The decoupling of opioid use from addiction liability when the drugs are prescribed for chronic severe pain relief was actually noted many years before the study that Purdue used to justify its claims for Oxycontin; I first read about it in the book Drugs And The Mind by Robert DeRopp, published in the 1960s. The pain patients who reported the low incidence of addiction were hospitalized patients with long recovery times, or people dealing with ongoing chronic—often lifelong—pain issues who were often stable and well-functioning, using just enough of the prescribed dose to relieve their otherwise intractable pain while declining to increase the dosage to a level that produced the euphoria that was a feature of higher doses.

The problem was that Purdue’s marketing department took that finding, extracted it out of its original context, and ran with a simplified conclusion that allowed them to justify marketing Oxycontin for a wide range of pain relief. The head of Purdue, Sackler, was already well-known in the industry—not as a pharmacologist, but as the first executive in the business to apply mid-20th century modern advertising and marketing techniques associated with consumer products to patent pharmaceutical drugs, beginning in the 1950s. Sackler came up with catchy brand names for his products; his first brand name inspirations included Valium, Librium, and the anti-ulcer medication Zantac. Sackler also led the way in advertising his brand-name drugs in medical journals, and training his traveling sales staff in persuasion techniques when doing cold calls to doctor’s offices.

All of that marketing focus was finely honed by the time of the rollout of Purdue’s newest product, Oxycontin, in 1995. Two features of Oxycontin distinguished it from earlier oxycodone oral medications like Percodan and Percoset. The first difference is that unlike Percodan, which was formulated with aspirin, and Percocet, which was formulated with acetominaphen (aka Tylenol), Oxycontin was formulated exclusively as an opioid. The compounding of the oxycodone with NSAID nonprescription pain relievers appears to have been intended to serve two purposes: 1) providing some additional pain relief in order to limit the opioid content in each pill; and 2) both aspirin and acetaminophen typically produce nausea and vomiting when ingested in large quantities, acting as an effective check on the number of pills that can be comfortably ingested and thereby working to limit the “abuse potential” of the oxxycodone ingredient. There are methods to separate the NSAIDs from the opioid, technically. But it’s typically difficult to do more than a partial extraction by using ‘household methods’, so someone seeking to remove the NSAIDs is still likely to be ingesting a nauseating quantity if they intend to ingest more than 10-20mg of the oxycodone. This worked to limit the appeal of using “percs” for recreational purposes—particularly for addicts with an opioid tolerance. (Another somewhat more sinister side effect is that unlike opioids, NSAIDs like aspirin and acetaminophen are toxic in large quantities, particularly to the liver and kidneys, especially when ingested with alcohol.) That limitation did not apply to Oxycontin, which had only oxycodone as its active ingredient.

Along with its absence of NSAIDs, Oxycontin’s extended release formula typically provided more active ingredient than percs—up to 160mg per pill. The most commonly prescribed dose was 40mg—4 to 8 times the usual dose of Percodan prescribed for transient acute pain conditions like wisdom teeth removal, or back sprain. But Purdue sales people sold Oxycontin as a formulation that could be used for minor and moderate acute pain, and also recommended that physicians prescribe it liberally, in 7 to 21 day amounts, while implying that the mere presence of even minor pain somehow automatically obviated the liability of becoming addicted to the substance.

The marketing reps sold a lot of Oxycontin that way. And the more familiar pharmacists got with seeing the prescriptions, the more they got used to dispensing it frequently and in large quantities. There was widespread ignorance on the part of both medical care professionals and pharmacists about the inherent properties of opioids; in many medical schools, the problems of pain relief hardly merited more than a couple of class sessions. That divide—between the “straight world” of institutional instruction, licensed pharmacies, and naive medical practitioners, and the clandestine subculture of illicit substance use that had become an endemic American subculture since the mid-1960s—provided the final factor that led to the explosion of Oxycontin use in the late 1990s and 2000s.

The people who understood what they were looking at when they saw the label on a bottle of 40mg oxycodone were the criminalized pariahs of the underground drug scene, particularly the opioid fanciers. They found out very quickly that Oxycontin could be converted to instant release simply by the expedient of chewing the pills.

That said, the vast majority of people who reported becoming addicted to Oxycontin said they had received their first supplies from a physician for a legitimate pain complaint. It isn’t easy to gauge sincerity, but it’s entirely likely that most of those people told the truth. It’s undeniable that many unsuspecting people had no idea what they were getting into with their first use, and they eventually found themselves with an opioid habit. The books on the Oxy epidemic provide some anecdotal cases. The most heart-wrenching one I read is the account found by the tragic protagonist in the book Dopesick. Because as it happens, while Oxycontin was sold as a slow release med delivering a 12-hour period of freedom from pain that allowed the users a full night’s sleep without interruption, even when used as recommended—by swallowing the pill—the extended release was actually more like 8 hours. Furthermore, even if it doesn’t hit all at once, 40mg of Oxycontin still packs a wallop in "drug-naive” users. Opt for taking an extra pill, and the endorphin cascade can be out of this world.

The foundation justifying that level of use—for conditions like ankle sprains, torn ligaments, and tooth extractions—was the Respectability of pharmaceutical prescription. That superstitious awe of Ceremonial Chemistry, the magical rite of a credentialed and licensed practitioner of Medicine waving a pen across a prescription pad. Very few Americans maintain the vigilance known as caveat emptor when a doctor prescribes anything at all for them. Meanwhile, opioid manufacturers all over the country were exhorting their sales staffs with bonuses and seminars on effectively pitching the newly lucrative patent medicines, which in some cases expanded beyond Oxycontin to include products like “slow-release” fentanyl lollipops.

Therein lies the problem with the argument that “legal opioids were the cause of the opioid epidemic”: the real problems related to fraudulent representation of the risks by the drug companies, the naivete of “the straight world”about the nature of opioid drugs. Heroin—only slightly more powerful by weight than oxycontin—was taboo, a contraband product reserved for the criminal monopoly. Schedule I, “no accepted medical use”, although it was considered a legitimate pharmaceutical drug in some other countries, like the United Kingdom. By contrast, oxycontin was sometimes not even recognized as an opioid. In any case, it became the “pain pill” of choice in the late 1990s and early 2000s, widely prescribed by doctors and hence held to be basically “safe.” A misconception fostered and maintained by the misleading soft-soap sales tactics pioneered by the Sacklers at companies like Purdue Pharmaceuticals.

https://prium-evidencebased.blogspot.com/2016/

https://www.npr.org/2025/03/27/nx-s1-5342368/addiction-trump-mental-health-funding?utm_source=firefox-newtab-en-us

“Not enough consequences” to drug abuse as it is? Really? Has compounding the consequences with legal penalties helped to solve the problem? How about treating every teenager arrested for drugs as a Drug Addict in need of Rehabilitation, assigned to mingle in the company and society of other confirmed Drug Addicts?

This is not the same thing as saying that society should tolerate public drug use, or ignore enforcement of the laws against shoplifting, car-break-ins, ignoring curfews in public parks, or any of the other malum in se criminal offenses committed by dysfunctional drug abusers and addicts. But drug use is not a criminal behavior in itself, and it’s been a huge mistake to treat it that way. Personal possession of alcohol was not criminalized during alcohol Prohibition. User criminalization would not have deterred users, it would have made the situation ten times worse.

As for the illicit market: any honest assessment has to include both sides of a prohibition policy: criminal penalties do work to keep many people out of the business of supplying the demand. But they also amount to conceding a career criminal monopoly over the supply of the forbidden substance. That means that drug dealers are subject to arrest and conviction for unscrupulously providing unsafe substances to an unregulated consumer market. A market of people voluntarily purchasing the substance, at their own risk.

An official U.S. government policy that classifies drug dealers as terrorists is ridiculous. And if its faulty logic is accepted uncritically, it’s entirely possible that policy will eventually be applied within U.S. borders.

Instead of scapegoating people who sell unsafe, hazardous and unregulated products to a base of willing customers as “terrorists”, we need to direct more attention toward solving the problem of people who have sold unsafe, hazardous and unregulated products to a customer base that has consumed them unwillingly. And, it increasingly appears, unwittingly.

Yeah. Disposable plastics. PFAS. PFOS. BPA.I didn’t order that. I’m a hippie. Pro-natural world, anti-materialist, anti-toxic waste, recycler, secondhand consumer.

But someone ordered that. For their grandchildren.

It wasn’t my call. I’ve been long been part of that vast cohort of Americans who were rendered politically powerless as part of their forcible exclusion from Respectable Society, because Doper. “Druggie”, in the original ascribed status parlance.Hippie- and then Aging Hippie. Brain-damaged burnout. Unlike the teetotaling Joe Biden and Donald Trump. The cream of the Baby Boom.

They say an ounce of prevention is worth a pound of cure. In the case of plastics, it seems like the benefits of prevention might have been worth a hundred pounds of cure. But that ship has sailed. So we’re left to pick up that bill. Which makes the recent full-court press for a multi-trillion dollar front-loading of investment in “Artificial Intelligence” appear all the weirder, as a vision of the human future. I can’t help wondering what a multi-trillion dollar investment in tertiary water treatment plants and other human population support infrastructure and public works might accomplish, if only Roboworld wasn’t given top billing.

How is it that sellers of cocaine to a willing consumer base are now branded “Terrorists”, but people who poisoned wells for decades are not even branded as criminals?

Toxic Gaslighting: How 3M Executives Convinced a Scientist the Forever Chemicals She Found in Human Blood Were Safe

Scientists Thought Parkinson’s Was in Our Genes. It Might Be in the Water

Wide­spread use of plastic puts harm­ful chem­ic­als in nearly every­one’s diet

Headline news from USA Today that just dropped into my feed:

Cannabis users under 50 are 6 times more likely to have a heart attack, new study shows

(Greta Cross, writer; published 3:48pm ET; updated 4:22pm ET, March 21, 2025)

"Until we have more solid data, I advise users to try to somehow put some regulation in the using of cannabis," researcher Ahmed Mahmoud said.

Well, yeah. That’s what I say, too. The part I wonder about is the “until we get more solid data” assertion. It isn’t as if cannabis effects on the cardiovascular system and related physical effects haven’t been studied already. Studies go back decades. Cannabis, pot, reefer, marijuana, weed, hashish, you name it, has been studied for many years. More studies all the time. But this is the first one I’ve read alleging that

people under the age of 50 who consume marijuana are about 6.2 times more likely to experience a myocardial infarction, commonly known as a heart attack, than non-marijuana users. Young marijuana users are also 4.3 times more likely to experience an ischemic stroke and 2 times more likely to experience heart failure, the study shows.

I’ve read many studies on cannabis effects on physical health over the years, and this one brings a lot of drama. “Huge if True”, as the social media jet set would put it.

So I thought I’d have a look at the original study, recently accepted and set for publication by the Journal of the American College of Cardiology, March 18, 2025. https://www.sciencedirect.com/science/article/pii/S2772963X25001152?via%3Dihub

Before I get into reviewing the details, I’ll re-state the position on the legal status of cannabis that I’ve held for decades: my non-negotiable bottom line is that personal possession and cultivation of cannabis in small household quantities by adults should be Federally legal and unregulated, similar to the provisions for moderate quantities of home brewing of beer and wine. That’s an absolute minimum restoration of a Constitutional right that should never have been at issue.

I’m ambivalent about the existence of the commercial market, but inclined to support it. I oppose some aspects of it. In the states where legal retail sales are presently ongoing, the currently continuing Federal prohibition on cannabis—with its restrictive effects on banking and leasing, and consequent requirement for a large amount of front-end cash investment—has indisputably worked to the advantage of wealthy venture capitalists and wealthy investors at the expense of small businesses and cultivators. I don’t think that’s a fair result. But current Federal government policy practically ordains it. Furthermore, I’m opposed to profiteering and any move to permit the advertising of cannabis in any television or radio medium. (I’d also support a ban on the TV advertising of alcohol and prescription pharmaceutical drugs.) I’ve written more extensive Substack posts on the subject earlier. Suffice it to say that my views are not informed by any financial interest connected with the cannabis business.

I’ve also written in detail about my personal views on the increasing potency of cannabis over the decades. In the the early 1990s I began hearing claims that increasing THC concentration was intensifying the effect of marijuana to the point where it was practically an entirely different substance bearing little resemblance to the mild, sensual mind altering properties of earlier eras. At first, I was dismissive. By the mid-1990s, I found that I had to agree; the effect, the high, from smoking pot had changed markedly. For one thing, where I had once regarded higher potency pot as a means of lowering my exposure to amount of smoke ingested into my throat and lungs, I now found that even one hit was too much. (Shades of tobacco! where one deep-lunged hit of tobacco and the vertigo can put me on the floor.) The new superpot contained so much THC that one inhalation was sufficient to trigger my receptors almost instantly. Not a bongload, either- a few little flakes were sufficient. The amounts were so small that I actually began mixing it with tobacco in order to have enough combustible substance in my pipe. Routine ingestion of tobacco, how ignominious. Anyway, I eventually found that even using very small amounts of super-engineered THC-laden weed had an onset that was just a little too abrupt for me to really find the lift enjoyable until it had worn off a bit. I think the medical term is “bolus effect”—the saturation effect resulting from the use of a potent product that hits the relevant receptors all at once, due to the means of ingestion. Bolus effects can be produced either by inhalation or injection. The front-loaded saturation works to produce an effect that comes on strong and wears off fast, and it’s most prominently associated with cocaine, in the form of crack. The effect of a THC bolus bears no similarity to crack or any other substance; it’s still THC, the cannabinoid realm. But it does hit roughly as fast as making the circuit in a revolving door, and there’s enough of a shift in consciousness that it can be experienced as disorienting, especially for new initiates and those who have little experience with cannabis. I have ample experience with cannabis. I can deal with the fast onset, but I don’t care for it.

