Blog & Announcements

Fentanyl deaths in Colorado dropped last year, but still inflicted a severe economic toll, says a new report by the Common Sense Institute (CSI), a free-enterprise think tank.

Fentanyl-related deaths in Colorado “dropped from 1,184 in December 2023 to 801 in November 2024, a 32.4 percent reduction, but that’s still well above death rates before 2020,” reported Derek Draplin in the Kiowa County Press.

CSI estimates that “the total cost of fentanyl-related overdose deaths in Colorado is on par with 2022 at $13.1 billion in 2024 – approximately $2,220 per Coloradan.”

Though last year’s overdose rates and their associated economic impacts are trending downward, “they are still highly elevated compared to any point before 2020. This mirrors the development of Colorado’s crime rate generally, which has recently improved from 2022 but remains far above the norm set in the previous decade.”

OTHER KEY FINDINGS

Fentanyl-related overdose deaths have declined since the passage of HB22-1326, the Fentanyl Accountability and Prevention Act. The legislation was a response to rising fentanyl overdose deaths in the state.

Colorado’s Drug Overdose Competitive Index is still higher (30th) than it has been since 2015. This is due to increased drug overdose per capita in Colorado and improvements in other states.

CSI recommends that policymakers consider reverting to the effective drug laws that imposed stronger criminal penalties for the possession of any amount of drugs like methamphetamine, cocaine, and heroin. “While the state made some strides in strengthening fentanyl possession laws with the passage of HB22-1326, the law fails to address other hard drugs that often contribute to overdoses,” the report says. The authorities should be “proactive in anticipating whatever drug will eventually replace fentanyl,” and “adopt a robust public health strategy with rigorous tracking criteria aimed at reducing fentanyl-related overdoses.”

Fentanyl is a powerful synthetic opioid that is up to fifty times stronger than heroin and one hundred times stronger than morphine. Its misuse is a major contributor to fatal and nonfatal overdoses in the United States. As the CSI report explains, “fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Even in small doses, it can be deadly. Over 150 people die every day [nationally] from overdoses related to synthetic opioids like fentanyl.”

According to the latest data from the Colorado Department of Public Health and Environment, there were 222 fentanyl-related deaths in 2019, 540 in 2020, 912 in 2021, 920 in 2022, and 1,097 in 2023. The total number of drug overdose deaths decreased 15.7 percent from 1,935 in November 2023 to 1,631 in November 2024.

OPIOID USE DISORDER

Opioids such as fentanyl and heroin can produce feelings of euphoria that make it more likely that people will continue to misuse opioids, despite severe negative consequences such as addiction and death. Opioid use disorder (OUD) is a serious condition requiring treatment.

NRT Behavioral Health treatment programs, including Foundry Front Range and Foundry Steamboat, strive to make addiction treatment as accessible as possible. Every person with addiction deserves effective medical care. When it comes to behavioral healthcare, the ability of your treatment provider to understand your needs, provide effective therapies, and identify the specific resources that will help you maintain health and recovery after treatment is vital to your success.

If you or a loved one needs help, please contact us at (720) 807-7867.

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Nearly 19 million children in the United States have at least one parent with a substance use disorder (SUD), according to a new study published in JAMA Pediatrics on May 12. A significant number of those children have a parent whose SUD is moderate or severe as opposed to mild, the study finds.

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Witnessing a parent misusing drugs and alcohol as a child is considered an "adverse childhood experience" (ACE) that can have long-term negative impacts on health and well-being. ACEs are common. About 64 percent of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six adults reported they had experienced four or more types of ACEs.

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"Children exposed to parental SUD are more likely to develop adverse health outcomes than their peers without parental SUD exposure, including early substance use initiation, substance-related problems, and mental health disorders," wrote study authors Sean Esteban McCabe, Vita McCabe, and Ty Schepis. "We aimed to estimate the number of US children living in the same household as at least one parent or primary caregiver with a DSM-5-defined SUD."

As Rhitu Chatterjee reported on NPR, "the new study used data from the 2023 National Survey on Drug Use and Health, a federal survey that estimated the prevalence of substance use and mental health disorders based on the most updated criteria in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). The national survey is managed by the Substance Abuse and Mental Health Services Administration, but the team in charge of the survey was let go as part of the recent reduction in force. It is unclear how the cuts will affect the future of the survey."

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"If one-quarter of kids in the US have a parent with a substance use disorder, that tells us that every day in our clinics we are encountering many, if not dozens of families that are affected by substance use disorders," Dr. Scott Hadland, chief of adolescent medicine at Massachusetts General Hospital told NPR. "We need to be poised and ready to help support those families."

"The study's main finding is significantly higher than previous estimates (7 million in a study originally published in 2022), which had relied on diagnostic criteria from the DSM-IV," reported Chatterjee. "The new study also estimated how many children have a parent with a moderate or severe addiction as opposed to mild."

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McCabe and his team found that 7.6 million US children have a parent with a moderate or severe SUD, and 3.4 million live with a parent dealing with multiple substance use disorders. The authors also found that more than 6 million children have a parent dealing with both a substance use disorder and a co-occurring mental health condition.

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"These estimates are incredibly important to understand the scope of parental substance use disorder in the United States," Davida Schiff, a pediatrician and addiction physician at Massachusetts General Hospital, told NPR. Dr. Schiff pointed out that a majority of the parents (12 million) had alcohol use disorder. "While alcohol is more socially acceptable in our society, the study points to a need to pay greater attention to a rising number of children exposed to parental alcohol use disorder."

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Adverse childhood experiences and other lifetime traumas are regularly encountered by addiction professionals. The strong correlation between addiction and trauma, especially childhood trauma, is well known.

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Addiction is truly a family problem.

NRT Behavioral Health Chief Clinical Advisor Dr. Michael Barnes is a foremost expert in family system disorders and trauma. The Trauma-Integrated Care Model, developed by Dr. Barnes and used at NRT Behavioral Health treatment programs, emphasizes the importance of identifying trauma and substance use in family systems. Because parental substance use disorder exposes children to physical and psychological danger and increases their risk of developing SUD in later life, addressing the effects of these problems on all family members is key to stopping generational cycles of behavioral health disorders. Family programming is a central part of treatment at NRT Behavioral Health programs. It focuses on educating clients and family members and helps families create recovery-supportive lifestyles and home environments.

