More Legal Weed, More Problems (For Physicians): Ethicist

This transcript has been edited for clarity. 

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine. 

Marijuana in the US has had quite a history. It's been viewed as a gateway drug to heroin, opioids, and addiction. It's been seen historically as something that drives people into uncontrollable, dangerous behavior. Some may remember seeing films way back from the 1920s and '30s, excerpts about reefer madness. It has wound up on the highly regulated Schedule I list of drugs since, I think, the Nixon administration, as a dangerous substance. 

We all know that there's been a huge push to change policy at the state level. Many states have added access to marijuana for medical purposes and allowed that to happen. Other states, some driven by referendum, have had recreational use legalized. It's fair to say that in nearly all parts of the country, the cops aren't prosecuting people for smoking a joint out in the street. They're probably not even paying much attention if you're growing it at home or in your garden anymore. It's just become something that slowly is being decriminalized, slowly is being normalized. 

I don't oppose that shift. The problems and dangers are not such, I think, as to treat this on par with heroin or opioids. It's just not that kind of a substance. On the other hand, I've long argued that we don't know enough about use and we don't know enough about its dangers for doctors and health professionals to counsel people about marijuana use. 

What don't we know? Well, for one thing, when you legalize marijuana, you're letting it be grown under controlled conditions.

What that means is some of the old worries about getting respiratory diseases from fungi and things that got into marijuana are not there anymore. That's good news. The bad news is it's more potent. People used to think, I'll just smoke something, and maybe I'll have to do that a little bit more to get a high. 

Today, the level of THC, the chemical that makes you high from marijuana, is much more present. You're gonna get a bigger bang for the buck. When the government grows it, when commercial entities sell it, we're in a different world of potency, and I don't think people understand that. 

Is it the same for gummies as it is for smoking as it is if you bake something into a product? We don't know. How much could you use before you got impaired to the point where you shouldn't be driving or engaged in the proverbial "don't operate heavy equipment" warnings? We don't know. 

We've never set standards for where it's safe to use marijuana out in public roles, in roles where others might be dependent upon you for their health and safety. We have it for alcohol but we don't really have it here. 

Also, if you're a really heavy user, we're starting to learn that there can be conditions caused by chronic regular use. There's something called cannabinoid hyperemesis, which just means a weakening of the esophageal tissue and flaps. People are starting to get vomiting, starting to get dehydration, starting to get dangerous symptoms and reporting to ERs when they are chronic users.

I think it's important that doctors tell patients there are side effects and dangers to marijuana use. It's not nothing. We don't really understand how different people will respond to different potencies, so keep that in mind. You may want to try it at home before you go out and try it somewhere and get yourself in some kind of trouble.

It's not a good idea to smoke marijuana and drive, or to engage in other behavior where you might put other people at risk. It may impair you. I'm not saying it always does, but we don't really know. If you're going to use it and use it regularly, particularly be alert as related to the impact on kids and the impact on people who seem to be high responders. You can get pretty sick if you're a chronic user, and you might even get psychologically dependent if you're just a regular user.

I'm not for bringing back the old laws, and I don't think we need to have people prosecuted for the sale and use of marijuana, but, like many other things that medicine encounters, physician education and comment — if somebody says "I use this" — is going to become very important as we see more access through deregulation.

I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.