The problem is that ultrahigh THC cannabis began taking over many of the markets 25 years ago. That effect is what’s considered a “normal pot high” nowadays, and it’s been that way for some years. I shifted from regularly using cannabis to seldom using it 20 years ago; there have been years when I haven’t used it at all. I was once a member of the heaviest user cohort, as a male in my late teens and early 20s. I can recall what it was to experience a high from smoking milder—but also more subtle and distinctive—varieties in the 1970s, and that’s a perspective the kids lack. I also know what the superweed effect is like. It’s my fieldwork opinion that in order to enjoy using large amounts of the New Cannabis on a regular basis, one has to be pretty much constantly using it. Otherwise, the effect is experienced too intensely to feel entirely comfortable. This encourages regular use to the point where the altered state becomes more or less the new baseline. And it has to be noted here that between the intensity of high-THC pot onset and the subjective advantages of using it all the time in order to counter that effect, the high-test product appears to have resulted in a side effect profile that any pothead I know of would have laughed out of the room in the 1970s or 1980s.

No one I know ever experienced cannabis hyperemesis syndrome, for example. And while I’ve known regular cannabis users who have told me that they found it difficult to quit, I never had the idea that they found it as difficult as quitting tobacco, or alcohol, or heroin. I was able to use cannabis without craving it when deprived; I often abstained voluntarily for a few weeks every year. It’s difficult for me to set aside my personal bias and skepticism when reading the recent studies on the “addictive” properties of cannabis. But it’s definitely being increasingly reported. So are acute negative effects like anxiety, paranoia, disorientation, and even more serious reactions like derealization and psychotic episodes. Those effects were not unknown in the 1970s and 1980s. But they were rare side effects, and practically never associated with violence or aggression. Now negative reactions are much more commonly reported. Admittedly, most of my research findings have been found in Internet social media discussions and chats: reddit, Erowid, various other websites and social media platforms. I think social media conversations have a way of encouraging the momentum of content in the direction of concentrating on drama, dysfunction, and dilemmas; the weather on the Internet always seems to be bad. But even given the force multiplier illusion, I’m willing to grant that marijuana in the 20%-30% THC zone—or even higher, as with the resin concentrates—turns into a product with a much increased side effect profile, when compared with lower-test product.

That lengthy introduction is my way of saying that I’m open to reviewing the evidence that the reported increase in negative effects from high-potency cannabis might even include an increased risk of serious negative cardiac effects—including high blood pressure, heart attack, and stroke.

With that in mind, it’s my conclusion that the JACC research study referenced in the USA Today article has some glaring flaws, and the claims that it makes are wildly exaggerated. I have some serious reservations about its methodology, and also some about claims to effectively counteract the possibility of confounding factors interfering with the results by using weighted comparisons of the cannabis user population with the non-using population.

Excerpted from the text of the study:

Methods

Data Source: This retrospective cohort study utilized the TriNetX health research network, which aggregates de-identified electronic medical records from healthcare organizations worldwide. The specific network used for this study was Research, which contains data from 53 healthcare organizations (HCO) throughout the United States. Given the nature of the study and included date, IRB approval was waived. (Italics added)

“IRB approval” refers to the Institutional Review Board that crafts guidelines for best practices in medical studies.

Study Population: Focused on adults aged ≤50 years between 2010 and 2018, divided into two cohorts. 1) The cannabis-user group with cannabis use diagnoses (ICD-10: F12.1, F12.9, F12.90). 2) The non-cannabis-user group. Both cohorts were free of significant comorbidities at baseline, including hypertension, hyperlipidemia or LDL>100 mg/dL, coronary artery disease including prior MI or history of coronary interventions, diabetes mellitus (DM) or HbA1c >7, and tobacco use. The relatively healthy status of these patients was a key aspect of this study design, ensuring that comparisons were not influenced by pre-existing high-risk conditions. Propensity score matching (PSM) was performed, covariates were matched by 1:1 PSM using the greedy nearest neighbor matching algorithm with a cutoff of 0.1 pooled standardized mean difference (SMD). The following covariates were included in the PSM: age at index, sex, race, chronic kidney disease, depressive episode (DD), family history of ischemic heart disease, pregnancy, cancer history, creatinine, LDL, HbA1c, BMI, systolic blood pressure.

(“Propensity score matching” refers to the weighting used in conjunction with the factors indicating increased health risks, in order to provide a more accurate comparison of the cannabis user and nonuser cohorts.)

Note the assertion made by the study: “The relatively healthy status of these patients was a key aspect of this study design, ensuring that comparisons were not influenced by pre-existing high-risk conditions.”

That statement implicitly assumes that all such “pre-existing high-risk conditions” were accounted for. However, in my opinion, the list provided is plainly not comprehensive. I realize that a complete inventory is too much to ask; still, there are some other conditions that aren’t included as possible confounders, even though they have a long track record of association with cardiac problems and stroke—most notably alcohol and illicit stimulants. I’d also include statistics on a record of incarceration, because confinement environments induce significant stress and PTSD in some of the population subjected to it. So I’m not assured that “both cohorts were free of significant co-morbidities”—especially given that the cannabis users in question were not simply a random sample of users, or even self-reported daily users; the >90,000 “users” had all been officially diagnosed with Cannabis Use Disorder, which would seem to indicate that they’ve been specifically flagged on the basis of details found in their medical records; they aren’t merely self-reporting daily use, they’ve been defined as dysfunctional for it. That’s a subset of a subset. Curiously, it’s also a group that may not necessarily be actively using cannabis—precisely because they’re in a treatment regime.

It’s also worth noting that a large percentage of referrals to substance use disorder treatment originate from legal entanglements. From a study on the subject:

Referrals to specialty SUD treatment from the legal system made up 24.2% of all 8.3 M treatment episodes between 2015–2019, with only the self/family/friend category of referrals making up a larger proportion (36.4%; Fig. 1) The number and proportion of referrals from the legal system to SUD treatment declined by more than 25,000 episodes or 4.4 percentage points (26.2 vs. 21.8%; p < 0.001) between 2015–2019…

Cannabis was implicated in almost half of all referrals from legal sources but only a third of non-legal sources (45.5 vs. 33.1%; p < 0.001).

It’s difficult to know how that situation might have played out in the gathering of the data, but the sample—already not even close to a random assemblage—may be even more biased than is already plain to see. The numbers indicate that of the 8.3 million total SUD referrals between the years 2015-2019, at least 2 million involved legal referral, with approximately 1 million referred specifically for Cannabis Use Disorder.

There’s another factor to be considered, in regard to a Cannabis Use Disorder diagnosis: of all the forbidden substances subject to identification on the basis of a urine drug screen, cannabis is by far the most frequently detected. Not only is it the most commonly used illicit substance, the fat soluble nature of THC metabolite means that it’s also the one that stays detectable for a long period of time—in stark contrast to the other substances, which can be washed out of the body by drinking enough water and taking mild diuretics like B and C vitamins. What this fact implies is that even patients subject to random drug tests are often able to pass clean urine with a couple of days advance notice. So those substances are less likely to be detected, and unless their use is habitual, it may not be detected in a drug screen.

The JACC study, again:

A total of 4,636,628 relatively healthy adults aged ≤50 years: 93,267 (2.01%) cannabis-users and 4,543,361 (97.99%) non-users.

What we have here is "a “Big Data” study—or anyway one with the pretense of relying on Big Data. It isn’t a clinical study, using identified patient case histories, with all the details those imply.

Cannabis-users were older (26 ± 8 vs 21 ± 9.5 years, P < 0.0001) and had higher comorbidities, including a nearly 15-fold higher prevalence of DD (30.63% vs 1.88%, P < 0.01) and BMI >30 (18.72% vs 3.25%, P < 0.0001). After PSM, each group had 89,776 patients with balanced demographics and baseline health characteristics.

“DD” = depressive disorder. “BMI” = body mass index. “PSM” is propensity score matching, a weighting score intended to select a group from the nonuser cohort that’s suitably matched with the CUD group. The group that’s already estimated as having a >30% prevalence of depressive disorder, and almost 19% prevalence of stage 1 obesity (at minimum.) So if I’m reading the methodology right, the end result of PSM resulted in a comparison to be drawn from two equally age matched, equally unhealthy* cohorts of equal numerical size: 89,776.

There’s no way I’m going to refer to any group with such a high prevalence of diagnosed clinical depression as “healthy.” Or “average”, or “normal.” As the study points out, that’s 15 times the average of DD incidence in the general population. So that’s the matched baseline for the two samples of roughly 90,000 that were compared against each other through years 2010-2018.

A note on Methodology: that comparison was not a longitudinal study, along the lines of the long-term clinical studies done by pulmonologist Donald Tashkin with in-person assessments of the participants active in the study. The comparison in this study is retrospective, and also entirely statistical, based on harvesting metadata from a huge number of anonymized patient records. To revisit:

Data Source: This retrospective cohort study utilized the TriNetX health research network, which aggregates de-identified electronic medical records from healthcare organizations worldwide. The specific network used for this study was Research, which contains data from 53 healthcare organizations (HCO) throughout the United States. Given the nature of the study and included date, IRB approval was waived.

This is the Trinex Health Network. https://trinetx.com/solutions/live-platform/#s_1

From the home page:

Our web-based platform, TriNetX LIVE™, puts you at the center of our real-world data and evidence ecosystem. With an interface that’s as powerful as it is easy to use, you can build and analyze cohorts drawn from around the world in just minutes. When you’re ready to invite these patients into a study, connect with their healthcare providers with a few clicks.

The researchers note that they didn’t actually look up any patients and invite them into an experimental study. That’s what the phrase “the TriNetX health research network…aggregates de-identified electronic medical records” means.

Instead, they harnessed the awesome! power! of “Big Data”! to formulate their researches and inform their conclusions.

Statistical analysis: The analysis was performed with TriNetX Live built-in analytics.

This “research study” was built entirely out of keyword searches of metadata, crunched with a statistics program. Studies of this sort have become enormously popular in all sorts of fields, most notably in fields like evolutionary biology, social psychology, and epidemiology. Because Now We Have The Technology. But—do we really have Big Data? I’d allow that sometimes we do. But not this study.

The authors say as much, in their closing remarks. In so many words, at least:

This study has limitations due to lack of detailed cannabis consumption data and potential misclassification. The inherent limitations of real-world data often result from inconsistent patient reporting in electronic medical records. Future research should investigate the dose-response relationship, and the effects of synthetic cannabinoids.

The bland phrase “potential misclassification” means that the data might be inaccurate, to some unknown extent.

The sentence “The inherent limitations of real-world data often result from inconsistent patient reporting in electronic medical records” discreetly implies what many primary care physicians already know, even though the conversation is still mostly carried out informally, without the complications of bringing it up in official channels: many people lie to their physicians about their illicit substance habits. Including the illicit substance to which 80% of surveyed illicit drugs users confine their consumption: Cannabis. Weed. Mary Jane. People lie about their healthy habits, too. But they really lie about weed consumption. Because if Insurance Company Big Brother finds out, Shit invariably gets more Complicated. It’s a sleeping dog that just about everyone would prefer to let lie, unless they’re forced into admitting it.

I realize that post-hipster multimillionaires get to say anything they want to their personal private practice physicians; some of them may even party together. But those of us in the rest of the world get processed through gigantic actuarial mainframes of HBOs and insurance plans and programs, and we don’t have that luxury. Just saying.

For that reason alone—and there are other possible confounders to be brought up, as unanswered questions that might be that quick and dirty keyword search—this is not a probative study. It arguably isn’t even a serious study. It’s a preliminary skim that’s easily performed, hardly more complicated than a set of advanced keyword searches. And this is what I can’t stand about so many of these statistical metastudies: they’re reported as authoritative and conclusive, until you notice how threadbare they are. Then they begin to resemble a product that’s similar to a collateralized debt obligation: laundered junk data presented as AA certified.

