The Daily - As Marijuana’s Popularity Grows, So Do Its Harms

Episode Date: October 22, 2024

Warning: this episode contains descriptions of a mental health crisis and violence.This Election Day, recreational marijuana could become legal across more than half of the United States. But as more Americans consume more potent forms of the drug more often, a Times investigation has revealed that some of the heaviest users are experiencing serious and unexpected harms to their health.Megan Twohey, an investigative reporter for The Times, explains what she found.Guest: Megan Twohey, an investigative reporter for The New York Times.Background reading: As America’s marijuana use grows, so do the harms.Stories of marijuana’s little-known risks.Trump signals support for marijuana legalization in Florida.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.

From the New York Times, I'm Rachel Abrams, and this is The Daily. This election day, recreational marijuana could become legal across more than half of the United States. But as more Americans consume more potent forms of the drug more often, a Times investigation has revealed that some of the heaviest users are experiencing serious and unexpected harms to their health. Today, I spoke with my colleague, investigative reporter Megan Toohey, about what she found. It's Tuesday, October 22nd.

Hi, Megan. Hey, Rachel. Thank you for being here. So Megan, today we're going to talk about something that a lot of people, myself included, have at least a glancing familiarity with, and that's marijuana. So tell me, first of all, how did you come to this story? Well, full disclosure, I am one of those people who has some familiarity with marijuana. I have dabbled in it on and off stretching back to the 1990s. And so I, as a consumer, have also been among those who have noticed the drastic transformation

of marijuana in this country in recent years as legalization spread and the commercialized legal industry sprung up and began offering products. And so here in New York a couple ago, when we implemented the legalization of recreational marijuana, there was sort of all of a sudden dispensaries selling products on nearly like every corner. Everywhere. Everywhere. And so I was one of the people who started going into the dispensaries and immediately noticed that the products I was

seeing there were very different from some of the products I had consumed. You know, there were pre-rolled joints and gummies and these like almost pure concentrates of THC, which is the intoxicating component of marijuana. And so I could see for the first time that there was a huge range and that there were products that had really, really high levels of THC. And so I would purchase these little containers of gummies that contain five milligrams of THC, which is on the very low end. But when I would go home and take little bites of them,

in my experience, they were actually quite strong and were being framed as completely almost innocuous. You know, I have to tell you, I've also had kind of a hard time navigating this market and these shops that are for recreational use. But you can also go in and you can say something like, I have a headache or I have trouble sleeping and somebody who is not a doctor, is not a pharmacist, is suddenly recommending a product to you to help you with your health issue.

Well, I think you make a really good point, Rachel, which is that legalization of marijuana began as the legalization of medical marijuana in this country. I mean, the first states to legalize did that for the purposes of people being able to use it for health reasons. But what we have seen in the last 10 years is that what began as a medical marijuana market has been superseded by a recreational marijuana market. And you know, the promise of legalization was that it was going to make marijuana more

safe, that with legalization you'd have regulation and oversight and more protection of consumers. But there's now a $33 billion industry that sprung up to deliver these products in this newly legal market. And the products that they're delivering are at potency levels that were almost unimaginable a generation ago. And I knew from not just my own personal experience of interfacing with the commercial market, but also from people in my life and in my various orbits.

I was hearing about people who were actually struggling with marijuana, and those folks and their families had a lot of confusion. What isn't this supposed to be this totally safe and totally natural and now totally legal drug? And it just felt like there was a real vacuum of information. So what did you do just to start trying to understand this world that's obviously confusing a lot of people? So with that kind of initial interest, I just started to make some phone calls. And one of the first people I called

was a long-time medical marijuana researcher who helped develop a couple of the only pharmaceutical drugs that have cannabis components that have received regulatory approval. Interestingly enough, one of the first things he said to me was, oh, my God, good luck reporting into this. It's like a total jungle. I've been in this world for decades and even I have a hard time following exactly what's going on because so much has been shifting so fast. And so that was a little scary to hear, but also intriguing.

