How risky is recreational marijuana use?  Nobody really knows.

How risky is recreational marijuana use? Nobody really knows.

Within two miles of Ryan McLaughlin’s cannabis research lab at Washington State University (WSU) in Pullman, there are dispensaries that legally sell far more potent cannabis products than his lab can get by. through the federal government for research.

“It’s very frustrating for me in a state where recreational cannabis is legal,” says McLaughlin, PhD, associate professor of integrative physiology and neuroscience and member of WSU’s Center for Cannabis Policy, Research and Outreach. . “I could go to a cannabis store and… [find] everything under the sun and different ways to consume it. But for me, as a researcher, my hands are tied.

McLaughlin uses animal models to study the effects of cannabis use on the brain and behavior. But because cannabis is labeled as a Schedule 1 drug by federal law, meaning it’s considered to have a high potential for abuse and no accepted medical benefits, McLaughlin can only get his product. from the University of Mississippi, the only producer licensed by US Drug Enforcement. Agency.

“We have a resource and the highest concentration of THC [tetrahydrocannabinol] is 12%,” McLaughlin says, referring to the cannabis chemical that is psychoactive and produces a high. “It’s on the low end speaking of the recreational market.”

In the 1990s, the average potency of cannabis flower was around 4% THC, but that’s increased to over 20% today — and some highly concentrated products used for dabbing (the inhalation of vaporized cannabis oils) may contain more than 90%. THC, says Rosalie Liccardo Pacula, PhD, Elizabeth Garrett Professor of Health Policy, Economics and Law at the Sol Price School of Public Policy at the University of Southern California (USC).

With the legalization of recreational marijuana a hot political issue, medical and health policy researchers who study cannabis, commonly known as marijuana, urge a focus on expanding research to guide evidence-based health policy.

This topic regained attention when, in October, President Joe Biden announced a pardon for all previous federal offenses of simple possession of marijuana and ordered the Secretary of Health and Human Services and the United States Attorney General to United to consider rescheduling the substance. In November, voters in Maryland and Missouri voted to legalize recreational use, bringing the total number of states where marijuana is legal to 21 (plus Washington, DC). And on November 16, the US Congress also passed a bipartisan bill to cut red tape for researchers studying cannabis.

“[Rescheduling would] enable a lot more research,” says Pacula, who co-directs the RAND-USC Schaeffer Opioid Policy Information and Tools Center and focuses on addiction issues. “This means that with federal research funds, we [could] examine the health effects of products already used and sold in legal markets.

Weigh the risks and benefits

There is significant evidence that cannabis may have medicinal benefits for certain conditions. A committee report released by the National Academies of Sciences, Engineering, and Medicine in 2017 reviewed thousands of studies on cannabis and found that while there is a huge knowledge gap on the risks and benefits of cannabis use, there was substantial evidence that it could be used therapeutically to treat chronic pain in adults and chemotherapy-related nausea, and to reduce symptoms of spasticity in patients with multiple sclerosis.

The United States Food and Drug Administration has even approved a cannabis-derived drug product, Epidiolex, for the treatment of epilepsy, and three synthetic cannabis-related products for nausea in chemotherapy patients, all of which are available at arrangement.

Many state policies that authorize the medical use of cannabis list hundreds of conditions for which the drug can be used, though few have a scientific basis, says R. Lorraine Collins, PhD, psychologist and director of the Research Center on cannabis and cannabinoids from the University. at Buffalo, State University of New York School of Public Health and Health Professions.

“You name a disorder, it’s probably listed somewhere in a state medical cannabis law,” says Collins, who was on the National Academies committee that released the 2017 Cannabis Report. “These lists are not based on research; they are based on political considerations.

Collins explains that lobby groups, such as those representing veterans with post-traumatic stress disorder (PTSD), have the power to influence lawmakers even without evidence of effectiveness.

It is also clear that cannabis use carries risks.

There is evidence that cannabis use during pregnancy can disrupt fetal development. Some studies have linked daily cannabis use to psychosis in genetically susceptible people. Cannabis use can impair brain development, especially when used by teenagers. And it can cause temporary intoxication that impairs brain function and has been linked to a higher risk of having a fatal car accident.

