When is it okay to smoke weed?

The down after thatWhat cannabis does to teenagers

"You get a heavy, warm feeling. A very relaxing one." The body just becomes heavy, the head becomes totally foggy, the eyes become heavy, you get tired. Sometimes you get a complete laugh, it all depends on what you smoke, indica or sativa. "

"There is a real drug epidemic. And that is the result of downplaying drugs."

"When bad thoughts come, you build yourself another joint and that's good. And so you always meander around the bad things. The only problem is, the bad things stay there."

"The current cannabis policy is an incredible waste of the resources of the police and the judiciary."

"You get nervous when you have nothing left or just can't. And then you just noticed that there were even withdrawal symptoms, which was no longer nice."

Experience reports from the addiction clinic

"I already told you that we have a report from Deutschlandfunk today, that is Ms. Bergemann. But everything will be anonymized ..."

Gunter Burgemeister heads the Dietrich Bonhoeffer Clinic in Ahlhorn, Lower Saxony - an addiction clinic. 46 patients are currently undergoing therapy here, all between 14 and 25 years of age. Some of them are addicted to cannabis, the others have consumed all sorts of things. The typical pattern: A daily dose of cannabis as the background noise in everyday life, with it now and then amphetamines, party drugs and cocaine.

"I woke up in the morning, looked for my glasses and built one for myself. That was the first thing I did when I got up in the morning. After that, you feel much better. And it works that way."

From smoking to weed

This is Jan, who, like all patients in this report, is actually called differently. He was 14 years old when he started smoking cigarettes. During the breaks, Jan stands in front of the school with the other smokers. She also gets him to smoke weed:

"You can only hang out with people who consume." "Because?" "Yes, you don't even know what to do with other people. Because you only meet to consume. And there is no other reason to go out and run around with friends. You can do that with other people not, you don't know what to do. "

More interesting than the "normal" cigarette? A girl rolls a joint. (imago images / Science Photo Library)

A normal youth stage?

As a teenager and as a student, I smoked weed from time to time. Most of my friends have finished school and completed their training without any notable absences. But two of us fell into schizophrenia. You have struggled with it to this day and live with many limitations. Actually, we all had an inkling that their illness had something to do with smoking weed - and yet we continued to smoke:

"When I was 16, I fell in love with a boy like that and he took me to his stoner boys. And they all sat there and hardly talked to each other."

Jan: "Yes, that comes with time. That's why, towards the end, I almost exclusively consumed it on my own. At some point it is boring too, I have no idea. And nobody wants to say anything, everyone is lesh." "Lesh?" "Oh, stoned, wide, stoned, something like that."

Contact with cannabis is almost inevitable

I now have a 14 year old daughter. What should I say to her? How dangerous is cannabis really? Because she will come into contact with it, I have no doubts. The stuff is just everywhere. Jan:

"You just look at it. You can get drugs in any city, you just have to ask when you look at it. And you already have everything you want. So that's really not difficult."

Gunter Burgemeister: "What is even worse, the dealers recognize you straight away. If one of our boys goes to the hairdresser's here, someone comes out of the Rewe and speaks to him. They'll see that straight away."

Equality with the legal drug alcohol?

Cannabis is considered a soft drug. The risk of dependence is estimated to be lower than, for example, with alcohol. Cannabis is becoming increasingly socially accepted.

In the Bundestag, the opposition parties, the Greens, the FDP and the Left, are campaigning for an end to the ban. Smaller steps towards legalization are now also planned in the SPD's election manifesto [*]. And even in the Union, people are more open to a more liberal drug policy.

The German Hemp Association estimates that 200 to 400 tons of cannabis are consumed in Germany every year. Illegal trade could bring in at least 1.2 billion euros - money that organized crime in particular earns. Supporters argue that this black market could be curbed with legalization. Critics, on the other hand, fear a further trivialization of cannabis and increasing consumption.

Escape from everyday stress

"If I find it perfectly legal and normal for him to drink six to eight beers on the weekend, that is certainly more harmful than if an adult smokes two or three joints on the weekend .."

