It's legal but is it harmful? Marijuana education needs a major boost.

Throughout the country, states are changing their marijuana laws at a dizzying pace.[1] New York legalized recreational marijuana for those over 21 in March 2021, positioning itself to become one of the largest markets of legal cannabis in the nation.[2] Missouri citizens voted to legalize recreational marijuana in November 2022,[3] Minnesota became the 23rd state to legalize recreational marijuana in May 2023,[4] and Ohio citizens will vote this November whether the state should follow this strong trend.[5] It seems like Pennsylvania is on track to permit adult-use cannabis, with Democrats taking control of the state legislature and Governor Shapiro signaling support.[6] While marijuana is illegal at the federal level, there have been strong attempts to decriminalize it.[7] The rapidly changing cannabis legal landscape coincides with a burst in public support for legalization.[8]

Despite the flurry of legalization, marijuana use can pose serious health risks, particularly because today’s marijuana is more potent than in the past.[9] The number of people in their twenties or early thirties suffering heart attacks has been rising in recent years.[10] Marijuana can lead to increased blood pressure, which is a heart attack risk factor.[11] It can also lead to a higher risk of stroke in young adults.[12] Marijuana can affect one’s mental health, leaving them feeling anxious, afraid, and panicked.[13] It can also cause impaired thinking and interfere with learning, driving, playing sports, and brain development.[14] The American Automobile Association (AAA) opposes legalization of recreational marijuana given concerns of marijuana’s effects on drivers and traffic safety.[15] Smoked marijuana has many of the same harmful components as tobacco smoke and can harm lung tissues and damage small blood vessels.[16] Those who “frequently use large amounts” of marijuana report lower life satisfaction, poorer mental and physical health, and less academic and career success compared to those who do not.[17] One study found that “approximately 3 in 10 people who use marijuana” have marijuana use disorder, which means that they cannot stop using marijuana even if it is “causing health and social problems in their lives.”[18] Users may have higher amounts of lead in their bodies.[19] Accordingly, “[m]arijuana use comes with real risks that can impact a person’s health and life.”[20]

There is “a concerning gap between public perception and scientific evidence on the risks and benefits of cannabis.”[21] While more than half of U.S. adults realize the dangers of cannabis, the majority of recent cannabis users feel that there is no risk from smoking cannabis daily.[22] In a 2021 survey, 44% of people thought that it was safer to smoke a cannabis joint rather than a cigarette daily despite experts saying that cannabis smoke might be just as harmful.[23] Studies indicate a steady decline in cannabis risk perceptions in recent years.[24] The prevalence of perceiving marijuana use as low-risk doubled from 2002 to 2018.[25] Social media, the internet, the cannabis industry, and peers can promote exaggerated beliefs about the health benefits of cannabis.[26] A recent study found that a reasonable number of people believed that cannabis could prevent or cure cancer despite insufficient evidence suggesting as much.[27] The study’s findings indicated that false beliefs about the medical benefits of cannabis are common.[28] Today’s teens are growing up hearing mixed messages about marijuana and many of them think that it is safe.[29]

While states move swiftly toward cannabis legalization, it is essential to educate the public of its risks and benefits.[30] It is critical to train healthcare workers and medical students about marijuana’s health implications.[31] Yet there is much work to be done.[32] A 2016 survey found that 85% percent of surveyed residents and fellows reported having no education about medical marijuana.[33] Other studies indicated that practicing physicians have a limited understanding about cannabis’ health effects and would like more training.[34] The regular population can benefit from marijuana education since their knowledge of its health effects is relatively low.[35] Recent users of marijuana are more susceptible to having a false perception of its consequences and it is important to teach them about its potential harms.[36] Educating people about the danger of marijuana is an effective way of reducing its use and future impact.[37]

The dearth of marijuana education is rectifiable. Parents can play an important role in educating children about marijuana and preventing its use.[38] Medical students should be offered coursework that examines the biochemical effects of cannabis and its clinical relevance.[39] Practicing physicians should have access to the same information through continuing medical education (CME).[40] Marijuana labels should become standardized and inform consumers how to use the product safely and of potential health risks.[41] Governments should implement public education campaigns by targeting frequent consumers using innovative outreach such as interactive tools and games. [42] Policymakers should study how to craft cannabis laws that prioritize public health and protect youth.[43] Marijuana is here to stay, and it is imperative to educate the public accordingly.