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Recognizing how families experience, normalize, and perpetuate substance use is vital to reducing high rates of SUD in America's rural communities. Close-knit families that spend more time together and are more isolated from other community members can inadvertently create an internal culture that makes using substances to self-medicate mental health disorders more acceptable. Ensuring that rural community members can access high-quality treatment is one way to address this problem. Helping individuals address anxiety, depression, loneliness, and other psychological problems through therapy and psychiatric medications can reduce their perceived reliance on alcohol and substances to reduce their symptoms. Sometimes, when one family member gets help, other members become more willing to accept help and to change their relationship with substances. 

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If you or a loved one is experiencing problematic drinking or drug use, we may be able to help. Please call us for a free and confidential conversation at (720) 807-7867.

Marijuana causes heart problems — A new study led by UC San Francisco researchers has found that chronic cannabis use, whether smoked or consumed in edible form, is associated with significant cardiovascular risks.

The report, published in JAMA Cardiology, found that people who regularly used marijuana in either form had reduced blood vessel function comparable to tobacco smokers. Vascular function in those who used cannabis by either means was reduced roughly by half compared to those who did not use it.

Decreased vascular function is associated with a greater risk of heart attack, hypertension, and other cardiovascular conditions.

"There is a popular belief that marijuana smoke is harmless," wrote Mohammadi, Navabzadeh, Jiménez-Téllez, et al. in their study. "However, marijuana smoke contains many of the thousands of chemicals contained in tobacco smoke, along with fine particles that contribute to cardiovascular morbidity and mortality. As cannabis legalization increases, it is crucial to understand the public health and clinical implications of marijuana use."

The researchers recruited 55 people between October 2021 and August 2024 who were outwardly healthy and either regularly smoked marijuana or consumed edibles containing tetrahydrocannabinol (THC), the primary psychoactive compound found in cannabis.

Along with decreased vascular function, marijuana smokers had changes in their blood serum that were harmful to endothelial cells, which form the inner lining of all blood and lymphatic vessels. Those who took edibles containing THC, however, did not display these changes in blood serum. It's unclear how THC damages blood vessels.

"This study enhances the understanding of the potential risks to vascular health linked to cannabis use and provides more evidence that cannabis use is not benign," the researchers concluded.

THE RISE OF HIGH-POTENCY THC

Cardiovascular issues are not the only risks associated with cannabis use, of course. Many well-meaning Americans have internalized the propaganda of the well-organized cannabis industry, suggesting that cannabis products can cause no harm and may even mitigate specific health problems such as glaucoma or anxiety disorders, despite a distinct lack of scientific evidence for such claims. In an astonishing turnaround, cannabis went from a dangerous gateway drug to a wellness product in a matter of decades.

Foundry Front Range Managing Partner Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his 2017 book Weed, Inc., he explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the weed people smoked in the 1970s. "The average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," he wrote in Weed, Inc. In other words, cannabis products have been weaponized. Cort's 2024 follow-up book, "Weed Inked," contains further evidence that high-potency THC products are harmful to personal and public health.

Chronic cannabis use is associated with an increased risk of developing a substance use disorder (SUD) and can induce psychosis.

Cannabis Use Disorder (CUD) is a growing problem nationwide. Studies indicate increasing rates of cannabis use disorder following the legalization and commercialization of cannabis in recent years. Cannabis use disorder poses specific health challenges, including hyperemesis, psychosis, paranoia, and—as the UCSF study confirms—heart health risks.

FOUNDRY FRONT RANGE TREATS CANNABIS USE DISORDER

Foundry Front Range has specialized expertise in treating cannabis use disorder. Cannabis, which is stored in fat cells, can remain in the body and cause psychoactive effects long after a person stops consuming it. This can lead to residual effects of cannabis that must be stabilized before clients are ready to engage in treatment programming. Specialized medical attention may also be required to help people experiencing severe CUD side effects, like nausea or psychosis, feel stable and comfortable.

Because 58-plus percent of people with SUD have more than one substance use disorder, treating the effects of cannabis use disorder can be even more complex. Patients with cannabis use and at least one other substance use disorder are more likely to need more clinical attention and medical resources. They may also have home environments or relationships that make substance use seem permissible or supported, requiring family programming and education about how to build recovery-supportive environments.

Continuing care planning, which ensures that individuals have a specific ongoing care plan after completing treatment, is crucial for allowing them to navigate the fragile period of early recovery safely. As this article suggests, cannabis use disorder and other substance use disorders increase the potential for chronic health problems. With growing evidence that cannabis can affect the heart and blood flow, cardiological assessment may be advisable during and after substance use disorder treatment.

With some of the most experienced clinicians, a modern and well-equipped clinical facility, and leading experts in addiction medicine, Foundry Front Range represents a good treatment option for people experiencing Cannabis Use Disorder. To learn more, visit www.foundryfrontrange.com or call (720) 807-7867.

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“A strange thing has happened on the path to marijuana legalization. Users across all ages and experience levels are noticing that a drug they once turned to for fun and relaxation now triggers existential dread and paranoia,” wrote Malcolm Ferguson, an assistant editor at The Atlantic, in August. Like other journalists, Ferguson is beginning to realize what many addiction professionals have known for many years. Cannabis products in the United States have been weaponized on an industrial scale.

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“In 2022, the federal government reported that, in samples seized by the Drug Enforcement Administration, average levels of tetrahydrocannabinol, or THC—the psychoactive compound in weed that makes you feel high—had more than tripled compared with 25 years earlier, from 5 to 16 percent. That may understate how strong weed has gotten. Walk into any dispensary in the country, legal or not, and you’ll be hard-pressed to find a single product advertising such a low THC level. Most strains claim to be at least 20 to 30 percent THC by weight; concentrated weed products designed for vaping can be labeled as up to 90 percent.”

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NRT Behavioral Health™ managing partner Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his 2017 book Weed, Inc., he explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the weed people smoked in the 1970s. "The average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," he wrote in Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." “Weed Inked,” Cort’s recently published “Weed, Inc.” follow-up, discusses how many of the predictions about the harmful effects of high-potency THC product commercialization and industrialization have come to pass.

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The consequences of making this largely unregulated psychoactive product available through legalization and commercialization have been devastating. 

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“In the past few years, reports have swelled of people, especially teens, experiencing short- and long-term ‘marijuana-induced psychosis,’ with consequences including hospitalizations for chronic vomiting and auditory hallucinations of talking birds,” reported Ferguson. “Multiple studies have drawn a link between heavy use of high-potency marijuana, in particular, and the development of psychological disorders, including schizophrenia, although a causal connection hasn’t been proved.”

