What If Weed Is Sometimes Bad?
The vast commercialization of the drug has had unintended consequences.
By Micah Cash
Micah Cash is a writer and tutor in New York City. His fiction and essays have appeared in Forever Magazine and The Village Voice and is forthcoming in Aesthetica Magazine, among other publications. You can occasionally find him on Twitter and Substack. Micah is from Tulsa, Oklahoma.
For years, the story of marijuana in America was one of moral panic in the media and a cruel, discriminatory carceral regime, a reactionary line from the 1936 propaganda film Reefer Madness to the “war on drugs.” Around 40,000 Americans are in long-term confinement for marijuana offenses, without counting city and county jails, even as recreational cannabis is now legal in 21 states, and all but 13 have passed medical laws. You may have heard that President Biden decriminalized weed, though his move was largely symbolic, clearing the records of federal offenders but releasing very few people from prison. Simple possession of marijuana is a crime “almost entirely prosecuted by the states,” and even as of 2018 40 percent of drug arrests were for marijuana.
Nevertheless, if you don’t live under a rock you might have noticed that the pendulum has swung; for a large majority of Americans, cannabis is not only accepted but embraced as a net good. I knew something had shifted in 2018 when my home state of Oklahoma, never known for its liberal social policy, comfortably passed a referendum to legalize medical sales. Within months there was a dispensary in every strip mall and billboards lining the highway. Marijuana is already a multibillion dollar industry, and the healthcare-industrial complex is eagerly accelerating the shift. Politicians and pundits of all stripes followed public opinion: conservatives have taken a libertarian view of legalization, while liberals and progressives use weed as a campaign promise. Perhaps the best illustration of marijuana’s utopian reputational makeover is New York City, where the dank smell on the street is a rare virtue uniting boroughs, backgrounds, and generations. In the words of our cop mayor, “seems like everybody is smoking a joint now.”
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Still, from giant green crosses lining the Oklahoma highway to minimalist wellness pop-ups on the Lower East Side, there is a sinister element in the rebranding of weed. The message seems to be that cannabis is not only good, but good for you, a sort of ubiquitous cure for the modern condition. Lost in this marketing consensus is the nuance that weed might not be great for everyone, nor is it a cure-all.
In college, I knew plenty of functional stoners; there was nothing disconcerting about someone who was high all day, every day. Since I smoked less than those friends, I especially didn’t see how it could be a problem. We all had a common refrain: once we were out in the real world, we’d snap our fingers and be casual smokers. We really believed it.
“But simply pointing out that a highly potent psychoactive substance can be dangerous for adolescents, people with mental health conditions, and people taking other medication is now often deemed as reactionary, or at least anti-fun.”
A few months before graduation, the pandemic arrived, and we were all alone and inside and shellshocked. The real world was upon us in more ways than one, and weed felt more essential than ever. After a while, the same way the pandemic forced so many to open up about mental health, it forced us to talk about our relationship to weed. The first thing we noticed was that it no longer felt the same; the wonder and joy had evaporated into a kind of numbness. Then there was the irritation and anxiety, the unspoken distance from nonsmoking friends and family, the toll on sleep and physical health, the incredible expense. But not only did we lack understanding of a drug we all had been told was non-addictive, we lacked the language to distinguish serious concern from joking bravado. Cursory reading turned up little between the poles of alarmism and marketing. Late one night I took a picture of a subway ad for a Columbia Doctors open trial for people looking to quit. When I called the next morning, they informed me the study was full; demand far exceeded their expectations.
Last year, I found myself in a graduate school class on investigative journalism and mental health, listening to a clinical psychologist tell us that self-medication of cannabis is a massively undercovered mental health issue. I decided to focus my semester-long project on the story, though I didn’t mention my personal connection to the class. As I continued my research, interviewing clinicians, doctors, and addicts in recovery, I cautiously brought up my changing opinions to friends. But simply pointing out that a highly potent psychoactive substance can be dangerous for adolescents, people with mental health conditions, and people taking other medication is now often deemed as reactionary, or at least anti-fun. Reading much of the popular writing against marijuana, it’s easy to see why; mainstream coverage left no room for complexity, and their authors were caricatures of a nightmare blunt rotation. I wanted to write something different, without a hand on the scale for stoners or squares, despite my allegiance to the former.
