https://news.yahoo.com/marijuana-addiction-real-those-struggling-
231626999.html

Courtney took her first marijuana puffs at 17. Two decades later, she was
raising a toddler son and hiding her dependence from most family members.
She would light her pipe more than a dozen times a day, sneaking to the
garage of her Missouri home while her son napped.

She still loves the earthy smell. But weed long ago stopped making her
giggly. It was not unusual for the 37-year-old to lose her train of
thought mid-conversation or zone out while playing with her son. Many
times, Courtney said, she tried to quit, flushing her stash and dumping
her pipe to no avail, except for the nine months she was pregnant.
Courtney felt she was addicted.

"It's been frustrating because you're not taken seriously," Courtney said.
"People say it's not as severe as meth, or alcohol, that it's not that
bad. They think it's not an addiction."

At a time when marijuana has been legalized for recreational and medicinal
use in more than 20 states - and the potency of the drug has been
increased - many experts believe that most people can use it without
significant negative consequences, not unlike enjoying occasional
alcoholic drinks. But for users like Courtney, the struggles to quit are
real and complicated by the powerful cultural perception that marijuana is
natural and therapeutic, not a substance that can be addicting.

Courtney's story reflects broader tensions about marijuana's health
consequences.

For decades, weed's deleterious health effects were exaggerated, experts
said, leading to excessive criminalization. But as legal recreational
sales have expanded - Maryland in July became the latest state to permit
sale of marijuana products for recreational use - the suggestion that
marijuana is addictive has often met with derision, especially because
science isn't always clear on the benefits and harms. There can be
reluctance to seek treatment. And other substances stir deeper fears and
greater attention: Opioids are driving an overdose crisis killing more
than 100,000 people each year in the United States.

"Because there are so many mixed messages in our society about cannabis, I
think it's very easy for people to minimize and rationalize problematic
use of cannabis," said Aaron Norton, a Florida mental health counselor who
supports legalization of recreational and medical marijuana but believes
it should be more tightly regulated.

Courtney and other marijuana users interviewed by The Washington Post
spoke on the condition that only their first name or initials be used
because they fear being stigmatized or because relatives or employers are
not aware of their use.

Twenty-three states and D.C. have legalized recreational marijuana, and
all of those states except for Virginia and Minnesota have recreational
sales up and running. Medical use is lawful in 38 states.

The number of regular users has increased. According to a 2019 federal
government survey, an estimated 31.6 million people age 12 or older used
marijuana within the past month, up from 22.2 million five years earlier.
The estimate rose to 36.4 million in 2021, although the numbers are not
directly comparable because researchers changed how they collect data.

Medical experts and even many proponents of legalized marijuana
acknowledge it can be addictive - akin to alcohol or some prescription
drugs. Estimates vary on the prevalence of what is known as cannabis use
disorder. One study from researchers at Columbia University and the
National Institute on Alcohol Abuse and Alcoholism found that nearly 3 in
10 users in 2012-2013 experienced cannabis use disorder.

"The majority of people who use cannabis products in general can handle
it," said Adrianne Trogden, a Louisiana addiction counselor. "But there
are still people who cannot - and they need help."

Darren Weiss, president of Verano, a cannabis company operating in 14
states, agreed that public health and industry officials should not
dismiss the potential for cannabis to be abused, but maintained that
concerns are often overwrought.

"Addiction is a fact of life," Weiss said. "There are folks who are
addicted to caffeine, to sex, to all sorts of different things."

The rise in marijuana use among teens has been highly publicized, along
with concerns about the effects of more potent products on the developing
adolescent brain. In May, the National Institute on Drug Abuse published a
study asserting that young men with cannabis-use disorder have an
increased risk of developing schizophrenia, although critics have pointed
to other studies that cast doubt on the extent of the role marijuana plays
in psychotic episodes.

Further fueling concerns among some experts: In the 1990s, THC, the
psychoactive compound responsible for inducing a high, constituted about 5
percent of a typical joint or smoke from a bong or pipe, according to the
Drug Enforcement Administration. Today, the THC content in smokable
marijuana in recreational products can range between 15 and 21 percent,
while products popular with young people such as edibles and oils can
contain well over 50 percent.

Higher THC levels could increase the risk the brain will get conditioned
to want more of the high-potency marijuana, said Nora Volkow, NIDA's
director. Last year, a study published in the journal Lancet Psychiatry
found that higher potency THC was associated with an increased risk of
cannabis use disorder.

Weiss questioned claims that higher potency marijuana is more likely to
cause addiction. Still, he acknowledged that companies market to cannabis
enthusiasts who will pay more for higher-potency products - because of the
economics of the industry.

If marijuana could be sold by pharmacy chains or liquor stores, Weiss said
there would be more incentive to sell lower-potency products marketed at
casual consumers. More sales of lower-octane marijuana to a broader
customer base would equal higher revenue, he said.

"There are a lot of people who demonize industry and think we are pushing
high potency, similar to what the tobacco industry did, as a way of
hooking consumers � and it couldn't be further from the truth," Weiss
said.

The Substance Abuse and Mental Health Services Administration estimates at
least 16.3 million people in the United States had a cannabis-use disorder
in 2021, putting it behind only alcohol. The agency's yearly estimates
rose in 2020 after it incorporated broadened American Psychiatric
Association criteria on diagnosing substance use disorders.

Most cannabis-use disorder cases were characterized as mild, which means
patients experience just two or three of 11 benchmark symptoms, such as
increased tolerance, intense cravings or repeated attempts to stop
marijuana use. An estimated 26 percent of cases are considered moderate,
while 16 percent are severe, according to SAMHSA's National Survey on Drug
Use and Health.

"It's the second-most common addiction Americans are struggling with, but
nobody hears about it," said James H. Berry, a psychiatrist and addiction
expert at West Virginia University.

Still, experts caution that mild cases of cannabis-use disorder may not
fit under what the public generally considers "addiction." The effect on
users' lives may be less severe - perhaps marijuana smoking has merely
caused friction with a spouse. For those patients, interventions are
typically geared toward minimizing the drug's harm, said Trogden, the
Louisiana counselor: "Maybe some counseling sessions, [introducing] some
coping strategies, or education on how to use responsibly," she said.

For people who consume medical marijuana, the risk of being misdiagnosed
with a use disorder is a real threat, said Tammy Chung, an addiction
researcher at Rutgers University. They can meet criteria for a use
disorder, such as developing withdrawal symptoms and a higher tolerance
for THC, despite being under the supervision of a medical provider.

"The threshold for cannabis-use disorder is relatively low," said Chung,
who has recommended revamping how the disorder is diagnosed.

E.H., a 44-year-old San Francisco-area schoolteacher, was never formally
diagnosed with cannabis use disorder but had a medical marijuana card for
years. He believes his decades of smoking marijuana day and night affected
his life in profound ways. His habit was costing up to $300 a week, and he
obsessed about needing to stay high. E.H. stopped using marijuana for a
few years - until California legalized recreational marijuana in 2016. He
waited in line at a dispensary for hours to buy a celebratory joint, then
quickly spiraled back into daily use.

Today, he said he has been sober for nearly a year after joining Marijuana
Anonymous. But he's sheepish about telling people about his struggle lest
they chide him for betraying the California counterculture cool of his
youth.

"It feels like if you don't smoke marijuana, you're one of the sellouts,"
E.H. said.

It's not unusual for people to turn to recreational marijuana products,
believing they treat assorted ailments - and doing so without a doctor's
guidance. Smita Das, an addiction psychiatrist at Stanford University,
said she encounters patients who use marijuana to treat anxiety.