WASHINGTON — The federal government should provide policy guidance to states that have legalized cannabis, close regulatory loopholes on intoxicating products derived from hemp, and create a public health campaign aimed at parents and vulnerable populations, among other measures that would protect public health and reduce the harms of rising cannabis use, says a new report from the National Academies of Sciences, Engineering, and Medicine.
More than half of U.S. states have legalized cannabis for adult or medical use, and in 2022, more adults reported daily use of cannabis than daily use of alcohol. While dried flower remains the most used cannabis product, concentrates, edibles, and vape oils are gaining in popularity, with many people using multiple products and administration methods, the report says. THC is the intoxicating component of cannabis, and the report says the THC concentration of products consumed today has markedly increased. The increased concentration makes it easier for people to consume higher doses of THC, which is associated with increased risk, making higher THC concentration one of the greatest public health concerns related to cannabis policy. Many states that have legalized adult use of cannabis impose serving size limits for THC in edibles or other consumable products, but few limit the amount of THC in other products like cannabis flower, oils, or vape pens.
Among states that have legalized cannabis, policies aimed at protecting public health vary widely, the report finds. For example, while all of the states have minimum age requirements for cannabis use, not all have mechanisms in place for enforcement through randomized checks, as they would for alcohol or tobacco sales.
The potential harms of cannabis use include increased risk of car collisions, development of schizophrenia or psychosis, respiratory symptoms including chronic bronchitis, and lower birthweight from prenatal exposure. Secondhand smoke from cannabis can also carry risks, as can accidental ingestion or poisoning. Research points to specific groups that may be especially vulnerable to harm — including those over 65, pregnant women, and children. While this report does not explore the health impacts of cannabis on individuals, a 2017 National Academies report includes detailed findings on health impacts.
“There is an urgent need for a coordinated public health approach to cannabis policy in the U.S.,” said Steven Teutsch, chair of the committee that wrote the report and senior fellow at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. “Our report shows that cannabis policy often focuses on regulating sales and revenue first, and protecting public health second. Now is the time for the federal government to create guidance for states that have legalized cannabis in the interest of protecting the public’s health.”
“A federal public education campaign targeting those most at risk of the negative impacts of cannabis — kids, teens, pregnant people, and those over 65 — would go a long way toward supporting public health,” said Yasmin Hurd, the committee’s vice chair, Ward-Coleman Chair of Translational Neuroscience, and director of the Addiction Institute at the Icahn School of Medicine, Mount Sinai. “Accurate information about reducing the risks of cannabis use can help people make the best decisions for their own health.”
The report recommends several actions for Congress and federal agencies:
Close regulatory loopholes for hemp-derived cannabinoids — The booming industry for unregulated hemp-derived products is of particular concern, the report says. The 2018 Farm Bill removed hemp from the Controlled Substances Act, and since then, products derived from hemp — such as CBD, delta-9 THC, and other intoxicating semisynthetic cannabinoids like delta-8 THC — have proliferated even in states where cannabis is illegal. Semisynthetic cannabinoids in particular may contain harmful by-products, such as strong acids and solvents. The report recommends Congress change the definition of hemp to make it clear that no form of hemp-derived THC or semisynthetic intoxicating cannabinoid is exempt from the Controlled Substances Act, so that they are regulated in the same manner as other intoxicating cannabis products.
Cannabis public health campaign — The CDC should develop targeted public health campaigns directed toward parents and vulnerable populations — such as youth, those who are or are likely to become pregnant, and adults over age 65 — to educate about the potential risks of cannabis, how to identify risky behavior, and strategies to lower risk. These public health campaigns should also discourage unhealthy use of cannabis, including using it in combination with alcohol or tobacco, and the increased risks associated with using high-concentration or high-potency products.
Best practices for cannabis policy — The CDC should develop best practices for protecting public health for use by states that have legalized cannabis, drawing on tobacco and alcohol policies. These should include best practices in marketing restrictions, age restrictions, physical retail and operating restrictions, taxation, price restrictions, product design, and measures to limit youth access, among other strategies.
Improved cannabis public health data and research — The CDC should create an adaptable public health surveillance system for cannabis, capturing a range of data from cannabis cultivation and product sales to use patterns and public health impacts. The report also calls for action to improve our understanding of how cannabis policies impact public health, recommending a new research agenda for the National Institutes of Health, CDC, and others.
Allowing research — Congress should remove the White House Office of National Drug Control Policy’s restrictions on studying the legalization of cannabis.
Required training for cannabis retail staff — State cannabis regulators should require training and certification for all staff who interact with customers at cannabis retail outlets. The training should address the effects of cannabis on humans, prevention of sales to minors, warnings about cannabis-impaired driving, cannabis use during pregnancy, high-concentration or high-potency products, and how to identify signs of impairment.
Automatically expunging criminal records — States that have legalized or decriminalized cannabis should implement criminal justice reform and automatically expunge or seal records for low-level cannabis-related offenses.
Model legislation — The National Governors Association and National Council of State Legislatures should develop model legislation for state cannabis policy, such as marketing restrictions or taxation, incorporating best practices from the CDC.
Setting product standards — The U.S. Pharmacopeia, an independent scientific organization that sets standards for quality and safety in medicines, dietary supplements, and foods, has established product quality and analytical standards for cannabis flower and is currently developing standards for cannabis extracts. State cannabis regulators should adopt and enforce these standards and others once available to ensure cannabis product safety and quality.
The report finds that the influence of the commercial cannabis industry on policy development raises concerns, and that there is a lack of safeguards against lobbying. Lobbying efforts by the industry have demonstrably impacted regulations; for example, they have thwarted attempts in Washington state to limit THC concentration and attempts in Colorado to restrict pesticides in cannabis cultivation. The report also points to revolving-door practices and financial entanglements between regulators and industry in some states, which it warns could impede development of robust public health protections.
The impact of legalizing cannabis on health equity is not well understood, and legalization may both mitigate and exacerbate social inequities, the report says. The commercial cannabis industry may contribute to health inequities by disproportionally marketing to minoritized communities or concentrating cannabis retailers in low-income communities or communities of color. Though there is a lack of robust data, racial disparities in cannabis-related arrests may have increased as more states have legalized. The report recommends jurisdictions responsible for enforcing cannabis laws should regularly gather and report data on arrests, sentences, incarceration, and diversion programs to help clarify how legalization impacts health equity. States also should evaluate any cannabis social equity measures to ensure they are meeting their stated goals and not having unintended consequences.
Undertaken by the Committee on the Public Health Consequences of Changes in the Cannabis Policy Landscape, the study was sponsored by the Centers for Disease Control and Prevention (through the National Council for Behavioral Health and the National Council for Mental Wellbeing), National Cancer Institute, National Center for Complementary and Integrative Health, National Institute on Drug Abuse, and the National Academies’ Cecil and Ida Green Fund.
The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
H/T: www.nationalacademies.org
