DISCLAIMER: This blog post is for informational purposes only, and should in no way be considered medical advice or cannabis promotion.
We are three years into the legalization of marijuana sales and consumption by Oregonians over the age of 21. A lot has changed since 2015, and watching everything unfold, I have formed my opinions. To summarize:
I support the decriminalization of cannabis at the federal level.
We need federal legalization to promote research into the usage and dosing of cannabis.
We need over the counter and prescription categories of cannabis products.
We need to raise the legal age of access to over the counter cannabis.
We need better oversight and training of cannabis facilities and staff.
Decriminalization - Generally speaking, cannabis use by adults carries a low level of risk. Compared to alcohol, prescription drugs, and other recreational substances, cannabis is pretty tame. For most people, the biggest risk is driving while under the influence - the same risk we assume with alcohol and prescription drugs. Excessive consumption of cannabis has been linked to chronic vomiting, which goes away on stopping cannabis. People with pre-existing psychosis may suffer a psychotic crisis from cannabis. But for most adults, the risks are quite reasonable compared to other legal substances, so criminalization under the guise of protecting the public doesn’t make sense. Given the history of using the criminalization of cannabis as a way of promoting a racist agenda, federal decriminalization is the most reasonable and equitable approach.
The need for research - The inclusion of cannabis on the Schedule 1 list of controlled substances has prevented meaningful, large scale scientific research and trials. While I offer my respect to the cannabis pioneers who labored in unfunded labs, and I acknowledge the compelling anecdotes of the many medical and recreational users, they are not a substitute for the scientific teams that typically apply their skills and knowledge to the investigation of medicines. Removing cannabis from Schedule 1 is necessary to fully open the gates of meaningful research. Sadly, this will also produce the patenting of cannabis strains by big pharma, so we will likely see some forms of cannabis removed from public access. It is also possible pharma will move to have research restricted to pharma labs, effectively preventing product development by grassroots producers. This is an important political issue that will doubtless arise as cannabis moves forward, and cannabis advocates should take pains to see that grassroots access is maintained. But cannabis is a complex medicine. Our understanding at this point is mostly limited to THC and CBD, the two primary active compounds in cannabis. Much is made of the relative abundance of THC versus CBD in many cannabis products, but the accuracy of those statements by any given producer isn’t guaranteed. And we don’t have research to tell us whether it is the absolute dose of THC versus CBD that matters more, or whether the ratio matters more. We don’t know, for example, the optimal quantity, frequency, and duration of cannabis treatment for seizures in children, or anxiety in adults. For people seeking relief from serious medical conditions, there is almost no guidance other than the cannabis enthusiast staffing the dispensary - a person who likely has no medical training at all. As a healthcare provider, the situation makes me unhappy. Patients are thrown into what is essentially a free for all when it comes to procuring the proper strain of cannabis and dosing it appropriately. We need well-funded, experienced labs to help us fill in the gaps in our understanding of cannabis as medicine and long-term recreational substance.
Over the counter versus prescription - This is a very basic concept in medicine that has existed as long as the tradition of the physician/ priest/ medicine worker. Humans have always had “home remedies” for everyday problems, plus special remedies that were accessed through a medical specialist. This is why your mom could give you an aspirin, but not antibiotics. This is why you can buy a weak concentration of topical cortisone, but need a prescription to take it by mouth, or in a strong topical preparation. With the increasingly potent preparations of cannabis that are available to the average consumer, it is time to establish over the counter and prescription levels of potency. My concern as a healthcare provider is wide open access to all kinds of cannabis leaves the uninformed public vulnerable to a host of not very dangerous but nonetheless really unpleasant and possibly long lasting adverse effects. In the last three years, friends and patients have reported cannabis mishaps from unknowingly ingesting way too much THC. If excessive THC is ingested via edibles, the bad trip can last all day. The general public is not at all savvy about selecting and ingesting cannabis. Establishing over the counter and prescription strengths of cannabis products would add a layer of protection for the casual cannabis user, as well as the suffering patient attempting to get relief through self-medication. Who would control prescription access? Likely it would start with professionals who currently have prescribing privileges, primarily MDs. Doctor-run cannabis clinics could dispense prescriptions, just as they did before recreational legalization.
Raising the legal age - In the United States, the age of 21 is the fullest attainment of adulthood. Yet in terms of neurodevelopment, we know the human brain continues to develop significantly until the age of 25; and there is some evidence emerging that cannabis can have long-lasting impacts on brain development in young people. While we need more research, discouraging recreational cannabis use before the age of 25 would provide a layer of protection against lasting damage for chronic users. Of course, it would be naive to assume raising the legal age would completely prevent underage consumption. Young people have ways of getting substances they want to imbibe. It would be a discouragement, nonetheless.
Oversight and training of the industry - The cannabis industry in Oregon right now is a free for all. Oregon is still trying to grapple with regulating the industry, and resources are not abundant. The Oregon cannabis supply has been compromised by high levels of pesticides multiple times, and product recalled. There are no standards for cannabis staffers, production workers or retail help. A consumer who knows nothing about cannabis may be assisted by a highly knowledgeable cannabis enthusiast who has taken the time to educate themselves about its chemistry, applications, dosing, and local suppliers; or they may be helped by a stoner who just loves to get high, assumes everyone else just wants to get high, and can’t believe he gets paid to help people get high. The onus is on the consumer to know their own needs, and be able to distinguish skilled help from unskilled. Basic training, like we have for food handlers, alcohol servers, and drivers, would offer some protection to cannabis consumers.
I am a practical healthcare provider. In the end, what matters to me is patients have access to safe and effective medicines. I am also a concerned citizen. I want the uninformed public to be protected from harm. I also don’t want drug laws to be used to unfairly single out vulnerable populations for persecution, which is how they are used now.
To my patients: Feel free to talk to me about your cannabis use, especially if you are using regularly, or using it to treat a medical condition. It may be important to your care. I am very open about this topic, and don’t want you to feel like you have to keep it a secret.
This blog represents my official wish for sensible federal cannabis policy.