ACP Calls for Evidence-Based Public Health Approach to Cannabis Regulation In Newly Published Paper

WASHINGTON July 23, 2024—A public health approach is necessary to address the legal, medical, and social complexities of cannabis use, says the American College of Physicians (ACP) in a new policy paper released today. “Regulatory Framework for Cannabis: A Position Paper from the American College of Physicians,” published in the Annals of Internal Medicine, issues recommendations to policymakers on adopting a public health approach to prevent and control adverse cannabis-related health outcomes.

“The legal status of cannabis is changing rapidly,” said Isaac O. Opole, MBChB, PhD, MACP, president, ACP. “We need to ensure that regulations are based on a public health approach in jurisdictions where it is legal and that they include consideration of prohibiting use among young people and unsafe use among adults.”

Among the recommendations, ACP supports rigorous research into the health effects, potential therapeutic uses, and the impact of legalization on cannabis use. Additionally, ACP calls for the decriminalization of possession of small amounts of cannabis for personal use to help address systemic inequities and promote a treatment-focused alternative to criminal penalties for substance use disorders. The policy paper goes on to outline a public health approach to controlling cannabis in jurisdictions where it is already legal. ACP also calls for insurance coverage of treatment for cannabis use disorder and incorporating information about cannabis into medical education.

“In part, due to the drug’s complicated legal status, clinicians have limited evidence about the effects of cannabis use, despite the drug’s prevalence,” remarked Dr. Opole. “We need additional research into the health effects, so we have better evidence about its adverse effects and therapeutic uses.”

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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram and LinkedIn.

https://www.acponline.org/acp-newsroom/acp-calls-for-evidence-based-public-health-approach-to-cannabis-regulation

Regulatory Framework for Cannabis: A Position Paper From the American College of PhysiciansFREE

Authors: Ryan Crowley, BSJ, Katelan Cline, BA, David Hilden, MD, MPH https://orcid.org/0000-0003-4509-2108, and Micah Beachy, DO Health and Public Policy Committee of the American College of PhysiciansAuthor, Article, & Disclosure Information

Publication: Annals of Internal Medicine

https://doi.org/10.7326/M24-0638

PDF/EPUB

Abstract

Cannabis, also known as marijuana, is the dried flowers, stems, seeds, and leaves of the Cannabis sativa plant. It contains more than 100 compounds, including tetrahydrocannabinol, which has psychoactive effects. Federal law prohibits the possession, distribution, and use of cannabis outside limited research activities, but most states have legalized cannabis for medical or recreational use. However, research into the potential therapeutic and adverse health effects of cannabis has been limited, in part because of the drug’s federal legal status. In this position paper, the American College of Physicians (ACP) calls for the decriminalization of possession of small amounts of cannabis for personal use and outlines a public health approach to controlling cannabis in jurisdictions where it is legal. ACP recommends the rigorous evaluation of the health effects and potential therapeutic uses of cannabis and cannabinoids as well as research into the effects of legalization on cannabis use. It also calls for evidence-based medical education related to cannabis and increased resources for treatment of cannabis use disorder.

Public policy on cannabis is changing rapidly as several states have legalized the drug for medical and recreational use even though its possession, use, and distribution remain illegal under federal law. Supporters believe that liberalizing cannabis laws would increase understanding of its potential therapeutic value, establish a regulatory regime to prevent unsafe or contaminated cannabis products, and raise tax revenue. They also argue that it would undermine the illicit market, reduce criminal justice costs, and provide a step toward achieving equity and justice in communities hit hard by punitive drug laws (1, 2). Opponents raise concerns about increased use among young people, higher prevalence of impaired driving, polysubstance use, societal normalization of a once-illicit drug, and the potential negative health effects of cannabis use, particularly on the cognitive development of adolescents, among others (3).

