Should a “Mental Health Tax” be placed on Marijuana?

Let’s talk about drug abuse.

Abuse of any kind is improper use, or dependency. In some cases, so-called “recreational” use is “abuse,” for there is no other kind of use, since a drug may be already illegal.

For the greatest part, those drugs, which are sometimes mistakenly called ‘narcotics’ (technically, narcotics are derivatives of and synthetic chemical relatives to the opium plant) are already illegal, and include LSD and other hallucinogens, heroin, methamphetamine (as “crystal meth”), etc. And, at the Federal level, like it, or not, agree or disagree, marijuana is included in that list.

Further, alcohol must be included in the list of abused substances, simply because we know that people’s lives can be, and are destroyed by alcohol abuse, directly and indirectly.

There’s a database of information based upon hospital admissions related to drug abuse. It’s called the Treatment Episode Data Set, or TEDS, and the information is collected anonymously by each facility in a state that receives “State alcohol and/or drug agency funds (including Federal Block Grant funds) for the provision of substance abuse treatment.”

It is not an exhaustive data set by any means, and there are limitations upon it, yet it does provide some reliable degree of accuracy to the extent, scope and nature of the problem. Consequently, information in “the tables focus on treatment admissions for substance abusers.”

In other words, someone abuses a substance on the list to the extent that they need some degree of care, including hospitalization, and that anonymous information about their admission gets collected and reported. For the purposes of that report, anonymous information is age, sex, ethnicity/race and drug(s) which led to the need for treatment.

The TEDS list of abused drugs are: alcohol, alcohol with other substances, cocaine smoked, cocaine other route, marijuana, heroin, other opiates (including legal narcotics), PCP, hallucinogens, amphetamines, other stimulants, tranquilizers, sedatives, inhalants, and “other/unknown.”

The “TEDS is an admission-based system, and TEDS admissions do not represent individuals. An individual admitted to treatment twice within a calendar year would be counted as two admissions. Most States cannot, for reasons of confidentiality, identify clients with a unique ID assigned at the State level. Consequently TEDS is unable to follow individual clients through a sequence of treatment episodes.”

Presently, there is active discussion in this nation – particularly among the states – about the crisis associated with “non-violent offenders,” and the burdens and costs associated with contact with the entire justice system, beginning with law enforcement, through the courts, and incarceration in local, state and federal prison systems.

Typically, the term “non-violent offenders” is politely worded code language meaning “marijuana law reform.” In other words, it refers to people who were arrested, convicted and locked up for possessing marijuana, most often for personal use, and have no other convictions.

Given the present political environment, and continuing efforts at local, state and Federal levels to reduce spending (along with revenue, which is obtained through taxation) it is incumbent to reexamine previously long-held assumptions about law and policy associated with drug abuse.

Many arguments made for reform are compelling, and the Department of Justice and all 50 states’ jails and prisons have been crowded and overcrowded to handle the increasing case load. Consequently, overcrowded jails and prisons lead to additional problems, not the least of which may subsequently lead to federal lawsuits related to abuse, neglect and inhumane conditions associated with punishment. In other words, things go from “bad” to “worse” by and through neglect and overcrowding. Witness, for example, that some states have abandoned public prisons in favor of private, for-profit prisons, such as the Corrections Corporation of America, a Wall Street-traded company which describes itself as “America’s leader in partnership corrections,” and is described by others as “a company that owns and manages private prisons and detention centers and operates others on a concession basis.”

Some of that increase may be attributed to convictions for the possession of marijuana.

To be certain, nothing is completely innocuous. One can choke on a piece of meat, or carrot, and die. Numerous people drown annually in shallow water. One way, or another, we all die. And yet, knowing those bad things happen gives no rational, reasonable excuse to neglect to act, to do good, or to prevent suffering or death. For example, years ago, we learned that Cardio Pulmonary Resuscitation could save the life of someone who had a heart attack, or whose heart had stopped beating because of injury. Now, CPR is widely taught in the widest diversity of places – from schools, workplaces and healthcare settings, to recreational facilities and more.

We can do some things to reduce the risks of injury we have in life, such as not smoking, exercising regularly, wearing seat belts in a car, or helmets when on motorcycle, bicycle, skates or skateboards. And yet, for all that, we still die, sometimes at the hand of another, either accidentally, or on purpose.

Having made the introduction, let’s hone in on what are perhaps the two most abused drugs in America: alcohol and marijuana.

There are numerous laws and regulations concerning the use of alcohol, and laws punishing those who misbehave when under it’s influence. But let’s focus more intently upon the TEDS information and what it might tell us.