That does not mean that cannabis has been cleared of all suspicion as far as the possibility of presenting increased cardiac risks. But I need to note a disturbing tendency that I’ve noticed in recent years, in regard to medical research on cannabis. There’s been a massive cascade of it in the aftermath of Colorado’s legalization of the commercial market. And at least some of it appears to me to have an axe-grinding agenda, to put cannabis in the worst possible light. I’m absolutely on board with following every research trail impartially. But speaking as someone who’s tried to keep up with the reading for the past 50 years, my hunch is that Politics and Law Enforcement continue to have a thumb on the scale. Where it doesn’t belong. And there’s no way to really get truthful assessments until they cut it out. I notice. I notice who these studies get funded, and who features them most prominently and uncritically on their web pages, and how they’re reported in the press. It isn’t just cannabis, of course. The manufacture of bogus fake “knowledge” by Power is all about who gets their first with the biggest headline banners. I detest that game, and all I can hope to do is reverse the process to what it needs to be, the only way with integrity: so that knowledge generates power.

Back 50, 60 years ago, research studies on the effects of cannabis were relatively scarce, at least those published in English. There were no sweeping surveys and estimates of hundreds of millions of users worldwide, either. But the studies that did exist were often quite comprehensive, such as the 1975 book by medical anthropologist Vera Rubin, Ganja In Jamaica. and the 1980 book edited by William E. Carter, Cannabis In Costa Rica. and the extensive writings of Tod Mikurya, MD, an oeuvre documented on this National Institutes of Health web page https://circulatingnow.nlm.nih.gov/2020/02/25/tod-mikuriya-papers-now-available-for-research/ (Access that link while you still can. It may not be available tomorrow.)

I’ll also note that while recent studies of cannabis report that using it increases blood pressure, the studies I’ve read from earlier than the 1990s were inclined to agree that cannabis use lowered blood pressure by 10-15 points, along with slightly lowering body temperature by about 1 degree.

I can’t help thinking that Big Data meta-analysis lacks the capability to offset that raging epidemic, Generational Amnesia—at least when it comes to the topic of Marijuana, for some reason. A textbook case of how the Sociology of Knowledge—the Politics of Knowledge—can influence scientific research with its taboos and dogmas, its profit motives and private ends. Sometimes shutting it down, other times warping it. Especially when Criminalization gets involved, and so much of the free exchange of knowledge is driven into the shadows.

There's a history of exaggeration--or confabulation--of the dangers of forbidden substances, with spurious studies purporting to rely on the protocols associated with the "modern medical research" of the 20th and 21st century to support their legal prohibition.

I've recently been reading reports from the 1800s by physicians who examined the effects of alcohol, tobacco, cannabis, opiates, and cocaine in the era before clinical studies were done on patients. Their writings were based entirely on empirical observations of users, and their opinions contained at least as much insight as the findings of clinical studies in the 20th and 21 centuries. Their scrutiny was typically dispassionate, and their conclusions about behavioral and public health impacts were not much different than modern medical consensus. Drug addiction was recognized as a liability, but rarely one of catastrophic proportions. The substance most widely viewed by physicians as a public health problem was alcohol. Overwhelmingly so.

It's worth noting that 19th century American and European physicians had relatively little to say about cannabis use and effects. Tincture of Cannabis indica--"hash oil"--was part of the medical apothecary and freely available both by prescription or over the counter for general purchase. But unlike alcohol, tobacco, opium, and the newly synthesized opiates and cocaine, I’ve found no reports of long-term cannabis habituation dating from the 1800s. "Recreational use" in 19th century Europe and the US consisted almost entirely of experiments by a self-selecting group of artistic and literary types. It just wasn't an issue. Even chloral hydrate and ether were more common intoxicants than cannabis. So the only 19th century medical reports of chronic cannabis use and habituation came from India--most notably the 1896 Chopra report from British colonial India, drawn up by a panel of British administrators and Western-aligned Indian Brahmins. I found the Chopra report conclusions to be a bit exaggerated in some respects, and open to criticism about some aspects of the methodology. But I found the basic conclusion to have merit: that cannabis preparations are used in various strengths (bhang, ganja, and charas or hashish), and that continuous heavy use of the most potent concentrated product, charas (hashish,) sometimes produced deleterious mental effects and triggered psychosis. It's now commonly known that serious mental breaks often occur in the teens and early 20s, and that extra levels of induced stress can induce the first onset, including as the result of substance abuse. There have been clinical observational studies that also show direct correlations with alcohol, tobacco, and coffee ingestion. I view cannabis as a nonspecific sensitization agent and amplifier of perceptions and cognition; that increased sensitivity can be experienced as disorienting or dysphoric, especially in people predisposed to mental fragility. As such, the experience probably is more liable to induce feelings of anxiety, panic, or paranoia than alcohol, nicotine, or caffeine, which are experienced by most (although not all) users as stimulus blockers. And emotional states like anxiety, panic, and paranoia are liable to be internally boosted by mentally unstable temperaments, sometimes to the extent of inducing acute psychosis. The exterior setting often plays a rule as crucial as the interior mental set; some settings are more stressful than others. In the general sense, the social Zeitgeist of the year 2025 is inherently more stressful than that of 1975. Indisputably.

To return to the topic of the study's claim of possible increased risk of heart attacks and strokes from cannabis use, I think that the research should have been prefaced by an epidemiological survey of incidence of heart attack and stroke in the US over the previous 75 years or so--because cannabis use skyrocketed between 1965 and 1975, and remained relatively common throughout the 1980s and 1990s and into the 21st century. If there's a pronounced direct correlation between cannabis use and deleterious physical effects like heart attack, stroke, and early mortality, its additive impacts should logically have shown up long ago as a statistical trend. I would expect that physicians would have noted such an association in the course of their practice, too—except that the use of cannabis, a forbidden and taboo substance, has most often been concealed from medical practitioners by almost the entire user population. The situation is further complicated by the contrast with the case of other forbidden substances, where users may be similarly inclined to conceal their use but are betrayed by the pronounced negative consequences of dysfunction and addiction. It’s just an empirical fact that even daily cannabis use doesn’t lead to nearly the same incidence of blatant dysfunction found with other other drug habits, so it’s more easily overlooked by physicians. So it’s possible that incidents like myocardial infarction and ischemic stroke in patients under age 50 might not have been subjected to scrutiny in regard to the possible role played by cannabis use.

Several other behavioral health trends have also markedly increased within the span of the previous 60 years, notably the increase in overweight and obesity, and the increasing amount of street drug abuse of all sorts, not just cannabis. But a rigorous study would have begun by reviewing overall epidemiological trends in the under-50 population for shifts from year to year, and decade to decade, before proposing a 600% increased risk of heart attack and stroke associated with cannabis use in people under age 50. The percentage of regular cannabis users in the US population is quite large; it’s a cohort sufficiently numerous to have shifted the wider epidemiological trend significantly in the wider population. Without a baseline depicting an increasing frequency of heart attacks and strokes in the under-50 age demographic over time within the general population, it’s difficult to provide a rationale for the recent JACC study in the first place.

Edit for additional review commentary, 03/23/2025:

The JACC study also seems to me to present a problem in regard to its choice of references, particularly Endnote 4, which is used to support this claim:

This analysis provides evidence linking cannabis-use to adverse cardiovascular events, including MI, ischemic stroke, HF and mortality. Notably, cannabis use appears to pose a substantial and independent risk for these outcomes, even in a population without traditional cardiovascular risk factors. These findings suggest cannabis as a novel and underrecognized risk factor for cardiovascular diseases. Our study results are consistent with prior research documenting acute coronary syndrome following cannabis use (4).

My preliminary keyword search was not able to locate the full text of the linked study referenced in endnote 4, which was titled Ramphul K, Kumar N, Dhaliwal JS et al. Prevalence of cannabis consumption among acute myocardial infarction patients across various age categories over a two-decade span in the United States. Curr Probl Cardiol 2024;49:102555

The search was able to find the first page of the study, with a reference to the survey data used in the research:

An estimated 20,041,408 AMI cases were studied and overall, the use of cannabis rose from 0.20 % in 2001-2005 to reach 1.76 % in2016-2020 (ptrend <0.01) (Table 1). The prevalence of cannabis use among AMI cases of patients <18 years fluctuated rising from 5.67 % in 2001-2005 to 7.41 % in 2006-2010. However, a drop was seen in 2011-2015 as it reached 5.26 %, followed by a surge in 2016-2020 to 8.09 %. This trend was not statistically significant (ptrend =0.19). Patients of ages 18-34 had the highest overall prevalence of cannabis with 9.44 %, and their use constantly increased from 5.23 % in 2001-2005 to 12.49 % in 2006-2020 (ptrend<0.01). Similar sharp rise was noted in patients aged 34-49 (0.98 % in 2001-2005 to 6.09 % in 2006-2020, ptrend<0.01), 50-60 (0.28 % in 2001-2005 to 3.42 % in 2006-2020, ptrend<0.01), and >60(0.01 % in 2001-2005 to 0.68 % in 2006-2020, ptrend<0.01)

That paper appears to have focused entirely on the changing percentages of cannabis-using myocardial infaction patients between the years 2000-2020, the data showing a marked increase in the percentage of identified cannabis users. (Note the ambitious size of the study: over 20 million cases in all age groups, compiled over 20 years.)

The results of my keyword search also turned up a related paper by the same authors published in the same month as the Current Problems in Cardiology article, June 2024, appearing in the Archives of Medical Science for Atherosclerotic Diseases. The full text of the study is available, and linked here https://amsad.termedia.pl/Unmasking-the-cannabis-paradox-in-hospital-outcomes-of-cannabis-users-admitted-with,189731,0,2.html

This study also reviewed a massive number of cases- nearly 10 million. The AMS study also goes into considerable detail in investigating data correlations between cannabis use and heart attacks and ischemic stroke, with detailed tables of possible confounding factors in order to produce a properly weighted comparative result. The co-morbidities examined are measured slightly differently, but most of them overlap. The JACC study includes factors like pregnancy and history of cancer, and the AMS study does not. Perhaps the most significant difference is that the JACC study makes no mention of screening for alcohol abuse.

Crucially, unlike the JACC data set, the cannabis using cohort does not consist exclusively of those identified in medical records as being diagnosed with Cannabis Use Disorder.

The abstract of the June 2024 AMS study:

Introduction:
Cannabis is increasingly becoming a socially acceptable substance, with multiple countries having legalised its consumption. Epidemiological studies have demonstrated an association between cannabis use and an increased risk of developing coronary artery disease. However, there is a lack of studies about the influence of cannabis consumption on the outcomes following acute myocardial infarction (AMI).

Material and methods:
We retrospectively analysed hospitalised patients with a primary diagnosis of AMI from the 2001 to 2020 National Inpatient Sample (NIS). Pearson’s X² tests were applied to categorical variables, and t-tests for continuous variables. We conducted a 1:1 propensity score matching (PSM). Multivariate regression models were deployed on the PSM sample to estimate the differences in several events and all-cause mortality.

Results:
A total of 9,930,007 AMI patients were studied, of whom 117,641 (1.2%) reported cannabis use. Cannabis users had lower odds of atrial fibrillation (aOR = 0.902, p < 0.01), ventricular fibrillation (aOR = 0.919, p < 0.01), cardiogenic shock (aOR = 0.730, p < 0.01), acute ischaemic stroke (aOR = 0.825, p < 0.01), cardiac arrest (aOR = 0.936, p = 0.010), undergoing PCI (aOR = 0.826, p < 0.01), using IABP (aOR = 0.835, p < 0.01), and all-cause mortality (aOR = 0.640, p < 0.01), but with higher odds of supraventricular tachycardia (aOR = 1.104, p < 0.01), ventricular tachycardia (aOR = 1.054, p < 0.01), CABG use (aOR = 1.040, p = 0.010), and acute kidney injury (aOR = 1.103, p < 0.01).

Conclusions:
Among patients aged 18–80 years admitted to hospital with AMI between 2001 and 2020 in the United States, cannabis use was associated with lower risks of cardiogenic shock, acute ischaemic stroke, cardiac arrest, PCI use, and in-hospital mortality.

The last passage was set in bold type by myself. The words are those of the study authors: lower risks of cardiogenic shock, acute ischaemic stroke, cardiac arrest, PCI use, and in-hospital mortality.

I have to wonder why the authors of the JACC study did not include this study as one of their references. Granted, it undercuts their own claims entirely.

The whole thing kicked off in the mid-1990s, when Purdue pharma salespeople were doing all the "drug education" for doctors who hadn't had any in medical school, telling them it was okay to prescribe Oxy for every little back sprain. Typical "time release" dose was 40mg- 8 times as much as 5mg Percodan that was the same drug. All anyone had to do was chew the pill and boom, better than street heroin. Powerful enough that overdoses from Oxy outpaced heroin by the end of the 2000s. So the Feds cracked down on the pill mills, and now most every state is signed up to a central Federal database, which should have been policy 25 years before it happened.

But the rapid cutoff of legit manufactured pills without any alternatives available led the addicts to the street heroin market, which rapidly turned into the fentanyl market, because this is the age of designer drugs. And ever since fentanyl, we've had a REAL drug problem. 30 times the number of overdoses, compared with heroin in the 1990s. 4-5 times the annual death toll from Oxycontin and the other prescription opioid pills in the first decade of the 2000s.

Nowadays the surveys show that teenagers are scared off of opioids, because almost all of them are aware of the counterfeit problem and the fentanyl contamination problem that affects other drugs. New users of opioids are down by 2/3 in the early 2020s- but the cartels have started to put it into every drug that passes through their hands, and it's gotten dirt cheap.