As experts point out, cannabis is a complicated plant, the effects of which can vary widely depending on the dosage and concentration of THC, the frequency of use, and the personal physiological and psychological attributes of the user.

Understanding the Effects of Cannabis on the Body and Brain

The latter of these factors is linked to the endocannabinoid system which, like the nervous system, regulates various bodily functions. The system, which was discovered in 1988, helps control learning, memory, emotional processing, sleep, pain control, eating and other bodily processes. Cannabinoid receptors in the brain are stimulated by natural molecules called endocannabinoids, which are structurally similar to molecules in the cannabis plant.

Cannabis’ effects on the body and brain are the result of a kind of “hijacking” of the natural endocannabinoid system, McLaughlin explains.

Although much is still unknown about how this system works, one of the reasons researchers believe cannabis has such different effects on different people could be that the natural state of the endocannabinoid system of a person influences the experience of additional cannabis.

“[It might depend on] whether you restore normal function or push it over the edge,” McLaughlin says. “People who use cannabis may find it effective in coping with stress; for others it can produce stress and anxiety.

Research is ongoing to discover ways to better understand the endocannabinoid system and find a balance that may be effective in treating stress-related disorders, such as PTSD.

Overcoming a History of Racism

At the forefront of the political debate surrounding legalization is historical and current discrimination in the enforcement of cannabis laws, as well as the cultural stigma that has associated cannabis use with people of color. The use of the term “marijuana” itself stems from anti-Mexican racism associated with the plant in the early 20th century, as reported by Eric Schlosser in a 1994 article in Atlantic.

According to a 2020 report from the American Civil Liberties Union, black people in the United States were nearly four times more likely to be arrested for cannabis possession than white people in 2018, although both demographic groups use cannabis at similar rates.

“The stigma was driven by many issues, including racism, as it was tied to Mexicans and people of color, for example, African-American jazz musicians,” Collins explains. “It felt like your white middle class shouldn’t go anywhere near that.”

Today, as legalization and public opinion move away from the stigma of cannabis use, Collins believes policymakers must be careful to be nuanced in their discussions of the substance.

She says current public health messaging varies widely from state to state and, in some places, is non-existent.

Research is needed to create guidance

The emergence of a thriving cannabis industry that markets products with little regulation or evidence on risk further complicates public health messaging, says Luke Niforatos, executive vice president of Smart Approaches to Marijuana (SAM), a organization that seeks to promote a middle ground between legalization and criminalization.

“We learned the hard way with tobacco,” says Niforatos. “We would like to see more research done now so that we can make policy decisions based on what we learn from science.”

SAM helped draft a bill to ease bureaucratic hurdles to conducting cannabis research that passed Congress in mid-November and awaits President Biden’s signature. The bill also directs the Department of Health and Human Services to report to Congress on the potential harms and benefits of cannabis use.

Experts say studying the impact of different dosages, as well as the effects of high-THC products, should be priorities.

Currently, the legal cannabis market in the United States does not have a standardized dosage of THC. With many states limiting sales by quantity or weight, rather than concentration, a person could purchase more than a six-month supply for a standard user in a single transaction in some parts of the country, Pacula says.

“We have to recognize that cannabis is not a homogeneous product,” she says. “We don’t treat hard liquor the same way we treat wine or low-ethanol beer.”

Pacula says medical students should learn about the endocannabinoid system. They should also be encouraged to ask more detailed questions about cannabis use during a patient’s history when it might be relevant to their care, “just as you would ask about alcohol with heart disease or smoking for someone with lung problems,” she says. .

It’s also important that healthcare professionals receive more information about cannabis products and effects, says Collins, who teaches a cannabis class at the University at Buffalo with a faculty member from the school. of pharmacy.

“Their thirst for knowledge is comforting and frustrating,” she says.

McLaughlin is counting on a relaxation of existing barriers to research, which could open up an avalanche of opportunities for researchers who have been caught up in bureaucracy.

“I never understood why [the government] made it so difficult for researchers to study the drug,” he says. “We have to figure it out.”

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