By most accounts, Oregon's experiment with legal recreational cannabis has been a success.
Alex Berenson says it's a fatal mistake.
It would be fair to call Berenson's new book, Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence, a sensation—even before its official publication date, Jan. 8.
Early this month, both The New York Times and Wall Street Journal published op-eds by Berenson, 46, a former Times reporter and the author of 12 spy novels.
In those pieces, he laid out a summary of his book, a premise that has ignited debate across the country.
His argument: Cannabis—now legal in Oregon and 32 other states, in one form or another—is deadly. Specifically, he argues, weed can trigger violent mental illness—and in states like Oregon with a recreational cannabis industry, he argues, pot is causing violent crime to rise.
"Legalization advocates have squelched discussion of the serious mental health risks of marijuana," Berenson wrote. "Because marijuana can cause paranoia and psychosis, and those conditions are closely linked to violence—it appears to lead to an increase in violent crime."
Berenson's book has collided with a vast range of people, from number-crunching social scientists to health-policy researchers, to say nothing of the cannabis-loving general public thrilled with the soaring quality and plunging prices of legal weed.
In Oregon, Berenson's message may be particularly jarring. Legalization has been a phenomenal economic success here—cannabis accounted for $82 million in state tax receipts in 2018. And that economic boom has been laced with a feeling of ethical triumph: We're redeeming the inequities of the War on Drugs with blunts and gummies.
Now Berenson says the rosy promise of weed is a dangerous lie.
Virtually every major publication in the country, from New York magazine to Rolling Stone to Mother Jones, has weighed in on Berenson's thesis—a reflection of how central the debate over cannabis has become in this country. Supporters applaud his willingness to ask hard questions. Critics say Berenson has cherry-picked his statistics, manipulated data to suit his preconceptions, and revived long-debunked myths used to justify cannabis prohibition.
WW caught up with Berenson last week for an interview. We asked him to defend his findings and respond to the avalanche of criticism he's faced.
"I wish I had known the blowback would be as intense as it has been," he said. "I think some people have criticized the book without even reading it. And some people have read it looking for stuff to criticize."
We also gave two Oregon experts—University of Oregon economics professor Ben Hansen, who studies the relationship between drugs and crime, and Adie Wilson-Poe, a neuroscientist who also runs a Portland-based cannabis services company—an opportunity to refute him.
We asked all three to address the five key claims in Berenson's book.
The interviews have been edited for clarity and brevity.
Claim 1: Cannabis consumption leads to mental illness and psychosis.
Berenson writes: "Federal surveys also show that rates of serious mental illness are rising nationally, with the sharpest increase among people 18 to 25, who are also the most likely to use cannabis."
WW: Critics have accused you of implying causation when there is only potential evidence of correlation. What's your evidence that weed leads to increased mental illness and psychosis?
Alex Berenson: It really started in 1987 with a giant study showing that cannabis use by Swedish conscripts led to later mental illness, later schizophrenia. Ever since then, the evidence has only mounted. In 2017, the National Academies of Science, Engineering and Medicine said quite clearly that cannabis use leads to an increased risk for the development of schizophrenia and other psychoses, and the higher the use the higher the risk.
There are always going to be scientific uncertainties about the amount of risk, about the certainty, but we know now, beyond a doubt, that marijuana use can cause temporary psychosis and that it very, very likely causes some cases of schizophrenia in people who wouldn't otherwise get it.
WW: Is there a causal relationship?
Ben Hansen: It is a challenging thing to answer that question. We're never randomizing who gets marijuana and who doesn't, which is the typical way you evaluate whether a drug has side effects. So at the moment, what you might notice are people who are presenting with psychosis, that they're more likely to use marijuana than people who don't. Does that mean that's actually causally related? Maybe.
Adie Wilson-Poe: There is no causal relationship, period. There is a correlation. But there's probably also a correlation between the number of alternative-fuel vehicles on the planet right now and the percentage of rise in sea level. So, does that mean Priuses have caused sea levels to rise? No!
There are actually two times this story has been told. One of them is in Berenson's book. And that story is cannabis is linked with psychosis and psychosis is linked with violence, therefore cannabis causes violence.
And there's another version of this story that appears in Chapter 12 of the National Academies of Science, Engineering and Medicine's The Health Effects of Cannabis and Cannabinoids. That study was published in 2017, and there's a whole chapter devoted to cannabis and psychosis. And it basically says there is a link—what specifically that link is, we don't understand. People who are already vulnerable to psychosis or schizophrenia may be more dramatically impacted by cannabis.
One thing we do know is, these sort of psychotic effects, the ability of cannabis to elicit these psychotic episodes, you're more likely to experience that with high doses or a lot of use. But beyond that, we just have so much more research to do. That's the reality.
Berenson's book refuses to acknowledge that reality and focuses on only one half of the evidence.
Claim 2: More weed is contributing to more violent crime.
