As America's Marijuana Use Grows, So Do the Harms

(nytimes.com)

39 points | by gist 20 hours ago ago

53 comments

  • lenerdenator 19 hours ago

    I imagine that the harms that come with medium-or-heavy marijuana consumption are still probably less than, say, being locked in a cell at a state prison for selling it, or using other drugs that are both illicit and tainted with opioids.

    I don't partake, but I'm in a recreational state, and I think it's accurate to say that the stuff you can purchase at a dispensary is one of the few guaranteed safe highs you can get in 2024.

    • deergomoo 19 hours ago

      This has always been my argument for legalisation (apart from a general feeling of "I am not hurting anyone else, so why do you get a say in this"). If you think it's harmless you're kidding yourself, but for most people, the associated harms of criminalisation far outweigh the harms of the drug itself.

      • kevinventullo 19 hours ago

        This is a false dichotomy. You can make weed illegal without putting people in prison for it.

      • slibhb 19 hours ago

        I think this is probably wrong. The total society wide harms of legalization are higher than the total society wide harms of criminalization. The former harms are more diffuse but probably greater in sum.

        Of course, criminalization isn't a binary. Probably, we could have just moved a little slower here.

        • drdaeman 19 hours ago

          > The total society wide harms of legalization are higher than the total society wide harms of criminalization

          Can you please elaborate why have you concluded so?

          I can see that legal consumption is naturally larger than illegal, as illegality is a deterring factor for some unknown to me fraction (all I know it's a lot more than 0%, but significantly less than 100%) of the population. Without the concrete numbers (how much bigger is legal consumption exactly, what's the probability of adverse side effects like those psychotic episodes, what's the probability of trying even less safe substances - like opioids - if cannabis is illegal vs with access to legal and well-regulated cannabis-only dispensaries, etc etc - lots of factors) it's really hard to me to make any sensible conclusion.

          According to the article, it estimates 18*3=54M users, out of which 3M (about 5.6%) have a use disorder (which, as I get it, is effectively a term for addiction). It is, however, unknown, how many of those actually exhibit any severe side effects, how many of those would be addicted either way (just illegally) and so on.

          E.g. if we have to weighting legalization with tax-funded information and rehabilitation/anti-addiction support services for people who are affected, vs full prohibition or medical-only cannabis - it's really not clear what's the best strategy (in terms of least adverse effects on the society in general).

          • slibhb 19 hours ago

            People in this thread have said that harms caused by criminalization exceed harms caused by legalization. I think that's wrong.

            My sense is that people have a cognitive bias here. Diffuse harms are hard to measure and usually underestimated. Whereas larger harms focused on a small number of people are very noticeable, draw a lot more sympathy, and are easier to measure. But the diffuse harms generally end up being greater in sum.

            • drdaeman 18 hours ago

              > My sense is that people have a cognitive bias here

              Of course - we all do! :-)

              I just thought you possibly have seen some more numbers/details about those diffuse harms, rather than merely a belief they must be bigger (which is totally fine, we're all entitled to our opinions or lack thereof, it's just that I believe that opinions are impossible to debate meaningfully until they become supported by facts).

              This said, I think I understand your logic, but even without having any numbers I also think it's really hard to weigh different harms against each other, especially when it comes to such diffused harms.

              As a simple contrived (and strictly synthetic, not connected to real life but merely a very naive thought online-comment-grade thought experiment to demonstrate the point) example - what's better, millions coughing or hundreds behaving aggressively? Or, say, thousands jailed for possession? (All numbers absolutely not related to real world situation, only to have different scales for the argument purposes!) How do we assign some "weights" to those, on what scale, and how do we "sum" those weights (it could be that a naive arithmetic sum is not the appropriate operation in the field of social well-being)?

              Hope this makes sense!

        • moomin 17 hours ago

          You talk like you haven’t even heard of drug cartels or narco states. We have organised our entire society and foreign policy around the prohibition of certain substances. It’s not an unreasonable question to ask if our time and effort would be better spent on other things.