And one of the things that he said was that he had major concerns with the way that legalization and commercialization of marijuana was playing out here in the United States. He said that scientists and researchers and doctors like himself were on the sidelines, that they weren't being consulted as this was rolling out, and that the industry that had sprung up, this $33 billion industry, was also not focused on the therapeutic products of the drug but instead had basically ended up in a race to produce the most potent products, the most intoxicating products possible. And what I next realized was that there was a real dearth of research, of scientific research

into the effects of marijuana. And that's in part because while marijuana is now legal in, you know, about half the states, it has remained illegal at the federal level. And it's also in this highly restrictive category of drug, which makes it really challenging for people to do research on it. Also, the hospital and other health care data on the effects of marijuana was really inadequate. And the patchwork of state laws that had sprung up to govern this was not equipped to do any meaningful tracking of the health outcomes. And so after a while, I realized that if we really wanted to have a deeper understanding of how this drug was affecting consumers across the country, we were going to have to figure out ways

to gather that information ourselves. I was lucky enough to, at this point, be joined by two of my colleagues on the investigations team, Danielle Ivory and Carson Kessler. And one of the first things that we sought to tackle was this data set on drug use in this country. Every year, the government does a population survey that asks Americans about their use

of drugs and how frequently they use it and seeks to measure the effect on their lives. And mostly what people have focused on are opioids because historically those drugs have killed the most people and done the most harm. So what this survey has shown on marijuana use hasn't received a ton of attention. It's sort of been flying under the radar. But we found a researcher at Columbia University who has looked at this data and looked at specifically at marijuana, and we asked her to do a more detailed analysis of those responses for us.

And what did that analysis find? Well, the survey has turned up some very interesting trends with regards to marijuana use in this country. It has shown that as legalization and commercialization of marijuana has taken off and accelerated, that marijuana use has been going up steadily among people 18 and over. And it's not just that more people are consuming here and there, there are pretty sharp rising rates of people who are using it on a daily or near daily basis. And this survey showed that in 2022, in fact, for the very first time, more people said that they were using marijuana on a

daily or near daily basis than said they were using alcohol. But not only are people using marijuana at higher rates than ever before, more people are reporting that their marijuana use is having a negative impact on their lives. And this is more broadly known as cannabis use disorder. There's 11 specific criteria that are used to measure whether or not somebody is having like a problematic use of a drug. And you know, it ranges from like building up tolerance to craving the drug to not being able to stop even if it's having negative effects on your social life or your job.

And you know, if you meet two of the criteria, then you are considered to have a mild case of cannabis use disorder. And then on the far end, if you meet six or more criteria, then you are considered to have a severe cannabis use disorder, widely seen as addiction. And what this analysis showed was that 30% of cannabis users 18 and over reported having some level of cannabis use disorder. That's like an estimated 18 million Americans. And of those, about 3 million people are considered addicted.

I have to say, I was really surprised to hear that, that people could be addicted to marijuana. And frankly, I guess I was like a little skeptical when we were discussing and planning this episode. And it actually prompted a whole discussion here at The Daily about this where people were saying, you know, actually I know this one person who has an addiction problem. I know this other person who has an addiction problem. It was really, at least for me, it was really quite eye opening. Yeah, listen, I think that there has long been this belief that marijuana is not addictive, and I think that that's

in large part because it presents differently than, say, alcohol addiction or opioid addiction for which withdrawal can sometimes be so severe that it can be fatal. But in recent years, medical experts have been able to show how when our systems are basically overrun with THC, you need more and more to get the same effect. And when you stop using, you can experience anxiety, depression, and other symptoms of withdrawal. So what else did you find in your analysis of the data?

We found that this problematic use of marijuana is, you know, really stark among young people. Like in the 18 to 25-year-old group, 4.5 million of them use marijuana daily or near daily. And of those, 81% meet the criteria of cannabis use disorder in some way. Wow. So basically, millions of young people are using marijuana every day. And a huge percentage of them are reporting problems with it. So, I mean, doesn't that seem like a clear warning sign? Yes, like for sure.

Now, I should say the vast majority of people who use just general users of marijuana are not having problems with it. But we wanted to learn more about those who were. And when we started gathering more information, we were surprised by just how severe some of those issues could get. We'll be right back. Okay, so what kind of problems were chronic users reporting? Well, there were actually a couple of issues that we heard about. And to get a clearer picture of them and understand how common they were, we started crafting

a bunch of surveys. And we posted them in a Facebook group where people had come together to discuss one of these severe health effects from marijuana. And we also sent out surveys to doctors from a variety of fields across the country asking what they were seeing with their patients. And we started to see some really concerning issues again and again. Like what? Well, let me tell you about one woman we met. Hello. Hi, is this Jennifer?

