The Colorado Springs teen was recognized at Rampart High School for his musical talent. Three years later, just shy of his 20th birthday, he is lost in a mental fog his mother and physicians say could have been induced by regular use of THC, the active ingredient of marijuana.
“Schizophrenia” is the formal diagnosis under which he has applied for Social Security disability insurance. “Chronic pain” is the medical condition for which the government of Colorado sanctions his use of the psychoactive drug — which he has refused to stop using despite pleas of his parents, doctors and some of the school friends who used to get high with him.
“The mental health professionals we’ve seen know what’s going on, but there aren’t enough hospital beds, treatment providers or long-term solutions here or anywhere in our country,” said the young man’s mother, who spoke with The Gazette’s Editorial Board. The Gazette agreed to protect her identity to avoid embarrassing her son or subjecting him to stigma.
“Colorado and the United States are not equipped for what is happening — and is going to happen — to our young adults,” she said. “More people have got to realize that these young adult brains can be pitched into psychosis with heavy use of marijuana and these high-concentration hash oils. We have got to put a stop to all of this political talk about ‘state experimentation’ and these claims that marijuana isn’t addictive. I was the same way. ‘It’s safer than alcohol,’ I said. ‘What’s the big deal?’ I said.
“Until this happened to my kid.”
Few things fire up marijuana advocates’ defensiveness faster than people sharing personal stories about their experiences with marijuana-induced psychosis — but the troubling mental condition is real and becoming an unavoidable topic in debates about the drug’s potential side effects.
Psychosis is a medical term describing psychotic disorders that move along a spectrum ranging from temporary delusion to a permanent break with reality, commonly known as schizophrenia.
Although the majority of THC users do not experience psychosis, the condition is becoming more common as use of the drug has increased and involved higher potency forms, including THC-infused foods and drinks, called edibles, and THC oil extracts, commonly known as “waxes” or “dabs.” Colorado hospitals are reporting more cases of psychosis in marijuana users. The numbers are still small compared with cases related to acute alcohol intoxication and abuse of prescription painkillers, but there is no centralized record-keeping, making it difficult to know the size and scope of the problem.
Physicians at Denver Health Medical Center and the University of Colorado School of Medicine recently reported in the American Journal of Psychiatry brief summaries about five patients diagnosed with psychosis after eating THC-infused edibles. The men and women, who ranged in age from 22 to 35 and sought treatment in July and August of 2014, reported they were daily marijuana smokers who had eaten more than 10 times the state’s average serving size of THC. That’s easy to do, given that producers of edibles typically include several average servings of the drug in units consumers normally would polish off in one setting, such as one brownie, one cookie, one candy bar or one bottle of soda.
Two of the patients sought help from the hospital’s emergency department after one day of experiencing bizarre behavior, while the others waited three or four days.
Doctors reported the patients, who had used no other drugs, presented with an array of problems, including paranoia, suicidal ideation, disorganized thinking, insomnia, depressed mood — and, in one case, a self-inflicted neck wound.
“I mutilated myself because friends wanted their energy back,” the 22-year-old male reportedly said of his injury.
The physicians also reported the patients returned to a normal mental state after one to two days of treatment, regimens that typically include the administration of anti-psychotic medications and abstinence from THC.
“Our hospital professionals have learned to ask specifically about cannabis, edibles and synthetic cannabis when interviewing patients, as patients no longer seem to associate these items with ‘drugs’ during an initial history taking,” the doctors wrote. “We advise that clinicians should be aware that edibles containing cannabis, because of pharmacokinetic differences (the timelines for drug absorption, distribution, metabolism and excretion), may be more likely to induce psychosis, which may outlast the period of intoxication.”
Cannabis, psychosis linked
Research of the connection between cannabis and psychosis has spanned decades and involved tens of thousands of people worldwide. Consistently, the relationship has been observed. After a committee of Colorado’s top experts reviewed the world body of medical literature and presented their findings last year, the Colorado Department of Public Health and the Environment also acknowledged the link: “We found substantial evidence for associations between marijuana use and memory impairments lasting at least seven days after last use, as well as the potential for acute psychotic symptoms immediately after use,” the department wrote in its report titled “Monitoring Health Concerns Related to Marijuana in Colorado: 2014.”
Experts do not question that THC users are at higher risk of experiencing psychosis. In some people, the drug appears to have triggered the problem, while in others it may be coincidental that the sufferer used the drug. Determining whether THC use has caused a mental break is made more difficult in part because marijuana users are more likely to use other drugs that can induce temporary psychosis. However, researchers also have found that marijuana is more strongly associated than any other recreational drug with the conversion from a temporary, drug-induced psychosis to schizophrenia.
While studies strongly link marijuana use and schizophrenia, scientists remain divided on the question of whether the drug causes the chronic illness in people who have genetic vulnerability and those who do not. However, the science is clear about some links between psychosis and THC:
• Exposure to the drug in adolescence predicts higher risk of psychosis, including schizophrenia. Yale University researchers reported last year “ … the risk is dose-related” — meaning the more marijuana people use before their 25th birthday, when the brain is fully developed, the greater their risk. That is consistent with a causal relationship.
• All THC users increase their risk of experiencing psychosis — especially users with underlying genetic vulnerabilities. Researchers have identified higher rates of psychosis in people with specific forms of one of two genes affecting the release of dopamine, which is one of the brain’s “feel-good” chemicals affecting important functions, such as behavior, motivation and reward. But “even if you don’t have those specific genes, there’s still a risk,” the National Institute on Drug Abuse notes on a website it produced for youth about cannabis and psychosis. “A psychotic event can even happen to pot smokers without these specific genes that put them at risk for long-term serious mental illness. Are you at risk? Right now, unless you’ve had your DNA tested for those specific genes, you don’t know. … ”
• People with established psychotic disorders who use THC tend to exacerbate their symptoms, trigger relapses and have an array of other negative consequences throughout the course of their illness.
