As I lay moaning in the emergency room, it dawned on me how badly our country had screwed up.

I'd been admitted for intractable nausea. By a weird coincidence, the young woman loudly retching in the next bed had, too. But with one crucial difference: I don't use cannabis, and she does, frequently. She's in fact made many emergency room trips for the same problem. So the doctors suspected she was suffering from cannabinoid hyperemesis—a condition where regular cannabis users get overcome by severe nausea, vomiting, and pain. Some can eventually lose teeth from all the stomach acid they throw up.

Never heard of it? You're not alone, but you will. Rates of cannabinoid hyperemesis have risen so quickly—ER visits for it in the United States doubled from 2017 to 2021—that it has gone from that a rarity 20 years ago to afflicting 6 million Americans today.

But tooth-melting vomit is just the tip of the iceberg.

Cannabis users now develop psychosis at five times the rate of non-users. The National Institutes of Health estimates that 30 percent of schizophrenia cases among men aged 21-30 are caused by cannabis. And overall, 18 million Americans now show signs of a cannabis substance use disorder.

Pause on that last figure—its implications are stunning. As Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse, told The New York Times, it means that "almost everybody that uses [cannabis] every day is reporting problems with it."

Almost everybody.

There may be even more going on. For instance, rates of depression, especially among younger Americans, have been rising rapidly in the past decade. One popular explanation is the increase in social media use, a known factor in mental health problems. But notice that the cannabis use revolution also happened at the same time. Studies show that depression and cannabis are linked, but which causes the other? Scientists aren't sure. The same is true for many other conditions. The most comprehensive report available on the medical effects of cannabis—a 2017 book-length compendium from the National Academies of Science—is shatteringly inconclusive. Heart attacks? Breathing problems? Strokes? There are concerning indications. But we can't really say.

And however far-reaching the cannabis effect is, the situation is likely to get way worse in the years ahead. We've dumped so much easy-access cannabis onto America that usage is exploding, with no sign of slowing down. Under one million Americans used the drug daily 30 years ago. Today, it's 17.7 million. Almost one-fifth of us have used it at least once in the past three years. Among Americans who use some intoxicating substance daily, more now use cannabis than alcohol. The train is accelerating.

And here's the real kicker. Everything we know about the harms—which is ominous—may be staggeringly incomplete, because of the industry's biggest not-so-secret: they're not selling us the thing we thought we legalized.

Cannabis products today are anywhere from four to 24 times stronger—measured in terms of concentration of the psychoactive compound in it, tetrahydrocannabinol (THC)—than the weed you might have scored 25 years ago. For practical purposes, it's not the same stuff we studied in the past, which is rarely even available anymore. And since state laws meant to impose some dosage limits are based on weight, not potency, they are essentially meaningless.

Imagine if Tylenol were illegal. Then people began noticing that taking a couple of pills made them feel good and didn't seem too harmful. So, a bunch of states legalized it. Then manufacturers upped the dose to the equivalent of 40 pills. Except people usually didn't know they were taking that much because it was sold in confusing new forms. And then millions of them started getting really sick.

That's essentially the story of cannabis in the past 20 years.

How did we end up in this great American bait-and-switch? From the late 1990s into the early 2000's, advocates were able to point to relatively well-demonstrated benefits for certain patients from mild, old-timey pot, and thereby convince legislators to allow cannabis for medicinal purposes in a handful of states. The resulting "system" was a confusing patchwork, but it didn't cause widespread problems.

Then, in the mid-2010s, several forces came together. People got used to these apparently harmless state experiments, so popular support for full legalization sharply rose. Business interests saw an opportunity and funded massive lobbying at the state level, emphasizing economic arguments on the right and social justice arguments on the left—both of which had some merit. In the following years, 11 states gave in to the pressure. In 13 others, advocates went straight to voters with referenda. Today, 39 states allow "medical marijuana," and 24 have full legalization.

But that distinction doesn't really matter anymore, due to the sneakiest bait-and switch that put the final nail in America's cannabis coffin. Because in 2018, Congress inadvertently legalized weed everywhere.

You read that right. The TL;DR is that what was pitched to Congress as a simple move to legalize hemp for industrial uses became, with some slick innovations in chemistry, a way for producers to sell gobs of potent, intoxicating, legal THC products anywhere in the US.

So that's our current reality: a powerful psychoactive substance that we are just beginning to study at this dosage is available everywhere, and millions are developing problems.

Is there anything to be done? Yes, a little-noticed September report from the National Academies of Science recommended practical steps that are still within the realm of the possible, and that could help. Among many other steps, Congress could undo the loophole that legalized THC products nationally. The CDC could and should create best practices to improve state regulations. There could be more a lot more research on these concentrated new products.

But no, it is hard to have any confidence that President-elect Donald Trump's chosen leadership at federal agencies, or the Republican-controlled congress, will act.

And the harder challenge is that cannabis is itself the tip of an even bigger cultural iceberg tearing through the country. As Michael Lewis brilliantly documented in his podcast Against the Rules, at the same time that cannabis advocates were sinking their teeth into legislatures, online sports betting lobbyists managed to legalize their product in about as many states, unleashing a wave of problem gambling in the country. Today's betting apps attack potential addicts with the ferocity of algorithmic sharks, and there's plenty of blood in the water.

At the same time, how else to describe the last 15 years of having social media in our pockets but a vast, real-time experiment on our brains and social constructs when we're all exposed to highly addictive activities that are known to affect our moods and understanding of basic facts? For that matter, we seem to have let go of the rope on online pornography too—an industry that, according to advocacy group Fight the New Drug, now rakes in $97 billion a year, harvests sensitive viewer data, and produces often violent content that has been seen by three-quarters of American teens and badly distorts their perceptions of normal sex.

We have entered the "yeehaw" era of American governance. And as we keep legalizing all our vices, they seem to be coming back at us awfully hard and awfully fast. So, we shrug and take another dose. Welcome to the brave new world.

Matt Robison is a writer, podcast host, and former congressional staffer.

The views expressed in this article are the writer's own.