As legalization spread, marijuana and other products that contain THC, which is the main psychoactive component of the plant, became more potent and dangerous.
Some products available today contain more than 90% THC, compared to the THC content that was common in the past.
The old buzz has been replaced by something much more alarming. According to federal research, marijuana-related medical emergency has landed thousands of people in hospital. Millions of people are also dealing with mental disorders related to cannabis use.
The regulators are not keeping up with the pace.
Consumer protections vary among states that permit the use and sale of marijuana derivatives.
Cassin Coleman is vice-chair of the National Cannabis Industry Association's scientific advisory committee. She said that in many states, the products are accompanied by a warning and there may be no further action from regulators.
The federal government generally has a hands-off attitude. The Controlled Substances Act still classifies marijuana as a Schedule 1 drug, a substance with no medical use accepted and a high risk of abuse. When it comes to cannabis, which has been legalized in many states, the federal government doesn't regulate any attributes such as purity or potency.
The FDA has 'basically sat on their hands and failed its duty to protect public health', said Eric Lindblom. He is a Georgetown University scholar who worked previously at the FDA Center for Tobacco Products.
Since generations of Americans first encountered pot, the dish has undergone a profound transformation.
Cannabis is now cultivated in order to produce much higher THC doses. In 1980, marijuana confiscated had a THC level of less than 1.5%. Many varieties of cannabis flowers -- the plant material that is smoked in a cigarette -- have a THC content higher than 30% today.
In a California dispensary recently, a strain with 41% THC was on the menu.
Legalization also opened the door to marijuana-derived products that look nothing like marijuana: waxy or crystalline THC concentrations heated and inhaled via vaping, dabbing or blowtorches.
Concentrates today can contain more than 90 percent THC. Some products are advertised as being almost pure THC.
John Boehner is a former U.S. House Speaker who personifies the mainstreaming marijuana. The Ohio Republican has long been against marijuana, and in 2011 he reportedly declared that he was 'unalterably' opposed to its legalization.
He's now on the board at Acreage Holdings - a marijuana producer.
Acreage Holdings is a good example of how the industry has evolved. Superflux, a brand under the Acreage Holdings umbrella, offers a vaping product - 'pure, live resin in an instant, convenient format' - and concentrates like 'wax,' budder', sugar', shatter', and a'sugar'. The company claims that its 'THCa crystallized' concentrate is the 'ultimate of potency.
According to the National Institute on Drug Abuse, higher concentrations are more dangerous. The National Institute on Drug Abuse website states that 'the risks of physical dependency and addiction increase when exposed to high concentrations THC. Higher doses of THC can cause anxiety, paranoia and psychosis.
According to a January survey by the federal Department of Health and Human Services, in 2021, 16,3 million Americans -- or 5.8% of those 12 and older -- will have experienced a marijuana-use disorder in the last year.
This was a far greater number than those who were found to be suffering from substance abuse disorders caused by cocaine, heroin, and methamphetamine. It also included prescription stimulants like Adderall or prescription painkillers such as OxyContin and fentanyl.
Other drugs are much more dangerous than marijuana. Most people who have a marijuana-use disorder only had mild cases. The federal survey revealed that about 1 in 7, or more than 2,6 million people, had a severe marijuana use disorder.
Wilson Compton is the deputy director of the National Institute on Drug Abuse. He said that most clinicians associate the term "severe Use Disorder" with addiction.
Smita Das is a Stanford psychiatrist who chairs the American Psychiatric Association's council on addiction. She said that cannabis use disorder 'can have devastating effects'.
Das has seen the lives of people who were very successful turned upside down by cannabis. They have lost their families and jobs. Das said, 'They don't even know how they got to this place because it was only a joint. It was just cannabis. Cannabis wasn't meant to be addictive for these people.
Cannabis is a medical diagnosis for 'cannabis addiction with psychotic disorder and delusions', as well as cannabinoid Hyperemesis Syndrome (a persistent form of vomiting).
According to a study by the government published in December 2022, an estimated 800,000 people visited emergency departments in 2021 because of marijuana.
A Colorado father believed it was only a matter time before cannabis would kill his son.
The father said that in spring 2021 the teen had run a red traffic light, hit another car, inflicting injuries on both himself and the driver, and then fled the scene.
The father found THC vape pens, THC joints, and empty containers of wax, a THC concentrate with high potency.
He found text messages and references to dabbing, marijuana and other drugs on his son's phone. The teen claimed he was dabbing and intended to commit suicide before the accident.
A few weeks later, the police had him held at a hospital involuntarily for a psychiatric assessment. A police report states that he believed cartel snipers had him in their sights.
The doctor who examined the teen diagnosed him with 'cannabis use'.
The doctor advised that he should stop using dabs and wax, as these substances can cause extreme paranoia. The doctor wrote: 'Go straight to the detox program you choose.'
According to the father, the teen has been involuntarily held several times over the last two years, had dozens of encounters and arrests with the police, spent time in jail, and was inpatient at various treatment facilities.
He texted at times, out of touch with the reality, that God had spoken to him and given him superpowers.
Financial damage was also a factor. The family spent almost $40,000 in February on out-of pocket expenses and health insurance claims.
The father was interviewed under the condition of anonymity in order to not undermine the son's healing.
The father believes that the mental illness of his son was not caused by drug abuse, but rather a result. He claimed that the symptoms subsided when his son stopped taking THC, but returned when he re-started.
