More than half of all U.S. states have legalized cannabis, be it for medical purposes, recreational use, or both. The shelves of cannabis dispensaries offer an ever-widening array of gummies, drinks and joints.
Meanwhile, the federal government still considers most types of cannabis illegal.
A new report from the National Academies of Sciences, Engineering and Medicine, released this week, finds this disconnect between the states and the federal government is leading to fragmented policies, and risks to the public.
As states built new commercial markets for cannabis, they initially focused on regulating sales and revenue. “The consequence of that is the public health aspects were often given a backseat and we're now playing catch up for that,” says Dr. Steven Teutsch, chair of the National Academies committee that wrote the report on how cannabis impacts public health.
The report calls for federal leadership and national standards on cannabis quality and potency, to safeguard public health.
Here are five takeaways:
1. People consume cannabis more regularly than alcohol in the U.S.
In 2022, more U.S. adults reported using cannabis than alcohol on a near-daily basis, according to the National Survey on Drug Use and Health. It was the first time that regular marijuana use surpassed regular alcohol use.
Regular cannabis use has skyrocketed in the past 30 years — from fewer than 1 million people reporting near-daily use in 1992, to more than 17 million in 2022.
Weed has gotten more accessible as it’s gained legal status in many states — around two-thirds of those 12 and older consider it to be “fairly easy” or “very easy” to obtain. And it’s also dropped in price, in terms of the price per unit of delta-9-tetrahydrocannabinol, or THC — the primary compound responsible for its psychoactive effects.
2. Weed and vapes can be super potent and that’s not always disclosed
The concentration of THC in cannabis flower has increased over time. “I think most people are aware of the phenomenon that 'this is not your grand daddy's weed'... I hear this all the time," Staci Gruber, with the Harvard-affiliated McLean Hospital, told NPR in 2019.
And while smoking dried cannabis flower is still how most people consume weed, there’s been a rise in cannabis edibles, vape oils and other products, says Dr. Yasmin Hurd, director of the Addiction Institute at Mt. Sinai and vice chair of the NASEM committee.
“There are now concentrates such as dabs, wax and shatter that contain very high concentrations of THC, even in the range of 60% to 90%,” she says. Hurd spoke at a press conference on Thursday announcing the report’s release.
Higher concentrations of THC make it more likely for people to take more than they intend to, which has contributed to more traffic accidents and hospital visits related to cannabis use, Hurd says.
While many states with legalized cannabis use have set limits on the amount of THC in gummies and other edibles, those rules often don’t apply to other cannabis products, according to the report.
3. You can get psychoactive hemp products even in states where cannabis is illegal
Cannabis is classified as a Schedule I substance by the U.S. Drug Enforcement Administration, meaning that the federal government considers it to be a drug with high abuse potential, and no accepted medical use.
Thanks to the 2018 Farm Bill — which defined a subset of cannabis as hemp, and excluded it from the Controlled Substances Act — there’s been a boom in products containing hemp-derived chemicals. These include CBD and delta-8 THC, a psychoactive compound extracted and synthesized from CBD, and they can be sold in states that have not legalized cannabis.
These have evaded regulation, though some of these chemicals have been processed to increase their psychoactive properties. U.S. health officials from the CDC and FDA have warned about the health and safety risks.
The report recommends that Congress close this loophole, by specifying that all intoxicating forms of cannabis — including those derived from hemp — are subject to regulation.
4. Research on cannabis is stifled
Scientific research on the health effects of cannabis has advanced little in recent years, because there are huge barriers to studying the drug.
Since cannabis is classified as a Schedule I substance, researchers often can’t get it for studies. Even if they can, they contend with all kinds of tight regulations.
The White House Office of National Drug Policy isn’t allowed to study the impacts of legalizing cannabis, even though it’s already happened in many states.
Earlier this year, the DEA proposed reclassifying cannabis as a Schedule III drug, like ketamine — one with recognized medical uses, low to moderate potential for abuse, and fewer restrictions.
The report also recommends that Congress remove the restrictions on research for the Office of National Drug Policy.
5. Cannabis can be dangerous but people hear more about its benefits than risks
People tend to think that cannabis is less dangerous once it’s been legalized, Hurd says.
But many people have not been fully informed of the potential harms. “The risks associated with THC consumption— psychosis, suicidal ideation, cannabis use disorder — those increase as the dose increases,” Hurd says.
More kids and young adults are now seeing pro-cannabis messages through advertising, and the cannabis industry lobby is increasingly influential — successful in swatting down efforts to limit THC concentration in Washington, for instance, or to limit pesticide use on cannabis farms in Colorado, according to the report.
“We really need to approach cannabis with a public health framework,” Dr. Pamela Ling, director of the UCSF Center for Tobacco Control Research and Education, wrote in an email after reviewing the report at NPR’s request.
“The good news is we don't have to start from scratch. We have models from best practices from tobacco control and alcohol that can be applied to cannabis — particularly regarding marketing restrictions, age restrictions, the retail environment, taxation, and ways to decrease youth access,” she says.
The report also recommends public health campaigns that describe the risks, especially for kids and young adults, those who are pregnant and the elderly. And it calls for training cannabis retail staff to talk knowledgeably about the risks and benefits to customers.
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