When a person does something extreme like, oh, I don’t know, try and assassinate a former president, the question invariably arises, what was he on? The “drugs made them do it” hypothesis is over 100 years old. In the 1900’s it was claimed that marijuana caused Mexicans to become bloodthirsty killers. In the 1930’s the trope was that marijuana made people go insane. In the 1960’s, it was said that LSD made people jump out of windows and lose their sanity forever. I am sure many of you remember the “face eating bath salts scare” of 2012.
Our society is keen on using drugs as a scapegoat for unhinged mental health. But, in the race to explain why people commit outrageous acts, we often discard the difference between correlation and causation. This is complicated by the fact that substance use and mental health ARE related, just not in the way the media and others portray them. With the rise in both cannabis access and consumption, let’s explore this relationship and what it means in the era of cannabis capitalism.
Confusing correlation and causation is one of the most commonly committed logical fallacies and the media is one of the biggest contributors. For them, saying one thing “causes” another is more attention getting that saying two things “may possibly be related”. After all, when A causes B, we can say with assurance that there is no other reason for B to happen other than A. As human beings, we are comforted by this kind of certainty. If we KNOW that B is caused by A, all we have to do is avoid A and B will not happen. When it comes to substance use and mental health issues, that is akin to saying, all you have to do to prevent mental health issues is not use drugs. We like this idea because most people do not use drugs (save for alcohol) and the drugs that are often included in the A category are drugs that very few people use. So, we like causation because it sets up a direct line between behaviors and gives us a sense of control. We DON’T like correlation because it says A “may” cause B, but so may C, D and E. And, A may only be “related” to B, which leaves a lot of questions about what else may be related to B that we don’t yet know about. Indeed, it is much tidier to simply tie A to B and call it a day.
One of the criteria for causation is that A happens before B. In order to say that banging your knee on a table causes swelling, banging your knee has to happen before the swelling. This may seem obvious, but when it comes to mental health and cannabis, things can get fuzzy. The average age of initiation of cannabis is 19, although the range can be 15-24. Trying cannabis at a younger age is associated with a higher likelihood of hazardous use and other mental health vulnerabilities later on. In terms of mental health issues, 50% of those with mental health issues first started experiencing symptoms by age 14, and 75% by age 24. The developmental overlap of cannabis initiation and mental health symptoms makes it extremely difficult to know which came first. If someone is experiencing early mental health issues as an adolescent, it is entirely probable that they would use cannabis to self medicate. In order to say that cannabis “causes” mental health issues, we would have to be certain that cannabis use comes first. We cannot.
We may not be able to establish that cannabis CAUSES mental health issues, but that does not mean there is not an association between the two. Cannabinoids impact the brain because we have endocannabinoid receptors there. And there are developmental implications for introducing phytocannabinoids into the brain at certain stages of life. In adolescence, it might hinder certain aspects of brain development. In later life, it may act as a protectant against certain neurodegenerative processes. However, going back to the chicken and egg discussion, adolescents who use cannabis heavily and experience developmental issues may not be illustrating “A causes B” because a second condition to prove causation is that there are no factors other than A that explain B. When an adolescent is using cannabis heavily and later on experiences mental health or developmental issues, there may be other factors related to both the cannabis use and the mental health outcomes. Genetics, family and social relationships and other environmental factors may be at play. Basically, it could be a cluster of associated conditions, rather than a straight line.
So, what does this all mean in the era of cannabis capitalism? Cannabis legalization has resulted in several changes to the consumption landscape. First, more adults are consuming cannabis. Notice I said “adults”. That is because, even though cannabis is legal in many places, adolescent use has not increased, but use among adults has. Secondly, cannabis is more accessible. Dispensaries are becoming more accepted as legal forms of retail, and most consumers in legal states have several options near them of where to shop, nevermind the prolific hemp market that is nationally available. This new retail environment has also resulted in a wide variety of products to choose from. While smoking used to be, and still is, the most common way to consume cannabis, newer consumers are flocking to edibles and the rise of consumption methods like vape pens is creating novel ways to ingest large amounts of THC. These non-smoked methods of consumption also get around the barriers that smoking presents in terms of smell, smoke and the time taken to prepare the product for consumption. In the time it takes someone to prep and roll a joint, a person could consume 100mg of THC via edibles or beverages. Vape cartridges are usually upwards of 50% THC and can be used without the tell tale smells of smoking herb. A final result of legalization is that the stigma around cannabis is lessening and social acceptance is increasing. This means that not only do more people feel comfortable trying cannabis, they are more likely to be offered it at a party or other social setting. All of this makes the act of consuming cannabis safer in several ways. People don’t have to worry about getting arrested. They have access to tested products with standardized doses. They don’t have to acquire cannabis from the illegal market. And they are not subject to as much judgment for using cannabis. But there is some reason for concern…
While 75% of mental health issues are realized before the age of 24, many people may have underlying mental health vulnerabilities that have never surfaced. Maybe there is a family history but the individual has never had symptoms. Or perhaps there was an issue earlier in life but treatment helped get the symptoms under control. Most people never know they have a mental health issue until it surfaces. Just like someone with a peanut allergy. If they never eat a peanut, they will never know if they have the allergy, even if it is there. In social work we like to say, genetics loads the gun and the environment pulls the trigger. Because of the way cannabis interacts with the brain, it has been reported to help with some mental health issues like PTSD, but, for others, it could be the trigger for mental health issues. With more people feeling comfortable about using cannabis, and products that offer higher potency with less work, it makes sense to handle this with care.
How do we reduce the chances of cannabis triggering mental health issues in people with underlying conditions or prior symptoms? Some suggest that we should ban high THC products, or raise the legal age of consumption to 25. Still others think that cannabis should go back to being illegal. But, bans and prohibition do not prevent consumption, they simply drive it underground and create illicit markets with products that may not be safe. Instead, I suggest the following:
We are in unprecedented times. Since cannabis was first used by humans thousands of years ago, this is the first time that cannabis has been as readily available in as many forms, for as many people. But, with great power comes great responsibility. If we want to maintain a long term, respectful relationship with the cannabis plant and the benefits she offers, we need to get past reefer madness, recognize the difference between causation and correlation, bring more nuanced language into the conversation, and be ready to support that cannabis is for anybody, but not for everybody.
