Studies have shown that the levels of THC, the main psychoactive compound in pot, have risen dramatically in the U.S. from 1995 to 2017.
David McNew/Getty Images
David McNew/Getty Images
As more states legalize marijuana, more people in the U.S. are buying and using weed — and the kind of weed they can buy has become much stronger.
That concerns scientists who study marijuana and its effects on the body, as well as emergency room doctors who say they’re starting to see more patients who come into the ER with weed-associated issues.
Some 26 million Americans ages 12 and older reported being current marijuana users in 2017, according to the National Survey on Drug Use and Health. It’s not clear how many users have had serious health issues from strong weed, and there’s a lot that’s still unknown about the potential risks. But scientists are starting to learn more about some of them.
The potency of weed depends on the amount of delta-9-tetrahydrocannabinol, or THC, the main compound responsible for the drug’s psychoactive effects. One study of pot products seized by the U.S. Drug Enforcement Administration found the potency increased from about 4% THC in 1995 to about 12% in 2014. By 2017, another study showed, the potency of illicit drug samples had gone up to 17.1% THC.
“That’s an increase of more than 300% from 1995 to about 2017,” says Staci Gruber, director of the Marijuana Investigations for Neuroscientific Discovery (MIND) program at the Harvard-affiliated McLean Hospital in Belmont, Mass. “I would say that’s a considerable increase.”
And some products with concentrated forms of cannabis, like hash and hash oil, can have as much as 80% to 90% THC, she adds.
“I think most people are aware of the phenomenon that ‘this is not your grand daddy’s weed,’ Gruber says. “I hear this all the time.”
But people might not be aware of the potential health risks of highly potent weed. “The negative effects of cannabis have primarily been isolated and localized to THC,” says Gruber. “So it stands to reason that higher levels of THC may in fact confer a greater risk for negative outcome.”
“In general, people think, ‘Oh, I don’t have to worry about marijuana. It’s a safe drug,’ ” says Nora Volkow, director of the National Institute on Drug Abuse. “The notion that it is completely safe drug is incorrect when you start to address the consequences of this very high content of 9THC.”
Pot’s paradoxical effects
THC can have opposite effects on our bodies at high and low doses, Volkow says. Take anxiety levels, for example.
“When someone takes marijuana at a low [THC] content to relax and to stone out, actually, it decreases your anxiety,” she says. But high concentrations can cause panic attacks, and if someone consumes high-enough levels of THC, “you become full-blown psychotic and paranoid.”
Weed can have a similar paradoxical effect on the vascular system. Volkow says: “If you take low-content THC it will increase your blood flow, but high content [THC] can produce massive vasoconstriction, it decreases the flow through the vessels.”
And at low concentrations, THC can be used to treat nausea in cancer patients undergoing chemotherapy. But Volkow says that “patients that consume high content THC chronically came to the emergency department with a syndrome where they couldn’t stop vomiting and with intense abdominal pain.”
It’s a condition called cannabinoid hyperemesis syndrome.
“The typical patient uses [inhales] about 10 times per day … and they come in with really difficult to treat nausea and vomiting,” says Andrew Monte, an associate professor of emergency medicine and medical toxicology at the University of Colorado’s school of medicine. “Some people have died from this … syndrome, so that is concerning.”
Scientists don’t know exactly how high levels of THC can trigger the syndrome, but the only known treatment is stopping cannabis use.
While the number of people who’ve had the syndrome is small, Monte says he and his colleagues have documented a rise in the number of cases at emergency rooms in Colorado since marijuana was legalized there five years ago. A study by Monte and his team found that cyclical vomiting cases made up about 18% of inhaled cannabis-related cases at his ER.
They also found that statewide, the overall number of ER cases associated with cannabis use has gone up. And Monte says his ER has “seen an approximately a three-fold increase in emergency department visits just by frequency. It doesn’t mean we’re getting overwhelmed by these visits due to cannabis, it’s just that means that there are more patients overall.”
Most people show up at his emergency department because of “intoxication” from too much pot, either straight or mixed with other drugs, Monte says. The bulk of these cases are due to inhaled cannabis, though edibles are associated with more psychiatric visits.