Yes, it is. Hi, this is— Her name is Jennifer Macaluso. She's from Illinois. And my colleague, Danielle Ivory, spoke to her over the phone. Is this still a good time for you to talk? Yeah, this is great. All right, excellent.

And in a way, Jennifer is a great example of a kind of person who started using weed post-legalization. You know, I'm 51. I used cannabis briefly when I was a teenager, like a lot of kids do. You know, I wasn't addicted. You know, nothing. It was social, whatever. You know, she had smoked when she was a teen,

but nothing very serious, and had actually stopped as an adult until she got a bit older. In 2019, I started having some other health problems. She got migraines. And she took a lot of medication to get them under control. Here I am popping pills every day just to function. So my doctor at the time suggested, what about medical marijuana? It had become legal in our state a few years prior.

And I thought, wow, okay, yeah, I'm always one for a more natural route. So she started using weed on the recommendation of her doctor to help with the headaches. And at first, it was phenomenal. I could, you know, take a couple of hits or take an edible and the migraine was gone. And I thought this is fantastic. I don't have to take all these pills anymore and all this stuff. And Jennifer found that using marijuana medically really helped her with her health problem. She was using a couple times a week and that was enough. It solved the issue right away.

And then, she starts to experience some nausea. I started waking up nauseous every single morning. I just was dry heaving and sometimes I would vomit and it just was... And an employee at the marijuana dispensary that she used advised her to increase her marijuana use. I would say we have really good luck with this one because it's what we give chemo patients. I'd say, all right, give it to me. And eventually she was using the drug nearly every day. And it would help me and I would feel better and I was okay to eat.

And then, you know, it would wear off and then it was a cycle that just kept going and going. But the nausea actually got worse. She starts to get cycles of severe vomiting and stomach pain. I was pretty much bedridden. I mean, on a good day, I was just mildly nauseous. On a bad day, I was, you know, on the bathroom floor, crying my eyes out, you know, just totally desperate for help.

She was often in immense pain and it was really scary to her. But when she sought medical attention, You know, they had no answers. They said, well, doctor after doctor could not figure out what was wrong with her. Then they started doing cat scans and stomach tests and I mean blood tests and all these work ups and you know, you name it, I had it. Over the course of three years, I went to 12 different doctors. I went to including four different gastroenterologists. I went to neurologists.

I went to internists. I went to functional medicine doctors, I did acupuncture, I did restriction diets, I gave up you know every food group for forever and I just kept getting sicker and sicker and sicker. She gets all of these different diagnoses at one point she actually has her gallbladder removed. Oh my God. And it was really discouraging because nothing was helping. I really had some very dark days where I thought, you know, I'm gonna die.

Because this is it for me. I can't get out of bed, you know? And no one seems to know what to do. And, you know, this is it. Then one day, June 16th, 2022, I will remember the day. She's once again on the internet trying to find any possible cause for this pain that she's in. And you know, way down on the Google search pages, I saw a link to the Facebook page. And she finds this Facebook group that is made up of people who are suffering from a

condition called cannabinoid hyperemesis syndrome, known as CHS. And it's the first time she has any inkling that the weed might be causing her pain. And what exactly is CHS? Well, it's really interesting, right? Because marijuana is widely known for helping with nausea. But in some cases, with certain chronic users, it can actually have the opposite effect. We're talking about really severe nausea, severe vomiting, cycles of severe vomiting, in which people are in so much pain that they actually use the term scromiting

because they're often screaming out in pain. It's so awful. Oh my God. Yes. And this is a relatively new syndrome. It was first identified in 2004 and basically it's rise, like completely tracks with the rise in legalization and commercialization and the change in these products. And it's still quite a mystery. They don't know why some chronic users get it and others don't. And there's also this telltale sign to the syndrome that is also not understood, and that's that hot water often relieves symptoms.

So people who develop the syndrome will often spend hour after hour in really, really hot baths or showers, sometimes to the point where they burn themselves. And the cases can be really severe. It can lead to extreme dehydration, seizures, kidney failure, and even cardiac arrest. We found eight deaths linked to CHS. Wow, how common is this syndrome? It's hard to say with certainty just how many people

are suffering from CHS at this point. Even 20 years after it was first identified, there's not a single diagnostic code for it. So there's no uniform tracking of it in the medical system. But what we heard from our interviews and surveys of doctors is that they're seeing more and more of it. And many describe it now as a common thing that is presenting in emergency departments.

