The Ethics of Recreational Marijuana Use
Why has public support of marijuana doubled during the very same decades that research scientists have revealed its damaging effects?
Today, 60% of Americans believe that recreational marijuana should be legal1, and 18 states have legalized the drug for recreational purposes. As a result, researchers now possess a vast sample from which they can collect data. Consequently, we are in a far better position than ever before to assess the effects of marijuana use. Yet, in a moment of great irony, cultural celebration of marijuana has increased at the very same time that the data have shown its damaging effects.
What should followers of Jesus think about recreational marijuana use? Is taking a hit from a joint or dab pen equivalent to drinking a beer or two? Is smoking marijuana immoral or unwise (or neither)? How exactly should followers of Jesus think about this issue in light of a rapidly changing culture?
The Biblical Case Against Recreational Marijuana?
A famous bumper sticker reads, “MAN MADE ALCOHOL, BUT GOD MADE WEED. WHO [sic] DO YOU TRUST?” Proponents of marijuana use argue that Scripture never mentions marijuana explicitly. Therefore, Christians have no biblical grounds to speak about it one way or another. Moreover, the Bible teaches that God created everything (including all plants) to be good. Paul wrote that “everything created by God is good” and “nothing is to be rejected if it is received with gratitude” (1 Timothy 4:4). Indeed, God told the first humans, “I have given you every plant yielding seed that is on the surface of all the earth” (Genesis 1:29). Surely this demonstrates that the Bible affirms marijuana, right? Not at all. This is misguided for several reasons.
First, the Bible never explicitly refers to marijuana, but silence is not affirmation. Think about it: If we applied such logic consistently, we would need to hold that the Bible affirms the snorting of cocaine, the smoking of crack, and even the swallowing of bath salts—none of which are prohibited or even mentioned in Scripture.
Second, God’s creation is good, but the use of His creation is not always good. When Paul states that “everything created by God is good,” he is referring in context to those who forbid marriage and certain foods (1 Timothy 4:3). Likewise, Genesis 1:29 refers to seed-bearing plants for the purpose of “food,” not intoxication. Of course, no one adds marijuana to their chocolate brownies for the flavor.
These biblical passages are clearly not a blank check for humans to ingest anything growing on the surface of the earth. (This seems like common sense, but unfortunately, common sense is often not that common.) After all, would anyone use such a strange interpretation of the Bible to justify eating poisonous plants like crown vetch, nightshade, or hemlock? Of course not. The same is true with regard to smoking, vaping, or ingesting marijuana: This is a misuse of God’s good creation.
Third, the Bible explicitly approves of alcohol. While my fundamentalist friends might grimace at this statement, I’ll gladly side with Jesus on the subject of alcohol. In his inaugural miracle, Jesus turned roughly 150 gallons of water into wine (John 2:1-11). Jesus himself drank wine (Matthew 11:19), and he will drink more of it in heaven (Matthew 26:29). Moreover, the psalmist writes, “[God] causes… wine which makes man’s heart glad” (Psalm 104:14-15; cf. Deuteronomy 14:26). Sorry, but the idea that “MAN MADE ALCOHOL, BUT GOD MADE WEED” comes from bumper stickers—not the Bible.
Fourth, the Bible clearly and emphatically speaks against the effects of marijuana—namely, intoxication. Solomon writes that anyone who is “intoxicated… is not wise” (Proverbs 20:1). Paul writes, “Do not get drunk with wine… but be filled with the Spirit” (Ephesians 5:18). Drunkenness is contrasted with a life of being filled with the Holy Spirit (Ephesians 5:19).
A lifestyle of habitual and ongoing drunkenness is so ethically serious that it could result in removal from fellowship (1 Corinthians 5:11)2. Indeed, Paul had no problem in calling this lifestyle “unrighteous” (1 Corinthians 6:10). By contrast, the Bible extols being mentally sharp and sober-minded (1 Thessalonians 5:6, 8; 1 Peter 1:13; 4:7), and Paul told Timothy to be “sober in all things” (2 Timothy 4:5). This emphatic language alerts us to the fact that intoxication is a serious sin—not a minor ethical issue.
Fifth, intoxication is serious because we face a brilliant and sadistic enemy. Imagine a lawyer who got wildly drunk at a bar, took a taxi home, and slept off the hangover in the safety of her apartment. Now, consider a different scenario: What if this same lawyer got embarrassingly drunk right before defending a client in court? Which drunken episode would be ethically worse? Of course, the second example is far worse, because her client’s life was on the line. By choosing to get drunk, this person made herself easy prey for the prosecuting attorney.