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The wider public remains largely unaware of these significant risks. In May, the number of Americans who use cannabis daily was reported to have surpassed the number who drink alcohol that frequently for the first time in the history of the United States. As the Associated Press reported, it is “a shift some 40 years in the making as recreational cannabis use became more mainstream and legal in nearly half of US states.”

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In 2022, an estimated 17.7 million people reported using marijuana daily or near-daily compared to 14.7 million daily or near-daily drinkers, according to an analysis of national survey data. In 1992, when daily cannabis use hit a low point, fewer than one million people said they used marijuana nearly every day.

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“Cannabis is in and alcohol is out”—a preference change likely driven by Gen Z, Nikki Battiste reported for CBS News in May. The cannabis industry has mostly succeeded in convincing large numbers of Americans—particularly young people—that their potent products are harmless if not beneficial for their well-being. As a consequence, millennials and Gen Z tend to think of alcohol as harmful and marijuana as healthy. 

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After years of promoting cannabis as "medication" (although the evidence for its efficacy is mostly anecdotal) and downplaying the risks of marijuana use, the cannabis industry is close to achieving another goal. In May, the federal Justice Department proposed reclassifying the drug, saying the change would recognize marijuana’s “medical” uses and suggesting it had less potential for abuse than other illicit drugs. 

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For now, however, the federal government continues to classify cannabis as a Schedule I controlled substance with “no currently accepted medical use and a high potential for abuse.” Any reclassification is not expected before the November election. 

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Meanwhile, the National Institute on Drug Abuse (NIDA)—one of 27 institutes and centers comprising the National Institutes of Health, which is part of the US Department of Health and Human Services—informs the public on its website that “marijuana use can lead to the development of a substance use disorder, a medical illness in which the person is unable to stop using even though it's causing health and social problems in their life.” A severe cannabis use disorder (CUD) is considered an addiction. “Research suggests that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder. People who begin using marijuana before age 18 are four to seven times more likely than adults to develop a marijuana use disorder.”

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Cannabis products—especially those with dangerously high THC concentrations—also affect brain development. When people begin using these weaponized THC products as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. 

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A 2022 review study found that higher THC concentrations are now causing more people to become addicted to cannabis. “One of the highest quality studies included in our publication found that use of high potency cannabis, compared to low potency cannabis, was linked to a four-fold increased risk of addiction,” study coauthor Tom Freeman told CNN.

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Foundry Treatment Center Steamboat, part of NRT Behavioral Health, developed a specific treatment track for people affected by cannabis use disorder because the condition poses particular challenges. In 2000, Cort co-authored the first published best practices on treating CUD alongside Dr. LaTisha Bader in a medical text and reference book entitled Cannabis In Medicine and Evidence-Based Approach. He has spent the years since working to educate clinicians and medical professionals in our field on these practices. Many people experiencing cannabis use disorder suffer from extended periods of cannabis-induced psychosis and must be safely housed and medically supervised until their symptoms subside enough for them to engage in treatment programming successfully. Cannabis use disorder treatment is also an area of specialty offered by Foundry Front Range, a comprehensive residential addiction treatment program opened by NRT in August. 

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It is a move that has been expected for a long time. After years of promoting cannabis as "medication" and downplaying the risks of marijuana use, the cannabis industry is about to score another victory.

On April 30, US Attorney General Merrick Garland recommended loosening the restrictions on marijuana, a historic shift in federal drug policy that could broaden access to the drug for "medicinal" and recreational use even further and boost the cannabis industries in states where it is already legal.

"Today, the Attorney General circulated a proposal to reclassify marijuana from Schedule I to Schedule III," the Justice Department said in a statement. "Once published by the Federal Register, it will initiate a formal rule-making process as prescribed by Congress in the Controlled Substances Act." On May 13, the Drug Enforcement Administration added its support for reclassification.

The proposal, which the White House has one to three months to review, would recognize the unproven "medical" uses of cannabis and acknowledge it has less potential for abuse than some of the nation's most dangerous drugs. However, it would not legalize marijuana outright for recreational use on a federal level. 

The proposed change could nevertheless increase the profits of the cannabis industry dramatically. Unsurprisingly, industry leaders believe that declassifying cannabis altogether, as opposed to reclassifying it, would be even better.

The FDA has approved just one drug, the epileptic seizure treatment Epidiolex, that contains CBD derived from cannabis plants. It has also approved three drugs containing synthetic THC compounds to treat nausea associated with cancer treatment and reduce wasting associated with HIV/AIDS. Like all prescription drugs, these FDA-approved medications are prescribed by doctors to treat very specific medical conditions. 

By contrast, “medical” cannabis can only be recommended by doctors to address a range of ailments. Research on other claimed medical and health benefits of marijuana is scant to non-existent, while the negative effects of mass consumption are becoming more and more evident in states that have legalized cannabis. One of those states is Colorado, where Chuck Smith, who leads an alliance of cannabis business executives, described rescheduling as progress.

"The HHS rescheduling recommendation marks a historic step toward federal cannabis policy reform," Smith said. "For over a decade, Colorado has been demonstrating states' ability to effectively regulate cannabis for medical and broader adult use, and it's time for federal law to reflect that reality. State-legal cannabis businesses that create jobs, pay taxes, and provide adults and medical patients with safe and legal access to cannabis deserve to be treated fairly, and this would be a big step in that direction."

Legalization in states across the nation has fueled rapid growth of the marijuana industry, with an estimated worth of nearly $30 billion. Rescheduling cannabis could reduce the tax burden by allowing deductions unavailable for a Schedule I substance. There are fears that rescheduling cannabis could now open the door for large pharmaceutical companies and other major corporations to take over the industry.

NRT Behavioral Health™ President Ben Cort has been raising awareness of the commercialization of cannabis products for years. In his book Weed, Inc., Cort explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the weed people smoked in the 1970s. The reason is the dangerously high THC content of today's cannabis products.

THC (delta9-tetrahydrocannabinol) is the main psychoactive ingredient in marijuana, and THC levels in cannabis products have dramatically increased in the last few decades from less than one percent THC in the seventies to well beyond 15 percent in recent years. And that's just the plants—concentrates can reach much higher levels of THC. 

"The average cannabis product sold in Colorado in 2020 had a THC content of 69 percent," says Cort. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," Cort wrote in Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." 

The National Academies of Science pointed out that despite a growing acceptance of marijuana in many states, "evidence regarding the short- and long-term health effects of cannabis use remains elusive" and that "no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively."

A 2020 letter from the director of the National Institute on Drug Abuse said, "Marijuana impairs short-term memory and judgment and distorts perception" and, as a result, "can impair performance in school or at work and make it dangerous to drive."