One doctor referred to it as a bread and butter diagnostic. Others said they see it every week, if not every day. And there are also researchers who have estimated that as many as 30% of heavy users, regular users of marijuana are experiencing some symptoms of the syndrome. So that would mean an estimated 6 million people. And Jennifer is one of those people, correct? What happened to her?

So after finding the Facebook group and realizing what's going on. And you know, I had taken my last edible at nine o'clock that morning, and this was at 9.30 when I found the page. I said, that's it, I'm done. There's even a tiny, tiny miniscule chance that morning and this was at 930 when I found the page. I said, that's it, I'm done. There's even a tiny, tiny minuscule chance that this is it. You know, I'm done, let's see what happens.

Yeah. She decides to quit marijuana on the spot. And that leads to a period of withdrawal that lasts for about two months. And I just got better and better from that. And, I mean, it's been two years and I'm fine. And after that, she's been totally fine. That is wild. I mean. And during this period of withdrawal, she sees yet another specialist who confirms that

she did indeed have CHS and actually told Jennifer that she was seeing multiple cases of the syndrome every week. You mentioned before that there were several potential marijuana-related health issues you were looking into with those surveys. What else did you find? So another significant harm that we identified that is very concerning is the relationship between marijuana and psychosis. And one of the ways that that plays out is marijuana causing a temporary psychotic episode

or symptoms, paranoia, hallucinations. And that can happen to all different kinds of people, people of different ages, chronic users of marijuana or first-time users of marijuana, people who are otherwise at risk for experiencing psychosis or have no other risk factors at all? And one of the people that I spoke to who had experienced this is a man named Javante Hill who lives in Colorado and tried marijuana at the suggestion of his girlfriend. You know, I'm not like a pot smoker. You know, I just got out of the military.

Mm-hmm. I was zero tolerance for drugs. So as soon as we got out, I was like, well, you know, let me go ahead and try what the hike is about. He was a recent Navy veteran with PTSD, anxiety, Let me go ahead and try what the hype is about. He was a recent Navy veteran with PTSD, anxiety, and depression. And his girlfriend was an occasional marijuana user and told him that it could be a nice way to chill out.

And it was honestly to wean off, like, you know, go from alcohol to this one because the media around we was that is is a much safer alternative. You know, you don't wake up hungover. So one night, and this was just his second time using it, he took a bong hit. And then literally after 10 minutes, I started to have almost like severe teramolia. And ended up totally paranoid and hallucinating. I started to have almost like severe paranoia. And ended up totally paranoid and hallucinating. Slowly, surely as the night went on, I completely lost all touch with reality.

And I replayed a lot of my time in Afghanistan. And it's almost like all my worst fears came to a forefront. and I replayed a lot of my time in Afghanistan. And it's almost like all my worst fears came to a forefront. And I was seeing depictions of the devil and hell and literal demons I thought were in real life. He said it was like he was in hell with devils. Oh my god. I was marching all throughout our house.

I was trying to find Eva the whole time. I had no idea where she was at. His girlfriend, Eva Zamora, who I also spoke with, was there trying to comfort him, but he didn't recognize her. Wow. And in the midst of this their dog started fighting. And then he had gone upstairs and he came downstairs and he had the gun in his hand that we had upstairs in our room.

And he ended up getting his gun. The best way I can explain it is like I was looking at him and like he was looking past me. And he looked like he was scared but he had the gun up and he took some shots and as soon as that happened I ran. And shooting and killing one of the dogs and actually shooting and injuring his girlfriend, Eva. It was very dramatic. Yeah, it was horrible.

He had no idea that this was a risk or even a possibility when he tried that marijuana. Nothing like this had ever happened to him before. He had no history of psychosis. He had no history of domestic violence. After the incident, he was diagnosed with drug-induced hallucinations, and he ended up pleading guilty to animal cruelty and assault charges. And he's actually suing the dispensary chain, claiming it failed to warn him about the risk of psychosis. And that type of temporary psychosis caused by marijuana is something that doctors are seeing across the country.

