Politics Foreign Affairs Culture Fellows Program

No Dope

Pot legalization stalls as voters start to see its unintended consequences, such as “scromiting.”

(Mitch M/Shutterstock)

In a 1988 interview with High Times, attorney-activist Michael Kennedy predicted that marijuana legalization was “inevitable.” 

Kennedy made that prediction as Ronald Reagan was on the warpath against pot, signing into law the Anti-Drug Abuse Act of 1986 and imposing substantial mandatory sentences on federal marijuana offenders. His First Lady had become the face of the national anti-legalization movement, channeling suburban parents’ anti-drug fervor and piloting the “Just Say No” campaign in schools across the country. For a moment, parents, religious leaders, and the federal government were arrayed against the counterculture’s drug of choice.


However bleak things looked for his cause at the time, Kennedy’s words look prophetic today. By the time Reagan took office, eleven states had already decriminalized marijuana possession. His predecessor, Jimmy Carter, had even considered lifting the federal ban, only declining to do so after his drug czar was allegedly caught using cocaine at a pro-marijuana group’s party. 

The tide of liberalization promptly resumed after Reagan left office, with five states legalizing marijuana for medical use in the decade after the 1988 election and another ten states and Washington, D.C., doing the same in the second millennium's first decade.

While marijuana remains illegal at the federal level today, High Times and its readers have won victories in state after state. Pot is legal for medical use in thirty-eight states and recreational use in twenty-one. Nearly 60 percent of Americans believe recreational use should be legal, and some 55 million admit to having smoked it themselves. Walk the streets of any major American city and inhale through your nose, and you can’t help but be impressed, if repulsed, by the pro-marijuana movement’s success.

But for all that success, pockets of resistance have emerged. In the 2022 midterms, legalization measures failed decisively in North Dakota, South Dakota, and Arkansas. And earlier this year, a referendum to legalize recreational use in Oklahoma fell by more than 20 percentage points, failing to win majority support in any of the state’s seventy-seven counties despite the pro-legalization side outspending its opponents twenty-to-one.

The Oklahoma referendum in particular illustrates the headwinds facing marijuana advocates as they try to flip the remaining holdouts—and why some advocates worry Kennedy may have spoken too soon.


Oklahomans voted to legalize marijuana use for medical purposes in 2018 by a 13-point margin.

The measure they passed allowed any Oklahoman adult, with the signature of a board-certified physician, to consume, possess, and grow their own cannabis. Those caught possessing the drug without a license were subject only to a $400 fine, provided they could “state a medical condition” to police. 

The measure did not specify which conditions qualified an applicant for a license and deferred to physicians’ discretion. It instituted a 7 percent tax on all marijuana sales, which advocates insisted would be a boon to the state’s budget. To receive state licensure, a prospective dispensary owner was required to be an Oklahoma resident and pay a $2,500 application fee.

The state’s medical department was charged with implementing the measure and regulating the medical marijuana market in keeping with the enabling legislation. The department drafted regulations that included rules not found in the original measure, including a ban on smokable forms of cannabis, a requirement that all dispensaries have an on-site pharmacist, and a statewide limit of 50 dispensaries. Those provisions prompted a backlash from marijuana advocates and progressive lawmakers, including a state Democratic representative who claimed the health department was insulting “the law-abiding citizens that showed up to vote for this initiative.” 

As a result of their efforts, and a bit of lawfare from pro-marijuana groups, the final bill signed into law by then-Governor Mary Fallin didn’t include the medical department’s oversight provisions.

Predictably, the law, shorn of almost any meaningful restrictions on patients and dispensaries, has been abused by a small group of activist physicians and enabled thousands of marginal “patients” to get high. 

The types of conditions marijuana-card holders most often cite to obtain their cards illustrate the point. According to a study by the medical journal Preventive Medicine Reports, the most common conditions cited by Oklahoma’s medical marijuana users were anxiety (43 percent), depression (33 percent), sleep problems (27 percent), and chronic pain (24 percent)—conditions impervious to external verification.

“State law says, your letter of recommendation to get a patient card has to be signed off on by a physician, but most physicians wouldn’t sign off that smoking marijuana is a remedy for the conditions that these people are seeking a card [for],” Mark Woodward of the Oklahoma Bureau of Narcotics said. Claiming anxiety or depression is very common in states where medical marijuana is legal because it “cannot be measured, it cannot be X-rayed, and it cannot be diagnosed. And so you can’t prove they’re lying.”