Although it is illegal for Coloradans under 21 to buy, have, or use retail marijuana, and it is a felony for anyone to give, sell, or share marijuana with anyone under 21, teenage consumption and addiction are on the rise. 

A 2021 systematic review found that past-year cannabis vaping nearly doubled from 2017 to 2020 in adolescents - jumping from 7.2 percent to 13.2 percent," warned Ty Schepis, a professor of psychology at Texas State University, in a recent article for The Conversation. "A more recent study in five northeastern US states found that 12.8 percent of adolescents vaped cannabis in the past 30 days, a more narrow time frame that suggests potential increases in use. In addition, a 2020 study found that one-third of adolescents who vape do so with cannabis concentrates."

The notion that Colorado is effectively regulating the medical adult use of cannabis seems to provide a partial view of cannabis use within the state by not also acknowledging widely accepted concerns about the negative effects of use and increased underage use. However, the state may only be providing minimal resources when it comes to regulating adult cannabis use, according to Ben Cort’s forthcoming sequel to “Weed, Inc.” The book also talks about how the state’s Marijuana Enforcement Division (MED), which is tasked with regulating commercial cannabis, seems primarily to be a recruiting apparatus to help grow Colorado’s commercial THC industry.

Cannabis misuse by adolescents is dangerous because it can alter the way their brains develop, explained Schepis. "Research shows that the brains of adolescents who use cannabis are less primed to change in response to new experiences, which is a key part of adolescent development. Adolescents who use cannabis are also more likely to experience symptoms of schizophrenia, struggle more in school, and engage in other risky behaviors."

Smart Approaches to Marijuana (SAM) President Kevin Sabet, a former White House drug policy advisor to Presidents Obama, Bush, and Clinton, issued the following statement:

"Politics and industry influence have loomed over this decision from the very beginning. [...] Now, against the recommendations of prior Attorneys General, the medical community, and law enforcement, the Administration unilaterally reversed decades of precedent despite volumes of data confirming marijuana's harmfulness. Moreover, a drug can be taken off Schedule I only if it has accepted medical use—raw, crude marijuana has never passed safety and efficacy protocols. A drug isn't medicine because it's popular."

"Medical and scientific studies, as well as government data, have conclusively linked THC drugs with addiction, psychosis, schizophrenia, depression, anxiety, suicidality, and IQ loss, among other impacts," Dr. Sabet wrote. "The Administration's effort to push through this action in an election year could be perceived as a thinly veiled attempt to reverse polling trends with the principal targets of the pot industry, namely young people."

Ben Cort also believes that the decision is “a reflection of politics rather than medical science. I’ve had several conversations with the nation’s thought leaders and researchers since this recommendation was leaked. They all agreed that there is no science to support the decision, while there are a lot of scientific indicators encouraging a much more careful and deliberate approach.” 

“This is a tight election year and somebody did the math on how many swing votes this might pull for the current administration,” says Cort. “We still haven’t learned our lesson as a nation that thoughtless engagement with psychoactive intoxicants doesn’t end well. We still haven’t understood that bad things happen when corporations sell things that have addictive potential.”  While groups promoting the purchase and use of THC products continue to get their way, across-the-board decriminalization of drug possession and use has seen some pushback lately. 

Marijuana use can lead to the development of cannabis use disorder (CUD), which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use THC products may have some degree of marijuana use disorder. People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.

At a time when growing evidence suggests that cannabis legalization and commercialization are making potentially dangerous products more available, increasing accidental THC poisonings and other adverse health events, and are not resulting in the promised financial boons to cannabis business owners or states where cannabis is legal, rescheduling could exacerbate these problems. 

Regardless of whether rescheduling cannabis changes the way it is sold, the move is likely to reduce further the perceived dangers associated with cannabis use. Research suggests that young adults are more likely to use cannabis after it is legalized because they perceive it as less dangerous. 

Rescheduling cannabis could send an even more significant signal to people that cannabis is not harmful, which may further increase its use. The same study suggests that increased use by adolescents and young adults could stimulate cannabis use disorder while making it less likely that they seek treatment. 

The behavioral healthcare field is seeing more patients presenting with cannabis use disorder and complex cases linked to high-potency THC use that are difficult to treat. Rescheduling could result in more people than ever before believing that cannabis use is without risks while THC products are more potent than ever, a situation that may lead to more problematic cannabis use with implications for individuals, families, and communities nationwide. 

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It was supposed to be the panacea for the opioid epidemic. If you decriminalize drug possession and get people with substance use disorder (SUD) into treatment, the crisis will go away. Except, it didn’t.

“When Oregon embarked on a landmark plan three years ago to decriminalize hard drugs, it wagered that a focus on treatment over punishment would create a new model for drug policy around the country,” Mike Baker reported for The New York Times earlier this month. “But after a deluge of overdose deaths and frequent chaos in the streets of Portland, Gov. Tina Kotek signed into law […] a measure to restore criminal penalties for drug possession.”

The new law rolls back a 2020 voter-approved measure by making so-called personal use possession a misdemeanor punishable by up to six months in jail. It also establishes ways for treatment to be offered as an alternative to criminal penalties by encouraging law enforcement agencies to create deflection programs that would divert people to treatment services instead of the criminal justice system.

Measure 110, approved by voters with 58 percent support in 2020, made the personal use possession of illicit drugs such as heroin, cocaine, and methamphetamine only punishable by a ticket and a maximum fine of $100. Supporters said treatment is more effective than jail in helping people overcome addiction and that the decades-long approach of arresting people for possessing and using drugs hasn’t worked.

Farther north, British Columbia became the first province in Canada last year to decriminalize the use of hard drugs as part of its efforts to tackle its deadly opioid crisis. But there, too, the policy is now facing pushback, leaving its future uncertain.

Portugal was the trailblazer for this approach, but the European country has also had second thoughts lately. “Portugal decriminalized all drug use, including marijuana, cocaine, and heroin, in an experiment that inspired similar efforts elsewhere, but now police are blaming a spike in the number of people who use drugs for a rise in crime,” reported Anthony Faiola and Catarina Fernandes Martins in The Washington Post last year.

“Portugal became a model for progressive jurisdictions around the world embracing drug decriminalization, such as the state of Oregon, but [...] some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades and the state-funded nongovernmental organizations that have largely taken over responding to the people with addiction seem less concerned with treatment than affirming that lifetime drug use should be seen as a human right.”

Clearly, decriminalization has not ended Portugal’s drug problem. Overdose rates hit 12-year highs and almost doubled in Lisbon from 2019 to 2023. Sewage samples in Lisbon show cocaine and ketamine detection is now among the highest in Europe.

