When Cannabis Use Kills

Many Americans are not aware of the grave dangers cannabis use can entail. Ever since the nationwide—if not international—movement to promote marijuana as a healthy substance or even as a medication succeeded beyond its wildest expectations, the risk awareness connected to the use of THC (delta9-tetrahydrocannabinol), the main psychoactive ingredient in cannabis, has been steadily eroded.

Twenty-four states (plus Guam, the Northern Mariana Islands, the US Virgin Islands, and the District of Columbia) now allow the recreational use of cannabis, and around a dozen states, plus Puerto Rico, allow the "medical" use of cannabis products. However, the federal government continues to categorize marijuana as a Schedule I drug, a category for substances like heroin and cocaine that have no medical use and a high potential for misuse and addiction. As of this writing, the recommendation of federal scientists and associated reporting indicate that cannabis may be rescheduled to a lower schedule, a move that could further relax cannabis prohibitions.

Addiction—a severe cannabis use disorder—is not the only risk. Marijuana use can also result in acute psychosis and violent behavior with devastating consequences.

In January, Los Angeles television station KTLA reported on a manslaughter case in which a man was stabbed to death by a Ventura County woman after both used cannabis together.
In May 2018, 32-year-old Bryn Spejcher killed 26-year-old Chad O'Melia after taking several hits from a bong filled with marijuana. Spejcher reportedly experienced an adverse reaction resulting in a cannabis-induced psychotic episode. During that psychotic break, she stabbed O'Melia multiple times, eventually killing him. She also stabbed herself repeatedly, officials said.
According to KTLA, police officers arrived the next morning at O'Melia's apartment to find him "in a pool of blood and Spejcher screaming hysterically while still holding a knife in her hands. As officers tried to disarm her, Spejcher plunged the knife into her neck, authorities said."
Officers had to use "a taser and several baton blows before they were able to finally disarm Spejcher," police said. "A long-serrated bread knife was taken from her hands." Spejcher, who had been dating the victim for a few weeks, was found to have stabbed O'Melia 108 times with three different knives.  

On January 23, a judge sentenced Spejcher to two years of felony probation and no prison time. She had been out on bail since the 2018 slaying. She had faced up to four years in prison along with sentence enhancements. However, the judge cited evidence and expert testimony, saying the defendant did not know marijuana would have this type of effect on her when she smoked with the victim that night.

Family members of Chad O'Melia expressed outrage at the leniency of the sentence and said they were worried about the broader impact of this ruling.  

NOT YOUR PARENTS’ WEED
The core of the problem is that most people don't know that today's cannabis products are largely unregulated and extremely potent. They don't believe that marijuana use can result in psychosis or violent behavior, and they have uncritically absorbed the claims promoted by the cannabis industry of unproven medical benefits of marijuana use for various ailments. Hence, the excuse that a defendant cannot know marijuana would have a murderous effect.  
The effect is well known, however. "Cannabis is involved in approximately 50 percent of psychosis, schizophrenia, and schizophreniform psychosis cases," wrote Shrivastava, Johnston, et al. in a 2014 study on the neurobiology of cannabis and psychosis.

A recent article in the Wall Street Journal pointed out that "more frequent use of marijuana that is many times as potent as strains common three decades ago is leading to more psychotic episodes, according to doctors and recent research."  

Foundry Treatment Center Steamboat CEO Ben Cort has been warning for years that the legalization of cannabis has been largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. "The average cannabis product sold in Colorado in 2016 had a THC content of 63 percent," he explained in a webinar last year. In the 1970s, "weed" contained roughly 1–3 percent THC.

"There are now users who consume several grams of this weaponized THC daily," Cort says. "I know that because we treat such patients here in our program." The result of the widespread use of these powerful concentrates: "Addiction rates are considerably higher, the higher the potency goes."

CANNABIS AND VIOLENT BEHAVIOR
"According to research studies, marijuana use causes aggressive behavior, causes or exacerbates psychosis, and produces paranoia," wrote Miller, Ipeku, and Oberbarnscheidt in a 2020 study on marijuana use and violence. They, too, noted that marijuana products are far more potent in THC concentrations than they used to be. "Accordingly, and demonstrated in direct studies, more potent marijuana results in a greater risk for paranoid thinking and psychosis. In turn, paranoid behavior increases the risk for paranoid behaviors and predictably associated with aggressive and violent behaviors."