In our interviews and in our surveys of doctors, they said that they were seeing more and more patients with those kind of experiences. Wow. And you said that that kind of psychosis was temporary, but are there any other longer term mental health implications? So marijuana can affect brain development, particularly during the critical period of adolescence, which actually goes up through age 25. And this is also the period when chronic psychotic disorders like schizophrenia typically emerge.

And there's growing evidence that marijuana use can contribute to the development of those psychotic disorders. Recent studies show that the more potent the cannabis, the more frequent the use, and the earlier the age of consuming, the greater the risk. And to be clear, this isn't like a clear-cut black and white cause and effect relationship between marijuana and chronic psychotic disorders. One researcher that I talked to, a professor at Yale University, who's paid a lot of attention to this issue, actually compared it to cigarette smoking and lung cancer. You know, not everybody who smokes cigarettes gets lung cancer, not everybody who has lung cancer smoked cigarettes.

But we know after decades that there's a strong association between the two. And as he put it, the same goes for marijuana use and these chronic psychotic disorders. And doctors told us that they are seeing more and more of these chronic psychotic disorders in which they believe cannabis played a role. You know, Megan, we've talked about a few of these potentially awful side effects from marijuana use,

like addiction, the bouts of vomiting, psychosis, and just longer-term mental health effects. And what strikes me is that all of this stuff really runs counter to the narrative that I imagine a lot of people have about marijuana, which is that it's relatively safe. Yeah. Listen, our public understanding of this drug hasn't kept pace with the transformation of it and this new commercial industry and these shifts in how people are using it. And I know at least from many of the people who have experienced harms from marijuana,

some of these harms that we've discussed, that when they tried to talk about it, they often ran into not just skepticism, but also sometimes downright hostility. Yeah, actually, you're reminding me, I noticed that when the Times posted your story on Instagram, there was this comment from the comedian Eric Andre, and he said something like, whose side are you on? And it made me wonder how broadly you felt that sentiment. Like, after all this work to increase access to marijuana, were people not receptive to hearing that it might be bad for you? You know, I actually saw that comment as well,

Rachel, that caught my eye. But I want to be very clear about what else we found in our reporting, which is that the majority of the doctors that we talk to support the legalization of marijuana. Even the majority of people that we interviewed and surveyed who had been harmed by marijuana, none of them were saying, like, this is categorically a bad drug and should not be made available. What we heard time and again is that the way that legalization and commercialization is

playing out in this country is flawed, That the government and the medical system need to be doing more to track the health effects of marijuana. They need to be doing more to document that. And they need to also be communicating that to consumers. That these consumers have a right to know about the associations with psychosis. They have a right to know about the risk of this becoming addictive. They have the right to know about CHS. You know, Jennifer Macaluso, for example, said,

if I had known that CHS existed, if that had been on a warning label, I wouldn't have increased my use of the drug when I started experiencing symptoms. Right. I wouldn't have increased my use of the drug when I started experiencing symptoms. And so I think that the uniform message that came out of this reporting was there needs to be better oversight, there needs to be better protections, and there needs to be better information. Megan, thank you very much. Thanks for having me.

We'll be right back. Here's what else you need to know today. In Lebanon on Monday, a top U.S. official said that the growing conflict between Israel and Hezbollah has spun out of control, and he outlined a proposal to bring it to an end. And I want to be very, very clear. Tying Lebanon's future to other conflicts in the region was not and is not in the interest of the Lebanese people. The official, the American diplomat Amos Hoxdeen, called on both sides to abide by a U.N. resolution reached back in 2006 that would require Israel to withdraw its troops from Lebanon and for Hezbollah to be disarmed along Lebanon's border with Israel.

its troops from Lebanon, and for Hezbollah to be disarmed along Lebanon's border with Israel. Israel's recent military operations against Hezbollah, the Iranian-backed group that has launched thousands of rockets into Israel, has caused a humanitarian crisis in Lebanon that has displaced about a fifth of the country's population. Today's episode was produced by Will Reed, Alex Stern, and Olivia Natt. It was edited by Mike Benoit with help from Mark George, contains original music by Alicia Be'etoop, Dan Powell, and Pat McCusker, and was engineered by Chris Wood. Special thanks to Danielle Ivory and Carson Kessler. Our theme music is by Jim Brunberg and Ben Landsberg of Wonderly. That's it for the daily. I'm Rachel Abrams.

See you tomorrow.