For 30 years, Dr. Libby Stuyt, a recently retired addiction psychiatrist in Pueblo, Colorado, treated patients with severe drug dependency. Typically, that meant alcohol, heroin, and methamphetamines. But about five years ago, she began to see something new.
“I started seeing people with the worst psychosis symptoms that I have ever seen,” she told me. “And the worst delusions I have ever seen.”
These cases were even more acute than what she’d seen from psychotic patients on meth. Some of the delusions were accompanied by “severe violence.” But these patients were coming up positive only for cannabis.
Stuyt wasn’t alone: Health care professionals throughout Colorado and all over the country were seeing similar episodes.
Ben Cort, who runs an addiction recovery center in Steamboat Springs, Colorado, watched a young man jump up on the table in the emergency department and strip naked, claiming he was the God of thunder and threatening to kill everyone in the room, including two police officers. A collegiate athlete Cort worked with also had a psychotic episode and was shot five times by the police with a beanbag gun before he was subdued. In Los Angeles County, Blue Stohr, a psychiatric social worker, had a patient who climbed a 700-foot crane and considered jumping off of it, not because he was suicidal but because he thought he was in a computer simulation, like The Matrix.
Those patients, too, were high only on cannabis.
In 2012, Colorado legalized marijuana. In the decade since, 18 other states have followed suit. As billions of dollars have flowed into the new above-ground industry of smokable, edible, and drinkable cannabis-based products, the drug has been transformed into something unrecognizable to anyone who grew up around marijuana pre-legalization. Addiction medicine doctors and relatives of addicts say it has become a hardcore drug, like cocaine or methamphetamines. Chronic use leads to the same outcomes commonly associated with those harder substances: overdose, psychosis, suicidality. And yet it’s been marketed as a kind of elixir and sold like candy for grown-ups.
“I got into addiction medicine because of the opioid crisis,” said Dr. Roneet Lev, an addiction medicine doctor in San Diego who hosts a podcast about drug abuse. Years ago, she advocated against the overprescription of opioid painkillers like OxyContin. Now, she believes she’s seeing the same thing all over again: the specious claims of medical benefits, the denial of adverse effects. “From Big Tobacco to Big Pharma to Big Marijuana—it’s the same people, and the same pattern.”
Prior to legalization, marijuana plants were bred to produce higher and higher concentrations of THC, a naturally occuring chemical compound in the plant that induces euphoria and alters users’ perceptions of reality. In the 1960s, the stuff the hippies were smoking was less than 2% THC. By the ’90s, it was closer to 5%. By 2015, it was over 20%. “It’s a freak plant that resembles nothing of what has existed in nature,” said Laura Stack, a public speaker who has advocated against the industry since her son, Johnny, killed himself three years ago at 19 years old after years of cannabis abuse drove him into psychosis.
In the era of legalized weed, the drug you think of as “cannabis” can hardly be called marijuana at all. The kinds of cannabis products that are sold online and at dispensaries contain no actual plant matter. They’re made by putting pulverized marijuana into a tube and running butane, propane, ethanol, or carbon dioxide through it, which separates the THC from the rest of the plant. The end product is a wax that can be 70% to 80% THC. That wax can then be put in a vacuum oven and further concentrated into oils that are as much as 95% or even 99% THC. Known as “dabs,” this is what people put in their vape pens, and in states like California and Colorado it’s totally legal and easily available to children. “There are no caps on potency,” said Stack.
If you’re over 30 years old and you used to smoke weed when you were a teenager, the strongest you were smoking was probably 20% THC. Today, teenagers are “dabbing” a product that’s three, four, or five times stronger, and are often doing so multiple times a day. At that level of potency, the impact of the drug on a user’s brain belongs to an entirely different category of risk than smoking a joint or taking a bong rip of even an intensively bred marijuana flower. It’s highly addictive, and over time, there’s a significant chance it can drive you insane.
If you’ve ever smoked a bowl and become irrationally anxious that everyone is staring at you and knows you’re high, what you experienced was a mild symptom of cannabis-induced psychosis. According to one study, about 40% of people react this way. If you experience that paranoia and keep smoking on a regular basis nonetheless—especially with today’s high-potency THC products, and especially if you’re young—there’s a good chance you’ll eventually suffer a full psychotic break; 35% of young people who experience psychotic symptoms, according to another study, eventually have such an episode. If you keep using after that, you run a decent risk of ending up permanently schizophrenic or bipolar. Cannabis has by far the highest conversion rate to schizophrenia of any substance—higher than meth, higher than opioids, higher than LSD. Two Danish studies, as well as a massive study from Finland, put your chances at close to 50%.
