She was likely predisposed to schizophrenia (because of her father - which we don't share) but I often wonder if it would have progressed the way it did absent the heavy smoking.

I say this also as a pot smoker myself (but only lightly in the past decade or so). I have nothing against it, and used to scoff at those who were against it.

Now... I'm absolutely convinced that marijuana use can have absolutely catastrophic mental health implications for some people. I'm also convinced it can help people with certain conditions.

At any rate, it's much less benign than I long thought.

For example, there is a high correlation between having schizophrenia and consuming nicotine[2]:

> A strong association between schizophrenia and tobacco smoking has been shown in worldwide studies. Smoking is especially high in those diagnosed with schizophrenia, with estimates ranging from 80 to 90% being regular smokers, as compared to 20% of the general population. Those who smoke tend to smoke heavily, and additionally smoke cigarettes with high nicotine content.

I'd argue that nicotine use isn't a cause of schizophrenia, but an effect, as nicotine is reported to alleviate some people's schizophrenia symptoms.

[1] https://en.wikipedia.org/wiki/Schizophrenia#Negative_symptom...

[2] https://en.wikipedia.org/wiki/Schizophrenia#Prognosis

Note that he told me so, even if his work during the last 15 years was mainly with the very poor people or refugees without health insurance, the ones suffering a lot from the drug dealers and all the associated black market, prostitution and abuse against minorities, women and kids.

We had lively discussion because I consider that legalizing drugs would reduce violence, gangs, etc. but it is hard to argue against somebody having clear first hand experience with both sides of the problem.

[0]: was in fact, he retired 2 weeks ago.

Anecdotally, I have seen several marijuana-using friends go down the tubes. One became extremely paranoid to the point he was unable to maintain relationships with the people around him (because he was worried everyone might be a spy), and several others became extremely unpleasant and irritable when they weren't high on the drug. This is perhaps the minority case and most people can partake relatively safely, but I definitely don't see it as a completely harmless substance.

I would bet you anything that this person was using a high-potency grade of cannabis and/or smoking a lot of it.

If they just used a little bit of a low-potency strain it's unlikely they would have suffered from paranoia.

"several others became extremely unpleasant and irritable when they weren't high on the drug"

So, wait, these people became nicer to be around while they were smoking and this is supposed to be a bad thing?

Edibles are usually highly opaque in terms of the strains used and tend to contain at least 5mg THC per dose, sometimes 10, and that's if you trust what's on the label. Due to how edibles are metabolized, the THC remains in your system for longer, too.

You no longer need to "smoke a lot" to consume a great deal of THC, a couple of edibles will do the job. A lot of edible fans don't smoke or vape at all.

We know when using a psychedelic dose, set, and setting become critical.

People taking a strong dose of a psychedelic and expecting it to be no more than a regular pot high might be in for a rude awakening, especially if they treat it casually instead of with great respect, take it in inappropriate circumstances (like at parties or clubs full of people they don't know or trust), etc.

It's no wonder that many people suffer from paranoia and other adverse effects from casual use of edibles. They should really be treating a strong dose of edible cannabis like they do a strong dose of LSD.

Take someone that suffers from paranoid schizophrenia; telling them God speaks to people and that they should obey him can have dire consequences! I've see this problem first hand, so I'm not just speculating.

People throughout history have claimed to be profits; but unless they are a fraud, it's far more likely that the voices they hear auditory hallucinations associated with schizophrenia!

This is why I totally understand the point of view of the therapists having to deal with the long term effects on these unlucky people. Both sides have good arguments, one cannot ignore them, only trade-offs to accept one way or another.

Case point 1 but simple fact is, tons of people have some sort of predisposition to some form of mental illness. Wife is a doctor and she nicely sums it up - its not binary, tons of folks having miserable life are in scale 1-10 somewhere in lower part of one or the other mental illness (or more). Bipolar, OCD, ADHD, schizophrenia, etc., you name it. She deals with them daily.

