More Americans are using cannabis daily than drinking

SCIENCE
New study shows more people use cannabis daily than alcohol

What happened: A new study from longtime cannabis and drug policy researcher Jonathan Caulkins found a quite shocking conclusion: More Americans consume cannabis daily than drink alcohol.

Let that sink in. 

The study was published in the journal Addiction, and was widely covered in the press and generated much conversation. 

What the study shows: The study, a broad statistical analysis of self-reported use data, found that 17.7 million Americans used cannabis daily, compared to 14.7 million daily or near-daily drinkers.

The study also shows that around 40% of cannabis users are consuming daily or near-daily. That has changed over the past few decades. 

In 1992, (yes the year I was born, I am old), less than one million people reported daily or near-daily cannabis use. That year, there were more than ten times the number of daily drinkers than cannabis users, indicating a sharp rise in cannabis use as more states have chosen to legalize. 

But the study cautions that we can’t draw the causal conclusion from their analysis. They say the bump in use could be because of generally more permissive attitudes, or other explanations — perhaps fodder for future research. 

What they’re saying: “The trends mirror changes in policy, with declines during periods of greater restriction and growth during periods of policy liberalization. That does not mean policy drove changes in use. Both could have been manifestations of changes in underlying culture and attitudes. However, whichever way causal arrows point, cannabis use now appears to be on a fundamentally different scale than it was before legalization,” Caulkins writes in the study. 

And: Caulkins and his colleague, Keith Humphreys, also wrote an op-ed in Washington Monthly touting the results of the study and warned of what they see are the dangers of this “explosion” in high potency cannabis use. 

“Still, it is worth asking what the population effects are of so many people consuming high-strength cannabis regularly. Science has struggled to keep up with the new world of cannabis, but potentially concerning signs include increases in emergency room visits for both psychotic episodes and cannabis-induced cyclical vomiting, increased risk of cardiovascular disease, and higher rates of automotive crashes involving impaired drivers,” they write.

“Regulators need to take seriously their responsibility to protect the public from cannabis companies.” 

But, but, but: There are clear and obvious problems with this analysis.

It’s entirely possible that people were worried about repercussions for reporting cannabis use in 1992 they’re not worried about today. That’s true for any self-reported study, and the researchers do address this in the conclusion.

Self-reported studies often don’t generate very useful data for policymakers, but let’s table that conversation for a different time. 

The researchers also seemed to have missed a glaringly obvious point. Smoked THC is metabolized differently in your body than that consumed via edible.

The researchers say that average cannabis in 1990 contained about 4% THC. In 2022, the most recent year the study analyzed, they say average potency has skyrocketed to 20-25%. 

But potency is often inflated by imprecise testing and as a marketing tool for cannabis brands, so that number is likely more in the 15-18% range. Still strong, but not quite as extreme as characterized. 

It’s notoriously unreliable data, and relying on it to make broad conclusions is suspect at best, and a deliberate attempt to force data to fit a pre-ordained conclusion at worst. 

Using this flawed logic, the study found that the average cannabis user smokes about 1.5 grams of cannabis per day — amounting to roughly 300 milligrams of THC, or about two or three regular-sized joints. 

In the Washington Monthly story, they use this fact to generate an argument that people are consuming far higher potency cannabis than they were at Phish concerts in 1993, and that has all sorts of knock-on risks for everything from traffic safety to adolescent psychosis. (I’ll deal with the traffic safety issue and how inconclusive most of those studies are in a future newsletter).

Reefer Madness: This is a Reefer Madness argument and not one reflected by people’s actual consumption patterns. 

All the study really says is that three averaged sized joints have 300 milligrams of THC, leaving aside the potency testing problem for now. The authors then make the leap that this must mean that daily cannabis consumers are averaging 300 milligrams of THC per day. It’s a flawed analysis. 

Much of the THC contained in joints when smoked is burned off in the combustion process. And, it’s metabolized entirely differently in your body, as little of it actually enters the bloodstream and the effects wear off far quicker than THC consumed as food. 

The way it’s characterized in the Washington Monthly story, it’s as if daily cannabis consumers are consuming the equivalent of about thirty normal dose edibles a day. Which is not what’s happening, per studies. 

The relative “high” a cannabis smoker feels from two or three average size and potency joints is roughly equivalent to two or three edibles. Not 30, as the authors suggest.  

Again, because it’s important, the flawed assumption is that because two or three average size joints contain 300 milligrams of THC, average daily cannabis consumers have 300 milligrams of THC entering their bloodstream per day. 

The problem is, it’s not true. 

While it seems like a pedantic distinction, it does undercut the argument that daily cannabis consumers are all addled from extreme high potency pot. 

And, the jury is still out on whether there is even a correlation between higher potency cannabis and cannabis use disorder, as well as psychological issues like anxiety or depression. 

Our take: The study has generated much conversation, to say the least, and most of it in bad faith.

Stop me if you’ve heard me say this before: Whether you’re alarmed by the results of this study, or you think it’s more Reefer Madness, probably depends on your agenda. 

Anti-legalization groups — readers of this newsletter know the culprits — are taking a very public victory lap. Pro-legalization groups are complaining that the study’s design is flawed. They have a point. 

Look, anyone who claims that there are no negatives associated with cannabis use probably has a bridge (or a pack of pre-rolls) to sell you. On the other side, anti-legalization groups tend to traffic in Reefer Madness hysteria and take any broad correlative study that proves their point as gospel. 

That’s not a good faith argument. It’s agenda-driven bias confirmation. 

In reality, all these studies can and should be looked at as conversation starters or even areas for future inquiry. They identify interesting trends, but they’re not causal. 

They’re correlations, and self-reported correlational studies are notoriously unreliable, have repeatability issues, and sometimes say more about the researcher’s bias than they do the issue being investigated.

There is also the core problem with much cannabis research that’s rooted in decades-old stigma: Any uptick in use must be bad because people that use drugs are bad, and therefore must be categorized as a public health emergency. 

Reality, of course, is more complex than that. 

The final word: It’s still obviously worthwhile to study how and why there has been such a marked increase in the use of cannabis, as Caulkins suggests we do in the study. 

And we should be clear eyed about the risks this increase in cannabis consumption can pose. Getting high all day every day and spending hundreds of dollars a week for that aim isn’t a good thing. 

So good policy should seek to capture the benefits and minimize the harms of legalization, rather than traffic in old-school Reefer Madness. But we need a lot more effective research to help policymakers make these difficult decisions. 

Caulkin’s study is a start, flawed as the analysis is. Weaponizing the results to push an anti-legalization agenda is not. 

And more: The same pattern plays out every time researchers find a slightly troubling trend with cannabis use. Take this recent JAMA Internal Medicine study covered in The New York Times, which found that “cannabis poisonings” in seniors rose sharply after edibles were legalized in Canada.

But the study is really discussing around 400 emergency room visits from seniors, most of whom were probably fine after receiving basic treatment.  

Despite the tiny number, it’s still important research to conduct to elucidate a potential risk. 

But nowhere do the researchers say this is a death knell for legalization. All they’re calling for are age-specific dosing guidelines. It’s a reasonable solution for a minor problem. 

-JB

“It’s been quite a bit of science that has developed over the last few years, certainly since more than a half century ago when those placements happened, that show us that this may not be where it belongs,” Dr. Rahul Gupta, the director of the Office of National Drug Control Policy (ONDCP), told WGCU. “It does make sense to make sure that we’re pursuing science and evidence when it comes to medications and use those medications for Americans with chronic illnesses, chronic pain, diseases like cancer.” 

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