Alex Berenson, author of the book Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, wants you to think that he's right about his alarmist views on cannabis. He thinks he’s right in Trump-like fashion; he thinks he has all the best facts, from all the best studies, from the best and smartest people, with the best terrifying anecdotes — many, many pages of them — to prove it.
And yet, since Tell Your Children hit the shelves of bookstores around the country, 75 medical professionals, researchers, and clinicians from elite institutions like New York University, Harvard, and Columbia have signed onto a letter strongly criticizing Berenson’s work, calling it an “example of alarmism designed to stir up public fear based on a deeply inaccurate misreading of science.”
In Berenson’s cannabis hellscape, by the year 2040, 160,000 children born in the past decade will suffer debilitating mental illness due to cannabis consumption, and many thousands of those will commit murder and other violent crimes. Like The Walking Dead, but with weed.
“The loveliest trick of the devil is to persuade you that he does not exist,” reads a quote from C.P Baudelaire on the opening page of Tell Your Children. The devil in Berenson’s portrayal are the drug policy reform organizations — with special ire aimed at the Drug Policy Alliance (DPA), a non-profit whose mission is to advance policies and attitudes that best reduce the harms of drug use and the Drug War — and whose only goal, in Berenson’s view, is to mislead the public about cannabis’ harms so they can get rich from legalization.
“Cannabis causes psychosis. Psychosis causes violence,” Berenson told Civilized. “The advocacy community — and the for-profit cannabis industry — have spread myths and in some cases flat-out lies about cannabis for far too long. It’s time for the pendulum to swing to a more honest discussion of risks and benefits, no matter how difficult that fact may be for cannabis lovers to accept.”
All right, then. Let’s get honest.
CANNABIS LEGALIZATION AND LAWMAKERS
For the most part, cannabis legalization has been catalyzed by voters through the initiative process, a form of direct democracy intended to solve the problems of government action or inaction inconsistent with the will of the voters. Where adult-use cannabis markets are legal, eight of the nine victories came via citizen initiative, like California’s Prop 64 and Colorado’s Amendment 64. However, lawmakers can, and do, tinker with initiatives after they’ve passed, and rarely to a less prohibitionist stance.
As a case in point, consider Utah’s Prop 2 initiative to legalize medical marijuana. After voter passage, local lawmakers, in collaboration with the Mormon Church, intervened and, in fact, held a special session to make changes to the law. Now called HB 3001, or the Utah Medical Cannabis Act, its alteration has drawn lawsuits, while policymakers argue that they are well within their rights to make cannabis distribution more restrictive than Prop 2 initially called for and narrow the list of qualifying conditions.
According to the National Conference of State Legislatures, “the preservation of the public health has historically been the responsibility of state and local governments.” So if cannabis consumption is creating “marijuana madness,” as Berenson writes in Tell Your Children — putting children, women, parents, and even strangers at risk of becoming entangled with someone in the grip of marijuana psychosis — what duties do policymakers have to ensure public health?
Berenson gives state lawmakers a pass, saying that they are left with their hands tied, forced to implement voter passed-propositions, and lawmakers are simply along for the ride. “Voter preference — encouraged by very canny advertising and marketing from drug policy advocates — has driven legalization,” he said.
But Sheila Vakharia, PhD, LMSW, and policy manager for the office of academic engagement at DPA strongly disagrees. “DPA does not advertise or market cannabis,” she flatly states. “Rather, DPA focuses on providing information to lawmakers and the public about the documented failures of criminalizing cannabis.”
It is true that DPA works with lawmakers and other local stakeholders on legalization initiatives, and has donated to local legalization campaigns, as they did in California, through their social welfare arm, Drug Policy Action. But in Vakharia’s view, the public's perception of cannabis, even away from coastal cities like Boston and San Francisco, is shifting. “It’s becoming a commonplace attitude that marijuana shouldn’t be a reason for people to be locked up, and that it has potential medical use,” she explained. “Even opponents have resigned themselves, at the very least, that people who use marijuana shouldn’t be criminalized. Even Berenson calls for decriminalization.”
Despite state lawmakers being, in Berenson’s estimation, essentially powerless when it comes to cannabis legalization, he believes that leaving legalization to the states is probably best. “But I think the federal government should lead a national effort to collect data on drug-related psychosis and crime, as well as to lead a national campaign to reduce cannabis use by teens and young adults,” he said.
Berenson even suggested that DPA should work together on drug policy with Kevin Sabet, the leader of SAM (Smart Approaches to Marijuana), a group whose mission is to promote policies and attitudes that decrease marijuana use, and educate the public and lawmakers about its harms. SAM, like DPA but on the side of continuing prohibition, coordinates and donates to anti-cannabis initiatives across the country. “I would bet that when and if DPA is ready to talk to Kevin Sabet about reasonable warnings on cannabis, he’d be willing to listen,” Berenson added.
According to Vakharia, Berenson’s assumption that DPA has not met with Sabet is yet another thing he wrongly assumes about advocacy groups. “DPA staff have met with and spoken to Kevin Sabet a number of times,” she said. “SAM’s goal is to maintain criminalization [of cannabis]. With criminalization you have no safety regulations and no consumer warnings — you can also disproportionately continue to target racial and ethnic minorities with enforcement.”
