by Kevin Schofield

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There was big news last week for the cannabis industry: The Biden administration is looking to move marijuana from the Schedule I list of drugs to the Schedule III list under the federal Controlled Substances Act. Schedule I drugs are believed to have no medicinal value, they have the tightest controls, and handling money on behalf of people buying or selling them is usually illegal — which makes it nearly impossible for a marijuana-related business to have a bank account.

Marijuana is a rapidly growing industry (no pun intended): 38 U.S. states have now legalized medicinal use of marijuana, and 23 have legalized its recreational use. Between them, more than half of U.S. adults have legal access to it. That said, with the growth of the industry has come more research on its effects, both positive and negative. And the news is far from all good. For some time now there has been evidence suggesting that marijuana use can cause or exacerbate psychosis, especially among adolescents and young adults whose brains are still developing. Very recently, a study found that because marijuana plants are especially good at absorbing a variety of heavy metals from the soil, regular pot users often have elevated levels of cadmium and lead in their blood and urine. And a recent “umbrella study” covering thousands of studies on the medicinal use of marijuana concluded that while marijuana can provide some moderate pain relief and can reduce seizures in some people with epilepsy, “evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine but not without adverse events.”

And that brings us to this weekend’s read, a study on “cannabis use disorder” (CUD), which is defined as “an inability to quit cannabis use, continuous use despite harmful consequences, or functional impairment.” It’s helpful to think of this as the equivalent of alcoholism but for marijuana, while recognizing that the chemical and biological causes and effects differ and don’t quite align between alcohol and cannabis. The standard diagnostic guide that health care professionals use lists 11 common symptoms of cannabis use disorder: increased tolerance (i.e., you need a higher dosage to feel the effects); uncontrolled escalation of use; cravings; withdrawal; hazardous situations; failed attempts to cut down; continued use despite consequences; excess time spent; interferences with role obligations; interpersonal problems; and giving up other activities in order to consume it. Some cannabis consumers experience none of these symptoms; some experience several. Experiencing 2–3 symptoms is considered “mild” CUD, while 4–5 symptoms is “moderate” and 6 or more is “severe.”

This study is particularly noteworthy for us because it was conducted entirely in the State of Washington, using 2019 data from Kaiser Permanente on its base of patients. This isn’t research on some other group of people elsewhere in the country or world; it’s research on us, right here. Washington allows for both medicinal and recreational use of cannabis products, so the state provides an opportunity to see how cannabis use disorder affects those consuming solely for medicinal purposes, those using it recreationally, and those doing both.

Those using cannabis solely for medicinal purposes were least affected by CUD: only one-quarter of them showed any of the 11 symptoms of CUD, about 13% showed two or more, and just 1.3% were categorized as having moderate or severe CUD. For those using cannabis recreationally, the statistics were much higher: 36% showed one or more symptoms, 22% had two or more, and 7.2% qualified as having moderate or severe CUD. But the numbers are even scarier for the group using cannabis for both purposes: just over half of them showed one or more symptoms, one-quarter had two or more, and 7.5% had moderate or severe cases.

The five most common symptoms for recreational users were uncontrolled escalation of use (almost 25% of users), cravings (about 19%), tolerance (13%), withdrawal (9%), and hazardous situations (almost 7%). All of those percentages are even higher for those consuming cannabis for both recreational and medicinal use.

The report provides additional information on differences in how these three groups consume cannabis products; for instance, the medicinal users tend to eat food items that contain THC (the main psychoactive ingredient in cannabis) or apply lotions that contain it and other cannabis-related chemicals. In contrast, recreational-only users mainly eat, smoke, and vape.

Here in Washington, more than one-quarter of adults report cannabis use in the prior year. Finding this level of CUD among the consumers of pot-related products in a state where it is so widely consumed means CUD isn’t just a health issue for specific individuals; rather, it’s a major public health issue hiding in plain sight. If the occurrence of CUD among cannabis users in this study generalizes to the entire state’s adult population, then there are nearly 350,000 Washingtonians with cannabis use disorder.

However, don’t expect the state government to rush in to try to get it under control, because pot has become a major cash cow here. Last year alone, the State of Washington brought in over half a billion dollars in tax and licensing revenues from cannabis-related businesses. While much of that revenue base is invested back into basic health care, little of it goes toward addressing the negative health impacts of cannabis consumption, including CUD. That’s not surprising, since those negative impacts are still not generally recognized: Most people believe pot is harmless.

Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use is Legal

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📸 Featured image by Michael Buffalo/Shutterstock.com.

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