Drug, Medicine, or Something In Between? Here's What You Should Really Know About Weed

When the Biden administration recently fired a handful of White House staffers for cannabis use, Americans received a not-so-subliminal message that they'd likely been hearing for decades: Cannabis has no place in the professional world.

Still, that news comes at a particularly interesting time for cannabis in the United States as 43 percent of the population now live in a state where recreational cannabis use is legal, and that number is growing quickly with more states jumping on board with legalization. What's more, a recent Gallup poll found that nearly three-quarters of Americans were in favor of legalizing cannabis for recreational use, which is the most positive overarching sentiment ever recorded by a Gallup poll.

Naturally, these seemingly opposing views stir up a particularly confusing message (and heated political debate): Is cannabis a dangerous drug, a medicine, or something else entirely?

A Quick Cannabis Primer

For starters, let's get clear on what cannabis is, exactly. Cannabis is a genus (aka family) of plants, including both marijuana plants and hemp plants, among others. The cannabis plant contains more than 100 components, including active cannabinoids — known as phytocannabinoids — such as cannabidiol (CBD) and tetrahydrocannabinol (THC). (More here: What's the Difference Between CBD, THC, Cannabis, Marijuana, and Hemp?)

Turns out, your body is somewhat primed to benefit from these cannabinoids; the human body has an entire endocannabinoid system that's recently been recognized as an important regulatory system in the function of brain, endocrine, and immune tissues, according to a review published by researchers in the department of endocrinology at the Medical University of Lodz in Poland. This system appears to play an important role in the secretion of reproductive hormones, the body's response to stress, and energy homeostasis, including the link between food intake and the central nervous system, as well as gastrointestinal tract activity — and this is just a taste of what science knows thus far. The endocannabinoid system also acts as a receptor for the feel-good chemicals contained in cannabis, and is the key to understanding cannabis' effects on the human body, says Fabianna Marie, N.D., a naturopathic doctor and certified cannabis educator.

Marijuana and Its Medicinal Beginnings

Although using cannabis medicinally might seem like a relatively new development (at least in our country's recent history), the plant's ties to health go way back, says Reginald Rousseau, M.D., a physician specializing in interventional pain management and anesthesiology with a certification to prescribe medical cannabis. "Cannabis was used extensively for different medical purposes for many years historically."

Dr. Rousseau notes that cannabis has been clinically shown to combat chronic pain, boost mental health, and potentially help ward off cancer (although that hasn't yet been clinically proven) — but the list of potential benefits is even longer. Of the 60 peer-reviewed U.S. studies on medical cannabis from 1990 to 2014, one of the largest meta-analyses conducted on the subject found a connection between cannabis use and positive health outcomes.

Dr. Rousseau also points out that, in the past 100 years, deaths by overdose have been particularly rare. While adverse side effects from cannabis alone are really uncommon, the mind-altering effects of use can sometimes lead to unintended injuries or illnesses, including motor vehicle accidents or incidental poisoning (usually from other substances), according to the Centers for Disease Control and Prevention (CDC).

Let's Talk About Cannabis' Racist Roots

So, how does cannabis move from medicine to stigmatized drug? The answer, while complex, is rooted in racism, says Karim Webb, social activist, entrepreneur, and CEO of 4thMVMT, a social equity nonprofit aimed at justice in the cannabis industry.

Since the 1920s, marijuana has been predominantly used as a tool to keep people of color imprisoned — starting with Mexican immigration to the States in the early 1900s, says Webb. When Mexican citizens fled to the U.S., they brought cultural norms, such as smoking cannabis, along with them. This ultimately led to the first wave of cannabis prohibition in 1911 in Massachusetts with California following suit in 1913. (On that note, some experts believe the word "marijuana" itself has similarly racist roots, and shouldn't be used any longer.)

That prohibition continued through 1930, when the first director of the Federal Bureau of Narcotics, Harry Anslinger, dropped this horrific, and often-referenced quote: "There are 100,000 total marijuana smokers in the US, and most are Negroes, Hispanics, Filipinos, and entertainers. Their Satanic music, jazz, and swing result from marijuana use. This marijuana causes white women to seek sexual relations with Negroes, entertainers, and others."

And by the time the movie Reefer Madness (an anti-marijuana propaganda film that posited cannabis as something that drives men to be sexually violent and women to moral corruption) was released in 1936, marijuana's tie to deviance (and, by association, people of color) was pretty much cemented in the first half of the century.

