A lack of federal regulations has helped create a dangerous situation regarding abuse of cannabis.
Unscrupulous parties are taking advantage of cannabis legalization to sell potentially harmful products.
Education of the public, starting in grade school, could help ensure that people make safe decisions on use.
Descheduling the drug could allow research, funding, and dissemination of information to all who may benefit.
The use of cannabis, both medical and recreational, has greatly expanded throughout the United States over the last several years. To date, 39 states and the District of Columbia have legalized medical use, and 24 states have legalized recreational use.
Along with this increase, there has been a jump both in ER visits by people of all age groups who have inadvertently taken cannabis products and in reported data detailing a relatively new phenomenon referred to as cannabis use disorder (first described in the DSM-5 in 2013).
The symptoms of cannabis use disorder (CUD) include the following:
Using more cannabis than intended
Unsuccessful attempts to quit or reduce use
Spending significant time obtaining, using, or recovering from cannabis
Experiencing cravings for cannabis
Failing to fulfill major obligations due to cannabis use
Continuing use despite social or interpersonal problems
Giving up important activities because of cannabis use
Using cannabis in physically hazardous situations
Continuing use despite physical or psychological problems
Developing tolerance (needing more to achieve the same effect)
Experiencing withdrawal symptoms
What Could Explain the Rise in CUD?
The rise of cannabis use disorder is perhaps not surprising, given that more and more people are taking cannabis in varying dosages and forms of ingestion, many without having a sufficient understanding of what the short- and long-term effects could be. What’s more, newly emerging commercially driven interests are (perhaps unwittingly) exacerbating the problem by introducing high THC products with little or no CBD (the other major cannabinoid that helps mitigate the psychoactive properties and other effects of THC).
Additionally, there is ongoing availability of synthetic products, cannabinoids like K-2 or “spice,” that are often for sale over the counter at gas stations and convenience stores. While touted as safe, these synthetic cannabinoids are actually vastly more potent and consequently more dangerous than plant-based products.
Perhaps not surprising is the fact that more and more people are experimenting with cannabis to self-medicate. In the absence of knowledge and guidance, they may assume that more is better and gravitate towards products with the highest amounts of THC and or synthetic ingredients available. It doesn’t help that, because of a lack of federal regulation, rules and regulations pertaining to cannabis vary greatly from one state to another, contributing to product inconsistencies and consumer confusion.
The problem is further compounded by the “Reefer Madness Crowd,” as I sometimes think of them, who dislike cannabis and/or seek to limit its use. With CUD, they have a new boogyman they can use to attack and try to undermine the vast array of benefits the plant provides.
Some have seized upon the prevalence of cannabis use disorder to support their assertion that cannabis is a dangerous drug that should continue to be classified as a Schedule 1 Narcotic. The Drug Enforcement Agency (DEA), the Federal Agency that schedules drugs, defines a Schedule 1 substance as that which has no currently accepted medical use and a high potential for abuse. (Examples of other Schedule 1 drugs are heroin, LSD, ecstasy, methaqualone, and peyote.)
Unfortunately, that boogyman has been abetted by an industry that has grown exponentially since cannabis was first legalized in 2010. It is profit-driven and has taken advantage of the lack of federal regulations to produce products that deliver, in some cases, close to 100 percent THC. As the New York Times documented recently in a well-investigated piece, major companies like Stiiizy, RISE, and Jetty, using their lobbyists, have fought ongoing attempts at state levels to regulate products and, more importantly, to stop those companies from making claims about their products alleged medical benefits.
Balancing Benefits and Side Effects Through Education
To be clear, cannabis is a powerful substance that has been employed effectively around the world for centuries to facilitate medical and spiritual healing. Like any powerful substance, its use is best guided by knowledge, ideally with professional oversight and an understanding of how to maximize its benefits and steer clear of unwanted and or dangerous side effects.
As a registered medical cannabis practitioner in New York for 10 years, I have lectured throughout the state with an eye toward educating the public on the pros and cons of cannabis. I’ve also spoken with state legislators and private and state agencies for the elderly and worked with New York State’s Office of Cannabis Management to encourage safe and responsible cannabis consumption.
In a perfect world, in my view, cannabis would be descheduled and removed from the DEA’s jurisdiction, and federal regulations would prevail to allow for a well-coordinated national effort to educate the public about the pros and cons of the plant, beginning with grammar school students where the temptations and allure of “weed” create the greatest potential for harm to minors; design packaging that would minimize the risk of minors being able to access products; thwart unproven claims about cannabis; and, fund well-designed studies to document the benefits as well as the risks of the plant and its many components.
As a physician who has practiced cannabis medicine since the inception of New York State’s Compassionate Care Act in 2016, I can attest firsthand to the tremendous benefits cannabis can provide for patients when administered responsibly. The plant has shown great promise in treating a variety of conditions, including autism, dementia, chronic pain, autoimmune diseases, opioid abuse, and withdrawal. We need to acknowledge and maximize the power of the plant’s vast potential for good through medical research and education, encourage responsible use, and discourage abuse.
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