Maryland lawmakers are exploring the possibility of legalizing the recreational use of marijuana. But during a meeting Wednesday of the House of Delegates’ Cannabis Legalization Workgroup, some health experts warned against moving forward without both strong regulations and a public health campaign.
The majority of states have legalized some form of marijuana use, whether only allowing medical use or allowing adults to use it recreationally. Maryland’s medical marijuana program launched in 2017.
“The general perception of the risk and harm of cannabis use decreases post-legalization as it becomes more socially and societally acceptable,” said Taylor Kasky, director of policy and government affairs at the Maryland Medical Cannabis Commission.
However, use of the drug, particularly prolonged or frequent use, carries a number of risks, the experts told the lawmakers.
Less severe risks include an increased heart rate or a decrease in blood pressure, “which can be a concern for patients with unstable or significant cardiovascular disease,” said Patricia Frye, the medical director at Takoma Park Integrative Care, who also teaches Medical Cannabis Science and Therapeutics at the University of Maryland School of Pharmacy.
Frye also flagged more serious concerns, such as cannabis use disorder and cannabis hyperemesis syndrome, in which users experience repeated and severe vomiting.
Increasing the risks of these conditions are changes in the potency of the marijuana products on the market.
“This is not the same product that people were using 20 years ago,” said Susan Weiss, the director of the National Institute on Drug Abuse’s Division of Extramural Research.
She said a key difference between the marijuana used today and the drug used decades ago is the ratio of THC, the chemical that can create a high, to CBD, another component of the cannabis plant that doesn’t contribute to a high.
“I would point out that not just the THC potency is rising, but the CBD levels are very low and the ratio of these is getting greater and greater,” she said.
A higher ratio of CBD to THC can help offset some of the potential health risks associated with marijuana use, she said.
The other difference between marijuana use decades ago and today is the frequency with which people use the drug.
Twenty years ago, “people may have been occasional users — the average user may have smoked a few times over the weekend — and now people are using all day every day, and they’re using these very high potency products,” Weiss said. “And they’re becoming tolerant to them, so they’re really getting exposed to very high doses of THC.”
She said the risks are particularly great with teens and pregnant women.
The experts who spoke Wednesday did not oppose legalization. But they urged lawmakers to consider guardrails, such as “ensuring that there is a robust system in place prior to legalization, or at least in tandem with legalization, for public outreach and education about the dangers of cannabis, specifically for youth, you know, for the younger population, but really for everyone,” Kasky said.
She said there should also be compliance checks on dispensaries to make sure they are checking IDs, as well as penalties for dispensaries that illegally sell to minors.
Weiss said Maryland could establish rules for marketing and labeling marijuana products. The state could require health warnings on packages, like there are on tobacco products, or testing to make sure products don’t contain certain ingredients. It could also limit how much can be sold to one customer.
“The concern around full commercialization is obviously that it’s driven by the profit motive,” Weiss said. “Profits come mainly from heavy users and users who are addicted to the substance, and users who start young are more vulnerable to becoming addicted to the substance. So there’s incentive there to appeal to youth.”
As for who is crafting the regulations, Weiss said it’s important that health experts are a large part of that decision-making body, and that the industry doesn’t get too great a voice in setting the rules.
Kasky also urged lawmakers to set aside funding for more study.
“There is very much a need for improved, consistent data collection when we’re trying to assess the actual effects of legalization, and part of that is it’s all relatively recent, and so there isn’t good long term data,” Kasky said.
She said that research should start as soon as possible — before the drug is legalized — so that policy makers can compare marijuana use after it’s legalized to current use.