The Wall Street Journal tells us today that more potent strains of marijuana are producing increased diagnosis of psychosis in teenage cannabis users:
Rates of diagnoses for cannabis-induced disorders were more than 50% higher at the end of November than in 2019, healthcare-analytics company Truveta said this week. The trend is contributing to the broader burden of caring for people who developed mental health and addiction problems during the pandemic.
....The average THC content of cannabis seized by the Drug Enforcement Administration was 15% in 2021, up from 4% in 1995. Many products advertise THC concentrations of up to 90%.
That sounds bad! But there are a couple of odd things. First, this data is for 2019-23 but the potency of cannabis hasn't changed much over that time period. All the increase came before 2019. Second, we've switched from "psychosis" to "cannabis-induced disorder." Third, there's no mention of teens here. Fourth, why no chart showing the actual data?
Truveta doesn't make this easy to find, but they do have a preprint article on their site with a nice chart. Here it is:
Hmmm. This shows cannabis ER visits as a share of all ER visits. That's a bit of an odd statistic. More to the point, though, it shows a sudden 75% increase over the space of two months at the start of the pandemic and then nothing since then.
There's obviously something weird going on here. A 75% increase in two months is not remotely credible. It has to be a statistical artifact of some kind, probably related to COVID since it happened precisely in March-April of 2020.
On the other hand, the rate has stayed high since then, compared to a steadily lower rate in 2019. So maybe it's real.
Bottom line: Something doesn't quite add up here. It's also worth noting that the raw rate of ER visits is minuscule: currently around 6 per 10,000 ER visits for all ages, or 0.06%. There's not a lot of this going on regardless of how you measure it. I'd take it all with a grain of salt for the time being.
i could really do with a nice year-long psychosis to get me through 2024
I've read that when a user gets to the point of an ED visit it's after a period without sleep or poor sleep. Enough so that behavior becomes bizarre and psychotic. There's usually pills thrown in as well as an exacerbating factor.
The WSJ is a Murdoch paper
This is all of it, 100%. Everything associated with Dems (pot legalization) is terrible, the world is getting worse, blame Biden!
Nothing? No. Just looking with MkI eyeball shows the local peaks have gotten higher and the local troughs have as well. I think a trendline starting Jan 2020 is in order.
True, but that isn't going to be the 75% increase the article claimed.
The text Kevin quoted claimed a rate was 50% higher. And insofar as the chart shows a “rate” around 4% of visits in 2019, and around 6% in 2023 that is accurate. Now, that “rate” is fraction of ER visits and so we want to know what happened with overall ER visits over time. For all we know, however unlikely, there has been a decline in ER visits overall, but a smaller decline on those involving “cannabis-induced disorder”
But that 50% jump is obviously an artefact of the big jump in spring 2020. Eyeballing a trendline from then would go from 5.75% to 6%.
Guessing:
Given the absolute number of “cannabis-induced” ER visits is small, might be an artifact of changes in the way medical claims are coded (ICD-10 codes) or reimbursed?…
Or maybe something *has* changed… a bunch of new, inexperienced marijuana users, changes in age of users, new trends in ingesting it (edibles are much more likely to cause overdose-like problems than smoking it)…
or maybe some producers have been slipping in some adulteration, cus it’s cheaper or more addicting or whatever. Like fentanyl slipping into meth, ketamine and MDMA, pot producers could be spraying on some “synthetic” marijuana chemicals, like the K2/Spice/bath salts of old.
many moons ago pcp made its rounds as a kicker; one of those 'abyss stares back' situations
I suspect 2020 doesn't represent just the pandemic - it also represents legalization in a raft of states.
When you put together a) people who didn't use (or use much) while it was illegal, b) being locked down at home, and c) new availability of delivery edibles, some of which are absolutely delicious, you get a recipe for people who ate too much delicious cookie/gummie/soda, got too high, and because they have no idea what that feels like or what to do (sleep, mostly) they go to an emergency room because they're panicking.
I think this is a good point. Plus, if you're using with other people around, you have a lot of people who can monitor how much you're using or talk you down when you start feeling paranoid. Using alone, at home, with no in-person contact with anyone? You panic more, have no outside perspective, and you're more likely to feel you need professional help.
There is pretty robust evidence weed is bad for developing brains. Ideally I'd say medical use only until 25 then fine.
There is weak evidence that weed is bad for developing brains. That's because it's not ethically possible to do proper double blind studies with a placebo group and an active drug group, so simple surveys are relied on. There have not been many such surveys and the evidence they have produced tends to show small effects.
The entire graph that Kevin shows is noisy - the jump in 2020 is the biggest but not really different from other changes. The total number of cases is about 80k/year, so I would expect a smoother trend. The result might be extrapolated from a sampling of a limited number of ERs, not really a national total.
There's a seasonality to that chart. Dip starts in fall and peak hits late spring/early summer.
I think if you average it out annually, there hasn't been much change since 2020.
I first read the headline as “cannibals”. The story would have been more fun if that was the case.
Your brain is still stuck in the True Crime post.
Forever the "pot is stronger now zOMG!" Look, if you drink beer, when you get a bottle of gin do you also drink 16 ounces of it? No, you stop drinking sooner. This is no different. This has been a canard since, what, the 90s?
I think I'd agree with the talk about the problems of edibles above, they are very hit and miss and it's easier to get too much that way compared to smoking it. And also, there's a number of people new to the whole thing in the first place, there's bound to be some newbies who overdo it.
Humanity's been smoking this stuff for thousands of years, we'll too adjust and be fine.
In my experience many of these are new users ingesting gummies. These are people who have never experienced the effects of THC. Also, gummies are absorbed through the digestive tract slowly over hours, unlike vaping or smoking, so the effect lingers and gives people more time to think.
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People go to the ED related to cannabis for 2 reasons.
1. Cannabis hyperemesis syndrome. They're vomiting and it's awful, and they don't stop because cannabis is supposed to help with nausea or whatever. Even though for some people, it causes it.
2. "Overdose", typically from an edible, since smoking too much is just going to cause couchlock and sleep.
In both cases, these people are discharged because there isn't an emergency.
Because cannabis, by itself, is not toxic.
More people come to the ED for hurt tum-tums x 2 hours after drinking all night and eating garbage than come to the ED for cannabis, but I guess the WSJ isn't attempting to stop the legalization of alcohol.
Talk about cannabis-induced psychosis always ignores a huge natural experiment that's just sitting there in plain sight. The high school graduating class of 1967 reached age 18 with (to a decent first approximation) no lifetime cannabis use at all. 11-12 years later, the classes of '78 & '79 were the pot-smokingest batch of teens ever, at 50% prevalence of lifetime use.
Meanwhile the incidence of schizophrenia in both cohorts stayed rock steady at about 2%.
Aloha, medical doctor here…
If a kid gets psychotic on weed, they should never use it again, at least not until they are much older….
Individuals who have had an episode of cannabis-induced psychosis may be at particularly high risk for developing schizophrenia.
As examples:
•A systematic review and meta-analysis of six studies involving 3040 participants with cannabis-induced psychosis found a transition rate to schizophrenia of 34 percent (95% CI 25-46 percent) [190].
•A Danish national registry study followed 1492 individuals with a diagnosis of cannabis-induced psychosis for up to 20 years [191]. Forty-one percent (95% CI 36.6-46.2) of these individuals converted to a diagnosis of schizophrenia, with 50 percent of men converting within 2 years and 50 percent of women within 4.4 years. The hazard ratio for conversion to schizophrenia, compared with matched comparison subjects without a history of substance-induced psychosis, was 101.7 (95% CI 74.1-139.7).