What are the recommendations for marijuana use, particularly for recreational and therapeutic purposes?

Recommendations for Marijuana Use: A Public Health Approach

The American College of Physicians (ACP) recommends that possession of small amounts of cannabis for personal use be decriminalized, while supporting an evidence-based public health approach to cannabis regulation that prohibits access to minors and prevents unsafe use among adults. 1

Health Effects and Risks of Cannabis Use

Cannabis use carries significant health considerations that should inform both recreational and therapeutic decisions:

Potential Health Harms

• Mental health impacts: Long-term use associated with mental health problems 1
• Respiratory issues: Smoking cannabis linked to chronic bronchitis and COPD 1
• Cardiovascular risks: Possible association with adverse cardiovascular events including myocardial infarction and stroke 1
• Cognitive effects: Memory impairment and other cognitive impacts, especially concerning in adolescents 1
• Cannabis Use Disorder (CUD): Higher prevalence among those who combine recreational and medical use 2

Therapeutic Applications

• Evidence supports use for:
  • Chronic nonmalignant pain management 3
  • Symptom management for conditions including cancer, headaches, migraines 3
  • Some psychological disorders (anxiety, PTSD) 3, 4

Recommendations for Different User Groups

For Recreational Users

1. Understand increasing potency risks: THC concentration has nearly doubled from 9% (2008) to 17% (2017), with concentrates reaching up to 70% 1
2. Avoid use if under 25: Due to potential impacts on cognitive development 1
3. Avoid driving: Cannabis use may be associated with increased traffic fatalities and impaired driving 1
4. Be aware of CUD risk factors: Young age, male gender, non-white race, living in the Midwest, using greater amounts, and having concurrent mental disorders 2

For Medical/Therapeutic Users

1. Consult healthcare providers: Physicians should be exempt from prosecution for recommending cannabis in accordance with state law 1
2. Consider THC:CBD ratios: Different ratios may be more appropriate for specific conditions 4
3. Monitor for CUD: Medical cannabis users who also use recreationally have higher prevalence of CUD 2
4. Consider delivery method: Smoking carries respiratory risks not present with other administration routes 1

Screening and Assessment Framework

Healthcare providers should implement the following approach:

1. Universal screening: Ask all patients about cannabis use 5

2. Increased vigilance for high-risk groups:

   • Adolescents and young adults
   • Patients with psychiatric or substance use disorders
   • Those with symptoms potentially related to cannabis (mood disorders, psychosis, respiratory symptoms) 5

3. Assessment parameters:

   • Frequency and amount of use
   • Presence of tolerance or withdrawal symptoms
   • Previous attempts to reduce use
   • Cannabis-related harms 5

Common Pitfalls to Avoid

1. Underestimating potency: Modern cannabis products are significantly more potent than in previous decades 1
2. Assuming medical use is risk-free: Medical users who also use recreationally have higher rates of CUD 2
3. Ignoring delivery method risks: Smoking cannabis carries respiratory risks not present with other methods 1
4. Overlooking drug interactions: Cannabis may interact with other medications, particularly in medically complex populations 1

Future Directions

The ACP strongly supports:

• Rigorous research into cannabis legalization effects 1
• Development of evidence-based medical education on cannabis 1
• Comprehensive insurance coverage for CUD treatment 1
• Scientific evaluation of potential therapeutic benefits 1

The rapidly evolving legal landscape of cannabis necessitates continued research and education to better understand both therapeutic benefits and potential harms, particularly as they relate to morbidity, mortality, and quality of life outcomes.