Drew Horowitz, MA, LADC, LPCC, CIP
Owner & CEO, Horowitz Health

Minnesota Legalizing Marijuana Is a Big, Potentially Bad Deal For those who are easily influenced, mentally shaky or predisposed to addiction, legalization is as good as an endorsement, one that’s more likely to harm than not.   It’s not going to be OK.   As someone who, substance-wise, has been there, done that; who founded and operates multiple Twin Cities substance abuse recovery programs; who as a clinical therapist and interventionist has helped more than 1,000 families steer their loved ones into treatment, I sound this ominous note from too much hard experience. Plenty of research (linked throughout) backs up that this isn’t just me being a naysayer—research that stands to become reality in Minnesota after recreational marijuana becomes legal August 1, 2023.    Legalization sends the message, particularly to those most at risk—youth—that marijuana is safe enough to be legal just like alcohol and nicotine, never mind that those substances are ineffectively subject to the same age 21 limitation and are addiction mainstays. For many—especially, again, our youth—the state’s medical marijuana preestablished a luster around marijuana that, if it’s helpful and good for some, it’s helpful and good for anyone experiencing any pain or discomfort. Look where medical endorsement of opioids as painkillers led us. Apples to oranges? The point is people don’t ask questions when they’re seeking relief.    Promoting marijuana as a means of self-medication or, worse, a casual, “recreational” plaything will be extremely harmful to our community, and by “community” I don’t just mean the recovery community.   Here’s what I anticipate is coming and what we can do about it:   Increased marijuana use “Why not? It’s legal!”Research in the Journal of the American Medical Association’s (JAMA’s) psychiatry publication showed that legalizing recreational marijuana in the U.S. has led to increases in cannabis use disorder in both adults and respondents ages 12 to 17 years, despite the legal age for use being 21. This early reliance sets the stage for marijuana-related mental health and substance use disorders.   Addiction and dependence Although marijuana isn’t considered as physically addictive as, say, opioids, many individuals develop a psychological dependence on it. Some of the most horrifying cases I’ve faced professionally were those who classified as “chronic marijuana users.” If it alters your mood, it’s addictive, period. Research in Drug and Alcohol Dependence, an international journal on biomedical and psychosocial approaches, examined medical marijuana laws across the country and found that legalization increased dependence and addiction by almost 4 percent: a relatively significant jump, given the total population. Marijuana users are also more likely to consume alcohol compared to non-users, according to research published in the National Institute of Health’s National Library of Medicine.   Mental health impact Marijuana use has been associated with an increased risk of mental health issues, particularly in vulnerable individuals. These conditions include 1) anxiety disorders, 2) depression, 3) psychosis and 4) an increased risk in predisposed individuals of developing schizophrenia. I’ve seen countless teens and young adults become psychotic from marijuana use. Worse is when they become isolated, paranoid and unable to function at a standard level. Preteens, teens and young adults don’t cognitively process risk and reward the way adults do, plus they’re more prone to experiment if substances are easy to come by and don’t have legal consequences. Trauma (known or repressed) survivors of all ages as well as individuals with existing anxiety disorders tend to become more symptomatic with marijuana use, opening the floodgates to ever-worsening conditions.   Impaired cognitive functioning Heavy, prolonged marijuana use, especially during adolescence (defined as ages 10 through 24) when the brain is still developing, has been linked to cognitive impairments the likes of reduced intelligence, memory deficits (Lisdahl et al., 2012)and decreased attention span. Such diminishment can affect educational and occupational outcomes and may require interventions to support affected individuals. In my practice, I notice that many of the students and young adults who already struggle with academics/work demands, anxiety or low self-esteem appear to begin using marijuana to cope with these issues, only to discover that marijuana make them worse, which then causes more challenges: dependence, mental health problems and hopelessness.    Professional preparedness Not only will legalization likely increase demand for mental health services and treatment, substance use disorder recovery programs will have to adapt their approaches and develop specialized programming. Marijuana users argue that its effects and impacts aren’t as harmful as stronger substances such as cocaine and heroin. Less lethal or not, it’s all relative when it comes to treating addiction, which is less about the drug’s strength than who can function or not function while using. Many of those in treatment for more harmful substances will agree to discontinue the bad stuff but continue to use the more widely accepted and now- legal marijuana. This will trigger an increase in relapse, which typically leads a person back to their substance of choice (the more lethal one). As it stands currently, marijuana is illegal and counselors are able to point to the fact that using illegal substances is highly discouraged and risky for continued sobriety. Counselors can certainly still point out that marijuana is a dangerous substance for those in recovery.  Addiction, however, is an illness of justification, one that uses any angle possible to justify a return to use.   Concern about readiness to deal with more marijuana-related health issues isn’t limited to those of us who treat substance use disorder. It applies to physical health, too: Take organ transplants as Exhibit A. And it very much applies, as touched upon above, to mental health. The American Counseling Association has issued guidelines around the mixed messaging, i.e., marijuana may be legal in Minnesota but is still classified as a controlled substance federally. The Minnesota Psychiatry Society issued a statement not supporting legalization. And now?   As a professional at the nexus of the above considerations, I’m grateful that the consequences of marijuana legalization are still being studied; however, we’ve already crossed into a dangerous area: The Minnesota law is passed. Only with candid, widespread public education can its impacts defy the existing research.   To be totally transparent, I’m scared.  I’m scared for our children, teens and high schoolers who’ll gravitate toward trying a drug they never thought they would.   I’m scared for the kid—the adult! —who’s depressed and withdrawn and who, instead of considering a true antidepressant medication or natural coping strategies, will use marijuana to address their issue.   I’m scared for addiction and mental health professionals. We’ll be on the receiving end of a massive influx in hospitalizations, people seeking treatment, high rates of relapse and substantially worsening mental health symptoms—this on the heels of COVID, during which we’ve seen a surge in mental health needs and massive spike in addiction. We simply are not prepared for this never-seen-before phase into which we’re being pushed.   The call now—and it’s a loud, urgent one—is for education, be it parents to their kids, teachers to their students, friends to their friends, counselors to their clients, doctors to their patients, recovery professionals to everyone who’ll listen: Marijuana may be legal, but it’s not without substantial risk.