A point on which SAM and DPA agree is that there is an urgent need to reduce restrictions on medical marijuana research.
ABOUT THOSE “NOT CHERRY PICKED” STUDIES
Berenson says that he has been accused of “cherry picking” studies that strictly validate the thesis of his book, that “marijuana causes psychosis and psychosis causes violence.” Dr. David L. Nathan, MD, DFAPA, is the founder and board president of Doctors for Cannabis Regulation. He is also a distinguished fellow in the American Psychiatric Association, and Nathan believes that Berenson is, indeed, cherry picking studies, in addition to drawing conclusions that evidence simply does not support. “He either minimizes or excludes evidence that contradicts his hypothesis, and he goes beyond what the evidence says, like cannabis causing psychosis,” Nathan said.
And Nathan is not alone. Recently, those aforementioned 75 scholars and clinicians who oppose Berenson's "junk science" about cannabis have collectively called him out not only for cherry picking, but also for selection bias, for confusing correlation and causation, and for ignoring the harms of prohibition. In fact, in their letter disputing Berenson's claims, they criticize him for going so far as to suggest "that one of the reasons that police so disproportionately arrest black people (three times as often as white) for marijuana use is that marijuana makes young black people mentally ill and violent."
Drawing a line from cannabis consumption to psychosis is not as clear as Berenson lays it out. “Psychosis is almost synonymous with thought disorder. It’s a break with reality, which is a phenomenon, it’s not a diagnosis by itself,“ Nathan explained. “What we know is that cannabis use can lead to the triggering or worsening of psychosis, and we know that can happen in individuals predisposed to psychosis. Can it happen to those who aren’t predisposed? We don’t know.”
In Tell Your Children, Berenson often refers to an exhaustive report from the National Academies of Sciences, Engineering, and Medicine (NASEM), which looked at more than 10,000 studies on marijuana. Using it as a primary source backing his assertion that marijuana causes psychosis, Berenson declares the issue “settled.”
The report itself is much less equivocal, saying that marijuana’s link to psychosis may be “multi-directional and complex.” Nathan explains that people with psychotic disorders will self-medicate with drugs, and one of those drugs will be cannabis. “With that being true,” he continues, “there may be a degree to which the causality goes the other direction, but again, we don’t know that. Correlation is not causation.”
Even Berenson admits to uncertainty about the interplay of cannabis and psychosis, pointing out that the United States has essentially no good data for the incidence and prevalence of either schizophrenia or broader measures of psychosis. He continues to say, “I don’t think the mechanism by which cannabis causes psychosis is fully understood at this point. For that matter, the way psychosis and schizophrenia develop at the most basic level are not well understood.”
It seems that Berenson is saying that the link between cannabis and psychosis — a topic on which he pontificates for page after page in Tell Your Children — is not fully understood at even the most basic level. So if that's the case, does he even believe the bunk in his own book?
Nevertheless, Berenson sharply defends himself on his Twitter feed and in print from those who speak against the book’s claims: “I am defending my book from unfair attacks and I’m going to continue to do so.” Continuing, he adds in italics, “And yet no one has disputed the plain facts in the book, (beyond a couple of tiny errors that do not even rise to the level of quibbles), or said that I misstate the scientific studies or government research reports I quote.”
This, like Tell Your Children, is not exactly true. We are definitely getting trolled. Online magazine Mother Jones issued a correction to their piece, “This Reporter Took a Deep Look Into the Science of Smoking Pot. What He Found Is Scary,” saying that they had overstated the connections NASEM researchers found between cannabis and conditions like bipolar, suicide, and depression, overstated the number of pot users that go to the emergency room with cannabis-induced psychosis, and a “handful of other facts and statements in the piece had been updated for accuracy.”
Dr. Ziva Cooper, research director of UCLA’s Cannabis Research Initiative, and one of the authors of the NASEM report told Cannabis Wire that Berenson’s interpretation of the report is “wrong and a gross misinterpretation of our conclusions in the text. And to make that claim is quite dangerous and is misinformed.” Noted drug addiction and drug abuse neuroscientist Dr. Carl L. Hart, chairman and Ziff professor of psychology and psychiatry at Columbia University, wrote in the Guardian that Berenson’s claim that cannabis consumption causes violence is “misinformed and reckless.”
As a writer, Berenson has the luxury to boldly choose his words and viewpoints, something not afforded to scientists, researchers, and doctors, lest they fall into the category of cannabis advocacy. “If it sounds like we are hedging, it’s not because we disbelieve in our point of view,” Nathan explained. “It’s because we are being true to the evidence. And Berenson sees that as an agreement of his point of view, or an inability to argue.”
The introduction to Tell Your Children is titled, “Everything You’re About to Read is True,” but perhaps it should be edited to say something like, “All the studies that support my point of view are true. And the studies that do not support it are not.” But that wouldn’t land him any speaking engagements, and it definitely won’t sell as many books.