> The annual incidence of schizophrenia was stable over time, while the incidence of psychosis NOS increased from 30.0 to 55.1 per 100 000 individuals (83.7%) in the postlegalization period relative to the prelegalization period.
So increased cannabis use after legalization did not result in increased rates of schizophrenia, though it might have made some cases worse.
causality might go the other way. having had a friend that was so, i wonder if a significant fraction of schizophrenics use cannabis to be functional in society
Scott Alexander wrote an article [0] on the mild antipsychotic effects of nicotine as the reason why such a high proportion of people battling psychosis smoke cigarettes.
There is the dopamine hypothesis for schizophrenia and new research suggest serotonin also plays a role. Nicotine increases the dopamine in the brain so it sounds like to me smoking would be a form of self medicating.
I'm not really surprised by this finding. My anecdotal experience has been that pretty much everyone knows a friend or a friend of a friend who smoked too much pot and had their life go off the rails. It is pretty clear to me that it is not a harmless herb despite that being the commonly held belief on places like Reddit.
Implying causality there is often misplaced. I’ve noticed some people smoke more after things start to fall apart from issues they have no control over, just as others binge eat when stressed.
It’s not a helpful coping mechanism, but there’s a reason double blind studies are considered so important. Untangling complex mechanisms especially when they have feedback in both directions is inherently difficult.
Some drunks drink more as they approach bottom. Is it the booze? Is it being the sort of person who becomes a drunk? Does it matter? More booze ain't helping.
You're really going to call for a double blind study here checking if excessive cannabis is bad for people conditional on their lives falling apart? How do you propose to get that past an ethics board?
It doesn't matter because you can't do a double blind study on pot. Double blind -> the patient doesn't know what they got. "Hmm did I get cannabis or oregano? I just can't tell". :)
You can still do a randomized trial and that's the one that wouldn't pass the IRB.
It's a great question. You can get high CBD strains now (it's getting dubbed "type 3") and you get the body relaxation and calming effects but none of the mental impact.
There aren't many studies on what are the real impacts of CBD.
Anecdatum: I personally know a mother who has a restraining order on her son, whom I also personally know, due to a psychotic episode. And the son's been smoking way too much weed for a long time. Heartbreaking.
My Bayesian prior has been sufficiently updated to effectively know: I don't know a single mother with a restraining order for a son who doesn't smoke too much weed. I have met a bunch of mothers and sons in my life.
In a Popperian sense we can all only assume so stop splitting hairs.
Clearly, smoking a shit ton is bad for people with marginal mental health or marginal emotional health.
According to Scott Alexander, I only hate the grey tribe outgroup ergo with enough e-risk paperclip minimization, we can drop p(doom) with lowered replacement fertility levels via lethargy from cannabis consumption, meaning marijuana is a hedon machine and positively utilitarian. Legalizing marijuana is effectively altruistic.
Couching it in pseudo-scientific babble doesn't change the fact that it's an isolated data point, and you're vying for the olympic goal for jumping to conclusions.
> Some drunks drink more as they approach bottom. Is it the booze? Is it being the sort of person who becomes a drunk? Does it matter? More booze ain't helping.
I mean, it kind of does. If you want to design intervention, it helps to know which causes the other to a greater degree.
If it's severe enough, quitting alcohol cold turkey can be life-threatening. And for some, they don't take longer than a day from drinking to realize they're on the path to delirium tremens.
But, should we (the gov) spend 10 million dollars on social services to prevent people's lives from going to hell, should we spend 10 million dollars on anti-alcohol addiction services or should we spend it half and half, are questions we as a society need answers to.
> My anecdotal experience has been that pretty much everyone knows a friend or a friend of a friend who smoked too much pot and had their life go off the rails
Sadly, I’m seeing a new trend of people taking too many psychedelics and going off the rails.
The way they’re being pushed as cure-alls for depression is getting scary.
One of my friends developed severe problems after following the microdosing trend. It developed slowly over a long period of time, but he thought he was okay because he was following one of those protocols from one of the biggest microdosing experts.
Syd Barrett and Peter Green always come to mind, as well as some local examples who wander the streets aimlessly. The appeal of psychedelics for depression –Or rather, what I thought was depression– tempted a younger me, until I observed that the people I knew who swore by it were quite strange and not exactly exemplars of good mental health.
Pot is one of those things that makes things worse if they're already going badly.
Like alcohol or opiates will make your good life bad if you fuck too hard with them.
