The Brief

As marijuana use among teens has grown in the past decade, researchers have been trying to better understand the health risks of the drug. Now, a new longitudinal study finds that cannabis use among adolescents increases risks of being diagnosed with bipolar and psychotic disorders, as well as anxiety and depression, years later.

"This is very, very, very worrying," says psychiatrist Dr. Ryan Sultan at Columbia University, a cannabis researcher who wasn't involved in the new study published in the latest JAMA Health Forum.

Strong study design

Researchers analyzed health data on 460,000 teenagers in the Kaiser Permanente Health System in Northern California. The teens were followed until they were 25 years old. The data included annual screenings for substance use and any mental health diagnoses from the health records. Researchers excluded the adolescents who had symptoms of mental illnesses before using cannabis.

"We looked at kids using cannabis before they had any evidence of these psychiatric conditions and then followed them to understand if they were more likely or less likely to develop them," says Dr. Lynn Silver, a pediatrician and researcher at the Public Health Institute, and an author of the new study.

They found that the teens who reported using cannabis in the past year were at a higher risk of being diagnosed with several mental health conditions a few years later, compared to teens who didn't use cannabis.

Teens who reported using cannabis had twice the risk of developing two serious mental illnesses: bipolar, which manifests as alternating episodes of depression and mania, and psychotic disorders, such as schizophrenia which involve a break with reality.

Now, only a small fraction — nearly 4,000 — of all teens in the study were diagnosed with each of these two disorders. Both bipolar and psychotic disorders are among the most serious and disabling of mental illnesses.

"Those are the scarier conditions that we worry about," says Sultan.

Silver points out these illnesses are expensive to treat and come at a high cost to society. The U.S. cannabis market is an industry with a value in the tens-of-billions — but the societal cost of schizophrenia has been calculated to be $350 billion a year.

"And if we increase the number of people who develop that condition in a way that's preventable, that can wipe out the whole value of the cannabis market," Silver says.

Depression and anxiety too

The new study also found that the risk for more common conditions like depression and anxiety was also higher among cannabis users.

"Depression alone went up by about a third," says Silver, "and anxiety went up by about a quarter."

But the link between cannabis use and depression and anxiety got weaker for teens who were older when they used cannabis. "Which really shows the sensitivity of the younger child's brain to the effects of cannabis," says Silver. "The brain is still developing. The effects of cannabis on the receptors in the brain seem to have a significant impact on their neurological development and the risk for these mental health disorders."

Silver hopes these findings will make teens more cautious about using the drug, which is not as safe as people perceive it to be.

"With legalization, we've had a tremendous wave of this perception of cannabis as a safe, natural product to treat your stress with," she says. "That is simply not true."

The new study is well designed and gets at "the chicken or the egg, order-of-operations question," says Sultan. There have been other past studies that have also found a link between cannabis use and mental health conditions, especially psychosis. But, those studies couldn't tell whether cannabis affected the likelihood of developing mental health symptoms or whether people with existing problems were more likely to use cannabis — perhaps to treat their symptoms.

But by excluding teens who were already showing mental health symptoms, the new study suggests a causal link between cannabis use and later mental health diagnoses. Additional research is needed to understand the link fully.

'Playing with fire'

Sultan, the psychiatrist and researcher at Columbia University, says the study confirms what he's seeing in his clinic — more teens using cannabis who've developed new or worsening mental health symptoms.

"It is most common around anxiety and depression, but it's also showing up in more severe conditions like bipolar disorder and psychosis," he says.

He notes that mental health disorders are complex in origin. A host of risk factors, like genetics, environment, lifestyle and life experiences all play a role. And some young people are more at risk than others.

"When someone has a psychotic episode in the context of cannabis or a manic episode in the context of cannabis, clinicians are going to say, 'Please do not do that again because you're you're you're playing with fire,'" he says.

Because the more they use the drug, he says the more likely that their symptoms will worsen over time, making recovery harder.

"What we're worried about [is if] you sort of get stuck in psychosis, it gets harder and harder to pull the person back," says Sultan. "Psychosis and severe mood disorders, particularly bipolar disorder are like seizures in your brain. They're sort of neurotoxic to your brain, and so it seems to be associated with a more rapid deterioration of the brain."

Maine Republican Sen. Susan Collins conceded to Democrat Troy Jackson early Wednesday, ending her race for a sixth term. The Associated Press has not yet called the race.

“For every family doing everything they can and wondering when somebody is going to do something for them, you have gotten me into this and you’re going to have someone who is fighting for you in Washington, D.C.,” Jackson told the crowd at an election night party in Portland.