That racism didn't stop as the century progressed, says Webb, nodding a particularly chilling quote from the Nixon presidency: "We knew we couldn't make it illegal to be either against the war or Black, but by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities," said John Ehrlichman, former Nixon domestic policy chief. "We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course, we did."

Today, Black people are 3.64 times more likely than white people to be arrested for cannabis possession. In 2018, 40 percent of all drug arrests were for cannabis, most of which were for possession alone (read: not for selling or growing), says Webb. And in 2020, POC made up 94 percent of cannabis-related arrests in New York City's five boroughs — despite their rate of actual usgae. A 2019 report by NYC Health found that 24 percent of white New Yorkers reported using cannabis, whereas only 14 percent of Black residents and 12 percent of Latino residents reported the same.

Why the Medical Community Isn't Studying Cannabis

On top of the fact that cannabis was used to criminalize POC, it also wasn't really dissected in the medical community, notes Jessica Knox, M.D., M.B.A., M.P.H., board-certified preventive medicine physician, endocannabinologist (someone who studies the function and dysfunction of the endocannabinoid system), and cannabinoid medicine specialist. "Most doctors continue to learn about cannabis only as a drug of abuse and a gateway drug," she says.

Of the dozen doctors interviewed for this article, none said they were taught about cannabis (or the endocannabinoid system) in medical school. "In most electronic medical records, the only way to formally code a patient's cannabis use is as 'cannabis use disorder,'" notes Dr. Knox.

"There are hundreds of peer-reviewed articles that show that cannabinoids have incredible medicinal properties," says pediatric physician and cannabis expert Bonni Goldstein, M.D. "But due to the restriction on human clinical trials in the U.S. [because it's not legal in every state], we still lack these types of studies — but many research groups in other countries are publishing them."

So, most doctors can't — and won't — back up cannabis or take it seriously until there's more clinical evidence in the US. And of the research that is dedicated to cannabis, most of it is geared toward its potential harms, says Dr. Knox.

Despite not being instructed on the benefits of cannabis in medical school, many of the medical experts cited here say they got into cannabis research because of the results they saw in their patients or their loved ones.

"When I began working with patients who were using cannabis as their medicine, I listened to their reports and found that, despite having different conditions, many reported improved quality of life, less pain, less anxiety, better sleep and other benefits," says Dr. Goldstein.

Jessica Peatross, M.D., a functional medicine doctor, says she was "so enthralled" by what she was seeing in cannabis research, she began to self-educate on cannabis through webinars and sorting through studies herself.

This is all to say — there's hope for the future of cannabis in medicine. "While the medical community as a whole is currently overly dismissive of cannabis, this doesn't mean they don't want to learn," says Smita Patel, M.D., a physician specializing in neurology, sleep medicine, and integrative medicine.

What Cannabis Can Actually Do for You

While the physicians and scientists referenced here emphatically noted that cannabis is not a cure-all miracle drug, they all had relatively good things to say about its potential health-related uses.

"As a naturopathic doctor, certified cannabis educator, and cancer patient myself, I am 100 percent in favor of using the [cannabis] plant as a therapeutic modality," says Marie — and this could be for a wide range of concerns from improving mental health to treating pain. (The benefits aren't all that far off from the benefits of CBD.)

For one, research shows that, in the short term, cannabis can significantly reduce self-reported levels of depression, anxiety, and stress. Other studies suggest that cannabis might positively impact patients with post-traumatic stress disorder, dementia, Huntington's disease, Parkinson's disease, and Tourette syndrome. (Related: What Happened When I Tried CBD Oil for Anxiety)

The "munchies" might be a joke, but cannabis can also help stimulate appetite in people with eating disorders or who are experiencing a loss of appetite (perhaps due to other medications or illness) or drastic unintentional weight loss, says Dr. Rosseau.

Cannabis may even act as a safer and more effective medicine than commonly prescribed conventional pharmaceuticals or even over-the-counter meds, such as those for pain management. "Not only is cannabis safer than many common prescription and over-the-counter drugs, but it often provides additional benefits that conventional drugs don't," explains Dr. Knox. Indeed, "marijuana can take the place of many NSAIDs, such as Advil or Aleve, especially since there is a limit to how much Advil you can take in a day or time frame without causing damage to your kidneys or stomach," says Dr. Patel.

