High Times in Therapy

Long before states started legalizing marijuana, New England had the most potheads per capita in the country. As an 11-year-old Mainer, I was one of them.

It’s my own personal theory that an annual six to seven months of winter contributes to Northeasterners’ love of the bud. I can tell you that for me and my other latchkey middle school friends, lighting up felt like the most entertaining means of whiling away indoor afternoons when our coastal town was muffled by snow. I still remember how good it felt to tromp to Chris, Michael, and Bobby’s empty houses, kick our soaked boots off in a tumble in the mud rooms, lie down in shag carpeting, and get ourselves, and sometimes our pets, thoroughly high.

I’m not proud of the pet part—although I swear Chris’s arthritic lab loved these afternoons as much as we did—but I can’t say I regret any of this. The four of us were still too young to have been briefed on pot’s potential damage to our brains, and smoking produced a calm goodwill in us that for those afterschool hours veritably wiped out the alienating, brutally hierarchical reality of junior high. The basement rooms, with their macramé wall hangings and fake wood paneling, were safe zones, where we fell more deeply in love with the music we already liked, and where we were free to indulge in our craziest revelations and stupidest jokes. When I’d see one of the boys in the halls at school, I’d relax reflexively.

Michael’s older brother was a small-time dealer, and we could sneak handfuls of loose leaf out of his stash. But it was Chris, with his early sideburns, who’d bravely buy bags of it from the scary guy in the army jacket who always sold on the railroad tracks. In time, we found ourselves more often turning up Chris’s driveway on our walks home from the school bus stop. Chris’s stash was bigger, and at his house there was no need to struggle with rolling papers and badly burning joints. He was the only one of us with a giant plastic purple bong hidden in his sweater drawer.

Maybe pot made us a little stupid in the moment—it probably wasn’t truly mind blowing to find repeating patterns in water stains on Chris’s ceiling tiles. But unlike the older kids and the tourists we’d see peeing in the snow and fighting in the streets when our town’s near-empty beach bars closed, we stoners didn’t do anything stupid. We stayed safely in place and stuffed ourselves with jumbo bags of chips that turned our fingers orange. And when we hit the point in the afternoon when things seemed moderately less profound or funny, we peacefully separated and ambled home through the bristling, sobering cold for dinner.

Once we were older and finally learned about the threat pot posed to our brains, various high school afternoon commitments had already disrupted our dope-smoking ritual, and the four of us drifted apart. But one night, as some track team friends were driving me home in a rainstorm, Chris appeared in our headlights. He was walking alone down the center yellow line of a busy road, his arms akimbo, singing and shouting and laughing as drivers swerved around him and laid on their horns. We stopped, and I ran to him through the pelting rain, but when I tried to pull him out of danger he shoved me away.

“What are you doing?” I yelled. “You’re gonna get killed!”

“So what?!” he yelled back. “So fucking what?!”

I insisted my friends drive me to his house a few blocks away and, in an unforgivable breach of teenage etiquette, I got his parents. Chris stopped speaking to me after that night, alienated more of his friends over time, and for the remainder of high school edged farther away from others and deeper into himself.

Today, as more states contemplate the full legalization of marijuana, the ramped-up scrutiny of pot’s impact on youth has me looking anew at Chris’s behavior that night. Had he kept smoking for all that time in high school while the rest of us tapered off? Was he suicidal when he shouted at me, in the throes of a dark depression accelerated by an addiction? Could he have been having the kind of pot-induced psychotic break that psychiatric emergency room docs warn us about? Could his downward spiral have been avoided if he hadn’t smoked so much? Or had pot been working its calming magic on him for all those years beforehand, helping him cope with difficulties he never shared with us, and keeping him out of that street?

