Omaha Tribe's Pot Idea

Marijuana Unknowns

Jul 16, 2025

Housekeeping matter: This is a long article with many sources and links. Please visit this column on the Substack site.

The Omaha Tribal Council has legalized recreational marijuana (https://www.omahatribe.com/omaha-tribe-of-nebraska-becomes-first-in-state-to-fully-legalize-and-regulate-cannabis/). I wish they had consulted with others, such as me. I would have advised they would be biting off more than they can chew.

Nebraska has a history with the plant from hemp to drug use. However, as a drug, it was referred to as “weed” and “grass” for a reason. It was found in the ditch, and people would cut up with stuff which was not marijuana.

Today, with the hemp revolution, there are many problems emerging. Many of the retailers appear to have ulterior motives for selling hemp. They appear to be developing a clandestine drug network. Also, while the majority of people will not run into problems with marijuana, a substantial number of people will.

How did this all come to be? I asked Perplexity.AI several questions such as “What City has the highest per capita us of illegal drugs“, “Known problems with current marijuana use“ and “Does marijuana interfere with other drugs“ and received results. But the first question brought up Omaha as shown below:

Omaha, Nebraska currently has the highest per capita use of illegal drugs among U.S. cities based on multiple recent analyses. Omaha ranks at or near the top for several major categories of illicit drug use:

Heroin use: Highest tied rate at 3.4% of the population1 3 4 5.
Methamphetamine use: Top three in the nation at 14% of the population1 3 5.
Marijuana use: Highest overall, with 66.2% of residents reporting use3 5.
Overall drug use: Omaha is widely recognized as the city with the highest cumulative rate of substance abuse across all major illicit drug categories1 4 5.

Other cities with consistently high rates of specific drug use (but not as high overall as Omaha) include Phoenix, Mesa, Tulsa, Wichita, and Oklahoma City, which all appear near the top for various substances such as cocaine, methamphetamine, and marijuana1 3 4 5.

In summary, Omaha, Nebraska is identified as having the highest per capita use of illegal drugs across multiple categories in recent studies and national rankings1 3 4 5.

I also asked “Known problems with current marijuana use“, and got this:

Current marijuana use is associated with several well-documented risks and harms, especially as potency increases, use becomes more frequent, and initiation occurs at younger ages. The most significant and researched problems include:

1. Addiction and Dependence

About 1 in 10 users will develop marijuana addiction, and the rate increases to 1 in 6 when use begins before age 181 3 7.
Symptoms of cannabis use disorder include tolerance, cravings, inability to cut down, and giving up important activities3 7.
Withdrawal symptoms can occur, such as irritability, mood changes, insomnia, decreased appetite, cravings, and restlessness4 7.

2. Mental Health Risks

Marijuana use is linked to depression, anxiety, and suicidal thoughts or behaviors, though causality remains uncertain1 2 5.
Use in adolescence or in those genetically predisposed dramatically increases the risk of psychotic disorders, including schizophrenia and acute psychosis2 4 6 7.
Even occasional use can lead to paranoia, panic attacks, and psychotic symptoms in some individuals5 6.

3. Cognitive and Brain Health Effects

Marijuana affects memory, learning, attention, decision-making, and coordination1 3 6.
Early and heavy use, especially in adolescents, can cause permanent IQ loss (up to 8 points), and these cognitive deficits can persist even after quitting1 4 6.
Evidence suggests heavy use is associated with structural changes in the adolescent brain, particularly impacting the prefrontal cortex6.

4. Physical Health Concerns

Smoking marijuana frequently leads to respiratory issues, such as chronic bronchitis, cough, and increased pneumonia risk4 7.
Use during pregnancy increases the risk of premature birth, fetal growth restriction, and neurological problems in children. THC is passed through breast milk, potentially affecting infant development1 4.
Cannabis can cause heart rate increases and acute blood pressure changes, potentially raising the risk of stroke or heart disease, particularly in susceptible individuals3.