Pot, in my experience, won't really ruin your life unless you're already on that path.
My thing is that it's mostly harmless, but the problem with it is that young people can become complacent with it. It won't necessarily ruin your life, but you'll be content to sit and veg your life away. So not bad, but not good.
Drinking too much coffee or even water can kill you. Too much sugar can kill you (albeit not too quickly). Obsessive eating or shopping can derail your life pretty quickly. Obsessive use of social media can induce depression. Some people kill themselves because of what they read or see in social media.
So it's not the legalization at fault, it's people who are overdosing any stuff that's available to them. Casual smoking a weed once a week won't harm you that much.
While I also have anecdotal experience that suggests early-life cannabis abuse can lead to short-term memory loss, I have not seen any evidence that it leads to much else. I would imagine that people with a genetic predisposition to schizophrenia would only not have it by chance, and that altering their brain with pretty much anything can risk upsetting that balance. Doesn't matter if it's weed, LSD, opioids... SSRIs, stimulants...
> that altering their brain with pretty much anything can risk upsetting that balance. Doesn't matter if it's weed, LSD, opioids... SSRIs, stimulants...
Of course it matters. Different drugs and doses have completely different effects on the brain.
Trying to to equate different drugs and claim they’re all similarly risky goes completely against everything we know.
Conspiracy theories. Every heavy pot smoker I know has ended up believing in multiple conspiracy theories. Back in the day before YouTube my friends were burning DVDs of 9-11 Truther documentaries, a chick I dated became obsessed with UFOs and alien abductions, a close family member began to believe they had found a way to develop psychic powers, and the boomers who got their medical marijuana cards deserve their own category based on the number of right wing conspiracy theories they repost on Facebook. The only exception I can think of got heavily into sports betting with a similar level of obsession and belief that they had deep insights that escaped everyone else.
I suspect that it triggers part of your brain that rewards you for making connections or something like that.
This is definitely not the case. Half these people had no connection whatsoever to “cultural doctrine” and a number were extremely conservative and completely mainstream before they started smoking late in life. As I mentioned one takes this same attitude to sports betting, another family member is always passing me some highly unconventional investment tip he’s just learned about from some random guy.
I’ve seen this pattern emerge time and again over decades in people with completely different backgrounds. It expresses itself in different ways but smoking absolutely rewires your brain, makes you more receptive to “secret insider information”.
It puts the brain in our "art enjoyment mode" which also means lowered epistemological immune system. Cannabis should be used occasionally to play outside, make music, watch movies, etc. Not used daily when thinking about politics or stock trading :-/
From one of the papers: “the Aberrant Salience (AS) construct […] refers to an excess of attribution of meaning to stimuli that are otherwise regarded as neutral, thereby transform them into adverse, dangerous, or mysterious entities. This leads the patient to engage in aberrant and consequently incorrect interpretative efforts concerning the normal perception of reality and its relationship with our analytical abilities. AS appears to play a significant role in the onset and perpetuation of psychotic disorders. The internal conflict arising from aberrant attributions of significance leads to delusional thoughts, ultimately culminating in the establishment of a self-sustaining psychosis.” — https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1343...
According to what i remember reading in 2010 (maybe the science has changed in the last fifteen years but I doubt it)
People with the Val158Met COMT polymorphism are more susceptible to develop schizophrenia sooner if they are exposed to cannabis. And that genetic mutation make them more successible to have cannabis use disorder. Knowing that I don't understand the question that this study is attempting to answer.
I agree it can cause those effects but it always seemed to me that the weed is just causing sleep deprivation which eventually leads to psychosis. IME it's not much different from alcohol in that way, they both disturb REM sleep so you end up deprived with daily use. It's just more apparent with weed because you don't get the hangover effects, so it's easy to overuse.
It is incredible that the slightest increase in any cancer associated with alcohol is immediately trumpeted, but no matter how much research shows marijuana has dangers, the stoners always brush it off.
Just accept the risks and live your life. Nothing is without risk. Drink your beer and smoke your joint, why bother living if you aren’t going to enjoy yourself
Plenty do those things out of desperation, disease, and despair. In some, that leads to generations of harm. To many, the risks aren't even part of the equation.