It seems that in all three places—Portugal, British Columbia, and Oregon—decriminalization primarily brought drug use out in the open without actually curbing it. So, why didn’t it work?

“Measure 110 did not reduce Oregon’s drug problems,” wrote Keith Humphreys and Rob Bovett in a recent analysis piece in The Atlantic. “The drug overdose death rate increased by 43 percent in 2021, its first year of implementation—and then kept rising. The latest CDC data show that in the 12 months ending in September 2023, deaths by overdose grew by 41.6 percent, versus 2.1 percent nationwide. No other state saw a higher rise in deaths. Only one state, Vermont, ranks higher in its rate of illicit drug use.”

It appears the notion that decriminalization will induce a flood of help-seeking from people with addiction was hopelessly naive. “The replacement for criminal penalties, a $100 ticket for drug possession with the fine waived if the individual called a toll-free number for a health assessment, with the aim of encouraging treatment, failed completely,” wrote Humphreys and Bovett. “More than 95 percent of people ignored the ticket, for which—in keeping with the spirit of Measure 110—there was no consequence.”

Humphreys and Bovett have spent the better part of their careers studying and working on drug policy and were not surprised that “trivial pressure” to seek treatment proved ineffective. “Fentanyl and meth addiction are not like depression, chronic pain, or cancer, conditions for which people are typically motivated to seek treatment. Even as it destroys a person’s life, addictive drug use by definition feels good in the short term, and most addicted people resist or are ambivalent about giving that up. Withdrawal, meanwhile, is wrenchingly difficult. As a result, most addicted people who come to treatment do so not spontaneously but through pressure from family, friends, employers, health professionals, and, yes, the law.”

The reporters contend that Oregon didn’t even need Measure 110 as “a rebuke to the War on Drugs” because Oregon “had never fought such a war.” The state had the country’s “lowest rate of imprisonment for nonviolent crimes. Short local jail sentences for drug possession were permitted, but diversion programs, including drug courts and community supervision with drug testing, were widely used. However, after Measure 110 was passed and the threat of jail time eliminated, the flow of people into these programs slowed.”

Humphreys and Bovett do not advocate a return to severe crackdowns by the justice system. “Many states are far more punitive toward drug users than Oregon was before Measure 110 passed. They overemphasize incarceration of people who use drugs, they do not provide adequate, publicly funded health treatment and health insurance, and they do not use criminal justice productively to discourage drug use (for instance, by using arrests and probations as leverage to get people into drug courts and treatment).”

If these states could be persuaded to dial down their overly harsh criminal-justice approach to approximate what Oregon had before Measure 110, “except with adequately funded, evidence-based prevention and treatment, substantial gains in public health and safety would likely follow,” they feel. “The future of successful drug-policy reform is not greater laxity in states that are already quite progressive in their approach to drug use; it is using criminal justice and public health together in a balanced, pragmatic fashion, as Oregon is now poised to do.”

While the decriminalization of heroin, cocaine, and meth was based on naive assumptions about addiction, at least proponents have not attempted to declare these substances to be harmless or even good for your health. In the case of the legalization and commercialization of cannabis, that is exactly what happened.

In Colorado, cannabis has been legal for “medical” use since 2000 and for recreational use since late 2012. On November 7, 2000, 54 percent of Colorado voters approved Amendment 20, which amended the state constitution to allow the use of marijuana in the state for approved “patients” with written “medical consent.” Twelve years later, that medical figleaf was dropped with Amendment 64, which led to full recreational legalization in December 2012 and state-licensed retail sales in January 2014.  

The impact has been widespread and negative. Few people are aware that marijuana legalization is largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. Foundry Treatment Center Steamboat Managing Partner Ben Cort has been raising awareness of these issues for years. In a webinar last year, Cort explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the "weed" people smoked in the 1970s. The reason is the extreme THC (delta9-tetrahydrocannabinol) content of today's cannabis products.

The average THC content of cannabis products seized by the Drug Enforcement Administration was 15 percent in 2021, up from just four percent in 1995. However, many commercial cannabis products now advertise THC concentrations of up to 99 percent. The potency of the plant is irrelevant because the plant is being converted into products not used on its own. According to Cort, "Rarely, if ever, do we treat an individual who is only using cannabis in anything like its natural form; they use highly concentrated THC produced by extracting THC from the plant."

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

According to healthcare analytics company Truveta, rates of diagnoses for cannabis-induced disorders were more than 50 percent higher at the end of November 2023 than in 2019. It has been estimated that approximately three in ten people who use marijuana have a cannabis use disorder.

Despite the addiction risk, Colorado is still expanding the availability of cannabis. Since January, retail marijuana stores have been allowed to accept payment for products ordered online. Online ordering became legal in Colorado late last year, but customers still had to pay for their orders in person.

American Heart Association warned last year that marijuana use is linked with an increased risk of heart attack and heart failure. “As more people across the US use marijuana, [...] two new studies suggest its regular intake may damage heart and brain health. In one study, daily use of marijuana raised the risk of developing heart failure by about one-third, even after considering other factors, compared to people who reported never using marijuana. In a second study, older people with any combination of Type 2 diabetes, high blood pressure, and high cholesterol who used marijuana, significantly increased their risk for a major acute heart or brain event while hospitalized, compared to those who reported not using marijuana.”

Legalizing dangerous substances like cannabis because people bought into claims of unproven medical benefits or tolerating the illegal use of heroin and cocaine in the hope that people addicted to these drugs will simply come forward asking for treatment without any encouragement is a path fraught with dangers as it turned out. Addiction is a complex bio-psycho-social disease characterized by the continued use of psychoactive substances or the continuation of addictive behaviors despite negative consequences.

Addiction is frequently driven by underlying trauma and depression, and simply decriminalizing maladaptive attempts to self-medicate such underlying conditions does nothing to address them. Treating a severe substance use disorder often requires the concerted efforts of the affected individuals, their families, and a team of treatment professionals addressing the root causes of the SUD.

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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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Some federal scientists have reportedly concluded that "marijuana is neither as risky nor as prone to abuse as other tightly controlled substances and has potential medical benefits, and therefore should be removed from the nation's most restrictive category of drugs."

This astounding recommendation is contained in a 250-page scientific review "provided to Matthew Zorn, a Texas lawyer who sued Health and Human Services officials for its release and published it online," Christina Jewett and Noah Weiland reported for The New York Times in January. An HHS official reportedly confirmed the authenticity of the document.

