Top Doctors Group Calls For Marijuana Decriminalization And Urges Better Evidence-Based Education On Cannabinoids

A new policy paper from the American College of Physicians (ACP) calls for the decriminalization of marijuana possession as well as increased resources to treat problematic use. It also promotes taking an evidence-based approach to medical education around cannabis and its health effects.

In the report, published this week in the journal Annals of Internal Medicine, ACP says that due partly to federal prohibition, “research into the potential therapeutic and adverse health effects of cannabis has been limited.” The group encourages “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,” the new paper says. It also calls for “evidence-based medical education related to cannabis and increased resources for cannabis use disorder.”

ACP, which represents nearly 161,000 internal medicine doctors, subspecialists and medical students, claims to be the largest medical specialty organization in the U.S. and has members from more than 168 countries.

“ACP strongly recommends adoption of policies to increase understanding of the effects of legalizing cannabis for medical and recreational use,” the paper says. “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.”

Aside from decriminalizing cannabis, some of the issues on which ACP is calling for reform include insurance coverage of evidence-based medical marijuana treatments, improved education for physicians and other health care providers, science-backed policies around delta-8 THC as well as shielding care providers from criminal liability or professional consequences for recommending or dispensing cannabis in accordance with state law.

“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,” the report says. “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,” it continues, “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.”

ACP says that a public health approach is necessary to address the legal, medical, and social complexities of cannabis use. ACP recommends policymakers to adopt a public health approach to prevent and control adverse cannabis-related health outcomes: https://t.co/jz3fVSelIT pic.twitter.com/rHu56urRAA

— ACP (@ACPIMPhysicians) July 22, 2024

ACP President Isaac O. Opole noted in a statement about the new policy paper that the “legal status of cannabis is changing rapidly.”

“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,” he said.

The new paper is the product of work by ACP’s Health and Public Policy Committee. Members conducted a review of academic literature and other sources of information on cannabis and hemp, including the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Substance Abuse and Mental Health Services Administration (SAMHSA), the National Academy of Medicine and the RAND Corporation.

The project resulted in the following recommendations:

1. 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.
2. 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.
3. 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.
4. 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.
5. ACP supports comprehensive insurance coverage of evidence-based treatments of cannabis use disorder.
6. 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.
7. ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of cannabis and cannabinoids.
8. 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.

“We need additional research into the health effects, so we have better evidence about its adverse effects and therapeutic uses,” Opole said in the ACP release. “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.”

ACP’s new policy paper comes only about a month after the American Medical Association (AMA) formally endorsed drug decriminalization more broadly.

At its annual meeting last month, AMA delegates voted in favor of the decriminalization proposal, 345–171, calling for the “elimination of criminal penalties for drug possession for personal use as part of a larger set of related public health and legal reforms designed to improve carefully selected outcomes.”

The position was a bolder one than what was included in the AMA Board of Trustees report that delegates initially took up. The prior policy statement simply said the organization should “continue to monitor the legal and public health effects of state and federal policies to reclassify criminal offenses for drug possession for personal use.”

Stephen Taylor of the American Society of Addiction Medicine (ASAM) reportedly proposed the revised AMA language. ASAM, which has historically aligned itself with prohibitionists and resisted modest marijuana reforms, came out in favor of drug decriminalization last year.

AMA’s new drug decriminalization position builds upon a broader drug policy reform platform that has developed over years. Last year, for example, the organization adopted positions advocating for psychedelics research, opposing the criminalization of kratom, calling for an end to the sentencing disparity between crack and powder cocaine and supporting the continued inclusion of marijuana metabolites in employment-based drug tests.

In 2022, AMA delegates also voted to amend its policy position to support the expungement of past marijuana convictions in states that have legalized the plant.

Following AMA’s call last month for drug decriminalization, an ACP delegate challenged some of the popular criticisms of an Oregon drug decriminalization law that officials rescinded earlier this year.

Marianne Parshley, a delegate for the American College of Physicians, said there are “several things wrong” with the assessment of Oregon’s decriminalization experience, pointing out that the reform was implemented at a time when fentanyl started become prevalent in the illicit drug supply, exacerbating the overdose crisis nationwide.

“It’s complex,” she said. “We need to pay attention to the fact that [the situation] doesn’t instantaneously change if you pass decriminalization and support for treatment.”

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