Legalising cannabis is one thing, advocating its safety is another
A few years back, a panel of sixteen prominent medical experts was assembled by the National Academy of Medicine in the United States, was tasked with analysing the scientific literature on cannabis.
In their 468 page report, which came out in January 2017, it repeatedly stated that despite cannabis' popularity in North America, it was still largely a mystery.
The panel did highlight the widely believed range of medical benefits of cannabis use, questioning the commonly accepted view regarding the effectiveness of marijuana in the treatment of pain, cancer, irritable bowel syndrome, epilepsy, dementia, glaucoma, depression, anxiety, and even reduction in nausea in chemotherapy patients. While there is evidence to support its effectiveness as an alternative treatment for these and many other ailments, the Panel pointed out that very little is known about the dosage, side effects, and safe routes of administration of commercially available marijuana products within the US.
The mist of doubt continued deeper into the report when the panel analysed the potential risk factors and safety concerns of cannabis use. The panel found that cannabis use would likely increase the incidence of motor vehicle accidents; however it was unclear by how much. Similarly, the findings detailed cannabis use would probably affect motivation and cognition, employment outlooks, academic achievement and many other areas of concern, however, what remains unclear was how much of a negative influence cannabis use would be.
The report has made it abundantly clear that more study is required. It concluded studies need to be conducted on children, teenagers, older populations, pregnant women and nursing mothers. Simply put, on everybody, not only on the college age demographics, who are most likely to consume cannabis.
The panel also wanted to see further research into “the pharmacokinetic and pharmacodynamic properties of cannabis, modes of delivery, different concentrations, in various populations, including the dose-response relationships of cannabis and THC or other cannabinoids.” In medicine, the dose and response relationship of new compounds is of paramount importance for pharmaceutical companies, to work out early in any human trials as it formulates new drugs for approval. Not enough of a drug, will simply not have any positive effect, while too much of the same drug can negatively impact health. Determining dosage, along with metabolic pathways that compounds take after entering the body, are factors that drug manufacturers will invest an enormous amount of resources into before getting approval to market their products.
We are still waiting for similar information in regards to marijuana. The lack of scientific study into cannabis is due primarily to the fact that only up until recently it has been illegal right around the world.
We do have a few studies dating back to the 1980s and 1990s, however, advancements in plant breeding and other growing technology have seen the typical concentration of THC, the psychoactive compound in cannabis, increase from small single digits to nowadays being higher than 20%, sometimes much higher.
There are also a number of ways to consume cannabis. It can be smoked, vaped, eaten or applied to the skin. We know very little about each of the various methods of administration, how they impact our health and how their impact can vary, compared to the alternative methods.
Is cannabis safe for mental health?
Cannabis has been long believed to treat mental illness. However, recent studies have pointed to the huge gap between the hype and evidence-based research supporting the claims.
Cannabis has been touted as an effective treatment for a variety of psychiatric conditions, such as anxiety, depression, post-traumatic stress, addiction, etc. It is observed that many psychiatric patients smoke a lot of cannabis. Supporters of legalising cannabis use, usually attribute this phenomenon to those with mental illness are using cannabis as a form of self-medication. These claims are partly true. However, there are also claims that heavy cannabis use often leads to mental illness and may increase the risk of developing schizophrenia and other psychoses.
Note that the cannabis plant is not a single substance, but contains over 500 identified chemical compounds. It contains more than 100 cannabinoids that, when ingested, interact with the endocannabinoid system, a naturally occurring communication network in our body. It can affect many naturally occurring physiological and psychological processes in different ways.
Erik Messamore, a psychiatrist in neuropharmacology and schizophrenia treatment, says THC may interfere with the anti-inflammatory mechanism of our brain, resulting in damaged nerve cells and blood vessels. Marc Manseau, a Clinical Assistant Professor at the New York University School of Medicine, agrees that for people with schizophrenia and related diseases, cannabis use may actually worsen problems, rather than treat them.
Can cannabis use increase violent behaviour?
In a study posted in the Journal of Interpersonal Violence, published in 2013, researchers surveyed more than 12,000 American high-school students. They assumed that alcohol triggers violent behaviour and marijuana does the opposite. However, the survey concluded that marijuana use was three times more likely to make users physically aggressive when compared to non-users, while alcohol increased violent behaviour by 2.7 times over abstainers.
Between 2013 and 2017, the aggravated assault rate in Washington, the first U.S. state to legalise recreational cannabis in 2014, rose 17 percent and the murder rate rose 44 percent. Though there is no clear evidence that cannabis use was responsible for that surge in violence, it’s strange that when Washington exposed its population to the higher level of a calming substance, citizens became more violent to one another.
Doesn’t easy access to cannabis due to legalisation pose risks for children?
Experts warn of dangers of cannabis to children through ingestion of marijuana edibles and second-hand smoke. There have been many cases about children who inadvertently ingested cannabis-infused edibles like brownies, cookies, chocolate bars, bear gummies, etc.
A study from Manitoba, Nunavut, and Ontario poison centres reveal that between 2013 and 2017, annual calls related to marijuana exposure to children under age 18 increased by 50 percent. Surveys revealed that only 30 percent of parents feel prepared to educate their kids about cannabis and more than half said there are not sufficient resources for youth about its risks.
Parents concerned about exposure of their kids to cannabis
Parents are concerned about how their kids will learn the importance of not driving under cannabis influence, the adverse effects of using the drug, and how to reject offers to try cannabis.
Edibles such as candies and cookies may attract teens who are looking for alternatives to smoking cannabis. This can result in inadvertent toxicity, as the drug’s absorption from edibles can take hours, leading to over-consumption.
We do need proper studies on the health effects of cannabis on everyone, including children, teens, pregnant and breastfeeding women, and the elderly population. There is also a need for the investigation of pharmacokinetic and pharmacodynamic properties of cannabis, different concentrations, dose-response relationships and modes of delivery.
However, we must be realistic in our approach and remember that not every single aspect of cannabis can be studied before legalisation occurs. Waiting for such a development will be a wild goose chase. As legalization happens, through a country-by-country, eventual process, the groundwork for studies will be laid, making them easier to conduct. In other words, legalization aids research, as the red-tape restricting such research will be removed.