Many physicians are hesitant to recommend medical cannabis because of a knowledge gap. It is topic not taught in medical school or residency. Additionally, much of the research we have been reading for years has been biased toward harm, therefore, for the medical profession, acceptance it is critical to have policies that ensure public safety.
Below are a couple of key public safety measure to consider when legalizing both recreational adult-use and medical cannabis.
Pediatric Accidental Overdose or Intentional Diversion
When looking at the regulating the medical market it is important to ensure access for qualifying patients, both adult and children, while preventing access to minors for illicit use and accidental exposures in pediatric populations. The potential harm to adolescents with respect to addiction to cannabis is almost 4 times greater than it is with adults. There are also concerns of danger with respect to chronic cannabis exposure on adolescent’s developing brains. Sadly, some studies suggest that up to 40% of adolescents are getting their marijuana from a legal medical cannabis patient.
Additionally, states that have legalized recreational cannabis for adult-use have an approximately 30% increase in unintentional overdose and exposure in their pediatric population. And for children, because of their size and weight even a relatively small or “normal” dose for an adult is potentially an overdose for a child. And while a cannabis exposure and overdose is nowhere near as dangerous as an opioid overdose, it still must be taken very seriously and considered when addressing public safety regulations. Therefore, it is critical to put regulations in place to stop this potential diversion and exposure to our minors. Measures such as keeping dispensaries safe distances from schools, prohibiting use of cannabis in public spaces, and only allowing qualified patients into dispensaries by requiring their ID cards are all important controls to consider. Additionally, not allowing edible products to resemble candy packaging and ensuring there is child-resistant packaging on all these items. As well as patient education to store and keep medical cannabis locked up like any prescription medications away from children.
The next critical issue that requires regulation consideration is the potential of impaired driving while using medical cannabis. Looking to Colorado, especially since their adult use legalization in 2012, according to the National Highway Traffic Safety Administration, between 2013-2016 there has been a 40% increase in fatal crashes, with 69% of involved drivers by 2016 having over 5 nanograms (ng) of cannabis on board and no alcohol in their system. In medical-only states theoretically this should be a smaller number of overall users, but it is still important to have the regulatory framework in place to protect all citizens. Laws that address what levels, if any, of cannabis are safe when medical patients are driving should be articulated and regulated at the time of legalization.
Additionally, detecting cannabis levels is much more complex than detecting alcohol levels, there needs to be regulations addressing these testing issues for drivers with unified standards and protocols in place. Certifying physicians should spend a great deal of time educating their patients on the potential dangers of using cannabis and driving, as we do for alcohol. There should be a consideration of creating regulations for warning labels on cannabis products about impaired driving. There should be funding for public health campaigns that also address safe and impaired driving with respect to cannabis.
Quality and Safety of Cannabis Products
And as a physician, the last but not the least important issue that I think is critical for medical cannabis regulation is related to testing, to ensure the quality and safety of the cannabis products themselves. Because of the federal illegality, states cannot rely on agencies such as the FDA or EPA to ensure standards. States must adopt their own regulations to create best practices to ensure safety standards for cannabis products that will protect their medical patients.
Creating regulated and consistent quality standards for botanical medication is difficult due to the high degrees of variability in cultivating these plants. Regulations to address safe and acceptable levels of potential contaminants as well as accurate levels of cannabinoids within products and then verify these by independent regulated 3rd party testing labs and protocols are even more critical for medical patients. Inhaled cannabis medication can pose potential risks especially for immune compromised patients such as cancer patients, due to possible bacterial or fungal contaminants.
The lipophilic nature, (literally meaning “fat-loving,” so it doesn’t dissolve well in water) of cannabis can require organic solvent extract techniques which can use potentially harmful and even carcinogenic solvents, so it’s critical to ensure there are safe levels in end products sold within the state. Therefore, regulation of analytic labs, testing and labeling requirements along with published Certificates of Analysis (CoA) are very important in medical markets. And something both patients and physicians alike need assurances on.
These are all important measures that policy makers need to consider as more states move to full legalization.
Dr. Leigh Vinocur is a board-certified emergency physician who also has a cannabis consulting practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a graduate of the inaugural class, with the first Master of Science in the country in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
This blog is not written or edited by Hearst. The authors are solely responsible for the content.