[1] JM Pedini, Major Changes to Cannabis Law Take Effect Around the U.S., NORML (July 7, 2023), https://norml.org/blog/2023/07/07/major-changes-to-cannabis-law-take-effect-around-the-u-s/. [2] N.Y. Cannabis Law § 2 (McKinney 2021); Luis Ferré-Sadurní, New York Legalizes Recreational Marijuana, Tying Move to Racial Equity, N.Y. Times (March 31, 2021), https://www.nytimes.com/2021/03/31/nyregion/cuomo-ny-legal-weed.html. [3] Mo. Const. art. XIV, § 2; Livvy Ashton, Is Weed Legal in Missouri? MO Cannabis Laws (June 2023), CFHA (June 1, 2023), https://cfah.org/missouri-marijuana-laws/. [4] Minn Stat. Ann. § 342.09 (West 2023); Shawna Mizelle & Sydney Kashiwagi, Minnesota Becomes 23rd State to Legalize Recreational Marijuana, CNN (May 30, 2023), https://www.cnn.com/2023/05/30/politics/minnesota-cannabis-legalization-recreational-marijuana/index.html. [5] Haley BeMiller, It’s Official: Ohio Will Vote on Legalizing Recreational Marijuana in November, Cincinnati Enquirer (Aug. 16, 2023, 5:20 PM), https://www.cincinnati.com/story/news/politics/2023/08/16/ohio-recreational-marijuana-issue-to-go-before-voters-in-november/70479067007/. [6] Mark O’Keefe, Is this the Year that Pa. Finally Legalizes Recreational Marijuana?, Pa. Cap.-Star (Feb. 19, 2023, 6:30 AM), https://www.penncapital-star.com/commentary/is-this-the-year-that-pa-finally-legalizes-recreational-marijuana-mark-okeefe/. [7] Rebecca Shabad, House Passes Landmark Marijuana Legalization Bill, NBC News (Apr. 1, 2022, 8:50 AM), https://www.nbcnews.com/politics/congress/house-vote-bill-legalize-marijuana-rcna22527; Dario Sabaghi, U.S. Lawmakers File Bipartisan Bill to Prepare for Federal Marijuana Legalization, Forbes (Apr. 20, 2023, 6:00 AM), https://www.forbes.com/sites/dariosabaghi/2023/04/20/us-lawmakers-file-bipartisan-bill-to-prepare-for-federal-marijuana-legalization/?sh=55a4d0a8145b. [8] Katherine Shaeffer, 7 Facts About Americans and Marijuana, Pew Rsch. Ctr. (Apr. 26, 2021), https://www.pewresearch.org/short-reads/2023/04/13/facts-about-marijuana/ (finding “[a]round nine in ten Americans say marijuana should be legal for medical or recreational use”). [9] What We Know About Marijuana, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/what-we-know.html (last reviewed Sept. 9, 2021); Mayo Clinic Staff, Marijuana, Mayo Clinic, https://www.mayoclinic.org/drugs-supplements-marijuana/art-20364974 (last visited Aug. 29, 2023); Suzette Gomez & David Hampton, Weed is Stronger Now than Ever Before, Addiction Ctr., https://www.addictioncenter.com/drugs/marijuana/weed-stronger-than-before/ (July 17, 2023). [10] Heart Attacks Increasingly Common in Young Adults, Am. Coll. of Cardiology (Mar. 7, 2019), https://www.acc.org/about-acc/press-releases/2019/03/07/08/45/heart-attacks-increasingly-common-in-young-adults. [11] Marijuana and Public Health, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/health-effects/heart-health.html (last reviewed Oct. 19, 2020); What’s the Link Between a Heart Attack and Blood Pressure?, Norton Healthcare (Jan. 25, 2019), https://nortonhealthcare.com/news/whats-the-link-between-a-heart-attack-and-blood-pressure/. [12] Marijuana Use Linked to Higher Risk of Stroke in Younger Adults, Harv. Health Publ’g (Feb. 1, 2020), https://www.health.harvard.edu/heart-health/marijuana-use-linked-to-higher-risk-of-stroke-in-younger-adults. [13] Paul Frysh, How Pot Affects Your Mind and Body, WebMD (July 6, 2023), https://www.webmd.com/mental-health/addiction/marijuana-use-and-its-effects. [14] How Does Marijuana Produce its Effects, Nat’l Inst. on Drug Abuse (July 2020), https://nida.nih.