Magazine article The Nation's Health

As Marijuana Decriminalization Spreads, Public Health Prepares: Health Effects, Regulations Examined

Magazine article The Nation's Health

As Marijuana Decriminalization Spreads, Public Health Prepares: Health Effects, Regulations Examined

Article excerpt

More than a dozen U.S. states have decriminalized the possession of marijuana, meaning it is no longer a criminal offense for someone to have small amounts of the drug, such as an ounce or less. States such as Colorado and Washington have gone even further--legalizing recreational use for adults 21 and older in 2012.

The public health implications that come with widespread decriminalization or legalization are beginning to surface as state health departments and scientific research attempt to stay in step with the trend.

Decriminalization has been supported by many health equity advocates because of disparities in law enforcement and imprisonment for marijuana possession among U.S. populations. Unequal arrests "force people into the criminal justice system and those with convictions have a difficult time getting jobs and the related access to health insurance," said Kathleen Hoke, JD, director of the eastern region for the Network for Public Health Law.

"Others say, 'We've worked for decades to fight against the scourge of cigarette smoking. Why are we embracing this substance?' Yet we don't have the same type of evidence we have with smoking. We never studied it this closely because it's an illegal product."

But emerging research already shows the potential short- and long-term effects of marijuana use on public health, with young adults a high-risk group. Young adults who use marijuana heavily as teens are more likely to become addicted, have altered brain development and perform poorly in school, according to a National Institute on Drug Abuse review published in June in the New England Journal of Medicine. Marijuana impairs driving skills and is often associated with motor vehicle accidents, particularly when combined with alcohol, said the review, which analyzed multiple studies on marijuana and its effects on health.

"It is important to alert the public that using marijuana in the teen years brings health, social and academic risk," said Nora Volkow, MD, a review author and director of the National Institute on Drug Abuse, in a June 4 news release. "Physicians in particular can play a role in conveying to families that early marijuana use can interfere with crucial social and developmental milestones and can impair cognitive development."

The risk to child health is of particular concern, especially with edible products containing marijuana that are not regulated on the same levels as the food and prescription drugs Americans use. Between 2005 and 2011, states that decriminalized marijuana saw a 30 percent increase per year in calls to poison control centers for children ages 9 and younger who consumed marijuana products, according to a June study in the Annals of Emergency Medicine.

Child poisoning is just one of the health concerns in Colorado, where safety of edible or infused-marijuana products is also a concern. There is no regulatory agency similar to the Food and Drug Administration to enforce edible manufacturing safety, as marijuana is still considered an illegal substance federally. Therefore, the burden falls on state and local agencies, said Tista Ghosh, MD, MPH, deputy chief medical officer and director of the Disease Control and Environmental Epidemiology Division for the Colorado Department of Public Health and Environment.

"You have people making these edible products, but are they using appropriate food safety practices?" Ghosh told The Nation's Health. "Then there's the maternal and child health issues. We've heard anecdotally that pregnant women are using marijuana products, so what is the effect on the fetus? From pediatricians, we're hearing anecdotally about breastfeeding moms using marijuana to help treat colic or calm fussy babies. And from geriatricians, we are hearing about older adult falls related to use. There's a variety of issues we never thought of."

With the new health concerns comes a need for adequate public health laws that address them. …

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