..means clinic director and psychiatrist Burgemeister on consumption by adults. But what about young people? Last year, in a survey by the Federal Office for Health Education, at least 10 percent of minors said they had smoked weed before. Among the 18 to 25 year olds it was even more than 40 percent - and the trend is rising. Burgemeister:

"It is not for everyone to escape into a euphoric world. Often it is also an escape into a remote and more calamitous world, and that's where they get stuck with cannabis."

Can cannabis cause heart problems?

The side effects of cannabis include a higher risk of cardiac arrhythmias and heart attacks. In a US study, users between the ages of 18 and 44 had a heart attack more than twice as often as non-users of the same age. However, the researchers were able to rule out tobacco as an alternative cause of the heart problems, but not other factors such as obesity or alcohol.

Another problem: the brain, which is probably particularly sensitive to cannabis, especially in young people. Because the human body itself produces substances that are very similar to the substances in cannabis, the so-called endocannabinoids, says Derik Hermann, psychiatrist and chief physician at the Ludwigsmühle Therapy Association in Landau in the Palatinate:

"The endocannabinoids play an important role in regulating brain development."

Disruptive factor in brain development

The brain develops in two phases. The first in the womb when the neurons are formed and move to the right place. A second phase runs during puberty. Hermann:

"The endocannabinoids then control which connections take place between the nerve cells and where the nerve cells have to migrate in order to be properly integrated into the network. Now you can imagine, if you add THC or other cannabinoids to this control from the outside, then this development is simply disturbed. "

Poor memory and decreased alertness are known side effects of cannabis.

Permanent damage and permanently reduced IQ?

In a long-term study from New Zealand, the psychologist Madeline Meier and her colleagues examined the intelligence quotient of consumers. While the IQ of the control group improved between the ages of 13 and 38, it worsened by up to 8 points in the case of regular stoners, and the greater the consumption. The IQ of adults who stopped smoking weed normalized - but only if they hadn't started as a teenager. A possible indication that cannabis is causing permanent damage in adolescents.

A number of smaller studies, on the other hand, came to the conclusion that side effects such as memory and attention disorders regress in the long term.

Jan: "Memory loss, oh my God, that's really bad. If you want to read a text, you read it and you don't even know what happened there. Or I can't remember so many things in my life remember, the days are just gone. Back then, when I was still smoking weed every day, I couldn't remember what I ate or what yesterday. That was really tough. "

Psychosis as a result of cannabis use?

The psychologist Eva Hoch from the University of Munich and colleagues on behalf of the Federal Ministry of Health created the so-called CaPRis study - an overview of the current status of cannabis research. One of the most important questions is whether the drug can cause psychosis.

"One can observe in healthy people that THC triggers psychosis-like phenomena. Then when intoxicated it can lead to experiences such as delusion, paranoia, hallucinations. The experience subsides after a few hours and leaves no secondary damage. One speaks of a psychotic disorder if these phenomena persist over a longer period of time and do not simply subside again. "

Higher active ingredient content, higher rate of psychosis

Researchers at King’s College London compared the incidence of psychotic illnesses in European cities. In fact, the psychiatrist Marta Di Forti and her colleagues found an above-average rate of psychosis cases, especially in cities where commercial cannabis contains a particularly large amount of the high-inducing active ingredient THC - namely London and Amsterdam. The review of the individual cases also showed: Daily consumption and high THC content increased the likelihood of a psychotic disorder; a result that was also shown in other studies. Eva Hoch:

"The incidence of psychoses increased the more intensely the cannabis use was reported. Occasional use increased by a factor of 2, with intensive use by a factor of 3, and when users stated that they consumed highly potent products on a daily basis then the occurrence rate increased by a factor of 5. "

The trend is towards cannabis with a higher content of the intoxicating active ingredient THC (imago / Chokri Mahjoub)

Doubts about the previously suspected causal relationship

In other words: 2 to 5 times as many people develop psychosis among cannabis users as among non-users. The reverse is also true: around a third of psychosis patients consumed cannabis at the time of their first illness.

But doubts remain: If more and more people across Europe are smoking weed and the THC content has increased in general in the last 10 years, why has not the number of psychosis cases also increased noticeably overall? Perhaps the question needs to be asked differently. Derik Hermann:

"Many genes have been identified, each of which has a small contribution to the risk of developing psychosis. And now, conversely, it has been investigated whether these genetically predisposed persons for psychosis use cannabis more or more frequently. And that is exactly the case."