The Adolescent Question

We Americans love our pot. Two-thirds of us think it should be legal, and despite our country’s reputation for puritanism, we consistently make it into the top five nations of pot users. As of this writing, 33 of our states and the District of Columbia have legalized medicinal or recreational marijuana or both. Psychiatrists are now prescribing it regularly for PTSD, and it’s being celebrated among some in the therapy world as an alternative to psychoactive drugs for the treatment of anxiety, depression, insomnia, and pain. Clients are even using it to lower their inhibitions and heighten their senses for better sex.

But sizeable protests against legalization are emerging, often aided or helmed by psychiatrists. And one of their biggest drivers is the drug’s potential effects on modern-day versions of kids like Chris and me.

Regular pot use starts early in this country. About half of us took our first hit or ate our first pot-laced edible between the ages of 12 and 17. Nearly a quarter of 18- to 29-year-olds use it, making up the highest percentage of American adults who do so. Marrying this concentration of youth to a new normalization of the drug gives even progressive doctors pause.

Here’s why: THC, the main psychoactive compound in pot, attaches to cannabinoid receptors on neurons in the brain, and while flooding users with pleasurable dopamine, it messes with the nervous system, affecting thinking, concentration, memories, coordination, and the perception of time. (CBD, another component of cannabis and of hemp, works differently and is not facing the same level of scrutiny, despite its growing popularity.) Too much of these THC effects in young people, some researchers believe, can lead to poor memory, cognitive impairments that affect learning, and a loss of IQ that doesn’t correct after quitting. Some warn that the higher THC content in today’s “new cannabis” will only intensify those problems.

The National Institute on Drug Abuse says people who start smoking before age 18 are four to seven times as likely to develop a use disorder than if they’d waited until adulthood. And some researchers say regularly getting high at an early age is associated with heightened levels of depression, cognitive decline, and a first psychotic episode. If a young person is already at risk for schizophrenia, that risk is increased. Adults who use daily may experience short-lasting effects on memory and be more vulnerable to psychosis and depression. However, studies on the effects of the drug on mature brains are more equivocal than those on still-developing brains, and they’re often complicated by the reality that the majority of adults who use marijuana started as teens. For seniors taking the drug medicinally, there’s even early evidence that the drug may affect elderly brains quite differently, paradoxically enhancing cognitive performance—at least in mice.

The American Academy of Pediatrics has a standing statement about marijuana’s negative effects on developing brains. A recent op ed in The New York Times from physicians affiliated with the Mount Sinai Health System and Rockefeller University suggests it’s time to extend that warning not only to children and teenagers, but to young adults as well. The writers call for the legal age to start at 25, not 21, since young brains, they say, are still forming before that age. They point out that the consistent use of even weak strains of marijuana has the potential to alter developing neuropathways implicated in learning, attention, and emotion—and now, in legal marijuana dispensaries across the country, the average THC content of pot can be as much as five times what it was in the ’90s.

There’s nonetheless conflicting evidence about whether legalizing pot is raising or lowering teen and young adult pot use—Colorado, one of the first states to legalize recreational marijuana, has seen a dip and a leveling off, but the public is being inundated by frightening stories about higher levels of psychosis. The Washington Post recently reported that cannabis-related visits to Colorado Children’s Hospital facilities, which included experiences of paranoia and psychosis, had increased nearly fivefold since legalization, as teens gained access to ever more enticing forms of potent edible candies and pastries, whose unpleasant side effects can last longer than buds smoked the old-fashioned way.

There’s also concern about greater potential for hospitalizations with the new practice of “dabbing.” This is when a strong, sticky, concentrated marijuana extract with very high levels of THC (60 to 90 percent, versus traditional percentages of under 20), is heated on a hot surface and inhaled. Effects on the brain of using pot this way are swift and strong and haven’t been thoroughly studied.

What Can We Know for Sure?

Many people have pointed to faulty science behind the studies that warn of the cognitive and mental health impacts of pot. As any addiction researcher knows, it’s tough to isolate a drug for study when it’s already immensely popular. And in the U.S., pulling off a proper study is doubly hamstrung by the government itself, which continues to list pot as a Schedule One drug.

