Connecting state and local government leaders
Public health and medical officials are grappling with a surge in demand for marijuana addiction treatment.
This article was originally published by Stateline, an initiative of The Pew Charitable Trusts, and was written by Christine Vestal.
SAN RAFAEL, Calif. — For as long as most residents can remember, smoking marijuana has been a part of life here. The fact that California legalized the practice in January went practically unnoticed in this quiet town a half-hour’s drive north of San Francisco, where some claim the normalization of America’s marijuana culture got its start.
For Quintin Pohl and countless teenagers before him, smoking pot was a rite of passage. It was a diversion from the loneliness he felt at home when his parents were splitting up and a salve for middle-school angst. It was his entire social life in seventh and eighth grades, when social life is everything.
Even though nearly all his friends were using marijuana and seeming to enjoy it, Pohl said, at some point his marijuana use took a turn he never saw coming: He became addicted.
Many people are unaware of marijuana addiction. But in the public health and medical communities, it is a well-defined disorder that includes physical withdrawal symptoms, cravings and psychological dependence. Many say it is on the rise, perhaps because of the increasing potency of genetically engineered plants and the use of concentrated products, or because more marijuana users are partaking multiple times a day.
“There should be no controversy about the existence of marijuana addiction,” said Dr. David Smith, who has been treating addiction since the 1960s when he opened a free clinic in San Francisco’s drug-drenched Haight-Ashbury neighborhood. “We see it every day. The controversy should be why it appears to be affecting more people.”
Although estimates of the number of people who have ever tried marijuana or who use it regularly vary widely from survey to survey, the federal government and the marijuana industry tend to agree that total marijuana use has remained relatively constant over the past decade. Increased use in the past three years has been slight, despite increased commercial availability in states that have legalized it.
The percentage of people who become addicted to marijuana — about 9 percent of all users, and about 17 percent of those who start in adolescence — also has been stable.
Yet here in Northern California, some addiction treatment practitioners say they’re seeing something new — a surge in demand for marijuana addiction treatment, particularly among adolescents, even though national surveys show little to no increase in the number of adults using the substance, and some studies show a decline in marijuana use among adolescents.
At fewer than 1 in 10 users, marijuana’s estimated rate of addiction is lower than cocaine and alcohol (15 percent) and heroin (25 percent). Unlike opioids and stimulants, marijuana dependence tends to develop slowly: Months or years may pass before debilitating symptoms begin to negatively affect the average dependent user’s life.
To be sure, there are no known reports of anyone dying of a marijuana overdose or its commonly experienced withdrawal symptoms — chills, sweats, cravings, insomnia, loss of appetite, nausea, anxiety and irritability.
Still, since so many Americans use marijuana recreationally — more than any other mood-altering substance other than alcohol — the number of people who develop a dependence on it is substantial. According to Nora Volkow, director of the National Institute on Drug Abuse, an estimated 2.7 million Americans meet the diagnostic criteria for marijuana dependence, second only to alcohol dependence.
Potency and Frequency
About 20 miles north of here, at Muir Wood Adolescent and Family Services, where Pohl eventually got treatment as he entered his senior year in high school, Smith, a visiting physician there, said the number of patients seeking help for marijuana dependence has more than doubled in the last two years.
And he doesn’t think the increased demand can be explained by greater public awareness of addiction or improved access to treatment. Smith speculates that it’s the potency of concentrated products that’s causing a higher prevalence of problematic marijuana use.
“Back in the day when kids were sitting around smoking a joint, the THC levels found in marijuana averaged from 2 to 4 percent,” Smith said. “That’s what most parents think is going on today. And that’s why society thinks marijuana is harmless.”
But selective breeding has resulted in an average marijuana potency of 20 percent THC, the primary psychoactive compound in marijuana. Some strains exceed 30 percent.
Marijuana concentrates and extracts, much more commonly used in the last five years, have THC levels that range from 40 to more than 80 percent, according to marijuana industry promotional information and Drug Enforcement Administration reports.
Other addiction specialists say that although the number of marijuana users may not be rising significantly, the percentage of users who use it multiple times a day is increasing, which may also be contributing to higher rates of dependence. According to the National Institute on Drug Abuse, daily use among young adults is at the highest rate in more than 30 years.
In general, only about 5 percent of people with marijuana addiction get specialized treatment, compared with nearly a quarter of those with an opioid addiction, according to the Substance Abuse and Mental Health Services Administration.
Federal officials are trying to increase awareness.
Dr. Elinore McCance-Katz, an addiction physician and director of the substance abuse administration told Stateline in an interview that she plans to be the first director of the agency in any administration to speak out about the dangers of marijuana and correct what she says is “rampant misinformation” being spread by the marijuana industry.