It looks like federal health officials could soon follow the example of many states and legalize cannabis products for "medical" and recreational use. This momentous volte-face has been expected for quite some time now.

Since the 1970s, marijuana has been considered 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. Despite this prohibition, proponents of legalized cannabis use have been pushing unproven medical benefits of marijuana use for various ailments.

"Empirical and clinical studies clearly demonstrate significant adverse effects of cannabis smoking on physical and mental health as well as its interference with social and occupational functioning," wrote Svrakic, Lustman, et al. in "Legalization, Decriminalization & Medicinal Use of Cannabis" in 2012. "These negative data far outweigh a few documented benefits for a limited set of medical indications, for which safe and effective alternative treatments are readily available. If there is any medical role for cannabinoid drugs, it lies with chemically defined compounds, not with [the] unprocessed cannabis plant. Legalization or medical use of smoked cannabis is likely to impose significant public health risks, including an increased risk of schizophrenia, psychosis, and other forms of substance use disorders."

According to The New York Times article, the new federal "documents show that scientists at the Food and Drug Administration and the National Institute on Drug Abuse have recommended that the Drug Enforcement Administration make marijuana a Schedule III drug, alongside the likes of ketamine and testosterone, which are available by prescription."

At the same time, the review noted that marijuana misuse does lead to "physical dependence" and "some people develop a psychological dependence." Nevertheless, the review concluded, "the likelihood of serious outcomes is low."

Many addiction experts disagree. "They note that any long-running study of marijuana that the federal authorities have reviewed may not account for the escalating strength and increasingly frequent use of marijuana, which has been tied to psychiatric problems and chronic vomiting among users in recent years," wrote Jewett and Weiland.

For years, there was the promise—ultimately unmet—that marijuana could be used to combat opioid abuse or treat mental health problems, Keith Humphreys, a Stanford health policy professor and a former federal drug policy official, told The Times. "As the science has gotten better in the intervening decades, most of the therapeutic claims about cannabis have been debunked," he said.

A recent article by Julie Wernau in the Wall Street Journal made the same point. "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," she wrote.  

Few people know that the legalization is largely driven by well-organized multi-state operators selling unregulated and unsafe commercial products. Foundry Treatment Center Steamboat CEO Ben Cort has been raising awareness of these issues for years. In a recent webinar, Cort explained how the potent products the marijuana industry is selling in the 21st century are a far cry from the "weed" people smoked in the 1970s. The reason is the extreme THC (delta9-tetrahydrocannabinol) content of today's cannabis products.

The Cannabis sativa plant has over 480 constituents, with THC being the main psychoactive ingredient. "The average cannabis product sold in Colorado in 2016 had a THC content of 63 percent," Cort said. He doesn't like to talk about the plant anymore because the people treated at Foundry Treatment Center Steamboat for cannabis use disorder (CUD) have not been smoking the pot passed around in the 1970s; they are using high-potency commercially produced cannabis-based products.

The average THC content of cannabis products seized by the Drug Enforcement Administration was 15 percent in 2021, up from just four percent in 1995. However, many commercial cannabis products now advertise THC concentrations of up to 99 percent. The potency of the plant is irrelevant because the plant is being converted into products not used on its own. According to Cort, "Rarely, if ever, do we treat an individual who is only using cannabis in anything like its natural form; they use highly concentrated THC produced by extracting THC from the plant."

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

According to healthcare analytics company Truveta, rates of diagnoses for cannabis-induced disorders were more than 50 percent higher at the end of November than in 2019, "The trend is contributing to the broader burden of caring for people who developed mental health and addiction problems during the pandemic," Wernau reported.

Symptoms of serious mental disorders, including schizophrenia, often emerge in adolescence. While cannabis cannot be definitively isolated yet as the only culprit in any particular case, a growing body of evidence seems to support this conclusion. Large studies show a clear link between frequent and more potent cannabis use and higher rates of psychosis, particularly in young users, Yale University psychiatrist Deepak D'Souza told the Wall Street Journal.

Even one psychotic episode following cannabis use was associated with a 47 percent chance of developing schizophrenia or bipolar disorder, a 2017 study published in the American Journal of Psychiatry showed. The risk was highest for people 16 to 25 years old and higher than for substances such as amphetamines, hallucinogens, opioids, and alcohol.

The Wall Street Journal cited the example of Dr. Karen Randall, who moved to Pueblo, Colorado, for a job in an emergency room more than a decade ago after working in Detroit for 18 years. She thought it would be like retiring early. She bought a ranch where she could ride horses in an area locals now call the Napa Valley of Cannabis. "I see more psychotic people here than I did in Detroit," she told the Wall Street Journal. "We're just making this huge population of people who we can no longer fix." Dr. Randall is right, we can 'no longer fix' these issues in an acute setting like an emergency department. Individuals affected by the type of THC-induced psychosis she sees need long-term care.

Cannabis use disorder (CUD) is a potentially serious condition frequently requiring treatment. Sadly, people presenting with CUD do not enjoy the same support from society as people with other substance use disorders, explained Cort. "If you ask your doctor for help because you drink too much alcohol or because you can't stop using opioids, you can typically expect encouraging words, immediate action, and specialist referrals. If you ask your doctor for help because you are concerned that you are using too much THC, you may only get a shrug or a simple recommendation to cut down." Many doctors, especially those who have not graduated recently from medical school or received new training in cannabis use disorder, think that cannabis use is relatively harmless or poses few risks. Some doctors believe that cannabis may be less harmful than using alcohol or medications to cope with stress symptoms and anxiety.

"At Foundry Steamboat, we treat patients whose cannabis use disorder had been dismissed as 'only weed' because our society does not recognize cannabis as an addictive substance even though it is objectively demonstratable as such," Cort said. In treatment, Foundry Steamboat has to prepare clients for a trigger-rich environment with ubiquitous "pot shops," billboards advertising cannabis products, and family systems and friend groups in which cannabis use is considered normal.

Foundry Treatment Center Steamboat offers men's residential treatment and telehealth for adults of all genders experiencing substance use and mental health disorders and offers specialized treatment for cannabis use disorder. Treating cannabis addiction can be complex and prolonged compared to the treatment for other types of substance use disorders. Some people presenting with a cannabis addiction experience lengthy periods of psychosis and hyperemesis syndrome, which may require lengthy periods of supervised stabilization before clients are mentally and physically able to safely engage in treatment.