“We’re seeing an increase in psychosis and hallucinations, as well as anxiety and even depression and suicidality,” Monte says.
He thinks the increased potency of marijuana plays a role in all these cases. “Whenever you have a higher dose of one of these types of drugs, the patient is at a higher risk of having an adverse drug event. If the concentration is so much higher … it’s much easier to overshoot the low-level high that they’re looking for.”
Not everyone is at equal risk, Monte adds. “Many many people use cannabis safely,” he says. “The vast majority don’t end up in our emergency department.”
Different risks for users
Some people are more vulnerable than others to the potential negative effects of high THC cannabis.
Adolescent and young adults who use recreationally are especially susceptible because their brains are still developing and are sensitive to drugs in general, says Gruber of the MIND program. In a recent review of existing studies, she found that marijuana use among adolescents affects cognition — especially memory and executive functions, which determine mental flexibility and ability to change our behavior.
Medical marijuana users can face unexpected and unwelcome effects from potent weed. “It’s very important for people to understand that they may not get the response they anticipated,” Gruber notes.
Studies done on the medical benefits of pot usually involve very low doses of THC, says Monte, who adds that those doses “are far lower than what people are getting in a dispensary right now.”
David Dooks, a 51-year-old based in the Boston area turned to marijuana after an ankle surgery last year. “I thought that medical marijuana might be a good alternative to opioids for pain management,” he says.
Based on the advice at a dispensary, David began using a variety of weed with 56.5% THC and says it only “exacerbated the nerve pain.” After experimenting with a few other strains, he says, what worked for him was one with low (0.9%) THC, which eased his nerve pain.
‘Start low, go slow’
Whether people are using recreationally or medically, patients should educate themselves as much as possible and be cautious while using, Monte says.
Avoiding higher THC products and using infrequently can also help reduce risk, Volkow adds. “Anyone who has had a bad experience, whether it’s psychological or biological, they should stay away from this drug,” she notes.
Ask for as much information as possible before buying. “You have to know what’s in your weed,” Gruber says. “Whether or not it’s conventional flower that you’re smoking or vaping, an edible or tincture, it’s very important to know what’s in it.”
And the old saying “start low, go slow,” is a good rule of thumb, she adds. “You can always add, but you can never take it away. Once it’s in, it’s in.”
The FCC’s proposal would allow phone companies to block “unwanted calls” by default. Customers would be able to opt out.
If the government’s new plan works, the number of robocalls you receive may go down in the near future.
The Federal Communications Commission is proposing to push phone companies to “block unwanted calls to their customers by default.”
If enacted, the proposal would not compel phone companies to impose default call-blocks. But it would shield telecom providers from legal liability for blocking certain calls.
“The American people are fed up with illegal robocalls. It is the top complaint we receive from consumers each and every year,” FCC Chairman Ajit Pai told reporters. “And we believe that we need to make it easier for phone companies to block these robocalls.”
This would be a major change from now, when customers typically need to opt in for unwanted call blocking. Under the proposal, “carriers would simply have to allow consumers who do not want that kind of service to opt out,” Pai said.
He said it would be comparable to the way email providers filter messages into spam folders. The FCC is pushing for phone companies to use an authentication framework for blocking unwanted calls that is dubbed “SHAKEN/STIR.” It’s a way for phone companies to verify that a call is actually coming from where a caller ID says it is.
The call-blocking company YouMail issues estimates of nationwide robocalls each month. It estimates there were 4.9 billion calls placed in April 2019 — a rate of 14.9 calls per person.
“Our belief now is that over half the robocalls out there are scams,” Alex Quilici, a robocall expert and the CEO of YouMail, told NPR. A rising problem is calls that are “spoofed,” meaning they disguise their identity on caller ID.
USTelecom, a trade group that represents telecommunications providers, applauded the FCC’s proposal.
“The criminals that are scamming consumers with this flood of illegal robocalls must be confronted by industry and government head-on,” the group’s president and CEO Jonathan Spalter said in a statement. “This is a big and bold proposal by the FCC that can bolster our industry’s cutting-edge call blocking and authentication efforts and do something important: stop unwanted calls from reaching consumers in the first place.”
The FCC has previously encouraged companies to take firmer action against scam robocalls.