        • deergomoo 19 hours ago

          I don't agree (of course), but admittedly it is difficult-to-impossible to measure the harms on either side at that level of aggregation. i.e. across all society.

          But from the perspective of the individual user, for the vast majority of people, being thrown in jail would be so much more harmful than any negative effects they or those around them would ever experience from cannabis usage.

        • bsder 19 hours ago

          > The total society wide harms of legalization are higher than the total society wide harms of criminalization.

          We have quite a lot of evidence to the contrary.

          In the US, marijuana legalization is being fought because the criminalization provides so much revenue to the enforcement system. That's a REALLY, REALLY BAD perverse incentive and it does an enormous amount of very visible damage. It provides incentives to jail people rather than treat them. It corrupts the "justice" system with monetary incentives. It funnels money into black market operators. etc.

          Unfortunately, the only real way to control that perverse incentive is to legalize. Yes, there are other ways, but they require a significant amount of sustained political will that is much harder to muster than that required for simple legalization.

          • slibhb 19 hours ago

            > We have quite a lot of evidence to the contrary.

            Such as?

            You assert that anti-legalization is about revenue. But what about millions of people with health issues caused by weed use/addiction? The ones discussed in the article. Is this all just made up?

            My point was simple: millions of people using weed will probably cause greater net harm than a much smaller number of people going to jail. Alcohol is similar: the net harms of alcohol are astronomical. People tend to underestimate net harm when it's diffuse and overestimate it when it's very focused on a few people.

            • fuzzfactor 15 hours ago

              I would assert that the criminal status-quo is about revenue more than anything.

              Seems like it's the criminals that actually kill people, and law enforcement effort that is misguided when they have non-violent victimless offenses on the books to pursue rather than dangerous criminals.

              The equation does change when you start talking about a substance that is toxic enough to kill on its own, in spite of any lesser disorders that would be considered side-effects if it was a medication you were taking.

              Then again, cannabis has been in the US Pharmacopeia for decades, but it was too onerous for physicians to prescribe when it was medically indicated, until the states themselves took action.

              There is some consensus that there would have been a lot less opiate deaths if it could have happened sooner to a more widespread degree.

            • Gud 8 hours ago

              I think I speak for every pothead on the planet when I say this:

              Mate, as someone who smokes a lot of weed, I’ll take some minor health issues over getting thrown into jail and having a permanent record as a criminal.

              I think you are vastly exaggerating the health consequences.

              • edanm 8 hours ago

                I'm not sure you're grappling with the actual claim parent is making.

                Of course for every individual user, it's better to have minor health problems than be thrown in jail.

                The question being posed (if I understood correctly) is - if legalization means 10x more people use marijuana, and therefore 10x more people have health problems, is that better or worse than marijuana remaining illegal, and some fraction of the X go to jail.

                (Btw this is a false dichotomy, it can be illegal without meaning you go to jail for using, but I digress.)

            • bsder 13 hours ago

              > Such as?

              The original article, for starters?

              The people in the article are sufficiently rare that doctors don't spot them very easily. And they're using a lot, every single day. That's pretty benign pharmacologically.

              > Alcohol is similar: the net harms of alcohol are astronomical.

              Funny you should mention that ... Prohibition directly shows that the net harms of alcohol not being legal are far, far worse.

              And, by the evidence, alcohol seems to be pharmacologically way less benign than marijuana.

              Is marijuana harmless? No. But you solve that by regulation rather than criminalization--just like alcohol and nicotine.

              And we haven't even touched on the whole issue of selective drug enforcement being institutionalized racism ...

        • bediger4000 19 hours ago

          Careful, this argument could easily be used to criminalize a whole lot of things, alcohol, tobacco, maybe even guns.