Julia Arnsten, chief of general internal medicine and professor of medicine at Montefiore Medical Center in the Bronx, oversees a medical marijuana dispensary affiliated with her institution as part of her work. She’s an addiction specialist who’s found herself in the middle of the debate about full legalization in New York.

“In the addiction medicine community, there’s a lot of concern around cannabis. Especially in some states, people are worried that legalization is moving too quickly, and we’re going to create widespread cannabis use disorder. I have sympathy for that perspective,” Arnsten says. But she believes that not just medical dispensaries, which not everyone can access, but legal, regulated markets, make marijuana safer for everyone.

I’m thinking of my middle school friend Chris when I tell her that the data I’ve seen are pretty suggestive that regular marijuana use—whether legal or not—has some negative impacts on young people, including the frightening potential to unmask psychotic tendencies. Arnsten agrees that the research is concerning—to an extent.

“While the studies are compelling, they’re hard to interpret because they’re observational studies. That means that rather than randomizing people to have marijuana exposure and see them develop psychosis, we’re observing people who’ve developed psychosis and asking what their marijuana use was in the past. The leap, and it’s one I’m not completely willing to make, is that the marijuana is causing the psychosis. There are always mitigating factors, including many other stresses in people’s lives. Marijuana is so common: the only way we’d be able to know it’s the cause for certain is to isolate that one variable, expose some people to it and not others, make sure all those other attributes were evenly distributed between people in two groups, and then measure the impact.”

Funding such a study with humans would be an ethical minefield, and there’s no animal model. But Arnsten isn’t only unsure about the limited science on psychosis; she also questions the studies reporting pot’s supposed benefits for mental health. “We frankly don’t have good evidence that cannabis is helpful for anxiety or depression or PTSD. There aren’t randomized control trials, and there may never be with cannabis,” she says.

This lack of evidence may seem surprising, given how passionate doctors and stakeholders who support or oppose legalization can be. That passion, Arnsten explains, originates from what they see personally in their own practices. “When you work in a psychiatric emergency room and see people who’ve been smoking a lot of marijuana come in psychotic, it affects the way you think about it. But I’m running a medical cannabis program at our academic medical center, and many patients tell me that smoking marijuana is the only thing that helps them. Just today, a third of my patients were here for depression and anxiety. They’re on Wellbutrin or benzodiazepines, and every one of them told me, ‘When I’m really anxious or depressed, smoking is the only thing that helps me.’ When you hear patient after patient say that, it’s hard to dismiss them as just wanting to get high. That’s a whole lot of anecdotal evidence, but it’s not the sort of data on which we make decisions.”

In the meantime, justifying legal alcohol and cigarettes, with their multiple health threats, while continuing to criminalize pot, which we know disproportionally affects Latinx and African American populations, may not make sense. “Adults and teenagers have always made choices about what risks they’re going to take with their health,” Arnsten says. “Trying to legislate those decisions has never been helpful. I think to combat problematic use we need to be more effective with our public-health messaging and prevention.”

Where does she think all of this leaves therapists who will likely need to weigh in on pot use with clients in this new era? “I think being open to talking about cannabis use and listening to what patients think helps them is important. If we’re open, we can ask questions like, “Is all of it for trauma or anxiety or depression or insomnia, or is it because you don’t know what to do with yourself that day?’”

The Pot Practitioners

Although marijuana is prescribed regularly for PTSD and pain, many adult therapy clients are self-medicating with no prescription, or just using it for fun. Plenty of them have felt that a therapy office isn’t a safe place to come clean about their use. Is the current trend toward legalization changing that?

Sara Ouimette is one of a handful of therapists who’ve started working explicitly with the drug in practice. Ouimette lives in California, where pot has been available medicinally for decades and commercially for the last couple of years. At this point, she hasn’t just embraced straightforward talk about marijuana in sessions: she’s hung a shingle proclaiming that she offers “cannabis-assisted therapy.”