Berenson writes: "The first four states to legalize—Alaska, Colorado, Oregon and Washington—have seen sharp increases in murders and aggravated assaults since 2014, according to reports from the Federal Bureau of Investigation. Police reports and news articles show a clear link to cannabis in many cases."
WW: Leading drug policy researchers have pushed back hard, saying you've cherry-picked numbers and anecdotes and ignored other possible explanations for the rise in violent crime. How do you respond?
Berenson: I use the biggest possible data set. I use violent crime in all four states that legalized in 2014 and 2015. I used murders and aggravated assaults in those four states in 2013, pre-legalization, and then I looked again at murders and aggravated assaults in 2017, which is the most recent year for which data is available.
There is no question violent crime in those four states—Alaska, Washington, Oregon and Colorado—has increased faster than the national average, even if you account for change in the population. There's no question about that. Now, am I saying that we know marijuana legalization led to that? No, I'm not, because we don't. But the promise that violent crime would drop has proven completely unfounded.
WW: Is he right about the numbers?
Hansen: I took a look at some homicide data to see if indeed the increases in violence he was reporting in his book, if those could be traced back to recreational marijuana legalization, and using some pretty standard statistical techniques to estimate what would have happened had these laws not been passed, I find essentially no evidence that recreational marijuana legalization has led to additional homicides in either Washington or Colorado.
I think the overall trend of increasing marijuana use throughout the early 2000s doesn't support his underlying hypothesis. It's only really in the last couple of years that we've seen homicides start to go up and some of these other types of crime start to go up. For all the decades prior, when marijuana use was going up, ever since about the year 2000, crime rates were actually falling.
Wilson-Poe: That cannabis causes psychosis and psychosis causes crime, this is just flawed logic. What's causing the rates of murders to go up in Washington state? I don't know. But to single out that one kind of crime and pin it on cannabis is just flawed logic.
He's also ignoring all of the evidence that shows rates of domestic violence are much lower in cannabis users than non-cannabis users. Has that been taken into account in his argument? Not at all.
If you look at this guy's job: What is he good at? He's a good investigator. Is he a good scientist? No. That's all it comes down to. He's good at digging up the things that support his argument. He's not really good at looking at things that would conflict with his idea—and there are a lot of things that would conflict with his idea.
Claim 3: Cannabis really is a gateway drug.
Berenson writes: "Marijuana use is linked to opiate and cocaine use. Since 2008, the U.S. and Canada have seen soaring marijuana use and an opiate epidemic."
WW: What evidence do you have that cannabis use leads to opiate and cocaine use?
Berenson: There's zero question that cannabis is a gateway to opiates and cocaine. The studies are all clear on that. The question is why.
You can make the argument that one reason that happens is because you're getting cannabis from a drug dealer. In an illegal environment, that drug dealer might also have cocaine or heroin. You might also be using it with other people who are trying those drugs, and thus, you're more likely to do it. And by the way, that's what the Dutch decided. So they said, "We're going to separate this from drugs so it's not a gateway anymore."
The other argument is that it's pharmacological, basically. People like cannabis, they like the high, it primes their brain to try other new drugs. I would say, despite literally generations of research on this issue, nobody quite knows yet.
The question is: Why are we telling people who are at high risk for addiction to use an addictive drug? Nobody ever, until the last five to 10 years, thought cannabis would be a good way to discourage people from using opioids.
WW: What's he missing?
Hansen: His book neglects to consider the fact that people might be consuming marijuana instead of other drugs. The choice he presents is almost marijuana versus nothing. And there's a fair amount of evidence out there that people actually substitute between marijuana and alcohol. And there's a much richer body of evidence that has established the social harms and violence associated with alcoholism than there is of evidence tying marijuana use to violence.
WW: Is marijuana making the opioid epidemic worse?
Wilson-Poe: [laughs] I'm sorry, It's super-unprofessional to just outright laugh at that, but it's totally laughable.
Again, it's a perfect logical fallacy that these two things are linked. We know that after a state introduces a cannabis law, opiate overdose rates drop by an average of 25 percent. Within a state, once cannabis is acceptable to its citizens, it's citizens are dying less.
There are more people using cannabis since legalization happened. And there are more people dying of overdose because we have a public health epidemic. But those two things are not linked, and, in fact, the actual relationship between them is probably more inverse than what his argument says. Chronic pain patients who are given access to cannabis, they reduce their opioid consumption by almost half.
Claim 4: The approach and risks of legal cannabis is analogous to opioids.
Berenson writes: "As Americans consider making marijuana a legal drug, it would be wise to remember the choices that fueled the devastating opioid epidemic. Decades ago, many of the same people pressing for marijuana legalization argued that the risks of opioid addiction could be easily managed."
WW: People die from opioid overdoses. Nobody dies from cannabis ODs. Is this
really an apt analogy?
