UB Researchers Call for Cannabis Policy Shift to Public Health

UB Researchers Call for Cannabis Policy Reform Focused on Public Health and Harm Reduction

October 24, 2024 – A significant new study from the University at Buffalo (UB), published in the American Journal of Public Health, highlights a critical gap in the health care support available to the millions of Americans who use cannabis for a range of medical and personal needs. With limited guidance from health professionals and restricted access to reliable information about cannabis products, users are often left navigating their use without the benefit of informed medical advice.

UB researchers argue that the current policy landscape, historically influenced more by political agendas than by scientific research, urgently needs reform. The study advocates for a shift from punitive approaches to policies that prioritize public health, harm reduction, and public education on cannabis consumption, especially as legalization expands across states.

Shifting from “Just Say No” to Harm Reduction

Dr. Daniel J. Kruger, the study’s senior author and a research associate professor at UB’s Jacobs School of Medicine, emphasizes that public health strategies for cannabis are currently inadequate. “Legalized cannabis is a freight train coming down the tracks, and public health is going to get completely run over if it’s only set up, as the slogan goes, to ‘Just say no,’” Kruger stated. He notes that with cannabis becoming increasingly available, public health measures must adopt harm reduction strategies that guide safe use and informed consumption.

Kruger and his co-authors suggest using the Social Ecological Model (SEM) to create policies that encompass all levels of cannabis use, from the individual to the societal level. SEM, which evaluates specific behaviors at multiple layers of influence, could offer an effective framework for addressing cannabis use by analyzing individual behaviors, social contexts, and regulatory structures. Such a model would provide a structured approach to understanding the diverse effects of various cannabis products on human health and the regulatory landscape shaping their consumption.

Unique Challenges in Regulating Cannabis

The researchers point out that cannabis is far more complex to regulate than substances like alcohol or tobacco. “Whereas alcohol, for example, is just one thing, there are hundreds of different psychoactive compounds in cannabis, and they all do different things,” said Kruger. This variety within cannabis compounds, which includes cannabinoids like THC and CBD, each with distinct physiological effects, means a “one-size-fits-all” policy is unworkable. Instead, individual cannabinoids should be studied and modeled separately to fully understand their effects on health.

This complexity is compounded by significant inconsistencies in cannabis regulations across states. Without a standardized federal framework, states have developed a patchwork of rules that vary significantly. “Right now, you have 50 states plus territories, all of which have a mishmash of rules and policies that don’t coordinate,” Kruger added. This inconsistency not only creates confusion for consumers but also poses public health risks, as products from states with differing regulatory standards cross borders.

Cannabis Remains a Schedule I Substance Despite Health Benefits

Cannabis is currently classified as a Schedule I controlled substance by the federal government, a categorization indicating that it is likely to be abused and lacks accepted medical use. This designation, however, is contradicted by numerous studies and the experiences of patients who use cannabis for conditions such as chronic pain, anxiety, and epilepsy. The UB researchers argue that this classification hinders research and public health efforts to create scientifically informed guidelines around cannabis use.

Due to these restrictions, cannabis users rarely receive quality information from health care providers. Most medicinal cannabis users, for example, may not disclose their cannabis use to their doctors, instead relying on friends, family, or personal research for information. This lack of professional oversight can lead to misinformed decisions about dosing and consumption methods, which in turn heighten risks like adverse reactions or unintended side effects.

The Importance of Public Education in Cannabis Policy

In light of this, public education has become crucial. The study reinforces the recommendations of the National Academies of Science, Engineering, and Medicine, which advocate for informing the public about safe consumption practices. As Kruger explains, consumers should have a clear understanding of THC levels in specific products, as well as information about safe dosing. For example, ingesting cannabis can have delayed effects, often leading users to take additional doses too soon, which can result in heightened anxiety, paranoia, and other unwanted effects.

A case study on THC-O, a synthetic cannabinoid, underscores the need for accessible, reliable information. Though vaporizing or consuming cannabis through edibles is generally suggested as a safer alternative to smoking, vaporizing THC-O can produce ketene, a toxic gas linked to lung injuries associated with vaping. Reliable information on the risks and best practices for using these products is scarce, often leaving users vulnerable to harm.

Potential Federal Rescheduling Offers a Path Forward

The researchers highlight that recent discussions about rescheduling cannabis as a Schedule III substance are a positive step. Reclassification could facilitate more comprehensive research and offer a pathway toward establishing standardized, evidence-based policies nationwide. If cannabis were reclassified, it would likely lower barriers to research funding and expand the scope of studies on its effects and medicinal potential.

A federal policy overhaul would also address inconsistencies in product labeling, dosing guidelines, and the distribution of safe products. Kruger concludes that for cannabis policy to fulfill its potential in promoting public health, it must be informed by robust scientific evidence. This requires not only clinical trials but also studies on real-world usage to accurately assess both the benefits and risks associated with cannabis.

A Call to Align Cannabis Policies with Public Health Goals

In calling for policy reform, Kruger and his team seek to move cannabis policy into alignment with broader public health objectives: to maximize benefits while minimizing risks and costs to both individuals and society. By shifting toward harm reduction and health promotion, policymakers could create a more effective framework for cannabis use that mirrors successful approaches used with other substances.

Kruger’s co-authors, Jessica S. Kruger, a clinical associate professor at UB’s School of Public Health, and Carlton CB Bone of Portland State University, also emphasize the importance of creating policies that address the specific contexts in which cannabis is used. These include social, environmental, and organizational factors that influence consumer behavior, product availability, and safety standards.

As the conversation around cannabis continues to evolve, this study underscores the need for a nuanced, scientifically grounded approach that acknowledges both the challenges and opportunities associated with widespread legalization. The researchers call on public health professionals, lawmakers, and the public to support a policy shift that places science and harm reduction at the forefront, helping to foster safer, more informed cannabis use.