          • slibhb 18 hours ago

            Weed was already illegal! We could have kept it illegal and simply punished people less for using and selling it. Whereas making alcohol, tobacco, and guns illegal is clearly impossible.

            • Teever 18 hours ago

              But it obviously wasn't impossible to make alcohol illegal in the past.

              • drdaeman 17 hours ago

                Alcohol is illegal in some countries out there, today. I'll refrain from making any judgements, but I'll note that the word is, people still drink it there.

                • bediger4000 17 hours ago

                  Sure, but the argument was that widespread, legalized use of $X caused more harm than the bad effects of using law enforcement to suppress and punish use of $X.

                  Maybe illegal alcohol consumption in some countries causes less harm overall, including whatever legal system punishments on the few consumers who get caught, than legal alcohol consumption would. I'd believe there's less drunk driving, fewer bar fights, fewer piles of puke in alleys in those countries.

        • johnea 17 hours ago

          Of course, people should use alcohol tobacco and firearms, like the little baby jesus intended!

          The deamonization of weed is a witch hunt, plain and simple. Paid for by the ATF industry.

          Through 50 years of routine marijuana use, I've seen a number of people shrivel up and die of various tobacco use cancers, I've seen people die from liver disease and car crashes due to alcohol (not to mention the routine bar fighting and gutter puking), but I've never know anyone who died from marijuana use, ever.

          As psychoactive substances go, it's about as harmless as they come. With probably only magic mushrooms being less harmful.

          This article speaks much more loudly to the NYT's support of the ATF industry, than to any harms due to marijuana. People who are allergic will die from eating peanuts, I think this is on the same scale of danger that marijuana brings.

          But, don't forget, that new chardaney is delightful!

    • wkat4242 17 hours ago

      There's some legit possibility of harm to people with genetic disposition to some specific mental illnesses like schizophrenia. It can bring in psychosis in people prone to it. Even though it can be very helpful to sufferers of other mental illnesses.

      I've been warned about this by psychiatrists who were otherwise very liberal about drug use (one of them I knew even boasted to have tried almost everything). And it's legal in my country. Which I agree with, the potential harm for a small percentage of people doesn't mean it should be banned for everyone.

      • avery17 30 minutes ago

        Do you have a source for this?

      • dgraph_advocate 17 hours ago

        That risk is overblown compared to the risks alcohol, tobacco and even coffee cause to people with pre-existing serious mental illnesses.

        Not to mention things like poverty, homelessness and social exclusion.

        • wkat4242 12 hours ago

          The last things you mention are consequences, not causes.

          But THC has a particular trigger for specific illnesses that alcohol doesn't. At least that is what I've been told several times. This is why I stay away from it. I do consume a lot of alcohol

  • deergomoo 19 hours ago

    Interesting that only two states cap THC quantity. I'm in the UK and my friend has a (quite rare, here) medical prescription; the part I find most appealing is his ability to purchase significantly lower % THC stuff (though high-THC is very much available, which I found surprising). I still like it recreationally from time to time, but the problem is anything I get black market is just incapacitating, because I have no tolerance anymore.

    I (and I suspect many users over a certain age) would like the equivalent of a few beers, but the only thing available is absinthe.

    • wkat4242 17 hours ago

      I think it's because the market has used THC content as a marketing point and that has driven its content to grow massively. Leading to infrequent users getting overwhelmed.

      I think it's good to keep that under control a bit. From what I hear the normal marijuana that's not "enhanced" is much more enjoyable.

    • ls612 18 hours ago

      You can buy edibles and then split them into whatever dosage does the trick for you. At least in most legal states you can.

      • zikduruqe 17 hours ago

        Or take a tiny hit off a vape pen. No need to rip clouds.

  • exabrial 19 hours ago

    Inhaling combustion byproducts of cigarettes, devils lettuce... a car tire, etc is terrible for your lungs. Theres nothing about weed that makes it safe to smoke. I imagine it's probably worse the tobacco in some areas I imagine (not that "filters" help, but I'm sure they do something), but I'm just speculating. I would treat it with the same risks as 'regular' smoking.