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The USFood and Drug Administration (FDA) has not approved the use of cannabis as a treatment for any medical condition. However, after a long legalization campaign, most states now allow "medical" use of marijuana to treat pain, nausea, and other conditions. Twenty-three states, theDistrict of Columbia, and Guam have fully legalized the drug for recreational use as public support for legalization rose rapidly—despite marijuana being illegal at the federal level.

Cannabis sativa (the marijuana plant) contains many active compounds. The best known aredelta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the primary ingredient in marijuana that makes people "high."

Today, many Americans believe in the unproven health benefits of cannabis, but few people know about the danger of addiction and other health impacts of marijuana use. The FDA continues to classify cannabis as a Schedule I controlled substance "with no currently accepted medical use and a high potential for abuse." Recent research estimates that approximately three in ten people who use marijuana have cannabis use disorder (CUD). For people who begin using cannabis products before the age of 18, the risk of developing a marijuana addiction is even greater.

Among the many risks and possible side effects of "medical" marijuana, the Mayo Clinic lists  

increased risk of heart attack and stroke, potential for addiction, hallucinations or mental illness, and withdrawal symptoms.

FoundryTreatment Center Steamboat CEO Ben Cort has raised awareness of these health risks for years. In a recent webinar forHarmony Foundation, Cort pointed out that the THC levels in cannabis products have dramatically increased in the last few decades from less than one percentTHC in the seventies to well beyond 40 percent in recent years. And that's just the plants—concentrates and other products can reach 99 percent THC. 

Cort doesn't really want to talk about the plant anymore because the people who are treated at Foundry Treatment Center Steamboat for CUD have not been smoking the pot passed around in the 1970s. "Concentrates are everywhere and are not just being used by the fringe; they are mainstream, and they are what many people picture when they talk about marijuana," Cort wrote in his 2017book Weed, Inc. "You are going to think some of this must be talking about hardcore users on the edge, but it's not; concentrates are everywhere and have become synonymous with weed for this generation of users." Cort will publish a new book in 2024 that focuses, in part, on the wide-ranging effects of expanded cannabis commercialization since the release of his first publication.

One group of individuals regularly self-medicating with cannabis is people with anxiety. "Lots of people with anxiety are counting on cannabis's ability to treat their symptoms," wrote Andrea Petersen and Julie Wernau in the Wall Street Journal in October. But "there's a problem: The science shows that it probably doesn't help, and it may make those symptoms worse."

The cannabis industry is promoting its products as helpful for anxiety because it's a very lucrative market. "Anxious consumers have turned to weed and edibles for relief as treatments for their ailments have become harder to find," wrote Petersen and Wernau. "The number of available and affordable therapists badly lags demand, and traditional medications don't work for everyone."

Petersen has personal experience with anxiety issues and cannabis use. In her 2017book On Edge – A Journey Through Anxiety, she used that experience and her expertise as a health reporter to explore the nature of anxiety and its treatment options. 

WhenPetersen smoked marijuana in college, she experienced a psychotic episode and had a panic attack. She didn't try to self-medicate with cannabis again. Sheavoided alcohol, too, realizing that her abstention was not typical. "Many people with anxiety disorder drink to relax, a way of self-medicating."

In OnEdge, Petersen also recalled the example of her friend Mike, who turned toalcohol and drugs to try to ease his anxiety and depression. "For Mike,marijuana and narcotics like Vicodin were a revelation," she wrote."They took away the worrying. They calmed his twitchy body." Itdidn't last, of course. "After a while, the marijuana turned on Mike. Itstarted making him more anxious. His drinking and use of narcotics slid intoaddiction. He went to rehab. He relapsed. He kicked the drugs and alcoholagain." 

Manyusers want to believe that cannabis can make them less anxious, and themarijuana industry is more than happy to accommodate that belief. "Yetlittle independent scientific evidence shows that cannabis is an effectivetreatment for anxiety problems, and some studies have found it can worsensymptoms," wrote Petersen and Wernau. "Researchers say this isparticularly true for products high in THC, the substance responsible formarijuana's intoxicating effects."

"Ihave patients who use it every day. They say it really helps," BethSalcedo, a psychiatrist and medical director of the Ross Center in Washington,DC, who specializes in treating anxiety disorders, told the Wall StreetJournal. "My message is that if it were really working for you, youwouldn't be here with me."

WhenDr. Salcedo talks with patients about what their anxiety was like before cannabis, she said they usually report that their anxiety is unchanged. Any transient relief they feel may be due in part to marijuana's high, she said.

Cannabis is big business. Anxiety is one of the most common symptoms that customers of cannabis dispensaries are looking to address. Several states have made anxiety a qualifying condition to receive a "medical" marijuana card despite there being any supporting evidence to support this. 

"Two recent studies show the potential problems with treating anxiety with cannabis," explained Petersen and Wernau. "Cannabis use was significantly associated with increased odds of developing anxiety conditions, according to a review of research published in 2020 in the Canadian Journal ofPsychiatry. Recent cannabis use was associated with more severe symptoms in people with anxiety and mood disorders, according to another review published in 2018 in the Journal of Clinical Psychiatry."

Unsurprisingly, the marijuana industry has funded its own studies. In some surveys, cannabis users have reported that they have felt relief from anxiety symptoms after consuming cannabis. "There is some evidence that cannabidiol, or CBD, which is a nonintoxicating substance derived from cannabis, may relieve anxiety symptoms," reported Petersen and Wernau. However, the science is limited and does not support the use of THC to relieve symptoms. 

While the benefits are questionable, the risks are clear. "Using cannabis regularly comes with a significant risk of addiction," wrote the WallStreet Journal reporters. "Marijuana use can become a disorder when people need to use an increasing amount to get the same effect and when the use interferes with work and relationships, among other symptoms."

Marijuana users also run a higher risk of psychosis. "Research has shown that cannabis use is associated with an increased risk for an earlier onset of psychotic disorders (such as schizophrenia) in people with other risk factors, such as family history," according to the National Institute on Drug Abuse(NIDA). "Cannabis intoxication can also induce a temporary psychotic episode in some individuals, especially at high doses. Experiencing such an episode may be linked with a risk of later developing a psychotic disorder."

Cannabis use disorder is a potentially serious condition frequently requiring treatment. "At Foundry Treatment Center Steamboat, we treat patients whose CUD was dismissed as 'only weed' because much of our society does not recognize cannabis as an addictive substance," says Cort. "One of the most pernicious effects of the cannabis industry's strategy of positioning the drug as medicine is that people generally believe that it is safe or poses no significant health risks. This extends to perpetuating the long-held belief that cannabis can provide a form of mental and physical relaxation. While this may be the case for some users, others have the opposite experience, and it can lead to very real and serious medical and mental health problems. The problem with allowing those profiting from the sale to define its uses is that they will always only tell one side of the story unless compelled to tell the entire story. Without considering negative, potentially negative, and unknown effects, it's like telling the story of Jack and The Beanstalk without the giant,"says Cort.