At a dollar a pill, some suckers will try that shit. It's an attractive introductory offer. It does, however, speak well of teenagers that even classic type-R adolescent males know better than to mess with fentanyl. Nope. If there’s a policy to have, it’s that.

There’s an effective way to save people curious about opioids—it’s inevitable that there will be some—from the folly of relying on the street market. We need a legal opioid option for adult consumers, like opium cough medicine, quantity and ID controlled at each outlet.* We have the technology to do it: I've had my ID copied when purchasing a 6-pack of beer, I've bought booze from stores with quantity limits. We can do the same thing for people buying a bottle of liquid suspension of opium. Also, tightly regulated physician prescribed opioid maintenance for the people with the heaviest habits. The rest of the opioids should remain illegal, but the criminal marketplace will shrink drastically, and that's the most important thing. Not a perfect solution, but it would work a lot better than most people think. I’m fine with throwing the book at anyone who sells to minors, or who diverts supplies to the illicit market.

Straight talk: I'm tired of hearing the problems of our catastrophic Drug War policy diverted into another issue. Drug use is overwhelmingly voluntary. That’s the part of the decision path that matters the most. Consider that drug and alcohol consumption is a situation where men are just plain more reckless with their decisions than women: males start underage more often, they experiment more widely, they take more dangerous drugs, they combine them together more, they care less about the source, they take them in greater quantities, they get addicted more often than females. As a result, men die from overdoses 2-3 times as often as women. https://www.nih.gov/news-events/news-releases/men-died-overdose-2-3-times-greater-rate-women-us-2020-2021

That situation will not be helped by targeting Anti-Male Sexism.

It isn't Misandry. It's Us, males. XYs. Most of drug addiction is a side effect of Type-R personality, which has a heavily male bias. Drugs are the wrong place to push limits and take risks, because there's no effort involved beyond ingestion, and hence none of the natural checks and brakes that are part of most other type-R challenges. The reward from ingesting a substance comes in one step, bypassing any authentic benefit from testing ones limits. (1) Men like to find an edge to be tested with, but drugs are deceptive like nothing else. It's like testing how deep you can sink in quicksand. And as Stupid Guy Tricks go, playing with drugs that can swallow you whole seems to have an enduring popularity.

I'm recommending liberalizing the laws on a dilute opium formulations because nothing else is going to ensure regulated product safety and starve the money supply of the criminal business, which has been booming for half a century. That's the only reason. I'm advocating it because I throw up my hands.People are going to do what they’re going to do, especially my fellow Americans. I’d like to see more social responsibility and a less self-absorbed notion of individual autonomy in my society, but that’s a long term project—and one that, in my opinion, is severely undercut by a regime of severely coercive prohibitions applied to even the mildest opioids. If some people want to get high on opioids, let them have them. In a safer form, one less frightfully lethal than the fentanyl and other super-potent synthetic opioids that are rampant on the illicit retail market.

I'm also tired of seeing Criminal Culture continuing to assert—inevitably, due to its economic clout—a controlling influence in the realm of music lyrics, music venues, clothing fashions, slang, the youth attitudes of cynicism, nihilism, conspicuous consumption materialism, alienation, the social divides.(2) The guns, the violence, the home invasions, the internecine gang wars, the climate of lawlessness that's resulted from decades of over-policing peoples personal decisions. We know that some of those decisions are reckless per se, when it comes to drug use. The lawlessness of criminalization makes those hazards incomparably worse.

Alcohol Prohibition repeal stopped the 14-year process of the gangsterfication of America- for a while. Then it came back worse with Other Prohibited Drugs, 30-odd years later. No top-down conspiracy- just the return of the repressed, plus the mobility and affluence of postwar American society, in an era when half of the country was under age 30.(3) And this society has been in denial about it ever since. For over 50 years. Roughly three generations, according to the 18-year rule. A time period four times as long as the duration of Alcohol Prohibition, with its 14-year span of the Roaring 20s, Jay Gatsby, the introduction of coed college students to binge drinking. The 1920s was the era that invented the drive-by shooting. How much worse is the decadence and corruption now than it was then- I dunno, 50 times worse, 100 times worse?

All that needs to end. We need to face the answer and take the steps required to provide safe and mild opioids in regulated quantities at licensed outlets, instead of forcing the users and addicts to the ultrapotent lethal on the street market. We have to divert enough demand to legally regulated sources and rigorously supply-controlled physician prescription addict maintenance to shrink the illicit and diversion market down to a level where law enforcement stands a chance of being effective.

But, sure, go on. Let’s go in unproductive circles with blame games. Blame it on neglected men, not getting our egos stroked enough, dying "deaths of despair." The despair is real. But very often the despair shows up at the end stage of addiction, not the beginning. Read some of the stories anonymously recounted in reddit threads on opioids or alcoholism or meth or anything that users get over their heads with. The ride often feels so carefree at the outset. So carefree that few of the addicts even read so much as a single piece of paper outlining the hazards. Especially not the fine print. Most of the illegal drug users I know just jumped in head first, beginning as teenagers- purchasing their products, incidentally, from their schoolmates. Most of them have been men. Nobody pushed them. Some of them have fallen hard. Both the men and the women in that situation deserve a better fate than to be pushed into a corner and poked at with sticks, at the mercy of both their criminal suppliers and the guards of their jail cells.

1. Yes, psychedelic drugs are a different story. But only in respect to the fact that the experience often has the aspects of an ordeal, struggle, existential challenge, particularly at high dosage amounts. But it’s also important to note that none of those disorienting and occasionally terrifying effects entirely discourage the instinctual inclination of some males to push limits, in both quantity and frequency of use, often as a competitive exercise. Or to gain some imagined extra level of “enlightenment”, of “trascendent consciousness”, based on the postulate that More Must Be Better. If only it was that simple.

2. Some readers might think they’re encountering an indictment of Blackness and Black Culture here. What a racist assumption. As if Criminal Culture could only be Black Culture. As if Black Culture could only be Criminal Culture.

3. The most “top-down conspiracy” feature of the Illegal Drug Culture is the Criminal Monopoly over the supply of the high-demand substances, which is a side effect ordained by Drug Prohibition. I’m not conspiracy-brained enough to claim that the lawmakers intended the results that have followed. All that “Sixties Counterculture Was A CIA Project That Worked” fake history narrative? That vaguely insinuative “Weird Scenes Inside The Canyon” drivel? Dope, Inc. by Lyndon LaRouche’s EIR? Rat dung. Anybody who thinks they can challenge me on that conclusion had better have read this Book List, because I have. Read. All of them. I own most of them, as hard copies. So I know that just because LaRouche’s mysteriously durable org cribbed a few provocative passages from some of those books, that does not make the narrative interpretation found in Dope, Inc. anything other than stem-winding nonsense. Written for the sort of audience that thinks a “bread-crumb trail” is a pathway to the Concealed Truths of History, rather than the original meaning of “bread-crumb trail”: a trail of false clues that appear to be valuable data, used for the purpose of misleading the researcher. The classical definition. The “MI6/CIA/FSB/every intelligence agency out there” meaning.

   Yes, there was an MK-ULTRA, and MK-NAOMI, and similar projects. But they were local beta test experiments that did not yield success, because psychedelic experiences defy predictability. CIA researchers weren’t even able to use those substances to produce predictable results in clinical settings, much less controlling the youth culture from above like Svengalis. Just imagine the reports to headquarters if the Agency ever ran across Steve Jobs and tracked his life path between age 15 and 22, for example. Their minds must have been already blown by acidhead cases like Tim Scully- of whom the Feds were most assuredly aware, at least after he was arrested, convicted, and sent to Federal prison. Read that last link. Read about Scully’s accomplishments, even before he was arrested for LSD manufacture at the age of 24.

   Respect your Baby Boomer geniuses. Don’t insult your own intelligence on this matter, either. I don’t doubt that intelligence agencies—from all over, potentially—still surveill the psychedelic scene, and some of the more well-known people associated with it. But the CIA doesn’t run it behind the scenes. That genie escaped their grasp around 1964.

   By contrast, the Social Media platforms, entirely legal, have provably been effectively and profitably engineered as a mind control project with impacts that exceed the wildest imaginations of 1950s MK-ULTRA investigators. It can’t be said to be a conspiracy any more, because this information is public and widely known. But it started out as one. All nice and legal-like, to be sure.

   My way of dealing with this circumstance of Modernity is to treat my cellphone as a phone, not as source of information or communication on the Internet, much less a social media feed. The phone in itself is only a problem if it’s misused; it isn’t a conspiracy, Steve Jobs could not have anticipated the way it would eventually be adapted for social media. But the phone is easily misused. I often leave mine off, or at home- a much healthier option than many suspect. I almost never use a phone to read news on the Internet, and I never use it to chat of “platforms.” I use a laptop, an adult computer; the keyword search and multiple reference link capabilities are incomparably superior, simply as a function of screen and keyboard size. (I suspect that most Substack readers use phones, because few of you bother to offer link support for your Substack comments. You basically talk through your hats. For cheap talk, and worthless talk.)

   I pick and choose my social media selectively, aware that there was plenty of social media available in the pre-Facebook era. We just didn’t call it social media back then. I can’t stand being fed by an algorithm. Fortunately, I can ignore it on Substack. Beware: the Information Stovepipe is Mind Control. That goes a long way toward solving the mind control situation, which is real- and actually quite concerning, viewed from the outside looking in. The rest of you are on your own. But you should know what you’ve gotten yourselves into, if you’re an addict of the Attention Economy. You’ve been recruited to join a mind control project. As a test subject.

Not this time.

The Drug War is in a funny place right now; in the 1980s, only pariahs said that it was doomed to fail. By the 1990s, bemoaning the failure of the Drug War became an more widely held sentiment; as of today, 2024, it’s the prevailing attitude. So much so that many journalists and politicians are referring to the “War on Drugs” in the past tense, as if the campaign of militarized enforcement and incarceration to Stop Drugs had ended. That is not the reality of the situation.

There have undeniably been some important moves made, particularly in the direction of liberalizing the marijuana laws. Some states have gone so far as to make legal provision for a regulated and age-restricted market in cannabis. But the local-regional regimes of legalization have also enabled the rise of a multibillion-dollar market in cannabis cultivated in commercial quantities for the purpose of diversion to the states where cannabis remains illegal. And the bottom line is that the Federal criminal laws have remained unchanged. Largely unenforced, except on Federal land, but still on the books.

Uneven enforcement of criminal statutes forbidding drugs has been as much rule as exception for nearly a half-century, in varying degrees. For the first 30 or so years after Federal marijuana prohibition was enacted in 1937, “crime was crime”; anyone arrested with a few marijuana cigarettes was looking at jail time, and anyone who sold or even gave a couple of joints to someone else faced a felony rap with prison time. Probably the most notorious case—although not an isolated one—was Beat culture hero Neal Cassady, who served two years in San Quentin in 1958 for obtaining a few joints of pot for an acquaintance who turned out to be a narcotics officer. Then the 1960s youth culture emerged—first in California and the Northeast, and then, first gradually and then suddenly, Everywhere: by the early 1970s, marijuana use had become common even among social classes and subcultures formerly dead-set against it. This could play out in very capricious ways; by the end of the 1960s, nearly all college campuses in the Northeast were informally treated as safe zones for drug use, possession, and retail dealing- but in less favored social environments and in other parts of the country, possession of only a few grams could still land the hapless arrestee in jail. As late as the 1980s, I recall reading a newspaper column written by a judge about an Arkansas case where a young kid in his early 20s was arrested and summarily jailed for a small amount of pot, and then gang-raped behind bars. I doubt that was the only time that happened, in the early years of the Drug War. It isn’t a history that scholarly researchers have pursued as a research topic, but I’d venture that a sufficiently thorough search of the relevant records would yield a partial accounting of such atrocities, along with other details of the impacts of draconian criminalization regimes on people whose only criminal transgression was violating the drug possession laws. That historical accounting isn’t a research project that anyone is really ready to undertake, at present. But the reality of the phenomenon undoubtedly accounts for most of the increased court leniency toward marijuana possession offenses that began in the late 1960s in some locales, extending over time until it became routine practice for first offense marijuana possession across most of the country by the 1990s. In fact, beginning in the 1980s, similar leniency began to be routinely extended toward first offense personal possession of other substances; in many jurisdictions, the main motivation was an effort to clear overloaded court dockets. The dockets often remained overloaded, but not hopelessly so. At least, not as hopelessly so as formerly.

This leniency toward first offenders in drug possession cases is often used by defenders of the Drug War status quo as proof that the worst injustices of Drug Prohibition have been ameliorated on a wide scale, and that the biggest obstacle to success at cracking the Drug Problem is the currently inadequate government funding of “education and treatment” to help the offending user population, of “addicts.”

Not hardly.