“Listen, no one’s ever died of a pot overdose,” Ouimette assures me when I ask her why she’s so on board with it. The alternatives that her clients could potentially use to dull psychic or physical pain, including alcohol and opioids, don’t thrill her. “I’m all about harm reduction and quality of life. If they’re going to medicate, what’s the least damaging way of managing their pain?” she posits.

The Oakland therapist isn’t pushing pot, she says, but rather providing a safe place for the growing number of cannabis users to come for therapy, judgement free. With some of them, her work resembles a version of addiction counseling: she’ll often gently help users explore whether pot is harming their close relationships or keeping them from making changes they’d like in their lives. And she’s found that exploration can be a window into deeper issues, like symptoms of trauma that clients take cannabis to mask.

Sharon, a client in her mid-20s, was an active user for years before she gobbled down too much of a pot-laced cookie and had a panic attack that landed her in Ouimette’s office. Sharon was so reliant on pot that she didn’t want help weaning herself from it; she wanted Ouimette to help her get back on it after this scary episode. For many addiction counselors, this would’ve been an opportune time to convince her to ditch pot altogether, but Ouimette suspected something important lay beneath her potent experience. So she asked Sharon to think back to when it happened. Was there anything special about that day?

“Well, I’d gone back home,” Sharon told her. “For the first time in a very long time.”

“And why had you stayed away so long?” Ouimette asked.

“Because home was a scary place,” Sharon began. “Both my parents are pretty out of control. Things can get bad for the smallest reason. Once I got out of that house, life was calm.” They explored what a relief it had been when she found that cannabis helped her keep it that way. So when she panicked while on the drug that had always kept her safe, she was devastated.

As Sharon shared more, it became clear to Ouimette that she’d been self-medicating with cannabis for genuine PTSD symptoms. The pot regulated her dread and anger, helped her get to sleep at night, and gave her moments of euphoria that she could hold onto when life seemed unbearable. (According to one study looking at medical marijuana with psychiatric patients, using cannabis may reduce PTSD symptoms by as much as 75 percent.)

“As we processed this fear of being out of control, we realized she’d had it for a really long time. This opened up a lot of work on her home environment. Her early life, rather than just her cannabis use, became a focus of our therapy,” Ouimette says.

Though she won’t specifically tell clients like Sharon to quit, Ouimette often sees clients who are in therapy because partners or friends or family members think they use pot too much. “I’ll say things like, ‘I wonder if you’re using it to escape your feelings. What do you think?’ Or I might ask, ‘How do you think it’s affecting your relationship? How do you think it’s affecting your sleep?’ A lot of people I’ve seen with PTSD use it as a way to regulate their emotions. But if they’re high all the time and unable to function, then we need to address that.”

Ouimette also suggests clients try using pot with intention, as a legitimate tool for personal growth. “I’ll definitely encourage people who are already using pot, and even abusing it, to do it without either watching TV or being social, but instead meditating on their own and recording their insights. I’ll suggest, ‘Take it, try a two-hour meditation, and then journal afterward and bring that back to therapy.’”

Pot can be effective at producing real insights for personal growth, because, she says, it has an amplifying effect on emotional states. Working with that amplification can produce the kind of self-awareness that helps folks get their use under control or heal other parts of their lives. “As a harm-reduction approach, I’m also a fan of microdosing a very small edible,” she says. “If you take very small amounts of THC throughout the day, you’re a little better but not altered.”

Ouimette doesn’t do what her tagline might lead people to believe, like encourage the smoking of certain strains to alleviate particular mental health issues (only doctors referring to dispensaries can do that), or intentionally offer therapy while someone is high on cannabis to heighten emotional breakthroughs—à la psychedelic therapy. And she draws a thick line when it comes to adolescents.