Here’s what I found: Behind the emerging narrative of cannabis as a miracle drug are two forces depressingly familiar to the mental health care system: commercialization and medicalization.
In the first case, marijuana’s potential as a cash crop has incentivized pharmaceutical companies, investment firms, and other opportunists to design a product and business model that maximizes profit. Often, these profit-seekers work hand-in-hand with doctors, researchers, and regulators so that corporate interest prevails over actual science. At the same time, the legitimate uses of medical marijuana are being supplemented by the unauthorized blanket promotion of weed as medicine, since a natural remedy is more convenient to market than a drug. As more and more cannabis users consider the drug medicinal, it’s important to ask who is really benefiting, and who is left to deal with the consequences.
A 2017 meta-analysis by the American Psychological Association found "only three therapeutic uses of cannabis backed by substantial or conclusive evidence: treating chronic pain, reducing nausea induced by chemotherapy treatment and decreasing the spasticity associated with multiple sclerosis.” Chronic pain is among the most common reasons Americans visit the doctor, which in part describes the narrative of cannabis as a medical breakthrough: it is a safe and effective treatment for a debilitating and incredibly prevalent condition. The latter two treatments, miraculous in their own right, are far more limited in scope. Notably, none of these three are mental health conditions.
Yet informal surveys and my conversations with psychologists indicate that there is widespread belief among users in cannabis as an effective treatment for anxiety, depression, and insomnia, among other prevalent mental health conditions. While the exact number of people self-medicating is unclear, many people tell their therapists that weed is the best thing they’ve found to mitigate their symptoms; simultaneously, millions of Americans struggle with marijuana dependence to the point of physical, social, and/or psychological impairment. For both groups, the line between self-medication and dependence is blurry, and there are few options for clinical or social support.
Most states that have legalized medicinal cannabis allow doctors to prescribe it for any number of conditions beyond its studied uses, a rarity for prescription medicine. This includes people already taking over-prescribed antidepressant, anti-anxiety, or antipsychotic medications; the aforementioned study warns of “individuals supplementing or replacing their use of FDA-approved psychiatric medications with cannabis to treat depression, anxiety, and symptoms of psychosis.” Cannabis is woefully understudied, largely due to the drug’s continued classification as a Schedule I controlled substance, in the same category as heroin and quaaludes. To further cloud the science nearly all medical cannabis studies use a product far less potent than what you can easily find in a dispensary or on the street. Throw in vaping, edibles, dabs and other creative methods, and it’s clear that lab-supervised research has little connection to how most people are using cannabis. While the strongest flower has a THC content around 30 percent, oil and wax frequently top 90 percent.
This rapid proliferation of the strength and breadth of marijuana products goes far beyond the oft-repeated line that this ain’t the same stuff your parents smoked in the 60s. Instead it is driven by the profit-seekers need to differentiate their product from competitors, and therefore sold by the industry as “innovation.” Almost needless to say, nobody is prescribed dabs for medical purposes, but in most states a medical card is a blank check to buy any product, often at a discount from the recreational price. As any stoner knows, frequent high-potency use means significant increase in tolerance, an expensive and vicious cycle, albeit a lucrative one for dealers and suppliers.
According to SAMHSA, 1 in 10 people who use marijuana will become addicted, and for users who start under the age of 18, the rate of addiction is 1 in 6. Indeed, up to 47 percent of habitual users experience withdrawals when they try to quit. A 2018 literature review in the International Review of Psychiatry concluded that “those with mental disorders are most vulnerable to the negative effects of cannabis use and the development of CUD [cannabis use disorder],” while a meta-analysis laments that “reports of anxiolytic [anxiety-reducing] effects of cannabis may merely reflect mitigation of anxiety-related cannabis withdrawal symptoms.”
“They described being laughed out of established meeting spaces like NA, given the competing narratives of marijuana as a non-addictive drug, a panacea, or a habit of lazy people.”
To summarize: young people with mental health conditions are at greater risk of becoming addicted, and therefore experience withdrawals whose common symptoms include anxiety, depression, and insomnia. Not good! There is also the rare but significant risk of cannabis as a catalyst for psychosis in predisposed populations, especially adolescent males. A clinically-focused, systematic review from 2020 in BMC Psychiatry Journal summarizes: “The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions.”