According to the Christian worldview, we all face a similar scenario—only we face much higher stakes, as well as a prosecuting attorney from hell! Peter writes, “Be of sober spirit, be on the alert. Your adversary, the devil, prowls around like a roaring lion, seeking someone to devour” (1 Peter 5:8). Satan is an ancient, brilliant, and deceptive being. He is intent on ruining your life and the lives of everyone you love. When we are not “sober” and “alert,” Satan can accomplish his vicious intent of deceiving us (2 Corinthians 11:3; 1 Timothy 4:1; Revelation 12:9).
With this in mind, is it any wonder why habitual marijuana smokers are often quite deceived about the seriousness of their drug use? Like a person with spinach in their teeth, they are often the last person to see their problem. This makes perfect sense in a Christian worldview: When we get drunk or stoned, we incapacitate ourselves from being able to refute deceptive and intrusive thoughts that can result in ruin.
To conclude, please don’t “baptize” marijuana use in the Bible. If you want to smoke weed, go ahead and smoke weed; that’s your choice as a free moral agent. But please don’t waterboard the Bible until you force it to say whatever it is you wanted it to say in the first place. This sort of tortured interpretation has all of the same intellectual integrity of a southern slave owner interpreting Scripture in the 1800s. Please, do everyone a favor and leave the Bible out of it.
The Scientific Case Against Recreational Marijuana
Marijuana use produces harmful effects for all people. However, it is particularly damaging for those under the age of 25, because the brain is still maturing and developing until that age. Research scientists have discovered several negative effects of marijuana use:
First, marijuana use lowers a person’s IQ. Regular users under the age of 18 had an eight-point drop in their IQ over a 25-year period3. This also appears to have been a permanent drop. Even when these test subjects stopped using marijuana “for periods of more than a year,” this did not “allow IQ levels to return to normal.”4
Second, marijuana use strongly correlates with depressive disorders. The human body naturally produces an endocannabinoid called anandamide, which produces dopamine, but marijuana disrupts this natural process. THC (the main psychoactive compound in marijuana) mimics anandamide and targets the same receptors of the brain, artificially inflating dopamine levels and downregulating natural dopamine production. The result? The marijuana user can either wean off of marijuana to get their anandamide flowing again, or he can keep smoking greater and greater amounts of marijuana to keep his dopamine levels high. Either way, depression constantly lingers in the lives of habitual marijuana users.5
Third, marijuana use strongly correlates with anxiety disorders. Many people “self-medicate” their generalized anxiety by using marijuana. This is a bad idea that leads to a vicious cycle. It’s true that THC can lower or even eliminate anxiety in the short-term. But as the drug wears off, anxiety comes flooding back.6 Natural coping mechanisms and healthy brain chemistry are drained and depleted by THC. Physicians refer to this as the “rebound effect,” because anxiety spikes higher and higher over time.7
Fourth, marijuana use strongly correlates with psychosis. Three meta-analyses found that the odds of developing psychosis were three times higher on average for marijuana users. Users of highly potent marijuana are five times more likely to develop psychosis8, and daily use increased the odds to seven times higher.9 One might think this is just coincidence or correlation, right? Not likely. One researcher called marijuana a “component cause”10 of psychosis, because it has an unusually high correlation, even after controlling for other possible causes.
Fifth, marijuana use negatively changes the physical structure of the brain. In 2014, researchers from Harvard Medical School and Northwestern University studied subjects between the ages of 18 and 25. These scientists discovered that weekly marijuana use resulted in measurable changes in the physical shape of the brain. They stated that physical “abnormalities relative to nonusers are observable” particularly in the “nucleus accumbens” and the “amygdala.” The right amygdala was “deformed inwards and this diminishment was highly correlated with drug use behavior.” These areas of the brain regulate things like emotions, learning, memory, and decision-making. And, to repeat, weekly marijuana use changed the physical structure of these regions of the brain. One of the researchers commented, “This study raises a strong challenge to the idea that casual marijuana use isn’t associated with bad consequences… Some of these people only used marijuana to get high once or twice a week. People think a little recreational use shouldn’t cause a problem, if someone is doing OK with work or school. Our data directly says this is not the case.”11
Sixth, marijuana use debilitates memory, verbal skills, and our ability to pay attention. All of these abilities are essential to Christian work. Yet, long-term marijuana users performed “significantly worse on verbal memory and psychomotor speed,” and they had worse “verbal fluency, verbal memory, attention, and psychomotor speed.” Indeed, these areas “appear to deteriorate with increasing years of heavy frequent cannabis use.”12 Moreover, the effects of THC on these portions of the brain persist for weeks or even months.13 This could be why teens who smoke marijuana every weekend for two years are six times more likely to drop out of high school, three times less likely to go to college, and four times less likely to finish a four-year degree.14
To conclude, just imagine if a pharmaceutical drug had the sort of side effects listed above. What if a prescription drug was strongly correlated with:
- A serious and measurable drop in IQ?
