Marijuana in Mass. should come with warnings about psychosis, group says
As Massachusetts continues to open marijuana stores, the government should do more to mitigate health risks associated with increased availability of the drug, a group of public health advocates said Wednesday.
Speaking at an event held by the Massachusetts Prevention Alliance, a nonprofit that opposed legalization, researchers and advocates suggested a number of policy changes, including requiring product labels that warn of marijuana’s potential to increase consumers’ risk for severe mental illness; restricting cannabis companies from advertising on billboards and in other ways; and increasing public awareness about marijuana’s risks.
“We need to contain the damage,” said Dr. Eden Evins, director of Massachusetts General Hospital’s Center for Addiction Medicine and a professor of psychiatry at Harvard Medical School. Cannabis use, she said, “is one of the few preventable causes of psychosis.”
The event at the John F. Kennedy Presidential Library and Museum included former New York Times reporter Alex Berenson, whose book, “Tell Your Children,” warns that marijuana leads to psychosis and violence.
Berenson praised Canada’s labeling requirements for cannabis products that warn of an increased risk for psychosis and schizophrenia.
“We’re not at 100 percent certainty, but we’re pretty close,” Berenson said. “We should be telling people this and we should be telling them loudly.”
Massachusetts’ labels warn against intoxicated driving and pregnant women consuming the drug, and note that “there may be associated health risks.”
Dr. Nora Volkow, director of the National Institute on Drug Abuse, said it’s hard to combat the public perception that marijuana is harmless because its consequences are less visible.
“Yes, tobacco is more harmful for cancer, but marijuana is more harmful as it disrupts who you are as a person,” she said. “We have 480,000 people dying from tobacco and none have died from marijuana, but it’s a distorted argument because marijuana harms your humanity, your brain.”
Will Jones, with the national antilegalization group Smart Approaches to Marijuana, said the government should do more to protect black neighborhoods, which are already targeted by tobacco and alcohol advertising.
“We can create a better future than replicating what we’ve done with alcohol,” said Jones, who is black and lives in Washington, D.C. “Advertisements and promotion of a new addiction-for-profit industry — that is another extreme that will disproportionately impact our communities.”
The Massachusetts Prevention Alliance released a statement last week signed by 40 doctors and researchers who called for the state’s cannabis regulations to focus more on public health. In response, regulators noted that the state was already doing a lot of the requested actions — such as launching public awareness campaigns and banning cartoon imagery that could appeal to youths — and said the statement badly mischaracterized the state’s social equity program.
The nonprofit has also drawn fire from marijuana advocates who say it doesn’t seriously engage in policy-making.
“This group was nowhere to be found when we wrote the adult use” regulations, Massachusetts Cannabis Control Commissioner Shaleen Title tweeted this week.
Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital who specializes in cannabis and teaches at Harvard Medical School, criticized the event as one-sided. The participants’ arguments, he said, overstated the harms of cannabis and ignored the benefits patients have found in treating pain, insomnia, and other life-altering conditions.
The group’s stance “is not representative of what doctors think,” Grinspoon said. “This is in the realm of drug war ideology — not the realm of science-based discussion.”
Berenson’s book has made him a controversial figure in the marijuana debate. Critics say he exaggerates the harms of cannabis, which muddies efforts to educate the public.
Scientists widely accept that marijuana use is correlated with chronic mental illness, specifically schizophrenia, but they disagree about causality.
Berenson’s assertion was based in part on a National Academies of Sciences, Engineering, and Medicine study in 2017 that found that “cannabis use is likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.”
One of the study authors, however, rebutted Berenson’s characterization on Twitter in January, saying that her team only “found an association between cannabis use and schizophrenia.”
“Since the report, we now know that genetic risk for schizophrenia predicts cannabis use, shedding some light on the potential direction of the association between cannabis use and schizophrenia,” wrote Ziva Cooper, director of the Cannabis Research Initiative at the University of California Los Angeles.
In a study published in March in Lancet Psychiatry, researchers examining 17 sites across Europe found that daily cannabis use and high-potency cannabis use were correlated with psychosis. While just 7 percent of the control group of healthy people used cannabis daily, 30 percent of people experiencing first-time psychosis did. The authors acknowledged they established correlation, not causation, but said the findings were significant for public health.
Dr. David Nathan, founder of Doctors for Cannabis Regulation and a psychiatrist in Princeton, N.J., said that people with family or personal histories of psychotic disorders should stay away from cannabis, but the vast majority of consumers don’t experience such issues.
“What we cannot say is whether cannabis will cause psychosis in individuals who are not otherwise predisposed to it,” Nathan said. “The problem with Berenson’s book is that he goes far beyond what the evidence tells us.”
Berenson said the torrent of criticism has been baffling.
“My book has been criticized as racist, alarmist, confusing correlation and causation, and cherrypicking,” Berenson said. “To me these aren’t just lies, they’re stunningly stupid lies.”