At the end of August, the U.S. Surgeon General released an alarming advisory. Although cannabis (known more colloquially as weed) has long been considered one of the “safest” drugs by users, especially as more and more states implement medical and recreational cannabis policies, the Surgeon General warned that cannabis remains associated with health risks for pregnant and adolescent users. One of the main reasons that this is true: Today’s weed and the weed of decades past are like apples and oranges — so different that comparisons don’t help much at all.
Approximately 24 million Americans used cannabis in the past year, double the number of Americans who used the drug 10 years ago. Ten percent of weed users say they use it for medical purposes based upon the small but growing body of evidence supporting the use of medical cannabis for a limited number of conditions. But critically, cannabis strength, or potency, is on the rise as well. There is an important and concerning disconnect between the drugs Baby Boomers may remember from the 1960s and the weed more common today.
There is an important and concerning disconnect between the drugs Baby Boomers may remember from the 1960s and the weed more common today.
Weed in the 1960s, '70s and '80s typically contained 3 to 4 percent THC, the active ingredient in weed that is responsible for the “high” that users experience. Recent reports indicate that weed available in dispensaries in medical cannabis states range from 17.7 percent to 23.2 percent THC, a startling increase. Meanwhile cannabis concentrates — often referred to waxes, shatter or oil — is much stronger than regular cannabis flower, and THC concentrations in these products may reach 80 to 90 percent THC. These trends are on a collision course, with potentially disastrous results.
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The Surgeon General’s warning is a response to these developments. Our brains develop into our mid-20s, so exposing young people to increasingly potent weed may have harmful consequences. Although often disputed, weed use can be addictive and studies show risk for addiction rises with increased potency. The relationship between potency and other adverse outcomes like anxiety and psychosis is less well defined, but it is likely that increased potency will lead to increased risk of these problems as well.
The risks of weed use are magnified because people still aren’t aware of them. Although adult use and youth use have remained relatively flat in the context of changing policies, perception of risks among both adults and youth has plummeted in recent years. Declining rates of risky drinking and cigarette smoking among young people suggest that we have the ability to educate effectively on risk-taking behaviors, but we have yet to master the complex messages needed to educate our kids about weed. For example, it is challenging to acknowledge that cannabis is less dangerous than fentanyl while helping them understand that weed may still be harmful to them.
There is also the historical narrative, popularized by movies, advocacy groups and users themselves, that weed is safe and even good for you. The ubiquity of weed coupled with its increasing legalization has fueled this narrative, as well as its popularity among artists and celebrities.
Although adult use and youth use have remained relatively flat in the context of changing policies, perception of risks among both adults and youth has plummeted.
Continued problems with edibles also underscore the need for better education. Many see edibles as a safer way to try weed, but they aren’t aware of how dosing works. A typical weed brownie contains 100 mg of THC and the average serving size is 10 mg, or 1/10th of a brownie. Most of us eat a whole brownie when it’s time for dessert, so many people don’t realize that only a small fraction of the brownie should be eaten.
And the effects of weed differ depending on whether a person ingests it or smokes it. Smoking weed usually results in effects within minutes that peak after 15-30 minutes. Eating weed results in effects after 30 minutes and they can last for hours. This can lead to confusion as people who normally smoke weed think something is wrong and eat too much of the brownie in an effort to overcompensate for the delayed effect of the drug.
The same scenario has played out over and over across the country: People consuming much higher doses of THC than anticipated end up intoxicated with high heart rates, slurred speech, anxiety and paranoia. These patients won’t die from a weed overdose, but such an unpleasant and scary experience is entirely avoidable.
As a country, we are in a difficult spot — and it’s largely of our own making. We have 33 states and the District of Columbia with medical cannabis policies and 11 states and D.C. with legalized recreational cannabis policies; more states are not far behind. There is no turning back the forces of increasingly liberal cannabis policies. But increasing legal access to weed does not and should not imply that weed is risk-free.
There are two key steps that we can take to achieve this. First, we need sensible, evidence-based education on weed for all stakeholders, including young people and health care professionals, to bridge the gap between the science of cannabis and public perception. Canada has done a commendable job in this area. Second, we have to work diligently to advance the science at a rate and scale that matches the incredible level of interest in weed products right now. The National Institutes of Health funds the bulk of this research, while states and companies that are profiting from weed products have, for most part, failed to contribute.
Ultimately, just because something is Iegal doesn’t mean we should use it whenever, however and with whomever we want. It’s a lesson we’ve learned the hard way with alcohol and cigarettes, among other products. Let’s not make the same mistakes here.