What if the Media Reported on Prescription Drugs Like They Do on Cannabis?
The New York Times’ recent cannabis coverage leans on cherry-picked data and fear-driven narratives—here’s why that matters.
This is a cross-post from the Doctor Approved Cannabis substack by Dr. Benjamin Caplan, MD. More information below the article.
Last week, the New York Time’s flagship podcast, The Daily, released an episode titled “As Marjiuana’s Popularity Grows, So Do Its Harms.” During the episode, Times reporter Megan Twohey addresses well-trod concerns about psychosis and cannabis use disorder as though nobody has truly discussed these issues before. Much of Twohy’s justification for the episode, and the print piece that preceded it, hinged on two premises. One— people perceive cannabis as a harmless drug and are unaware of potential risks, and two—the harms of cannabis stemming from state level legalization are downplayed. Both are disingenuous.
Most Americans learned from a young age that cannabis is an addictive, personality-altering drug, and polling data show most adults know it’s not harmless. But the media continues to insist that Americans are naive about its risks. Last year, The Conversation published an article headlined “Many people think cannabis smoke is harmless − a physician explains how that belief can put people at risk.” But the survey in the article doesn’t actually show that Americans think cannabis smoke is harmless—just that it’s safer than tobacco smoke. Which… it is.
At the beginning of The Daily episode, Twohey caveats what’s to come, “I should say the vast majority of people who use, just general users of marijuana, are not having problems with it,” she says, “But we wanted to learn more about those who were. And when we started gathering more information, we were surprised by just how severe some of those issues could get.”
Digging into the content of the episode and the print piece that preceded it, the Times measured tone is undermined by statistical manipulations. The authors claim that harms from cannabis use are “more severe than previously reported,” based in part on an analysis the Times commissioned from a Columbia epidemiologist. The epidemiologist analyzed data from the U.S. 2022 National Drug Use Survey, and found that 18 million Americans have symptoms of cannabis use disorder. It’s unclear why the Times commissioned its own analysis, or why they’re suggesting that their reporting shows previously unreported levels of harm. The National Survey on Drug Use is conducted by SAMHSA, and their own analysis of the same data actually showed worse results than the Times—they found that 19 million Americans had cannabis use disorder in the previous year. (Incidentally, the SAMHSA report also found that 29.5 million Americans had alcohol use disorder that year.)
Later in the episode, Twohey speaks with a patient who suffered from Cannabinoid Hyperemesis Syndrome, a severe health condition where frequent cannabis users experience problems with stomach pain and vomiting. It’s very important that people are aware of CHS, but the Times takes an extreme leap when discussing its prevalence. In the print piece, they write:
Since the syndrome was first documented in 2004, doctors say they have observed a sharp rise in cases. Because it is not recorded consistently in medical records, the condition is nearly impossible to track precisely. But researchers have estimated that as many as one-third of near-daily cannabis users in the United States could have symptoms of the syndrome, ranging from mild to severe. That works out to roughly six million people.
Like any condition, CHS needs to be recognized to be diagnosed, so a rise in its prevalence could be in part because doctors are now more aware that it exists. I looked into where the Times got that “one third” number, since they chose not to include a hyperlink to the research. It appears to be from a 2018 study that had several crucial limitations. It only included 155 people, all of whom were patients visiting the same emergency room, and it only used two criteria to identify CHS—that patients used cannabis daily or near daily, and that they used hot showers for relief from their nausea, which is a hallmark of the syndrome, but maybe not enough to diagnose it, especially given that people with cyclic vomiting syndrome, a similar condition, also use hot baths to relieve their symptoms.
Ethan Russo, the doctor who the Times interviewed about CHS, has a financial stake in Americans’ perceptions about the condition. He has a patent pending for a genetic test intended to predict patients’ susceptibility to CHS—a fact that the Times did not include.
Had the authors chosen a more scientifically robust study, rather than the one that showed the most alarming numbers, they might have cited more recent research from 2022, that looked at administrative health databases on emergency visits in Alberta, Canada, which has a population of 5 million people. The study did find that the prevalence of CHS went up after cannabis legalization, from 15 emergency visits per 100,000 population before legalization to 32 per 100,000 after. They also found that CHS treatment prevalence for “chronic cannabis users” was 6 per 1000, amounting to less than one percent, or less than 1/50 of what the Times article claims.
This habit of cherry picking the most alarming numbers, while ignoring most of the vast literature of scientific research on cannabis’s harms and benefits, is common in the media. So is cherry picking the worst anecdotes, with the Times did, interviewing a patient who experienced CHS, as well as a woman whose boyfriend shot their dog and injured her after experiencing cannabis induced psychosis. The story is gut wrenching, but it is not representative of what cannabis typically does to people.
In the print piece, the writers do link to some studies about cannabis and psychosis. But again, it appears the authors cherry-picked studies to only include the most alarming results.