I agree that publicly funded addict rehabilitation is underfunded overall, and even practically unavailable in a lot of jurisdictions, compared to the number of people who are seeking it. The problem is that a focus on “stopping addiction”—on users alone—will never solve the core problem, which is the existence of the burgeoning illicit market. Consider that during Prohibition War I- the one against alcohol, 1920-1933- personal possession of alcohol was not Federally criminalized, and only rarely enforced in the few jurisdictions where personal possession was deemed a criminal offense. Prohibition War I targeted the Illicit Trade, nrade, not the users. It failed because it became widely recognized that the efforts to stop the Illicit Trade were not only ineffective, but terribly counterproductive as far as deterring the violent crime and epidemic corruption connected with the Illicit Market. The Underground Empire, then and now. Organized Crime syndicates. The people often referred to nowadays as the Drug Dealers. The Drug Gangs. The Cartels. The 1920s were the first era of the Drive-By Shooting.

Fourteen years was sufficient for the logic of Prohibition Repeal to be widely accepted by Americans in 1933. In 2024, we’re still fighting a War on (some other) Drugs that has been going in for 100 years, in some of its most crucial aspects. Although the real escalation of the Drug War began in the mid-1960s, officially certified with an emphasis on globalizing the War during the Nixon administration. And the real big-budget crackdown didn’t begin until the era of the Reagan administration, which was still under the mistaken impression that the American market in prohibited drugs could be eradicated by a sustained law enforcement push. That is not what happened.

Instead, what began happening is that so many people got busted that eventually the courts had to set up quasi-official leniency regimes to deal with the overload of drug offenders. One interesting aspect being that the same leniency was even sometimes extended to small-time retail dealers- and in some jurisdictions, to dealers caught with quantities of powder drugs, like cocaine, that were more like wholesale quantities. There’s been a lot of talk and ink spilled over the draconian Federal mandatory minimum penalties for “crack” vs. powder cocaine that were a provision in the antidrug gavel-pounding passed by Congress in 1986. Federal mandatory minimums mean that no judge can modify the sentence, and also that the convict has to do 80% of the time (for non-mandatory felonies, including crimes like rape and manslaughter, most convicts are eligible for parole once 50% of their time is served, or even less.) The old Federal drug mandatories decreed a minimum 5 year sentence for possession of 5 grams of freebase cocaine, “crack”; the same Federal 5-year sentence for cocaine hydrochloride, “powder”, required 500 grams in order to be applied. Those provisions were grotesquely irrational and unjust, and I applaud their repeal. But it’s a little-known fact that most crack and cocaine possession cases are not prosecuted as Federal offenses. They’re prosecuted in State courts, and most states have more lenient provisions than a bottom line of 5 year mandatory imprisonment. And—depending on the jurisdiction, and the decision of the individual prosecutor assigned to the case- it’s entirely possible to bargain down a quantity of drugs that both the statutes and ordinary good sense says is a saleable quantity, a felony, down to a personal possession charge- and, sometimes, from there to a drug court diversion. This prosecutorial discretion is mostly an admission that the illicit drug economy has overwhelmed the local courts. It’s also an attractive opening for corrupting DAs and judges, but in my observation that motive doesn’t account for most of the leniency in plea bargaining possession of large quantities down to the level of personal possession misdemeanors. It’s mostly about clearing the dockets. The thing is, few of the dealers who get those bargains—typically for their first arrest—take that leniency as a signal to immediately quit the game. People arrested for multi-ounce quantities of cocaine are almost always in too deep to want to quit- not quit using; quit dealing. To quit depending on cocaine for their income. They may not be able to quit—they might face the prospect of foregoing an illegal business and immediately having a formerly lucrative income dropping to zero. Hunting for a legitimate job with little or no experience or resume to show anyone who does the hiring.

That’s the Business of Illegal Drug Dealing for you: it’s an Attractive Nuisance. A job making good money, cash on the barrelhead, calling your own hours, that’s also a crime. Typically as participation in a continuing criminal enterprise. A multilevel marketing scheme, only with a product so in demand that it practically sells itself. A be-your-own-boss marketing opportunity, sometimes beginning at age 12. Although most of the entry-level retail marketers run a bit older than that, almost all of them start by age 17; hardly anyone goes into the street drug game for the first time in their 20s. The weirdly capricious System that makes and enforces the ground rules of the Game has included a loophole that confers a unique advantage to teenage participation in the illicit drug economy: the legal status of Juvenile. It’s as if the law clears the books and resets the counter, and nothing that happens before age 18 counts. Teenagers are still liable to get busted and convicted—including for serious violent offenses—and the legal consequences don’t follow them into adulthood. But other consequences often do, for the Minors who don’t merely dabble in dealing drugs but find the Game sufficiently rewarding that it seems like it would make a Career. Typically at the expense of the legitimate, law-abiding paths available. However, this isn’t widely recognized by 16-year old teenage boys. Especially those growing up in “low-income households”- which could mean any circumstance from a hardworking, law-abiding Christian mother working two jobs and leaving her son as a latchkey kid, to a teenager coping with dire poverty in a household so dysfunctional and insecure that they abandon it to shift for themselves on the streets.

So, yeah, nowadays the Drug War is real lenient on Drugs- at first. From minor status and juvenile conviction records sealed at age 18, to Drug Courts, to prosecutors bargaining down hard-drugs possession cases to misdemeanor offenses that are even sometimes eligible for “diversion” and having the record wiped are a few years, if its a first offense. A way out for the users, perhaps. But for dealers, the early leniency of the courts is just a setup for an eventual fall. Makes for more extended vacancies in the resume.

But there’s more to the story than that. The real hardcore criminality of the Drug Dealing industry is more than simply a matter of trafficking in forbidden substances. The Drug Industry is like the pawn shop business- except that the pawn shop business is legal. It’s routine for pawnbrokers to carry a firearm when they close up for the night and take the bundle they’ve made from their all-cash business with them. If someone tries to rob them and they have to pull the trigger, they get to do that—legally; they’re in fear of life and limb, from someone trying to deprive them of their livelihood. They’re able to protect themselves against the burglary of the inventory of their legally chartered, sign-advertised business establishment with shutters and locks, and they’ve made arrangements with insurance companies to recover losses and damages in the event of theft.

The business of dealing illicit drugs has none of that. Their weapons possession is a felony (illegal gun possession is most often listed in crime statistics as a “violent” felony); they aren’t able to open a brick and mortar storefront (at least not without risking a police raid); their business assets are not eligible for insurance protection. As if that wasn’t vulnerability enough, the goods that they deal in are practically as compact and fungible as cash. Thousands of dollars worth of powder drugs can be carried in ones pants pockets. Tens of thousands of dollars worth of that inventory can be carried in a backpack. And while these goods aren’t as fungible as currency-- legal tender—they’re easier to sell than, say, a stolen guitar or computer.

Maybe some readers can see where I’m heading with this.

The business of dealing drugs on the street seems so easy at first that it’s like instant money. The easiest entry-level job someone could have. Until someone robs you, and it’s understood that the police are no help at all. Your bottom line of protection is you alone- your physical courage, your ability to engage in physical violence- including carrying a pistol and willing to pull the trigger, if need be. But as a rule, that isn’t enough. You need friends in the same position as yourself, for mutual assistance and protection. A crew, a posse. A Gang. Organized crime. Then personal security gets much easier, in some ways. Although not in others. As the saying goes, when It’s On. Crew vs. crew. And all of it a Criminal Conspiracy. Arrest, conviction, and time behind bars the price of doing business, fully understood. At least by adults, after that first bust. Especially by the adults who realize that they’re in too deep to just walk away from the business just like that. So most of the people who stay in the illegal business of forbidden drugs for any length of time eventually find the need to protect their business with violence.

How many of the “nondrug” felonies that have landed people in prison can be traced back to their involvement with dealing drugs from an early age? Those statistics are not publicly available—and may not be available at all, not even as an estimate. I doubt that they’ve even been compiled, at least not in a comprehensive, authoritative way, on a large scale basis. How many murders are due to gang involvement- especially in the cities with the highest murder rates and the lowest case clearances? Those details are often only found in police reports that note details like gang tattoos, clothing signifiers, other physical evidence traces. Or details found in the decedents police record.

Those details have seldom been included in crime statistics; when they have been noted, it’s only done as a project within local police jurisdictions, and not tracked comprehensively and annually, the way more general indicators are compiled by agencies like the FBI. Bearing in mind that not all victims of gang-related homicides are gang members, or even intended targets.

According to this 2022 Atlantic magazine article,

In the 1960s, more than 90 percent of all homicides were “cleared” by police, with an arrest or the identification of a dead suspect. But the clearance rate has declined in each of the past six decades. In the most recent data available from the FBI, the clearance rate hit an all-time low of just over 50 percent. That means that about half of all murders in the United States today go unsolved.

In the conversation between Derek Thompson and Jeff Asher, there are six factors affecting this situation: 1) some of the decline is said to be due to paper inflation of the clearance rate in the 1960s and 1970s by police. 2) The decline in the of the use of unethical “3rd degree” interrogation tactics in the aftermath of the Miranda decision was also said to be a factor in the lower closing rate, down to about 70%.

Then something changes that accelerates this gradual decline, beginning in the 1980s. Among other clues, 3) many more murders are committed with firearms.

Asher: In the 1960s, about 50 percent of murders were committed with guns. Today, almost 80 percent of murders are committed with guns. And the share of murders committed by firearms has crept up at a nearly identical rate to the steady decline of murder clearances. Correlation does not equal causation, but if you plot the two together, you see a very strong correlation in the last 40 years.

I think this point is important, because Asher goes on to point out that firearms murders are more likely to involve killing from a distance, and they’re therefore inherently more difficult to investigate. Which is true, as far as it goes.

But there’s an alternate narrative here. And it accounts for an angle that Asher and Thompson never mention: the rise of the economic power of the gangs, which among other things made them a key consumer market for expensive pistols and automatic weapons. There had been gangs in the big cities for years- some of them quite large, notably the gangs of Chicago. But only the gangs turned into street retail drug syndicates really made crime pay, in the 1980s. In the last 40 years.

Organized gangs involved in continuing criminal enterprises enforce a No Snitching rule.

The no snitching rule is already everyone’s teenage code, at least in the US. Most everyone knows to keep their mouth shut about some things they’ve learned. Some even understand the resilient imperative of the rule as adults, depending on the circumstances. Including law-abiding citizens of a neighborhood where the illicit trade is powerful and wealthy. The gangs enforce that rule with the death penalty. That’s probably the single most important reason for low murder clearance rates in some neighborhoods: everyone who knows incriminating details scared into silence. It gets to be taken for granted that talking to the police leads to trouble.

Thompson and Asher never mention this reality, just like they never mention the connection between the gangs and the increase in sales of high-powered assault weapons and pistols that began in the 1980s.

The 4th explanation presented is “higher standards from district attorneys and juries.” The hypothesis that the threshold of evidence required for a jury conviction has been raised so high in the public mind that DAs find it tougher to make the decision to bring a murder case to trial. Asher demurs that “we don’t have great data to know for sure if this is a big deal.”

The 5th explanation:

Thompson: Explanation No. 5 is racism. I’ve seen evidence that the clearance rate for Black victims in the last few decades has gone down while the clearance rate for white victims has gone up. That is, the cops are better at solving crimes when the victim is white, and as Black Americans make up a larger share of murder victims, the police solve fewer crimes.

Asher: There is obviously racism in the criminal-justice system and in policing. But are police getting more racist every decade, for 60 years? I don’t know. We don’t have clearance rates broken down by race as clearly as you suggest…

Thompson: How do you feel about this explanation: As Black victims of gun murders have increased as a share of all gun-murder victims, the poor relations between Black Americans and police officers have made it harder for the police to get evidence about who might have committed these murders. And therefore, the impression, often accurate, of police being racist feeds into Black Americans being less responsive to and less cooperative with police, which then feeds into a lower clearance rate for Black victims of gun homicides.

Asher: That’s the entire thesis of Jill Leovy’s Ghettoside. I think that it’s certainly plausible. There are certain neighborhoods where the police just don’t solve murders. In New Orleans, 90 percent of murders in the French Quarter are going to be solved. A mile away in the Seventh Ward, maybe 15 percent of those cases are being solved. The geography of murder is very important. Certain communities don’t trust the police. They don’t trust the state. They take things into their own hands. And it sort of creates a cycle of violence that’s very difficult to interrupt, because you don’t have that initial layer of trust in the police to have a monopoly on violence.

That’s obfuscation. We’re talking about Murders here, not merely the myriad other sorts of conduct that people keep their mouths shut about when it comes to police. People who witness murders and then don’t talk don’t do it out of fear of the police. They do it out of fear of getting murdered themselves. It is calumny, to blame the police for the people intimidated by the criminals in their own neighborhoods.Those folks have an all-too-valid excuse for their silence—one related to a threat that’s a lot more immediate than Police Racism. There are people in their own neighborhood who might kill them if they disclose what they know. In some cases, they might not be able to move away far enough as a protected witness to escape retaliation. How is this not even brought up, as a real-world dilemma for the witnesses?