Woodward said that while many doctors refuse to sign off on prospective patients’ application forms, a small group of “green doctors” will do so, for a fee. They’ll often attend parties with a few hundred people who take turns getting the activist physicians to sign their application forms.

“When it’s your turn, you go back to see the doctor, the doctor says, ‘What do you want me to put on your recommendation letter for your card?,’ and, number two, ‘Did you bring cash?’”

The ease of getting a medical card, combined with the relatively modest regulatory burden placed on growers, has led to an explosion in the number of dispensaries in Oklahoma—nearly 2,200, more than any state in the country, and more than the number of gas stations statewide.

Supply follows demand. Oklahoma, despite having fewer than 4 million people, today has almost 400,000 enrolled medical-marijuana patients, meaning roughly one in ten Oklahomans has a medical marijuana license.

State Question 820, put on the ballot ahead of a March 2023 special election, would have legalized marijuana in Oklahoma for recreational use.

One concern for voters ahead of the special election was the potential effect of legalization on teenagers. The state had already seen a rash of incidents involving pot-smoking teenagers after it was legalized for medical use in 2018. In 2019, for example, a 17-year-old who claimed to have hallucinated after having smoked a laced joint was arrested after slamming an infant on concrete, exposing himself to passersby, and trying to bend a parking sign in half. That same year, a survey found that more than one in three seniors in an Oklahoma high school had smoked marijuana. 

According to Woodward, since medical-use legalization, his department has seen a spike in children displaying signs of addiction and mental illness.

“I get kids as young as 15 or 16 who can’t make it through middle school without going to the bathroom and hitting their vape pens because they get anxiety and depression because they don’t have THC in their systems,” he said.

The pro-marijuana lobby tried to tamp down voters’ fears that legalization would harm the state’s teenagers. Ryan Kiesel, a senior consultant to Yes on 820, a pro-pot advocacy group that formed to support the Oklahoma legalization referendum, dismissed the concern out of hand.

“There is zero correlation with states that have legalized recreational marijuana and an increase in teen or adolescent use of that substance,” Kiesel said. “We need to give our schools and our health care providers the resources to be able to help curb real dangers, which is opioid abuse and teens using nicotine vape pens.”

Woodward, however, said that’s not the case.

“We’ve absolutely seen tremendous spikes, very concerning spikes, in underage use, underage admissions to the hospital from overdoses. It’s very, very concerning,” Woodward said.

For example, in 2017, the last year before Oklahoma legalized medical marijuana, a total of five children aged 0 to 5 were hospitalized with marijuana-related issues. In 2021, the most recent year with available data, that figure had risen to 299. 

In other states, marijuana legalization has led to surges in teenage emergency room visits. 

Between 2005 and 2010, as marijuana became more potent and states liberalized their possession laws, the number of teenagers admitted to emergency rooms with marijuana-related injuries nationally rose by more than 50 percent.

Colorado in 2009 became one of the first states to legalize recreational marijuana use. Since it legalized pot, the frequency of E.R. visits for “cyclic vomiting” in the state more than doubled. Over time, patients, especially adolescent patients, were presenting with increasingly bizarre symptoms. In 2018, a boy was admitted to an emergency room with a strange set of symptoms and was described as “scromiting”—simultaneously screaming and vomiting—for hours on end.

The boy was experiencing cannabinoid hyperemesis syndrome, a condition first identified by researchers in 2004 as a side effect of frequent marijuana use.

Researchers hypothesize that “scromiting” symptoms stem from marijuana’s interaction with users’ brains. When a person smokes pot, the euphoric sensation they experience is caused by delta-9-tetrahydrocannabinol (THC), a psychoactive compound in the drug that binds to receptors in the user’s brain associated with thinking, pleasure, and movement. 

While limited use of the drug in cancer patients has been shown to reduce chemotherapy-induced nausea, extended exposure to marijuana can weaken the brain’s endocannabinoid receptors and lead the user to lose control over nausea and vomiting altogether. It has become increasingly common in emergency rooms around the country, particularly in states that have legalized pot. 

