More Research on Marijuana Use Is Needed to Ensure Public Safety, Says Ethicist

This transcript has been edited for clarity. 

Hi. I’m Art Caplan. I’m head of the Division of Medical Ethics at NYU’s Grossman School of Medicine in New York City. 

I’ll fess up. In my lifetime, I have smoked marijuana. On the other hand, I’m not a big user. I don’t really like the feelings it produces, so I would have to say I’m a small-time marijuana user.

I’m not against it. It seems to me that the dangers associated with marijuana use are often overinflated. I’m not sure that the case that it’s a gateway drug to fentanyl, cocaine, and opioids was ever convincing. I’m not alone in believing that strict penalties for marijuana use, or even minor sale, don’t make much sense.

Many states have legalized marijuana for medical use. Many states have legalized marijuana for recreational use. It’s still considered a dangerous drug by the federal government, which does hinder the ability to conduct research on marijuana use using federal funds, and that’s a problem. 

You can find many folks using marijuana today. It’s often viewed as less harmful than alcohol, a fairly minor bad habit, or something that isn’t even in the category of a bad habit. That isn’t really fair because we put marijuana out there without really testing a number of things about the ways in which it could be abused, what its impact is on young kids, or what daily use and high-volume use might mean to health. 

It’s become a $33 billion industry, selling all kinds of products. I took a visit not long ago to a marijuana dispensary in Massachusetts and saw two things. One, the potency of the drugs that they were selling is way higher than anything I remember from my marijuana days in college many decades ago.

The marijuana that’s out there is a much higher percentage of materials that will get you high, and it’s bred so that it gives a high quickly. It’s potent stuff. That raises an issue about whether or not it’s going to be more addictive or abused by users. 

There’s plenty of information coming in from the mental health field describing that there are many people who are heavy marijuana users who are suffering from paranoia and psychosis. Emergency departments are reporting a weird new phenomenon of constant vomiting induced by marijuana use. That condition was rare, but they say it’s increasingly common and one that they didn’t really have to deal with previously. 

You’ve got tens of millions of people using the drug either recreationally or to treat a wide variety of medical conditions that the marijuana business touts, from migraine control to gout to cancer therapies to who knows what, for much of which there’s no evidence at all. 

What we’ve got is widespread use of a much more potent drug for all kinds of purposes without much guidance on whether that drug is going to impact you in a different way if you’re a small person with low weight vs if you’re a big person and have a large body. 

What about kids who are smoking every day in junior high? What about people who use enormous blunts or have many different exposures on the same day? Are they, if not physiologically addicted, then becoming mentally addicted? 

We’re not tracing the impact of this. What’s it doing to driving accidents or operating equipment via the usual warnings that we get with some drugs and alcohol, all the way from don’t fly your plane to don’t drive a truck to don’t be a ship captain? 

Do we really know even how to enforce expectations about ability, let’s say, to drive motor vehicles with respect to standards on marijuana exposure? The answer is no. It’s the judgment of the cops, if you will, as to whether you’re intoxicated or impaired, but we don’t have the same standards that we created for alcohol. 

I’m not saying to go back to the old days of marijuana madness, where we were treating this the same as heroin and people were getting locked up for having small amounts or trying to grow their own, or getting arrested for dealing marijuana or driving a car in which a marijuana sale was involved. I think we can get rid of all that. 

We have a public health issue about this increasingly commonly used drug. We ought to be assessing what it helps in terms of medical conditions and what it really doesn’t help. What do “high-dose use” and “high-frequency use mean”? What about age? What about body size? 

The time for study has not gone away just because of increasing state legalization. Federal officials ought to make room for much more study and assessment of marijuana use, so that we can make sure those who use do so with better-informed consent, that doctors know what to watch out for in terms of abuse of this particular substance, and that we can make sure people are not impaired by marijuana use so our roads and public thoroughfares are safe. 

I’m Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.