In their study, Miller et al. presented many case examples, one of which pertained to Nikolas Cruz, who killed 17 students and staff at the Marjory Stoneman Douglas High School in Parkland, Florida, in 2018. "Cruz was diagnosed as developmentally delayed at age three and had numerous disciplinary issues dating to middle school. From a young age, he started consuming marijuana heavily." He would "frequently 'hear demon voices' and would consume large amounts of marijuana to try and silence those voices. He also attempted suicide. During an interview after his mass shooting, he stated that he used a lot of marijuana as well as [the] prescription tranquilizer Xanax."

In May 2017, Richard Rojas purposely drove a car along three blocks of pavement in New York's Times Square, killing a teenager and injuring 22 other people. "Evidence indicates that Rojas was a heavy marijuana user. He admitted to the consumption of spiced-up marijuana right before committing the attack," reported Miller et al. in their study.

The year before, Arcan Cetin carried out a mass shooting that killed five people and injured many others at the Cascade Mall in Washington, DC. "Evidence indicates that Cetin was a heavy marijuana consumer. Further, he had a past of violent behavior, with some incidents including the consumption of marijuana."

Twenty-one-year-old white supremacist Dylan Roof murdered nine black people who were attending a prayer service in Charleston, South Carolina, in 2015. His declared intention was to start a race war. His acts were preceded by years of substance misuse. Reports revealed that Roof's drug use started at the age of twelve when he would smoke marijuana three times a day.
Dzhokhar Tsarnaev and his brother Tamerlan, who killed three people and injured more than 250 in the 2013 Boston Marathon bombing, were heavy marijuana users since they were young teenagers.

In the cases presented by the authors, "one of the recurring conditions that most likely led perpetrators to commit violence was paranoia… It is very likely that marijuana played an active role in these people's paranoia, considering that the chemical composition of the drug has compounds that alter a person's perception of reality."

The authors note that "marijuana intoxication results in panic reactions and paranoid feelings whose symptoms lead to violence. The sense of fear, loss of control, and panic are associated with violence. Also, marijuana use increases heart rate, which may be associated with violent behavior."

When people stop using marijuana, they may experience a variety of withdrawal symptoms, including sleep disturbance, irritability or restlessness, loss of appetite, anxiety, and sweating. "Experiencing any of these symptoms can make a person angry, ranging from mild irritation to violent rage," explained Miller, Ipeku, and Oberbarnscheidt. "Marijuana withdrawal can lead to intimidating violent or bullying behavior, endangering the perpetrator or other people and property."

In the case of Bryn Spejcher and Chad O'Melia, the use of high-potency THC sadly also resulted in a psychotic break and the death of a human being. "We now have concentrated THC products such as oil, shatter, dab, and edibles that have been able to get the THC concentration upwards of 95 percent. There is absolutely no research that indicates this level of THC is beneficial for any medical condition. The purpose of these products is to produce a high, and the increased potency makes them potentially more dangerous and more likely to result in addiction," wrote Elizabeth Stuyt, MD, in "The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist."

Foundry Treatment Center Steamboat treats adults experiencing cannabis use disorders and other substance use and co-occurring mental health disorders. While cannabis has long been one of the substances used by people suffering from substance use disorders, Foundry Steamboat clinicians have seen significant increases in the acuity of symptoms arising from problematic cannabis use. High-potency THC products, like other psychoactive substances, pose unique health risks, including the potential to cause or exacerbate paranoia, psychosis, hyperemesis, anxiety disorder, and more. While violence and severe adverse mental health impacts resulting from cannabis use affect a small percentage of cannabis users, it seems that these potential harms should be better known. It is also worth noting that treating cannabis use disorder and its co-occurring mental health disorders can be especially challenging. Patients experiencing psychosis, paranoia, or heightened anxiety related to cannabis use may require more treatment than people not experiencing these conditions.

Despite growing evidence that today's high-potency THC products pose specific health risks, reporting indicates increasing rates of adolescent and teen consumption, and states and the federal government seem likely to reduce further cannabis restrictions to expand commercial access.

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