Not all cannabis is created equal; neither are the people that use it. As an epidemiologist, I have studied cannabis as a plant, potential therapeutic agent and potential health risk over the past decade. My research has revealed a concerning trend of confusion and false promises when it comes to the purported health effects of this increasingly popular substance.
Routinely, a new cannabis-infused product claims to relieve a multitude of ailments. But alarmingly, most of these unregulated products make such claims with neither scientific evidence to back them nor regard for potential long-term health consequences. When it comes to cannabis, the pace at which scientists are coming to understand the health effects of the substance pales in comparison with the speed at which it is becoming available to patients and the general population.
That situation hasn’t slowed the push to legalize cannabis, however. Last month, New York State governor Andrew Cuomo vowed to legalize marijuana in the state for adult use. In this effort, New York joins New Jersey and South Dakota, which will have ballot measures on recreational cannabis legalization in November. And several other states are reportedly considering such legalization as well. Though legalization has its pros and cons, increased cannabis availability seems inevitable. For this reason, nationwide decision makers should consult rigorously designed multidisciplinary prospective studies in order to create evidence-based policies on cannabis use. At the very least, it should be understood that not all cannabis is the same.
Since 2017 a National Academies of Sciences, Engineering, and Medicine report entitled The Health Effects of Cannabis and Cannabinoids has served as a warning even as cannabis has become more available and legal. This systematic, comprehensive review notes that the dearth of rigorous research on the health effects of cannabis poses a public health risk. In other words, research to date is unclear in determining if cannabis is safe or unsafe with respect to long-term health effects in areas such as cardiovascular disease risk. The lack of evidence regarding various health outcomes for cannabis users leads to confused patients, heath care professionals and policy makers.
While research on cannabis has made notable strides in the past five years, along the way, the translation of evidence to the bedside has sometimes skipped crucial steps. In my own research in southern Florida, most of our sample of new users did not know that there were many components within the overall category of cannabis, each with its own health effects. During an interview, one participant noted that hearing cannabis ointment relieves pain had prompted that person to begin smoking cannabis. This example is not unique.
It’s not that the supposed health benefits and risks of cannabis are being withheld from the American public. Cannabidiol (CBD) and tetrahydrocannabinol (THC), in particular, have sparked plenty of discussion among health care providers, patients and the public. But I have directly observed how few cannabis users understand what they are using. In our sample, only 4 percent knew the composition of the cannabis product or flower they were using, in terms of both cannabinoids and fillers. Results from our studies and others suggest a disconnect between the peer-reviewed information scientists are providing and the knowledge the general public is absorbing.
That lack of public awareness includes knowledge about the risks and benefits of cannabis use. From a public health standpoint, it is paramount that education be based on scientific findings rather than hearsay. Unfortunately, people’s eagerness to try cannabis is outweighing their eagerness to understand its long-term health effects. For that reason, decision makers should strategically prioritize cannabis-related health surveillance and research on health effects in parallel with creating policy and regulation.
Colorado is an example of a state that has proactively translated public health research into regulation. According to a an article published last year in the Nation’s Health, an American Public Health Association publication, legislation in Colorado requires the state’s Department of Public Health and Environment to regularly examine science on the health effects of cannabis in addition to a required cannabis-use surveillance-and-reporting system. States that have already blended these strategies into state-wide policies and initiatives should continue this trend. For those states that haven’t done so, such as Illinois, steps should be taken to strategically ensure funding is earmarked for public health surveillance of cannabis and research on its potential long-term health effects.
The collective goal should be to ensure improvement and maintenance of a healthy, disease-free population. To accomplish it, the first step is to understand that not all cannabis is created equal—and neither are its users.