In 2012, the last year for which there is complete data, there were 1,787,197 admissions for substance abuse in 15 categories. Of that number (in descending order):
384,503 – alcohol alone, 21.5%
312,568 – alcohol with a secondary drug, 17.5%
312,038 – marijuana, 17.5%
291,555 – heroin, 16.3%
175,429 – other opiates, 9.8%
125,651 – amphetamines, 7.0%
84,907 – smoked cocaine, 4.8%
39,041 – cocaine other route, 2.2%
30,331 – other/unknown, 1.7%
17,746 – tranquilizers, 1.0%
5,730 – PCP, 0.3%
3,425 – sedatives, 0.2%
2,112 – hallucinogens, 0.1%
1,127 – inhalants, 0.1%
and
1,034 – other stimulants 0.1%.

Expressed as percentages, “alcohol alone” accounts for the clear majority of admissions, while “alcohol with a secondary drug” is tied with “marijuana” at 17.5%. Even more disturbing is the rate of heroin admissions at 16.3%.

Clearly, “alcohol alone” is the number one reason for seeking treatment, while “alcohol with a secondary drug” is second. What is fascinating, is that marijuana is the highest non-alcohol drug for which people seek treatment, and corresponds very closely to “alcohol with a secondary drug.” That fact seems to be strictly counter-intuitive to claims such as ‘marijuana never hurt anybody,’ or that ‘nobody ever goes to the hospital for smoking marijuana.’ The data speaks otherwise.

What age group do we see most affected by marijuana? According to the TEDS figures, the majority are aged 12-17, and account for 29.6% of all marijuana-related admissions. Figures for marijuana admissions don’t return to single digits until the age 31-35 category, while both alcohol-related admissions go to double digit figures at the age 21-25 category and don’t return to single digits until the age 51-55 category.

Predictably, most are male, and statistically roughly approximate the ethnographic profile of America.
TEDS White 66.5%, Black 19.9%
Census White alone, percent, 2013 – 77.7%
Black or African American alone, percent definition and source info Black or African American alone, percent, 2013 – 13.2%

But let’s ignore the more anonymous TEDS information, and look for specifics. Are there any data about specific health problems associated with marijuana use? Yes, there is. In fact, there are volumes of longitudinal data which demonstrate a very specific problem associated with marijuana use. That problem is psychosis.

In fact, there is a significant and growing scientific body of medical evidence that marijuana use contributes significantly to schizophrenia – a particularly debilitating mental health condition that strikes during the most productive years of one’s life.

From 1987, there is a 15-year study involving over 45,000 Swedish soldiers that demonstrated, when adjusted for other factors, a 400% increase in the risk of suicide, and significant risk for schizophrenia.

A study of 35 years duration in London demonstrated that schizophrenia rates doubled among marijuana users.

Researchers in New Zealand found that those whom had smoked marijuana only three times by age 15 were 300x more likely to develop schizophrenia, and that cannabis consumption factored in 80% of schizophrenia cases.

A 10-year study in the Netherlands among nearly 2000 participants aged 14-24 found that 51% of cannabis users experienced schizophrenic symptoms versus 26% of non-users.

An Australian study examining marijuana use exclusively among 20,000 psychotic patients found that most schizophrenic patients had been marijuana smokers, and of those who had been, the onset of mental illness occurred 2.7 years earlier.

Additional research has demonstrated conclusively that cannabis use in one’s youth is particularly damaging to the developing brain.

One study of over 1000 individuals found that 10% of youth aged 11-26, those who used cannabis by age 15 were four times as likely to have a diagnosis of schizophrenia at age 26 than those who had not smoked, and that after psychotic symptoms at age 11 were factored in, the risk for adult schizophrenia remained higher among those who used cannabis at age 15. The findings were that early cannabis use by age 15 directly increases greater risk for schizophrenia than later cannabis use by age 18.

So definitely… there is STRONG evidence conclusively demonstrating that cannabis use by youth can be significantly damaging in later life.

If we are to change the laws concerning marijuana, such as to decriminalize it’s use, we must take into account matters of reduction and prevention of the use by youth, whom as the data shows by admissions to treatment, are it’s greatest users. In fact, by the time most youth graduate high school, nearly 46% will have tried marijuana. And in 2010, an estimated 2.4 million people tried marijuana for the first time, and more than half were under age 18.

Given also that in some states the rate of incarceration of the mentally ill have risen significantly after closure of clinics, slashing budgets and funding for mental health services, there is legitimate concern for what may very well be a significant increase in the numbers of those suffering mental illness. Granted, they’re in lockups for minor offenses, most of which are related to homelessness or “acting out” behaviors in public. However, it’s significantly less expensive to properly care for the mentally ill, than it is to incarcerate them.

Now, the question arises: From a pragmatic perspective, how do we communicate the message and reduce the risk if we’re going to legalize marijuana? Should we place a “Mental Health Tax” upon marijuana? If so, how should it be taxed – by THC content? Flatly? By weight? How do we work to construct viable mental health care facilities? What should they look like? What should be done about those convicted and incarcerated for possession of marijuana? Should we expunge their records? Do they need Executive Pardon? Restoration of Voting Rights? Should they be compensated in some way?

Where do we go from here, and how do we get there?