The father's son, now 20 and off marijuana, is doing well. He added, "I have no doubt that cannabis use was what caused his paranoia, psychosis and delusions."
According to MJBizDaily a trade magazine, medical marijuana use is now legal in forty states, including the District of Columbia. Recreational or adult use of marijuana is legal in twenty-two states, plus D.C.
During the early stages of the covid-19 epidemic, when much of America was on lockdown, marijuana shops delivered. Many states have declared marijuana dispensaries essential businesses.
Gillian Schauer, from the Cannabis Regulators Association (a group of state regulators), said that only two states have caps on THC levels. Vermont and Connecticut both cap the THC level at 30% for cannabis flowers and 60% for THC concentrations. Pre-filled vapes are exempted from these caps.
Some states limit the amount of marijuana that consumers can purchase. Rosalie Liccardo Paula, professor of health, law, and economics at the University of Southern California, says that even a small amount of marijuana can contain a large amount of THC.
In Texas, for example, only substances containing less than 0.5% THC are allowed to be used medically. Some states also require warning labels. New Jersey requires cannabis products with more than 40% of THC to declare that they are a potent product, which may increase the risk of psychosis.
Colorado's marijuana laws are more than 500 pages long. The disclosure highlights the limitations of consumer protections.
Finding the right rules is not always easy. Warning labels, for example, could shield the marijuana business from liability in a similar way to how they protected tobacco companies many years ago. Limiting potency may limit the options available to people who are taking high doses of marijuana for medical reasons.
Pacula stated that the cannabis industry, on a state-level, has blunted the regulatory efforts. They claim that the onerous regulations would make it difficult for legitimate cannabis businesses compete with illegal ones.
Pacula, along with other researchers, has called on the federal government for action.
Scott Gottlieb, who resigned as FDA commissioner in December 2015, made a similar appeal.
Gottlieb, who complained that the states were 'far ahead of the federal government' while they sat at the sidelines', called for the creation of a 'uniform national scheme' for THC to protect consumers.
It was 2019 and not much has changed.
It regulates prescription drugs, over the counter drugs and medical devices. It regulates nicotine, tobacco, and nicotine-containing vapes. It supervises the tobacco warning labels. It also regulates medical products, which can contain plant material, in the interest of public safety and health.
The FDA is largely absent when it comes the marijuana people smoke, cannabis-derived THC concentrated they vape or dab and edibles with THC.
Medical marijuana sold in dispensaries has not been FDA-approved. The FDA has not determined dosage or endorsed its safety and efficacy. The agency does not inspect the production facilities and doesn't evaluate quality control.
The agency invites manufacturers to submit cannabis products for clinical trials as part of its drug approval process.
On the FDA website, it is noted that THC is an active ingredient in FDA-approved cancer treatments. The FDA is able to regulate the substance based on this alone.
Lindblom, a former FDA official, said that the FDA had 'all it takes to regulate state-legalized marijuana products much more efficiently'.
The FDA, at least publicly, has not focused on THC-based concentrates or cannabis smoked in joint form, but on other substances. These include a THC derivative derived hemp, which was legalized by the federal government, and another cannabis derivative, cannabidiol, or CBD, that has been marketed for therapeutic purposes.
Courtney Rhodes, FDA spokesperson, said: 'The FDA has a commitment to monitor the market, identify cannabis products that are risky, and act, within our authority, to protect public health.'
Many/most THC-containing products are controlled substances. The Controlled Substances Act is regulated by the Drug Enforcement Administration (DEA). For questions regarding regulation and enforcement of the CSA provisions, we refer you to the Drug Enforcement Administration' wrote Rhodes in an email.
The DEA (part of the Justice Department) did not answer any questions in this article.
Congress' most significant step was to limit the enforcement of federal prohibition.
A Congressional Research Service 2022 report stated that the federal response so far to state legalization actions has been to let the states implement their own laws.
In October, Joe Biden instructed the Secretary of Health and Human Services and Attorney General to review the federal governments stance on marijuana -- if it should be classified as one of the most dangerous and tightly regulated substances.
Biden signed in December a bill that expanded research access on marijuana and required federal agencies to examine its effects. The law allowed agencies one year to publish their findings.
Some marijuana supporters say that the federal government can play a more positive role.
NORML is not of the opinion that marijuana is harmless, but believes that the risks associated with it can be best minimized through legalization, regulation and public education. This was stated by Paul Armentano. He was the deputy director of the former National Organization for the Reform of Marijuana Laws.
He said that 'products must be tested for potency and purity' and that 'the federal governments could have some oversight on licensing the laboratories who test these products'
Coleman, an adviser for the National Cannabis Industry Association said that states have to 'become USDA + FDA + DEA at the same time'.
What does this mean for consumers? Wendy E., an elderly small-businesswoman in her 60s who is retired, struggles with the effects of marijuana today.
Wendy, who asked to remain anonymous, began smoking marijuana during high school, in the 1970s, and it became a part of her life for many years.
She bought it from dispensaries when it was legalized in her state. "I noticed very quickly that the potency of it was much higher than I had used traditionally," she said. It seemed to have increased exponentially.
She said that in 2020, the legal marijuana, which was much stronger than the illicit weed she smoked as a child, left her thinking about ways to end her life.
The self-described "earth-mother hippy" found camaraderie when she shared a joint with her friends. She now attends Marijuana Anonymous with other people who are recovering from their addiction.
The independent source of health policy research, journalism, and polling.