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects; Marijuana and Public Health, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/health-effects/driving.html (last reviewed Oct. 19, 2020). [15] Andrew Gross, Fatal Crashes Involving Drivers Who Test Positive for Marijuana Increase After State Legalizes Drug, AAA NEWSROOM (Jan. 30, 2020), https://newsroom.aaa.com/2020/01/fatal-crashes-involving-drivers-who-test-positive-for-marijuana-increase-after-state-legalizes-drug/. [16] Marijuana and Public Health, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/health-effects/lung-health.html (last reviewed Oct. 19, 2020). [17] Cannabis (Marijuana) DrugFacts, Nat’l Inst. on Drug Abuse (Dec. 24, 2019), https://nida.nih.gov/publications/drugfacts/cannabis-marijuana. [18] Marijuana and Public Health, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/health-effects/addiction.html (last reviewed Oct. 19, 2020). [19] Sandee LaMotte, Marijuana Users Have More Heavy Metals in Their Bodies, CNN (Aug. 30, 2020), https://www.cnn.com/2023/08/30/health/marijuana-heavy-metals-wellness/index.html. [20] Know the Risks of Marijuana, Substance Abuse and Mental Health Servs. Admin., https://www.samhsa.gov/marijuana (Feb. 27, 2023). [21] Yoshiko Kohlwes, Salomeh Keyhani & Beth E. Cohen, Perceptions of Risks of Cannabis Use in a National Sample of US Adults, 38 J. Gen. Internal Med. 1094, 1094-97 (2022). [22] Id. [23] Sandee LaMotte, Many Americans Wrongly Believe Exposure to Marijuana Smoke is Safer than Tobacco, Study Finds, CNN (Aug. 14, 2023), https://www.cnn.com/2023/08/14/health/marijuana-smoke-wellness/index.html; Beth Cohen, Many People Think Cannabis Smoke is Harmless – a Physician Explains How that Belief Can Put People At Risk, The Conversation (Aug. 30, 2023), https://theconversation.com/many-people-think-cannabis-smoke-is-harmless-a-physician-explains-how-that-belief-can-put-people-at-risk-211601. [24] Kohlwes, Keyhani, & Cohen, supra n. 23; Samantha Goodman & David Hammond, Perceptions of the Health Risks of Cannabis: Estimates from National Surveys in Canada and the United States, 2018-2019, 37 Health Educ. Rsch. 61, 61-78 (2022). [25] Pia Mauro, Christine Mauro & Luis Segura, Perceptions of Risk, Availability Contribute to Cannabis Use, Columbia Mailman Sch. of Pub. Health (July 15, 2021), https://www.publichealth.columbia.edu/news/perceptions-risk-availability-contribute-cannabis-use. [26] Goodman & Hammond, supra n. 24. [27] Id. [28] Id. [29] Raychelle Cassada Lohmann, How Teens Perceive Marijuana, Psychology Today (December 9, 2017), https://www.psychologytoday.com/us/blog/teen-angst/201712/how-teens-perceive-marijuana. [30] Kohlwes, Keyhani, & Cohen, supra n. 23; Cannabis Strategy, Ctr. for Disease Control and Prevention, https://www.cdc.gov/marijuana/pdf/CDC-Cannabis-Strategy-2020-2025-Fiscal-Year-3-Pager-508.pdf (last visited Aug. 31, 2023). [31] Nathaniel P. Morris, Educating Physicians About Marijuana, 179(8) JAMA Internal Med. 1017, 1017-1018 (2019). [32] Id. [33] Id. [34] Id. [35] Goodman & Hammond, supra n. 26, at 76. [36] Kohlwes, Keyhani, & Cohen, supra n. 23. [37] Arthur Hughes, Rachel N. Lipari & Mathew R. Williams, Marijuana Use and Perceived Risk of Harm from Marijuana Use Varies Within and Across States, The CBHSQ Rep. (July 26, 2016), https://www.ncbi.nlm.nih.gov/books/NBK396156/. [38] Marijuana: Facts Parents Need to Know, Nat’l Inst. on Drug Abuse, https://nida.nih.gov/sites/default/files/mj_parents_facts_brochure.pdf (last visited Sept. 1, 2023). [39] Morris, supra n. 33. [40] Id. [41] Daniel J. Kruger, Natalie J. Korach & Jessica S. Kruger, Requirements for Cannabis Product Labeling by U.S. State, 7(2) Cannabis Cannabinoid Rsch. 156, 156-60 (2022). [42] See Goodman & Hammond, supra n. 26, at 76; Maisam Najafizada, Bui K. Petersen, Jennifer Donnan, Lisa Bishop & Sandy Brennan, Cannabis Education Should Aim to Normalize – Not Prevent – Safe and Legal Use, The Conversation (March 7, 2021, 9:36 AM), https://theconversation.com/cannabis-education-should-aim-to-normalize-not-prevent-safe-and-legal-use-153966. [43] Educating Policymakers on Cannabis Regulations to Protect Youth, Public Health Inst. (2021), https://www.phi.org/about/impacts/educating-policymakers-on-cannabis-regulations-to-protect-youth/.