- An increase in depressive and anxiety disorders?
- A three-fold to seven-fold increase in developing psychosis?
- A physical deforming of the brain?
- A lowering of memory, verbal skills, and attention that resulted in far lower academic achievement?
How would people respond to such side-effects? Surely, a pharmaceutical drug like this would “either be withdrawn from the market or would only be prescribed with clear warnings about the risk to patients and prescribers.”15 And yet, by and large, our culture doesn’t warn about the use of marijuana, but rather laughs about it.
Marijuana and Alcohol Are NOT Equivalent
It seems theoretically possible that a person could take such an incredibly small dose of marijuana that they could remain sober. After all, those who eat poppy seed bagels have trace amounts of morphine in their system. But is this theoretical possibility helpful in understanding recreational marijuana use today? Hardly. Marijuana users quickly move from sober to stoned—even after a single hit from a joint or a dab pen. Let me put this as simply as possible: A person may have a drink without getting drunk, but a person does not have a smoke without getting stoned. Consider several key differences.
First, marijuana is a cocktail of drugs—not just one drug. This makes measuring sobriety—even for oneself—very difficult. Marijuana contains roughly 100 cannabinoids—only one of which is THC. While these various cannabinoids do not get a person high, these “interact with THC to affect its impact in a variety of ways.”16 This combination can result in various and unpredictable levels of intoxication.
Consider an illustration: Ibuprofen is harmless, and a blood thinner is harmless. So, taking them together will also be harmless, right? Wrong. The combination of these drugs can lead to serious complications and even death. Marijuana is similar in the sense that its intoxicating effects are hard to predict because it contains so many cannabinoids. Indeed, marijuana can have an impairing effect “even with very low blood levels of THC.” These various cannabinoids make it virtually impossible to use “a particular THC blood threshold to make fair legal determinations of impairment.”17
Second, the marijuana industry is notoriously unreliable in its labeling of THC percentages. Various studies have revealed that the industry “often misrepresents the actual ingredients in those products” and “consumers often have no idea what exactly they are smoking or ingesting.”18 Marijuana growers want dispensaries to buy their weed, and often the dispensaries select “the ones that yield the most favorable results, regardless of the facts.” Consequently, a pot product can be labeled with a certain percentage of THC, even though “this assessment doesn’t reflect the true quality of the product or, in some cases, have any semblance of accuracy whatsoever.”19 Maybe someday in the future the marijuana industry will become an ethical and trustworthy institution. But for now, this is simply not the case, and consumers cannot even trust the labels in the dispensaries themselves.
Third, when marijuana is inhaled, it makes consumption very difficult to measure. When we drink a beer, we can read the alcoholic percentage on the bottle. But how does one measure the volume of smoke (or vape) inhaled into the lungs? Should the person count the seconds that they take a drag on a joint? Should they count how long they hold their breath after inhalation? Do you see the problem? These measurements are completely untrustworthy—far different from alcohol consumption. This is why one researcher states that “marijuana smoking is a complex process that does not permit controlled dosing.” 20
Fourth, the effects of alcohol consumption and marijuana use are fundamentally different and very difficult to predict. Alcohol is a depressant that slows down the nervous system, while marijuana creates complex reactions with the entire endocannabinoid system that encompasses receptors across the entire body.21 This is why our attempts to measure sobriety face insuperable problems. Some have argued that 5 nanograms of THC per milliliter is equivalent to a blood alcohol concentration (BAC) of 0.08%. But this is reductionistic. As one narcotics investigator commented, “We’re applying the alcohol rules to a substance that doesn’t play by them.”22 Indeed, THC remains in the fatty portions of the body days after use, and this residual THC has been correlated with decreased performance in driving and an increase of car accidents.23 At the same time, “THC levels in biofluids were not reliable indicators of marijuana intoxication” and the blood, urine, and oral fluid “did not correlate with cognitive or psychomotor impairment measures.”24 This makes measuring sobriety a nightmare for law enforcement. Coordination tests, blood tests, and saliva swabs have failed to accurately identify if someone is too impaired to drive a car. Consequently, police officers need to make a “judgment call” and “there’s a lot of subjectivity” involved.25 If scientists and trained law enforcement officials have great difficulty determining what marijuana sobriety even means, then we should proceed with extreme caution.