Earlier this year I spoke with several members of Marijuana Anonymous (MA), one of the largest communities of recovering cannabis addicts. They described being laughed out of established meeting spaces like NA, given the competing narratives of marijuana as a non-addictive drug, a panacea, or a habit of lazy people.
“I definitely thought: this is medication,” a young woman named Heather told me, “but once I stopped, I realized the medications I’d been on all along were finally able to work.” Others shared similar stories, stressing that many in MA struggled with pre-existing mental health concerns. Audry, who is in recovery and a member of MA’s board, put it best: “A lot of people say marijuana worked, until it didn’t.”
Emblazoned over a panoramic view of the earth from space, the slogan for the Releaf cannabis treatment tracking and research app is styled in all lowercase: “partake in the collective mission to discover how cannabis can help millions.” Releaf is categorized as “Medical” in the App Store, but it is a glaring example of the seedy intersection between medicalization and commercialization. The app’s advertised function is an individual log of medicinal cannabis use. Before a session, you input specs like method of ingestion, strain, and species. Then you’re prompted to select four “symptoms” from a litany of common mental and physical diagnoses ranging from dissociation to constipation. Using a one to ten slider, you tell the app how acutely each of these symptoms afflicts you; then you get high, and reposition the sliders at time intervals throughout the experience. In return, Releaf gets your anonymized data, which they use to sell targeted ads for dispensaries in your area.
I’d already encountered Releaf, along with dozens of similar apps and cannabis-health-tech start-ups, when I stumbled upon a study published in the Journal of Cannabis Research in December 2020 which concluded that a majority of patients experience relief from anxiety, agitation, and other distress-related symptoms following consumption of cannabis; furthermore, “higher THC levels were the strongest predictors of relief.” This was a surprising conclusion, given that the bulk of randomized control studies found high-THC cannabis carries far greater risk of abuse and negative psychological effects than low-potency or CBD alternatives. Data for the study was supplied by “the real-time Cannabis effects recording software, Releaf App.” Three of the five authors of the study are not part of a university or research institution; their listed affiliation is MoreBetter Ltd., a venture-capital funded company based in Washington. On their website, MoreBetter states that they are a “creative agency” that “aim[s] to elevate the social understanding of cannabis as medicine.” They are also the creators of the Releaf App; MoreBetter’s profile picture on LinkedIn is a green smiley face, identical to Releaf’s icon.
In the study’s “Competing Interests” section, the authors admit that the app generates revenue by selling advertising space to dispensaries, before a whopper of a closing sentence: “the authors’ declare that they have no competing interests.” At least three other studies conducted by the same authors using Releaf app data find similarly outlying results regarding depression, fatigue, and insomnia. No matter what they declare, their anomalous findings are an ideal citation for medical marijuana companies and doctors working at the platforms advertised on the Releaf App. MoreBetter and Releaf did not respond to requests for comment.
Anyone who says they have a sophisticated understanding of the relationship between marijuana and mental health is lying. But my personal experience with the strange balance of joking and worrying about cannabis use matches what recovering addicts, clinical psychologists, and academic researchers know: for the vast majority of people, lab-grown high-potency marijuana is a drug, not a medicine.
When the idea is to get stoned, it’s a pretty great drug, and with moderate use extremely safe. It is also both positively and negatively reinforcing; that is, using marijuana can create a reliable positive feeling (this is often described as euphoria), as well as reliably diminish negative feelings (like depression and anxiety). This is a fancy way of saying it lets you relax and escape, takes the edge off. But thinking of it, or prescribing it, as psychiatric medicine creates an altogether different relationship.
Count me among the many who welcome the positive shift in marijuana’s perception. But it’s far from reactionary to push back against the commercial and medical profiteers marketing high-potency weed as a cure-all for the psychological conditions of late capitalism. In Biden’s statement on marijuana reform, he vaguely recommended that “limitations on trafficking, marketing, and under-age sales should stay in place.” But the cat is out of the bag, and it’s well past time to shift the focus of law enforcement from users to hucksters. While politicians and columnists debate legalization, the most important fight in marijuana policy is cracking down on a burgeoning medical and commercial consensus that preys on dependent users. Until then, we may have gotten a nug in every grinder and a dispensary on every corner, but at what cost?