|
Abstract
|
Hall and Lynskey's masterful essay1 provides a comprehensive assessment of the public health consequences of recreational cannabis legalization, which wise policy‐makers will consider as they design regulatory systems. We urge US policy‐makers to recognize that recreational cannabis legalization changes the political environment in a way that creates an important public health opportunity: cleaning up the under‐regulated and frequently harmful US medical cannabis industry.
Medical cannabis legalization initially emerged as a political cause in California in the mid‐1990s. The explicit goal of many of its advocates was to pave the way for recreational legalization by exploiting both the public's compassion for seriously ill individuals and the public's trust in medicine. Of course, some individuals with serious diseases did access legalized medical cannabis and some of them may well have benefited from it. But the bulk of the “medical” customer base were young adult males with a long history of consuming cannabis along with a range of other drugs2. From a regulatory viewpoint, the system was medical in name only, functioning instead as an aggressively commercialized, quasi‐recreational cannabis industry.
California was not unique in this respect: in many states implementing or planning to implement recreational cannabis, “medical” providers operate both lines of business. Most of the states with legalized recreational cannabis thus have a pre‐existent medical industry that could be likened to a vestigial organ, except that it does significant harm, including but not limited to the following.
First, unlike a truly medical industry, the “medical” cannabis industry develops, promotes and sells drug products without submitting them to the Food and Drug Administration (FDA) for approval. So, physicians are in the awkward position of discussing drug products with patients without any reassurance that they are safe or effective. Lack of FDA approval and standardization for all but a few cannabis‐based products also means that physician recommendation letters cannot specify dose, frequency, route of administration, strength, or any other attribute. This means that vulnerable patients are being sent out to try drugs under the false belief that the normal protections they expect from the health care system are in place.
Second, the public may view cannabis dispensaries as analogous to pharmacies, but they are not subject to the regulation that make pharmacies beneficial. Any written advice from a physician in no way constrains what putatively medical cannabis products are dispensed to customers. Point‐of‐sale advice comes from “budtenders” who have no medical training. In this role, they sometimes give unsound advice, such as encouraging pregnant women to smoke cannabis3. Such potentially harmful advice is probably more likely to be followed than it would be in a strictly retail setting, because it comes wrapped in medical trappings.
Third, unlike in real medicine, individuals harmed by the “medical” cannabis industry have no right to redress. If following the medical advice of a physician caused a birth defect in a woman's newborn, she would have grounds to sue or petition for removal of the physician's license. But budtenders have no medical license to remove and are not responsible as physicians are for the advice they give. Similarly, in an industry that sells non‐FDA approved drug products, there is no way for a regulator to pull from all shelves a product that is discovered to cause detrimental side effects.
Fourth, medical cannabis product labelling, unlike FDA‐approved drug labelling, is loosely regulated and minimally enforced ...
Language: en |