Medical marijuana programs — Why might they matter for public health and why should we better understand their impacts?

Abstract

ObjectiveAlthough cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs — also vis-à-vis other psychoactive substance use — remain under-explored.MethodsWe briefly reviewed the emerging evidence on MMP participants' health status, and specifically other psychoactive substance use behaviors and outcomes.ResultsWhile data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and — to some extent — tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur.ConclusionMMP participation may positively impact — for example, by way of possible ‘substitution effects’ from cannabis use — other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms.

Measuring Protective Behavioral Strategies for Marijuana Use Among Young Adults

“…In addition, the benefits of medicinal marijuana are becoming better understood (Fischer et al, 2015). Long-standing barriers limiting medical and psychological research with marijuana and its derivatives are beginning to ease, thereby opening the way for scientific study of the therapeutic effects of the drug.…”

The Protective Behavioral Strategies for Marijuana Scale: Further examination using item response theory.

“…However, recent longitudinal studies have found that even long-term use of marijuana in young adulthood and adolescence has minimal lasting negative consequences on health factors traditionally believed to be negatively affected by use, such as asthma and poor lung functioning, complications related to cardiovascular health, and mental health problems like anxiety and depression (Bechtold, Simpson, White, & Pardini, 2015; Meier et al, 2016). Emerging research is also finding benefits to use of medical marijuana, such as in reducing nausea and vomiting, promoting weight gain, limiting intraocular pressure from glaucoma, decreasing frequency of epileptic seizures, and relieving symptoms of chronic neuropathic pain in conditions such as multiple sclerosis (Fischer, Murphy, Kurdyak, Goldner, & Rehm, 2015; Grant, Atkinson, Gouaux, & Wilsey, 2012; Koppel et al, 2014; Volkow, Baler, Compton, & Weiss, 2014; Whiting et al, 2015). …”

Cohort study of medical cannabis authorisation and healthcare utilisation in 2014–2017 in Ontario, Canada

“…Collectively, despite the legalisation of cannabis in many jurisdictions around the world,21 25 the evidence for medical cannabis in its crude herbal form10 11 16 (as opposed to highly regulated cannabis derived, pharmaceutical product) on healthcare resource utilisation outcomes in the both the short-term and long-term periods is sorely lacking 7–9. Future well-controlled clinical trials are needed to be able to fully elucidate its potential therapeutic benefits.…”

“…However, political and social influences have significantly hindered research efforts into the examination of medical benefits of cannabis,3 4 which has rendered much of the potential therapeutic benefit of cannabis5 as solely anecdotal in evidence. Currently, there remains a significant knowledge gap particularly around the health outcomes of medical cannabis use,6 and lack of rigorous large-scale cohort research,7 that underlines the discrepancies on the risks and benefits of cannabis consumption. Clarity of health outcomes of current authorised medical users of cannabis is needed to support physicians in evidence-based healthcare and to measure its impact on the healthcare system, particularly with cannabis legalisation 8.…”