Fifth, marijuana stays in the body far longer than alcohol, because marijuana is fat soluble—not water soluble. Because alcohol is water soluble, the average person metabolizes a beer within an hour or so. THC, on the other hand, stores itself in the fatty portions of the body, slowly leaving the body after the initial high. How slowly? If you smoke a joint today, the cell membranes in your brain will retain 50% of the THC a week later, and 10% of the THC a month later. This means that a “monthly joint will ensure the drug a permanent presence in the brain.”26 So, while the obvious psychoactive effects of THC will only last for a few hours, the chemical itself “remains detectable in the blood for several hours and, for some chronic users, up to 7 days after use.”27 The same is simply not the case with alcohol.
Sixth, marijuana has become much stronger since the 1970s. Between 1975-1980, the THC percentage of confiscated marijuana ranged somewhere between 0.74% and 2.06%.28 Today, on average, marijuana contains 17% THC, and edibles contain 55% THC.29 Some marijuana retailers sell products with 95-99% THC30. Thus, even using conservative figures, marijuana contains eight times the percentage of THC that it contained in 1980. To put this into perspective, an eight-fold increase would be similar to going from drinking 12 ounces of Budweiser to drinking 12 ounces of Bacardi. Older people often think the pot they smoked was strong. Sorry Boomers, but your pot was so weak that we “might as well be talking about two different drugs.”31
Indeed, even the “sin city” of Amsterdam has classified marijuana with a 15% THC content as a “hard drug,” classifying it alongside cocaine. In January of 2021, the mayor of Amsterdam enforced a national law that prohibited tourists from buying marijuana—even though it is a booming industry in the city.32 This should get us to pause: When even Amsterdam is calling weed a “hard drug,” we should pay attention.
To conclude, consider a case study regarding the effects of marijuana use on driving. Put simply, if marijuana use affects something as simple as driving a car, then it surely affects something as complex as Christian work. Even Switzerland (where marijuana has been largely decriminalized) has a zero-tolerance policy for driving while high,33 and there are strong reasons why:
One study found “incontrovertible evidence” that marijuana impaired driving. Marijuana users had a reaction time that was 36% slower than sober drivers. To put this in perspective, if you needed to slam on the brakes at a speed of ~60 mph, this would add an additional 139 feet before you came to a stop.34
Another study surveyed 860 drivers who were in the hospital for causing a car accident. When the researchers selected only the marijuana users, they found four times the rate of accidents compared to sober drivers.35
In a study of 6,000 people, a low use of marijuana correlated with two times the number of car accidents, while higher usage correlated with four times the amount of accidents.36 A New Zealand study found that habitual marijuana users were ten times more likely to cause a car crash than sober drivers.37
In 2012, researchers did a meta-analysis of the nine best studies on the relationship between marijuana use and car accidents. They found that those who smoked marijuana within a few hours of driving were two times as likely to get into a serious or fatal wreck.38
These data points fit with what we see in states that have legalized marijuana. For instance, since the state of Washington legalized marijuana, traffic deaths doubled for those who were high.39
Again, we need to ask the question: If marijuana disqualifies us from doing something as simple as driving a car, then how can we be considered sober enough to do something as complex as Christian work?
Over the last two decades, public opinion on marijuana has doubled from 30% to 60% in favor of legalization. But Scripture hasn’t changed during the last 20 years—even if society has. Moreover, the only other change that we can observe is the growing scientific consensus that only further discourages marijuana use. As followers of Jesus, this is a no-brainer. When we consider both the scriptural and scientific data, we should surely reject recreational marijuana use.
Appendix: Answering Common Pastoral Questions
(1) “I can take one hit from a joint without getting intoxicated. How is that any different than drinking a beer or two?” As we have already shown above, this statement is quite mistaken. But let’s concede this point just for the sake of argument. Even if this was true, what exactly would this demonstrate? This would only prove that the individual had built up a high tolerance to THC by abusing the drug for so long. Indeed, alcoholics use this same argument to say that they are “sober enough to drive,” even when they are six beers deep. Even if their claim is true (which it certainly is not), this would only signal a problem with substance abuse—not sobriety.