For some, weed could trigger it. For some, some other drug or some big shock (close relative death, accident, violent crime etc). Since we don't ban the rest, banning the weed is just cargo culting due to US policies re hippies from Nixon era, enforced globally due to UN treaties. Which led to ridiculous situations where places like India or Nepal having marihuana as holy flower of god Shiva for literally thousands of years, using it to celebrate him, and suddenly had to ban it... at least on paper. Because bureaucracy.

Your father is not a good reference for this topic, its often a sad story when such people are asked to make policies that govern us all. They are always 'too deep' in the problem, see only the worst cases, so inevitably for them its the source of all evil and extremely dangerous. They don't know how happy, connected with nature and universe one can feel, how sex can be 10x better than best one he ever had, and orgasm can be literal nuke in your cranium, by far the strongest experience in ones life. Or tons of other, positive effects if not used in excess.

Ask doctors who work on alcohol rehab clinics whether it should be banned. Most will say definitely, and those who don't simply because they use it to self-medicate depression. And that is only because its socially acceptable drug, although way more destructive than weed could ever be.

That's contrary to my understanding. I think you're overestimating the damage of one and underestimating the damage of the other. If you've underlying conditions susceptible to drinking or to smoking, indulgence in either can have dire consequences. For what it's worth, smoking for days straight is much much better in all ways than drinking for days straight.

A close relative had that since ~30 years of age until death at ~80 years of age. During his twenties he abstained. Then it was social drinking, then it became more frequent, then he started becoming dysfunctional, not being able to perform in his professional life, all the while his mental state degraded, around 50 years of age you could still argue with him, around 60-70 there wasn't anyone to argue with anymore, there was only a craving left.

I don't think it's just the alcohol. I presume that it concealed a psychological problem. But, I can't help thinking that if it were some other drug the person in question would have had a higher life quality. Alcohol is very punishing in all ways.

Even heroin can be used intravenously for decades as long as proper caution is observed, but that tends to become a low priority if availability and thus price fluctuates. If quality fluctuates, death by overdose is a matter of time. The opioid epidemic is no joke, but it took a turn for the worse once doctors stopped prescribing opioids and supplies dried out, making people pay inflated prices and/or switch to fentanyl.

At least alcohol is available, so people don’t drink mouthwash.

Also, there's a fundamental right to self medicate.

Absolutely. I am cutting down on weed after seeing it wreck a friend. They were really bright and down to Earth, but they use weed to deal with anxiety and now need to smoke before hanging out with friends. Now they are fully dependent on weed.

It has turned them into an unbearable person with no motivation. My friend is now totally unaware of how much of an asshole they are and no one wants to deal with them.

Weed can be an awesome relatively safe drug but please look for the warning signs of dependence and know that r/leaves exists.

OP was commenting on why there may not necessarily be a causation, and you commented on how the doctors tend to think there's a correlation. It just as well could be that schizophrenia tends to lead to increased marijuana consumption as people are self medicating. I'm no expert, so I don't have any strong beliefs around causation, but I do think both lines of thought (marijuana causing schizophrenia, or vice versa) seem pretty logical to me.

It's pretty widely believed that there is a correlation between the two, but the reason behind the link is where there's a lot of debate.

The discourse around how destructive it is encourages this thinking, similarly to how Americans struggle with alcoholism while Italians do not, despite the latter's culture of continuous exposure at young ages.

I think this is a good explanation. It's also important to acknowledge that norms around marijuana use and the perception of schizophrenia and its symptoms have changed drastically in the last 25 years. So have schizophrenia treatments.

Older neuroleptics have severe side effects that cause permanent Parkinson's-like movement disorders and are responsible for lowering patients' life expectancies. It wasn't until the mid-to-late 1990's that the atypical antipsychotics were approved by the FDA, which had significantly less side effects than older drugs. And then it wasn't until the mid-to-late 2000's that those drugs had affordable generics. Several new antipsychotics were approved in the 2000's that have less side effects, as well.

So in the past, if you couldn't see a doctor, you couldn't get a schizophrenia diagnosis even if you had it.

[1] https://www.commonwealthfund.org/blog/2020/aca-10-how-has-it...

