“Religion…is the opiate of the masses,” Karl Marx declared in 1844, but today in the secular West, one might argue that marijuana has elbowed religion aside. Americans’ marijuana use has doubled over the last two decades, and 67 percent of US residents now favor overturning federal law under which marijuana remains a proscribed substance.11xAndrew Daniller, “Two-Thirds of Americans Support Marijuana Legalization,” Fact Tank: News in the Numbers, Pew Research Center, November 14, 2019, https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/. The states are dropping their opposition to legalization with metronomic regularity, eleven of the fifty, plus the District of Columbia, having legalized cannabis for recreational use since 2012. Marijuana is also set to become big business. The data analytics firm Nielsen projects that legal weed sales will quintuple, to an estimated $41 billion, by 2025.22xSean Williams, “US Cannabis Sales to More Than Quintuple by 2025, New Report Finds,” The Motley Fool, September 29, 2019, https://www.fool.com/investing/2019/09/29/us-cannabis-sales-to-more-than-quintuple-by-2025-n.aspx. “This is one of the most exciting opportunities you’ll ever be part of,” John Boehner, former Speaker of the House of Representatives and now a board member of marijuana investment firm Acreage Holdings, told the National Institute for Cannabis Investors. “Frankly, we can help you make a potential fortune.”33xElizabeth Williamson, “John Boehner: From Speaker of the House to Cannabis Pitchman,” New York Times, June 3, 2019, https://www.nytimes.com/2019/06/03/us/politics/john-boehner-marijuana-cannabis.html.
What are we talking about when we talk about weed? Until recently, when someone announced that it was time for a serious debate about marijuana, what that person typically had in mind was a debate about the function of law in liberal society. The libertarian says, “What business is it of government what I choose to ingest into my body?” Meanwhile, the progressive decries the failed prohibition regime that has led to the criminalization of 600,000 Americans a year, and rues a war on drugs that has had such disproportionate effect on African American communities. For a generation, in terms of our national discourse, we have so fixated on the question of whether we should be allowed to get high that we have neglected to talk about whether it would even be advisable.
Last year, however, the debate changed, when former New York Times reporter Alex Berenson published a book, Tell Your Children: The Truth about Marijuana, Mental Illness, and Violence, that provoked the ire of pot enthusiasts with its contention that marijuana can induce psychosis.44xAlex Berenson, Tell Your Children: The Truth about Marijuana, Mental Illness, and Violence (New York, NY: Free Press, 2019). When we talk about cannabis, we should not be talking about the law any more, Berenson contends. We should be talking about health.
Berenson begins his book with the admission that he, too, had long thought pot was harmless. As he puts it, “I’ve smoked it myself, I liked it fine. Maybe I got a little paranoid, but it didn’t last. Nobody ever died from smoking too much pot.” But one night he was talking to his wife, Jacqueline, a psychiatrist, who specializes in evaluating mentally ill criminals. They were discussing a particularly grisly case when she said, “Of course he was high, smoking pot his whole life.”
Hearing his wife voice her profession’s working assumption sent Berenson on a mission to explore the connection between marijuana and psychiatric disorders. He began by unearthing the most authoritative studies. For example, in Dunedin, a coastal city on New Zealand’s South Island, a database was initiated in the late 1960s on every baby born in Queen Mary’s Hospital (Dunedin’s main obstetric center). It has enabled creation of the most comprehensive study of human development ever conducted. Because they were able to obtain data drawn from individual cases at age eleven years, researchers were able to account for preexisting psychoses when investigating whether cannabis triggered later psychotic states. Their results, published in the British Medical Journal, are terrifying: People who had used cannabis at age fifteen were four times more likely to develop schizophrenia than those who had not.55xLouise Arseneault, et al., “Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study,” The British Medical Journal, November 23, 2002: 325, https://www.bmj.com/content/325/7374/1212. This is a useful summary of the findings from the Dunedin longitudinal study.
Next, Berenson went to the professionals working at the frontlines, such as Erik Messamore, a psychiatrist who moved to Ohio in 2013 to work at a high-end private psychiatric center attached to the University of Cincinnati. What Messamore encountered there was a new type of patient: privately insured, affluent, stable, with family, a job, and advanced degrees, who had used only cannabis before succumbing to a disease that resembled schizophrenia, but had developed later and responded poorly to antipsychotics.
Berenson’s book has touched a nerve. It has been denounced as dangerously alarmist and as playing fast and loose with the facts, particularly regarding the connection between pot use and violent crime. (And it should be said that Berenson’s contrarianism has led him, more recently, to some questionable conclusions about the reality of a COVID-19 pandemic.) Yet there can be no getting away from the reality of our unnerving ignorance about what marijuana actually does to our minds, and from the fact that, while policymakers are becoming more confident about the safety of cannabis, the medical community is becoming less so. For instance, in January 2017 the National Academy of Medicine published a 468-page report saying a lot about knowing a little.66xA summary of the report findings: “Health Effects of Marijuana and Cannabis-Derived Products Presented in New Report,” The National Academies of Science, Engineering, and Medicine news release, January 12, 2017, https://www.nationalacademies.org/news/2017/01/health-effects-of-marijuana-and-cannabis-derived-products-presented-in-new-report; the full NASEM report “The Health Effects of Cannabis and Cannabinoids” is available for purchase at https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and-cannabinoids-the-current-state. Even though ascertaining the “dose-response relationship” of a new compound is par for the course for a drug company when initiating trials in human subjects, the authors wrote, this work has not been done with cannabis. In advance of the legalization of cannabis in Canada the following year, an editorial in the Canadian Medical Association Journal decried the move as “a national, uncontrolled experiment in which the profits of cannabis producers and tax revenues are squarely pitched against the health of Canadians.”77xDiane Kelsall, “Watching Canada’s Experiment with Legal Cannabis,” Canadian Medical Association Journal 190, no. 41 (2018): E1218, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188945/#.
Yet despite psychiatry’s penetration of public consciousness on the issue of wider access to cannabis, we may still ask how far we have really advanced when we are able to discuss marijuana use only in a highly medicalized away. If we are talking about social practices and not legal permissibility, what might it look like to bring into view the fundamental question of the nature of getting high as a social practice, and its relationship, if any, to human flourishing. Let’s ask about the kind of life we aspire to, what kind of culture we hope for or even expect, in which marijuana is not only decriminalized but commercially sold and promoted. Let’s think about how dropping the prohibition against the adult use of marijuana might not only compare with the legalization of alcohol but possibly compound the individual and social costs of having another widely available intoxicant. How are we ethically to evaluate the practice of getting stoned? What kind of phenomenon is this? What is its telos, its peculiar end?