Thompson: I wonder if some police are just not doing their jobs. Is it possible the quality of detective work is just much worse than it used to be? Police today spend much of their time clearing homelessness or responding to mental-health crises in downtown areas. That’s not being a detective. That’s being a social worker with a gun in your pocket.

That…I mean…I’ve never been a cop. But I know the meaning of the words “don’t tell me how to do my job.” You never did that job. You don’t know what it is. That’s some flimsy speculation, and flimsy speculation doesn’t make the person saying it sound very wise. So maybe that should be rephrased. The way I’d put it is that you can’t fight a War On Drugs- including dealing with the late-stage collateral damage that has piled up after decades of expensive failure- and support a priority of fighting crime at the same time.

Asher: This isn’t something we can measure in a satisfying way. But something we’ve seen is police numbers dwindling or flatlining while violence has increased. Let’s say you have 30 detectives who are investigating 150 murders. That’s five murders per detective, which is the standard. But if violence doubles and some officers leave to retire or go work in the suburbs, 250 murders among 25 officers is 10 cases per person. Now you’re going to have a harder time solving murders. And I think that you’re probably seeing some of that, especially since 2020.

Good point. Fewer police can lead to more problems. Fewer seasoned professionals can lead to less productive investigations. Fewer people want to be cops any more, especially in most of the big cities, especially in neighborhoods gone gangster. 40 years after the rise of the streetcorner retail trade in high-dollar, high-demand cocaine, there are still plenty of pistols around. Street retail isn’t the glamor job it used to be, now that the clientele has shifted to opioid users. But the money still rolls around. The demimonde ebbs and flows. The antisocial values of criminality become endemic.

Some people find a way out.

5 things I learned living in the projects--Latimore

As long as the crews and the gangs and the castaways of Pinocchio’s Pleasure Island are a neighborhood institution as role models of upward mobility, or anyway ‘doing-what-I-gotta-do’ “survival”, the neighborhoods will not cure themselves. The simple addition of more police to the force will not cure them, either.

Thompson: I count six possible explanations for the decline in the clearance rate. One: The 1960s numbers were bunk. Two: The effects of Miranda. Three: Guns. Four: Higher standards from juries and DAs. Five: Racism and distrust between police and Black communities. Six: Fewer and overextended police officers. With the understanding that crime data is imperfect and that these are all hypotheses, which one explains most of the decline in clearance over the last 30 years.

Asher: It’s the guns. The nature of murder in America is changing in ways that we don’t really talk about enough. You’ve got a bunch of cities where firearms make up 80 to 90 percent of murders today. That is the main driver. Guns make murders much harder to solve, and it leads to lower clearance rates everywhere.

At the risk of sounding cliche: guns don’t kill people, any more than lawnmowers decide all by themselves to take advantage of a cool spell and a clear afternoon to cut the grass. I think we have entirely too many guns in this country, and the swerve in the retail gun trade from bolt-action hunting rifles to paramilitary gear was not something I would have anticipated in the 1960s and 1970s. Few Americans back then would have approved of it. It began with the arms race of the 1980s, between the crack gangs and the police TAC squads. And then all of those gang-related rifles somehow caught on as a Consumer Item, just like TV shows about drug dealing, police, and prisons have caught on. Meanwhile, the possibility of being victimized by violent street criminals has gotten to feel like more of a threat to a lot of us, particularly those Americans in the less favored neighborhoods. Much of the problem is overblown, but the part that isn’t is no joke. People want to be prepared to handle things in the moment, when it counts.

That’s how it is. And it’s probably the case that somewhere in the State-generated condition of bureaucratic Iatrogenesis that built all of those extra prisons in the 1980s and 1990s there’s at least one kid who got in over his head in the wrong retail trade and pulled the trigger in a case of him-or-me self-defense that couldn’t be sold to a jury because Drugs, now doing life in prison. That is not justice, it is not Stopping Drugs, it is not stopping the demand for firearms, legal or otherwise. Think about what leads to some of these murders. Big business, and its discontents. Look at how slipshod the statistics data is. How many uncleared cases involve automatic weapons fire, certain types of ammunition, extended gun battles, execution-style modus operandi? No one is tabulating that as a subcategory, paying attention to the running total? No one paying attention there? I can find more details in relation to traffic fatalities, at least in terms of easily reviewable publicly accessible data.

And yes, to the dismay of you Second Amendment Absolutist Fanatics in the audience, I do support a national regime of accountability for firearms owners. Including a ban on some of the Force Multiplier weaponry out there. Even though I realize that the ship has sailed, we don’t need any more new additions to the voluminous inventory of paramilitary firearms out there already. But I’m not under any illusion that more firearms regulation is the key to restoring civic order in crime-beleaguered neighborhoods, or public confidence in the police.

The factor leading to most of the increase in uncleared cases is the organized crime monopoly over the trade in prohibited drugs. Directly or indirectly. A comprehensive overhaul of the drugs laws is overdue. As of now, the still-continuing War On Drugs is the dry rot of public policy.

Neither Derek Thompson or Jeff Asher uttered the words "drugs" or "gangs" anywhere in the excerpted podcast interview, much less devoting any attention to how those factors might have influenced the decades-long decline in the homicide clearance rate.

One of the most important misdirections in American politics is for the political establishment of both parties insistence on solving the drugs&crime problem at the wrong end, as if it began and ended with problems related to criminal law enforcement, police, and prisons. Because hey, if we're talking an Official Government Response by a law-making body, that's the occupational sector to be focused on, at that End. After the damage has already been done and the cascading problems are being handled (as much as possible, after it's too late) by people careening around with Code 3 sirens on and lights flashing. And then elements of the confused public demand that Official Government Inquiries nit-pick over every exceptional incident of violent policing, when all of the unjustifiable force incidents combined don't add up to the casualty toll of a three day weekend in the same city. "Looking for those dropped keys under the streetlight": the Government exerts Policy control and accountability over policing procedures, so they focus on fixing that. They sure can't threaten the gangs with disciplinary action, can they? Those streets are a gray wall of silence. And those dropped keys are to be found in the Shadow side of Official Government Policy- the Prohibition-enabled illegal drugs economy. But the Lawmakers don't examine their own flawed decisions in relation that situation. Instead, they leave those burdens for the Police to carry. At the back end, after all of the damage has been done, as a result of an illicit market in forbidden substances with currency-like fungibility.

We also need to stop resorting to euphemisms like “mass incarceration”, when the heart of the incarceration problem is and has always been the War On Drugs.

I know, I know: “only 20% of Americans are imprisoned for drug offenses”, or some statistic similarly small in percentage, if not in number. From my reading, everyone asserting that statistic simply stops looking into the illicit drugs economy any further, as if that statistic closed the case: the War On Drugs is not the significant cause it’s said to be, let’s talk about Race instead- most often, with the most hostile and polarized extreme positions dominating the conversation. Or, for the liberals in the middle, the discussion tends to divert toward vague generality that can be finessed with rhetoric.

What’s being ignored are the indirect impacts of the illicit drugs economy; the way that the illicit trade generates other criminal offenses—notably crimes of violence—and the social entropy that results when an underground drug economy becomes a cornerstone source of income- for individuals, families, urban neighborhoods, small towns, rural counties. I’m working on another post to outline some of those impacts, specifically and in more detail.

The problem begins with the legal regime of Prohibition, and the illicit economy that results in a perverse sort of regulatory capture- by organized crime and career criminals. There's an Official Government Response to that situation, too: reforming the Drug Laws. Not to be confused with a Drug User-focused solution a la Decrim or Narcan vending machines. A solution that addresses the corrupting power of the political economy of Drug Dealing. Hundreds of billions of dollars annually. Youth demand for opioids has decreased by 2/3 over the previous 10 years. But this is how far out of hand the supply situation has gotten over the last couple of years: https://kstp.com/kstp-news/top-news/price-of-illicit-fentanyl-drops-to-dangerously-cheap-in-twin-cities-metro/

"In recent months, the price of buying fentanyl on the street in the Twin Cities metro fell to $1-$2 a pill, a longtime narcotics investigator for the Hennepin County Sheriff’s Office confirmed.

That’s down from a roughly $20 price point a couple of years ago, Hennepin County Sheriff’s Major Rick Palaia said, adding that’s still about the cost far outside the metro.

Often, a single pill is more than one dose, meaning a dollar purchase could end in multiple overdoses. The “dangerously cheap” price, Maj. Palaia believes, is exacerbating what has already been a crisis. Although it’s tough to quantify such an impact, he added."

Current price of one illicitly manufactured counterfeit opioid fentanyl pill; $1. Potency uneven from pill to pill, but tending toward strong enough to be a lethal dose. A newbie could conceivably get a serious first opioid high for 25 cents. That indicates a saturation amount of supply, and low demand. Opioids don't have the fad popularity that they had ten years ago. https://adwjeditor.substack.com/p/long-term-trends-in-american-drug

But at 25 cents a pill, someone is going to bite eventually. And since fentanyl is a synthetic opioid, the overhead of manufacture is always going to be low. Given that the dosage range hovers around 1/10 of a milligram. And there are other related substances 100 times as powerful by weight.

"Speaking to the sharp price drop and asked if there’s a similar phenomenon with another illicit opioid to compare it to, Maj. Palaia said, “I’ve never seen anything like this. And I’ve been in this line of work for well over 25 years.”

I've been paying attention for more than 50 years, and I've never seen anything like this. Saturation quantities of ultra-powerful opioids imported and distributed under syndicated crime control nationwide and sold retail at Dollar Store prices- in Minnesota? In 1972, no one could have envisioned that even a science fiction scenario.

The problem of gang-controlled illicit markets has been solved before. The only thing that worked was depriving the bootleggers of their market. It's obviously going to be more complicated in the case of drugs--especially those with a scarily high lethal potential, like refined powder opiates and synthetics. I'd bet that if fentanyl were sold over the counter next to opium tincture, the fentanyl wouldn't sell until the opium was sold out- but I still wouldn't legalize fentanyl. But we're going to have to return to trusting personal adult decisions more. Opium helped to get Lewis and Clark over the Rockies and back in 1804, and it got Richard Burton through an expedition into equatorial Africa.

I never thought that I'd be endorsing the sales of limited weekly amounts of opium to adults with ID. But I never thought that I'd see the day when potentially lethal bootleg fentanyl pills were available on the street for a dollar, either.

Press reports on “marijuana poisoning” incidents have increased markedly in recent years, with particular emphasis on increases in the aftermath of commercial legalization in U.S. States like Washington, Colorado, and California. These increases are typically cited in terms of increases in percentage, without much other information provided. This post is intended to supply some of the most relevant details required to place the phenomenon of cannabis poisoning in a wider context, in order to obtain an accurate perspective on the problem. The metrics include the number and percentage of cannabis-associated incidents that were considered severe enough to require hospitalization; the number that were associated with death or lasting after-effects; and an overview of annual reports for all causes of poisoning.

Currently, even in states with commercial legalization, reports of cannabis poisoning do not feature significantly in annual poisoning reports. Other substances are much more common. Most of the reported incidents are handled with phone advice, with no need for a visit to a hospital or clinic. More than half of them involve unintentional ingestion, mostly by children.

It’s notable that most of the reported increases in cannabis poisoning incidents result from the ingestion of cannabis edibles, which are commonly marketed as confections, including the popular sugar candy known as “gummies.” Gummies are not by any means reserved for cannabis edibles, of course. Not only are they a popular candy, in recent years they’ve become widely used for vitamins and supplements. The “drug delivery system” of chewable sweets has also become a prominent feature in pediatric poisoning incidents.

For the purpose of comparison with recent reports on pediatric cannabis poisoning, I’ve chosen the supplement melatonin: in 2020, melatonin “became the most frequently ingested substance among children reported to national poison control centers.” The use of both cannabis edibles (especially in the legal states,but not exclusively) and melatonin (which is of course available OTC in all 50 states, and DC) has skyrocketed in recent years. The phenomenon of pediatric poisoning resulting from melatonin overdose hasn’t achieved the same headline prominence as the post-legalization rise in cannabis poisoning, but it has been widely reported in various press outlets. I’m using the same study that provided the basis for those mews articles for my comparison.

Both cannabis and melatonin are known to have mildly toxic physical side effects when consumed in excess by adults. The toxic effects are occasionally more serious when overdoses are consumed by children under age 6. Significantly, both cannabis edibles and melatonin are commonly marketed in the form of gummy candies, a feature that tends to make them relatively more attractive for ingestion and overconsumption, particularly overdose due to accidental ingestion by children. Neither substance features prominently in terms of producing severe poisoning or lethality, but both have seen dramatic year-to-year increases as far as being specifically identified in reports to poisoning centers and emergency room visits.

This overview has a number of the usual problems related to statistical comparisons between disparate studies of similar phenomena: the years of study often overlap but are not identical, and year-to-year totals are sometimes missing. One study relies on a 9-month time period, not a 12-month time period. The age group demographics are not subcategorized in the same way between studies. Detailed data on relationships between the tabulated severity of assessed outcomes and the associated age demographics is not presented. Detailed data on total annual numbers is sometimes not subdivided by age. As a result, I can only hazard rough estimates when offering comparisons between studies. I’m just trying to do my best with what I’ve been able to find.