“One out of every 20 daily users can expect to develop schizophrenia if they don’t quit,” Dr. Christine Miller, an expert on psychotic disorders, told me.
But quitting THC products of that potency is “almost impossible,” Stuyt said, comparing its addictive power to tobacco. The days of marijuana addiction being merely “psychological” are over. “There is a definite withdrawal syndrome that includes irritability, anger, anxiety, massive cravings, can’t sleep, can’t eat,” said Stuyt.
And it’s even harder because so many users believe it’s good for them.
As a teenager, Kevin Bright suffered from depression and anxiety. He started smoking pot at around 15 years old to self-medicate. As his tolerance built up, he started using THC concentrates—the stuff made from those high-potency waxes and oils—which was legal and easily available in the Bay Area suburb where he grew up. His personality began to unravel, his father, Bart, told me. He was constantly irate. He attempted suicide several times—once by ingesting pills, once by trying to hang himself, and another time by driving his car into the Bay. Then he began developing full-blown delusions, imagining that the FBI was after him. When he called his parents, he would scream at them in gibberish. Eventually, at 29 years old, he put a plastic bag over his head and breathed nitrous oxide through a tube until he suffocated to death.
Kevin had a hardcore drug addiction, but in his imagination, he was just taking medicine—and a $13 billion industry was telling him he was right.
“The line about it being medicine—he bought that,” Bright said about his son. “I told people, what medicine do you get from a doctor that’s 100% always approved, that you can get within 10 to 15 minutes online, you can take as much as you want per year, you never have to come back to renew it?”
Since marijuana is still considered a Schedule I Controlled Substance by the federal government, there’s no such thing as a “prescription” for medical cannabis. Instead, you can get a “recommendation” from a physician.
“This doctor’s recommendation typically has no expiration, has no dose, has no duration, and no change across state lines,” Ben Cort said. “It’s basically, ‘Take as much as you want as often as you want until you feel what you want.’” (Colorado has tightened rules around medical cards, but only for 18- to 20-year-olds, in an effort to mitigate drug dealing in high schools.)
To get a recommendation, you can go to websites with names like “NuggMD” and get approved in less than 10 minutes. With that recommendation, you can acquire a state-licensed medical marijuana card. In states where recreational use of cannabis is legal, you don’t need a medical marijuana card to buy cannabis products, but the card exempts you from certain taxes—it’s basically a discount card for high-frequency users.
At a dispensary, there’s no distinction between cannabis products made to be consumed for fun and ones created for their supposed healing properties. “You walk into a store, it’s the exact same product,” Cort said. “If you have a med card, you pay less tax.”
The array of products on offer is dazzling. On WeedMaps.com, you can buy your cannabis in the form of a joint, flower, vape, concentrate (budder, crumble, or crystalline), cookie, brownie, corn nut, caramel corn, jalapeño cheese cracker, rice crispie bar, macaron, pretzel bite, cereal, tincture, syrup, seltzer, iced tea, herbal tea, tonic, apple juice, punch, mocktail, root beer, cream soda, lemonade, agua fresca, powder, gummy, mint, chocolate, gum, balm, salve, bath bomb, salt, oil, shower gel, or soap, and have it delivered to your doorstep.
These products are all sold as “medicine,” even though none of them is FDA-approved. (There are only four cannabis-based drugs that have received FDA authorization, all of which require prescriptions.) And although it’s illegal for anyone without a medical degree to offer medical advice, dispensary “budtenders” do it all the time. Their advice is completely evidence-free, because no evidence exists that the specific products they sell have any medicinal value.
“Drug companies are forever doing drug trials to see if this new drug helps or doesn’t help,” said Dr. Robin Murray, a psychiatric researcher at King’s College London who specializes in cannabis-induced schizophrenia. “Why would cannabis companies do this? They’re doing so well without the trials. The trial might show that it wasn’t helpful. So they’ve got no incentive to do these trials.”
“There is research out there supporting the use of cannabis for some medical conditions,” said Stuyt, “But it’s all less than 10% THC. Nothing has been studied greater than 10%. But we have all this research showing that greater than 10% puts you at risk for psychosis, addiction, suicide, cannabis hyperemesis syndrome [constant, severe vomiting]—all these things that high-potency THC is doing.”
“High-potency” describes almost all of the cannabis products sold in the United States today, the vast majority of which are over 15% THC.
