It's time to change the narrative!
The following forum occurred late last week.
I sat in and have a few thoughts to share in response.
I attended the “Cannabis Legislative Forum” co-sponsored by The Norwalk Partnership and the Westport Prevention Coalition on January 12, 2023. Dr. Robin Oshman was present and delivered information on the “medical and mental health risks” of cannabis. From what I have found online, Dr. Oshman is on the board of the Fairfield County Medical Association and is a successful dermatologist. I could, however, find no publicly available indication that the doctor has, in any demonstrable way, researched and studied the endocannabinoid system or medical cannabis. Nor were there links to her sources in the material provided to attendees. I am still unclear on which credentials make Dr. Oshman a medical authority on cannabis.
I am a Fairfield County resident and have been practicing nursing in Connecticut for nearly two decades. Early last year, I completed additional studies at an accredited university on the endocannabinoid system and medical cannabis care. I am also a medical cannabis patient. It is imperative that we approach conversations about cannabis regulation and education with full awareness of history and use the highest quality, currently available research to guide decisions. Reiteration of false and exaggerated claims, like those from Dr. Oshman during this presentation, hinders progress and perpetuates bias, doing nothing to advance the agenda of public safety at the root of this conversation.
100% of people have an endocannabinoid system (ECS). Our bodies constantly make and use cannabinoids that closely resemble the chemistry and effects of THC (the intoxicating cannabinoid in the plant) to keep us healthy, balanced, and well. Experts have coined the work of the ECS as “relax, eat, sleep, forget, and protect.1” The ECS is vital to our health and well-being, yet few in healthcare acknowledge its existence. This is not an accident. For over 5000 years of documented human history, cultures around the world have recorded the medicinal qualities of cannabis1. It is only the last 100 or so years of prohibition and the manufactured War on Drugs that we have ignored and vilified this plant. This ‘war’ led to the extreme financial success of such industries as corrections and pharmaceuticals. It undoubtedly contributed to epidemic addiction, mental health problems, and economic disparity in minority and impoverished communities2.
The solution to protecting public health (and the children) is NOT to continue perpetuating prohibitionist talking points, stigmatizing users, and stoking fear. DARE did not work to prevent my generation from becoming drug addicts, as evidenced by the opioid epidemic3. DARE 2.0 will not work to prevent our children from misusing drugs either. I do not seek to insult or dismiss those who put last week’s legislative forum together. I, too, have concerns about many of the same issues, as do most healthcare providers who support medical cannabis. But I believe these concerned citizens are doing more damage to their cause by perpetuating misinformation and prohibitionist rhetoric. I believe the solution to protecting public health is honest, informed education about cannabis for healthcare workers, the public, and young people. I urge the legislators in our county and the public to seek sources of information from a wide range of authorities. Those opposed to cannabis use often state the lack of studies. That lack is because it was illegal to study for nearly 100 years (unless you were researching its harms). But remember that this means that MOST claims about cannabis- the positive and negative effects- are still poorly researched and understood. There are very, very few findings that can be held up as definitive, even by those who claim to be cannabis experts, let alone dermatologists.
Below are several points made during the forum and a quick summary of my rebuttals and sources.
Words Matter- Marijuana: Dr. Oshman used the word marijuana throughout her presentation. This is a term with racist origins. In fact, the state of Washington has made it illegal to use the word. Quoted in the article, state representative Melanie Morgan explains: “The term 'marijuana' itself is pejorative and racist. As recreational marijuana became more popular, it was negatively associated with Mexican immigrants. [The term marijuana] was used as a racist terminology to lock up black and brown people.” As a cannabis advocate, Dr. Oshman’s use of the term alone speaks volumes about her bias.
Teen Brain Development: I will say emphatically that no one I know in the cannabis industry, no healthcare provider supporting cannabis use, supports the use of cannabis recreationally by children or teens. We do not know enough. Cannabis use in adolescents is not necessarily benign, but nor has it been as heavily correlated with brain development as some make it seem. Adolescent rats showed some delays in brain development in certain regions. Alas, rats are not human. If it were possible to state that animal studies were definitive, we could make thousands of claims about cannabis medicine. There are over 40,000 peer-reviewed studies on medical cannabis. Many are cellular and animal models and have shown incredible potential for this plant as medicine. There is little agreement among scientists on whether there are any long-term harms of cannabis use versus whether those harms result from other risk factors.
