In Maine, a pediatrician sees teenagers so dependent on cannabis that they use it virtually all day, every day — “an incredibly scary amount,” she said.
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Across the United States, psychiatrists have been treating an increasing number of people whose cannabis use has caused them delusions, paranoia and other symptoms of psychosis.
And in hospital emergency departments, doctors encounter patients with severe drug-induced vomiting —a potentially devastating condition that was once rare, but is now, they say, common.
Tens of millions of Americans use the drug for medical or recreational purposes—most of them without problems. But as more people use more potent and more frequent cannabis, a growing number, mostly chronic users, is suffering serious health consequences. And gaps in state regulations, limited public health messaging, and federal restrictions on research have left many consumers, government officials, and even doctors in the dark about these results.
Many users believe that people cannot become addicted to cannabis. But about 18 million people—nearly a third of all consumers over age 18 in the U.S.—have reported symptoms of cannabis use disorders, according to estimates from a data analysis conducted for The New York Times by a public health researcher at Columbia University in New York. That would mean that they continue using the drug despite the significant negative effects on their lives. About 3 million of them are considered addicts.
The estimates are based on responses to the 2022 US national drug use survey. The results are particularly striking among young people ages 18 to 25: more than 4.5 million use the drug daily or almost daily, and 81 percent of those users meet the criteria for the disorder.
Marijuana is known to calm nausea. But for some users it has the opposite effect.
Jennifer Macaluso, a hairstylist in Elgin, Illinois, turned to the drug at age 40 when a doctor suggested it to relieve her severe migraines. He started using it in 2019 and it worked.
But after several months, had episodes of nausea and vomiting so debilitating that he had to stop working. About a dozen doctors misdiagnosed the problem. One removed her gallbladder, another removed her breast implants. Several blamed the menopause.
Finally a doctor correctly confirmed Macaluso’s diagnosis: Cannabinoid hyperemesis syndrome, or CHS, a condition caused by excessive cannabis use and characterized by nausea, vomiting, and pain. It can cause extreme dehydration, seizures, kidney failure, and cardiac arrest. In rare cases, it has caused deaths — at least eight in the US.
Since the syndrome was first documented in 2004, doctors have seen a sharp increase in cases. Because it is not recorded consistently, it is almost impossible to track the condition accurately. But researchers have estimated that up to a third of those who use cannabis almost daily in the US may experience symptoms, sometimes severe.
Doctors and researchers recognize that marijuana can offer substantial health benefits for certain patients. The majority was in favor of the legalization of the drug. But many were concerned about significant gaps in knowledge of its effects, commercial market regulation and disclosure of risks.
The United States began legalizing marijuana almost 30 years ago, initially for medical use. But cannabis remains illegal under federal law, which has hampered oversight and scientific studies.
And States have implemented inconsistent standards and regulations. Only two states limit levels of THC, the intoxicating component of the plant.
“Until we do research on dramatically transformed cannabis in all its forms, I think putting it under the umbrella of a safe, legal drug is a mistake,” said Yasmin Hurd, a neuroscientist at Mount Sinai Hospital in New York. “It is misleading at best and dangerous at worst.”
Many doctors have seen an increasing number of patients with temporary cannabis-induced psychosis—lasting hours, days, or even months. While it is more common among younger users, it can affect people of all ages, whether regular or first-time users, and with or without a family history or other risk factors for psychosis.
Doctors have also seen an increase in chronic psychotic disorders, such as schizophrenia, in which they believe cannabis was a contributing factor. Marijuana use can affect brain development, particularly during the critical period of adolescence through age 25. This is also the period in which psychotic disorders usually emerge, and there is increasing evidence linking the two.
Recent studies show that the more potent the cannabis, the more frequent its use and the younger the age of consumption, the greater the risk.
A study conducted at 11 sites in Europe found that people who regularly used marijuana with at least 10 percent THC were almost five times more likely to develop a psychotic disorder than those who never used it. A study in Canada found that the risk of developing one was 11 times higher for teenage users than for non-users. And researchers estimated that up to 30 percent of schizophrenia cases among men in Denmark aged 21 to 30 could be attributed to cannabis use disorder.
Javonte Hill, 33, had been diagnosed with post-traumatic stress disorder, anxiety and depression before leaving the US Navy. His girlfriend, Eva Zamora, 26, used marijuana occasionally and told him it was a good way to relax. Last year, Hill took a hit on a cannabis flower pipe from a Denver, Colorado, dispensary.
He quickly became overcome with fear, paranoia and hallucinations. About an hour into the episode, when the couple’s two dogs began fighting, he grabbed his gun and began shooting, wounding Zamora and killing one of the pets.
“It was like reality dissolved in front of me,” Hill said. “I was seeing depictions of the devil in hell and demons.” He was diagnosed with drug-induced hallucinations and is on probation after pleading guilty to assault and animal cruelty.
Nathanael Katz, 21, started using marijuana at age 12, when a cousin handed him a churro. At 13, I was using all day, every day. For a while, he liked how it relieved his anxiety. But as his tolerance grew and his use increased, he began to feel more anxious. I couldn’t sleep or eat without cannabis.
“That’s how I knew it was a problem, because I was like, ‘I don’t like how it makes me feel,’ but I still did it constantly,” Katz said. Eventually he also used opioids and ended up in rehab. He has now been sober for more than a year and mentors teenagers looking to quit drugs.
Quitting marijuana can be difficult. People with CHS tend to experience the most difficulties, including physical pain similar to withdrawal from stronger drugs, but others also struggle to eat, sleep, and function. People who have turned to the drug to help relieve anxiety or depression find that those problems initially worsen without cannabis.
Macaluso, the Illinois hairstylist, said that if she had known the drug could cause so much suffering, she would not have continued using it after her symptoms began.
“People need to know,” he said. “You just have to warn them about it.”
“There is a difference between legalizing the original cannabis… and the products that exist today.”
Yasmin Hurd
neuroscientist who said the medical field has fallen behind in its understanding of the drug.
“Why don’t doctors know more about her? Why didn’t anyone mention it to me?
Jennifer Macaluso
suffered terrible health effects from using cannabis for migraines.
“At first, the herb relieved anxiety, but then it caused anxiety.”
Nathanael Katz
He started using cannabis at age 12, when a cousin gave him a churro at a family gathering.
“It was out of reality. “It was hell.”
Javonte Hill
He took a hit of a cannabis flower pipe and within minutes he found himself seized by fear, paranoia and hallucinations.
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