Hallucinations (e.g., hearing voices), delusions (e.g., believing one has special powers), disorganized speech and behavior, reduced emotional expression, lack of motivation, withdrawal from social interactions, problems with attention, memory, and decision-making
Yep. Had nearly all of the above when I was bored out of my mind and smoked every single day during covid. I was working remotely and was high half of the time I worked. That went on for about 1 year. Thank goodness I was a mature adult when I first started and could eventually remember that life was better without weed. Sober for 1.5 years now.
I highly recommend r/leaves to read other people's stories trying or wanting to quit weed.
Edit: For those wondering, after being sober for 1.5 years, I'm pretty much back to my old self. My memory took a while to come back but it's drastically better than it was when I first quit. I feel much more motivated in life. My relationships with family and friends are better and so is my physical health. I was smoking about 0.5g - 2g/day for 1.5 years.
Nearly all are all symptoms of depression, delusions with manic depression. Nearly all are symptoms of being stoned too.
It's unlikely you were experiencing schizophrenia unless you were actually hearing voices, thinking that you were a "Targeted Invididual", things like that.
I was merely going by the symptoms after a simple google search. I wasn't hearing voices.
I never got to that point though I believe I would have eventually had I continued. The weed I had access to were of questionably quality and wasn't professionally grown like the dispensary ones. I also never tried THC oil or other super strong weed products - which I read can drastically increase schizophrenia.
I have used weed a number of times. I also consider myself a schizoid personality disorder person. Supposedly that is on the very mild end of Schizophrenia. I have never found it to lead to psychosis or anxiety in myself.
All it does for me is make me feel relaxed and euphoric. If I use a lot I feel more relaxed and euphoric.
I am normally a person who is very detached from what people call a sense of self.
I believe this immunizes me from the anxiety many feel when losing self control under substances.
I do find annoying how many "pot heads" seem to think that weed is a panacea rather than a pacifier with some risks for some people.
Although the effects are different I would very much consider it akin to alcohol or an opiate.
If you have problems it will likely make them harder to deal with.
If you are just looking to relax or escape and are not prone to anxiety then it is effective but in my experience not much different from alcohol or opiates except less physical harms or potential for physical addiction.
I agree with the posters that for many if not most people, including myself, weed can give the illusion of some special insights or special connections to others but it is important to recognize just that, that this is an illusion, that our subjective feelings at any given time do not necessarily correspond to objective reality.
It is shocking to me how many people in all kinds of areas of life think that because they feel something is true it must be true or important or relevant.
Weed evidently makes many weed users feel it is a wonder drug, thus propagating and sustaining the mind virus.
I think it should be legal.
I also think if you want to be successful in life habitual use is ill-advised.
I can certainly see how for anxious, over thinking, controlling types it could lead to psychosis, like any number of other things, even including ideas. However I believe this effect is more due to a pre-existing neurotic psychology of the specific user rather than an intrinsic property of the drug.
But regardless it's not harmless.
Additionally the long term effects are not well known.
I've tried cannabis a few times but I couldn't get it to do nearly anything at all. I've tried a few different kinds and also tried THC tincture, but could never get anything to happen other than some slight dissociation. Is that "stoned"? Is my brain just not receptive to it or something?
Every human brain is different, some smoke a lot of pot and develop serious mental issues— others smoke a ton for years and you don’t notice any change.
The problem imo with this kinds of studies is that people can’t take the nuance and rather see it as “weed = bad” or some other binary outcome.
Imo all drugs have a potential to be dangerous — all adults should have free agency what they do with their bodies.
Sure cannabis, alcohol or mushrooms are dangerous, but I would argue a society that makes their use completely illegal without nuance is not a free society
It's very interesting. I am extremely sensitive to THC, in a way I am not to any other drugs. A small amount (5mg) gives me full on disassociation/derealization, very anxious thoughts, etc.
I always wondered if other people had the same experience of THC as I did, but responded _psychologically_ differently to me, or if it was a _physiologically_ different experience. It was very confusing during high school.
Bizarrely I've found this react to weed much more common in the UK than California. There would be no reason for that to be true, though.
> I am extremely sensitive to THC, in a way I am not to any other drugs. A small amount (5mg)
5mg is not a small amount for someone without tolerance.
An old chemistry major college friend went into the THC industry. His company was very careful about production, measurement, and labeling.
He said it was very common for people to tell him that they needed some high number of milligrams to feel anything, then they’d ask him for samples from his company. They’d take what they thought was their normal dose and get completely knocked out.
A lot of products are (or were in the past) apparently very optimistic about their THC content. 5mg is actually a significant dose for most people without tolerance.
