Opinion: What The New York Times gets wrong about cannabis

Editor’s note: Today’s Sunday Read is an op-ed from Dr. Corey Burchman, responding to the recent The New York Times story regarding the harms of cannabis use. At Cultivated, we endorse legalization as a policy but believe there is room for healthy, constructive debate. You can read the original New York Times piece here.

There is no doubt that cannabis should be regarded as having certain risks. 

The creation of state legal markets and its classification as a natural substance do not make it intrinsically safe. Similar to other intoxicants like nicotine and alcohol, and therapeutic drugs such as acetaminophen, cannabis use carries risks — a fact that was thoroughly explored by the Department of Health and Human Services (HHS) in its recent recommendation to move cannabis from Schedule I, the most restrictive, to Schedule III of the Controlled Substances Act.

But risks do not make a substance “good” or “bad”. 

Ice cream has risks. Caffeine has risks. Allergy medications have risks. Assessing and understanding these risks, allows us to educate the public and create appropriate guardrails. Misinformation and fear based reporting do immense damage to our ability to protect public health.

None of this was addressed effectively in The New York Times article. For this reason, I’d like to offer a series of corrections to the record.

Potency / THC limits exist.

Contrary to the article’s assertion, potency limits — regulations placed on the amount of THC, the main psychoactive component of cannabis — are common and differ significantly across states. Establishing limits on potency is a vital policy consideration for states that have legalized cannabis for adult use. Many states place restrictions on THC products, either by quantity or percentage, while another seven limit potency based on product category. Restrictions include milligrams per package, purchasing limits, and testing for consistency per serving or package.

Physicians do not tell their patients to “experiment”

It is misleading to suggest that physicians instruct patients to “experiment” with cannabis. Drug titration is a common practice among healthcare providers. Physicians treating conditions such as depression, anxiety, nausea and pain often advise patients to maintain a symptom diary to track the effects of doses, especially when starting a new medication. This is not unique to cannabis.

Youth use is not on the rise.

Much of the negative information around cannabis legalization centers on the potential impact on youth. Those fearful of state-regulated markets, worry that an increase in regulated products means increased access, even if restricted to adults 21 and older, and may lead to higher usage rates among teenagers, negatively affecting their cognitive development and educational performance. 

Understanding the impact to cognitive development is an important point for researchers to explore, and our federal government should be funding and supporting this research at every turn. It is also a critical reason why state legal markets continue to restrict access based on age.

According to the Youth Risk Behavior Surveillance System (YRBSS), a Center for Disease Control (CDC)-conducted survey monitoring health-related behaviors among middle and high school students since 1991, there is no indication that youth use has increased following legalization. Other studies have pointed to similar results, that teen cannabis use remains flat or even decreases following legalization in various jurisdictions. 

And recent national trends have also indicated a decline in youth marijuana use. Further research is certainly needed, and I am hopeful that rescheduling and federal engagement will increase funding and accessibility for such research.

Correlation is not causation.

If you take one thing away from this article, please let it be the simple undisputed fact that correlation does not equal causation. Many things are correlated in life, but this does not mean one caused the other.

Studies have suggested that the connections presented are often muddied by alcohol consumption, and that mental health issues may lead individuals to use marijuana rather than the other way around. Notably, some studies have suggested that the medical use of cannabis might be associated with lower suicide rates, particularly among males aged 20–39. Other research indicates that cannabis may serve as an effective treatment for conditions like bipolar disorder. 

The pain relieving properties of cannabis, as has now been confirmed by the Food and Drug Administration (FDA), may also allow patients to avoid more dangerous prescription painkillers and tranquilizers. Evidence suggests that states with medical cannabis programs have lower suicide rates, which could be linked to cannabis substituting for more harmful opioids.

In conclusion

In my 2017 study, I found that medical cannabis patients were significantly substituting cannabis in place of opioids, sleep aids, and alcohol. Importantly, there is no inherent tendency for cannabis users to progress to harder substances. The pharmacological properties of cannabis do not compel users to transition to more dangerous drugs.

Today more than ever, we must ground our conversations in medical science to avoid misleading information that stokes fear and prevents progress. 

HHS, with the support of the FDA and National Institute on Drug Abuse (NIDA), conducted a comprehensive review of cannabis data and found that cannabis has both a medical use and a low risk of abuse and dependence.

As a medical professional and as an educator, I support further research and will always follow the science. Today, science tells us that cannabis is a substance worth pursuing, with an open and curious mind.

Dr. Corey Burchman is a seasoned physician with over 35 years of experience, specializing in neuro-anesthesiology and obstetrical anesthesiology. He served as a U.S. Navy physician for over a decade, including deployment in the Persian Gulf. Recently retired as an Assistant Professor of Anesthesiology at the Geisel School of Medicine at Dartmouth, he remains involved with the Admissions Committee. A recognized authority on cannabinoid pharmacology and therapeutics, he has held leadership roles in the cannabis industry, including Chief Medical Officer at Acreage Holdings. He is actively involved in cannabis advocacy, serving on the Coalition for Cannabis Scheduling Reform and advising various organizations on cannabis reform initiatives.