They don’t mention the majority of studies—some published in widely revered journals like JAMA and Nature—that found that the legalization of recreational cannabis did not increase population levels of psychosis related disorders and ER visits. Teasing out the relationship between cannabis and psychosis is tricky, because scientific research shows that people who are genetically predisposed to psychosis related disorders like schizophrenia are also predisposed to like cannabis. So higher levels of cannabis use in populations who experience psychosis don’t necessarily mean that cannabis caused the psychosis. Some scientists question whether cannabis can induce psychosis and related disorders in people who weren’t already susceptible to them. But the Times mentions none of this. Instead, Twohey says:
One researcher that I talked to, a professor at Yale University who’s paid a lot of attention to this issue, actually compared it to cigarette smoking and lung cancer. Not everybody who smokes cigarettes gets lung cancer. Not everybody who has lung cancer smoked cigarettes. But we know, after decades, that there’s a strong association between the two. And as he put it, the same goes for marijuana use and these chronic psychotic disorders.
According to the CDC, cigarettes are linked to 80-90 % of lung cancer deaths and people who smoke cigarettes are 15-30 times more likely to develop lung cancer. Even if you forget complications around correlation versus causation, no reading of the studies looking into the relationship between cannabis exposure and psychosis risk suggest anywhere near this strong a relationship between cannabis and psychosis.
If the Times chose to, they could create an equally, if not more alarming exposé about many of the prescription drugs that treat the same conditions as medical cannabis, like anxiety, insomnia and depression. Multiple studies have found that SSRIs increase the risk of suicidal and homicidal thoughts and actions. Antidepressants have been implicated in homicides since they were first introduced to the market. Convicted murderers, as well as their friends and family, say that antidepressants changed their personality, made them psychotic, and drove them to murder.
One Swedish study from 2020 found that patients were more likely to commit violent crimes during periods when they were taking SSRIs than periods when they weren’t.. A 2015 study found that children and adolescents on antidepressants were more than twice as likely to display aggressive behavior. Other pharmaceutical drugs, including stimulants, Ambien and Xanax can also increase the risk of mania, suicide and psychosis.
Javonte HIll, the man in the Times piece who killed his dog during an episode of cannabis induced psychosis, is suing the dispensary that sold him the implicated product for failing to warn him about the risks. There have been similar lawsuits relating to antidepressants. In 2001, a jury found the pharmaceutical company GlaxoSmithKline 80% responsible for Donald Schell’s murder-suicide, in which he killed his wife, daughter, granddaughter and himself.
The Times used to cover how antidepressants might increase the risk of suicide and violent crime, back in the 2000s, around the time that the FDA required antidepressants to include a black box label warning of the increased risk of suicide. But in recent years, the Times has stayed away from this topic, although they have questioned whether antidepressants work. It’s hard to say why they aren’t covering more serious risks—other than conversations around the dangers of antidepressants have fallen out of fashion in recent years, even if those dangers have not gone away.
These rare, tragic events, might not actually say much about whether antidepressants and other pharmaceuticals are capable of helping large groups of people. Doctors and researchers do not choose drugs because they have zero risk—they instead constantly assess whether the risks of a drug outweigh the benefits. In fact, seeing these tragedies framed as an argument against pharmaceuticals might be frustrating and enraging for the people who rely on them. They might protest that I haven’t included enough research or details about the people these drugs have helped. And they’d be absolutely right. But this is exactly how the Times article frames cannabis.
And unlike the pharmaceutical drugs discussed above, cananbis’s legal position is in jeopardy. The great irony of the Times exposés is that the authors repeatedly lament the lack of high quality research on cannabis.
They quote neuroscientist Yasmin Hurd, who helped write a report on why we need more research into the risks of cannabis. In the piece, she says, “Until we do research on the drastically transformed cannabis in all its forms, I think putting them under the umbrella of a safe, legal drug is wrong..It’s misleading at best and dangerous at worst.”
But continued federal prohibition is exactly why scientists in the U.S. are forbidden from researching the cannabis that people are actually using. Because cannabis is a controlled, Schedule I substance, researchers have to use low-potency cannabis from government controlled sources. For that to change, cannabis must be rescheduled—a process that is currently underway. The DEA will hold a hearing on cannabis rescheduling in December. That hearing will include testimony from witnesses, including those who want the federal prohibition of cannabis to continue. A story like the one in an outlet as prestigious as the Times could be a great weapon for them.
Introducing Doctor Approved Cannabis—a trailblazing, free resource reaching over 250,000 monthly readers at the cutting edge of cannabis science and innovation. Curated by renowned physician Dr. Benjamin Caplan, MD, this newsletter delivers breakthrough insights, featuring the latest research translated for all to understand, transformative interviews, and inspiring stories from patients and pioneers redefining cannabis medicine. Don’t miss out on exclusive content that reveals the true potential of cannabis and join a community exploring the future of health and wellness.