I used to think cannabis was relaxing.

Then I started wearing a watch which doubles as a heart-rate monitor.

I generally suffer exclusively the singular negative effect of others finger wagging and disapproval of a rather pleasurable funcional vice or medication or whatever you wish to call it.

I’ve quit a few times for up to a year and always decided consciously to go back. One of the times I left tobacco behind. Countless studies will only ever have access to what users are willing to divulge, to the degree that it’s not an open regulated or at least informed market.

There is an interesting singular fact. Not one single overdose death has ever been conclusively linked to cannabis. The LD50 is something crazy like 15kg in the span of 15 minutes for a 75kg human.

A practical application of this is to suggest that those who want to use cannabis for a good night;s sleep, get started two or three hours before bedtime.

I got twenty excellent years out of regular cannabis use. Tradeoffs there were, but worth it.

I'm a lot more sensitive now and sometimes it gives me panic attacks. But even when it doesn't, cannabis consistently raises heart rate and lowers blood pressure, that's just how it works.

I still employ it, carefully, from time to time.

Have you tried using the minimal amount of very low-potency weed?

In my experience negative effects like paranoia and panic attacks come from overdose, either by using high-potency weed and/or smoking too much.

Panic attacks are well under a 1 in 20 response now or I just wouldn't bother, since it isn't any fun at all for about 20 (subjectively very long) minutes.

I have what's called a paradoxical reaction to whatever they use to put you under anesthesia. I wake up in a rage, they have to take me out very slowly.

I have a friend like this with marijuana. She finds indicas make her euphoric and energized and creative, when she should be couch-locked with a body high. Until she swapped types she kept getting super anxious and it led her to bad trips. But the benefits outweighed the downsides for her (she was able to eat and sleep normally).

Also- coughing (which you almost certainly will), will raise your heart rate.

So how do we know what is a bad effect of the plant in general? This is worrying to me, and as a marijuana smoker I would really love more studies to be done on it.

Euphoria and relaxation aren't identical concepts...

Just saying 'marijuana did this to me' without context of the strain or if it was constant across strains isn't super helpful.

The effects also vary from person to person, and even in the same person at different stages of their life.

I don't remember the exact details anymore, but more or less they claim to address causation by 1) starting with a non-schizophrenic population, 2) segmenting by marijuana use, and 3) evaluating schizophrenic status N years later. The theory is that by limiting 1) to non-schizophrenics, they've factored out the possibility that schizophrenia drives drug use rather than the other way around.

Of course, most schizophrenics are not actually diagnosed until waaaay past the point where they are showing symptoms, and if you've ever known a schizophrenic who was diagnosed in college, for instance, you know that that diagnosis usually comes at the end of a long chain of subtle and not so subtle mental issues, shrink appointments, and life problems that start much earlier but don't present as full blown schizophrenia. So the whole supposed filter in 1) is complete trash, and they're probably including a lot of people who are already symptomatic, just not to a clinically diagnosable degree.

> "There has been emerging evidence of an association between tobacco smoking and schizophrenia spectrum disorders (SSD). Two meta-analyses have reported that people who smoke tobacco have an ~2-fold increased risk of incident schizophrenia or psychosis, even after adjusting for confounding factors."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255982/#:~:tex....

More likely, marijuana use accelerates the development of schizophrenia among people already at risk.

> it could also be increases in the percentage of cases that actually get diagnosed, etc.

This is generally a valid stock response to these sorts of studies. But it strikes me as a bit unlikely that there was previously a large amount of undiagnosed schizophrenia.

(Unless we have broadened the definition recently).

As another commenter pointed out, US health insurance did not typically cover mental insurance until relatively recently, making diagnosis impossible for many.

1. THC concentrations have increased which usually means there is less CBD. 2. Legalization probably increased casual use. 3. People who suffer from schizophrenia are simply more likely to be diagnosed for whatever reason.

The sum of these three things could easily account for a significant increase in diagnosis.