(I understand that researchers are often making do with incomplete reports, and that their studies are often focusing on one central question without considering others. But how are we ever going to get to a reliable era of Big Data without studies that share a common basis of relevant metrics and parameters, with the details researched as thoroughly as possible?)

Screenshots of some of the tables and figures provided in the studies are found below.

My data summary, including estimates drawn from the data:

The number of poisonings recently reported for all cannabis products combined- flower, concentrates, edibles, etc.- is only a small fraction of the annual incidents of pediatric melatonin poisoning.

According to the study, 83.8% of cases between 2012 and 2021 involved children under the age of 6. In 2021, there were 52,563 cases of melatonin poisoning; using a rough estimate of 80%, that works out to 42,050 cases of children under 6 (age 0-5.)

In 2019, 1963 cases of cannabis poisoning by children under the age of 10 were reported to U.S. Poison Centers; there’s no detailed breakdown by year, but the ballpark average shown for the three studied years 2017-2019 is that 75% of them involved children under age 6: so 1472 cases.

The melatonin study lumps together “moderate” and “major” poisoning events as “more serious” outcomes; it also includes figures for hospitalization and ICU use, along with deaths attributed to melatonin poisoning (2). There are no annual breakdowns for the numbers of poisoning cases admitted to the hospital, or to the ICU. There are totals. Extrapolating from those figures to provide a rough estimate for the most recent year of the study, around 807 children were hospitalized in 2021, and 57 cases ended up in the ICU.

The most detailed cannabis study- for reported incidents reported to poison control centers in the US nationwide- provides the numbers for both “moderate” and “major” outcomes, but the numbers are aggregated for 2017-2019. The total number of events for children under age 10 (0-9) between 2017 and 2019 was 4172; the total number of “major” cannabis poisoning events in the three years between 2017 and 2019 was 57, or around 1.36% of 4172. Applied to the 2019 figure of 1963 cases, that indicates a total of 27 in the year 2019.

This nationwide study is notable for its focus on the role of edibles in pediatric cannabis overdose; it includes a separate category for edibles ingestion. The referenced melatonin study does not include that level of detail, which I think is an unfortunate oversight. I think it’s likely that sweetened chewables play a prominent role in both cannabis poisoning and melatonin cannabis poisoning- and also various other vitamins and supplements- in cases of toxic ingestions by small children. I view this as a fixable problem; there’s no need for that form of substance delivery for any of those products. The overdose problem would probably diminish markedly if they were banned from sale.

I’m old enough to remember getting “candy cigarettes” as Halloween candy. I also remember when were banned. The only rationale for their banning was their kinda-sorta resemblance to actual cigarettes- they were white cylinders dyed tan at one end, to resemble a cigarette filter. They were also much smaller than actual tobacco cigarettes, and no one would mistake one for the other. But that resemblance was enough to have the candies banned, on the basis that they were “grooming” children to view cigarettes as harmless, and possibly conditioning them in the direction of consumption. Compared to the current problem of child poisonings resulting from chewable sweets as a delivery method for compounds that are toxic when consumed in overdose, I think that ban is silly. But nobody ever complained that candy cigarettes were taken off the shelves, because it would have been even sillier to complain about it.

I think the situation of “active substance containing” chewable candies is much more serious; it rises to the level of being an Attractive Nuisance for children. It’s arguably even an attractive nuisance for adults; as an occasional melatonin sleep aid user (it works well, for me), I used to pop two or three chewables at once, before I found out that more than one was completely unnecessary. I was mostly prompted to eat more than one as, well, a bedtime snack…and then I had to brush my teeth, when I was done chewing them. (Or else, hmm? I learned about cavities the hard way.)

What’s up with that? This whole infantilization of adults, as if we won’t take our vitamins unless they’re formulated with sugar. 21st century modernity. A digression for another time, perhaps. I need to get back to my point: if it’s possible to cut incidents of toxic pediatric ingestion of cannabis, melatonin, and other supplements and vitamins- which number in the thousands (at minimum), annually- by 50% or more, simply by banning their compounding as chewable sweets and other candies, wouldn’t that be a good idea?

I think this is an especially important question in terms of the ramifications of cannabis legalization. Presently, pediatric cannabis overdoses are only a fraction of those resulting from melatonin. But melatonin is legally available in all 50 states, often huge jars of it with no childproofing. If cannabis becomes legalized nationwide, the number of pediatric overdoses is likely to rise considerably if THC products are sold as confections. It doesn’t matter if 85% of the poisoning incidents can be handled with a phone call. The other 15% present more serious problems- and the most severe of those cases have the potential to lead to tragic outcomes. It’s the numbers that are important here, not the percentages. Cannabis is renowned for its lack of toxicity, historically. But that long history preceded the advent of the potential for a toddler to eat a bag of THC gummies. Some of those cases have ended up in the ICU.

That’s Bad News, to be avoided. I would hope that even the cannabis industry can comprehend the liabilities of the resulting Bad Publicity. The industry needs to pay serious attention to this. If legal cannabis is associated with a death toll from pediatric poisoning, it’s no good hand-waving it with whataboutist statistical comparisons to aspirin and acetaminophen. The natural plant provides its own check on THC poisoning; raw cannabis is not an attractive edible. (I do get that toddlers can choke on anything, which means that attentive parents don’t keep pot buds within easy reach of tiny hands.) But the more THC is concentrated and the easier it is to swallow, the more problems are likely to arise, whether for children or adults. In my view, the across-the-counter commercial market should not be streamlining the process.

Cannabis consumers also need to think about this. If you’re that found of gummies, why not make your own? Does everything have to be consumer convenience, instant gratification, fast food nation? How invertebrate is that?

Sources

Some of the data I’ve found on melatonin and cannabis poisoning incident reports: I’m adding bold and italics for the information that I find to be most significant.

Melatonin, 2012-2021

Pediatric Melatonin Ingestions — United States, 2012–2021

Melatonin is an endogenous neurohormone that regulates the sleep-wake cycle (1). It is used therapeutically for insomnia in adults and for primary sleep disorders in children (2). Melatonin is regulated by the Food and Drug Administration (FDA) as a dietary supplement. Various synthetic melatonin preparations are widely available over the counter (OTC) in the United States with sales increasing from $285 million in 2016 to $821 million in 2020 (3). Children are at increased risk for melatonin exposure because of the supplement's widespread use and growing popularity as a sleep aid. In 2020, melatonin became the most frequently ingested substance among children reported to national poison control centers (4); however, more research is needed to describe the toxicity and outcomes associated with melatonin ingestions in children.

This study assessed isolated melatonin ingestions among the pediatric population (defined here as children, adolescents, and young adults aged ≤19 years) during January 1, 2012–December 31, 2021, using the American Association of Poison Control Centers’ National Poison Data System (NPDS). During the 10-year study period, 260,435 pediatric melatonin ingestions were reported to NPDS, and the annual number of ingestions increased 530%. In addition, pediatric melatonin ingestions accounted for 4.9% of all pediatric ingestions reported to poison control centers in 2021 compared with 0.6% in 2012. Pediatric hospitalizations and more serious outcomes due to melatonin ingestions increased during the study period, primarily related to an increase in unintentional ingestions among children aged ≤5 years. Five children required mechanical ventilation, and two died.

During 2012–2021, a total of 260,435 pediatric melatonin ingestions were reported to poison control centers, representing 2.25% of all pediatric ingestions reported during the same period. The majority of ingestions were unintentional (94.3%), involved males aged ≤5 years [no percentage given. ed.], occurred in the home (99.0%), and were managed on-site (88.3%) (Table). Most children (82.8%) were asymptomatic. Among those with reported symptoms, most involved the gastrointestinal, cardiovascular, or central nervous systems. Among 27,795 patients who received care at a health care facility, 19,892 (71.6%) were discharged, 4,097 (14.7%) were hospitalized, and 287 (1.0%) required intensive care. Among all melatonin ingestions, 4,555 (1.6%) resulted in more serious outcomes. [“More serious”- what exactly does that mean? ed.] Five children required mechanical ventilation, and two died. Both deaths occurred in children aged <2 years (3 months and 13 months) and occurred in the home. One ingestion involved intentional medication misuse; the reason for the other is unknown.

The number of pediatric melatonin ingestions increased 530% from 8,337 in 2012 to 52,563 in 2021, with the largest yearly increase (37.9%) occurring from 2019 to 2020 [excuse me. what is that? numerically, I mean. ed.] In 2021, pediatric melatonin ingestions accounted for 4.9% of all pediatric ingestions compared with 0.6% in 2012. The annual rate of ingestions per 100,000 U.S. population increased during the 10-year study period (Figure 1). This resulted largely from an increase in unintentional ingestions among children aged ≤5 years. There was also an increase in the number of ingestions requiring hospitalization and in those resulting in more serious outcomes (Figure 2). Most hospitalized patients were teenagers with intentional ingestions, whereas the largest increase in hospitalization occurred among children aged ≤5 years with unintentional ingestions…

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169525/

addition and correction, with charts https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290379/

[My grade of this study: D. Too many relevant metrics are missing. ed.]

Cannabis

Nationwide U.S. reported cannabis exposures, children 0-9 years 2017-2019

There were 4172 cannabis exposure cases among children aged 0 to 9 years during the study period, of which 45.7% (n = 1906) were associated with edible cannabis products (Table 1). (See below. ed.)

Children aged 3 to 5 years experienced the highest proportion of all exposures (43.1%). Most cases were exposed by ingestion (72.0%). A small proportion experienced major (1.4%) or moderate (15.4%) medical outcomes. In 2019, areas with legal adult cannabis use reported greater pediatric cannabis exposures compared with states without this policy: 975 exposures (8.9 per 100 000 population) versus 972 exposures (3.4 per 100 000 population). The proportion of calls due to edible cannabis product exposures was greater in legal states than in states without this policy: 62% vs 46% (P < .001).

Colorado 2021

incidents reported to Rocky Mountain Poison and Drug Safety (RMPDS)

total, all ages: 310

5 years and younger: 151

unintentional poisoning: 179

ingestion of edibles: 175

Washington State

Jan.1-Sept. 30, 2020

total, all ages 424

5 years and younger 122

[my grade of this study: B+. ed.]

https://marijuanahealthreport.colorado.gov/health-data/poison-center-data

[my grade of this study: A. ed.]

Washington State

https://www.wapc.org/data/data-reports/cannabis-data-report/

[my grade of this study: B. ed.]

Canada, 1/2016- 3/2021 (my full analysis has not yet been done. Study excerpt is below.)

Unintentional Pediatric Cannabis Exposures After Legalization of Recreational Cannabis in Canada

A similar phenomenon has been happening in Canada. A study published in JAMA Network Open examined all cannabis-related emergency department visits and hospitalizations in Ontario among children 9 and under between January 2016 and March 2021. The researchers found that after marijuana edibles became available in early 2020, a greater proportion of kids were hospitalized. Overall, 19 of the children, or 3.6 percent, were admitted to intensive care…

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2787715

U.S. National Poison Control Call Statistics, 2021 (in the interest of context)

National Poison Control Call Statistics, 2021

https://www.poison.org/poison-statistics-national

The secret is out: marijuana remains popular with Americans, evidently more so than ever. This finding arrives at the same time that an unprecedented number of Americans are dying from drug overdoses, particularly from the powerful synthetic opioid fentanyl (40 times stronger than heroin by weight), or from drug combinations that include fentanyl (it’s increasingly showing up combined with the most powerful illicitly supplied stimulants methamphetamine and cocaine, sometimes sold to unwitting buyers, or unwitting users who share the substance.)

Is there a causal link between that correlation? No. Most of the overdose casualties are confirmed opioid addicts; according to my sources, that epidemic appears to have peaked around 10 years ago.

A note about the source that I’m using to supply the data cited below in this post: all tables and figures are taken from the Monitoring The Future survey reports done by the University of Michigan. These reports represent the first detailed surveys of the substance habits of Americans nationwide; they date back to 1975. (I was a participant in the 1977 survey; it was anonymous, and the individual participants chose their own alphanumeric code for the survey report.)The original emphasis of the surveys was on young people- college students, in particular- but they’ve since expanded their scope to include a much broader cross-section of Americans. The MTF surveys provide the clearest, most comprehensive, most detailed metrical data that I’ve found on this topic. (MTF surveys cover many other topics, for what it’s worth.) The surveys have been funded by the NIH National Institute on Drug Abuse (NIDA) since their inception. I presume that the surveys provide much of the data used for the SAMHSA NSDUH annual reports, if not all of it; however, the SAMSHA tables I’ve found don’t cover any year prior to 1992, and many of them don’t provide numbers for years earlier than 2000. The MTF data is invaluable for providing the additional time context required to make sense of trends in American substance use, legal and illegal.

The methodology of the U. Michigan Monitoring The Future reports is also much more readable and more easily accessed than that found for the NSDUH reports put out by SAMHSA. To quote a brief summary outline from 2007:

Every year since 1975, University of Michigan researcher Lloyd Johnston’s team has conducted the Monitoring the Future study of 50,000 young Americans. In this first part of a multi-part interview, Johnston describes how the survey that has interviewed more than 1 million people all began.