Jackson, a former Maine Senate president, took over as the Democratic nominee in July after primary winner Graham Platner dropped out. He was tasked with defeating the longtime incumbent after a chaotic primary season that left the Democrats in disarray and briefly without a candidate.

“It has been the honor of my life to serve the people of Maine in the United States Senate. I’m proud of all I have been able to accomplish for our state and for our country in the past 30 years,” Collins said in a statement after calling Jackson to concede.

Democrats had seen the race as a top opportunity to flip a Republican-held seat. Maine has supported Democrats for president since 1992, and Collins was running for reelection at a moment when President Donald Trump is deeply unpopular.

But Democrats’ bid to flip the seat hit setbacks. Party leaders in Washington initially backed Maine Gov. Janet Mills to run against Collins, only to see her fall flat while facing Platner in the primary. Platner overcame a wave of controversies, including the revelation of a tattoo recognized as a Nazi symbol, to win the nomination, only to drop out in July after facing an allegation of sexual assault that he denied.

Jackson was chosen as a replacement nominee during an emergency convention, and he had roughly 100 days to barnstorm the state trying to drum up support for his bid against one of the Senate’s most influential members.

Collins, who is the sole remaining Republican lawmaker in Congress from New England, stressed her ability to deliver for Maine. She tried to distance herself from Trump, saying during a debate that she is “not exactly his favorite senator.”

Although Collins has shown a willingness to buck her own party and Trump, Jackson and other Democrats portrayed her as beholden to him and criticized her for caving to his wishes. Jackson hammered Collins on her vote to confirm Supreme Court Justice Brett Kavanaugh, a Trump nominee who eventually helped overturn constitutional protections for abortion. Collins, who supports abortion rights, has said she didn’t regret her vote.

It could take a few days or longer before the winner is known, as Maine is one of two states with ranked choice voting. Collins and Jackson are the only candidates on the ballot, but write-in candidates could keep either from reaching 50% of the vote, in which case a ranked count would take place.

Collins was first elected 30 years ago

Collins, 73, was first elected in 1996 and is one of the most well-known figures in Maine politics. She grew up in the northern Maine city of Caribou where her family owns a sixth-generation lumber business. Collins worked for former Republican Sen. William Cohen for many years, starting when Cohen served in the U.S. House of Representatives, and would later succeed him in the Senate.

She has long touted her independence from Trump and her party. She has said she didn’t vote for Trump in 2016, and she voted to convict the president after his 2021 impeachment over his role in the Jan. 6 Capitol riot.

When Vice President JD Vance made trips to Maine, Collins did not appear with him. Vance told the crowd at a May rally that he sometimes gets frustrated with the senator and wishes she were more partisan.

Collins has been a top target of Democrats before. She won handily in 2020 during a year that Democrats won the presidential race and both U.S. House seats in Maine.

During this year’s race, Collins touted her longevity in the Senate and her status as a key player in powerful committees and budget negotiations. She said those aspects of her service remain critically important for Mainers.

“It has been 92 years since a Maine senator was chair of the Senate Appropriations Committee, the most powerful committee in the Senate,” Collins told reporters. “When I took over last year, I realized I had a once-in-a-century opportunity to help the state of Maine and pursue national priorities as well.”

Collins has also tried to highlight Jackson’s temperament. Her campaign criticized Jackson for telling her to “shut up” during a debate.

Jackson became the nominee during a time of crisis for Democrats

Jackson, 58, initially ran for the Democratic nomination for governor and lost. He then won the nominating convention for Senate in July.

It made for a rushed start to the campaign for Jackson, a fifth-generation logger from rural far northern Maine. Since then, he has held events at churches, union halls and bars to tout issues such as workers’ rights and fighting the high costs of housing and healthcare.

He has long had support among progressive Mainers, as he worked as independent Vermont Sen. Bernie Sanders’ presidential campaign leader in Maine. At times, his campaign rhetoric is reminiscent of Sanders, who joined Jackson for rallies in October.

“In the end, if you work hard, you should be able to build a decent life,” Jackson said at a campaign event near Portland in September. “But that’s not the reality right now.”

He criticized Collins as not doing enough to stop Trump. Jackson noted she voted to advance Trump’s signature tax cut and budget legislation out of committee, before she was a “no” vote on its final passage.

“Sen. Collins is like an arsonist who helps set the fire and then she wants credit for bringing a cup of water to put it out,” he said.

