Trevor Hughes, Stephanie Innes and Jayne O'Donnell, USA TODAY
NETWORK December 15, 2019
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
co-workers 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 other family members states away to
converge at the young man’s side.
They
found a shell of the once-star baseball player. For months, he’d 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 taught
at Yale and Brown universities and held senior posts for state substance
abuse agencies before joining HHS under the Obama administration as the
Substance Abuse and Mental Health Administration chief medical officer.
She pointed out
that hospitalizations more than doubled for serious mental health disorders
among 18- to 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.
The
data on cannabis-induced psychosis, she said, demands the government both
speak out and manage fears. 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.”
McIntosh's
problems started when his time at Scottsdale Community College ended without
being drafted or recruited by a four-year school.
Mourning
the loss of a 16-year baseball career, the 20-year-old started vaping THC to
feel better. It didn’t work. A report released in October that analyzed 83 studies
found marijuana is not effective for the treatment of depression or other
mental illnesses. Many physicians say it increases the risk and severity of
depression and thus the chances of suicide.
In the
weeks leading up to McIntosh’s hospitalization, his brother and roommate,
Morgan, grew worried and called their father. McIntosh was staying up all
night, he reported, and at 6 a.m. was still awake "doing weird things.”
McIntosh
doesn't remember that time, but the day in March at the driving range is clear.
He felt "out of it, delusional" and thought people were
following him. "I was pretty scared," he said. "I didn’t
know where I was at."
When
Rob McIntosh and his wife, Marie, Madison's stepmother, arrived at 3 a.m. from
his home in Nevada, he said his son seemed “possessed.”
“He was
seeing double rainbows and insisting, 'I’m good, Dad.' It was lunacy," he
said.
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."
'Think this through'
In May,
more than 40 Massachusetts doctors, psychiatrists, pediatricians and other
public health professionals urged the state to add psychiatric risk warnings to marijuana packaging and
to prohibit most advertising.
The
group cited research in The Lancet that found the use of high-THC marijuana increased risk
of first-time psychosis by 50% in Amsterdam.
Members said the more potent a drug, the higher the risk.
“Just
as not all tobacco use causes cancer, not all marijuana/THC use causes the
negative effects; however, the risk is substantial enough to require
policies which discourage use,” the group's report said.
The
state's Cannabis Control Commission rejected most of the health professionals’
recommendations.
"People
say, 'This is only THC, and THC is harmless.’ That’s the assumption we all have
to question," said Sharon Levy, a group member and pediatrician who heads
the Adolescent Substance Use and Addiction Program at Boston Children's
Hospital. "I don’t think it’s harmless at all."
She
noted growers look to use the highest THC strains and companies make even
higher-concentrated products, including gummy bears, oils and waxes, some
with up to 90% THC.
“This
is a business-driven framework, not a public health one,” Levy said. “There are
very serious questions on this front.”
The
psychotic side effects of marijuana are used to bolster arguments on both
sides of the legalization debate. They find common ground in the need for more
testing and studies.
Because
marijuana remains a Schedule 1 controlled substance, the federal government
strictly limits who can conduct research. Though Canada and Israel permit far
more research access, approvals to study marijuana's benefits can take years in
the USA where government-grown marijuana is tightly controlled.
Tests
by marijuana legalization advocates found the federal government's testing
supply can be 10%-15% weaker than cannabis sold in state-licensed dispensaries.
In the past 20 years, average pot potency has tripled, from 4% THC in 1995 to
12% in 2014, according to federal testing.
It’s
possible to buy a marijuana flower that’s more than 35% THC. Concentrates like
those vaped by McIntosh can contain up to 90% THC.
Jim
Carroll, director of the White House Office of National Drug Control Policy,
said he talks to the Drug Enforcement Administration daily
and pushes the agency and the FDA to "open up research" and
make it possible for those who want to study medical uses of marijuana to
obtain the type they want to study. The DEA announced plans to register more qualified marijuana
growers for the research program, but Carroll told the USA TODAY editorial
board this month legislation might be needed.
More
research and stricter regulation would improve both the quality and the
fact-based promotion of cannabis, said Scott Krakower, the assistant unit chief
of psychiatry at Zucker Hillside Hospital in Queens, New York. The information
would help legislators better determine if the benefits of legalization
outweigh the risks.
He said
many marijuana users are familiar with the possibility that smoking cannabis
can cause paranoia, and paranoia is a textbook definition of an episode of
psychosis, along with hallucinations and a distorted sense of reality.
"I
think the biggest problem is that people think THC is a panacea cure for
conditions, and they use an exorbitant amount of it" despite a lack of
research to back that up, Krakower said.
Tvert
acknowledged cannabis use comes with risks, which is in part why his
legalization efforts focused on regulating marijuana like alcohol. It requires
a delicate balance.
“We do
need these potential harms conveyed, but we need them conveyed in a way that is
credible and based on evidence,” he said.
McCance-Katz
isn't taking a public stand on whether more states should legalize marijuana
for medical or recreational uses, although her skepticism is apparent when she
puts quotes around the word "medical" as it applies to
marijuana.
"It’s
really important the government be responsible and say, ‘You need to know
this and think this through before you decide to use.'" she said.
"That’s all we want."
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This
article originally appeared on USA TODAY NETWORK: Weed and psychosis: Does high THC lead to suicide, schizophrenia?
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