New York, which legalized recreational marijuana use in 2021, has seen a surge in similar adolescent cases in its emergency rooms. Dr. Marita Michelin, who heads Rochester Regional Health’s Department of Emergency Medicine, told me that her hospital has seen a spike in adolescents admitted with pot-related vomiting symptoms since New York legalized recreational use of marijuana in 2021.

“We've admitted patients to the hospital because they’re vomiting so badly that their electrolytes and especially their potassium levels are low, which puts them at risk of dying from heart arrhythmias,” Michelin said. 

“They don’t even have to smoke it for very long,” she said. “Some people are hit with it right away, some people take time to develop it. And it’s basically their body’s way of resisting or reacting negatively to marijuana and the components of it. They basically get severe cramping, abdominal pain, and they can't stop vomiting. Some of them get diarrhea, they’re very sick with it, they get very dehydrated, and oftentimes end up in the emergency department—some of them live in the emergency department.”

Beyond the extreme vomiting symptoms, marijuana use among teenagers has been linked to spikes in the onset of schizophrenia—triggering a psychotic break in those who may otherwise never have snapped, and exacerbating the timeline of those already disposed to psychosis. It also permanently affects the teenagers’ brains, diminishing their ability to experience pleasure and stunting their intellectual development.

“Our research has shown that exposure during adolescence to THC, the major psychoactive component of cannabis, has long-term effects that last long into adulthood that impacts brain function and behavior including aspects of cognition and reward sensitivity,” said Yasmin Hurd,  the Ward-Coleman Chair of Translational Neuroscience and the Director of the Addiction Institute at Mount Sinai Hospital.

Hurd said that while cannabis use can exacerbate psychotic illnesses in people with “increased genetic risk for schizophrenia or psychotic disorders,” it even does so to users without those genetic markers, as “the use of cannabis, especially high THC potency cannabis, can induce psychosis.” 

The rise in emergency-room visits and psychotic episodes among teenagers in Oklahoma and across the country is associated with the rising THC content found in marijuana.

Paul Larkin, senior legal research fellow at the Heritage Foundation, has followed marijuana’s evolution before and after legalization in states across the country, and said the pot on the market today is more potent than anything that’s come before. 

“The potency of the cannabis that’s out there today greatly exceeds the potency of what everybody smoked at Woodstock. Back in the ’60s and early ’70s, there was a 3 to 6 percent THC content. Now, the average joint is up near 20 percent,” he said. “Hash is up in the thirties. You can get certain products that are distilled THC, one of which is known as ‘shatter,’ that are at 90 percent. You are going to see an enormous number of people having severe problems if they start using a great deal of the highly potent cannabis that is out there today.” 

Competitive pressures within the marijuana market driven by the persistence of black-market and gray-market dealers has helped to fuel the rise in THC content.

Participants in the illicit drug market built an infrastructure of suppliers, runners, and dealers that preceded legalization of marijuana. And because regulatory compliance is expensive, the illegal market has persisted even in states that have legalized the drug, since the black market offers a cheaper, unregulated option. 

“You will never eliminate the ability of the black market to underprice the legal market,” Larkin said, “because the black market will always be able to avoid charging taxes.” 

In theory, the legalization of marijuana should have decreased the demand for foreign-grown dope, and increased the demand for both legal and illegal domestic product. Even illicit gray-market sellers should have benefited from the declining enforcement associated with legalization. 

But the windfall for domestic pot growers hasn’t materialized, in part because foreign growers have responded competitively by variously increasing the potency of their product or offering the product at lower prices than are available on the legal domestic market. 

Andrew Arthur, resident fellow in law and policy at the Center for Immigration Studies, notes that illegal sellers have taken different tacks on both sides of the border in response to legalization. 

The Mexican cartels, he said, have always imported cheap, low THC content pot, which they continue to sell on the black market. 

“The Mexicans are happy just growing the same weed that they’ve always grown and shipping it in, because there is still a market for it,” he said.

Street-level dealers, trading in Mexican and domestic-grown weed, have also started lacing low THC pot with fentanyl, Arthur said, helping to create reliable customers.

Because Mexican producers are still flooding the market with cheap dope, U.S. growers in Oklahoma and elsewhere have responded by raising the THC content of their marijuana to justify customers’ paying a premium for the legal product. It has also led peddlers of illegal weed grown in the United States to push higher potency pot—not only to compete with Mexico’s cheap imports, but to hook users and create reliable customers.

