Friday, December 1, 2023

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Guest Commentary

Marijuana should be legal. Moderation in all things.


Last September in an essay I wrote for The Des Moines Register, I advocated the legalization of recreational marijuana (“It’s time to legalize recreational marijuana in Iowa and nationally,” Sept 26). In the past week, the editorial board of USA TODAY raised similar concerns in calling for federal legalization of marijuana.

I am not advocating marijuana use any more than I advocate the use of alcohol, to which I compared it. People ask me if I still hold that view in light of more recent medical information on the dangers of chronic marijuana use.

I still do, with caveats.

I have been concerned about the health consequences of drugs for a long time. When in Congress, I gave a general assembly talk at a Council Bluffs high school on the dangers of drug abuse. I outlined the addiction problems and health issues of methamphetamine, cocaine and heroin, among other recreational drugs. The students were bored and restless so I switched tactics. I said, “If you boys want bigger breasts and smaller testicles, just smoke a lot of grass.” Needless to say, they all sat up and paid attention!

I explained how THC, the active chemical in marijuana, can, especially with teenage boys, act like a feminizing hormone and cause gynecomastia and smaller testicles. In my medical practice, when I saw teenage boys for breast enlargement, I always asked them if they were smoking a lot of grass. If they were, I explained how the THC could be contributing and that they should give it up for six months before we decided on surgery. I explained that, if they quit the marijuana, the breast enlargement might reside on its own.

I still think that the balance sheet shows that alcohol causes significantly more health problems than marijuana and that the legal penalties for marijuana possession are disproportionate, especially given the impact on minority populations. I continue to hold that legalization would help regulate its use and decrease the chances of contamination with other drugs such as fentanyl, which can be deadly.

In my previous op-ed, I acknowledged that “both marijuana and alcohol can have bad health effects.” What is changing is that higher-potency THC is causing more people to become addicted around the world. Compared with those who use lower-potency marijuana for sleep, such as the 5-mg to 10-mg gummies retired Iowa State University professor Dick Haws discussed in his recent essay (“For me, marijuana gummies are worth the drive and the taxes,” July 31), using higher-potency marijuana is more likely to cause addiction and mental health problems. A recent study published in Lancet Psychiatry showed that high-potency cannabis increases your chances of cannabis dependency syndrome fourfold.

People can become addicted to many things, but these things are not equally addictive. In the past, only 3% to 4% of people who tried marijuana met criteria for cannabis use disorder, but 20% or higher of those who try cocaine get addicted. That risk increases with the use of higher-potency THC.

Physical withdrawal from marijuana is not particularly life-threatening compared with withdrawal like delirium tremens from alcohol or narcotic withdrawal with significant cardiovascular changes. Nevertheless, it can cause anger, aggression, irritability, anxiety, nervousness, decreased appetite and sleep difficulties. It can also cause physical symptoms such as headaches, nausea, vomiting and abdominal pain. We are learning that higher concentrations of THC increase not only the chance of withdrawal but the severity of it. 

This is not just smoke in the wind! According to a 2020 British study, THC concentrations in a gram of herbal cannabis have increased by 2.9 milligrams annually, while cannabis resin extracts, which are typically more potent than the flower, have increased about 5.7 mg each year.

Coupled with this change in potency is the invasion of drug cartels into rural California growing higher-concentration plants. This is not your ma-and-pop plot of 50 plants of the variety the baby boomers smoked in the ’70s. Just recently, California authorities in one raid confiscated 15.5 tons of marijuana worth $1.2 billion. The cartels are growing so much marijuana that they are stealing huge amounts of water from drought-stricken farmers, in the range of 2 to 3 million gallons of water per day.

If the crime caused by cartels in the rural areas and the loss of water to farmers isn’t bad enough, this high-potency marijuana is illegally hitting the streets, and sometimes contaminated with fentanyl. 

While recreational marijuana is now legal in the majority of states, most have found that illicit markets are still larger than the legal ones. The USA TODAY editorial blames high taxes on legal marijuana and bureaucracies slow to set up authorized stores, monitor growers and regulate manufacturers. The combination of higher-potency THC with cartels flooding the markets with cheap, unsafe marijuana must be met with even more aggressive law enforcement of marijuana cultivation. 

The best way to do this is to regulate the market on both the state and federal level so that customers can be aware of safe dosages and be free of worries of contamination by buying only authorized product. Government should lower taxes to make legal product more competitive with street marijuana, streamline the bureaucracies in licensing, strictly enforce age limits to those 21 and older, destroy illegal mass marijuana cultivation, and punish those illicit mega-growers with stiff prison sentences.

We regulate the production of alcohol and tobacco; we should do a better job with marijuana. So, yes, I still favor state and federal marijuana legalization, maybe even more so, but with provisos as we further consider the health effects of marijuana.

Aristotle’s principle of moderation in all things applies to use of marijuana as it does to alcohol. ♦

Dr. Greg Ganske is a retired surgeon and former U.S. congressman from Iowa in 1995 to 2003.

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