Dr. David Smith, an addiction medicine doctor who founded the Haight Ashbury Free Clinic in 1967, is highly optimistic about the prospects of cannabis research for medical purposes, as well as the medical potential of psilocybin and other psychedelics. “There’s a lot of promise in cannabis medicine,” he told me. “But you’re not going to get that by vaping in a classroom.” The pantomime version of drug prescription that characterizes the cannabis market today “is not the way medicine’s supposed to be practiced,” he told me.
“It’s insulting to the medical profession,” said Dr. Lev. “They’ve hijacked the word ‘medical.’”
“This is not medicine,” said Stuyt. “This high-potency THC has not been studied as medicine. But because it’s allowed to be heavily marketed and advertised as medicine, people believe it’s safe. And so they believe it’s medicine. And when you take medicine for a chronic problem, you take it every day. Sometimes you take it all day long. And that makes you addicted to it. And so then you’re in constant withdrawal.”
To imagine the market potential for a legal, highly addictive drug, all you have to do is look at the colossal success of the industries that pioneered the addiction business: tobacco, alcohol, and pharmaceuticals. Today, all three are heavily invested in cannabis. In 2019, Altria, the parent company of Marlboro cigarettes, acquired 45% of Cronos, one of the world’s biggest cannabis companies. Constellation Brands, a major alcohol conglomerate, has billions invested in Canopy, another cannabis company. Last year, Jazz Pharmaceuticals acquired GW Pharmaceuticals, the company that makes one of the four FDA-approved, cannabis-derived drugs. Even a former CEO of Purdue Pharma, the company that made OxyContin, co-founded a medical marijuana company called Emblem after helping to create the modern opioid epidemic.
“People think it’s a miracle drug, that it’s nonaddictive, that it helps with cancer and anxiety,” said Jordan Davidson, who recovered from cannabis addiction and now works for Smart Approaches to Marijuana, which advocates against the expansion of the cannabis industry. “It’s more like Big Tobacco 2.0.”
The future of the industry that these investors are now betting on is focused on families like Aubree Adams’ in Pueblo, Colorado.
Aubree’s older son started using legal cannabis products in the eighth grade. By his freshman year in high school, he was addicted. He became psychotic: “Self-harming, violent behaviors, couldn’t even regulate any moods—crying obsessively, inconsolable, paranoid over things, thinking people were after us,” his mother recounted. He tried to kill his little brother several times. Once Aubree’s younger son had to run away from his brother barefoot in the snow. Aubree had to quit her job to stay home to protect him. Her older son attempted suicide. He started selling marijuana, and ended up on the streets. He got beat up. Someone threatened to shoot up the family’s house.
On one occasion, Aubree found herself trying to calm down her son as he frantically searched the house for the key to the lock on the family’s gun, believing people were coming after him. “There were many moments when I had to tell my younger son, ‘Get out of the house,’” Aubree said. “There were moments when I said, ‘Get the dog. Lock yourself in my bedroom.’”
When Aubree tried to get her son to stop he would say, “It’s medicine, Mom. You’re the only one not using it, Mom. Maybe you need to start using it, Mom. You’ll feel better. What you’re saying is a lie, Mom. It’s all propaganda, Mom.”
Even while watching all of this unfold, Aubree’s husband began secretly using cannabis as well, believing it would calm his anxiety. He went to a dispensary and complained about panic attacks. The budtender readily offered him spurious medical advice, recommending marijuana flowers that were 24% THC. Aubree’s husband began regularly consuming cannabis as his family was falling apart, and fell into a pattern of depression and suicidal ideation.
It’s a common pattern: People start consuming cannabis to fix their anxiety, but the withdrawal from the THC instigates anxiety instead of alleviating it. “People think, ‘Oh, it’s my symptoms. That’s why I need it. I’m anxious and it’s treating my anxiety,’” said Stuyt. “No: It’s the withdrawal that’s causing your anxiety.”
It’s a vicious cycle that’s great for business. At the root of the misconception is the myth that “cannabis” as it exists today is a safe, natural, medicinal substance. But if people thought of today’s high-potency THC products the way they think of hard drugs, far fewer people would fall under its influence—which is why it’s so important to the industry that they don’t.
“Everybody knows meth is bad,” Cort said. “There’s not a user who does not think meth is bad. You survey America, about 65% of them are going to tell you there’s nothing wrong with weed.”
And now those Americans are facing a tidal wave of corporate advertising telling them they’re right.
“This is a for-profit industry,” said Stuyt. “And they profit off of addiction.”