I’m a longtime fan and back in the “Hey Faggot” days I used to run in many of the same circles as you and we met a few times. I remember one racy and very fun evening at The Vogue! Anyway, I’ve followed you over the years and admire you a great deal. I’ve read your books and enjoy Savage Love and Blabbermouth every week. I am a clinical social worker and I agree with (and use myself in my practice) almost all of your advice. The exception, which brings me to the purpose of my note, is your approach with cannabis.

You recently had a caller on the Savage Lovecast who expressed concern over her boyfriend’s nearly constant use of cannabis. You’ve talked about your own use of the drug, suggested callers to try it to help with anxiety around sexual issues and generally advocated for what many feel are the medical/psychiatric benefits of cannabis. With this caller today, you suggested that her boyfriend may be “self-medicating” and the cannabis may be helping him with depression, anxiety and enabling him to live a functional life. You compared cannabis to antidepressants and went on to cite a long and scary list of side effects from those medications. The implication being that cannabis is a more effective or safer alternative.

I think it’s important to make the point that cannabis is not a benign substance.

It’s a widely held myth that cannabis is “not addictive.” The truth is “addiction” is no longer used as a clinical term. It is stigmatizing and not a helpful way to think about substance use disorders. Physiological dependence is characterized by two elements, tolerance and withdrawal. You can see evidence of this in many articles for users online on how to manage “tolerance breaks.” As far as withdrawal, there is recent research showing irritability and anxiety. More studies have shown depression, cravings, sweating, stomach problems, insomnia and decreased appetite from cannabis withdrawal.

Dependence, in and of itself, is not necessarily a negative thing. Lots of people are appropriately dependent on injectable insulin, for example. Cannabis dependence, therefore, is not a “bad” thing if what you suggest is true, i.e. that it helps people with things like anxiety and depression. There are two problems with this line of thought. One having to do with the real world approach most (nearly all, if we are honest) people take with cannabis, seeking out euphoria. Yes, there are many who claim to get benefit from high CBD ratio preparations of cannabis but nearly all average cannabis users are looking for the euphoria inducing effects of THC. There are many medical medications that also produce euphoria (barbiturates, benzodiazepines, narcotics, stimulants) and all of them have had disastrous consequences for many users. Euphoria does not treat problems like anxiety and depression, it simply masks some of the symptoms. Antidepressant medications attempt (at least in theory) to treat the causes of mood and anxiety problems and do not cause euphoria.

The other, more important, problem with the idea that cannabis helps people with mood and anxiety problems more safely and effectively than medications is plain and simple clinical trials. There is some scant information on cannabis helping people with stress and grief but (to date) there is zero evidence of its effectiveness for depression. There is also some evidence that cannabis can induce or worsen existing mental illness.

The truth is, Dan, we simply don’t know enough about the effects of cannabis on the brain to know if it’s helpful or not for mental illness. Admittedly, much of the blame for this rests on the government and societal irrational fear over cannabis. That irrationality led to cannabis being labeled as dangerous substance and making it very difficult to study. We now know that cannabis isn’t the “refer madness” danger we used to think it was. However, we also need to come to grips with the fact that we don’t know a lot about it and that from what we do know, it is not a benign substance.

Rethink Your Pro-Pot Advice

Thanks for reading and for listening all these years, RYPPA, and I remember the Vogue back in the very early 1990s — those were good/racy/kinky times, huh? And lemme just say I have nothing but respect and appreciation for anyone who does social work. The pay social workers receive exists in inverse proportion to the good social workers do. As for the reason you wrote...

I shared your letter with Lester Black, a staff writer at the Stranger and for many years our cannabis columnist. Here's what Lester had to say...

RYPPA is essentially making two arguments in his letter — the first is a straw man argument, the second is bullshit.

To start, yes, of course pot can be addictive. Just as with coffee, pasta, working out, sex, crack, social media, and literally any other activity or substance on earth, people can develop unhealthy relationships with weed. Although we should note that studies have shown pot smokers are less likely to get addicted to pot than alcohol users or tobacco users are to their substances of choice. (The Atlantic: "Of all the people who smoke pot, in other words, about 9 percent will become dependent. But of all the people who drink, about 16 percent will become alcoholics.")

But, like RYPPA points out, the possibility for addiction and dependency doesn’t preclude a substance from being beneficial. RYPPA appears ready to stop shaming sad people for smoking pot if he sees evidence that it can help depression, but he can’t do that because according to him “there is zero evidence of its effectiveness for depression.”

This is simply not true.

There is an unfortunate lack of research on cannabis in general but when researchers have been able to study pot and depression they’ve found very promising evidence. CBD injections appeared to have an anti-anxiety and anti-depressant effect on mice in a 2014 study. In a 2006 review of 60 studies concerning cannabis use and mental health, researchers found evidence that pot might help treat depression, although apparently it was less helpful as a treatment for PTSD or anxiety. A 2016 study using mice found that CBD showed depression fighting chemical effects on certain serotonin receptors and “could represent a novel fast antidepressant drug.” A 2010 study showed that THC had a direct antidepressant effect on lab mice.

The connection between pot and depression makes sense. Our body’s endocannabinoid system, which was discovered in the 1990s by researchers looking for how pot works on our brains, is thought to play a key role in mood and related disorders.

The few studies where researchers have been able study cannabis and depression with actual humans smoking pot have found evidence of a positive relationship. A 2006 study surveying 4,400 cannabis users found that daily users were not more likely to report problems with depression, leaving the researchers to say “adults apparently do not increase their risk for depression by using marijuana.” A study by Washington State University published this summer used data from an app called StrainWise to examine almost 12,000 strain reviews for how well they treated depression — they found that 50 percent of users reported a reduction in depression and 58 percent reported feeling a reduction in anxiety. The researchers also found that pot wasn’t a silver bullet for depression, showing the possibility that pot may actually worsen depression over time.

This perceived increase in depression symptoms when pot is used over long periods of time is still not a reason to say that we need to shame depressed people into smoking less pot. The study showed a clear difference between the types of weed smoked, with higher CBD strains even more effective at treating depression. Would someone smoking a strain with a 1:1 ratio of CBD to THC show that same worsening of depression over time? We don’t know.

Why don't we know? Because American pot policy has been driven by people who think like RYPPA — in other words, people who want to keep pot off limits until we know all of its dangers. To accomplish that the government has made it incredibly difficult for researchers to directly handle pot, while also funding hundreds of studies examining pot’s potential harms. The result of this system is that we now have plenty of evidence of pot’s safety and only tidbits of information about its efficacy in treating various medical conditions. This is bullshit. Pot is safe. Before the War on Drugs brainwashed people doctors knew it was safe. Marijuana was included in the American Pharmacopeia (an encyclopedia of drugs) in 1851 and depression was listed along with a dozen other disorders cannabis could treat.

Depressed people should see counselors and mental health professionals and, if they want to, experiment with using cannabis. Their therapist will likely see signs of troubling pot use — signs that RYPPA has no ability to diagnose via girlfriend, via podcast, via Dan Savage, like some game of medical telephone. — Lester Black