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Medical cannabis is now actually in 2018 in the hands of Maryland residents, after years of procedural and political delays. Recreational use of “marihuana” is legal as of January 1st in California, the state where the liberalization began with the legalization of “medical marihuana” in 1996. Other states have also changed their laws to make cannabis more available to medical and recreational users. I believe that some clear benefits will result from these changes, but important problems will be exacerbated as well. Here are my current best guesses about what to watch for.

I think that the most pressing issue will be impaired driving while under the influence of cannabis. Because cannabis binds to body fat and stays in the system for so long, setting blood levels which correspond to impairment is not as straightforward as is the case for alcohol. Furthermore, the impairment is more pronounced when a person mixes cannabis with alcohol. Advertisements are already being published in wine-making areas of California promoting the pleasure of combining these substances.

A good resource for exploring this issue further is a website established by my colleague, Dr. Robert DuPont at Stopped Drug Driving, He describes how this problem has been growing and highlights the importance of public education and research about ways to address its complexities.

A more insidious problem is the in-utero exposure of fetuses to cannabis ingested by their mothers. While the dangers of in utero alcohol exposure have been extensively studied, the impact of cannabis is in the early stages. An increase in THC positive newborns has already been documented in Colorado, but the long-term significance of this development requires research.

Unfortunately, something that we will not see this year will be any acceleration of such research on cannabis in the U.S. The current Attorney General at the U.S. Department of Justice has made clear his intention to try to reverse the more relaxed policies of the Obama/Biden administration. Already, the DEA’s welcome decision to allow additional sites in which research-grade cannabis can be grown has evaporated into unidentified areas of the Justice Department, which have failed to respond to specific positive site recommendations by the DEA.

So far, underaged use of cannabis has not increased in states where medical cannabis has been allowed. In California, recreational legalization has already been accompanied by prominent advertising; during a recent trip to San Francisco, I saw large billboards heralding the availability of home delivery of cannabis. We will see if the past excesses of the alcohol and tobacco industries in marketing to youth will be repeated by the burgeoning cannabis industry.

Those of you interested in reading more about medical cannabis in 2018 can find a brief summary on the topic that I have written for the current issue of “Maryland Medicine,” the journal of the Maryland State Medical Society. 

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