Higher Rates of Psychosis and Schizophrenia: Anti-cannabis mouthpieces throw out this association all the time; that cannabis causes schizophrenia and psychosis. It is simply not a fact and remains hotly debated among scientists. It was 1987 when researchers linked cannabis use and schizophrenia in Swedish military conscripts, finding that those who used cannabis more than 50 times before joining the military were six times more likely to be diagnosed with schizophrenia within the next 15 years4. The association became even weaker when they controlled for other factors. Many studies have loosely supported these findings in other populations, but the fact is there are plenty of theories and no evidence proving cannabis use causes schizophrenia. Extensive research showed that rates of schizophrenia vary with factors such as gender, immigration status, the latitude at which one lives, or primarily living in an urban vs. rural environment5. Yes. Research suggests there are possible links between developing psychosis and cannabis use. However, even the National Institute on Drug Abuse (NIDA) caveats that statement on their website, stating “the strongest evidence to date concerns links between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability.6” Suppose we truly want to protect children and ensure they have the best possible future. In that case, we should normalize and talk openly and constantly about mental health problems, symptom recognition, and how to get help. Let’s focus on early interventions for which we have mountains of evidence. I urge everyone involved in the forum and who has put out the call to action to shift their focus toward this far more dangerous epidemic of our modern world.
Potency Caps for Concentrates: I agree that the risk of negative or unwanted side effects from highly potent cannabis is an issue. As a cannabis nurse, I help those who want to use cannabis safely (medically or otherwise). Once a person finds the doses, products, and regimen that works for their symptoms, it is beautiful to see life return to them. In her presentation, Dr. Oshman vilified high-potency products and made them seem entirely dangerous and without merit. People who use THC products regularly develop a tolerance and may require high doses to achieve their desired response1. This is no different from many pharmaceutical drugs. In fact, cannabis works so differently on each individual's body that some need high doses right from the start1. Dr. Oshman also failed to recognize that we can very well mitigate the impact and risk of high THC products by ingesting a ratio of THC to CBD because of how the two cannabinoids attach to our receptors. THC provides systemic (whole-body) effects with reduced intoxicating effects on the central nervous system when taken with CBD because CBD bonds with the central nervous system receptors more easily3. Capping concentrates is problematic for a straightforward reason. Concentrates, by definition, are products made by removing as much plant matter as possible to leave just the trichomes (glands of the flower that contain THC). So if done well, a concentrate takes cannabis flower that is somewhere around 20% THC trichomes and removes everything else. Usually, 90%+ of what is left is THC trichomes; the rest is residual material from the plant or the extraction process. If you tell producers to cap their concentrate at 60% THC, they must fill the other 40% with something else.7 To date, no one has supplied the industry with a suitable substitute that is proven safer to inhale than cannabis. Simply capping THC percentages without regulating the rest of the manufacturing process means it will be left up to the producers to decide what to use as a filler and may produce hazardous products. Remember the vaping lung disease crisis we faced pre-Covid? That was very much due to illicit market cannabis vapes containing dangerous additives in the form of vitamin E.8
I believe, as a healthcare professional and a medical cannabis patient, that it is far past time to put away the lies and damage of the War on Drugs. Instead, we need to start being more open and honest about the tough issues we face as a society around mental health, addiction, and healthcare disparities with each other and, especially, with our children. I offer myself (and access to several medical cannabis organizations with which I work) as a resource for my community. It’s time to stop being afraid of a plant that humans have used for as long as we have had written records, has no lethal dose9, and has a much safer profile of use than most antidepressants10. If we continue to vilify and stigmatize this plant, it will not serve to protect our children. There are better choices we can make as a community and this unique time in our history offers us a great opportunity to do just that.
1Clark, C. S. (2021). Cannabis: A handbook for nurses (1st ed.). Wolters Kluwer Health.
2Hart, C. (2021). Drug use for grown-ups: Chasing liberty in the land of fear. Penguin Books.
3West, S. L., & O’Neal, K. K. (2004). Project D.A.R.E. outcome effectiveness revisited. American Journal of Public Health, 94(6), 1027–1029.
4Shen, H. (2020). Cannabis and the adolescent brain. Proceedings of the National Academy of Sciences, 117(1), 7–11. https://doi.org/10.1073/pnas.1920325116
5McGrath, J., Saha, S., Chant, D., & Welham, J. (2008). Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality. Epidemiologic Reviews, 30(1), 67–76. https://doi.org/10.1093/epirev/mxn001
6National Institutes of Health. (2020) Is there a link between marijuana use and psychiatric disorders? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/marijuana/there-link-between-marijuana-use-psychiatric-disorders
7Thys, F. (2022). Cannabis Control Board recommends lifting THC cap on solid cannabis concentrates. VTDigger. https://vtdigger.org/2022/12/24/cannabis-control-board-recommends-lifting-thc-cap-on-solid-cannabis-concentrates/
8Blount, B. C., et. al. (2020). Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. The New England Journal of Medicine, 382(8), 697–705. https://doi.org/10.1056/NEJMoa1916433
9Robinson, M. (n.d.). Here’s how much marijuana it would take to kill you. Business Insider. Retrieved January 16, 2023, from https://www.businessinsider.com/can-marijuana-kill-you-2016-11
10Rare and Potentially Serious Side Effects of Antidepressants. (n.d.). Verywell Mind. Retrieved January 16, 2023, from https://www.verywellmind.com/negative-effects-of-antidepressants-1067351