Democratic Party leaders are breathing a sigh of relief after voters rejected Proposition 39, a GOP-backed voter ID measure that drew interest — and millions of dollars — from Republican megadonors across the country.

About 60% of voters rebuffed the measure, which Democratic leaders opposed in unison and heavily campaigned against, arguing it would amount to voter suppression. Republican Party leaders and other supporters of the initiative characterized Prop. 39 as a common-sense idea that has precedence in more than two dozen states across the country.

With 49% of votes counted, The Associated Press declared the measure had failed.

The measure has amassed $37 million in support from Republicans nationwide, and could be a bellwether for similar initiatives in other states.

There is widespread consensus among experts that voter fraud is rare in California, and election officials, including Secretary of State Shirley Weber, have said such claims are unfounded.

What do supporters say?

Backers say requiring voter ID would be a small yet meaningful step to help deter voter fraud and guarantee California’s elections are secure. They also note that 36 other states require or recommend some form of identification to vote, according to the National Conference of State Legislatures, although only 10 states are considered strict about it.

Republican San Diego Assemblymember Carl DeMaio put the measure on the ballot in tandem with his right-wing political group Reform California after similar previous failed attempts in the state Legislature. He and others have emphasized national polling that shows bipartisan support for voter ID requirements.

“We’ve structured this initiative based on what voters across the political spectrum would want,” DeMaio told CalMatters in March.

The measure qualified in March after proponents collected more than the 875,000 signatures required to put the initiative on the November ballot.

The California Republican Party and Howard Jarvis Taxpayers Association are major endorsers, and major donors include packaging magnate Richard Uihlein, who’s contributed $17 million, and Airbnb co-founder and White House official Joe Gebbia, who’s given $8 million.

Southern California businessman Steven Bray and Reform California each contributed more than $3 million.

What do opponents say?

Prop. 39 detractors argue that showing voter ID is a needless hurdle that would prevent eligible voters from casting ballots. Critics include a coalition of civil rights, voting and good governance groups who say ID requirements are unnecessary because noncitizen voting and impersonation is rare. People who recently moved or changed their last name might not yet have an updated ID and would be unfairly kept from voting, groups such as Common Cause and the American Civil Liberties Union claim.

“There is no widespread noncitizen voting that would justify adding these strict requirements,” League of Women Voters of California Executive Director Jenny Farrell said.

Opponents also point to its potentially high expenses to the state. The measure could cost tens of millions to the low hundreds of millions of dollars to implement, according to the nonpartisan Legislative Analyst’s Office.

Democratic heavyweights have played a big role in putting a public face to the opposition. U.S. Gov. Gavin Newsom and Sen. Adam Schiff stumped at No campaign events across the state, as well as gubernatorial favorite Xavier Becerra who created a committee with Assembly Speaker Robert Rivas to raise money to oppose it.

The Democratic Party is the biggest donor at nearly $6.5 million of the opposition’s $35 million total. California labor and tribal groups have given more than $2 million each. Philanthropists Quinn Delaney and Patty Quillin combined have given $3 million.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.

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In a historic night for the Democratic Socialists of America, a record number of candidates endorsed by the organization and its local chapters were elected to the House of Representatives.

The results grow the organization's presence on Capitol Hill, bringing to Congress a bloc of lawmakers who will now look to translate their electoral success into policy wins that push the Democratic Party further to the left.

At least five DSA candidates in reliably blue congressional districts have won their races, according to race calls by the Associated Press. They are Darializa Avila Chevalier and Claire Valdez in New York; Melat Kiros in Colorado; Donavan McKinney in Michigan; and Chris Rabb in Pennsylvania.

Their victories follow a fiercely competitive primary cycle, where DSA candidates rode to victory by championing economic populist policies like universal healthcare and childcare, as well as more polarizing stances, such as abolishing Immigration and Customs Enforcement.

Throughout the primaries, candidates endorsed by the group were unafraid to criticize or break with Democratic leadership, challenging sitting incumbents or competing against establishment picks.

That included Kiros, who defeated Rep. Diana DeGette — a 15-term incumbent and member of the Congressional Progressive Caucus — in Colorado's 1st Congressional District in July. Just days earlier, Chevalier delivered a major upset in New York's 13th Congressional District, narrowly defeating Adriano Espaillat, the influential chair of the Congressional Hispanic Caucus.

On top of emphasizing a core value set aimed at bettering the working class, many DSA candidates tapped into voter frustrations with the larger political system. Candidates swore off campaign donations from corporations and pro-Israel lobbying groups. They fiercely condemned the war in Gaza and called for the U.S. to stop supplying Israel with military aid.

