The Health Challenges of Legalized Marijuana

When Hannah Kaneck was hired by the FDA as a tobacco compliance specialist in Colorado in 2013, she was in heaven.

Raised in a home with secondhand smoke, Kaneck developed a personal vendetta against the tobacco industry and the marketing tactics it employed to create generations of smokers. Now a M.P.H. student at the Yale School of Public Health, Kaneck sees many of the same strategies driving marijuana sales in Colorado and in Alaska, Oregon and Washington, D.C. where recreational use has also been legalized.

As an intern with the Colorado Department of Public Health last summer, Kaneck discovered a paucity of scientific data existed to inform policy decisions. Because there was little or no baseline population data about users prior to legalization in 2014, researchers are scrambling to gauge the health implications of legalization. Meanwhile, with millions of dollars in new tax revenue being generated, many politicians are hesitant to impose restrictions on a budding industry.

Colorado already had a robust medical marijuana marketplace, and with legalization dispensaries are as ubiquitous as coffee shops. But Colorado’s experiment in legalization as Kaneck sees it, also has created pressing public health concerns. She cites increased use of emergency rooms and calls to poison control centers. High doses of the drug can cause cyclic vomiting, paranoia, heart palpitations, auto accidents (especially when combined with alcohol) and blackouts.

Kaneck, a second-year student in the Department of Environmental Health Sciences, is also concerned about how easy it is to accidently overuse marijuana, especially for young or new users. Modern marijuana is much stronger, with tetrahydrocannabinol (THC) levels more than four times higher than they were in the 1960s and 1970s.

Meanwhile, public health’s successful messaging against tobacco smoking has persuaded a new generation of marijuana users to avoid lighting up and embrace the drug in its edible form. The average cannabis-infused food item contains 100 mg of THC—10 times the recommended dosage. “Could you eat a tenth of this cookie?” Kaneck asked the audience at the Association of Yale Alumni Assembly in November as an image of a freshly baked chocolate chip cookie flashed on a giant screen.

The tobacco industry has made an art out of creating new generations of smokers,” she said. “It would be naïve of us to think that the marijuana industry won’t or hasn’t already succumbed to the same interests that tobacco has had for almost a century.

Hannah Kaneck

The dangers of edible marijuana products are compounded by its delayed effect. It takes a half hour for a person to start feeling the effects of ingested THC, compared to just 10 minutes when it is smoked. Many people get impatient and eat a second cookie, thus taking in 20 times the recommended THC dosage. “And what happens when a child gets ahold of that cookie?” Kaneck asked.

Edibles are now being sold as snack-food-style products in the form of rice crispy treats, Swedish fish and other candies that are widely appealing, especially to children who are likely to find the drug-laced snack in their homes.

“The thing about edibles is they are marketed, produced and sold in a very familiar fashion,” said Kaneck. “They come in displays with lots of bright colors and discrete packaging, resembling cigarettes, e-cigarettes or tiny bottles of alcohol.”

“The tobacco industry has made an art out of creating new generations of smokers,” she said. “It would be naïve of us to think that the marijuana industry won’t or hasn’t already succumbed to the same interests that tobacco has had for almost a century.” Kaneck believes now is the time for public health to apply lessons learned from tobacco to marijuana legalization to avoid a repeat of history.

In the coming years, marijuana availability is likely to increase further in the United States and this will lead to increased adverse drug events, said Andrew A. Monte, M.D., Kaneck’s preceptor and assistant professor at the University of Colorado Anschutz Medical Center. “More robust systems to measure the adverse health effects from marijuana are needed since the drug falls outside the typical regulatory framework used for pharmaceuticals,” he said.

Kaneck hopes to work in research and regulation upon completing her M.P.H.

Kaneck was one of five public health students who presented to the 75th Association of Yale Alumni Assembly on the Yale campus. The student presentations were part of a daylong program marking the Yale School of Public Health's centennial.

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This article was submitted by Denise Meyer on January 21, 2016.

Marijuana dispensary
Hannah Kaneck at a drying and curing room at an industrial growing center at Medicine Man in Denver, Colorado. The center services both medical and recreational marijuana users.