FoundryTreatment Center Steamboat developed a specific treatment track for people affected by cannabis use disorder (CUD) because the condition poses specific challenges. In 2000, Ben co-authored the first published best practices on treating CUD alongside Dr. LaTisha Bader in a medical text and reference book entitled Cannabis In Medicine and Evidence-Based Approach. He has spent the years since working to educate clinicians and medical professionals in our field on these practices. Many people experiencing cannabis use disorder suffer from extended periods of cannabis-induced psychosis and must be safely housed and medically supervised until their symptoms subside enough for them to start treatment programming.

“More Americans than ever are dying fromfentanyl overdoses as the fourth wave of the opioid epidemic crashes throughevery community, in every corner of the country,” reported Nadine Yousif on BBC News in September.

A recent study by researchers at theUniversity of California, Los Angeles, outlined the four waves: “The UnitedStates overdose crisis has escalated in an exponential fashion for over fourdecades, yet with a shifting profile of drugs implicated in each successive ‘wave’of the crisis. The first wave of the overdose crisis is typically argued tohave begun in the late 1990s or early 2000s with the rise of deaths involvingprescription opioids, the second wave beginning in 2010 driven by a shift toheroin, and the third wave beginning in 2013 driven by illicit fentanylanalogs. Recently, scholars have argued that the ‘fourth wave’ of the USoverdose crisis has begun, in recognition of rapidly rising polysubstanceoverdose deaths involving illicitly manufactured fentanyl, with stimulantsplaying a key role.”

In 2018, in a rare moment of bipartisanship,Republicans, Democrats, and former President Trump came together aroundlegislation that dedicated $20 billion to the treatment and prevention of andrecovery from drug addiction. Five years later, the SUPPORT Act has lapseddespite the fact that the number of Americans dying from drug overdoses hasincreased by more than 60 percent in those five years—largely driven by thepowerful synthetic opioid fentanyl.

“We are in the middle of a crisis ofproportions we couldn’t have imagined even five years ago when the originalSUPPORT Act was passed,” Libby Jones, program director of the OverdosePrevention Initiative at the Global Health Advocacy Incubator, told Politico. “If they can’t pass this, it’sreally sad.”

“Community-based organizations are on thefrontlines of the overdose crisis, and the SUPPORT Act delivers crucial fundingand resources, allowing them to continue providing hands-on overdose preventioncare,” Libby Jones, the program director of the Overdose Prevention Initiativeat the Global Health Advocacy Incubator explained on a Johns Hopkins webpage. “Some of the originalprovisions in the 2018 SUPPORT Act saw modest increases, while others sawsizeable expansion of funding.”

Highlights of the SUPPORT Act include:

●     Funding for communities ofrecovery was raised by $11 million each year (from $5 million to $16 millionfor each of the fiscal years 2024 through 2028).

●     Residential treatment programs forpregnant and postpartum people saw an increase in funding of $9 million yearly(from $29,931,000 to $38,931,000 for each of the fiscal years 2024 through2028).

A few days ago, the 2018 SUPPORT Act expired,and it doesn’t look like Congress is coming to the rescue any time soon. TheHouse just restarted legislating after emerging from 22 days without a speaker.“Despite its dysfunction, the House is further along legislatively than theDemocratic-controlled Senate,” wrote Carmen Paun on Politico. “The House Energy andCommerce Committee unanimously approved a new SUPPORT Act in July. But thatmeasure’s limited ambition suggests a reason for the lack of urgency to passit.”

A bipartisan group of representatives focusedon mental health and substance use has proposed more than 70 bills to fight theoverdose crisis. Still, there hasn’t been the sense of urgency lawmakersdisplayed five years ago.

While some have hailed the SUPPORT Act as asignificant accomplishment, it has barely made a dent in the drug overdoseepidemic. “Over 100,000 deaths is not a success in this country. It’s not apolicy success,” Regina LaBelle, a former White House Office of National DrugControl Policy acting director, told Politico.

Addiction is an extremely complex diseasedriven by complicated bio-psycho-social aspects. Allocating funds to a fewgroups and organizations can only be a small part of the solution.

“When addiction epidemics strike, we want toknow why,” wrote psychiatry professor Carl Erik Fisher in his sweeping 2022analysis of the addiction crisis, The Urge. But a complex situation with amultitude of factors is too often reduced to a simplistic scenario. “What isnecessarily a complex web of intersecting forces is too often reduced to onesimplistic story: trauma, brain disease, an evil and unstoppable drug, a badpill-mill doctor, a hereditary taint, or a weak will, or poor morals.”

While certain pharmaceutical, alcohol,cannabis, and tobacco industries cannot exactly be viewed as blameless—Fisherregards many such companies as “addiction supply industries”—they are only partof the problem. “Epidemics are never caused solely by an inherent power of thedrugs themselves or the efforts of the addiction supply industries; there isoften if not always, social wounding underneath, driving the substance use.”

The combination of social disconnection,anxiety, depression, and substance misuse can expose individuals to seriousphysical and mental health risks. People with substance use disorder needcomprehensive treatment to address all relevant concerns.

Foundry Treatment Center Steamboat ChiefOperating Officer Tom Walker is well-versed in the effects of governmentpolicies and funding on population health. “Our legislators need to prioritizethe continuation of the SUPPORT Act or legislation like it to ensure thatresources exist to fight the nation’s leading cause of preventable death. Ourelected officials and government departments responsible for allocating fundsshould look carefully at the social determinants of health that lead to theastonishingly high and deeply troubling rates of mental and behavioral healthdisorders we are facing. Funding treatment is important, but understanding andstemming the underlying factors contributing to intensifying and rampantanxiety, depression, trauma, hopelessness, homelessness, and family systemdysfunction is also critical,” says Walker.

Foundry Treatment Center Steamboat operates aspecialized treatment program for men experiencing substance use andco-occurring mental health disorders. Its parent company, NRT Behavioral Health^TM,also operates intensive outpatient and telehealth services for adults inColorado and Wyoming. These programs focus on helping individuals and familiesidentify the root causes that lead to the development of substance use andco-occurring mental health disorders, learn ways to manage these issues, andreduce the stressors that perpetuate a perceived need to use substances to feelnormal or escape overwhelming distress and pain.