Psychosis disposition Cause for heavy cannabis use?

In 2014, the geneticist Robert Power was able to show for the first time in a twin study that the innate risk of psychosis could be the cause of cannabis consumption. Hermann:

"This is of course an important finding because it naturally means that not everyone carries the risk of developing psychosis from cannabis."

An international team of researchers led by the Dutch psychologist Joelle Pasman came to the same conclusion. She compared the genome of over 180,000 cannabis users with that of non-users. Genetic variations could be determined, which according to the authors explain the consumption to 11 percent. Some of these "cannabis markers" were consistent with genetic variations that have also been linked to a risk of schizophrenia. With the help of a so-called Mendelian randomization, Pasman and colleagues also examined the genetic data for causality. In fact, there was one direction of action in particular: the genetic risk of schizophrenia as the cause, cannabis consumption as the consequence.

Particular vulnerability makes you more susceptible to drugs

"In psychotic disorders, experts assume a multifactorial event, on the one hand there is probably a vulnerability. On the other hand, environmental factors, risk factors play a role. Perhaps several risk factors are needed, and cannabis then comes along like the drop, that brings the barrel to overflow ", suspects psychologist Eva Hoch.

Hen or egg? British psychiatrist Suzanne Gage suggests a triangular model. That would mean that especially people with a genetic predisposition are affected, with a particular vulnerability. Because of their mental instability, they are more prone to excessive cannabis use - they are more likely to become high-volume users. However, drug use causes additional stress and can potentially trigger a psychotic disorder. Clinic manager Burgemeister:

"Of course you can't say: cannabis makes you schizophrenic. The predisposition still applies, the life story still applies. But even if you factor that out, you realize that cannabis gives you more than anything else. It has you." Own share in the schizophrenogenicity, in the development of the disease, and the earlier, the more. And I can say one thing, if a cannabis patient comes in here, then I already know who started at 10 and who started at 15. "

Meeting in the therapy group

"Noah, why did you miss career counseling? And you haven't been to any sports this week."

Meeting on ward 1 in the addiction clinic. The patients sit in a circle. Like every Monday there is a review of the past week. Did the patients all go to therapy? Did you have arguments with others in the group? Their opinion is also asked for.

Nelson: "You're not getting your throat full. You have to work on it. So be happy that none of us lend you any more money. Because you spend your little bit of money anyway. You run into debts, debts, debts. You can in every addiction slip into this behavior, it doesn't matter at all with you. It doesn't end with you. It's dangerous ... "

From consumer to dealer

Knowing no boundaries, mindlessly following a self-destructive impulse - Nelson knows what he is talking about. The 22-year-old started smoking weed early. When he was 13 he and his friends smoked a joint over the summer vacation. For the others it stayed that way, but Nelson always needed more:

"In the beginning you put 0.3 grams of cannabis into a joint. And now I was alone at 10 grams in the end. On the one hand, tolerance increases and you just want more and more, at some point you are no longer satisfied with the old high that you have. And then you don't get your throat full, at least that's how it was for me. "

In order to be able to have such quantities at his disposal every day, Nelson began to deal. He cared little that he made himself a criminal offense.

Addiction itself is also a disease

In the discussion of which mental illnesses can be triggered by cannabis use, it is easy to overlook the fact that addiction is itself a disease. More than 8,000 minors were treated for cannabis addiction in 2017, almost a third of them as inpatients in a clinic. Nelson:

"The best example for me is relationship life. You can no longer reflect so much in order to live together in a partnership. You just can't do that. You are too high. If you are really high, if you are a real stoner, that If you smoke a joint every day, then it is very difficult to be honest with yourself. And unfortunately you don't notice any of that. You suppress a lot, you no longer talk about things that stress you or that get too close to you. "

Relapse is not a question of free will

The diagnostic manual DSM-V of the American Psychiatric Association APA no longer differentiates between substance abuse and drug addiction. Instead, it describes the symptoms of a substance use disorder, which can be more or less severe.