In support of causation, research also has found that the risk of psychosis in cannabis users depends on the frequency of use and the potency of THC used. A study published in February in the prestigious medical journal Lancet Psychiatry examined nearly 800 people ages 18-65 in South London. Researchers at King’s College London found nearly a quarter of all new cases of psychosis were associated with use of marijuana with a THC concentration of at least 15 percent. (In Colorado, marijuana exceeding
25 percent THC is common, and dispensaries typically sell oil concentrates starting at 85 percent THC.) On average, daily use of any type of cannabis was associated with a threefold increase in risk for psychosis, the researchers reported. For daily users of high-potency cannabis, the increase in risk quintupled.
In Colorado, there are plenty of daily and near-daily marijuana users. Last year, state officials reported the top 22 percent of marijuana users — people defined as using the drug daily or near daily — drove
67 percent of demand.
“It is now well known that use of cannabis increases the risk of psychosis,” Robin Murray, a professor of psychiatric research and lead co-author of the study, said in a statement released by King’s College. “However, skeptics still claim that is not an important cause of schizophrenia-like psychosis. This paper suggests that we could prevent almost one quarter of cases of psychosis if no one smoked high potency cannabis.”
Murray was even more pointed in commentary he wrote in January for The Dana Foundation, a New York-based nonprofit that supports brain research: “Eventually, the sheer volume of data convinced European and Australian psychiatrists of a link (between cannabis use and schizophrenia). Cannabis is now generally accepted as a cause of schizophrenia, though less so in North America, where this topic has received little attention. Argument does continue over just how significant cannabis-associated psychosis is.”
Marijuana-legalization advocates typically argue only 1 percent of the U.S. population on average receives a diagnosis of schizophrenia and the rate of the disorder should have risen as marijuana use increased. But no one has been tracking the incidence of schizophrenia in the United States. It is not a disorder required to be reported to the Centers for Disease Control and Prevention. Even if it were, the nation would have to make significant changes in health data collection to capture accurate information.
“Nothing makes my blood boil more than people who insist on this unchanging 1 percent average — especially when no one is counting,” said Christine Miller, a Ph.D. neuroscientist in Baltimore who has researched the causes of psychosis and schizophrenia for more than 25 years, including a decade of work at Johns Hopkins University. “There is no disease known to man that remains constant, and schizophrenia is no exception. But to show any fluctuations now, while the marijuana-using population is still a small minority of the country, would require the best epidemiology in the world — and our country isn’t going to make that investment because big money is not to be had — nobody makes any money in this kind of work. Maybe if today’s highly potent THC products are eventually used by the majority of the population, we won’t need the epidemiology and will just get to live the science — which will mean a lost generation or two.”
Whether bouts of psychosis are permanent or fleeting, the damage a sufferer can exact on self and others can be irreparable.
Among the high-profile cases where marijuana use and psychotic symptoms have made recent headlines:
• Attorneys for Richard Kirk, 49, a Denver man expected to stand trial in December for the April 2014 shooting death of his wife after consuming THC-infused candy, are expected to argue that his actions were the result of involuntary intoxication. Three of the defense’s expert witnesses filed reports that, considered together, suggest THC triggered Kirk’s psychotic break.
• Levy Thamba, a 19-year-old
university student in Wyoming, jumped to his death in March 2014 from a hotel balcony in Denver shortly after consuming THC for the first time. The one lemon poppy seed cookie he ate contained
• 6.5 servings of the drug. According to a police report, Thamba had been “marijuana-naïve, with no known history of alcohol abuse, illicit drug use or mental illness.” Friends who witnessed his behavior said he was incoherent, speaking to inanimate objects, trying to remove things from walls and smashing furniture. The Denver coroner cited “marijuana intoxication” as a significant contributor to this death.
• In May, CBS4 in Denver reported on its investigation of the September 2012 death of 18-year-old Daniel Juarez. The Brighton teenager stabbed himself 20 times, piercing his heart, after smoking marijuana with friends. They reported to authorities that Juarez said he’d had “an epiphany” before running around wildly, stripping off most of his clothes before entering his nearby apartment, where he grabbed a knife.
Speaking up about THC-induced psychosis invites torrents of vicious reactions. Sally Schindel of Arizona refuses to be bullied into silence about the role marijuana played in her son’s death by suicide in March 2014. She is working with a few other women from around the country to build MomsStrong, to help parents with marijuana-addicted children who struggle with co-occurring mental health problems find information and support.
“We have been called liars and have been told we suffer from
‘Reefer Madness,’ ” Schindel said. “I have been named #FailedParent
in social media. Commenters diagnose our children, usually with mental illness, and claim marijuana should not be blamed. Since he was a veteran, I have been told George Bush killed my son. I have been told I killed my son. The attackers make it clear they support legalizing drugs, claiming that will be safer for our children. I cannot understand that — especially now that I look at this issue from the perspective of a mother missing her wonderful son, who should still be here today.”
Andy Zorn started using marijuana when he was in his young teens. By his mid-20s, the young Army veteran, who had planned for years to become a partner in his mother’s financial services firm, had begun to “fail at everything,” Schindel said. “I didn’t know it was marijuana taking over his brain.”
After a few years of struggling with marijuana addiction and symptoms consistent with psychosis, Zorn closed his suicide note with these words: “My soul is already dead. Marijuana killed my soul + ruined my brain.”
Christine Tatum is a veteran journalist and former national president of the Society of Professional Journalists. To see past installments of The Gazette Editorial Board’s Clearing the Haze series, go to gazette.com/clearingthehaze.