Steps Should be Taken to Improve Safety of Medicinal, Recreational Marijuana

Cannabis potency could be regulated to reduce side effects.

In many countries, marijuana is becoming largely legalized for both medicinal and recreational purposes. Experts in a Personal View article published by The Lancet Psychiatry are now advising that researchers and policymakers search for ways to make the drug safer.

The authors recommend regulating the potency of cannabis to reduce the co-use of tobacco, and investigate how the drug can be altered to reduce harm. Over the past few decades, cannabis has become more potent, and many individuals have sought treatment for cannabis use disorder in Europe, the UK, and the United States.

While restrictive laws were placed on the drug during the 1960s, cannabis use has increased, which suggests that the current laws are ineffective at deterring use, according to the study. Uruguay and some US states allow cannabis to be sold for recreational use, while Canada is expected to legalize the drug this year. Additionally, multiple European countries have lessened or removed sanctions of cannabis use/possession.

Cannabis contains the active compounds delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Other studies indicate that CBD can protect against THC-related side effects, such as memory impairment and paranoia, but high potency cannabis can have low or absent levels of CBD, which may pose harm.

The study authors suggest that exploring harm reduction in cannabis use should be explored further. Particularly in Europe, cannabis is frequently used alongside tobacco, which poses additional harm and addiction risks to users.

In countries that have legalized cannabis, the authors advise regulatory and government agencies to address potency concerns. In states where cannabis is legalized, THC is unregulated, and extremely potent products have become popular, according to the study.

While policymakers in the Netherlands and Uruguay have proposed limiting THC content to 15%, more evidence is needed to implement the regulations. The study authors suggest that taxing cannabis in line with THC content may be an effective way to keep potency down.

However, the authors note that these suggested strategies may do little to deter high potency cannabis, because many recreational users prefer a higher THC content. Increasing CBD content in cannabis could reduce harm associated with high THC content without reducing effects, and may present an effective approach.

Additional research is needed to determine any harm linked to THC and CBD content, and may contribute to safe use guidelines, according to the study.

"Although most users will not develop problems from their cannabis use, it is vital, especially now that cannabis is becoming increasingly liberalised [sic], that we explore alternative and innovative ways by which we can reduce and mitigate cannabis related harms," said lead study author Amir Englund, PhD. "With the rapidly changing political climate around cannabis, the demand to effectively reduce cannabis-related harms has never been greater, and more research is urgently needed to inform policy decisions. A strategy based on increasing the content of CBD in cannabis might be especially promising because CBD can offset several harms associated with cannabis without compromising its rewarding effects."

These recommendations are important, since a growing number of individuals have begun seeking medical cannabis treatment for certain conditions. Altering cannabis to increase or decrease the active ingredients in the drug could improve medicinal treatments by improving symptom management and reducing side effects.

"In the last 8 years, the number of people in the UK entering specialist treatment for cannabis increased by over 50%. During the same time period, street cannabis has become increasingly strong with high levels of THC and little or no CBD,” said study co-author Tom Freeman, PhD. “Further research on CBD is now needed -- both to investigate its potential role in mitigating the harmful effects of THC in cannabis, but also as a potential treatment for the minority of people who develop problematic cannabis use. Efforts to reduce the common practice of mixing cannabis with tobacco could potentially prevent people progressing to nicotine dependence, providing a substantial benefit for public health."