Fruit-flavored gummies. Tinctures. Creams.
Today’s cannabis is not simply dried flowers in plastic baggies or the special ingredient in dorm-room brownies. These days, it comes in candy form, suppositories and even vaporizable dab and wax concentrates. This new cannabis is heavily engineered, cultivated and manufactured to reach THC concentrations of up to 90 percent (delta-9-tetrahydrocannabinol), whereas earlier plants had only 2 to 4 percent. And while the cannabis of yore was something that required more under-the-radar action, today’s cannabis, blended into a cornucopia of products, is readily available at a neighborhood store, depending on where you live.
The ubiquity of cannabis creates the impression that it is akin to an evening glass of wine or a nice IPA. That is misleading. The reality is that scientists, policy makers and public knowledge have not kept pace with the rapid expansion of the cannabis market; we do not even know if the products on shelves of dispensaries are truly safe or alleviate the specific symptoms retail cannabis sellers claim they will.
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I study both the beneficial and harmful health effects of cannabis, and in a recent report released by the National Academy of Science, Engineering and Medicine (NASEM), my co-authors and I broke down the public health concerns we saw with the commoditization and high-THC cultivation of cannabis in this country. The bottom line is that our state patchwork of laws leaves many users in legal limbo. Our knowledge of what high-potency cannabis does to the body is evolving. To treat it simply like a food, cosmetic or over-the-counter medication as it’s now sold is misleading, if not dangerous. We have to do more to make sure what people consume is uniform and safe.
The push to legalize cannabis in the U.S. has created an unprecedented situation. The Food and Drug Administration by law mandates thorough safety and efficacy testing to determine whether new plant, medicine or food products can be marketed to the public. For cannabis, voters and ballot measures have decided that cannabis is “medicine” and “safe” for public use.
Thus cannabis and derived cannabinoid products, which are marketed as treatments for sleep, anxiety and pain, and as ways to augment creativity, have largely bypassed this federal regulation. That legislative leapfrog has resulted in a state-by-state patchwork of laws in the U.S., allowing new cannabis products to enter the market with minimal oversight. While those gummies and tinctures may tell consumers how much THC is in them, or in what form, consumers don’t know if the product is safe. Nor do we know if it’s effective. We don’t even independently know if the “dosage” on the label is actually correct.
This includes hemp-derived products, sold on the unsubstantiated assertions that they are “THC-light.” While these are intoxicating, consumers are told they are safer than traditional cannabis (hemp has less than 0.3 percent THC). Until rigorous research is conducted on the various forms of cannabis, classifying it uniformly as a safe drug is wrong.
In my work as director of the Addiction Institute at the Icahn School of Medicine, Mount Sinai, I know that we still lack sufficient understanding of how these modern, highly potent and concentrated forms of cannabis affect our health. Highly potent and concentrated cannabis and cannabinoid products are associated with significant mental and physical health risks, including the development of schizophrenia or psychosis, respiratory symptoms including chronic bronchitis, and lower birth weight from prenatal exposure. This is not adequately or equitably reflected in our legislation or public understanding
What this means is that states that fully legalize cannabis use fail to consider the hazards of high potency and concentrated THC. Hemp-derived semi-synthetic products, including delta-8-THC, are far removed from the original plant, and on top of intoxicating users, they can contain harmful chemicals that are a byproduct of processing. Marketing these products as safe is dishonest and not supported by data.
If we want the public use of cannabis to be not only safe, but effective and nondiscriminatory, laws on cannabis must be standardized nationally, based on data. In many states, using the products of cannabis plants still arbitrarily carries criminal charges. In others, while hemp products are being sold legally from stylized brick-and-mortar dispensaries, using other forms of cannabis is illegal.
The federal government must be proactive; rather than waiting to address further harms, which is how we developed our alcohol and tobacco policy, it can use that established policy to set the groundwork on safe cannabis use.
In many ways, cannabis legalization has made it easier to conduct research on its use. What we know now is that cannabis use disorder is a growing concern likely because of the availability of extremely potent products, as well as daily or near-daily use. Cannabis use in people ages 12 and older currently exceeds that of alcohol consumption. My research, along with that of many other investigators, demonstrates that developmental THC exposure has long-term effects on both brains and behavior that are relevant to psychiatric risk into adulthood.
Framing cannabis as a general wellness product or a benign recreational drug is an overcorrection from the fear-mongering days of it being a “gateway drug.” While those fear-based campaigns caused real harm to our communities, the current promotion of cannabis as completely harmless is equally misleading. An evidence-based, public education campaign, especially one targeting people most at risk—such as children, teens, pregnant individuals and those over 65 — would significantly improve knowledge and encourage safer health choices regarding its use.
Providing accurate information about reducing the risks associated with cannabis can empower individuals to make informed decisions about their health. Health equity must also address the impact of the high density of cannabis retailers now placed in low-income communities and communities of color, which have already suffered from the previous harsh cannabis laws. Moreover, while cannabis arrests did decrease in states that legalized it, the NASEM report indicates that this decline primarily benefited white people. Our current landscape of state laws continues to promote racial inequities in both justice and health.
In addition to standardizing legalization policies, I strongly urge policy makers to remove barriers to effective research on the health impacts of cannabis legalization. As noted in our report, enhanced population-level data collection from the CDC, and elimination of the restrictions against studying the legalization of cannabis by the White House Office of National Drug Control Policy, would enable health researchers to keep better pace with the evolving cannabis landscape. This would ensure that cannabis products are safe and that there are data to inform consumers about their effectiveness.
The cannabis plant itself is not inherently good or bad, but its modern iterations are more varied and less understood. This knowledge gap should be a real cause for concern; a historic 42 percent of adults in 2023 ages 19 to 30, and 29 percent of those ages 35 to 50, used cannabis during the prior year. Without more nuanced and updated data on cannabis, policies will unfortunately continue to be driven by public perception rather than public health. We owe it to the public to investigate this complex and evolving cannabis landscape and to develop evidence-based policies that prioritize people’s health.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.
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