In one case, a desperate middle-aged mother sought her out to talk through whether she should buy marijuana herself and give it to her anorexic daughter to jumpstart her eating again. But Ouimette demurred. In the daughter’s case, she says, it wouldn’t have been harm reduction at all, since, she says, “plenty of evidence shows that regular use of the drug is bad for adolescents.”

Psychotic or Psychedelic?

The whole question of pot’s relationship to psychosis takes an interesting turn when you speak to the small group of practitioners who are interested in its potential to provide psychedelic healing. “In high enough doses, cannabis will work like a psychedelic,” Ouimette told me. “In fact, some people can have a powerful awakening on cannabis and think they’re having a psychotic break. What’s happening instead is they’re having an overwhelming experience of insight.”

Renn Butler lives in Canada, which, along with Uruguay, has countrywide legalization. A healer trained in Stanislav Grof’s practice of using holotropic breathwork to elicit deep inner experiences, Butler offers retreats for what he calls “THC-internalized sessions.” Like Ouimette, he believes that under the right circumstances, what in the ER might look like a marijuana-induced psychotic episode could become a supported psychedelic journey that might prove life changing.

“Grof said if we could support the person who’s having a strong, even frightening experience to keep facing their emotion, instead of giving it a label and suppressing it, then the likelihood they would come through it unharmed is very high,” he says. At his first cannabis-assisted psychedelic weekend in British Columbia, he saw no evidence of psychosis. Instead, he said, he watched THC bring forth the same inner healer that those studying the effects of MDMA on PTSD report surfaces during a trip.

Though Butler doesn’t yet have hard evidence of the impressive results that MDMA- and psilocybin-assisted psychotherapy investigators are producing with PTSD and anxiety sufferers, his process of working with the drug mimics theirs. He and his team did careful medical and psychological screenings beforehand, refusing folks with high blood pressure or serious heart disease, pregnant women, and those who are bipolar, suicidal, or paranoid. They then created a calm and positive “set and setting” before the tripping began.

Attendees stayed at a soothing forest retreat center outside of Victoria, where they spent time getting to know Butler, his cofacilitators, and others in the group before getting started. They then paired off with a supportive partner, who stayed with them for the duration of the three to five hours they’d be high. The pairs switched roles with each other the following day.

Butler and his cofacilitators bought the pot that everyone used from a government-approved dispensary. It had a fairly high THC level, of about 19 percent, and came in a little black box, which, not unlike American cigarette packages, carried a government warning on its packaging. In this case it read, “Regular use of cannabis can cause psychosis and schizophrenia.”

Ava, who’d been plagued by traumatic memories of sexual abuse as a child, had come to Butler’s retreat hoping for a breakthrough. She’d already had a chance to bond with the woman who would be her sitter by the time she stepped out onto the center’s deck and took a few puffs of the dispensary pot. Once back inside, her sitter sat down next to her as she stretched out on a foam mat and donned the headphones to her iPod. The evocative music it played had been chosen by Butler and the co-facilitators, who said it creates “a sound shade between the inner and outer world.”

She put on her eyeshades next. As the drug started transporting her deeper inward, she remembered the instruction that Butler had shared with them from mindfulness guru Jack Kornfield: “open all the doors and windows of your house and pay attention to whatever comes in.”

After a short while, Ava was able to focus on a sense of physical pressure that intensified as she thought back to her childhood, to scenes of her abuse and the abuse she witnessed of her younger relatives. Scary as it was, she could feel a sense of progress with this focus, but soon she felt herself wanting to float away from the pain, just as she always had before.

She fought back against this sensation, intent on confronting her past this time. To keep herself contained, she asked her sitter to apply pressure to her chest. The sitter spoke to one of the facilitators and together they placed some soft couch pillows on top of Ava. It wasn’t enough, she said, and the facilitator gently added his own weight to the cushions. Ava told him yes, that was good, and asked him to “please stay.”

