Now that marijuana is at a new level of scrutiny, here’s what the research says

“Illinois Democrats legalized marijuana,” proclaims a new billboard in Chicago. The ad, paid for by Gov. J.B. Pritzker’s campaign fund, takes credit for a change that polls show is supported by about two-thirds of Americans.

Chicago resident Sheila Hogan, one of the state’s 140,000 registered to use medical cannabis, believes in its power. She uses mild gummies before bed to ease the debilitating pain of spinal stenosis, allowing her to get back to gardening and pickleball.

“I couldn’t believe it,” she said. “It was remarkable. I was able to be so much more active.”

Despite support for legalization and the growing use of marijuana across the country, a recent Gallup poll found that a slim majority believe it negatively impacts both society and most people who use it. Yet it is still less harmful than tobacco and alcohol.

The changing perception of cannabis comes at a time when major changes are underway in the regulation of the drug.

The Biden administration has proposed reclassifying marijuana as less dangerous, making it legal with a prescription. Democratic presidential candidate Kamala Harris has called for decriminalization, while Republican candidate Donald Trump, who legalized hemp, has said he is open to decriminalization and that legalization should be left up to the states.

On the state level, more jurisdictions continue to legalize marijuana. Ohio became the latest state to do so, effective this year. Florida and North and South Dakota residents will vote on the issue on Nov. 5. So far, 24 states, representing a majority of the nation’s population, have legalized marijuana for adults, and most states allow some level of medical use.

With the country at a potential tipping point in its treatment of cannabis, what have we learned from its legalization and what does the latest research show about its effects?

Effects on public health

First, the sky hasn’t fallen in the states that have legalized it. A 2021 Cato Institute report found that the effects, both pro and con, have been fairly limited.

Proponents have suggested that legalization reduces crime, improves public health, and boosts the economy. Critics have argued that legalization encourages marijuana and other drug use, increases crime, harms public health, and harms children in schools.

But many of these claims were exaggerated and sometimes unfounded, Cato reported.

While adult marijuana use is at record highs nationally, teen use has not increased significantly in states that have legalized it, surveys show. In Illinois, the legal age to purchase marijuana is 21.

As for crime, murders and other violent crimes in Illinois have risen significantly since recreational use was legalized in 2020, before recently declining significantly. That was part of a nationwide trend that criminologists say was influenced by many factors, including civil unrest and the COVID pandemic. In an earlier study, the Cato report found no substantial increase or decrease in violent crime through 2018 in states that legalized.

Illinois also saw its traffic fatality rates rise in 2020 and 2021 before falling in 2022, again part of a nationwide trend fueled by the pandemic. A 2022 study found a 6% increase in injury crashes and a 4% increase in fatal crashes in states after legalization.

The number of edibles ingested by toddlers and the number of overdoses suffered by adults have also increased in Illinois since legalization. However, the overdoses are still much less common and less harmful than overdoses from other substances.

One major economic impact is that legal marijuana has generated substantial tax revenue: about $1 billion since 2020 for Illinois.

After administrative costs, 25 percent of that money goes to community reinvestment; 20 percent to substance abuse prevention and mental health treatment; 8 percent to local governments for law enforcement; and 45 percent to the state budget. Illinois has allocated $244 million to community programs from marijuana tax revenues.

Effects on individuals

Despite widespread claims about the effectiveness of marijuana use in treating a wide range of medical conditions, evidence for this is limited.

After an extensive review of its medical use last year, Health and Human Services concluded that marijuana use is justified for three conditions: anorexia associated with a medical condition; nausea and vomiting; and pain, particularly nerve pain.

The findings are consistent with the Food and Drug Administration’s previous approval of a synthetic derivative of THC, known as dronabinol, for treating nausea, vomiting and anorexia. The agency has also approved pure CBD, under the brand name Epidiolex, for treating a rare form of severe epilepsy.

But marijuana has been shown to have variable or inconclusive effectiveness for anxiety, inflammatory bowel disease, and post-traumatic stress disorder.

Anxiety disorder is a good example of the divided opinion on cannabis. Despite being one of the most common reasons people use the drug, the Illinois Medical Cannabis Advisory Board recently failed to recommend it as a qualifying condition in a tie.

Board member and family nurse practitioner Katie Sullivan said that with guidance, high doses of CBD, a non-psychoactive component of marijuana, with low amounts of THC (the part of marijuana that gets users high) can help some people with anxiety.

But a study of 12,000 patients found it didn’t help much for many and could cause parts of the brain to shrink, neurologist Amarish Dave warned.

“There is a real risk,” he said. “There are studies that suggest it can make it worse for a significant proportion of people.”

Now that people in Illinois can buy cannabis for any reason, they may be using it for anxiety without medical guidance. Board members agreed that Illinois needs better education of doctors and the public about the medical use of cannabis.

One of the benefits of marijuana is that it does not have the side effects of opioids, such as constipation or causing a fatal overdose. Many people use low doses occasionally without incident.

But modern commercial marijuana is much more potent than the street weed of the past. It can cause mild to moderate side effects, such as anxiety or, in rare cases, psychotic episodes.

Even more alarming, a study from the National Institute on Drug Abuse found that young men who are dependent on cannabis are at a significantly higher risk of developing schizophrenia.

And smoking or vaping can damage the lungs. One study found that cannabis use was linked to an increased risk of severe COVID-19.

The most popular non-psychoactive component of cannabis, CBD is generally well-tolerated by users, without the anxiety or other side effects of THC. It has been shown to help people with certain severe forms of epilepsy, although in high doses it can cause anemia, flatulence, and drowsiness.

A small study from the University of Colorado suggested that CBD was associated with improvements in cognition and emotional problems associated with Parkinson’s disease. Other studies have suggested potential benefits for ulcerative colitis, opioid withdrawal and sleep, but doctors say much more research is needed to substantiate widespread health claims.

Replan

Last year, at the request of President Joe Biden, the U.S. Department of Health and Human Services and the National Institute on Drug Abuse recommended reclassifying marijuana from Schedule 1 (the highest) to Schedule 3 on a scale of 5 that rates narcotics for their dangers and medical effectiveness.

At the federal level, marijuana is currently classified as a substance with no medical benefit and a high risk of abuse and addiction. This risk is even greater than fentanyl or methamphetamine, which, unlike marijuana, kill thousands of people each year.

Instead, pot would be classified as moderate to low dependence and would be legal for medical use with a prescription. It would allow for more research and would let marijuana companies take federal business tax deductions, making it easier to make money. Consumers would likely see little direct effect, since state law would still dictate where and how pot is legal.

At the local level, there is one aspect of Illinois’ medical program that angers both patients and doctors.

Cannabis patients in the state are still limited to obtaining their medical products tax-free from the 55 original designated medical dispensaries. Some of those companies, which operate a captive market, have lobbied to keep it that way.

Dr. Leslie Mendoza Temple, a member of the state’s cannabis advisory board, said the state should allow patients to pick up their medications at any recreational dispensary.

“The consistency of delivery to our medical patients has always been an issue,” she said. “It reduces compliance and trust in the program. Our medical patients who have built this program are being wiped out by market forces.”

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