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Marijuana,Mental Illness,and Violence
January 2019 a Volume 48,Number 1 e Alex Berenson
Alex Berenson Author, Tell Your Children: The Truth About Maryuana, Mental Illness, and Violence
F
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3 Alex Berenson is a graduate.of Yale University with degrees in history and economics. He began his
career in journalism in 1994 as a business reporter for the Denver Post,joined the financial news website TheStreet.com in
1996,and worked as an investigative reporter for The New York Timesfrom 1999 to 2010, during which time he also served
two stints as an Iraq War correspondent. In 2006 he published The Faithful Spy,which won the 2007 Edgar Award for best
first novel from the Mystery Writers of America.He has published ten additional novels and two nonfiction books, The
Number:How the Drive for Quarterly Earnings Corrupted Wall Street and Corporate Americaand Tell Your Children: The
Truth About Mar�uana, Mental Illness, and violence.
The following is adapted from a speech delivered on January 15,2019,at Hillsdale College's Allan P.Kirby,Jr.
Center for Constitutional Studies and Citizenship in Washington,D.C.
Seventy miles northwest of New York City is a hospital that looks like a prison, its drab brick buildings wrapped in layers of
fencing and barbed wire.This grim facility is called the Mid-Hudson Forensic Psychiatric Institute.It's one of three places
the state of New York sends the criminally mentally ill—defendants judged not guilty by reason of insanity.
Until recently, my wife Jackie—Dr.Jacqueline Berenson—was a senior psychiatrist there. Many of Mid-Hudson's 300
patients are killers and arsonists. At least one is a cannibal. Most have been diagnosed with psychotic disorders like
schizophrenia that provoked them to violence against family members or strangers.
A couple of years ago,Jackie was telling me about a patient.In passing,she said something like,Of course he'd been
smoking pot his whole life
Of course?I said.
Yes, they all smoke.
So marijuana causes schizophrenia?
I was surprised,to say the least. I tended to be a 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 medicine,and I'd watched the slow
spread of legalized cannabis without much interest.
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.
So I did. The big studies,the little ones,and all the 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
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tested.against otfiei 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:Omits 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
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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
nincreased 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
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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 andwas"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 widespreaho, ignore.
Whether to use cannabis, or any drug, is a personal decision. Whether cannabis should be legal is apolitical 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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MARIJUANA: MAN--MADE DISASTER '
Gateway to Other Drugs Think Marijuana is harmless? You don't know POT!
- Marijuana—a powerful neurotransmitter— � P01
E N CY.
works on the same receptor system in the
brain as heroin.'
- Marijuana primes the brain to seek stronger drugs.' Marijuana (a.k.a. Cannabis) today is
- Marijuana users are more likely than non-users to
use heroin and abuse pharmaceutical opioids.'° stronger
Marijuana and the Brain" Om4Oxthan 40 years ago
- Causes and exacerbates: Addiction,
Depression, Psychosis, THC (the mind-altering chemical in marijuana that gets a
Schizophrenia, Hallucinations user high) is a hallucinogenic drug. It is stored in fat tissue
- Psychotic breaks /Violent acts /Anxiety and is slowly released back into the blood stream keeping
- Loss of memory, perception, motor skills that THC in the body for many days, even weeks after the
- Mental degeneration pot is used. This THC continues to negatively affect
memory and emotional processing, organs and bodily
Drugged Driving systems.3
- Driving tests show marijuana impairs reaction times, TETRAHYDROCANNABINOL
divided-attention tasks, lane-position variability
(weaving), peripheral vision, cognitive function & (THC Concentration)
coordination.'
- 1 of every 8 traffic fatalities in Colorado are
marijuana related (+32% increase). 10
- Marijuana driving deaths doubled in one year after '
legalization in Washington. 11
- For every 1 marijuana-user death,
.7 innocents die (pedestrians, 2%
bicyclists, passengers, etc.) 5 404
- Combining marijuana with alcohol Pot Pot Liquid Solid
increases impairment up (1970's) (Today) Concentrates
to 8 times.'
Teen Use/Users
- Increases dramatically wherever marijuana is legalized."
- Causes irreversible IQ loss up to 8 points and higher likelihood of Amotivational
Syndrome.'
- 1 in 6 teens who try marijuana will become addicted.-
- Heavy Users are less likely to graduate.
- 7x increase in suicide attempts. 9
- Big Marijuana's goal —teen users today become lifetime consumers tomorrow.