The physical pressure wasn’t easy: it brought to the surface memories of how she and other family members had been physically held down, but it led her to feel an opposing strength gathering deep within her, a rising force that helped her struggle against the pressure and fight for herself and the other kids. She told her sitter and the facilitator what was happening and started pushing back on the weight. She shoved and kicked and the facilitator hopped off as the couch cushions flew into the air. Soon they were all three sitting up and laughing. She told them that a great rush of giddy relief had overcome her. At the end of the day, she was beaming.

Butler calls THC a “middle-of-the-road” catalyst for psychedelic breakthroughs, one that can be more appealing to some clients than a longer-lasting psychedelic experience. “I don’t want to sound judgmental,” he says, “but people who are using cannabis to medicate every day are missing out on a tremendous opportunity to go much deeper and get more out of the experience than they are. When you have a psychedelic experience on cannabis, you’re given the opportunity to fully experience the emotion that is coming up.”

Easy Pickings

I might not live in Canada, where I could buy pot commercially without a prescription, but I do live in Washington, DC, where cannabis is both medicinally and recreationally legal and very, very available. The smell of it can seem like it’s everywhere; it hits you on the sidewalks of both the grungiest and the leafiest neighborhoods. It even wafts past when you’re downtown, an area thick with Secret Service agents and lawyers and federal rulemakers of every persuasion.

Unlike in my adolescence, where carrying or cultivating any amount of pot could land you in jail, you can have two ounces of pot on your person in DC and grow up to six plants yourself. If you’re not growing it or don’t have a medical marijuana card, you can find it, slightly less legally, through word-of-mouth delivery services and at pop-up events whose social media and email mailing lists you can join. At the pop-ups, you can receive marijuana in its regular form, or in gummies or edibles or tinctures, as a “gift” for buying something nominal, like a key chain or a sticker, which costs about the same as an eighth of an ounce of pot. Or you can visit a grow house or cannabis club established under the auspices of helping residents nurture the cannabis plants they’re growing at home. All these options include showing a dealer your DC ID.

I wanted to explore what a young adult with a fake ID, like my old friend Chris, might do were he, say, under pressure to produce pot for a party. I’d heard there was a grow house in a popular strip of bars and restaurants not far from where I live. Once I got to the block, there was no mistaking it. The entryway was covered with posters of healthy marijuana plants. The door was shut hard, and when I knocked, it was opened by a bouncer of sorts, a thin guy in his early 30s. “Hello ma’am,” he said, without a hint of friendliness. “Please come in and close the door behind you.”

I found myself in a tiny, dingy room that looked like a cross between a band’s practice basement and a run-down gardening shed. A few feet away from me was some unimpressive plastic shelving with growing materials. A friendlier-looking guy stood behind the counter. I saw no pot at all. The bouncer held out his hand for my ID then asked, with the humorless, formal cadence of a police officer, “Can you tell me why you’re here today?”

His tone made me nervous, but I got out that I wanted to secure some pot for a friend who was anxious. (This was not untrue, by the way.) I expected him to let me pass, but he startled me by looking me hard in the eye and asking what I did for a living. I could’ve lied about this part, but I’ve learned not to over the years. “I’m a journalist,” I said, and held my breath.

He immediately went into a rehearsed spiel that included telling me I was not at a dispensary, nor was anyone there a doctor who could make a professional recommendation. I was also not at an illegal, pot-selling establishment, but a nonprofit that provided the entirely legal public service of teaching people how to grow the cannabis plants we’re entitled to keep in our homes in this town. He impressed upon me that they were so legal that the mayor herself had stopped by for a visit and told them she supported their efforts.

He pointed to a closed double door, behind which I could hear people laughing and yelping, and simultaneously handed me some forms to fill out if I wanted to take any of their classes or become part of their grower’s club, where likeminded people can pass through those doors and come together to “enjoy each other’s company.”

I said I’d give it some thought but really was just wondering about the pot for my friend. There was a second’s hesitation when I thought he might finally ask me to leave, but he pointed me toward the counter instead. The smiling guy who’d heard our every word produced a selection of buds that the bouncer called out would provide a “mellower high.” I could have one for a donation—mine was the $50 size—to their nonprofit.