While the DSA's platform energized some voters on the left, it also became a prominent attack line for Republicans, who sought to paint the broader Democratic Party as too extreme and link more moderate candidates to democratic socialist figures like New York Mayor Zohran Mamdani and Rep. Alexandria Ocasio-Cortez, D-N.Y.

The DSA is not a registered political party, but with Tuesday's victories, the number of DSA members in the House is on track to more than triple when the new Congress is seated in January. Currently just two sitting lawmakers — Rep. Rashida Tlaib, D-Mich., and Ocasio-Cortez — are members of the organization.

It's a small, albeit growing coalition, but one that could complicate the legislative agenda of Democrats if they succeed in winning back the House. In a new Congress where Democrats have only a thin majority, the bloc could wield outsize influence. If Democrats can win a broader majority, their influence could prove more limited.

The upcoming vote for House speaker may serve as an early test. If Democrats win the House, Rep. Hakeem Jeffries, D-N.Y., is poised to be elected the nation's first Black speaker. Currently, none of the incoming members with DSA endorsements has committed to supporting Jeffries.

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California voters have overwhelmingly rejected Proposition 44, which would have required community health clinics to spend at least 90% of their revenue on program services.

With 81.7% of voters against it on Tuesday, the measure was defeated as polling had indicated. A Public Policy Institute of California survey in October found only 25% of likely voters supported it.

The result is another loss at the ballot box for SEIU-United Healthcare Workers West, the labor union that sponsored the measure. Voters rejected the union’s three earlier measures on dialysis clinics in 2018, 2020 and 2022.

The outcome is a win for the California Primary Care Association, which led the opposition and an array of opponents in the healthcare industry, that collectively outspent the union 2 to 1.

“Today’s resounding defeat shows that health centers will not be bullied and that protecting the whole-patient, whole-community care we are known for will always be a priority,” Francisco Silva, president of the California Primary Care Association, said in a statement Tuesday night.

Proposition 44 would have required community clinics to spend at least 90% of their annual revenue on patient care or pay fines to the state. While spending varies by clinic, on average, clinics today spend about 80% of revenue on providing services, according to a nonpartisan analysis by the Legislative Analyst’s Office.

The labor union Service Employees International Union-United Healthcare Workers West placed Prop. 44 on the ballot. The union argued the measure would add a layer of accountability to how clinics spend taxpayer dollars. Clinics are the safety net for an estimated 7 million low-income Californians and are paid largely through reimbursements from public insurance programs and federal grants.

Union spokespeople pointed to “excessive” executive salaries — some of which recently became the subject of a complaint filed with the Internal Revenue Service — as an inappropriate use of taxpayer dollars.

“Money should not be directed towards excessive executive compensation or other non-essentials that we have seen within … our clinic system,” Renée Saldaña, a union spokesperson, said.

The opposition, led by clinics, raised $39 million to defeat the measure, more than double the $17 million supporters reported. Clinics argued they had a lot to lose, and so did their patients. An analysis commissioned by opponents estimated the measure could cost clinics about $1.7 billion in noncompliance penalties in the first year, forcing some of them to close or reduce services.

“This puts our patients in danger, limiting our patients' access to care,” Dr. Jerry Abraham of Kedren Health, a community clinic in South Los Angeles, said during a recent rally. “Unfortunately, that doesn't mean patients' need for care goes away. Guess where they are going to go? If they can’t come to clinics, they’re gonna go to the emergency department.”

Clinic leaders added that their health centers are already heavily regulated by state and federal health authorities.

A key question in this proposal was exactly what type of costs would qualify as appropriate healthcare spending.

Prop. 44 left the answer up to the state's attorney general, directing that office to issue guidance. Depending on those guidelines, clinics argued that they could have been penalized for spending on critical items such as medical equipment upgrades, support staff and construction projects, or for keeping money in their budget reserves.

Prop. 44 was the second attempt by the healthcare workers’ union to restrict clinic spending – a similar bill failed to advance last year.

The California Primary Care Association, which represents about 2,000 community clinics, sued the union twice. First, it sued to keep the measure off the ballot, but a federal judge dismissed that case over the summer. In September, the clinics filed a separate case accusing the union and its president, Dave Regan, of exploiting the ballot process to coerce clinics into accepting the union’s bargaining demands.

The union said the allegations were “categorically false.” This second lawsuit is still pending.

The union also backed Proposition 40, which would impose a one-time 5% tax on California residents worth $1 billion or more.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.