For the first time on record, cannabis has outpaced alcohol as the daily drug of choice for Americans.
In 2022 there were 17.7 million people who reported using cannabis either every day or nearly every day, compared with 14.7 million who reported using alcohol with the same frequency, according to a study, published on Wednesday in the journal Addiction that analyzed data from the U.S. National Survey on Drug Use and Health.
While far more people drink than use cannabis, drinking frequently has become slightly less common than it was around 15 years ago, the study found. But the proportion of people in the U.S. who use cannabis frequently has increased 15-fold in the three decades since 1992, when daily cannabis use hit a low point.
Cannabis legalization has also rapidly accelerated since the ’90s. The drug is now legal for recreational use in 24 states and Washington, D.C., and for medical use in 38 states and D.C.
The sharp increase in the prevalence of high-frequency cannabis use over the last three decades might partly be attributed to a growing acceptance of the drug, said Jonathan P. Caulkins, a professor of public policy at Heinz College at Carnegie Mellon University. And because the survey data was self-reported, people may now feel more comfortable disclosing how often they use it.
Even so, “I don’t think that for most daily or near-daily users it is a health-promoting activity,” he added. “For some, it’s truly harmful.”
Several experts who were not involved in the research said the study’s findings were concerning. Those in favor of legalizing cannabis have argued that making the drug widely available would draw people away from the harms of alcohol, said Beatriz Carlini, a research associate professor in the psychiatry department of the University of Washington in Seattle.
But the study’s data, which shows only a slight decline in frequent alcohol use, suggests this has not been the case.
“It is disheartening,” she said.
Dr. Carlini and others noted that the concentrations of THC, the psychoactive component in marijuana, have increased dramatically over the years.
In 1995, the concentration of THC in cannabis samples seized by the Drug Enforcement Administration was about 4 percent. By 2021, it was about 15 percent. And now cannabis manufacturers are extracting THC to make oils, edibles, wax, sugar-size crystals and glass-like products called shatter with THC levels that can exceed 95 percent.
In the last decade, research has shown that frequent cannabis use — and particularly the use of high-potency products with levels of THC greater than 10 percent — is a risk factor for the onset of schizophrenia and other psychotic disorders.
“But that isn’t to say that use less frequent — monthly or yearly — is necessarily safe,” said Dr. Michael Murphy, an assistant professor of psychiatry at Harvard Medical School and a psychiatrist at McLean Hospital in Belmont, Mass.
“As we see higher rates of cannabis use in young people, I expect to see higher rates of psychotic disorders,” he said.
The risks of developing psychotic symptoms are higher for those who use cannabis before age 25, people who use it frequently, those with a genetic predisposition (for example, a parent or sibling with a psychotic disorder) or individuals who experienced stressful events like abuse, poverty or neglect during childhood.
In states that have legalized cannabis for recreational use, anyone 21 and over can purchase it.
Those who use cannabis frequently are also at risk of developing cannabis addiction as well as cannabinoid hyperemesis syndrome, a condition that causes recurrent vomiting, the experts said.
This latest study arrives on the heels of the Biden administration’s move last week to downgrade marijuana from the most restrictive category of drugs, known as Schedule I, to Schedule III, which includes drugs thought to have a low-to-moderate risk of abuse.
The survey did not collect information about the concentrations of THC in the products purchased by frequent users or note how often the respondents used cannabis each day.
“A lot of people go home and have a vape after work or take a gummy to go to sleep at night,” said Aaron Smith, the co-founder and chief executive of the National Cannabis Industry Association. He didn’t see that kind of casual daily use as a problem, he added.
At the same time, there may be young people who are using throughout the day “and are exposing themselves to a lot more THC than those people who are just taking a puff a day,” said Ziva D. Cooper, the director of the Center for Cannabis and Cannabinoids at the University of California, Los Angeles. “The mental health and the physical health outcomes are probably going to vary drastically when you look at those different groups of people.”
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