I walked out of there trailing the skunky smelling, fat green buds of a strain of indica called “Man Down.” It had been squished into some clear plastic the size of a ketchup takeout container, and as I held it aloft for a while, passing brunchers and strolling families and security guards, I couldn’t help grinning at the bold immunity of being so public with what was—clear as day—a handful of weed.

As I walked on, the unsettling feeling of being grilled at the door started to fade. But it was unpleasant enough that I doubt even a confident kid with a very good fake ID would relish going through it. Still, there was something paradoxically comforting about the seriousness of the encounter. My pot felt safer than anything Chris or I could ever have bought on the railroad tracks back in middle school.

The Inevitability of It All

Legalization has come so far so fast that it’s hard to imagine the country returning to a time when smoking or growing pot will go back underground, or clients will abandon it. Along with Arnsten’s argument that society can’t justify criminalizing its use if alcohol and cigarettes are legal, is the growing acknowledgement that stark racism has surrounded the arrest and prosecution of individuals carrying or selling pot. African Americans and Latinos continue to be disproportionately jailed for minor pot offenses, and according to the ACLU, African Americans are almost four times as likely to be arrested on marijuana charges as whites. This, despite the reality that use is roughly equal between the races, and white users most often buy from white sellers.

But even if every state eventually bends to popular opinion about legalization and makes right the racist wrongs of their drug policies, burning questions remain for practice. Will therapists be expected to suspend judgment of regular pot smokers? Will our bias, one way or the other, be apparent? Do we really know what qualifies as a marijuana-use disorder? Where do we fall on the question of psychosis versus awakening? How do we address pot use with a curious teen?

At the start of researching this story I called a psychiatrist with an interest in alternative medicine, expecting that his openness meant he’d already considered these questions from both sides of the aisle. But Henry Emmons surprised me by opening the conversation with an admission that he’d never smoked a joint in his life. “I’m very careful with my brain. I’ve been doing this work for 30 years and have seen a lot of problems associated with pot. Every year, I still see a handful of college students who become psychotic after smoking it. But in the last few years, my stance has softened,” he told me.

“Street marijuana affects so many neurotransmitters, it’s so nonspecific, that it’s a crapshoot,” Emmons said. “But we do have medical marijuana here in Minnesota, and I’ve referred 15 of my patients with PTSD to the dispensary. Personally, I wish it were available for a wider array of mental health issues. It’s certainly no bigger a risk than typical pharmaceuticals we use. We need to appreciate the risks, and clients need to know what they’re getting into, but there are valid therapeutic benefits. So I’d encourage therapists to be open to it. It’s coming, and soon enough, it will be legal everywhere.”

The other night it hailed here in DC, at the end of a hot and swampy summer day. There was something almost biblically threatening about this freak weather event and the pummeling noise it made. After I finally settled the kids, I had trouble falling asleep, and as I lay there, I could smell the pungent, unopened ketchup container of “Man Down” that I’d tossed inside our bedside bureau.

Younger me might’ve rolled over and lit up without a second thought, but I had second thoughts now. Thoughts about Chris, wherever he is. Thoughts about how grateful I was that pot was being talked about in nuanced ways these days. Appreciation at the brutally honest assessments I’ve heard about what we do and don’t know about this most beloved of drugs—and about both what we’re newly afraid of and what we still think we can gain from its promise.

I still love the idea of pot and the gorgeous sense of calm it gave me at a time in my life when everything seemed so frighteningly off. Lying there as an adult with a now fully formed brain, I wondered whether it might be a good time for the plant and me to get reacquainted. But my kids were upstairs. What if the smell roused them? I decided I could try smoking it later, with the kids at a sleepover and the windows open—or maybe, I thought, as I stared at our stain-free ceiling, once they’re finally grown.

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