5. Severe and Emerging Medical Problems

An increase in highly potent cannabis products has been linked to severe nausea and vomiting (cannabinoid hyperemesis syndrome), which has become much more common4 5.
There’s some evidence of a correlation between adolescent marijuana use and a rare, aggressive form of testicular cancer4.
The long-term consequences of high-THC potency products are still not fully understood but are suspected to be more severe, especially for young users4 5 6.

6. Impact on Daily Life and Functioning

Marijuana use may lead to lower educational achievement, reduced career success, and difficulties in relationships and overall life satisfaction1.
It impairs motor skills and reaction time, which increases risks associated with driving and athletic performance1 3.

7. Other Issues

Regular use can act as a gateway, increasing the risk of developing other substance use disorders4.
The widespread legalization and normalization of high-potency marijuana have increased access among youth, who are most vulnerable to its harms1 6 5.

In summary, contemporary marijuana use—particularly when use is frequent, started at a young age, or involves high-potency products—carries established risks across mental, physical, and social health domains, and these risks are more extensive and severe than previously recognized1 2 4 5 6 7.

And I asked, “Does marijuana interfere with other drug“:

Marijuana can significantly interfere with other drugs, leading to a range of potentially dangerous interactions due to its active compounds, especially THC and CBD. These interactions occur with both prescription and over-the-counter medications1 2 3 4 5 6 7 8.

Key points regarding drug interactions with marijuana:

Metabolism Interference: THC and CBD are metabolized in the liver primarily via the cytochrome P450 enzyme system. Marijuana can compete with or inhibit these enzymes, which can raise or lower the levels of other drugs in your body, resulting in decreased effectiveness or increased toxicity4 6.
Number and Severity of Interactions: Over 400 prescription drugs are known to interact with marijuana; 28 are classified as major interactions, while 373 are moderate2.
Notable Drug Categories Affected:
- Sedatives and CNS depressants: Enhanced sedation and risk of respiratory depression (e.g., benzodiazepines, sleeping pills, antihistamines)1 5.
- Antidepressants and anti-anxiety medications: Increased risk of drowsiness, confusion, and poor judgment1.
- Anticonvulsants/anti-epileptic drugs: Notable risk of altered drug levels and breakthrough seizures (e.g., clobazam, valproic acid)3 4 8.
- Blood thinners (anticoagulants): Increased risk of bleeding (e.g., warfarin)1 4 6 7.
- Immunosuppressants (transplant drugs): Elevated drug levels and toxicity risks (e.g., tacrolimus, sirolimus)3 8.
- Heart medications and thyroid drugs: Potential for life-threatening side effects due to altered blood concentrations (e.g., amiodarone, levothyroxine)4.
- NSAIDs: Heightened risk of gastrointestinal bleeding when combined with THC5.
Over-the-Counter Medications and Supplements: Marijuana can interact with common OTC drugs like NSAIDs, antihistamines, and herbal supplements (melatonin, valerian, St. John’s Wort), modifying their effects or increasing side effect risks5.
Alcohol: Marijuana can amplify the effects of alcohol, increasing impairment and toxicity2 7.
Mechanisms of Interaction: THC may induce or inhibit certain cytochrome enzymes (e.g., CYP1A2), which can either reduce or increase the concentration of co-administered drugs, respectively6 9.

Clinical Consequences: These interactions can result in excessive sedation, increased bleeding risk, heart rate or blood pressure changes, drug toxicity, breakthrough seizures, or diminished therapeutic effects1 3 4 5 6 8.

Medical Guidance: Due to the complexity and unpredictability of these interactions, patients should inform their healthcare providers about any marijuana use before starting or while taking other medications1 4 6. Regular monitoring and possible dose adjustments may be required.

In summary, marijuana does interfere with many drugs, sometimes seriously, and should not be combined with prescription or over-the-counter medications without medical supervision.

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