Defining the Cannabis Revolution

by Stephen Holt, MD, DSc

Distinguished Professor of Medicine (Emeritus)

Consultant to the Cannabis Industry

The Evolving Use of Cannabis

The increasing availability and support for the use of cannabis present important issues of medical, economic, social, legal and political significance. These challenging events form the basis of the “cannabis revolution” which has accelerated in its progression in recent times. As cannabis creeps toward the status of national legalization in the US, many people are attracted by its recreational use and medical treatment applications. As a consequence, a burgeoning cannabis industry is taking shape, but this industry is not always operating like the ethical pharmaceutical or nutraceutical industries.

Many people argue that the corporate culture of the cannabis industry will have to change and consolidation appears to be inevitable. Decisions to legalize or prohibit cannabis (marijuana) use in the US have triggered endless debates. These arguments are becoming somewhat futile as the US further evolves with the inevitable legalization and decriminalization of marijuana use. At the time of this writing, there has been legalization of cannabis for recreational use in the states of Colorado and Washington. This expanded use of marijuana has emerged with an increasing recognition of the medical benefits of cannabis.^1–6 These benefits are hard to dismiss and impossible to deny.^5,6

Current federal laws regulating cannabis use amount to a circumstance of “prohibition.” These federal regulations are increasingly perceived as “behind the times” due to their incorrect definition of cannabis as a drug without medical benefits. President Barack Obama has indicated that legislation and regulation of cannabis use should occur at the state level of government. Accusations have been made that these circumstances are a “cop-out” by the federal government. At the time of this writing, there are a couple dozen states that have passed legislation for the use of medical marijuana. This circumstance is creating some degree of confusion as each state legalizes cannabis with some differences in legislation and certain parochial restrictions.

The absence of consensus opinions on precise indications for the medical applications of cannabis may lead to different future legislation and regulations in some states.^5,7 At present, there is room for the potential clash of state legislation and federal government policy. Regulatory agencies run by the federal government have found themselves between “a rock and a hard place.” However, signs are developing that the federal government is “backing off” or acting like a “crocodile with no teeth.” A solution to these pending problems would be widespread acceptance of revised federal legislation that could be defined for cannabis legalization. However, this potential approach has been the subject of much disagreement, and it is unlikely to occur in the near future.

The former widespread “prohibition” of cannabis (marijuana) use as a result of the 1937 Marijuana Tax Act has led to an unfortunate lack of scientific studies on the biological actions of the many components of the cannabis plant and their effects on health and well-being.⁷ Up until about a decade ago, 90% of all cannabis research focused on the negative outcome of cannabis use.^5,7 Furthermore, a significant number of people have accused regulatory officials of “standing in the way of cannabis research,” even in recent times. There are some anticipated needs for change in the ever-evolving regulations concerning marijuana use. Political and legal systems will be challenged by some of these changes. Arguably, politicians should not be making unaided “medical decisions” about indications for cannabis use. That said, widespread concerns exist about the current lack of knowledge about cannabis science among the healthcare professions. This situation is compounded by shameful inertia in the planning of medical education on the science and application of cannabis.

The emerging landscape of the use of cannabis presents “information overload” for many people, including medical professionals.⁸ Rapid political reforms have created some degrees of misunderstanding and confusion among the general public. Such misunderstandings could impact the responsible use of herbal cannabis and related products. Therefore, urgent and widespread education is required on how society should apply the psychoactive and medicinal effects of marijuana. This education is necessary to ensure cannabis use in a safe and responsible manner. It is clear that the internet is playing a role in shaping the use of cannabis, but a significant portion of on-line (Internet) information about marijuana is inaccurate, biased, and sometimes incorrect. This situation hampers the broadcast of valid information to help guide the public on the use of cannabis. Moreover, illegal cannabislike products (synthetic pot) with major toxicity concerns are available for sale on the Internet.

The “cannabis revolution” has mounting support among the general public. For example, the Pew Research Center undertook a survey (March 2013) of the public support for medical cannabis legalization. This survey indicated that 52% of the public favored cannabis legalization versus 45% against legalization. It is apparent that there have been significant increases in the number of Americans who support marijuana legalization over the past few years, and current estimates are that 58% of the population of the US may favor medical cannabis legalization. While widespread support for medical cannabis use is growing fast, significant reluctance to support the legalization of cannabis for recreational purposes persists.