“That’s the nature of the drug trade,” Arthur said. “There’s a certain phenomenon that exists with respect to street-level dealers. If some user overdoses on the product, that doesn’t hurt their business, it improves it, because that tells all the other users that that’s the dealer who’s got the good stuff.”

Those dynamics have also led Canadian dealers to push high THC content weed to compete against both the illicit Mexican drugs and the legalized, regulated product in the United States.

“Canada legalized marijuana a couple of years back, so it’s easy for producers up there to create their high potency dope and run it between the much less defended northern border.”

Because of its lowest in the nation permitting fees for marijuana growers and the ease of accessing medical cards, Oklahoma has become a destination state for entrepreneurs and cartels alike looking to make a quick buck. 

Woodward said that during the pandemic, when neighboring states locked down and people needed work, criminal organizations from China and Mexico bought farms in Oklahoma to grow and push marijuana. The state’s licensing fees for growers, which totals $3,000 regardless of the quantity of marijuana grown, is the cheapest in the country. In other states, which have tiered permitting systems, growers can pay upwards of $500,000 for a license depending on how much they grow.

“You’ve got human trafficking of the workers, you’ve got sex trafficking—we’ve had homicides and executions of these workers at some of these farms because they didn’t pay the debt that was owed to the people who operate those farms.” 

While state law requires growers and dispensaries to be owned by someone living in Oklahoma, Woodward said cartels often used law and consulting firms based in the Sooner State to sign on as the nominal owners while allowing the cartels to run the farms.

“We started having these law firms and consultants making millions of dollars creating these fraudulent ownership structures, and putting some people on the license who were, in many cases, employees of their law firm—putting the secretary down as the owner on 200 or 300 licenses,” he said. 

Since 2021, the Narcotics Bureau has shut down nearly 1,000 criminal marijuana farms in Oklahoma, made about 400 arrests, and seized almost 800,000 pounds of black-market marijuana.

State Question 820 proposed instituting a 15 percent sales tax on recreational marijuana. Advocates promised this would be a windfall for the state. Other states have found, however, that legalizing marijuana doesn’t bring in the level of tax revenue that advocates claim—and may even be a net loss for taxpayers.

As Charles Fain Lehman noted in a recent Substack essay, within three years of California legalizing marijuana, only a quarter of the weed sold was bought from licensed dispensaries. And as scholars Robin Goldstein and Daniel Sumner observed, in many states, “it is not clear whether the price of legal weed will ever be competitive with the price of illegal weed for most consumers.”

In Colorado, one of the first states to legalize recreational marijuana use, a Centennial Institute study found that taxpayers spent nearly $4.50 to mitigate the effects of legalization—hospital visits, arrests and incarceration, lost productivity—for every dollar in marijuana tax revenue. The average heavy marijuana user was estimated to cost the state $2,200 annually.

The think tank also found that 69 percent of marijuana users statewide admitted to having driven under the influence of marijuana at least once, the estimated cost of which was close to $25 million in 2016.

Woodward said that in Oklahoma, advocates made similar promises, but after living through the legalization of medical cannabis, voters doubted they would come to fruition.

Voters were told legalizing the drug would give the state “more money for roads, schools, and bridges,” Woodward said, but “there was very little bump in tax revenue—hardly enough for most schools to notice.” What voters saw instead were tax increases and bumps to their water bills to pay for the costs associated with cartel farms in rural water districts.

The vote to defeat the recreational legalization measure, Woodward said, “was a whole lot of people saying, ‘I want my yes vote back.’”

In 1979, Keith Stroup, the founder of the National Organization for Reform of Marijuana Laws (NORML), said his organization wanted to reclassify pot as a medical substance to use “the issue as a red herring to give marijuana a good name.” Oklahomans found out the hard way that the legalization of medical marijuana can be a Trojan horse for later efforts to legalize the drug for recreational use. 

At the heart of the marijuana dispute, in Oklahoma and around the country, is a dispute between two cultures: one predicated on order, and another on degeneracy. Lawrence Pasternack, an Oklahoma pot-legalization advocate, put it plainly: “The anti-revolutionary forces want to return Oklahoma to their dream of this bygone era. They see marijuana as anathema to that dream.”

Oklahoma voters dealt the most recent of what may be several future blows to the prospects of the “revolutionary forces” in support of marijuana—a victory, however small, for those who don’t think America’s cultural decline is “inevitable.”