Questions still surround cannabis use and public health

Susan R. Bailey, MD , Past President

Public attitudes about legalizing the use of cannabis have changed dramatically over the last 30 years. Recent national polling suggests that roughly two-thirds of Americans favor legalizing cannabis for adult use, while even more support legalizing it for medical use. Adult use of cannabis is now legal in 16 states, and the tax revenue generated by its sale is calculated in the billions of dollars.

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But even so, significant public health and safety questions remain. The National Academies of Sciences, Engineering and Medicine maintains that the medicinal benefits of cannabis are largely unknown, and that its use is associated with lower birth weight, an increased number of car accidents and other risks. The U.S. Surgeon General has also issued warnings about health risks tied to cannabis use.

The science about the benefits of cannabis is limited, while the available evidence demonstrates that legalizing the adult use of cannabis poses a threat to public health. Our AMA does not support legalization of cannabis for adult use until additional scientific research has been completed to fully document the public health, medical and economic consequences of its use.

We remain particularly concerned about cannabis use by young people as well as by pregnant or breastfeeding women, and continue to call for robust public health messaging on the deleterious health effects of cannabis.

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Marijuana policy should be guided by evidence, not the ballot

In states that have already legalized cannabis, the AMA believes jurisdictions should take steps to regulate the product effectively to protect public health and safety. This includes regulating retail sales, limiting the potency of cannabis extracts and concentrates, and requiring that the packaging for edible products is child-resistant to protect children from unintentional ingestion.

We also encourage jurisdictions to allocate a substantial portion of their cannabis tax revenue for public health purposes, including:

  • Substance-use disorder prevention and treatment programs
  • Cannabis-related educational campaigns
  • Scientifically rigorous research on the health effects of cannabis
  • Public health surveillance efforts

Additionally, it is important to ensure that data is available on:

  • The short- and long-term health effects of cannabis, especially emergency department visits and hospitalizations
  • Impaired driving
  • Workplace impairment and worker-related injury and safety
  • Prevalence of psychiatric and addictive disorders, including cannabis-use disorder

This data is necessary to fully evaluate the current regulatory framework, and to inform and protect public health.

Even still, it is clear that cannabis prohibition and enforcement policies have disproportionately and adversely impacted marginalized and minoritized communities. Our AMA supports public health-based strategies, rather than incarceration, in the handling of individuals possessing cannabis for personal use.

We also support social equity programs to address the impact of cannabis prohibition and enforcement policies, and provide an opportunity to those negatively impacted by previous policies to meaningfully participate in the legal cannabis industry.

Cannabis for medical use

We cannot ignore the fact that more than 35 states permit patients to use cannabis for a wide variety of what legislatures have determined to be “qualifying medical conditions.” It is the AMA’s position that scientifically valid and well-controlled clinical trials, conducted under federal investigational new drug applications, are necessary to assess the safety and effectiveness of all new drugs. The same goes for potential cannabis products. As physicians, we rely on clinical experience, combined with evidence from clinical trials and biomedical research, to guide us during the diagnostic and treatment process—and cannabis should be no different.

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How AMA follows science to be powerful voice on today’s top issues

The AMA has long advocated for comprehensive, well-controlled cannabis studies to determine its role in the treatment of disease. To advance this policy, our AMA supports removing federal cannabis research roadblocks, since we cannot generate sufficient scientific evidence without sufficient research. To that end, we support the Cannabidiol and Marihuana Research Expansion Act now pending in Congress.

This measure was first introduced in 2016 and has drawn strong bipartisan backing. Its passage will allow legitimate and comprehensive clinical research to evaluate the potential medical benefits, risks and harms posed by cannabis and cannabis derivatives.

The proposed law would also require the Department of Health and Human Services to detail the effects of cannabis and its derivatives have on the brain and other organs. It would also streamline the development of Food and Drug Administration-approved drugs which contain cannabis and cannabis-derived products.

Approval and use of any drug must be based on sound, evidence-based scientific research. Our AMA believes that in the case of cannabis, that burden has not yet been met.

Because cannabis is not a benign substance, we must take steps in our practices, and as patient advocates and researchers, to promote and protect our patients’ health.