Fetal Risk
Marijuana use during pregnancy crosses
Coastal Communities the placental and blood/brain barrier and
Drug-Free Coalition increases the baby's susceptibility to:°
- Lower birth weight
12247 Emerald St., San Diego, CA 92109 - Addiction later in life
Scott@Chipman.info (619) 990-7480 - Birth defects & cancers
- Problem solving, attention and learning difficulties later in life
Studies show genetic changes in offspring of heavy users.5
SOURCES: 1-R Hartman,M Huestis"Cannabis Effects on Driving Skills",Clin Chem 2013. 2-Dr.Forest Tennent and NIDA. 3-R Holmes MD,Florida Alliance for Drug
Children"Health Consequences of Using MJ:Effects on Infants,Children and Young Adults"4-E.Fride,J Neuroendocrinol.2008;20:75-81&EC Blume-UNC,Cancer Cau
Control.2006 June 17,(5):663-9. 5-Fatality Analysis Reporting System,2014&2015,National Highway Safety Transportation Administration. 6-E Sassenrath,UC Davis P
Research Ctr and Neuropsychopharmacology,2014 May 39(6):1315.23. 7-NIDA,"The Science of Drug Abuse and Addiction"by Dr.Nora Volkow referencing Monitoring the
Future Study,2010. 8-Dr.M.Seal,Melbourne University,APP article,"MJ causes brain damage"August 2012. 9-E Silins,et al 2014,"Young Adult Sequelae of Adolescent Cannabis
Use-an Integrative Analysis"Arendt et al 2006;Kvitland et al 2016;Clark et al 2014. 10-Rocky Mountain HIDTA,2015. 11-AAA"Driving under the in Influence"Foundation for
Traffic Study,May 2016. 12-US Dept.Health&Human Services-SAMSHA 13-Dr.B Madras,Professor of Psychobiology,Dept of Psychiatry,Harvard School. 14-"Cannabis Use
and risk of Prescription Opoid Use Disorder in the US"Olfson,Wall,Liu,Blanco,September 2017. 8/4/18
/ Heavy marijuana use is linked Less than 1% of all state
to downward social class mobility, prisoners are in jail for
anti-social behaviors, and simple possession.17
relationship conflict.'
Crime
08
Physical Health Impacts - 50% of men and 30% of women
LUNGS: Smoke from marijuana contains 4-5x the arrested for any crime test positive
toxins, irritants & carcinogens as tobacco smoke; for marijuana.'
20 times more ammonia. - 70% of inmates are addicted to
Increases likelihood of HEART ATTACK drugs and/or alcohol.'
IMMUNE SYSTEM is weakened - Guns and other weapons are
Negatively impacts REPRODUCTIVE SYSTEM' common at both large and home
DEATH RATE 4x higher than non-users. 13 cultivation sites.
Edibles / Vaping
Butane Hash Oil (BHO) - THC liquid concentrate is used in "Vaping" R
- Increases THC potency to 90+%11 devices (aka e-cigarettes); creates a
- Causes severe high. cancer-causing aerosol with no smell.
- As dangerous to make and consume as - Candy, brownies, soda, gummies, etc.
meth. 1 containing THC can be very potent; cookies
- Easily causes explosions and fires in with 1 000m of THC each are available.
neighborhoods where it is cooked. - Vaping and Edibles are favorite ways for
- AKA dabs, wax, budder, shatter, and solid youth to ingest marijuana (THC).
THC concentrate. - Neither THC liquid nor solid concentrates
(BHO) are overseen by any regulatory body—
no quality controls, no limits on potency, or
Marijuana is Big Money QW
limits on contaminates (pesticides, herbicides).
(but not for the community)
- One plant can bring $2,000 to $4,000 annually to a Marijuana is NOT
grower/distributor.
- Black Markets still thrive after legalization.' Earth-Friendly '0
- Tax revenues from pot sales do NOT cover increased crime, - 1 plant uses 6 gallons of water
health care or addiction services. Revenues are projected to per day. la
be less than .003% of total CA state tax revenue.' - Streams diverted to grow sites
- Cost of law enforcement increases, not decreases with kill plants & animals downstream.
legalization.i, - Poisons and illegal fertilizers
- CA already has 50,000 illegal cultivation sites that supply 60% contaminate streams and forests. 15
of marijuana to the US.3 - Carbofuron is illegal but commonly
used at arow sites - 'l8 t can kill a 300
Ib. bear."
Is Marijuana really Medicine?
The Federal Food and Drug Adminisration confirms "First,Do No Harm" 14 OPPOSE MARIJUANA USE
that whole plant marijuana and THC oils are NOT Marijuana is harmful
C� American Medical Association
medicine. i American Cancer Society
- Components may have medicinal value, i.e. CBD (Cannabidiol)5 American Epilepsy Society
- To protect the public, the FDA testing and approval process determines 56o American Academy of Pediatrics
drug safety, dosing efficacy, side effects, potency, duration, interactions, etc. American M.S.Society
- Pot shop "baristas" who recommend this psychoactive drug make medical National Eye Institute
conditions worse (e.g. PTSD, pediatric seizures, glaucoma and even pain). 14 American Lung Association
and others
SOURCES: 1 -T Coates,Atlantic Monthly,"The Case for Reparations",June 2014. 2—State of California 2015-2016 Full Budget,Alcohol tax revenue. 3-Senator Mike
McGuire&Asm Mike Wood,2015. 4-CASA-Behind Bars II-Research Project.5-NFIA—National Families in Action,2015. 6-VK Cortessis MSPH PhD 2012.
7-UC Davis study,March 2016,"Persistent Cannibis Dependence...A Longitudinal Cohort Study"8-Washington Post,April 14,2016,"Dozens arrested in
Denver-area pot raids targeting exporters:'9-Dr.B Madras,Professor of Psychobiology,Dept of Psychiatry,Harvard School. 10-California Fish&Game Warden
Association,2010. 11-Keith Graves,PD-Graves&Associates. 12-U.S.Dept.Health&Human Services-SAMSHA.13-Callahan et al,Dr.Bertha Madras 14-
American Medical Association Claims 15-www.silentpoison.com<http://www.silentpoison.com> 16-Colorado and California Police Chiefs Association 17-
"Who's Really in Prison for Marijuana"-ONDCP 8/4/18