The recent upsurge in medical and recreational marijuana laws is creating novel public health concerns for physicians, health advocates, and state regulators alike. Implications of the new laws include packaging risks, accessibility to children, dosage dangers, and the potential for greater drug-related traffic injuries.
Now "is really the time for public health [leaders] to engage on some of these issues" surrounding changes in state laws regarding marijuana use, Colorado Assistant Attorney General Eric Kuhn said during an American Society of Law, Medicine, and Ethics webinar on the expansion of medical marijuana laws. Twenty-one states and the District of Columbia have legalized medical marijuana, and eight other states are considering legislation in 2014. Two states – Colorado and Washington – have legalized recreational use of marijuana. Most recently, Florida legislators overwhelmingly voted in May to legalize a strain of marijuana for limited medicinal use. The bill is now in the hands of Florida Gov. Rick Scott.
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Public health officials are struggling to determine how best to regulate the drug and ensuring that accessibility does not lead to related harms.
Health challenges include how best to regulate the drug and to ensure that accessibility does not lead to related harms. Purity and packaging of marijuana are already posing significant worries for states that allow use of the drug, said Mr. Kuhn, who is a National Attorneys General Training and Research Institute/Robert Wood Johnson Foundation public health fellow and the author of a paper about public health issues related to marijuana legalization.
Marijuana samples "have been found to be contaminated with pesticides, herbicides, mold, fungus, bacteria, viruses and other contaminants," he said. Further, "a public health department can’t certify that a product, inherently adulterated with a schedule I substance, is pure."
"The emerging hazards of edibles [are] just beginning to get recognition," Gordon Smith, professor of epidemiology and public health at the University of Maryland, Baltimore, said during the webinar. Of particular concern is the inability to regulate dose. "The standard dose might be an eighth of a brownie. ... Who on earth eats an eighth of a brownie?
Edibles also pose driving risks. "You may start driving and feel fine and then a half an hour later, once the edible starts to get absorbed and have an effect, you start to become very intoxicated," Mr. Smith said. "You really can’t control the dosage."
Some marijuana packages have been labeled to resemble candy and have names similar to those of candy bars. A 2013 analysis of a large Colorado children’s hospital showed that before Sept. 30, 2009, there were zero cases of marijuana ingestion by pediatric patients. After that time, there were 14 cases of marijuana ingestions by children at the hospital, according to a study published in JAMA Pediatrics (2013;167:630-3). The study was conducted before the state’s January recreational marijuana law went into effect but after medical marijuana was decriminalized.
Physicians and health centers are integral to research and safety analyses of medical and recreational marijuana use, health experts said. For instance, more marijuana testing of injured patients by emergency care providers is necessary to determine the role cannabis is playing in traffic crashes, Mr. Smith said.