MISSOULA - Hospitalization among Missoula's youngest residents due to marijuana sickness has increased sharply over the last five years, including a growing number of cases involving intoxication, psychosis, anxiety and withdrawal.
Health professionals and city leaders are now questioning whether Montana laws around packaging and advertising marijuana products are strong enough, or whether they're being properly enforced by state and local officials.
“The city and City Council needs to look at what our sideboards are and what we can do for enforcement,” said council member Amber Sherrill. “There are examples all around us that the packaging is not what the code is saying, that the advertising is not what they're saying. If you look at the Big Tobacco playbook, that's exactly what this is starting to look like.”
Leah Fitch-Brody, the substance use disorder prevention coordinator for the Missoula City-County Health Department, said alcohol and cigarette use among Missoula teenagers has decreased over the past 20 years, though marijuana has defied those trends.
According to the Youth Risk Behavior Survey, nearly 25% of youth in Missoula are now using marijuana on a regular basis. Fitch-Brody said health officials saw “quite a bit of increase” between 2019 and 2021 in the number of high-school students using marijuana on a regular basis.
In Missoula, the perception of whether marijuana use is harmful is also falling among teens. Fitch-Brody said that correlates with the increase in use, which also explains the increase in youth emergency room visits and hospital admissions.
“What we have seen from more than 20,000 studies related to harms associated with marijuana is that it's more harmful for youth,” she said. “Youth in states that have legalized are using much more potent products because they're available, and higher doses are more likely to induce anxiety, paranoia, agitation and psychosis.”
Some of those mental-health issues may come with long-term impacts related to THC, which has grown more pure in recent years. In 2000, THC — the active ingredient in cannabis — potency was around 5%. Fitch-Brody said that increased to 17% in 2017, and some products now include concentrates with a purity of 99%.
In Montana, marijuana is already the most common reason that youth seek medical treatment between the ages of 12 and 17, local health experts said.
“I have a good friend who is an emergency room doc, and he's seeing that very thing in the St. Pat's emergency room,” said Sherrill. “They're coming in with schizophrenic symptoms. It's a real thing that our physicians are dealing with and our community is dealing with.”
High density of marijuana retailers in Missoula
Montana voters approved recreational marijuana in 2020, allowing adults over the age of 21 to possess up to 1 ounce of pot. In 2020, the newly passed law allowed medical marijuana providers to begin selling recreational pot. Next year, that will be expanded to all marijuana operators.
But if voters believe legalizing marijuana was a good thing, Missoula may have too much of it, according to health officials. The city currently has 52 dispensaries with active storefronts. Many of those are concentrated in some of the city's lowest-income neighborhoods.
“Public health recommends there be one dispensary for every 15,000 people,” said Fitch-Brody. “For Missoula County, that would mean we only have eight dispensaries. But we have 52.”
Enforcement of packaging and advertising
While the concentration of marijuana dispensaries has emerged as a potential issue feeding the increased use among the city's youth, enforcement of state laws may be another.
In legalizing marijuana, the state set boundaries around advertising. Providers can't advertise marijuana or marijuana projects, though they can engage in digital advertising. But those digital ads cannot contain any statements claiming marijuana health benefits, nor can they appeal to minors.
The state also implemented restrictions around packaging and product labeling. Logos and designs cannot have symbols and imagery that might appeal to children, such as candy and other temptations. But many believe enforcement is lacking.
“Packaging is important and some of these questions of deeper regulatory capacity and jurisprudence is important,” said Dr. Chelsea Bodnar, a pediatrician and mother. “But we don't need to do much more than drive down the streets of Missoula right now with a 12-year-old to see where we're in violation of the spirit of what we do for the health of our children in our community.”
Bodnar cited one local dispensary where the logo closely mirrors that of Dairy Queen, tempting young children to visit. A recent family visiting from Bozeman had a son wanting a cookie who inadvertently walked into a marijuana store.
“While those little guys aren't out getting marijuana on their own, the way in which we deliver it, the ways in which we package it, the ways in which we market it has implications for those little guys in the home,” Bodnar said.
Since legalization, other Montana cities have tried to address issues of density, advertising and location of marijuana dispensaries. Recently, Bozeman attempted to cap the number of dispensaries that could operate within city limits – an effort that was successfully challenged and overturned.
But with more than 220 local youth treated or hospitalized for marijuana-induced illness in Missoula, the City Council may be taking a closer look at local regulations and enforcement.
“Five or six years ago, to even have 150 kids doing emergency room runs because of cannabis is horrific to me. Now we're well over 200,” said City Council President Gwen Jones. “We're going in the wrong direction. As a community, we need to be paying attention to this.”