In 2008, the American College of Physicians (ACP) published “Supporting Research Into the Therapeutic Role of Marijuana” (4), which offered recommendations to better understand the health effects and potential medical use of cannabis. In a 2017 position paper (5), the College called for “research on the individual and public health effects in states that have legalized or decriminalized the use of marijuana and the effectiveness of regulatory structures in those states that may minimize any adverse health effects, especially on children and adolescents.” The current position paper considers the complicated legal status of cannabis, its potential therapeutic uses, and its negative health effects and offers recommendations to policymakers on adopting a public health approach to prevent and control adverse cannabis-related health outcomes. It also calls for additional research into the potential therapeutic benefits of cannabis and cannabinoids and policies to correct injustices resulting from drug control policies that have unfairly affected systemically marginalized racial and ethnic populations.

Methods

The Health and Public Policy Committee of ACP, which is charged with addressing issues that affect the health care of the U.S. public and the practice of internal medicine and its subspecialties, drafted this policy brief. The Committee scanned available English-language peer-reviewed studies, reports, and surveys on cannabis and hemp-derived products identified by searching PubMed; Google Scholar; journals, including Annals of Internal Medicine, the Journal of the American Medical Association, and Health Affairs; U.S. government agency websites, including those of the Centers for Disease Control and Prevention, Food and Drug Administration, and Substance Abuse and Mental Health Services Administration; and websites of think tank and research organizations, such as the National Academy of Medicine and RAND. Inclusion preference was given to data-driven sources, although opinion or commentary pieces were included to describe the policy environment. On the basis of this review, the Committee drafted recommendations with input from ACP’s Board of Governors, Board of Regents, Council of Early Career Physicians, Council of Student Members, Council of Resident/Fellow Members, and Council of Subspecialty Societies. The policy brief and recommendations were approved by the Health and Public Policy Committee on 3 March 2024 and by the Board of Regents on 16 April 2024.

Recommendations

ACP supports rigorous research into the effects of legalizing cannabis on its use (including prevalence, frequency, and intensity of use) among older adults, adults, adolescents, and children; prevalence of cannabis use disorder and other behavioral health conditions; motor vehicle injuries and impaired driving; poisonings; and other adverse outcomes.

ACP recommends that possession of small amounts of cannabis for personal use be decriminalized. ACP calls on policymakers to take an evidence-informed approach when considering amending the legal status of cannabis.

ACP supports an evidence-based public health approach to addressing cannabis and hemp-derived products (including low-tetrahydrocannabinol cannabidiol and Δ-8-tetrahydrocannabinol products) in jurisdictions where they are legal, with a focus on prohibiting access to minors and preventing unsafe use among adults.

ACP supports sufficient resources for cannabis-related public health activities, oversight, and regulation. The U.S. Food and Drug Administration and other federal, state, local, and tribal agencies should receive necessary resources to regulate cannabis products.

ACP supports comprehensive insurance coverage of evidence-based treatments of cannabis use disorder.

ACP supports the development of evidence-based medical education on the health effects of cannabis and cannabinoids. Cannabis content should be incorporated into substance use curricula at all levels of physician education.

ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of cannabis and cannabinoids.

ACP reiterates its strong support for exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who recommend, prescribe, or dispense cannabis in accordance with state law.

Conclusion

ACP strongly recommends adoption of policies to increase understanding of the effects of legalizing cannabis for medical and recreational use. A robust public health approach to controlling cannabis should be implemented in states where it is legal, with attention toward prohibiting use among young people and preventing unsafe use among adults. Educational resources should be made available to physicians so they can provide accurate information about the health effects of cannabis and care for patients with cannabis use disorder. Extensive research into the health effects of cannabis use must be done, including on potential harms when used by older adults and more medically complex populations. Finally, to address the disproportionate effects of aggressive drug control policies on marginalized racial and ethnic populations, ACP calls for the decriminalization of possession of small amounts of cannabis for personal use.

Read full paper

https://www.acpjournals.org/doi/10.7326/M24-0638

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ACP Calls for Evidence-Based Public Health Approach to Cannabis Regulation In Newly Published Paper

Regulatory Framework for Cannabis: A Position Paper From the American College of PhysiciansFREE

Abstract

Methods

Recommendations

Conclusion

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