> I always wondered if other people had the same experience of THC as I did, but responded _psychologically_ differently to me, or if it was a _physiologically_ different experience. It was very confusing during high school.
I wonder this too. Maybe, say, non-autistic people would interpret differently what I see as mild dissociation, and experience all of the... whatever the fuck THC is supposed to do to Normal People. Or so the theory goes.
> A small amount (5mg) gives me full on disassociation/derealization, very anxious thoughts, etc
It is pretty common for people to have panic attacks while using cannabis. Those can be the symptoms of a panic attack.
> There would be no reason for that to be true, though.
Concentration, cannabinoid composition, adulteration (analogues, enhancement, etc), contamination (heavy metals, pesticides, mold, environmental or biotic toxins) are a few things that come to mind.
That was my experience also. I would smoke with my stoner friends, and it didn't seem to do much. I would think maybe I wasn't inhaling enough or something but then I would look in the mirror and my eyes were blood red.
I think it's just an expectations thing. I was doing max doses of acid for a long time before I ever used marijuana, and that ain't "some slight dissociation". On acid, you would watch the houses across the street stand up, join hands, and dance around in circles. Pot just didn't move the needle.
I knew a few people when I was young (20s) that "pot does nothing" to them. Then one day they took a toke from a joint going round and were totally munged.
I've seen it a few times, and I have no idea why it's like that for some people.
I've never heard about rainbows and stuff, at least not for weed. I've heard for some people it increases their depth perception to potentially painful levels, I've heard for some people it makes them feel like they can see with their eyes closed, I've heard for some people it makes daydreams more vivid/accessible, I've heard for some people it makes things feel/appear funnier than they actually are... but for me it's just some slight dissociation, which doesn't exactly manifest as a particularly interesting or impaired experience since I experience dissociation all the time just naturally (thanks to my dissociative disorder).
Your brain is not receptive. This could be a worse, however. If you have schizophrenia within the family, you might be at risk. The doctor strongly recommended I do not take any cannabis because there is a risk it triggers a psychosis episode. I wouldn’t see cannabis having no effect as good news as that’s not representative of the average experience.
I'm not sure how to do more. I think in all cases I tried to take as much as I could. I basically can't smoke or vape it because every time I try, I feel like I'm going to choke and die, and I cough for something like 5 minutes straight.
When I tried the tincture, I took 50mg of THC orally. (250mg per 30oz, so 6oz.) Although I guess I could just be unable to take THC orally, which would suck, because smoking it is miserable. (I am really not a smoker...)
As a population based study, how did they control for other substances? Acid in particular is notorious for flashbacks years later that can be psychotic. I also note that the period in question is also associated with massive increase in methamphetamine abuse. Greater access to THC being associated with an increase in crazy people using it makes complete sense, but is a causal link between legislation and schizophrenia really demonstrated amongst chronic potheads (the study is about psychosis in people with CAD), that being the subject of the paper?
Are acid flashbacks real? I thought that was an urban myth.. I've never had one and I don't think I've ever encountered someone who has. It seems like one of those drug war era scare tactics or viral rumours.
The big question remains: is this downside worse than the innumerable and absolute known downsides associated with alcohol? If not, this is a purely acedemic issue.
However, on an individual level, I think people need to know about the psychosis risks. It undoubtedly can trigger schizophrenia and make it much worse once it exists.
I know more than a few people who have severe alcoholism problems in their families, and just chose to never drink alcohol. I think a similar choice may be wise for cannabis if there is a history of psychosis.
On a public health level there was a theory that people would substitute cannabis for alcohol. But unfortunately, this doesn't seem to be bearing out.
Previous studies have shown that young adults who are susceptible to schizophrenia are more likely to develop it if they were heavy cannabis users at a younger age. As they get older it is less likely to develop, or they are better able to keep it from developing. My brother-in-law smoked cannabis in high school and college and was hospitalized for schizophrenia when he was in college. It wrecked his life and he still has schizophrenia at age 65. I don't think it is just an academic issue.
There are practical reasons to understand the effects of both cannabis and alcohol. It’s not like we can only care about one of them at a time based on which is winning the social harm olympics.
I don’t see how your conclusion follows. I quit heavy weed use because of noticeable cognitive and social problems. The warning is useful for users to know about regardless of the problems associated with alcohol.
"Education about these substances is the most important thing."
Indeed.
