Why is marijuana legalization so confusing in New York? The answer seems clear: As Gov. Kathy Hochul put it, the rollout of licensed dispensaries was “a disaster” due to misguided policies and bureaucratic incompetence. But Manhattan Institute researcher Charles Fain Lehman is not satisfied with this explanation. He prefers a statement that makes no sense but gives him an excuse to discuss “the real problem with legal marijuana”: Marijuana addiction is more common and serious than people think.
in the most recent new york times magazine In the article, Lehman argued that Americans generally do not pay enough attention to the problems caused by excessive or reckless marijuana use. While he may be right, he exaggerates his own views by equating “cannabis use disorder” (CUD), a term that encompasses a wide range of behaviors, with addiction (a particularly severe subset of CUD). Broad concept.
Lehman noted that “ongoing litigation” over the state’s licensing incentives has hindered legalization, that “programs designed to give disadvantaged license holders a head start have struggled to secure funding and storefronts,” and that “the state’s primary cannabis regulator The agency, the Office of Marijuana Legalization, the Marijuana Administration, was given almost no enforcement power in the original law. ” While “these setbacks don’t help,” he said, “every policy rollout has flaws. “
New York’s marijuana dilemma ‘seems[s] “It’s even worse,” Lehman said, because “marijuana is addictive.” “Combining addiction with the profit motive creates perverse incentives for businesses to compete to help people ruin their lives.” Once you understand these dynamics, New York’s weed problem isn’t confusing anymore—it’s It is obvious. A great opportunity with no negative consequences”. They slowly discovered that they were wrong. “
As an explanation for the problems New York faces in seeking to displace the black market, Lehman’s argument is puzzling. After all, marijuana is no more addictive in New York than in other states with better-regulated legalization. And even if that were the case, how does that explain the extremely slow pace of legal marijuana stores opening? But Lehman’s dubious analysis of the situation in New York is just an excuse for his belief that capitalism and marijuana are a dangerous combination.
Lehman Brothers said that “approximately 30% of users” smoke marijuana “compulsively” and thereby “endanger their health.”[ing] For obvious reasons, marijuana prohibitionists like to cite this seemingly authoritative number. When a gentleman.
To support this compelling claim, Lehman cited two sources. “The Centers for Disease Control and Prevention states that approximately three in 10 marijuana users suffer from ‘cannabis use disorder,’ or CUD,” he wrote. The Centers for Disease Control and Prevention (CDC) cited a 2015 JAMA Psychiatry The study is based on data from the National Epidemiological Survey on Alcohol and Related Diseases. Lehman also cited the National Survey on Drug Use and Health (NSDUH), which found that “19 million Americans” in 2022 — about 30% of last year’s marijuana users — “had a marijuana use disorder.”
By comparison, a 1994 study based on the National Comorbidity Survey estimated that 9 percent of marijuana consumers experienced “dependence” at some point in their lives, compared with 32 percent of smokers and heroin users. 23% for those who use cocaine and 17% for cocaine users. Lehman’s annual estimates imply a much higher lifetime risk. This also seems inconsistent with the detailed analysis from 2010. lancetThe risk of dependence is similar for marijuana and alcohol, but alcohol causes more than three times the overall harm, the study found.
Although Lehman did not specify the large gap between his estimate and earlier calculations, he suggested a possible explanation. He noted: “According to the National Institute on Drug Abuse, the average concentration of THC has increased from around 4% in the mid-1990s to 15% in 2021. Legalization also allows for the production and sale of high-potency concentrates, and as a result, The THC content is as high as 80%. Although public awareness lags behind, addiction has become more common.
A closer look at the NSDUH data leads to a more likely explanation. CUD, especially as measured by surveys, is a broader category than what psychiatrists used to call “dependence,” covering a wide range of marijuana-related problems that don’t necessarily fit into traditional understandings of addiction.
NSDUH is based on the latest version of the American Psychiatric Association’s definition of CUD. Diagnostics and statistics Handbook of Mental Disorders (DSM-5), which combines two separate labels in the past: “dependence” and “abuse.” Lehman glossed over this change, saying, “Modern psychiatry tends to describe addiction (often called ‘substance use disorder’ today) as the continued use of a substance despite negative consequences.” He thus implies that CUD is related to ” Addiction” is the same, which is inaccurate.
A CUD diagnosis requires “clinically significant impairment or distress” manifested by at least two of 11 criteria:
1. Marijuana users use marijuana “a lot” or “for a longer period of time” than expected.
2. He “persistently hopes” to reduce consumption, but fails.
3. He spent an “excessive amount of time” obtaining, using, or recovering from the effects of marijuana.
4. He has a “craving” for marijuana.
5. He neglected his “social obligations” due to “frequent use”.
6. He continues to use marijuana “despite social or interpersonal problems.”
7. His marijuana use caused him to give up “significant social, professional, or recreational activities.”
8. He continued to smoke marijuana “without regard to physical harm.”
9. He continued to smoke marijuana “despite physical or psychological problems associated with it.”
10. He has a tolerance and needs a larger dose to achieve the same effect.
11. When he quits smoking, he experiences withdrawal symptoms.
NSDUH includes questions that reflect these standards. It grades CUD as “mild” (two or three criteria), “moderate” (four or five criteria), or “severe” (six or more criteria). In the 2022 survey, 30% of last year’s cannabis users met the requirements for the CUD label, a number Lehman highlighted. But last year, only 5% of users met the requirements for the “severe” category, while the proportion of users with “moderate” CUD was about 8%, and the proportion of users with “light” CUD was 17%.
In other words, the “light” category accounted for 55% of cannabis users thought to have experienced CUD in the previous year. Given the wide range of answers that might put someone in this category, it is misleading to say, as Lehman does, that someone with “mild” CUD “compulsively uses cannabis,” let alone their cannabis consumption “Harm yourself and those around you.”
For example, if the respondent said he spent a “significant” amount of time smoking marijuana, sometimes in larger quantities than he planned, that would be enough to qualify for a CUD label. Likewise, if he reports that he sometimes has a “strong urge” to use marijuana, and he increases his dose to compensate for tolerance. Such answers don’t necessarily indicate that someone uses marijuana “compulsively,” and they don’t mention whether he harmed himself or others.
Lehman Brothers has repeatedly suggested otherwise. DSM-5He said, “CUD is defined in part as ‘the inability to stop using marijuana, even if it causes health and social problems.'” However, as measured by NSDUH, CUD does not necessarily cause “health and social problems” or “the inability to stop.” Use of marijuana.” Stop using marijuana. ” Lehman Brothers also said that marijuana “causes health problems in up to 30% of users,” which is misleading for the same reason.
Equating the NSDUH’s CUD measure with addiction is also problematic because the survey does not assess whether respondents have experienced “clinically significant impairment or distress,” which is a prerequisite for diagnosis. Critics of applying psychiatric diagnoses based on survey results point out that such data can lead to overestimation because they do not measure clinical significance.
This does not mean that NSDUH respondents who were eligible for the CUD label did not experience marijuana-related problems. But the issues were wide-ranging and often “tame,” contrary to the impression given by Lehman Brothers.