Consider a case study of the effects of “microdosing.” Researchers recruited volunteers (ages 18-40) who had experience smoking marijuana, but were not daily users. The team put these volunteers through stress tests. In one group, participants took 7.5 mgs of THC and reported “significantly reduced self-reported subjective distress.”40 However, participants in the other group consumed 12.5 mgs of THC and reported “increased negative mood overall” and perceived the stress tests as “threatening and challenging.” Moreover, this “impaired [stress test] performance and attenuated blood pressure reactivity to the stressor.”41
What should we take from this study? Does this mean that 7.5 mgs of THC might be good for us, while 12.5 mgs could be over the line? Does this validate microdosing THC? Not so fast.
For one, the participants in the study already had experience using marijuana. What level of tolerance did they have with the drug? This question is vital to determining the effects of even low doses of THC.
Second, the typical joint contains 140 mg of THC, and even the 12.5 mg dose resulted in negative effects on the participants. Thus, even a hit or two from a normal joint would place a person in this range.
Third, this example of a microdose of THC (7.5mg) is equivalent to the average joint in the 1970s (7mg). Of course, people who got high in the 1970s knew they weren’t sober after smoking an entire joint. But, ironically, this same amount of THC was considered a “microdose” in this study! Let me explain.
A standard joint for medical testing contains 700 milligrams of marijuana. This means we can measure the dosage of THC by its percentage like this:
- A joint with 20% THC = 140 mg.
- A joint with 10% THC = 70 mg.
- A joint with 5% THC = 35 mg.
- A joint with 2% THC = 14 mg.
When marijuana is smoked, 30-50% of the THC is burnt up (i.e. pyrolysis), not making it into the person’s body.42 Typical “Woodstock weed” was around 2% THC. Therefore, when it was smoked, only 50% of the THC would make it to the person’s body. This means that a person smoking a joint in the 1970s would only consume 7 mg of THC per joint. To repeat, the “microdose” for this test (7.5 mg) would be roughly equivalent to the typical joint at Woodstock (7 mg). Surely, no one could seriously argue that smoking an entire joint at Woodstock would be consistent with sobriety.
(2) “If marijuana becomes legal (or is legal), should Christians reconsider their ethical stance?” Not everything that is legal is necessarily moral. In Jesus’ day, “any reason divorce” was perfectly legal (Matthew 19:3), but Jesus taught that it was profoundly immoral (Matthew 19:4-9). In Nevada, it is currently legal to get drunk, watch pornography, and pay a prostitute for sex. But this doesn’t make drunkenness or prostitution ethical (1 Corinthians 6:15; Ephesians 5:18). The morality of marijuana use shouldn’t be determined by a shift in societal norms.
(3) “Some claim that marijuana abuse is far safer than alcohol abuse. Is this true?” One can make a strong argument that marijuana abuse is better than alcohol abuse: For one, it is virtually impossible to overdose on marijuana. (Indeed, one would need to smoke a joint the size of a telephone pole to do so!) Second, marijuana is statistically less addictive than “tobacco, alcohol, cocaine, stimulants, or heroin.”43 And finally, marijuana cessation has a much easier withdrawal than alcohol addiction, because it is fat soluble and leaves the body slowly. However, and this is important, all of these “benefits” deal with the abuse of marijuana or alcohol. Perhaps it would be better to abuse cannabis, rather than alcohol, but this is beside the point. As Christians, we don’t endorse any form of substance abuse.44
(4) “What is CBD, and how does it compare to regular marijuana use?” Cannabidiol (CBD) is not intoxicating or psychoactive, and it “may even have antipsychotic activity.”45 It has a “calming, or anti-anxiety effect, and increasing amounts of research point to CBD having antipsychotic effects as well in reducing the frequency and severity of psychotic symptoms.”46 Medicinally, CBD has far more benefits than THC. Indeed, Epidiolex (a CBD medication) has been approved by the FDA for seizures and epilepsy. In my estimation, I would not encourage or endorse the use of CBD, but neither would I consider it immoral. Like any drug, CBD should be taken in concert with medical supervision and mature Christian counsel. I would categorize its use as an issue of wisdom—not morality.
(5) “What is delta-8 THC, and how does it compare to regular marijuana use?” Marijuana contains trace amounts of the cannabinoid delta-8. Delta-8 gets its name from the double bond on the eighth carbon atom. This is similar to delta-9, the main psychoactive cannabinoid in marijuana, that has the double bond on the ninth carbon atom.
