by 
A new scientific report shows that the gap between federal and state cannabis regulations is leading to emerging public health problems
Jim Mone/AP
hide caption
change caption
Jim Mone/AP
More than half of all US states have legalized cannabis, whether for medical purposes, recreational use or both. Cannabis dispensary shelves offer an ever-increasing selection of gummies, drinks and joints.
Meanwhile, the federal government still considers most types of cannabis illegal.
A new report from the National Academies of Sciences, Engineering and Medicine, released this week, finds that this divide between the states and the federal government leads to fragmented policies and risks to the public.
As states built new commercial markets for cannabis, they initially focused on regulating sales and revenues. “As a result, public health aspects often took a back seat and we are now catching up,” says Dr. Steven Teutschchairman of the committee of the National Academies that wrote the report on the impact of cannabis on public health.
The report calls for federal leadership and national standards on cannabis quality and potency to protect public health.
Here are five takeaways:
1. In the US, people consume cannabis more often than alcohol
More American adults reported using cannabis almost daily than alcohol in 2022, according to the National Survey on Drug Use and Health. It was the first time that regular marijuana use exceeded regular alcohol use.
Regular cannabis use has increased explosively over the past thirty years: from less than 1 million people who used cannabis almost daily in 1992, to more than 17 million in 2022.
Marijuana has become more accessible as it has gained legal status in many states. About two-thirds of people aged 12 and over consider it “fairly easy” or “very easy” to obtain. And the price has also fallen, in terms of the unit price of delta-9-tetrahydrocannabinol, or THC – the main compound responsible for the psychoactive effects.
2. Weed and vapes can be super powerful and that isn’t always revealed
The concentration of THC in cannabis flowers has increased over time. “I think most people are aware of the phenomenon that ‘this isn’t your grandpa’s weed’… I hear this all the time,” says Staci Gruber of Harvard-affiliated McLean Hospital. told NPR in 2019.
And while smoking dried cannabis flower is still the way most people consume weed, there has been an increase in cannabis edibles, vape oils and other products, says Dr. Yasmin HurdDirector of the Addiction Institute at Mount Sinai and Vice Chairman of the NASEM Commission.
“There are now concentrates such as dabs, wax and shatter that contain very high concentrations of THC, even between 60% and 90%,” she says. Hurd spoke at a press conference Thursday announcing the release of the report.
Higher THC concentrations make it more likely that people will take more than they intend, which has contributed to more traffic accidents and hospital visits related to cannabis use, Hurd says.
While many states with legalized cannabis use have placed limits on the amount of THC in gummies and other edibles, those rules often do not apply to other cannabis products, according to the report.
3. You can get psychoactive hemp products even in states where cannabis is illegal
Cannabis does classified as a Schedule I substance by the U.S. Drug Enforcement Administration, meaning the federal government considers it a drug with a high abuse potential and no accepted medical use.
Thanks to the 2018 Farm Bill – which defined a subset of cannabis as hemp and excluded it from the Controlled Substances Act – there has been a boom in products containing hemp-derived chemicals. These include CBD and delta-8 THCa psychoactive substance extracted and synthesized from CBD, and they can be sold in states that have not legalized cannabis.
These have circumvented regulations, although some of these chemicals have been processed to increase their psychoactive properties. US health officials from the CDC And FDA has warned about health and safety risks.
The report recommends that Congress close this loophole by specifying that all intoxicating forms of cannabis – including those derived from hemp – are subject to regulation.
4. Cannabis research is suppressed
Scientific research into the health effects of cannabis has made little progress in recent years because there are enormous barriers to studying the drug.
Because cannabis is classified as a Schedule I substance, researchers are often unable to obtain it for research. Even if they can, they have to deal with all kinds of strict rules.
The White House Office of National Drug Policy is not allowed to investigate the consequences of legalizing cannabis, even though that has already happened in many states.
Earlier this year, the DEA proposed to reclassify cannabis as a Schedule III drug, such as ketamine – a drug with recognized medical uses, low to moderate potential for abuse, and fewer restrictions.
The report also recommends that Congress lift restrictions on research for the Office of National Drug Policy.
5. Cannabis can be dangerous, but people hear more about its benefits than its risks
People often think cannabis will be less dangerous once it’s legalized, Hurd says.
But many people are not fully informed about the potential harm. “The risks associated with THC consumption – psychosis, suicidal ideation, cannabis use disorders – increase as the dose increases,” says Hurd.
There are more children and young adults now seeing pro-cannabis messages through advertising, and the cannabis industry lobby is becoming increasingly influential – successful in crushing efforts to limit THC concentrations in Washington, for example, or to limit the use of pesticides on cannabis farms in Colorado, according to the report.
“We really need to approach cannabis from a public health framework,” wrote Dr. Pamela Ling, director of the UCSF Center for Tobacco Control Research and Education, said in an email after reading the report requested by NPR.
“The good news is that we don’t have to start from scratch. We have models of best practice in tobacco control and alcohol that can be applied to cannabis – especially in relation to marketing restrictions, age restrictions, the retail environment, taxation and ways to reduce access for young people,” she says.
The report also recommends public health campaigns that describe the risks, especially for children and young adults, pregnant women and the elderly. And it calls for training cannabis retail staff to talk knowledgeably about the risks and benefits to customers.