Oh, and you might recover from your workouts faster. "For many who work out on a regular basis, muscle soreness and joint pain come with the territory," says Lazlo Mechtler, M.D., medical director at the Dent Neurologic Institute. "Those seeking relief have increasingly turned to cannabis products to aid in recovery due to its therapeutic, anti-inflammatory properties."

Still, if your doctor prescribes you a medication, or suggests you opt for an OTC pain reliever, talk to them first before just swapping cannabis in its place.

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Okay, But Are Health Concerns About Cannabis Warranted?

While there are a trove of benefits that may come along with cannabis use, Amol Soin, M.D., anesthesiologist and medical director of the Ohio Pain Clinic, warns that, as with anything, weed isn't a cure-all — and that's especially true if you're battling a disease.

"I often find that many patients have very high expectations of the effect cannabis may have on their disease state," says Dr. Soin. "The truth is, we don't actually have enough (or any) strong, solid, scientifically controlled studies to prove [it's effectiveness]."

Janice Vaughn-Knox, M.D., an anesthesiologist, cannabinoid medicine specialist, and clinical endocannabinologist, notes that, while cannabis is relatively safe, it's always ideal to chat with your doctor prior to using it if you have liver disease, cardiac disease, are at high risk for stroke, are taking blood thinners, or are on any anti-epileptic medications due to potential complications.

"There are a lot of diverse chemicals in the marijuana plant," says Dr. Soin, "And it is unclear to us physicians how these may interfere with other medications they may be on." (See: How Dietary Supplements Can Interact with Prescription Drugs)

That classic marijuana "high" — defined by grogginess, anxiousness, or paranoia — might also be a deterrent for you. Still, there are numerous ways to reap the benefits of cannabis without experiencing a high at all, notes Dr. Mechtler. This can be achieved through non-psychoactive cannabinoids (CBD, for instance) or by using a topical product (such as a cream or ointment). (Or even a cannabis arousal oil, which can do amazing things for your sex life.)

How to Use Cannabis the Right Way

If you're a first-timer, an under-educated user, or are just a little wary about trying a new substance, it helps to keep a few best practices for cannabis use in mind.

1. Avoid smoking.

If you're considering using weed for its potential health benefits, Dr. Peatross and Marie both strongly advise against vaping and smoking, as there are healthier ways to consume cannabis (tinctures, edibles, capsules, etc.). Studies have proven that even if what you're smoking is theoretically healthy (i.e. cannabis), smoking just isn't good for your lungs or respiratory health.

2. Learn the compounds and strains.

From strange-sounding strains to various potency amounts, walking into a dispensary for the first time can be super overwhelming. If you buy from a reputable dispensary, there's a solid chance someone on staff will be there to walk you through it — don't try to DIY if you don't know where to start.

3. Know your dose.

Knowing how much to take is a tough subject because dosing is still kind of a big question mark — this is why it's important to find an open-minded practitioner to figure out what works for you.

While dosing really isn't a one-size-fits-all scenario (and likely another good question to ask your doctor or dispensary worker), Kim Dupree Jones, Ph.D., family nurse practitioner, recommends roughly five to 10 milligrams when needed to start. After the first few weeks, you can start to up the dose, depending on your goal (i.e. easing anxiety versus chronic pain).

That being said, it's important to listen to your body, says Dr. Goldstein. "If someone is having unwanted side effects from their cannabis use, they're not using the right dosing, delivery method, or strain, and should seek advice from someone with experience managing cannabis regimens," says Dr. Goldstein.

The Final Say on Cannabis

Despite the fact that cannabis may not be legal in every state, there's no rule saying that what's legal is necessarily safe and, of course, that something illegal is unsafe. (Take alcohol, for example: According to the CDC, alcohol is responsible for roughly 95,000 deaths per year.) While cannabis might still have some legal red tape and social stigma, it's a promising new area for alternative medicine, but it should be approached with intention.

"Cannabis continues to be a societal curiosity that is becoming an evolution of the misconceptions," says Marie. Scientific research is still playing catch up, but will lead the way in exploring the medicinal properties of cannabis and the many positive uses it has to offer.

If you're interested in trying cannabis, be open with your doctor. "And if you're being dismissed, seek out a naturopath with the education to help," says Marie. "My advice to doctors, whether you are pro, against, or neutral: be open-minded and non-judgmental. Your patients are worth the time, effort and education on every modality of healing."