Marijuana: Warn Users of Risks, Especially When Driving

 Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine.

Well, I don't know if you saw this, but the Biden administration is pushing to make a big change in federal policy about marijuana. For a long time, marijuana has been on the Schedule I list of highly controlled drugs, much closer to heroin and opiates. There are severe penalties, at least on the federal books, for dealing in marijuana. You can go to jail for 15 years for a second conviction. There are many people still in prison for dealing and selling marijuana.

As I think many watching this know, many states have decided to permit marijuana use for medical reasons and have decriminalized it at the state level, allowing clinics to open where you can get a prescription (say, in the state of Pennsylvania) and get marijuana prescribed for a huge number of conditions. There are even a few states that have allowed this for recreational use, decriminalizing it.

State laws are allowing it in some parts of the country, whereas federal laws are still treating it like a very dangerous drug. The administration is saying, let's shift that from Schedule I to Schedule III. The penalties will go away, and it'll be more consistent with what states are permitting. You won't go to jail if you use; you won't go to jail if you sell. There may be restrictions that you have to buy it at a licensed distributor and so on. Let's make the change.

Now, I am all for decriminalizing marijuana. It makes no sense. The drug is widely used. Having severe penalties for this kind of substance seems to be not the right public policy approach. Clearly, there are medical uses for marijuana that have come into the healthcare system where it's a legitimate agent to be prescribed and used. You don't want federal penalties getting in the way of that.

On the other hand, we're treating marijuana as if it has no dangers, risks, or problems associated with it. It's a wonder substance that makes you feel better. Well, I don't think that's the right attitude to take toward marijuana either.

Look, there have been numerous studies that show that people under the influence of marijuana are involved in motor vehicle accidents at much higher rates, and of more severity than people who are not under the influence of marijuana. It gets up to the level of alcohol. We don't have laws yet to figure out how to handle using marijuana when you're operating a motor vehicle, but we should.

We have to come up with tests or measures that say you're going to get penalized if you harm others who are involved in an accident under the influence of marijuana. Don't use it and drive, which seems to be very good advice. On the other hand, I know plenty of people do drive under the influence.

Another problem is there are all kinds of ways to take marijuana, right? You can use gummies. You can smoke it. You can smoke large amounts. You can smoke small amounts. Marijuana is much more potent today. The people who grow it and produce it have learned to make it more powerful by concentrating the active agents in marijuana. It's not your dad's marijuana anymore, and that means that people can get psychologically addicted to it.

You can certainly find people who, if they're using heavy amounts, are starting to ingest substances into their lungs that might be dangerous for them. It's not good for their health. I wouldn't ban it, but like alcohol, you want to be able to advise people to use it in moderation. There are dangers. Even some of the contents are potent depending on your body size and weight. You may want to be careful about how you are using it, how often you're using it, and when you're using it. We don't have that kind of system set up for counseling patients about marijuana use.

Many times when I'm in the office, people ask me on a questionnaire before I see the doctor, if I use marijuana. If I check the box and say, yes, it never comes up again. It's just something that is there as a checkbox, but I'm never counseled or advised. No one says anything about heavy use, dangers, or driving under the influence; that it may be better for you to use edibles as opposed to smoking because there's less danger to your health; or whatever one might say.

We don't really understand all the health impacts of marijuana. More research is needed, I think, and it shouldn't stop just because we decriminalize it. At the same time, it's one thing to allow marijuana use. It's another thing to overlook the obvious risks, adverse events, and dangers that it poses — particularly with heavy use — to younger people, people who are vulnerable to addictions, and so on.

Sure, let's make the change. Let's stop the jail sentences. Let's stop the discouragement of trying to prescribe medical marijuana by having these severe federal penalties. Let's follow the states and start to allow it.

Let's also say we're going to regulate its content. We're going to make sure that people know how potent marijuana is. We're going to make sure that they know the best way to use it if they want to use it for medical or recreational purposes, when to use it (not driving) when to use it in certain amounts, what the risks are, and smoking it vs other ways to use it.

Let's not just treat this as a miracle substance that just makes you feel good and has no consequences. I've yet to find that substance, and marijuana certainly isn't it.

https://www.medscape.com/viewarticle/996920