THC, CBD & Vaping: Our Natural Experiment on the U.S. Population
I am not someone who thinks marijuana is a gateway drug (though many smart people do). To my way of thinking, it should have been rescheduled long ago, which would have led to more research and study of its risks and benefits—particularly THC, which is the psychoactive constituent of cannabis. Many drugs we know today, most famously aspirin and digitalis, originally came from plants.
The situation is even more confusing for THC’s chemical cousin, cannabidiol (CBD). As with THC, we have very little evidence of its impact on human health. Last year’s Farm Bill legalized growing the type of cannabis known as hemp (from which CBD is derived), the legal status of CBD remains unclear.
Given the little we know about marijuana, THC, and CBD, it makes sense that we try to scientifically answer questions about their short and long term effects on humans—both good and bad. But instead of systematically studying THC or CBD, we are instead racing to decriminalize THC and/or allow its use for medical purposes, and simply letting CBD flourish in the marketplace.
As a consequence, we find ourselves conducting a nation-wide experiment on our population.
However, the absence of reliable scientific evidence has not deterred the public and politicians from having strong opinions about THC, CBD or marijuana in general, which is why we find ourselves where we are today. Without truly knowing what public health harm each has on any segment of our population, especially on younger people, we are allowing access with too few guardrails.
Specifically, because marijuana is lightly regulated, it is being used by people who may be a special risk—such as younger people and pregnant women—and many people use it regularly, both moderately and heavily, in their daily lives. We do not know whether and how this reality will put our public health at risk.
In his book, Tell Your Children: The Truth About Marijuana, Mental Illness and Violence, former New York Times reporter Alex Berenson wrote that THC can cause psychotic episodes and that evidence is emerging that this psychosis can lead to violence, which he claims is increasing in states with legalized marijuana. While Mr. Berenson has received some pushback about his book, he is to be credited for jumping into the debate, sharing evidence and advancing an important claim that, if true, would be critical as we try to get a handle on this emerging issue.
While much focus has been on THC, CBD may potentially have a larger market. What is most alarming is that this exponential CBD market growth is happening under a regulatory quagmire. While hemp became legal under the 2018 Farm Bill, CBD’s legal status has not changed in that it remains illegal to make medical claims and to add it to food without first providing evidence that it is not toxic. This situation has caused confusion in the marketplace. The FDA recently sent a warning letter to a company making medical claims.
Before he left the FDA, then-Commissioner Scott Gottlieb began the process of regulating the CBD industry. Since then, however, progress has stagnated while more CBD-infused products have become available and major retail companies including Walgreens, CVS Health, Rite Aid and GNC have entered the chase for CBD-demanding customers. Products being sold in pharmacies include topical creams, patches, sprays and oils, all carefully nuanced to not make a clear medical claim, but aimed at persons looking for relief from joint and muscle pain. Even my local ice cream store has gotten into the game by selling CBD infused coffee. Recently Dr. Gottlieb called on the FDA to hasten the process to regulate CBD, highlighting its health risks—liver damage at high levels and even worse, potential “undeclared ingredients and impurities.”
If this is not enough of a challenge, add vaping and the curious and experimental American mind to the mix. While the cases for and against vaping are well known, the latest news is troubling (though we may have actually missed even earlier evidence). Early evidence is showing that THC and/or CBD, along with yet to be determined unknown substances, are being added to the vaping liquids either at the wholesale or individual level and that when the mixture is heated and taken into the lungs, is causing the emergence of a yet unidentified lung disease.
Because we have let each of these trends go forward with no evidence of the impact they may have on our public health, nor any ideas about what happens if they are combined, and little to no regulation of their manufacture or use, we have unleashed what could be the equivalent of the cigarette/tobacco scourge that has led to lung cancer being the leading cause of cancer death in the U.S.
Unfortunately, the horse is out of the barn for all three of these products. So, as we race headlong down the pathway of greater THC/CBD/Vaping access we must ask ourselves what can we do to warn the public of the potential hazards and what steps must we take to regulate their health risks?
But we do not have a lot of time. The number of lung illnesses are increasing as are the number of deaths. And we do not know the long-term impact of each.
So, our policymakers must address the central question of why they are permitting this national natural experiment to play out among our population, leaving action until after the fact with all its consequences as we did with tobacco? Will they take the tough and likely not popular steps now, to protect our population from a public health tragedy of preventable illnesses and deaths?
The ball is in their court. We wait for their answer.
William Pierce is a senior director at APCO Worldwide and a former spokesman at the Department of Health and Human Services with over 30 years of health policy and communications experience.