Generally, this Friday column is about something outrageous. This one is more just a call for caution as North Carolina is likely poised to open the door to medicinal marijuana next week. As we do so, it will be important to consider the experiences of other states and the latest research on the mental health impacts of marijuana.

Growing up in the D.C. area in the 90s, the suggestion that marijuana was in any way dangerous was laughable, at least among those in my circle. “They” would tell you it was harmful or addictive or could make you “go crazy.” But we all knew “they” had no idea what they were talking about.

The quintessential example of just how off base the powers-that-be and their scare tactics were was the cartoonish film from the 1930s, “Reefer Madness.” It became kind of a cult classic, giving young pot smokers the same kind of smug laughs that a snarky atheist might get watching footage of the Scopes Monkey Trial. In the film, people would take a single puff, then lose their minds and launch themselves out the window or viciously attack their best friend.

Despite this obvious hyperbole, there may have been more to this caricature than we had thought. As more and more states decriminalize marijuana laws, authorize medicinal marijuana, and even legalize recreational use, the effects of the drug are just now being more deeply studied.

Many of my more libertarian-leaning colleagues here may not agree, but both my personal experiences and the emerging evidence suggest that it is not as simple as legalize it and forget it. It’s especially important for society not to give its collective thumbs-up to marijuana as a mental-health crisis continues to escalate here in North Carolina, especially among teens and young adults.

Anecdotes, for what they’re worth

Because I stopped around 20 years ago, I’ll assume there’s not a major risk to admitting my personal experience in this area. Without getting into too much detail, as a teen, I really enjoyed it for a while. But then suddenly, I didn’t. It became clear something had changed in how my mind or body reacted to the drug. Every thought, sensation, and interaction becomes almost tortuous in that state. I believe it contributed to a struggle with anxiety around that time.

Regardless, because it became so unpleasant, I stopped my freshman year in college, just as many others on campus were just getting introduced to the plant. Just to make myself even more popular, I also ditched my punk-rock leftism for conservatism. But that’s another story. After stopping, though, it took a little while for my anxiety to reduce and mental sharpness to return.

My experience with marijuana is not unique. I encourage you to listen to comedian Louis C.K. describing in the video below why he can’t smoke marijuana (be warned of some bad language). He says that marijuana now is so much more potent than in the 1970s, that he can’t even smoke a small amount without losing his mind.

This comical retelling of fleeing in a panic after some young fans gave him a couple hits of a joint highlights some important points related to the psychological impact of the drug.

Increased potency

Marijuana had only 1-2% THC (the intoxicating chemical that many enjoy) in the 1960s and 70s. This rose to 6% by 2002, and now it frequently has 20% or even as high as 30% THC in pot dispensaries in places like Colorado. That means one hit might be like taking 20 or more 1970s hits.

Because it is so much stronger, it really is causing some reefer madness that the 1% THC varieties likely did not. A study released this month by the National Institutes of Health found that “as many as 30% of cases of schizophrenia among men aged 21-30 might have been prevented by averting cannabis use disorder.”

The fact that a close childhood friend of mine, who did not stop when I did, was diagnosed with schizophrenia in his early 30s and soon after committed suicide certainly came to mind as I read that data.

Road dangers

C.K also chose to drive (assuming that part of the story was true). In places that have fully legalized marijuana for recreational purposes, there’s evidence of a major spike in traffic accidents related to the drug.

Dr. Christian Thurstone, director of behavioral health at Denver Health and professor of psychiatry at University of Colorado, spoke to North Carolina media and policy experts last November to warn about this and other potential unintended consequences of opening the door to marijuana in the state. He said in Colorado, the number of traffic accidents where the person was determined to be under the influence of marijuana went from 9% of all accidents in 2009 to 21% in 2019.

Emergency room visits

Lastly, C.K.’s panic attack or psychotic episode is not an uncommon experience, as Thurstone also highlighted, and frequently leads to emergency room visits.

I was flipping channels recently and came across a reality show that followed EMTs as they responded to calls in their ambulance. The first call they responded to was from a girl who was having negative effects from smoking marijuana. The EMTs both laughed it off, and the driver said, “I thought the only side effects of weed were happy, hungry, sleepy.” Many people are under that impression, but when they spoke to the girl, she was in great distress and insisted she needed to go to the hospital immediately.

A report by U.C. San Diego said many older residents of California are trying marijuana to treat conditions they’ve heard it can help with, like nausea or loss of appetite, but instead are ending up in the E.R.

“I do see a lot of older adults who are overly confident, saying they know how to handle it — yet as they have gotten older, their bodies are more sensitive, and the concentrations are very different from what they may have tried when they were younger,” said Benjamin Han, MD, MPH, who authored the study.

Han, who is a geriatrician at U.C. San Diego School of Medicine, found that there was a 1,808% rise in marijuana-related emergency visits by those over 65 after legalization in California.

As North Carolina considers opening the door to medicinal marijuana next week with Senate Bill 3, the N.C. Compassionate Care Act, which will be heard in the House Health Committee, it’ll be wise to tread carefully, and for both patients and the public to be aware of what they’re getting into.

Even though this bill is very limited compared to other states on which conditions can be treated and how it will be distributed, those advocating complete cultural and legal acceptance are celebrating this as just a first step. With a mental health crisis raging, that goal should be considered skeptically and with an eye on the latest research.