Researchers say cannabis policy needs to shift towards a harm reduction and health promotion approach

Millions of Americans use cannabis to treat a plethora of health conditions. They are rarely supervised by a healthcare provider, and their access to quality information about the substances they use and their potential risks is limited at best.

An article published in the American Journal of Public Health by researchers at the University at Buffalo, draws attention to this troubling and potentially dangerous situation, which they say is the result of a policy environment historically driven by politics, not science.

The article explains why there needs to be a shift in cannabis policy towards a public health approach, as opposed to the prevailing, more punitive approach that encourages abstinence rather than public education. Now that cannabis is legal to some degree in most states, the argument for such a shift is all the more urgent.

“Legalized cannabis is a freight train coming down the rails and public health will be completely run over if, as the slogan goes, it is just set up with ‘Just Say No,’” says Daniel J. Kruger, Ph.D. , senior author of the paper and research associate professor of emergency medicine at the Jacobs School of Medicine and Biomedical Sciences at UB. He is also a researcher at the Clinical and Research Institute on Addictions of the UB.

“We say the field needs to move toward harm reduction and health promotion, using the tools that health care professionals are already familiar with,” he says.

Kruger and his co-authors say 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 to develop cannabis policy.

The model provides a way to study the range of cannabis products, their effects on human health, the behavior of the individual consuming them, as well as the social environment in which they function, and the organizations and policies that govern that behavior.

Unlike tobacco or alcohol

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

“For example, while alcohol is just one thing, there are hundreds of different psychoactive substances in cannabis and they all do different things,” says Kruger. “It is important to model the cannabinoids individually. We are only at the beginning of knowing how they differ from each other.”

The lack of authoritative information about cannabis and the vast differences in how different states regulate cannabis pose an additional challenge.

“It would be great if there were federal policies other than the criminalization of cannabis,” Kruger says. “Right now you have 50 states plus territories, all of which have a hodgepodge of regulations and policies that don’t align. You can have products coming in from the other state that may 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 that it is likely to be abused and provides no medical benefit even under medical supervision. The article notes that these characterizations directly contradict the empirical evidence.

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

The role of public education

For that reason, Kruger notes, public education should play an important role, a point that has been made recently 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 is in a specific product and how much someone should 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 difficult to find. While it is recommended that vaping cannabis or eating edibles may be safer and have less potent effects as harm reduction techniques, in the case of THC-O, vaping THC-O can produceketene, the toxic gas that causes the same type of lung injury causes. that vaping causes.

Recent indications that US regulators could switch cannabis to a Schedule III substance from Schedule I are a positive step, the authors say, which could in turn make it more likely that cannabis policy can be standardized nationwide.

“We need science-informed policy,” Kruger concludes, “and for that we need research; we need clinical trials, but not just clinical trials. We need to do other types of research to explore how people use cannabis and what benefits it has. or the harms they experience to fulfill the true mission of public health: to maximize benefits and minimize costs, risks, and harms to the individual and society.”

Kruger’s co-authors include Jessica S. Kruger, Ph.D., 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.