Pandora’s Box Has Opened

When it comes to the recreational and medical use of cannabis (marijuana), Pandora’s box has opened, or is opening, in many locations in the US. All that remains in the box is “hope.” “Hoping” for positive consequences of these circumstances, many people seem to be satisfied with current legislative changes, but some have shown disinterest, and several groups have formed to protest and stop further approvals of its availability. With cannabis legalization there are changes in the frequency of cannabis use and its selected composition with preferred types of cannabis that favor the use of high potency cannabis (rich in THC [tetrahydrocannabinol]).

One need not be blessed with the talent of a visionary to appreciate that greater strides in legalization and decriminalization of marijuana are “around the corner.” A principal feature of the “hope” that remains in Pandora’s box is an overriding desire to create circumstances that satisfy the dictum of Hippocrates: “Above all, do no harm.”¹ Harmful consequences of cannabis use do exist, even though many people have considered these risks to be low. That said, most young people think that cannabis is quite safe. Moreover, cannabis can contribute in specific circumstances to “harm reduction” or “harm production.” A key issue is the presence of harm that can occur in adolescent and teenagers. Prevention strategies should be applied to these youngsters.

The Revolution

The cannabis revolution involves global advances and fundamental changes in the acceptance of marijuana use over the past decade and rather precipitous legislation in some places in the US to accept legalization of its use. Once subject to general prohibition, cannabis consumption has blossomed into circumstances of increasing acceptance and widespread consumption with a “dual status” (legal or illicit). Depending on where people live in the US, cannabis is still viewed in a confusing manner as a legal or illicit drug.

Cannabis use is accompanied by a fundamental change in how many people think about this complex natural drug concoction (produced by the plant Cannabis sativa). I reiterate that major factors in its increasing popularity are the perceptions that marijuana is safe or even innocuous. Safety issues remain the basis of occasional ferocious debates among some politicians and scientists, but general opinions of safety have emerged. Perhaps it is more relevant to think about degrees of safety of use that are context specific. Furthermore, the emotional index on cannabis use by consumers is often “high,” especially for compassionate use in palliative care and for children with severe epilepsy. Like it or not, the electorate has tilted toward support for cannabis use.

The DEA’s Position on Cannabis

The Drug Enforcement Agency of the US (DEA) makes it clear that it does not recognize marijuana smoke as a medicine. Its negative opinions focus on smoking cannabis, which it describes as unsafe and having “not withstood the rigors of science.” The DEA has stated that it “will vigorously enforce the CSA (Controlled Substances Act) against individuals and organizations that possess, manufacture or distribute marijuana for recreational use, even if such activities are permitted under state law.”

I conclude my position statements by emphasizing the current and growing enigma of disagreement between state and federal government laws. While medical legalization of cannabis proceeds without apparent federal opposition, the federal government stands firm on its antimarijuana opinions. In further articles, I shall summarize aspects of the ongoing cannabis revolution.⁹

Notes

1. Institute of Medicine; Joy JE, Watson SJ, Benson JA, eds. First, do no harm: consequences of marijuana use and abuse. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academies Press; 1999.

2. Institute of Medicine; Joy JE, Watson SJ, Benson JA, eds. The medical value of marijuana and related substances. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academies Press; 1999.

3. Musty RE. Natural cannabinoids: interactions and effects. In: Guy GW, Whittle BA, Robson PJ, eds. The Medicinal Uses of Cannabis and Cannabinoids. London: Pharmaceutical Press; 2004.

4. Ministry of Health Welfare and Sports, Office of Medicinal Cannabis [Netherlands]. Medicinal cannabis: information for health care professionals [online document]. 2008. https://www.cannabisbureau.nl/en/doc/pdf/Information%20for%20Health%20Care%20Professionals%20(version%20October%202013)_18980.pdf.

5. Robson P. Therapeutic aspects of cannabis and cannabinoids. Br J Psychiatr. 2001;178:107–115.

6. Russo E. History of cannabis as a medicine. In: Guy GW, Whittle BA, Robson PJ, eds. The Medicinal Uses of Cannabis and Cannabinoids. London: Pharmaceutical Press, 2004.

7. Russo EB, McPartland JM. Cannabis is more than simply delta(9)-tetrahydrocannabinol. Psychopharmacology (Berl). 2003;165:431–432.

8. British Medical Association. Therapeutic Uses of Cannabis. Amsterdam: Harwood Academic Publishers; 1997.

9. Holt S. The Cannabis Revolution. AuthorHouse; forthcoming.

Stephen Holt, MD, DSc, PhD, LLD, DNM, is a best-selling author. He has received many awards for teaching and research. He holds the appointment as Distinguished Professor of Medicine (Emeritus) at the New York College of Podiatric Medicine and has many citations of his books and articles in medical literature.