Berenson: I am not going to tell you I think marijuana is as dangerous as opioids. It's clearly not. It's not even close. If you become an opioid addict, your risk of dying in any year is enormous. So if cannabis truly gets people off opioids, that's a good thing. And I think I say at the end of the book, we should study that in case it happens to be true. Unfortunately, there's a ton of evidence that it's a hope and not a reality.
WW: What's your impression of his analogy?
Hansen: I take it to heart in the sense that marijuana policy is changing pretty rapidly. Are we making mistakes along the way? Probably. My hope would be that we look at lessons we've learned from other drugs, and not repeat those mistakes again. In Oregon, one of the things I would be most concerned about is that advertising of marijuana could be targeted toward children. Joe Camel was just a way to get kids smoking. I think if there was to be harm on someone's brain by consuming marijuana, a lot of research suggests it would be among youth because their brains are still so malleable.
Wilson-Poe: The only people who were advocating for the widespread use of opioids were the people manufacturing the drug. And, in fact, it's probably drug manufacturers that are lobbying against cannabis because they see it as a threat to their pain-relieving pharmaceutical.
However, what can we learn from the opioid epidemic that we don't want to repeat with cannabis? One thing we never did ever with opioids is say to our patients, "This stuff causes you to develop tolerance. Over time you're going to have to increase your dose to achieve your desired effect. One way of diminishing tolerance is to periodically take breaks from your medicine. Periodic tolerance breaks will diminish your need to continue to ramp up your dose over time, which will diminish risk for overdose." We know people develop tolerance quite quickly to cannabis. And we also know that if people take a 48-hour tolerance break, a lot of the stuff inside our brains desensitizes back to a normal level of a non-cannabis user.
Yes, it is super-bad for the developing brain. That's why we have a legal framework for regulation so we can make sure this stays in the hands of people who don't have growing brains—in other words, those who are 21 years and older.
So the responsible use of cannabis and periodic tolerance breaks are definitely two things we can learn from the opioid epidemic. But it is absolutely not the same people advocating for cannabis use who are advocating for opioid use. Not at all.
Claim 5: Cannabis advocates are disingenuous and motivated by profit.
Berenson writes: "Advocacy groups don't view decriminalization as an acceptable compromise. They want full legalization, making marijuana a state-regulated and -taxed drug that businesses can sell and profit from."
WW: Are you saying the alleged health and equity benefits of legalization are convenient fictions masking a profit motive?
Berenson: Not exactly. I think there are nonprofit advocates who genuinely believe everything they're saying about the health benefits and the racial justice issues—although they've clearly overstated both of those claims. But I also do think there's a for-profit industry that wants to make money selling an addictive drug. If the history of the last 50 years has taught us anything, it's that when people can make money selling a drug, whether it's tobacco or opioids or alcohol, they're gonna do whatever they can to sell it.
WW: What's your take on his claim?
Hansen: Well, I'm an economist, so I think everybody is self-interested.
WW: Do you think self-interest is allowing people to make claims for economic purposes that are masquerading as health claims?
Hansen: I'm not sure about that. I'm sure there are some people who might be exaggerating the potential health benefits of marijuana use as a pathway to getting it legalized. There are probably other industries that are demonizing marijuana, also to protect their bottom line. But if you're going to sell a book talking about the harms of marijuana, you probably have your own interests as well.
Wilson-Poe: He's basically assuming every advocate has skin in the game, and that's not at all true. They certainly have skin in the game in terms of keeping their communities and young people of color out of jail.
Is Oregon Getting More Violent?
Among the key claims in Alex Berenson's book is the contention that Oregon's weed legalization coincided with a crime wave.
Berenson uses the murder and aggravated assault numbers for 2013 and 2017 to argue that violent crime is on the rise since Oregon legalized recreational cannabis in 2015.
He's right to say violent crime has increased. Statewide numbers do show an increase in the number of murders—from 80 to 104—and aggravated assaults: from 5,610 to 7,139.
But those numbers don't tell the whole story.
Oregon's violent crime rate hit historic lows in 2013 and 2014 after more than a decade of falling crime. Those crime rates started to slightly increase in 2015. (Recreational cannabis became legal in October of that year.) The numbers climbed a little more in 2016 and 2017.
Yet Oregon's violent crime rates remained far below the national average. In 2017, the national murder rate was 5.3 victims for every 100,000 people, compared to Oregon's murder rate of 2.5. Nationally, 248.9 people were assaulted for every 100,000, but the rate was only 172.3 in Oregon. The national violent crime rate—which includes murder, assault, rape and robbery—was 382.9 for every 100,000 people, compared to Oregon's 281.8.
Oregon's relatively low crime rate is important, because a small increase in crimes will look dramatic, even as the state remains one of the safest in the country.
And diving deeper into the past, it's easy to see that even with increases over the last three years, Oregon's violent crime rates are much lower than they were in the 1990s. In 1995, Oregon saw 129 murders and 10,638 aggravated assaults. 2017 was far less violent, with 104 murders and 7,139 assaults. That drop becomes even more significant when you consider the explosion in Oregon's population since the 1990s.