While research on delta-8 is still fairly new, many reports state that the drug is intoxicating. The FDA reports that delta-8 “has psychoactive and intoxicating effects, similar to delta-9 THC.”47 One chemistry textbook on natural products states that delta-8 has only a “slightly lower psychoactive potency” than regular THC48, and the CDC states that it is 50-75% as intoxicating as regular THC49. Marijuana proponents openly state that delta-8 “will get you high, albeit not as high as common delta-9 THC.”50 In my estimation, this is ethically out of bounds for a follower of Christ because of its potential dangers and its known intoxicating effects.
(6) “What about medicinal marijuana?” My friend and colleague Jim Leffel has addressed this subject at length in his article titled, “What about Medical Marijuana?” In principle, I am open to the use of medical marijuana. In my estimation, this should be reserved in the vast majority of cases as a form of palliative care for those with terminal conditions (e.g. HIV/AIDS, cancer, etc.). While THC is mind-altering, so is severe pain. So, in principle, using painkillers seems ethically permissible for those in need of severe pain management—particularly toward the end of life. However, a few caveats are in order:
First, we shouldn’t be naïve regarding the rampant abuse of “medical marijuana.” According to one study of 4,000 Californians, the average medical marijuana “patient” was a 32-year old white male with a history of drug use.51 One study of “patients” in Colorado found that 94% claimed that “pain” was the reason for their medicinal marijuana, and only 2% used it for cancer and 1% for HIV/AIDS.52 Indeed, receiving a medical marijuana card has become somewhat of a joke in these states.
Second, we should be aware that medicinal marijuana is a key strategy to normalize marijuana in American culture. In 1979, the founder of NORML (National Organization for the Reform of Marijuana Laws) stated, “We will use [medical marijuana] as a red-herring to give marijuana a good name.”53 More recently, the current director of NORML stated, “In California, marijuana has also been de facto legalized under the guise of medical marijuana.”54
Third, and finally, medicinal marijuana should be distributed in a carefully measured pill form—not smoked in an unregulated way. To state the obvious, no other “FDA-approved medication is smoked.”55 We don’t smoke willow bark for our headache; we pop an aspirin. Moreover, doctors give morphine to patients in severe pain; they don’t tell them to smoke opium (from which morphine is derived). As an intoxicating, psychoactive substance, THC should be distributed in a controlled and responsible way for those who would ethically qualify for its use (e.g. dronabinol and nabilone). Furthermore, a patient should work closely with his doctor to develop a responsible pain management plan, keeping up with current alternatives and modern research. For instance, I do not agree with using medicinal marijuana for glaucoma—despite its popular association with this condition—because the Glaucoma Research Foundation does not recommend it.56 Todd Miles’ book Cannabis and the Christian (2021) has excellent wisdom on the use of medicinal marijuana that should be considered (see chapter 7 and his appendix for more details).
 Ted Van Green, “Americans overwhelmingly say marijuana should be legal for recreational or medical use.” Pew Research. April 16, 2021.
 Dr. Todd Miles places unrepentant marijuana use in this category. Todd Miles, Cannabis and the Christian: What the Bible Says about Marijuana (Nashville, TN: B&H Books, 2021), pp.161-162.
 Madeline H. Meier et al., “Persistent cannabis users show neuropsychological decline from childhood to midlife,” Proceedings of the National Academy of Sciences 109, no. 40 (2012): E2657-E2664.
 Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), p.47.
 Arpana Agrawal et al., “Major Depressive Disorder, Suicidal Thoughts and Behaviours, and Cannabis Involvement in Discordant Twins: A Retrospective Cohort Study,” The Lancet Psychiatry 4, no. 9 (2017): 706-714.
Jacqueline Duperrouzel et al., “The Association Between Adolescent Cannabis Use and Anxiety: A Parallel Process Analysis,” Addictive Behaviors 78 (March 2018): 107-113.
Gabriella Gobbi et al., “Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis,” JAMA Psychiatry 76, no. 4 (2019): 426.
Bonnie Leadbeater et al., “Age-varying Effects of Cannabis Use Frequency and Disorder on Symptoms of Psychosis, Depression and Anxiety in Adolescents and Adults,” Addiction 114, no. 2 (2019): 278-293.
Louisa Degenhardt et al., “Exploring the association between cannabis use and depression,” Addiction 98, no. 11 (2003): 1493-1504.
 José Alexandre Crippa, Antonio Waldo Zuardi, Rocio Martín-Santos, Sagnik Bhattacharyya, Zerrin Atakan, Philip McGuire, and Paolo Fusar-Poli, “Cannabis and Anxiety: A Critical Review of the Evidence,” Human Psychopharmacology: Clinical and Experimental 24, no. 7 (2009): 515-23.
 Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), pp.49-50.
 Marta Di Forti et al., “The Contribution of Cannabis Use to Variation in the Incidence of Psychotic Disorder across Europe (EU-GEI): A Multicentre Case-Control Study,” The Lancet Psychiatry 6 (May 2019): 427-436.
 Pierre, Joseph. “Cannabis, synthetic cannabinoids, and psychosis risk: What the evidence says.” Current Psychiatry. 10:9. 2011. 50.
 Emphasis mine. Pierre, Joseph. “Cannabis, synthetic cannabinoids, and psychosis risk: What the evidence says.” Current Psychiatry. 10:9. 2011. 51
 Dr. Hans Breiter (professor of psychiatry and behavioral sciences at Northwestern University). “Casual Marijuana Use Linked to Brain Abnormalities in Students.” Science Newsline. Published April 15, 2014.
 Messinis, Lambros. A Kyprianidou. S Malefaki. Papathanasopoulos. “Neuropsychological Deficits in Long-term Frequent Cannabis Users.” Neurology. 66:5 (March 2006): 737.
See also Solowij, N. et al. (2002). Cognitive functioning of long-term heavy cannabis users seeking treatment. Journal of the American Medical Association, 287(9), 1123-1131.
 Pope, H.G. et al. (2001). Neuropsychological performance in long-term cannabis users. Archives of General Psychiatry, 58(10), 909-915.
 Fergusson, D.M. et al. (2003). Cannabis and educational achievements. Addiction, 98(12), 1681-1692.
 Wayne Hall and Louisa Degenhardt. Cited in Jonathan Caulkins et al., Marijuana Legalization: What Everyone Needs to Know (Oxford: Oxford UP, 2012), p.73.
 Jonathan Caulkins et al., Marijuana Legalization: What Everyone Needs to Know (Oxford: Oxford UP, 2012), p.6.
 Battistella, Giovanni et al., “Weed or Wheel! fMRI, Behavioural, and Toxicological Investigations of How Cannabis Smoking Affects Skills Necessary for Driving” PLOS One 8:1 (January 2013): 1.
 Kevin A. Sabet, Smokescreen: What the Marijuana Industry Doesn’t Want You to Know (Forefront Books, 2021), p.217.
 Kevin A. Sabet, Smokescreen: What the Marijuana Industry Doesn’t Want You to Know (Forefront Books, 2021), p.43.
 Emphasis mine. Mario Pérez-Reyes. “Marijuana smoking: factors that influence the bioavailability of tetrahydrocannabinol.” (Research Findings on Smoking of Abused Substances. NIDA Research Monograph, 1990), p.61.
 THC is a foreign cannabinoid (or phytocannabinoid) that upsets our naturally well-balanced endocannabinoid system (ECS). Our ECS focuses on one part of the brain or body, giving a healthy response to whatever area needs attention (e.g. stress, memory, sleep, motivation, appetite, emotions, etc.). But THC disrupts this beautifully orchestrated system, flooding the body by blasting all of these areas at once. THC is like a machine gun firing at all of the cannabinoid receptors, rather than like a sniper rifle. Instead of surgically shooting endocannabinoids at a specific area, THC is like a “bull in a china shop,” spraying cannabinoids over all sorts of cannabinoid receptors. This is why smoking marijuana affects a person in so many different ways all at once—everything from our appetite to our anxiety—our motivation to our perception. When the ECS becomes overloaded by THC, the entire system shuts down. The technical term is downregulation, where both the “keys” (endocannabinoids) and the “locks” (cannabinoid receptors) shut off. This is why people have such different reactions to marijuana use. Its use is unpredictable.
 Alicia Wallace, “Testing drivers for cannabis is hard. Here’s why.” CNN Business (January 2, 2020).
 M. Kathryn Dahlgren et al., “Recreational Cannabis Use Impairs Driving Performance in the Absence of Acute Intoxication,” Drug and Alcohol Dependence 208 (March 2020): 107771.
 “Field Sobriety Tests and THC Levels Unreliable Indicators of Marijuana Intoxication.” National Institute of Justice (April 5, 2021).
 James Queally and Sarah Parvini, “For Police, Catching Stoned Drivers Isn’t So Easy,” Los Angeles Times, March 22, 2018.
 Mary Brett, “Ten Key Facts that Teachers Need to Know about Cannabis” Education and Health. 26:3 (2008), p.47.
 Pacula, Rosalie et al., “Developing Public Health Regulations for Marijuana: Lessons From Alcohol and Tobacco.” American Journal of Public Health 104.6 (June 2014): 1025.