Sometimes increases in diagnosis correlate with better detection. Sometimes they correlate with incentives to diagnose people. I’m not even suggesting a nefarious connection. Sometimes incentives with the best intentions can have a big impact.

Why would that be unlikely?

(Though perhaps dishonesty isn't the correct word to use here: I don't have a high prior on the journalist even understanding this complaint)

I'm also not sure if it's journalists wanting to push one narrative over the other, or just a lack of understanding.

Cigarette smoking also has a heavy association with schizophrenia, but the biases we have about it don't lend themselves to the kind of sloppy causality that you see with marijuana. I know you can legitimize biases by calling them priors, but then you need to show your work: those priors themselves should be based in harder data and explicitly referenced.

Otherwise, sloppy science (and reporting) become indistinguishable from considered priors.

The drug itself also changed over the years with current breeds having way more active ingredients than the ones used decades ago.

It's mostly true for the United States, although even back in the day there were strains (Maui was famous for this) which had nice crystals and were grown without males around to spoil the product.

In Europe, hashish was the normal form of cannabis, and it's hard to make hash more potent than it already is. It varies in quality and strength like any natural product, but over a range that is higher than a flower can achieve, pretty much by definition.

Hard-core concentrates and pure THC products are new, sure, but hashish gets you most of the way there.

"Resin potency increased from a mean [95% confidence interval (CI)] of 8.14% THC (6.89, 9.49) in 2006 to 17.22 (15.23, 19.25) in 2016. Resin price increased from 8.21 euros/g (7.54, 8.97) to 12.27 (10.62, 14.16). Resin increased in value, from 11.00 mg THC per euro (8.60, 13.62) to 16.39 (13.68, 19.05). Quadratic time trends for resin potency and value indicated minimal change from 2006 to 2011, followed by marked increases from 2011 to 2016. Herbal cannabis potency increased from 5.00% THC (3.91, 6.23) to 10.22 (9.01, 11.47). Herbal price increased from 7.36 euros/g (6.22, 8.53) to 12.22 (10.59, 14.03). The value of herbal cannabis did not change from 12.65 mg of THC per euro (10.18, 15.34) to 12.72 (10.73, 14.73). All price trends persisted after adjusting for inflation.

Conclusions European cannabis resin and herbal cannabis increased in potency and price from 2006 to 2016. Cannabis resin (but not herbal cannabis) increased in the quantity of Δ9-tetrahydrocannabinol per euro spent. Marked increases in resin potency and value from 2011 to 2016 are consistent with the emergence of new resin production techniques in European and neighbouring drug markets."

Certainly, the potency is much higher than it was in the 1960's and 1970's.

When it was available back then it was always some low quality dirt weed that you could smoke for days and still function on.

With the legal recreational stuff, I was so blasted out of my mind that I couldn't hold a conversation. I had a mild panic attack because of slow playing music, and was high for the rest of the night. It was not fun, it was scary.

Maybe my tolerance has decreased, sure, but the strength differences in modern recreational weed are so severe that they probably should not be considered to be the same drug any longer.

If what was available to me as a teenager was like beer, the new stuff starts at vodka and goes way past Everclear.

I find it disappointing the same'ol propaganda reappear still today for MJ...now all left to do is to find out who sponsored the study this time and dictated the outcome...

That's not always true -- especially among new, naive users.

I knew someone who for their first time smoked an entire joint because they thought that was a single dose.

Unsurprisingly, they had a bad time because they basically overdosed... and that was more than a decade ago, when cannabis was significantly less potent than it is now.

I'm sure there are plenty of new users today who repeat the same mistake with dire (psychological) consequences.

Of course there are also alcohol first-timers who get abolutely shit-faced, that's a really bad trip as well. Probably also some who die of alcohol poisoning.

I'm curious, why did you say "dire (psychological) consequences", what do you mean by that?

Many of the vape pens are also extremely potent, and it’s even easier to overuse those.

I’m not saying the old propaganda has any value, but I do think it’s a lot easier than many think to level up to “heavy use” very quickly with modern offerings.

