Everyone is talking about federally legalizing cannabis! The problem is that simple legalization will not be good for medical patients.
When it comes to new cannabis policy, there are really three options: making cannabis a medication by prescription, decriminalizing cannabis possession, or commercial legalization. Keeping cannabis as a medication will stimulate medical research and provide care and medication to those in need. Decriminalization will end the War on Drugs and prevent continued targeting of people of color. Legalization, on the other hand, while ending the War on Drugs, will also sabotage medical research, end the knowledgeable use of cannabis as a medicine, and lead to an industry hellbent on sales revenue at the cost of patients’ wellbeing.
Current discussion about legalization does not address patient care at all. There is a lot of talk about the harms of prohibition and social justice. There is no acknowledgement that medical care is a social justice issue and that patients must be protected.
For example, legalization will be the death knell for science into cannabis. Drug development research is slow, painstaking, and expensive – why would any cannabis company spend the time and money to prove that their product works and are safe if the law allows them to simply go to market and say whatever they want?
Further, in California only 4% of cannabis sold was through their medical system. These numbers suggest that the vast majority of purchasers were getting their medical information from the non-medical salespeople at the dispensaries or from their buddies. We have ample evidence that this is not the ideal way to get medical advice.
In my practice, I have seen patients who start with very reasonable and effective regimens suddenly go overboard following the advice of these salespeople. I have seen harm done to patients from the rampant misdirection and conflict-of-interest-laden advice from dispensaries. We avoid these pitfalls in the conventional medical system by requiring clinicians to prescribe the medication complete with instructions on use and an amount to be sold. Only Florida requires an actual prescription (they call it an “order”) for a specific cannabis medication with an amount to be dispensed – and requires dispensaries to uphold that order.
There is a substantial practical and moral difference between ending the War on Drugs and granting an industry carte-blanche permission to sell vast amounts of cannabis using whatever sales tactics they can devise. The legal sales of large amounts of cannabis suits the industry well but is not good for patients nor citizens.