About 17.7 million Americans now use cannabis daily or near-daily in some form.
As cannabis becomes legal in an increasing number of U.S. states and usage rates remain at historically high levels, harm reduction experts are calling for an overhaul in the way public health approaches the drug.
About 17.7 million Americans now use cannabis daily or near-daily — more than alcohol, a study in May’s Addiction found. While still illegal at the federal level, recreational cannabis is now legal in nearly half of U.S. states. Without consistent regulation or clear guidance on safety, the number of emergency department visits involving cannabis has risen to unprecedented levels, research shows.
The trends have led many health and medical experts to reach a similar conclusion: To reduce harm, the U.S. needs a coordinated public health approach to cannabis policy.
“Cannabis policy often focuses on regulating sales and revenue first, and protecting public health second,” Steven Teutsch, a senior fellow at the University of Southern California’s Leonard D. Schaeffer Center for Health Policy and Economics, said in a September news release. “Now is the time for the federal government to create guidance for states that have legalized cannabis in the interest of protecting the public’s health.”
Teutsch was chair of the committee of a recent report from the National Academies of Science, Engineering and Medicine that says cannabis should be treated like other substances with known health risks, such as alcohol and tobacco.
Recommendations in the September report include creating product quality standards, closing loopholes for unregulated products and establishing a surveillance system that could capture public health impacts. The report also calls for a public health campaign that would warn people at high risk of harm about the dangers of cannabis use.
One of those groups is youth. Cannabis use before age 18 can harm brain development, affecting functions such as learning, attention and memory, according to the Centers for Disease Control and Prevention. A new study published in October found cannabis use among teens can cause regions of their brains to physically shrink, which can be seen on imaging scans. Nearly a third of 12th grade students in the U.S. report using cannabis in the past year, with 6% using it daily.
Another group at high risk of harm from cannabis is pregnant people. About 6% of the population use the drug, which contributes to health problems such as lower birthweights and preterm births.
Many pregnant people who use cannabis are unaware of the risks, according to a recent survey by researchers at the University of California-San Francisco. More than half of survey respondents who used cannabis during pregnancy did so believing it was safer than other medications or treatments, Claudia Zaugg, MPH, shared during APHA’s 2024 Annual Meeting and Expo in October.
Instead of using cannabis for recreational purposes, most people in the survey said they used the drug to manage their pregnancy symptoms.
“Research done by our team and others also indicates that pregnant people do not trust the evidence on the health effects of cannabis use during pregnancy,” said Zaugg, who is project director of the university’s Advancing New Standards in Reproductive Health program.
Standardizing cannabis policies at the federal level would promote safer use of cannabis products by consumers, according to an October editorial in APHA’s American Journal of Public Health.
Daniel Kruger, PhD, a research scientist and associate professor with the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences, and colleagues urged public health to move beyond prohibition and abstinence and adopt a more holistic approach to cannabis.
“Rather than avoiding the topic, public health should take an active role in it,” Kruger told The Nation’s Health. “We want to be able to shape the policies and practices, and make sure that as the sector continues to evolve, that it’s evolving in ways that are good for people.”
More oversight of products needed
A public health approach to cannabis could also include tactics such as sales restrictions, package labeling, taxing strategies and regulation of ingredients, experts say. The latter is especially important, as new products are rapidly entering the market without oversight, leaving consumers unaware of the potency and safety of the products they use.
Thomas Lilliston helps a customer at Harborside Health Center in Oakland, California, in 2018. A NASEM report recommends cannabis retail staff be certified before they can sell the product, as users look to them for advice.
Photo by Amy Osborne, courtesy San Francisco Chronicle/Getty Images
Products derived from hemp, such as CBD and delta-8 THC, have spread throughout the country, “and most of them are completely unregulated,” Beau Kilmer, PhD, MPP, co-author of the NASEM report and the co-director of the Rand Drug Policy Research Center, told The Nation’s Health.
“When people go into a store, a gas station and buy a delta-8 product, it’s not entirely clear what’s in those products and that is a cause for concern,” Kilmer said.
The NASEM report also recommends that cannabis retail staff be required to be trained and certified before they can sell the product, as many users of the drug look to them for advice. Staff training could include prevention of sales to minors, warnings about cannabis-impaired driving and how to identify signs of impairment, for example.
“Even if the federal government hasn’t legalized, there still are things that can be done right now to improve public health, whether it be providing guidance for states that decide to do this or putting more money into research and analysis on health consequences,” Kilmer said.
Another issue in need of attention is cannabis-impaired driving. Traffic-related deaths that involve cannabis have been on the rise in recent years. About 1 in 8 high school drivers report driving after using cannabis at least once during the past month.
While some states have zero-tolerance policies, some have limits on blood THC. And unlike alcohol, roadside testing methods are limited.
“We need educational campaigns that help the public think of cannabis as dangerous for driving,” Ashley Brooks-Russel, PhD, MPH, co-author of the NASEM report and associate professor at the University of Colorado Anschutz Medical Campus, told The Nation’s Health. “We need to find the language to communicate with people and help them reframe their behavior as risky.”
For more information on the NASEM report, “Cannabis Policy Impacts Public Health and Equity,” visit www.nationalacademies.org.
- Copyright The Nation’s Health, American Public Health Association