But even at insanely high concentrations, you’re still most likely to just have a bad time, not get seriously injured.

This should be addressed by education though, not regulation/propaganda.

It would be very surprising if there weren't (at least) a substantial minority of weed-smokers who have trouble knowing when to stop.

With food the issue is how our body is tricked to not feel full when in fact through more sugar and fat he got way too much calories. Then getting addiced to sugar and fat. While of course very problematic, that's a different matter, not directly comparable.

In general though, by nature's design, people start to consume everything unknown slow and increase the amount/dosage. That is how we function.

The fact some people do not know moderation, for various reasons, is not a sound argument for prohibition. Some will always abuse anything.

You can die of drinking too much water, and certainly people did in the past. Can you prevent that from happening, by controlling the access to water somehow? No.

In my opinion the more nonsensical idea is to try to forcefully protect people from doing harm to themselfes, when common sense and normal behavior will do on its own. There is free will and autonomy over the own body. That's the limit of regulation.

The better aproach is education in a honest, factual way.

The first study is commissioned by the European Monitoring Centre for Drugs and Drug Addiction and the second was funded by a Senior Academic Fellowship from the Society for the Study of Addiction.

The larger scientific discussion where study is confirmed is after peer review.

On HN, they are specifically disagreed with super often. Especially anything "softer" It is not like it was taboo.

And second, it is not scientific behavior to treat a single study as gospel. It is scientific when consensus emerges from many different studies and when those are reproduced and verified.

Pearl clutching over "peer-review" mostly suggests people don't know what peer review can or can not do.

No "science denial". Questioning of this specific study and disregarding your appeals for authority.

You explain it well enough yourself. The was a wide gap of difference hash in Europe in the 90’s vs your average weed in the US. All too often the stuff in the US would barely get you high whereas a few tokes of hash would be pretty intense.

Sure, you always had special strains, but they were the exception. Now the strains and derived products is competitive with hash and you have to be careful.

>It is "the notion that everything one perceives in the world relates to one's own destiny", usually in a negative and hostile manner.

After all, MJ does alter the mind and broadens the worldview so to say, which could be called paranoid through a certain lens, and also dulls the senses and makes more tolerant for micro signs and non-verbal communication, which could be called, with some exaggeration, more narcisstic.

To my knowledge schizophrenia is hearing voices and similar hallucinations, which are beyond trust issues.

But from experience with weed smokers, I certainly have the impression that there might be some truth to the story.

Something about THC is at the center of this. And also something about age.

I used to be able to smoke as much as I wanted and just enjoy it, then one day it started making me crazy.. and I kept smoking for a few years and truly lost my mind.

I've heard this story countless times... something (usually around age 20) just snaps, and suddenly THC == paranoia.

Also to note, psycho active drugs are as they are called: psycho active. With prolonged use, tolerance increase, with further use some imbalance occurs especially when not under the influence of that substance. Re establishing that balance takes time. We are very poorly educated when it comes to mental stability, and pharmaceutical treatment is the de facto answer by medical corps.

I do hope you get better, just don't forget substance use has an impact on the brain subtle chemistry, that's in a way what makes them attractive in the first place, and this impact doesn't disappear after a day like a hangover. Take some time off stimilant and psychedelics, you will slowly regain your normal self.

It's common for people to smoke more and more cannabis as their tolerance grows, and higher doses of cannabis can easily lead to paranoia and other adverse mental effects.

If these people took a long break and then tried the smallest amount of the weakest pot they could get, they might find that they can enjoy it again without getting paranoid.

And in your first sentence, do you mean you get psychosis or hallucinations from smoking pot? Or literal schizophrenia? Interestingly, around 19-22 years old when I smoked a lot, I had some psychosis-like symptoms, mostly auditory hallucinations. They weren't very disruptive or paranoid-feeling though, it was always the sound of a group of people at a party or backyard barbecue or something standing around laughing & talking, and I could only actually make out like 1/5 words. It felt very real though, I looked out my window countless times to see if my neighbors were having a 2am party in their back yard.

That sure seems causative.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255842/