SAN RAFAEL, Calif. — For as long as most residents can remember, smoking marijuana has been a part of life here. The fact that California legalized the practice in January went practically unnoticed in this quiet town a half-hour’s drive north of San Francisco, where some say the normalization of America’s marijuana culture got its start.
For Quintin Pohl and other teenagers before him, smoking pot was a rite of passage. It was a diversion from the loneliness he felt at home when his parents were splitting up and a salve for middle-school angst. It was his entire social life in seventh and eighth grades, he said, when social life is everything.
Even though nearly all his friends were using marijuana and seeming to enjoy it, Pohl said, at some point his marijuana use took a turn he never saw coming: He became addicted.
Many people are unaware of marijuana addiction. But in the public health and medical communities, it is a well-defined disorder that includes physical withdrawal symptoms, cravings and psychological dependence. Many say it is on the rise, perhaps because of the increasing potency of genetically engineered plants and the use of concentrated products, or because more users are partaking multiple times a day.
“There should be no controversy about the existence of marijuana addiction,” said David Smith, a physician who has been treating addiction since he opened a free clinic in San Francisco’s drug-drenched Haight-Ashbury neighborhood in the 1960s. “We see it every day. The controversy should be why it appears to be affecting more people.”
Although estimates of the number of people who use marijuana vary, the federal government and the marijuana industry tend to agree that total marijuana use has remained relatively constant over the past decade. Increased use in the past three years has been slight, despite increased commercial availability in states that have legalized it.
The percentage of people who become addicted to marijuana — estimated at about 9 percent of all users, and about 17 percent of those who start in adolescence — also has been stable. Some studies report that even higher proportions of marijuana users develop a dependence, which means they experience withdrawal symptoms when they stop using the drug.
Yet here in Northern California, some addiction treatment practitioners say they’re seeing a surge in demand for help, particularly among adolescents.
Marijuana’s estimated rate of addiction is lower than that of cocaine and alcohol (15 percent) and heroin (24 percent). Unlike with opioids and stimulants, marijuana dependence tends to develop slowly: Months or years may pass before symptoms begin to affect a dependent user’s life.
There are no known reports of anyone dying of a marijuana overdose or of the drug’s common withdrawal symptoms: chills, sweats, cravings, insomnia, loss of appetite, nausea, anxiety and irritability.
According to Nora Volkow, director of the National Institute on Drug Abuse, an estimated 2.7 million Americans meet the diagnostic criteria for marijuana dependence, second only to alcohol dependence.
Smith, a visiting physician at Muir Wood Adolescent and Family Services, a treatment center for boys where Pohl eventually got help, speculates that the potency of today’s pot is causing a higher prevalence of problematic marijuana use.
“Back in the day when kids were sitting around smoking a joint, the THC levels found in marijuana averaged from 2 to 4 percent,” Smith said. “That’s what most parents think is going on today. And that’s why society thinks marijuana is harmless.”
But selective breeding has resulted in an average potency of 20 percent THC, the primary psychoactive compound in marijuana. Some strains exceed 30 percent.
Marijuana concentrates and extracts, much more commonly used in the past five years, have THC levels that range from 40 percent to more than 80 percent, according to marijuana industry promotional information and Drug Enforcement Administration reports.
Susan Weiss, who directs research on the health effects of marijuana at the National Institute on Drug Abuse, told a group of addiction doctors at the annual meeting of the American Society of Addiction Medicine in April that the federal government is trying to get the message out that marijuana can be addictive.
“But believe it or not,” she told the group, “we’re having a hard time convincing people that addiction exists.”
The National Cannabis Industry Association’s chief spokesman, Morgan Fox, said he’s not surprised the federal government is having a hard time convincing the public that marijuana can be addictive.
“It’s their own fault,” he said of the government. “When people find out they’ve been lied to by the federal government about the relative harms of marijuana for decades, they are much less likely to believe anything they have to say going forward, even if that information is accurate.”
Fox said his organization has no disagreement with the finding that about 9 percent of people who use marijuana become addicted, and his organization urges its members to make that clear in their marketing information.
But he disagrees that more-potent forms of marijuana may be causing an increase in addiction.