    There are better ways.

    • david-gpu 18 hours ago

      Growing up it was not unusual for people to smoke one or two packs of cigarettes a day. That is 20 to 40 units daily.

      Do you have a sense of how much weed most people consume? It is a tiny fraction of that. I honestly don't know how I would feel after smoking a whole joint all by myself because I have experienced hallucinations after a lot less than that. Granted, I have low tolerance, but still. Modern weed packs a punch.

      Not to mention that vaping bypasses the need for burning the flowers in the first place.

    • terminalbraid 19 hours ago

      Good news! Marijuana consumption isn't limited to smoking.

    • 17 hours ago
      [deleted]
  • toomuchtodo 20 hours ago

    Previous:

    https://news.ycombinator.com/item?id=41771085 - October 7th, 2024 (4 comments)

    https://news.ycombinator.com/item?id=41743399 - October 4th, 2024 (1 comment)

    (no material discussions previously)

  • bsder 19 hours ago

    Part of the problem is that, currently, marijuana seems to be the only socially acceptable "treatment" for your mental health.

    None of the people in this story were using marijuana for pleasure. They were using it heavily as a medical treatment.

    This is just like lots of people who used alcohol and nicotine for exactly these same reasons for many, many years until those drugs became regarded as socially unacceptable.

    A better solution is for us all to have genuine medical mental health treatment rather than a bunch of people all relying on ad hoc personal chemical experiments.

    • drdaeman 17 hours ago

      It also must be widely accessible so there is minimal effort necessary to get help if you suspect you need it.

      When mental health is not accessible (reasons vary from country to country - in some it's merely a stigma, but in some it can have legal consequences[1], and in some it's simply financially prohibitive) there no surprise folks tend hit a joint, or swig from a bottle, rather than visit a doctor's office.

      [1] Like a difficulty to obtain or renew a driver license with a medical history of having a diagnosed mental disorder (even if it formally shouldn't be an issue). Which is why I'd even argue for ability to seek help anonymously (if desired so) as a potential requirement. Should help with any stigmas just as well.

    • readthenotes1 17 hours ago

      You're saying that the kids are using marijuana on a daily basis and a scary amount are taking it as medical treatment? For what? Growing up? It is traumatic and definitely causes anxiety but the people I know that resorted to regular marijuana used to handle the anxiety never learned to handle anxiety...

      • SauciestGNU 15 hours ago

        Cannabis plus SSRIs have allowed me to manage depression/anxiety symptoms as well as ADHD tendencies. It's been genuinely life-changing for me. I suspect that's more along the lines people are talking about.

  • api 20 hours ago

    I have known alcoholics and heavy marijuana users. Alcohol is hands down far worse for health long term if used heavily and regularly. It’s not even close. I personally consider alcohol a “hard drug” at least at higher doses.

    That being said there is this myth that weed is harmless. It’s not. It’s a drug. If it’s smoked it damages the lungs just like smoking anything else, and the compounds in it might have negative long term effects on cognition.

    Like anything else of the sort if it’s used at all it should be used in moderation.

    • nelup20 19 hours ago

      > If it’s smoked it damages the lungs just like smoking anything else, and the compounds in it might have negative long term effects on cognition.

      Also higher risk of a heart attack and/or stroke: https://www.ahajournals.org/doi/10.1161/JAHA.123.030178

    • shrubby 19 hours ago

      Alcohol and tobacco are worst ones as in addition to harms they're also available practically everywhere and the harms are huge. Weed is harmful as well, but it might not be quite as obviously harmful as ethanol.

      I have considered and read a crapton, trying to learn addiction. And there isn't a safe substance and there's no way of knowing how close to problem use one is, as genetics, repetitions and traumas are personal.

