Pot, psychosis link real, doctors warn
Advocates argue government not credible
Early one morning in March, Madison McIntosh showed up on his day off at the Scottsdale, Arizona, driving range and restaurant where he worked. The 24-year-old sat in his car until the place opened, then wandered around all day, alternating between gibberish and talk of suicide as coworkers tried to keep him away from customers.
When he was still there 12 hours later, the manager contacted McIntosh’s father in Las Vegas, who called police and rallied family members states away to converge at the young man’s side.
They found a shell of the former star baseball player. For months, he had been vaping a potent form of THC, the ingredient in marijuana that makes people feel high, and staying up all night. He swung wildly between depression and euphoria.
The family rushed McIntosh to Banner Behavioral Health Hospital, where staff psychiatrist Divya Jot Singh diagnosed him with cannabis use disorder and a “psychotic disorder unspecified.”
Singh expects to make McIntosh’s diagnosis official soon. If he remains off pot and symptom-free a year after the episode, the psychiatrist can say with certainty he suffered from “cannabis induced psychosis.”
“What shocked me is that I had never heard of it,” said McIntosh’s dad, Rob. “All you hear is all these proponents of legalization of pot without thought to the risks and the consequences.”
A number of physicians and parents are pushing back against the long-held assertion of users and advocates that marijuana is a safe, benign and even beneficial drug.
Those sounding the alarm include the nation’s “mental health czar,” as well as doctors in Colorado, California and Massachusetts where marijuana is legal for recreational use. They say the facts are irrefutable: Excessive use of high THC pot and concentrated oil is linked to psychotic episodes that in some cases develop into full-blown schizophrenia.
There is great disagreement over the strength of the science linking pot and psychosis. Advocates on either side of the marijuana debate have different interpretations of the connection reported in a National Academies cannabis study in 2017 and other studies. In March, The Lancet, a British medical journal, reported a two to five times higher risk of psychotic disorders for daily consumers of high-THC marijuana compared with people who never used.
Arguments surround how much of the illness is preceded or worsened by the drug use, how often marijuana is used in response to it and whether the psychosis would have occurred anyway.
“At the end of the day, you can’t make a causal statement,” said Ziva Cooper, research director of the UCLA Cannabis Research Initiative and a member of the National Academies panel. “You need to have some biological premise to show that this kind of exposure causes psychotic disorder.”
The federal government and other health officials say the type of psychosis McIntosh experienced and other psychiatric disorders are clearly tied to the drug.
“It is time for Americans to understand there are substantial risks with marijuana,” said Elinore McCance-Katz, the Department of Health and Human Services’ top mental health official. “This is not the government making up data.”
‘Settled science’
McCance-Katz pointed out that hospitalizations more than doubled for serious mental health disorders among 18to 25-year-olds nationally from 2012 to 2018. She cited a study in July that shows a 77% increase in suicide deaths from 2010 to 2015 among Colorado 10- to 19-year-olds with marijuana in their systems.
Among people who use marijuana, 10% to 20% will develop a marijuana use disorder and “be at risk for these other kinds of mental and physical adverse events,” she said.
“That’s not the majority, that’s the minority of people who use marijuana, but here’s the problem: We don’t know who they are a priori (in advance),” McCance-Katz said. “We do not want to exaggerate the risks.”
Many marijuana users and industry officials say that’s precisely what the Trump administration is doing.
They pointed to other studies, including one by Columbia University professors in the journal Drug and Alcohol Dependence that showed cannabis use disorder dropped significantly across all ages reporting daily or almost daily cannabis use from 2002-2016.
Longtime marijuana legalization advocate Mason Tvert said millions of Americans are rightly skeptical about warnings of the dangers of cannabis use, given it’s the most widely used illicit substance in the country.
“When people claim that smoking a joint will lead to psychosis, many consumers are going to write that off, and as a result are going to write off other warnings,” said Tvert, who led Colorado’s first-in-the-nation cannabis legalization effort in 2012 and works for Denver-based VS Strategies.
Die-hard marijuana advocates strongly push back against news reports that suggest cannabis might have made someone sick, often criticizing such coverage as hearkening back to the days of “Reefer Madness,” the 1936 film that purported to show the drug’s dangers.
When Surgeon General Jerome Adams included the link between cannabis and psychosis in his advisory in August on marijuana’s effect on the “developing brain,” he was trashed and threatened on Twitter. Alex Berenson, a former New York Times business reporter who wrote the book “Tell Your Children: The Truth about Marijuana, Mental Illness and Violence,” was widely condemned for his warnings of the drug’s dangers.
Tvert said legalization advocates want research conducted without bias or political motivation. It’s an area, he said, where the federal government has little credibility.
“That’s what happened for decades,” he said. “The federal government spread misinformation and exaggerated the risks so much that people just started ignoring all the warnings.”
McCance-Katz said it was not a difficult decision at HHS to include the link between marijuana and psychosis in the surgeon general’s advisory.
“This has been settled science,” she said. “This is something that has been known for many years, yet there has been virtually no attention paid to it.”
‘Marijuana killed my soul’
Clay Whiting deals with a lot of parents and other family members at Scripps Mercy Health hospital in San Diego, where he is an emergency room physician. In the past month, he said, he’s had back-to-back ambulances carrying young people experiencing psychosis after trying marijuana for the first time.
Since the drug was legalized in California last year, Whiting said, “we see people every shift now” because of marijuana, including some experiencing violent vomiting known as hyperemesis. The incidents led to the term “scromiting,” to describe people screaming and vomiting at the same time. “Greater access means great trials by younger people,” Whiting said.
USA TODAY interviewed a dozen parents whose children suffered psychotic episodes – some of which led to schizophrenia – related to their marijuana use. Several of the children died by suicide.
Andrew Zorn of Phoenix was 14 when he started smoking marijuana daily in high school, said his mother, Sally Schindel. He was about 25 and working on his community college degree when he told his mother something was going on in his brain. He tried to read and study, but his mind seemed to disappear on him, she said.
Zorn was diagnosed with “severe cannabis use disorder,” bipolar disorder and borderline personality disorder with auditory hallucinations, paranoia and anxiety.
“In a roomful of people, in the midst of conversation, his eyes would just go somewhere else,” Schindel said. “He later realized it was marijuana use causing that, but from that time on, it just grew and grew to where he was more and more disabled.”
Zorn ended up taking his own life. In a suicide note, he wrote: “I want to die. My soul is already dead. Marijuana killed my soul + ruined my brain.”
After McIntosh was released from the hospital last spring, he said he stopped using marijuana “cold turkey.” He moved to Texas for a while and sold home security systems before returning to Arizona to do similar work in the Phoenix suburb of Mesa.
He’s no longer suicidal or tempted to use marijuana. “I know what I put myself through and my family through,” McIntosh said. “I want to help other people any way I can.”
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