As a family physician filling the gaps in our substance use and mental healthcare system, I cheered President Joe Biden when he announced his new plan to expand mental health and drug abuse treatment services in his State of the Union address. With Beto O’Rourke campaigning as the “healthcare candidate” here in Texas, Democrats could lay claim to being “the party of mental health” on the heels of being able to claim credibly they were more “the party of science” with respect to COVID-19 vaccination rates. But the vast majority of Democrats support “medical” marijuana, and most agree with O’Rourke that marijuana should not just be decriminalized to protect users from harsh punishment but entirely legalized.
“Follow the science” shouldn’t be a situational ethic. Such marijuana expansion flies in the face of scientific evidence and expert recommendations. The “Position Statement in Opposition to Cannabis as Medicine” from the American Psychiatric Association states clearly that “there is no current scientific evidence that cannabis is in any way beneficial for the treatment of any psychiatric disorder” and that there is “a strong association of cannabis use with the onset of psychiatric disorders.” Further, the organization advises that any proposed treatments should be evidence-based and FDA-approved, “not authorized by ballot initiatives.”
The National Academies of Sciences has also debunked many of marijuana’s other touted medical benefits. Although the report found a few proven medical uses for some derivatives of the plant, it also found evidence of “problem cannabis use,” priming for other addictions and adverse mental health outcomes. It warned that there is “substantial evidence” that marijuana use increases the risk of developing schizophrenia and other psychotic disorders. Since then, more prospective studies have shown an increase in psychotic illnesses of 3 to 10-fold depending on the age of first exposure, THC concentration, and length of use.
Though toxicology reports receive scant attention after mass shootings, the contribution of marijuana to such paranoid, delusional, and psychotic acts is becoming harder to ignore. No single factor fully explains a heinous act of violence such as the one perpetrated on the 19 children and two teachers in Uvalde. Law enforcement’s timid response and the 18-year-old’s easy access to such powerful weapons are important factors. But we must also explore the “why” of these seemingly random killings if we are to prevent them — not just the “how.” Marijuana aficionado Darrell Brooks Jr. used his car in the Waukesha Christmas parade mass murder.
While the Texas Director of DPS was still saying we “don’t see a motive or catalyst right now,” those who have experience with youth and marijuana psychosis knew what was coming next. The New York Times has confirmed (then inexplicably took down) a report from his co-worker that one of the conflicts Ramos had with his grandmother was because she “did not let him smoke weed” under her roof. Ramos and Sutherland Springs church shooter Devin Kelley are more the rule than the exception as chronic marijuana users. While individual responses to THC exposure are highly variable, it can cause paranoia, delusional thinking, and psychosis. As marijuana use and potency increase, we will only see more such tragedies. Portland had only 16 murders in 2013, the year before marijuana was legalized. Last year, it had 90, and it is on pace to break that record in 2022. While no marijuana states allow “recreational” use for minors, studies show teenage cannabis use disorder has increased while risk perception has decreased, presumably due to the normalization and commercialization that inevitably follows in the wake of legalization.
The “social justice” case for marijuana also calls for more scrutiny. While it brings money into the coffers of pro-marijuana politicians, all it brings to underprivileged neighborhoods are marijuana shops. The tax revenue is likely dwarfed by the increased spending on marijuana’s social costs. In marijuana states, the black markets became stronger and roads less safe. Here in Texas, the 2020 Department of Family and Protective Services report showed the substance most likely to be actively used by the perpetrator of abuse or neglect fatalities was marijuana, with 84 such incidents. By comparison, the number for alcohol was 25, and opioids just four.
Addiction specialists report that 3 in 10 chronic users suffer from a use disorder — much higher than for drinkers. Primary care doctors like me know all too well that marijuana can cause or worsen mental health problems and promote suicidal thoughts. Researchers know marijuana leads to everything from impaired driving to impaired IQs.
The young and the underprivileged will suffer the most from marijuana industry expansion, which will stress our healthcare system where it is already weakest. If Democrats want to be the party of marijuana, then they may have to set aside their aspirations for being the party of science or mental health.
Matt Poling is a family physician, former foster parent, and medical adviser of Citizens for a Safe and Healthy Texas.