 National Institute on Drug Abuse. “Potency Monitoring Report.” Report 104. 2008-2009.
 Suman Chandra et al., “New Trends in Cannabis Potency in USA and Europe During the Last Decade (2008-2017),” European Archives of Psychiatry and Clinical Neuroscience 269, no. 1 (2019): 5-15.
 Mark A. Prince and Bradley T. Conner, “Examining Links Between Cannabis Potency and Mental and Physical Health Outcomes,” Behaviour Research and Therapy 115 (2019): 111-120.
Elizabeth Stuyt, “The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist,” Missouri Medicine 115, no. 6 (November-December 2018): 482-486.
 Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), p.24.
 “Experts warn that keeping tourists out of Amsterdam coffee shops won’t be easy.” Dutch News (May 26, 2021).
 Battistella, Giovanni et al., “Weed or Wheel! fMRI, Behavioural, and Toxicological Investigations of How Cannabis Smoking Affects Skills Necessary for Driving” PLOS One 8:1 (January 2013): 52546.
 Schwartz, Richard. “Marijuana: A Decade and a Half Later, Still a Crude Drug With Underappreciated Toxicity” Pediatrics. 109.2 (February 2002): 287.
 M. Asbridge et al. “Cannabis and traffic collision risk: findings from a case-crossover study of injured drivers presenting to emergency departments” (Apr. 2014) International Journal of Public Health.
 B. Laumon et al. “Cannabis intoxication and fatal road crashes in France: population based case-control study” (Dec. 2005) British Medical Journal.
 Blows, S. et al. (2005). Marijuana use and car crash injury. Addiction, 100(5), 605-611.
 Mark Asbridge, Jill A. Hayden, & Jennifer L. Cartwright. (Feb. 2012). Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ, 344.
See also Mu-Chen, L. et al. (2012). Marijuana use and motor vehicle crashes. Epidemiological Reviews, 34(1), 65-72.
 Andrew Gross, “Fatal Crashes Involving Drivers Who Test Positive for Marijuana Increase after State Legalizes Drug,” AAA Newsroom, January 30, 2020.
 Emma Childs et al., “Dose-related effects of delta-9-THC on emotional responses to acute psychosocial stress.” Drug Alcohol Depend. 2017 Aug 1; 177: 136-144.
 Emma Childs et al., “Dose-related effects of delta-9-THC on emotional responses to acute psychosocial stress.” Drug Alcohol Depend. 2017 Aug 1; 177: 136-144.
 Mario Pérez-Reyes. “Marijuana smoking: factors that influence the bioavailability of tetrahydrocannabinol.” (Research Findings on Smoking of Abused Substances. NIDA Research Monograph, 1990), p.60.
 Jonathan Caulkins et al., Marijuana Legalization: What Everyone Needs to Know (Oxford: Oxford UP, 2012), p.59.
 To be clear, marijuana addiction is a reality. For those who use marijuana, 9% of adults and 17% of adolescents will develop a dependence on it. Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), p.36.
 Jonathan Caulkins et al., Marijuana Legalization: What Everyone Needs to Know (Oxford: Oxford UP, 2012), p.7
 Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), p.101.
 “5 Things to Know about Delta-8 Tetrahydrocannabinol.” (9/14/2021) www.fda.gov.
 Emphasis mine. Craig A. Townsend & Yutaka Ebizuka (volume eds)., Comprehensive Natural Products II: Chemistry and Biology (Elsevier Ltd., 2010), p.1058.
 “Increases in Availability of Cannabis Products Containing Delta-8 THC and Reported Cases of Adverse Events.” CDC Health Alert Network (September 14, 2021).
 “What is Delta-8?” Leafly. March 31, 2021.
 Thomas J. O’Connell and Ché B Bou-Matar (Nov. 3, 2007) “Long term marijuana users seeking medical cannabis in California (2001-2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants” Harm Reduction Journal.
 Colorado Department of Public Health. (n.d.) Medical marijuana statistics.
 Emory Wheel Entertainment Staff (February 6, 1979).
 Proper strategy in Afghanistan; wildfires in California continue; marijuana legalization. (May 9, 2009) CNN Newsroom.
 Kevin P. Hill, M.D., Marijuana: The Unbiased Truth about the World’s Most Popular Weed (Center City, MN: Hazelden Publishing, 2015), p.109.
 Henry D. Jampel, “Should You Be Smoking Marijuana to Treat Your Glaucoma?” Glaucoma Research Foundation, October 29, 2017.