For example, the person affected develops a tolerance and needs an ever higher dose. Its consumption is determined by a strong desire, the so-called craving. If he doesn't get the substance, he will experience withdrawal symptoms. Regular use leads to failure at school or work and to social and interpersonal problems. Burgemeister:

"In our heads we will probably never get that this is an illness. I always say that if someone relapses in the context of a high level dependency syndrome, it is like if someone with staphylococcal sepsis gets a fever of 40. But anyway, one still differentiates and thinks, Will? Why does he do that? "

The reward system in the forebrain changed

It is assumed that consumption changes the reward system in the forebrain, known as the nucleus accumbens. Due to the increased irritation, the region seems to dull.The urge to consume is an automatism that is practiced over a long period of time and is difficult to overcome, says clinic director Burgemeister. This also has consequences for the treatment:

"It used to be a relapse. It was very simple; they said he had no motivation. And for us it is very clear that motivation is not a prerequisite for therapy, but motivation is the goal and purpose of therapy. Nobody comes here voluntarily because he says he wants to get clean as the only goal. "

Nelson: "When I'm sober and actually need my weed now, and I don't have it right now, then you get thin-skinned, aggressive, you're electrified. You go up much too fast because of little things."

Many addiction patients delinquent

Section 35 of the Narcotics Act makes it possible to undergo therapy instead of going to jail in the event of a drug-related crime. Almost half of the patients in the Ahlhorn addiction clinic have committed offenses. Mainly because of dealing, but also because of robbery, theft or bodily harm, like Nelson. That was four years ago. During this time he swallowed and sniffed not only cannabis, but also alcohol, ecstasy and cocaine with increasing frequency. Nelson was then often involved in fights. And at some point he attacked his mother:

"That was already three in the morning. I came back from a party and wanted to sleep. There was a big argument between my mother and me. I was too loud and woke her up. And then, uh, I freaked out, I have doors dismantled, furniture dismantled, and then at some point I woke up again in a cell. "

Imprisonment as a wake up signal?

Nelson was sentenced to over two years in prison. He spent nine months in prison. That opened his eyes, he says today. It should never go that far again.

Nelson wished he had gotten help sooner:

"Ever since I committed a criminal offense, everyone has wanted to help me with this. Everyone is there for me, everyone wants to take me in, I can go to the clinic here, the health insurance pays. I am helped to rehabilitate myself. I never have any preventive measures There were enough warning signs. I went to school for several years with 50 absent days, I went to school with guns, I was caught with drugs at school, I became violent, not much happened. "

Addiction prevention isn't everywhere in the curriculum

Teachers who simply look the other way - Clinic Director Gunter Burgemeister knows that from many of his patients:

"I have just introduced myself to the teacher in his situation. He has a student in front of him and realizes, man, who smokes. What do I do now? Then he is quickly in this dilemma: Do I want to criminalize this boy now? What do I do, if I do something about it now? You're just afraid of that too. And then he'll let it go. "

Addiction prevention is only firmly anchored in the curriculum in some federal states. In the others, on the other hand, the schools decide whether they want to take up the topic or not. This is also the case in Berlin, where young people start consuming at an above-average age, as Tina Hofmann from the Berlin Office for Addiction Prevention says:

"The data that we have evaluated by the Addiction Prevention Unit shows that the starting age is 14.6, when young people try cannabis, and then you have to talk to them about it. It is very important that schools do not Close your eyes to it. And obviously it is always the case that a taboo takes place. That you don't talk about it. "

Parents are often indifferent to cannabis

Hofmann and her colleague Katrin Petermann also observe that parents prefer not to look too closely and shy away from addressing the topic. On the one hand, because they want to avoid the conflict. On the other hand, because they often do not have a clear stance on cannabis.

"This is also often my introductory slide in teacher workshops. I have a picture from the film 'Fack ju Göhte'. There are these two types of teachers, the cool, casual one. And next to them the stuffy one. And there is the question of who do you want But the question has to be answered as a parent. What role do I have now? Who am I for my child in the phase of learning, growing up? My child needs orientation, including clear messages. "

Shops open: Cannabis purchase has been allowed in Canada since 2018 - only for adults, mind you (AP / The Canadian Press / Paul Daly)

Experience with legalization in the USA

What are the consequences of legalization? Would any more teenagers smoke weed? It is interesting to take a look at the USA. There have Washington DC. and Colorado legalized cannabis in 2014, and more [*] states have been added. Burgemeister:

"Now the question is, if I legalize; is that verbatellization? Are the boys taking more now? No, not. Well, at first you could mean it, but if you look at the facts, you can't follow it."