Unfortunately, the page link for that quote leads to audio interview and transcript that are no longer accessible. But that’s the gist of how much data is collected. More detail on data collection and the weighting used for some of the figures in their tables and bar graphs is provided in the text portions of the reports.

Now, let’s review some of the tables from the 2021 MTF reports. (Reference links for the MTF reports that connect to the .pdf documents that have supplied the source for all figures of the tables and figures shown are provided at the bottom of the page.)

The term “narcotics” in the tables below is used with strict accuracy, as a synonym for opioids.

The figures are similar for almost every substance- whether legal or illegal- other than marijuana, and a noteworthy recent resurgence in the use of “hallucinogens” (a miscellaneous category ranging from LSD to ketamine, along with the continuing parade of “research chemicals” that have achieved popularity and/or notoriety in the Internet/Dark Net era.) The levels of hallucinogen use are still far below those of the peak years of the 20th century, however. And overall, the “gateway drug” effect alleged for marijuana seems to be nonexistent. Consider the summed chart below, beginning with the year 1988: the “any use in the previous 12 months” figure for all “illicit substances other than marijuana” of any kind combined remains roughly stable, with no evidence of a sustained increase in those numbers over the previous 15 years:

The most relevant metrics, of course, relate to the “hard drugs” that lead to the most dysfunction, addiction, and public health impacts.

In that regard, have a look at the course of the so-called “methamphetamine epidemic”; as with the opioids, the total number of Americans reporting use- both high school age and older- has dropped precipitously in recent years:

A resurgence in cocaine use has also been reported in the news media, primarily relying on statistics on a marked increase in cocaine overdose deaths to support the claim. But the U. Michigan MTF survey data published in 2022 does not bear out that conclusion:

Given the trends indicated by the data: is the United States of America really still under siege by an surging epidemic of hard drugs use? It’s undeniable that the number of users of opioids had at one time markedly increased: beginning in the mid-1990s, with the end of the peak era around 2010-2012. But the drop in newer initiates to opioid use has been dramatic- which indicates that most of the overdose casualties of the most recent years were people in the population of users who had already acquired their addiction some years before they succumbed to the lethality of the illicit opioid market, where bootleg fentanyl has recently become the mainstay. The increasing supply of fentanyl has also indisputably played a role in the rising number of cocaine and methamphetamine overdoses in recent years. (The CDC does not as a rule make note of whether or not a given drug was ingested alone, or in combination with other substances; most often it simply makes note of the presence of a given substance in the overdose victim. Attributing the cause to a specific substance in cases of combined drug overdose is often difficult or impossible. Substances often interact in ways that result in the combined lethality being more than the sum of the separate components, particularly in the case of CNS depressants- including alcohol.)

There’s no question that we still face major challenges in lowering the numbers of Americans who are addicted to the most harmful drugs. But new recruitment appears to have fallen off dramatically, judging by the charts shown above. Those figures indicate that the rising tide of new opioid and meth addiction began to abate ten years ago, and that decline of new users has been neither gradual or intermittent.

Those trends bode well for the future. They indicate success- at least as far as the showing the ability of Americans, particularly young people, to voluntarily refrain from using the most harmful substances available on the illicit market. It’s good news. Why is it so seldom reported in the American news media?

URL links for the U. Michigan Monitoring The Future reports that I’ve excerpted:

MTF Annual Report on Adult Drug Use, 1976-2021

https://monitoringthefuture.org/results/publications/monographs/panel-study-annual-report-adults-1976-2021/

MTF Tables And Figures for High School Students (complete)

https://monitoringthefuture.org/results/data-products/tables-and-figures/

Just to make note of the array of MTF survey statistics collected for specific substances:

Interestingly, the article content itself does not make that claim, and while the story does focus some attention on the proliferation of unlicensed pot shops over the course of 2022—while state & local government efforts were making the legislative sausage required for a regulated NYC commercial regime—the story has nothing at all to say in relation to the recent official rollout of the officially licensed retail outlets. And the source found at the link highlighted in the beginning of the story—an article in NYC Chalkbeat, an internet publication focusing on local doings in New York City—had to have been written in reference to a situation that already existed before officially licensed commercial legalization; it was published January 4, 2023.

The New York Times article also provides some details from earlier years that cast doubt on the implied takeaway of the headline:

There is little definitive data on marijuana use among children, and what information is available can sometimes offer a contradictory picture. Disciplinary data from the city education department reflects a 10 percent increase in alcohol- and drug-related offenses this year compared to 2019. But a city survey found teen cannabis use had declined in 2021, the same year that the state legalized marijuana for recreational use, to the lowest level recorded since the question was added to the survey in 1997…

(Italics mine. For figures from an on-topic nationwide survey by the U. Michigan Monitoring The Future Project covering the years 1991-2022, refer to the chart at the bottom of the page.)

Southall then goes on to provide opinions and anecdotal views from an assortment of students and teachers. While quite a few are quoted and I don’t doubt the validity of the sources and the sincerity of their views, it should also be noted that anecdotal accounts of any sort are a slippery slope, including for a journalist employed in a newsroom. Their editors will do what they want with the reporter’s draft, and nothing stops them from shaping it up for hot-take tabloid journalism and propaganda- whether the story topic is about drugs, NIMBY controversies, wars, or whatever. (At its worst, the game is as phony as Hollywood can get at its worst. Maybe someone should do a Robert Altman type take on it, recasting The Player in the newsroom.)

The 237 posts in the story comments for the NYT article also contain a lot of anecdotes. And also many speculations and predictions (mostly of doom, and civilizational collapse.) I have a couple of posted comments in there myself. They aren’t anecdotes, speculations, or predictions, though. Unlike the case with many NYT stories on cannabis (which often draw >1000 comments), the antis were out in full force on this one, and I was a dissenting minority opinion. A certain sort of head might find that comment section educational and even entertaining to peruse. I may use some of the comments as grist for a future post, possibly.

I don’t doubt that stories related in the New York Times article are real, or that kids are rampantly smoking weed and coming to school high. The thing is that this has been happening for more than half a century, in many places almost as a rite of passage for teenagers, especially the boys. Some of them do it it every day.

Not just in the big cities, either. Ever since the national marijuana market matured and stabilized from coast to coast- by 1975, no more than three years later at the outside- kids attending classes after smoking weed- or skipping classes, to smoke weed- has happened at some time or other in the vast majority of high schools in the country, public or private, in nearly every school district in the country. I knew kids my age in towns of 300 residents who had their connections wired back in 1971.

So there isn’t anything new about kids smoking weed and showing up in class high. Marijuana has been very popular with American young people for over 50 years. So has alcohol, of course. Not nearly as many kids show up in class under the influence of alcohol, compared to pot. (Although it does happen.) But there are some marked differences between the two phenomena. I think the most important one is that in the places where it’s illegal, the retailers for marijuana are other teenagers- their classmates, to be clear. Their fellow students. A school that hosts an illicit retail economy of peer-to-peer drug sales is liable to have a lot of energy sapped from its mission right from the jump.

There’s also the fact that cannabis provides a more tractable high than alcohol, of course. It’s easier to “maintain”, as we used to say. It’s easier to maintain a surface impression of sobriety, that is, even though you’re too stuporous to multiply two two-digit numbers even when allowed to use a pencil and paper. No, I don’t endorse trying to learn any skill by getting high on marijuana. If someone is ever going to get into using weed, that’s to be saved for after the skills get learned. This is especially true of academic skill sets. Those skills are not optional. I can do sums in my head- did I not learn any of the basics of math while stoned on weed. I didn’t learn any of the basics of reading and writing while stoned on weed, either.

Taken in aggregate, potheads are mellow and easygoing compared to drunks. But I don’t think that’s the crucial factor in the comparative lack of kids showing up to school drunk, and not being drunk around the clock.

For teenagers, what really provides the advantage of pot over alcohol as far as encouraging the acquisition of heavy use or a daily habit is that your friends and classmates aren’t running the local retail liquor business. They’re running the local retail pot business. For high school graduating classes up to the year 2014 (in Colorado and Washington State only), drug dealers were the only people who could run the local retail market in marijuana, and nearly all of the retail salespeople who sold directly to teenagers were other teenagers. No matter the household income level, the ethnic identity, the neighborhood, or the particular school in question. Although it has to be said: illicit drug dealing has always been a >90% male business. (And >60% of the heavy user population.) User or dealer, most people start into the game while adolescents.

Illegal drug dealing is often fun, for teenagers. It has yet to get serious, in terms of the law. The participants are afforded minor status protections for their violations. (That’s a good thing, in balance. But some teenage drug dealers can’t help but work it.)

Marijuana was Prohibited, by some of Adults, to Criminalize all of the Adults, Everywhere in the U.S. of A. Illegal. For all the good it did.

For minors, alcohol is a binge thing. It’s still the drug that’s used by the most teenagers. As an experiment, or episodically. Alcohol is sufficiently popular and used casually enough that it’s often possible to divert some stock to supply teenage demand. Occasionally. In household quantities. But adults run the alcohol markets. Therefore, most minors find that alcohol is much more difficult to use on a regular basis, compared with marijuana.Because if you don’t have convincing photo ID showing your age to be over 21, you don’t have the connection to the plug.

In my assessment, that thriving teenage-staffed illicit retail market in weed is what primarily accounts for the fact that in the decades since official government reports like the ONDCP and SAMSHA surveys have been keeping score, the age cohort comprising the second-largest number of marijuana users- and heavy marijuana users- is teenage boys. Males in the age range 12-17. (The top cohort is males age 18-25.) It’s been that way for decades.

There’s no way for reporter Ashley Southall to have any firsthand perspective on the marijuana (or other substance) habits of American teenagers from the last quarter of the 20th century- she’s too young. The students she interviewed are too young. The teachers are all probably too young.

I’m not dismissing the concerns expressed in the article by pointing that out. This isn’t a hand-wave. I don’t want to see teenagers showing up for class high on weed. More to the point, I don’t want to see anyone failing at learning scholastic skills because they’re impaired from being high on weed. Or anything else. It’s a real problem, and a significant one. But not a new one. It’s a problem that’s older than the median age of the U.S. population. A pandemic that turned endemic many years ago, before the turn of the century.

It’s unfair to blame a legal retail marijuana market only inaugurated five months ago for a problem that pre-existed it by 45-55 years. And much too early to draw conclusions about the success of controlled and regulated legal sales. The legal regulated market with effectively enforced age restrictions on retailers is the most logical way to address the problem of underage substance use- and the one with proven success. As a non-smoker of tobacco, I saw the changes in enforcement diligence for age-restricted tobacco purchase between the 1960s and the 1990s. In the 1970s, regulations were there on paper, but enforcement was a joke. There was no accountability for retailers, and the penalties for selling tobacco to minors were trivial. By the 1990s, effective regulation and penalties had been implemented in most parts of the country, including strict enforcement of age restrictions that had been once easy for minors to get around.

The enforcement of age restrictions for the purchase of tobacco products is the biggest success story in the history of American drug policy, and it provides strong evidence that substances can remain on the commercial market under a regulatory regime of restrictive controls without being banned entirely, as long as the regulations are effectively enforced with heavy penalties for non-compliant sellers. In the example of tobacco, decades went by before anyone in power took the problem of tobacco use by minors seriously enough to implement effective enforcement. Enforcement of age restrictions for marijuana purchases should be an easier lift (although not an effortless one.) I don’t know of any reason why a diligent regime of regulatory enforcement of age restrictions for cannabis products can’t be implemented over a timespan that’s more like 1-2 years than 15-20 years. But insisting on total enforcement compliance after only five months of the new regulatory regime for marijuana is imperious.

Long-term context: the chart below shows the measured 30-day prevalence of Daily marijuana and alcohol use by 8th grade, 10th grade, and 12th grade students, 1991-2022, as surveyed by the Monitoring The Future program of the University of Michigan. (All charts provided should be expandable with a touchpad or mouse click.)

The chart for Daily Use of Marijuana, Alcohol, and Tobacco for Grades 8, 10, and 12 Combined, 1991-2022

The U. Michigan Monitoring The Future (MTF) program began doing the first set of its surveys in 1975, making it the longest-running survey of drug and alcohol use by Americans that I know of; the surveys have widened their scope over the years and become much more detailed- along with presenting much more transparent statements of methodology than those of the SAMHSA NSDUH and ONDCP surveys I’ve seen. The U. Michigan MTF project has received funding from the National Institute on Drug Abuse of the NIH since its inception, and its primary source data is used- in some fashion- in official reports, presumably including those by SAMHSA and the ONDCP. I haven’t yet done a comparison of the tables and charts from the MTF project with those of the recent NSDUH reports, but I know this much: the data sets of MTF reports most often go back many years before any of the survey results I’ve accessed in NSDUH reports. Long-term context over time is imperative in order to gain an accurate picture of substance use by Americans (and also features of American illicit drugs markets such as amounts confiscated, and estimated annual quantities consumed.)