But it may be a challenge for companies to figure out which robocalls are truly scams and which contain information that a consumer would want to get, like automatic calls about school closings.
And according to Quilici, one of the challenges to stemming relentless robocalls is that companies have been reluctant to assume legal liability for blocking calls that customers wanted.
“What we find is there’s a range of things that people are comfortable with having blocked,” he told NPR.
Quilici said it’s safe to assume everyone would want to block scam calls. But other types are less clear. For example, some people want to receive automated payment reminders from credit card companies, whereas others might prefer to block such calls.
And then there are extreme examples, he added, that might have made providers reluctant to embrace sweeping action in the past that could expose them to legal liability: “It’s the fear that you block a number and it’s Grandma calling and she’s having a heart attack.”
“It is very important that the proposal makes it clear that emergency and other vital calls are not blocked and that carriers give consumers ample information about these services and methods,” Pai told reporters.
The FCC has not yet released the specific details of its proposal — in particular, what kinds of guidelines the agency will provide companies for determining whether a call is “wanted” or “unwanted.”
Will Wiquist, a spokesperson for the FCC, said the call-blocking programs “would be based on reasonable analytics, like current call blocking apps.” He said the analytics are aimed at stopping scams and look for patterns like “floods of calls in the network or numerous short-duration calls.” Wiquist added that the proposal would allow for flexibility about what to block, or for customers to opt out altogether.
The FCC’s proposal also would allow providers to offer customers an even more aggressive form of blocking than the default option. If passed, customers could opt in to a filter system that would only allow calls through from numbers in their contacts, dubbed a “white list.”
“The number of
#robocalls we get is INSANE. For too long the @FCC has wasted time holding workshops and summits instead of holding bad actors responsible,” said FCC Commissioner Jessica Rosenworcel, who is a Democrat.
“Today it finally proposes new policies to help block robocalls. I sincerely hope this is not too little, too late.”
The FCC will consider the proposal at a meeting on June 6. Pai, a Republican, says he hopes it will give consumers the “peace of mind that they deserve.”
Six years ago, I was traveling in India, working on a story about measles. I was visiting a public hospital in New Delhi, when I walked into the waiting room and saw the tiniest baby I had ever seen.
An elderly woman — perhaps a grandma — was cradling the newborn in her arms. The little baby was wrapped in a blanket, and a tiny knit cap covered her head, which wasn’t much bigger than a small orange. The newborn could not have weighed more than four pounds.
I couldn’t believe this infant was simply sleeping in the hospital waiting room. Why wasn’t the newborn in the intensive care unit?
For the first time, the World Health Organization has estimated the progress made in preventing low-weight births — a condition that raises the risk of health problems for a child’s entire life. And the progress is slow — too slow, says epidemiologist Joy Lawn at the London School of Tropical Medicine.
Each year, more than 20 million babies are born weighing less than 5.5 pounds, the WHO reports Wednesday in The Lancet Global Health journal. Half of these babies are born in South Asia and a quarter in sub-Saharan Africa.
Since 2000, the world has reduced the rate of low-weight births by only about 3%, from 18% to 15%, the study found. Almost all that progress comes from low- and middle-income countries, where more than 90% of these births occur.
“Shockingly, progress is really slow in high-income countries,” says Lawn, who helped to lead the study. For example, there has been almost no improvement in the U.S., U.K., Germany, Australia and New Zealand in the past 15 years.
For the study, Lawn and colleagues collected data on 281 million births from 148 countries. For countries lacking comprehensive health records, the team used household surveys to estimate the rate of low-weight births in 2015.
Sweden leads the world with the smallest rate, at 2.4%. Bangladesh has the worst rate, at 28%.
The U.S. ranked 31st, with an 8% rate — 20 slots below China. That rate means more than 300,000 babies are born in the U.S. each year weighing less than 5.5 pounds.
The study mentions two major reasons for the relatively high rate in the U.S.: the prevalence of fertility treatments and high rates of unnecessary C-sections.
In southern Asian countries, the major issue is poor maternal nutrition, which can restrict fetal growth. In Africa, the major drivers are high rates of teenage pregnancies and infections during pregnancy.
Regardless of the underlying reasons, being born underweight can have health repercussions for decades.
