Many doctors are reluctant to recommend medicinal cannabis due to a lack of knowledge. It is a subject that is not taught in medical school or specialist training. Additionally, much of the research we’ve read for years has been focused on harm, so it is vital for the medical profession to have policies that ensure public safety.
Below are some key public safety measures to consider when legalizing adult recreational use and medicinal cannabis.
Pediatric accidental overdose or intentional distraction
In order to regulate the medical market, it is important to ensure access for legitimate patients, both adults and children, while preventing access by minors for illicit use and accidental exposure in pediatric patients. The potential harm to adolescents in terms of cannabis addiction is almost four times greater than that of adults. There are also concerns about the danger related to chronic cannabis exposure in the developing brain of adolescents. Unfortunately, some studies suggest that up to 40% of teenagers get their marijuana from a legal medical cannabis patient.
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In addition, states that have legalized recreational cannabis for adult use have increased accidental overdose and exposure in children and adolescents by approximately 30%. And for children, because of their height and weight, even a relatively small or “normal” dose for an adult is potentially an overdose for a child. And while cannabis exposure and overdose is nowhere near as dangerous as an opioid overdose, it still needs to be taken very seriously and considered when following public safety regulations. Therefore, it is vitally important to put regulations in place to stop this potential distraction and exposure to our minors. Measures such as maintaining safe distances from pharmacies to schools, banning cannabis use in public places, and allowing pharmacies to only be open to qualified patients by requiring their ID are important controls to consider. In addition, edible products must not look like candy packaging and it is ensured that all these items are packaged in a child-proof manner. As well as patient training on how to keep medical cannabis out of the reach of children and contain them like all prescription drugs.
The next critical issue to require regulation is the potential for impaired driving ability when using medicinal cannabis. Looking at Colorado, particularly since adult use was legalized in 2012, there was a 40% increase in fatal accidents between 2013 and 2016, with 69% of drivers involved above 5 nanograms by 2016, according to the National Highway Traffic Safety Administration had (ng) cannabis on board and no alcohol in their system. In purely medical states, this should theoretically be a smaller number of total users, but it’s still important to have the legal framework to protect all citizens. Laws stating what amounts, if any, of cannabis are safe for medical patients to drive should be formulated and regulated at the time of legalization.
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In addition, determining cannabis levels is much more complex than determining alcohol levels. There must be rules for these test problems for drivers with uniform standards and protocols. Certifying physicians should spend a lot of time educating their patients about the potential dangers of cannabis use and driving, as we do for alcohol. Consideration should be given to creating regulations on warnings on cannabis products about impaired driving ability. Funding should be made available for public health campaigns that also address the issue of safe and impaired driving related to cannabis.
Quality and safety of cannabis products
And as a doctor, the last but not the least important issue that I believe is vital to the regulation of medical cannabis is testing to ensure the quality and safety of the cannabis products themselves. Due to federal illegality, states cannot rely on agencies like the FDA or the EPA to ensure standards are met. States must enact their own regulations to establish best practices to ensure safety standards for cannabis products that protect their medical patients.
The creation of regulated and uniform quality standards for botanical medicinal products is difficult due to the high variability in the cultivation of these plants. Regulations that address safe and acceptable levels of potential contaminants, as well as precise amounts of cannabinoids in products, and then validate them through independent, regulated testing laboratories and third-party protocols, are even more important to medical patients. Inhaled cannabis medications can pose potential risks due to possible bacterial or fungal contamination, especially for immunocompromised patients such as cancer patients.
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The lipophilic nature (i.e., high fat content) of cannabis may require extraction processes using organic solvents that may involve the use of potentially harmful and even carcinogenic solvents. Therefore, the regulation of analytical laboratories, testing and labeling requirements, and published Certificates of Analysis (CoA) are very important in the medical markets. And both patients and doctors need assurances.
These are all important measures for policy makers to consider as more states move towards full legalization.
Dr. Leigh Vinocur is a state-certified emergency doctor who also runs a cannabis consultation practice for patients and industry. She is a member of the Society of Cannabis Clinicians and a first-grade graduate with the country’s first Masters of Science in Medical Cannabis Science and Therapeutics from the University of Maryland School of Pharmacy.
This blog is not written or edited by Hearst. The authors are solely responsible for the content.