Susan Weiss, who directs research on the health effects of marijuana at the National Institute on Drug Abuse, told a group of addiction doctors at the annual meeting of the American Society of Addiction Medicine in April that the federal government is trying to get the message out that marijuana can be addictive.
“But believe it or not,” she told the group, “we’re having a hard time convincing people that addiction exists.”
The National Cannabis Industry Association’s chief spokesman, Morgan Fox, said he’s not surprised the federal government is having a hard time convincing the public that marijuana can be addictive.
“It’s their own fault,” he said of the government. “When people find out they’ve been lied to by the federal government about the relative harms of marijuana for decades, they are much less likely to believe anything they have to say going forward even if that information is accurate.”
Fox said his organization has no disagreement with the scientific finding that about 9 percent of people who use marijuana become addicted, and his organization urges its members to make that clear in their marketing information. But he disagrees that more potent forms of marijuana may be causing an increase in addiction. “It just means people need to consume less to achieve the desired effect,” he said.
So far, no scientific studies have shown that stronger pot increases the likelihood of addiction, and large swaths of the general public continue to question the existence of marijuana addiction. But for Quentin Pohl, addiction was real.
Pohl said his marijuana addiction took years to develop. His mother, Kimberly Thomas, said that once she realized her son was using marijuana frequently, “it was like a roller coaster chugging up hill, chugging, chugging, chugging. You know something is happening,” she said, “and then just within a couple of days, you reach the peak and zoom downhill. It was awful, awful.”
Scott Sowle, director of the Muir Wood center, where Pohl got treatment, said he gets the same call from parents nearly every day.
“It’s like Groundhog Day,” he said. “They call and say, ‘My 16-year-old son was doing really well in school. He was interested in sports and involved in extracurricular activities. But suddenly, he’s just not the same kid anymore.’”
Pohl recalled that he drank a little, off and on, but that marijuana was his constant obsession. After middle school, he got involved in rowing for a couple of years and took a break from his marijuana friend group. But after he decided competitive rowing wasn’t for him, Pohl said he started smoking pot again, this time with a new group of friends who smoked all the time.
And then the roller coaster plunged.
His grades plummeted; he stopped going home most of the time and was couch surfing for a while. Finally, he said, his mom called the cops on him for stealing her car. “At that point, I was heartless, emotionless,” he said. “I was just kind of a blob taking up space. I was baked 24/7.”
Pohl’s mother said she saw that he was in trouble and demanded that he stay at home every moment he wasn’t in school. (Pohl’s father was living in San Francisco and his sister was away at college.)
“She told me to come back home. So, I did,” Pohl said. “At the time, I wasn’t sure why she did that. I was still in that whole miserable phase, smoking at least an ounce of weed a week — two ounces on a good week.” (One ounce is enough to smoke four to eight joints every day for a week, depending on their size.)
Then early one morning before school, Pohl recalled, “I got out of the shower with a towel around my waist. I walked from the bathroom into my bedroom. There was steam everywhere. But through the haze, I could see two big guys in my room in leather jackets, two really big guys.
“They said, ‘Get dressed, young man, and come with us.’”
They were private investigators his mother hired to take him to Muir Wood.
Pohl said he went through a week of pure misery at Muir Wood: angry, in denial and suffering. “I couldn’t sleep for a week. I was cold and then I was sweating. I hated everything,” he said. “And then the sun hit my face one morning and it felt great. Things tasted good, smelled better, everything was just enhanced.”
During his six weeks at Muir Wood, Pohl took intensive classes with about 10 other boys and talked to his therapist frequently. His mother spent eight hours a week there, attending parent classes, sharing meals with her son, and working with him and his therapist to address the underlying issues that led him to self-medicate with marijuana.
Pohl says he hasn’t smoked marijuana since he left Muir Wood last July and hasn’t had any desire to. For the rest of the summer and after school in the fall, he attended classes at a Muir Wood outpatient clinic in San Rafael.
“In general, kids who come out of residential and go through an outpatient program and then go to meetings for sober teens are pretty successful,” Sowle said. “It’s the kids who don’t have a continuing care program and whose parents think a short stint in a residential program is a cure-all who aren’t so successful.”
Wearing black pants, a black sweatshirt and a pink skull cap on a cool but sunny day in late May, Pohl smiles broadly when he talks about his future. He graduates June 14 and plans to start working full time at the grocery store where he’s had a part-time job for the last year. He also plans to move to Petaluma and share a house with friends, he said. “I like it up there in cow country.”
As for smoking marijuana again, Pohl is confident he’ll be able to smoke socially when he’s an adult. He plans to stay in Northern California and can’t picture not smoking pot when he grows up.
Squatting under a statue of Louis Pasteur at San Rafael High School, he proudly explains his town’s place in marijuana history. In 1971, he says, a group of high school kids who called themselves the Waldos met at the statue every day at 4:20 p.m. to smoke pot.