"obviously much worse than a few people who develop mental issues."
So maybe start by comparing the average heavy weed smoker, to the average non drug user, to see if the issue with cannabis is really "just some people developing mental issues"
(Disclaimer blabla: I always was pro legalisation and am happy, it finally is legal in germany now)
History has shown that _bad_ education about substances doesn't work, as most kids know that pot rarely turns you into an axe wielding homicidal maniac. Educate using the truth - pot probably won't turn you crazy, but it might cost a lot of money and waste a lot of time.
For what it’s worth education sees alcohol as a much less harmful substance than weed (for example in Germany since you brought it up) - it’s completely acceptable to drink heavily every weekend to the point of almost landing in the hospital, while heavy weed use is seen as very deplorable (lazy etc).
So while weed is not without harm i think alcohol has a magnitudes worse impact on society
Oh for sure, the first time I vomitted from alcohol was when I was 14 on a catholic winefestival - the wine was given to us as a present from the official organisators.
But it has been some years and I believe (and hope) at least that changed a bit. Otherwise alcoholism is epidemic. But stoners, or well, people combing both and meth and whatever is a thing as well.
Either way, also weed on its own is not harmless either, easily abused and your comment gave me the impression it is no big deal. Just like it was introduced to me as a teenager from the cool kids. And this is dangerous.
I think we are on the same page here. I just want to emphasise that for example alcohol and tobacco are magnitudes more abused than any other substances, 10x to be exact:
Results: Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million).
That is quite subjective and not solid data. At least I am not aware of a scientific consensus in that regard.
Alcohol is just more widespread because it was legal and part of the culture, so more abuse there. But this context here is about how that might change with the legal status.
Laut dem Alkoholatlas 2022 des Deutschen Krebsforschungszentrums ( DKFZ ) starben in Deutschland im Jahr 2020 rund 14.200 Menschen (davon 10.600 Männer und 3.600 Frauen) an Krankheiten, die ausschließlich auf Alkoholkonsum zurückzuführen sind.
That are 14200 deaths solely due to alcohol in Germany every year — the only figure I found for cannabis was about 1-200 - so it’s more than 100 times more dangerous if you only look at official death statistics — this is as solid as the data gets.
Sure things might change with legalisation— but looking at the Netherlands the opposite is most likely the case.
So yea I retract my earlier statement— alcohol is not 10 times more dangerous, it’s >100 times more deadly.
This doesn’t even account for all the accidents and other injuries related to alcohol.
>"I mean, it's legal, right?" asked the Tesla founder, before taking a drag on the joint.
"Tesla founder." You'd hope that the BBC would get right that he's not the founder but an early investor that ended up taking over the company and kicking out the original founders.
Why do you even care. If I call him JackAssElon what harm does that cause you or society that you feel the need to chastise people for it? It's kinda odd to see you jumping to his defense when literally no one else gives a shit what we call that fuckwit.
"ultra-potent weed" is weak and you need to stop with that talking point. SWIM are on 90%+ THC cartridges or concentrates 24/7. Smoking the strongest weed, low 30%s, is a tolerance break thing or for fun.
A lot of things can mess you up after only one time. For example, I got hit by a truck in July of last year :) all my injuries have healed but I still have protective reflexes and some really strong emotions about it. Trauma is powerful!
Could also just be an increase in symptoms the person already had but in minor form. We tend to think of people as being either schizophrenic or... "not," but it seems far more likely that it exists, like everything in humans, on a spectrum.
People develop schizophrenia in their early twenties. Once it develops, you have it for life. The evidence is that cannabis use at an early age makes people who are susceptible to schizophrenia unable to control it and it fucks up the rest of their life. Some people smoke a ton of pot and never develop schizophrenia. Some people who are susceptible to schizophrenia and wait until their late 20's to smoke pot or use it minimally before then are able to avoid schizophrenia.
This is a perfectly valid reason to avoid heavy cannabis use before the age of 25.
it's pretty hard to establish causality for something like this, but you have:
1) very solid evidence of correlation at a population level
2) a lot of clinical experience from doctors that patients with psychotic disorder diagnoses who use cannabis tend to do worse. and, similar stories from family members of people with psychotic symptoms who aren't in treatment.
so unfortunately I think there is something real here, it's not just people having transient bad reactions to weed and going to the ER and getting a diagnosis.
So increased cannabis use after legalization did not result in increased rates of schizophrenia, though it might have made some cases worse.
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