This is a remarkably intelligent look at the growing problem of cannabis “overuse” and its associated consequences. It’s something we should all be preparing for once decriminalization or legalization become likely:

How to prevent casual pot smokers from slipping into abuse and dependence

This is a policy piece, not a clinical review, so it helps to follow carefully as the author marshals his arguments in favor of a specific proposal.

His premise: At the moment, we appear to be moving towards adoption of a model for cannabis use based on the one we’ve developed for alcohol. He thinks that’s a bad idea. Hard to argue with that. Alcohol’s been legal for a very long time and it continues to cause way more trouble than any sane person could want. That’s not an outcome to aspire to.

There’s beaucoup evidence that cannabis causes problems, too, just different ones. More may emerge as use widens. It’d be naive to count on age restrictions to prevent youth from experimenting. How’d that work with alcohol? Or cigarettes?

The alcohol model, the author claims, involves “weakly regulated commercialized legalization, with taxes that are too low.” I can think of a few exceptions, but for the most part, he’s right. And the signs of future challenges are clear. We’ve all heard about the dramatic increase in THC content. He cites some other interesting data:

  • By self-report, more than 4 million people currently meet DSM5 criteria for CUD. Of course, the actual number is substantially higher– many who would qualify simply don’t recognize it.
  • Half a million people visit the ER annually for cannabis-related problems, mostly using too much and experiencing symptoms of overdose.
  • This one was new to me: “…the number of people who report using cannabis daily or nearly daily has multiplied by approximately a factor of seven over the past quarter-century. It now stands at some eight million (out of 37 million who have used it in the past year).” That’s just under 22%.
  • Also, “… daily and near-daily users consume about three times as much cannabis per day of use as more casual users.” Now that does remind me of drinking– a subset of heavy users who consume a wildly disproportionate share of the total consumption.

What this suggests to me? A major public health problem in the making.

The author’s proposal involves “user-set” limits on consumption, to increase awareness of exactly how much someone uses, compared to their own targets. Developing this type of discrepancy is an established principle of motivation enhancement. So far so good.

Do I think his proposal, if implemented, will prevent users from slipping over the line into cannabis disorder? Some, perhaps, but not most.

Once a drug is as widely available, with falling prices and an expanding market, it’s exceedingly difficult to stuff the cat back in the bag. Here’s the problem, as summed up by the author.

“Low prices generate high volume, but they also mean that high volume is the only way the industry can stay in business. Daily and near-daily users account for some 85 percent of current cannabis sales. That means the for-profit commercial industry will, like its illicit counterpart, and like the alcohol industry, be financially dependent on the minority of users who are chemically dependent. That industry will do everything in its power to create and sustain the biggest possible population of chronic stoners.”

There you go. That’s it in a nutshell.


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