06/11/2024
Cannabis Policy Impacts Public Health and Health Equity
The cannabis plant contains more than 100 “phytocannabinoids,” compounds that are unique to the cannabis plant, and hundreds of compounds not unique to the plant, such as terpenes and flavonoids.
Although sometimes referred to as “hemp” or “marijuana,” all cannabis plants fall within the same genus: Cannabis.
Cannabis use has both benefits and harms.
BENEFITS
Therapeutic benefits include treating chemotherapy-induced nausea and vomiting (via oral cannabinoids such as nabilone and dronabinol), management of chronic pain in adults, and improving patient-reported spasticity symptoms in multiple sclerosis (via oral cannabinoids such as nabiximols and nabilone).
Delta-9-THC is the most well-studied cannabinoid. Its therapeutic effects include the ability to reduce nausea, increase appetite, and decrease chronic pain.
“Dronabinol,” a synthetic version of delta-9-THC, and “nabilone,” a THC-like drug, are approved by the U.S. Food and Drug Administration (FDA) for treating nausea and vomiting caused by chemotherapy, and dronabinol is approved for treating anorexia in AIDS patients.
The biological effects of delta-9-THC are attributed primarily to the compound’s actions as a cannabinoid receptor type 1 (CB1) agonist.
There is tremendous consumer interest in CBD’s therapeutic benefits.
CBD is not a CB1 receptor agonist and does not engender the constellation of effects of delta-9-THC.
Epidiolex®, a purified form of CBD, is approved for oral administration by the FDA for the treatment of specific seizure disorders in patients 1 year of age or older. However, its off-label benefits are not well studied.
HARMS
Harms include increased risk of motor vehicle collisions; development of schizophrenia or psychosis (particularly for those with other risk factors); respiratory symptoms, including increased chronic bronchitis; and lower birthweight in offspring exposed prenatally.
Delta-9-THC can induce intoxication, affect cognition, impair motor function, and lead to physiological dependence after chronic exposure.
CBD can elicit side effects such as dry mouth, diarrhea, reduced appetite, drowsiness, and fatigue. CBD can also interact with other medications, such as blood thinners.
IMPACTS OF LEGALIZATION
The committee reviewed 14 systematic reviews evaluating the public health impacts of cannabis policy.
The committee found limited or only suggestive evidence that the perceived risk of cannabis use declines after legalization, that use among adults increases, that traffic collisions increase, and that hospital visits related to cannabis use (e.g. accidental ingestion) increase.
For all other outcomes (adolescent use, gateway to other drugs, mental health problems), the committee judged the evidence to be insufficient.
National Academies of Sciences, Engineering, and Medicine. 2024. Washington, DC: The National Academies Press. https://doi.org/10.17226/27766.