“Low birth weight is probably the single piece of information about you that most predicts your health throughout your whole life course,” Lawn says. It increases the risk of stunting, disabilities and developmental delays during childhood and chronic conditions — such as heart disease — later in life.
“All of these outcomes result in human suffering, but they also perpetuate intergenerational poverty,” Lawn adds. In other words, if the world can decrease the rate of low birth weight babies, it will simultaneously help reduce the rate of poverty.
But the problem has been a tough one to fix. Back in 2012, the World Health Assembly set the goal of reducing low-weight births worldwide by 30% before 2025. To reach that figure, Lawn says, the world would have to speed up its progress by more than double.
“This is a wake-up call to governments, to the U.N. and to all partners,” Lawn says. “We must do more to tackle low birth weight. We owe it to every newborn around the world and to their families.”
Jerry Castillo prepares a steel pipe at the Borusan Mannesmann Pipe manufacturing facility Tuesday, June 5, 2018, in Baytown, Texas. The company is seeking a waiver from the steel tariff to import tubing and casing.
David J. Phillip/AP
David J. Phillip/AP
The Trump administration is preparing to add tariffs — or taxes — on virtually everything the U.S. buys from China. But the president offered reassurance that in some cases, waivers will be granted, so Chinese goods can be imported tax-free.
The administration has offered similar waivers from its steel and aluminum tariffs, putting the Commerce Department in the awkward position of literally picking winners and losers.
Rep. Jackie Walorski, R-Ind., called the process, “a master class in government inefficiency.” Her district includes big steel and aluminum users, including RV manufacturers.
The administration has received more than 80,000 requests for relief from the steel and aluminum tariffs imposed last year. As of last week, more than 55% were still awaiting a decision.
“It is a nightmare, like dealing with a lawyer and the IRS at the same time,” said Paul Everett, vice president of purchasing at Omega Steel.
The St. Louis company sells heavy-walled steel pipe, mostly to the oil and gas industry. Everett says there are only a handful of mills around the world that produce that kind of pipe, so Omega has asked the Commerce Department for tariff waivers for numerous specialty products.
“We filed approximately 300 exclusions,” Everett said. “And we’ve got, I think, 19 accepted.”
Most of the company’s applications for tariff relief are either still in limbo or were rejected, usually because an American steel company said it could provide the same steel, duty-free.
“The good news from the steel producers’ perspective is the tariffs, so far, are working,” said Scott Paul, who represents U.S. steelmakers and steelworkers as president of the Alliance for American Manufacturing.
He points to data from the American Iron and Steel Institute showing steel imports fell 35% after the tariffs took effect last year. U.S. mills are now operating at more than 80% capacity for the first time in over a decade.
“There have been about 12,000 jobs added in steel and aluminum since the tariffs were first announced, and you’ve seen more product lines come on line,” Paul said.
Domestic steelmakers are only supposed to object to an application for a tariff waiver if they can supply the same steel within eight weeks. But Rep. Walorski points to steelmakers who’ve filed objections while quoting delivery dates of up to 21 weeks. And Everett complains that U.S. mills have promised products they can’t deliver at all.
“Some of the mills just can’t produce the sizes they say that they can, and have not ever produced those sizes,” Everett said. “Unfortunately, nobody’s really checking the mills to make sure they’re capable of producing the product.”
American steelmakers have successfully blocked thousands of waiver applications, with more than half the objections coming from just a handful of big steel producers. Trade economist Christine McDaniel of the Mercatus Center at George Mason University says U.S. Steel, Nucor and AK Steel have each raised objections to duty-free imports totaling far more steel than they actually produce.
“They have a very good batting average,” she said. “Because when they object to something, it either gets denied or it just goes into the pending pile.”
Since the government has granted only a few of Omega Steel’s requests for tariff waivers, the company has had no choice but to keep paying the 25% tariff. Some steel importers absorb that extra cost. But Everett said Omega largely passes the bill along to its oil and gas customers.
“Nobody wants to pay the additional 25%,” he said. “The only people that have that kind of money are in the oil and gas business. And it’s really a pass-through for them because you’re paying for it at the pump.”
That consumer tab is likely to increase, as new and increased tariffs on Chinese imports take effect.