There are multiple reasons why the legalization of marijuana is facing challenges in New York. Governor Kathy Hochul has described the rollout of licensed dispensaries as a “disaster” due to misguided policies and bureaucratic ineptitude. However, Manhattan Institute Fellow Charles Fain Lehman offers a different perspective, focusing on the perceived prevalence and severity of marijuana addiction.
In a recent article in the New York Times Magazine, Lehman suggests that Americans may not fully grasp the negative consequences of excessive marijuana use. He equates “cannabis use disorder” (CUD) with addiction, although CUD encompasses a broader range of behaviors. Despite acknowledging setbacks in New York’s licensing process, Lehman argues that the state’s issues are exacerbated by the addictive nature of marijuana and profit-driven motives.
Lehman’s emphasis on addiction as a key factor in New York’s struggles with legal marijuana overlooks the slow pace of dispensary openings and fails to account for successful legalization efforts in other states with similar addiction rates. His reliance on statistics indicating a high prevalence of CUD among marijuana users may misrepresent the actual number of individuals with severe addiction issues.
While Lehman attributes the rise in addiction to increased THC concentrations and the availability of high-potency products, the broad definition of CUD used in surveys may contribute to inflated prevalence rates. The criteria for diagnosing CUD, as outlined in the DSM-5, encompass various behaviors and consequences associated with marijuana use, but do not equate to addiction in all cases.
It is important to differentiate between problematic marijuana use and severe addiction when discussing the impact of legalization efforts. Lehman’s focus on addiction as a primary obstacle in New York’s marijuana rollout may oversimplify a complex issue and detract from addressing the root causes of the state’s challenges.
Only 5 percent of past-year users met the criteria for the “severe” category of Cannabis Use Disorder (CUD), while about 8 percent fell into the “moderate” category and 17 percent into the “mild” category. Interestingly, the “mild” category made up the majority of marijuana users who experienced CUD in the previous year, accounting for 55 percent of cases. However, being in the “mild” category does not necessarily mean that one uses marijuana compulsively or harms themselves or others.
For example, simply spending a lot of time using marijuana or occasionally using more than planned could qualify someone for the CUD label. Similarly, feeling a strong urge to use marijuana or increasing the dose due to tolerance does not automatically indicate compulsive use or harm to oneself or others. Despite this, Lehman implies otherwise, citing DSM-5’s definition of CUD as including an inability to stop using marijuana despite health and social problems, which may not always be the case according to NSDUH data.
Equating the NSDUH measure of CUD with addiction is problematic because it does not assess clinically significant impairment or distress, which is necessary for a diagnosis. Therefore, applying psychiatric diagnoses based on survey responses may lead to overestimates of the prevalence of CUD. While NSDUH respondents who qualify for the CUD label may have experienced marijuana-related issues, these problems are typically mild and varied, contrary to the portrayal by Lehman.
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