Researchers show why cannabis policies should shift to a harm reduction, health promotion approach to safeguard public health

A paper published today in the American Journal of Public Health, the official journal of the American Public Health Association, by University at Buffalo researchers calls attention to this concerning and potentially dangerous situation, which they say is a result of a policy environment historically driven by politics, not science.

The paper explains why there needs to be a shift in cannabis policies to a public health approach as opposed to the prevailing, more punitive approach that pushes abstinence instead of public education. With cannabis now legal to some extent in most states, they say the case for such a shift is all the more urgent.

"Legalized cannabis is a freight train coming down the tracks and public health is going to get completely run over if it's only set up, as the slogan goes, to 'Just say no,'" says Daniel J. Kruger, PhD, senior author on the paper and research associate professor of emergency medicine in the Jacobs School of Medicine and Biomedical Sciences at UB. He is also a researcher with UB's Clinical and Research Institute on Addictions.

"We are saying the field should move toward harm reduction and health promotion, using the tools with which public health practitioners are already familiar," he says.

Kruger and his co-authors say that the social ecological model (SEM) of public health, which looks at specific behaviors at multiple levels, is well-suited as a comprehensive framework with which policies for cannabis should be developed. The model provides a way to study the range of cannabis products, their effects on human health, the behavior of the individual who consumes them, as well as the social environment they function in, and the organizations and policies that govern those behaviors.

Unlike tobacco or alcohol

Figuring out how to develop cannabis policies that safeguard public health is fundamentally different from developing policies for tobacco or alcohol, the researchers point out.

"Whereas alcohol, for example, is just one thing, there are hundreds of different psychoactive compounds in cannabis and they all do different things," says Kruger. "It's important to model the cannabinoids individually. We're at the very beginning of knowing how they are different from each other."

The lack of authoritative information about cannabis and wide disparities in how different states regulate it present an additional challenge.

"It would be great if there were federal policies other than criminalization for cannabis," says Kruger. "Right now, you have 50 states plus territories, all of which have a mishmash of rules and policies that don't coordinate. You can have products coming into one state from another that might not have the same regulations."

And despite the establishment of state-regulated dispensaries such as in New York State, many cannabis users still obtain the product illegally.

Cannabis is classified by the federal government as a Schedule I controlled substance, which indicates it is likely to be abused and provides no medical benefit, even under medical supervision. The paper notes these characterizations directly contradict the empirical evidence.

The researchers say cannabis users often lack quality information about its effects and how best to reduce risk. They may access information from friends or family, and most who use it for medicinal purposes never disclose that information to their health care providers.

The role of public education

For that reason, Kruger notes, public education should play a significant role, a point that was made in the recent report on cannabis by the National Academies of Science, Engineering and Medicine.

People need to know basic things, Kruger explains, such as how much THC there is in a specific product and how much should someone take. He says consumers sometimes start with a low dose and then take more because cannabis can have a delayed effect when ingested. Additional doses can then cause unwanted effects, such as anxiety, paranoia and panic.

Using THC-O as a case study, the researchers show that with this one product, as with many other cannabis products, reliable information is hard to find. Although it has been recommended that vaporizing cannabis or eating edibles can be safer and produce less potent effects as harm-reduction techniques, in the case of THC-O, vaporizing it may produce ketene, the toxic gas that causes the same type of lung injury that vaping causes.

Recent indications that U.S. regulatory agencies may switch cannabis to a Schedule III substance from Schedule I is a positive step, the authors say, which may, in turn, make it more likely that cannabis policies can be standardized nationwide.

"We need to have scientifically informed policies," concludes Kruger, "and for that we need research; we need clinical trials but not just clinical trials. We need to do other kinds of research to examine how people are using cannabis and what benefits or harms they are experiencing in order to fulfill the true mission of public health: to maximize the benefits and minimize the costs, risks and harms for the individual and society."

Co-authors with Kruger include Jessica S. Kruger, PhD, clinical associate professor of community health and health behavior, UB's School of Public Health and Health Professions, and Carlton CB Bone of Portland State University.

The work was not funded.