Calvert County Health Department

Cannabis Legalization- Health Considerations

Cannabis (also called marijuana, weed, etc.) became legal for recreational use in Maryland on July 1st. As with alcohol and tobacco, the legal age for use is 21. There are restrictions on how much cannabis a person can possess and where they can use it (not in public spaces) that you can read about elsewhere, but this post will focus on health considerations and not the legal dos and don’ts.

Cannabis causes effects in our bodies because we have millions of receptors in our brains, digestive systems, and immune systems that bind and are activated by various chemicals found in the plant. This is analogous to the receptors we have in our brains, gut, and elsewhere that bind chemicals found in opium poppies. There are well over 100 chemicals (collectively referred to as “cannabinoids”) in cannabis/marijuana plants that interact with various receptors in our bodies. Each of us has different genetic sensitivities to these cannabinoid interactions. As a result, the effects of cannabis use from person to person varies. Like with opioids, people can experience pleasurable effects from cannabinoids and can also become physically dependent. Years ago, it was thought that people did not become addicted to cannabis. Research has shown that physical dependence is real. However, unlike opioids, overdoses are extremely rare with cannabinoids.

As adults make decisions for themselves and prepare to talk to their children, it’s important to keep in mind that legal does not always equal safe. Just like with tobacco and alcohol, there are potential harms with the use of cannabis. Among these are impaired judgment that can lead to dangerous decision making (e.g., driving while impaired) and progressive lung damage from smoking cannabis. Studies have shown that the risk of emphysema from smoking cannabis is equal to or greater than the risk from smoking cigarettes. Because of limited long-term research, the potential for cannabis to cause cancer is still uncertain. Cannabis strains currently grown are multiple times more potent than those used in past decades. As levels of THC (the group of cannabinoids that produce a high) have escalated, some people experience severe anxiety, panic attacks, and even psychosis instead of feeling mellowed out as was almost always experienced with milder strains of the plant grown in the past.

There are potential benefits for people with certain medical conditions. Due to prohibitions on cannabis research enacted by Congress in the 1970’s, there is limited scientific evidence to judge the benefits from cannabis for most conditions, including anxiety, sleep disorders, irritable bowel syndrome, and many other health problems. Experts at the National Academy of Sciences have concluded that there are modest benefits from cannabis for a limited number of medical ailments. Please note the following only applies to adults. Risks/benefits for children and adolescents are different. Modest benefits are found for those with the following conditions:

• In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective antiemetics.
• In adults with chronic pain, patients who were treated with cannabis are more likely to experience a clinically significant reduction in pain symptoms.
• In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.
• For all other conditions evaluated there is inadequate information to assess their effects.

If someone is considering using cannabis to treat a medical condition, they should discuss it with their healthcare provider. Like any substance that produces effects in our bodies, there are potential benefits and harms. It’s best to consult with a medical professional to best understand how cannabis is likely to impact your health.

One of the benefits of cannabis legalization is that purchasing products from a licensed retailer ensures that you are getting the product you intend to purchase. Marijuana purchased on the street can contain anything from cheap filler material to fentanyl. You also have no idea how strong each batch will be. Some over the counter CBD products have been found to contain psychoactive THC and other unlabeled additives. Products for sale at licensed cannabis retailers will only sell products that have been verified to contain the specific ingredients at the specific potencies listed on the labels.

For those who decide to use cannabis, here are some general guidelines to keep you safer and get more benefit from your purchases:

• Do not smoke. The risk of lung damage from inhaling cannabis is substantial. If you decide to use cannabis, whether it’s recreationally or for medical purposes, tinctures or edibles are the safest ways to go. Vaping is not as harmful as smoking, but still causes lung damage.
• Start with a low dose. As noted, the strength of products available in 2023 are more potent than marijuana in years past. Retailers will have a range of potencies. You can gradually increase in strength if needed.
• CBD and THC are both components of cannabis plants. They affect the body differently. CBD does not produce a high, but it can produce a calming effect. THC produces a high and changes your mental status. Some people may get the benefit they seek with a CBD-only formulation or CBD with a small amount of THC. Licensed retailers should be able to work with you to maximum benefit and minimize disorienting effects.
• If you are considering taking cannabis to help with pain, look for a product that has a 1:1 blend of THC and CBD. Some studies have shown this blend provides benefits with fewer disorienting and anxiety-provoking effects than formulations with higher concentrations of THC. If you decide you need more THC, you can always gradually increase with less risks of side effects than starting with a higher potency.
• Make sure you understand how cannabis affects you and how long those effects last before you allow yourself to drive a vehicle, operate power equipment, or do anything else that requires high degrees of concentration and control. Edibles take effect more slowly (30-60 minutes) and last longer (hours) than inhaling.
• Do not mix cannabis with any other substances that cause drowsiness. This includes alcohol, sleep aids, anti-anxiety medications such as Xanax, and opioids.

Special considerations:

• Pregnancy and breast feeding: THC and other cannabinoids pass through the placenta and through breastmilk. There is no safe amount for a developing fetus or infant. The chemicals in cannabis impact the developing baby’s brain. At this point, there is evidence that babies exposed very early in development can have behavioral changes as they get older. The full impact of cannabis on very young children is not fully understood at this time.
• Even if a new parent isn’t breastfeeding, cannabis may impair someone to the point that they don’t recognize their baby needs attention.
• Storage in households with children: Keep cannabis products in childproof containers. Keep the childproof containers out of sight and in a locked cabinet or other storage device. If a child should accidently ingest cannabis, call the Maryland Poison Center at (800) 222-1222. States that have legalized cannabis for recreational use have seen increases in cannabis poisonings among children, especially when edible formulations are in households.
• Storage in household with teens: Just like with alcohol, if teens have access to cannabis, they may be tempted to experiment. Research has shown the younger someone is when they begin using an abusable substance, the higher the likelihood of addiction. Teens are also more susceptible to severe anxiety and psychotic reactions, especially with higher potency formulations of cannabis.

Regardless of people’s feeling about the legalization of cannabis, starting July 1, it is a reality in the Free State. For those who decide to use a cannabis product, for your own well-being and for the safety of others, please make wise choices as to what you purchase and when, where, and how you use it.