      And addiction is transferable, learnt with one substance the nervous systems will quickly pick up a new one should the supply be cut off.

      And it's also a disease that progresses. Like a coil in a bolt, once it's broken you can't turn back. And there's no torque wrench for substance use.

      I loved my alcohol, weed and nails. But unfortunately there's no use that's safe.

  • gist 20 hours ago

    Also see this and note who the OP is: https://gothamgal.com/2024/10/journalism-vs-media/

    • Terretta 18 hours ago

      Authored and editored sentence in the NY Times article:

      NY Times: ”Researchers don’t know why heat soothes the syndrome, known as C.H.S., nor why certain chronic marijuana users develop it and others don’t.“

      Let's read that again: "why certain do ... and others don't".

      Now, a sentence containing numbers from Gotham Gal:

      Gotham Gal: “Cannabinoid hyperemesis syndrome is what a lot of the article focused on. Reporters surveyed 200 physicians who have different specialties and found almost 600 people who suffer from this syndrome. 600 people spread throughout 200 physicians? I mean seriously. Thirty-five million people use cannabis daily in the United States.”

      Certain do. Others don't.

      Later in the NY Times article we get this selection-bias + self-reporting bias gem:

      “A 2018 survey of emergency department patients at Bellevue Hospital in New York found that among 18- to 49-year-olds who disclosed consuming cannabis at least 20 times a month, one-third met criteria for the syndrome.”

      Pot or not, what are the odds of ER patients reporting symptoms meeting critera of "nausea, vomiting, and pain"?

      Followed immediately by extrapolating to everyone:

      “Based on those rates, the researchers estimate that today about six million near-daily marijuana users in the United States could have symptoms of C.H.S.”

      They could. Certain do. Others don't.

      And then one last amazing couplet about our 600 person sample:

      “600 people with C.H.S. who responded to the Times survey said ...”

      “Many of the respondents, who are in a Facebook support group, said...”

      Oh. These do. Others don't.

    • tyleo 19 hours ago

      I really appreciate you sharing both sides of this story. Haven’t really made up my mind on the matter myself but both perspectives are interesting.

      • Me001 19 hours ago

        I don’t understand, it’s not two sides just evidence vs lack of evidence.

    • slibhb 19 hours ago

      This response guestures towards a few things, but it doesn't really dispute the claims being made.

      I was left confused with exactly what the author disagrees with in the Times article (other than the overall conclusion: "weed is bad").

  • musicale 11 hours ago

    No one could have predicted this.

  • metalman 18 hours ago

    down ,Cuba way, they are dealing with a weed derivative they call "chemico" which by all accounts will FUU (fuck you up) Here is the deal with humans and substinces we will keep refining anything and everything untill we get it concentrated into a white chrystaline powder,ie: 100% X.And then moan and groan till we can find something else with a bigger kick and bang for the buck and start refining that.

  • meiraleal 11 hours ago

    I've been smoking weed daily for the past 15 years and if much, my health is much, much better today than it was 15 years ago. Yeah, not a great study of 1 case, but tacit knowledge is the real deal.

  • johnea 17 hours ago

    Of course, people should use alcohol tobacco and firearms, like the little baby jesus intended!

    The deamonization of weed is a witch hunt, plain and simple. Paid for by the ATF industry.

    Through 50 years of routine marijuana use, I've seen a number of people shrivel up and die of various tobacco use cancers, I've seen people die from liver disease and car crashes due to alcohol (not to mention the routine bar fighting and gutter puking), but I've never know anyone who died from marijuana use, ever.

    As psychoactive substances go, it's about as harmless as they come. With probably only magic mushrooms being less harmful.

    This article speaks much more loudly to the NYT's support of the ATF industry, than to any harms due to marijuana. People who are allergic will die from eating peanuts, I think this is on the same scale of danger that marijuana brings.

    But, don't forget, that new chardaney is delightful!

  • ldehaan 14 hours ago

    [dead]