It is still too early for reliable data. But a tendency is already emerging: In the so-called "legal states", the probability that a teenager smoked weed on a regular basis fell apparently by 9 percent. This is the result of a study published in the specialist journal JAMA Pediatrics, which compares the consumer behavior of over 1.4 million adolescents over a period of 15 years. The study's lead author, agricultural economist Mark Anderson of Montana State University, believes that legalization has made it harder for teenagers to get access to the drug. Another reason could be that the new laws have raised parents' attention so that they can talk more to their children about drugs. Karin Petermann:

Addressing drug dangers, admitting your own youthful sins

"We know from studies that there is a connection, that is, no causality, but a connection, between parents who clearly say I don't want you to use drugs and less consumption. As parents who do not address that at all or very much Laisser faire are, drug use tends to be greater there than where parents clearly forbid it. That doesn't mean that young people don't try it out. But they have that in the back of their minds. "

In conversation with the addiction experts, I realize that an ambivalent relationship to weed does not make talking to children any easier. As a mother, I have to provide orientation and set guard rails. But what do I answer when my daughter asks about my wild years or tells me about my cigarette smoking? Teens know exactly how to checkmate parents. In such cases, Hofmann and Petermann recommend admitting mistakes from time to time - everything doesn't have to be on the table right away. Parents could also express a wish that the child do better. Petermann:

"Nor can we leave all the responsibility with the parents. That is a task for society as a whole. It would be very important to us that prevention is expanded further. And when legalization comes, then at least in a package with youth protection, but also with education and prevention. So that a competent handling can be found. "

Legal delivery, but better control

In Portugal, possession of illegal drugs was downgraded from a criminal offense to an administrative offense in 2001. The measure, which was aimed primarily at the glut of heroin in the country, significantly reduced deaths from overdose and HIV infections. And contrary to expectations, Portugal did not become a stoner's paradise. The number of young people who use cannabis has remained below the European average to this day.

The head of the Ahlhorn addiction clinic, Burgemeister, also sees opportunities in legalization - if it is accompanied by better controls:

"There are two uncontrolled markets. A legal uncontrolled market and an illegal uncontrolled market. One is nicotine and alcohol in the legal area and the other is the drugs. That also means simply restricting the sales outlets. In Uruguay it is via pharmacies They are then also kept on delivery slips and you know who has bought how much. "

Stop the trend towards "high-proof" cannabis

With a controlled release, a maximum value for the THC content could also be introduced, says the psychiatrist Hermann. This could stop the current trend towards stronger and stronger cannabis:

"This is a phenomenon that is already known from the prohibition of alcohol in the USA. In the past, a lot of beer was drunk there. And in Prohibition it was of course much easier not to transport such large amounts of liquid. That's why we made the switch And basically that's the situation now. We now have types of cannabis that are similar to schnapps or whiskey. They are in vogue, whereas 20 years ago, cannabis that could be compared to beer was more common. "

Better legal than illegal - and best of all: hands off!

Of course there are also many doctors and psychiatrists who see things differently than Burgemeister and Hermann, for example. Still, I'm surprised how many medical and addiction professionals are in favor of legalization.

"By bringing drugs to the 'Oh, for heaven's sake, just don't' corner, and at the back also in the illegality that it must be concealed, that one must not reveal oneself, not go to seek help, that is allowed will not happen. And if that is the result of illegalization, then we have to give it a different direction. "

For better protection of minors than before, there would have to be effective control over what is being sold and to whom, namely not to young people. All of this at low prices that would dry up the black market. The hope: If it were really difficult for young people to get hold of it, one or the other would lose interest. Because there seems to be a consensus among all experts: Young people should keep their hands off cannabis.

Repetition from January 19, 2020

[*] Update:

When the show first aired in January 2020, eight US states had legalized cannabis. More have now been added, most recently New York State.

The position of the SPD has also evolved. As recently as November, the party did not approve a corresponding bill by the Greens. In the election manifesto for the federal election, however, she is now in favor of model projects for the controlled distribution of cannabis and for the legalization of the possession of smaller quantities.