Visible Problems with “Invisible Pot Addicts”

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD candidate in history at Southern Illinois University. 

The Atlantic, as one critic remarked, “perfectly captures…the puzzled dining club member’s approach to civic and political organizing, and the all-around obtuseness of elite discourse”; it is an “ideological compromised organ of beltway consensus.” Matt Christman, of Chapo Trap House fame, quipped in one episode that The Atlantic is “neoliberal Dabiq,” a death-cult of discredited ideas concealed in a glossy facade. Jeffrey Goldberg, the Atlantic‘s editor-in-chief, was an early and enthusiastic promoter of the Iraq War, injecting into the bloodstream such fantasies as the collaboration between Saddam Hussein and Al Qaeda. His journalistic style, as one watchdog organization put it, was “complete with cherry-picked evidence, dubious inferences, rejection of contradictory evidence and ideological blinders.”

Don’t get me wrong, The Atlantic isn’t total garbage, but, like a kitchen after Thanksgiving, garbage is involved.

By that I mean that the Atlantic has a tendency to generate two kinds of content: the inane and the disingenuous. An example of the former: attributing “bigotry on the right,” to the left. Another example: solving New York’s subway system à la hoverboards.

But Annie Lowrey’s recent article, “America’s Invisible Pot Addicts,” isn’t inane, just disingenuous.

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Drug reform coverage creates arbitrary measures for success or failure. Sometimes these measures are calculated based on aggregate deaths or perceived harm. The so-called opiate epidemic is evaluated by deaths. Cannabis, on the other hand, is evaluated by potential risks to public health. Often one’s conclusion comes down to how ambiguous statistical data is interpreted. Unfortunately, this isn’t helpful.

Drug coverage comes with narratives, where data functions as a shortcut to reach predetermined conclusions. And it is very easy to do. It only works if the narrative is accepted at face value, however. For example, pollution kills 9 million people worldwide every year. That’s a scary-sounding number. If I wrote an outraged op-ed about the lives lost and proposed prohibiting pollution, it would be ignored. It would be ignored because it overlooks the bigger picture. Prohibiting all pollution is quixotic. The way to manage it is by considering tradeoffs and devising plans to mitigate risk, not to eliminate risk altogether. When it comes to drugs, though, mitigating risk is secondary. Instead the reader is treated to scary numbers, outrage, and feigned concern. Solutions are the same old ones, just repackaged. Because it is presented within a narrative that people accept, however, these drug reform ideas are taken seriously, not ignored.

If you’re Annie Lowrey, how do you find a problem with cannabis restricted to this public health criteria? You create a dire picture of “invisible pot addicts.” These kinds of articles, at first glance, often appear reasonable, and they take a while to think through. But the problems eventually reveal themselves.

So, let’s do that. The problem, according to Lowrey, is that since “the early aughts” the “the share of cannabis users who consume [cannabis] daily or near-daily has jumped nearly 50 percent.” That sounds like a major spike in daily use. But that number could be meaningful or meaningless – we don’t know the context. And while she does link to two NCBI and SAMHSA studies, these studies themselves are problematic. In the SAMHSA study, for example, drinking a glass of wine every night qualifies as “heavy drinking,” so daily use of cannabis is assumed to indicate similarly negative consequences. The NCBI study, on the other hand, uses an outdated version of “addiction” based on the DSM-IV. In more recent updates, including the DSM-V, the delineation between “use” and “cannabis use disorder” (“addiction”), is better defined. In the DSM-V, a use disorder disrupts a person’s ability to meet their obligations like work and family. Moreover, use disorders must cause distress. But use alone is not a problem, and even daily use does not necessarily connote addiction. As Dr. Carl Hart explained in a recent interview when asked about “addiction” versus using a drug:

We’re not talking about somebody who uses a substance every day, goes to work and they’re fine and able to live normally with their substance use. We can think about people who have a glass of wine at dinner every day, for example, who are fine. They’re not distressed. They handle their business. They’re not an addict. This same is true with somebody who might use heroin every evening and go to work and do their thing. They’re not an addict. That’s how we define it.”

Beyond conflating use and disorder, these studies also lump together medical and recreational cannabis. Medical marijuana, like other prescriptions, is typically used daily. It is unsurprising, then, that we’d see an uptick – a phenomenon Lowrey ignores. Also, consider her starting point, the “early aughts.” California, the first state that allowed medical marijuana use, did so beginning 1996. Today, the number of legalized medical marijuana states has increased to thirty-three, making it easy to imagine why daily use has gone up.

Outside of strict medical use, it is also easy to imagine situations where daily use could be beneficial. If someone switched from self-medicating with opiates or alcohol to cannabis, even if they were using pot daily, that would still be better overall, since cannabis is less harmful than those other substances. But this form of individual harm reduction isn’t something Lowrey takes into consideration, either. That’s the problem with statistics and numbers: they don’t speak by themselves. They always need an interpreter.

While masquerading as an empathetic exploration of “invisible” voices, Lowrey relies heavily on one: Evan, a Californian who “asked his full name not be used for fear of professional repercussions.” On my second or third reading, I noticed something strange about this. Lowrey writes that Evan has “a self-described cannabis-use disorder.” Wait…self-described? Medical professionals diagnose “cannabis use disorders”; self-descriptions carry no medical value. If you doubt this, ask a pharmacist to give you medication for a self-described disorder like diabetes or mental illness. Anyone can be a self-described anything. Until recently, Commerce Secretary Wilbur Ross was a self-described billionaire. Then his financial records leaked out.

The other information on Evan includes that he stopped using cannabis and experienced the following: “sleepless nights, intermittent nausea, irritability, troubling focusing, and psychological turmoil.” Of course, this is inevitable. It would happen if a person stopped taking anything, including sleeping pills. But it’s unclear whether we can ascribe these issues to cannabis or lack of sleep. Are Evan’s problems related to his cannabis use, or other personal problems? Are they the result of undiagnosed health conditions? Is this what other daily cannabis users can expect if they were to cut themselves off, too? If there are legions of “invisible addicts,” you might think Lowrey could expand her research, and maybe find a single clinical case.

Interestingly, however, a central theme of Lowrey’s article blames not just the Evans of the world for their problems, but rather our relaxed attitude, how we’ve gone “from treating cannabis as if it were as dangerous as heroin to treating it as if it were as benign as kombucha.” But this also seems to go against the grain of her larger article. After all, I doubt kombucha drinkers need anonymity.

Typically, publications like the Atlantic don’t provide space for the readers to react. Much of the blowback was the sort of thing you’d expect. A more thoughtful and measured response came as a letter to the editor from Dr. Angela Janis:

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Dr. Janis makes good points. When we discuss drug policy using one metric–in this case public health–it’s insufficient. For every Evan struggling with disturbed sleep, consider the legal ramifications as well. In 2015, the FBI reported that, of the 643,121 arrests for marijuana that year, 574,641 were for possession alone. The costs associated with these marijuana arrests are at least on par with 2010 figures, which were calculated at $3.6 billion. Arrests remain racially discriminatory and unequal as well. Marijuana use is “roughly equal among blacks and whites,” the FBI report found, but “blacks are 3.73% more likely to be arrested for possession.”

These are some of the most obvious issues, but I’ve barely scratched the surface. Other problems associated with criminalizing cannabis include issues related to the inability to access financial aid and public housing as the result of an arrest.

But my larger argument remains the same: we should certainly value health and public health, but it should not be the only value we consider. Instead of keeping certain areas invisible, all should be visible as part of our calculus when talking about drug reform, whether we do this as historians, journalists, or citizens hoping to effectuate change in public policy.

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