has reduced violent crime. In a 2017 speech calling
for federal legalization, U.S. Senator Cory Booker
said that "states [that have legalized marijuana] are
seeing decreases in violent crime." He was wrong.
The first four states to legalize marijuana for
recreational use were Colorado and Washington in.
2014 and Alaska and Oregon in 2015. Combined,
those four states had about 450 murders and 30,300
aggravated assaults in 2013. Last year, they had
almost 620 murders and 38,000 aggravated assaults
—an increase of 37 percent for murders and 25
percent for aggravated assaults, far greater than the
national increase, even after accounting for
differences in population growth.
Knowing exactly how much of the increase is related
to cannabis is impossible without researching every
crime. But police reports, news stories, and arrest
warrants suggest a close link in many cases. For
example, last September, police in Longmont,
Colorado, arrested Daniel Lopez for stabbing his
brother Thomas to death as a neighbor watched.
Daniel Lopez had been diagnosed with
schizophrenia and was "self-medicating" with
marijuana, according to an arrest affidavit.
In every state, not just those where marijuana is
legal, cases like Lopez's are far more common than
either cannabis or mental illness advocates
acknowledge. Cannabis is also associated with a
disturbing number of child deaths from abuse and
neglect—many more than alcohol, and more than
cocaine, methamphetamines, and opioids combined
—according to reports from Texas, one of the few
states to provide detailed information on drug use by
perpetrators.
These crimes rarely receive more than local
attention. Psychosis-induced violence takes
particularly ugly forms and is frequently directed at
helpless family members. The elite national media
prefers to ignore the crimes as tabloid fodder. Even
police departments, which see this violence up close,
have been slow to recognize the trend, in part
because the epidemic of opioid overdose deaths has
overwhelmed them.
So the black tide of psychosis and the red tide of
violence are rising steadily, almost unnoticed, on a
slow green wave.
***
For centuries, people worldwide have understood
that cannabis causes mental illness and violence-
just as they've known that opiates cause addiction
and overdose. Hard data on the relationship between
marijuana and madness dates back 150 years, to
British asylum registers in India. Yet 20 years ago,
the United States moved to encourage wider use of
cannabis and opiates.
In both cases, we decided we could outsmart these
drugs—that we could have their benefits without
their costs. And in both cases we were wrong.
Opiates are riskier, and the overdose deaths they
cause a more imminent crisis, so we have focused on
those. But soon enough the mental illness and
violence that follow cannabis use will also be too
widespread to ignore.
Whether to use cannabis, or any drug, is a personal
decision. Whether cannabis should be legal is a
political issue. But its precise legal status is far less important than making sure that anyone who uses it
is aware of its risks. Most cigarette smokers don't die of lung cancer. But we have made it widely known
that cigarettes cause cancer, full stop. Most people
who drink and drive don't have fatal accidents. But
we have highlighted the cases of those who do.
We need equally unambiguous and well-funded
advertising campaigns on the risks of cannabis.
Instead, we are now in the worst of all worlds.
Marijuana is legal in some states, illegal in others,
dangerously potent, and sold without warnings
everywhere.
But before we can do anything, we-especially
cannabis advocates and those in the elite media who
have for too long credulously accepted their claims—
need to come to terms with the truth about the
science on marijuana. That adjustment may be
painful. But the alternative is far worse, as the
patients at Mid-Hudson Forensic Psychiatric
Institute-and their victims-know.
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Imprimis is the free monthly speech digest of Hillsdale College and is dedicated to educating citizens and promoting civil and religious liberty by covering cultural, economic, political, and educational issues. The content of Imprimis is drawn from speeches delivered at Hillsdale College events. First published in 1972, Imprimis is one of the most widely circulated opinion publications in the nation with over six million subscribers.
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