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Due to the legalization of recreational marijuana, people in the US are increasingly seeking the benefits of cannabis. While some opt for products that contain tetrahydrocannabinol (THC), others choose options that either combine THC and cannabidiol (CBD) or simply have just CBD. According to the National Academies Press, cannabis can help with various medical conditions, including cancer, multiple sclerosis, and chronic pain.  A Harvard Medical School study found that cannabis can replace non-steroidal anti-inflammatory drugs and is safer than opiates. The study found that cannabis is also an excellent muscle relaxer, serving as an ideal tool for easing tremors from Parkinson’s disease, and calming pain caused by ailments like fibromyalgia, endometriosis, and interstitial cystitis. Other common cannabis applications include Alzheimer’s disease and epilepsy/seizures. Based on an August 2022 Gallup Poll, nearly half of adults have tried marijuana. Whereas 30% of adults aged 18 to 34 years reported smoking marijuana, the percentage was much less for adults aged 34 to 54 (16%) and adults 55 and older (7%).

The legal and regulatory nature of cannabis can be confusing, but it would behoove physicians to gain some understanding of it. Federal law still classifies cannabis as a Schedule I substance, considered as having potential for abuse and not possessing any valuable medical use, making it against the law to possess or sell cannabis products with more than 0.3% THC. However, the Farm Bill of 2018 rendered any part of the cannabis sativa plant and substances derived from it, with a THC level of less than 0.3% to no longer be controlled substances under federal law. In November 2023, medical-use cannabis became legal in 38 states and the District of Columbia (DC), and recreational cannabis use became legal in 24 states and DC. Given the legalization of recreational marijuana and medical marijuana within the US, it is imperative that physicians understand the various terminologies associated with cannabis. For instance, the cannabis sativa plant provides both marijuana, which has more than 0.3% THC, and hemp, which has less than 0.3% THC. Unlike marijuana-derived THC, hemp-derived CBD does not have the psychotropic effects brought on by THC.

While many medical professionals praise the benefits of cannabis use, there are certainly medical professionals who do not support its use. Professor of psychiatry at the University of Maryland School of Medicine’s Psychiatric Research Center in Baltimore, David Gorelick, MD, asserts that there is a concerning public misconception that cannabis and cannabinoid products are harmless. According to Dr. Gorelick, heavy or long-term cannabis use can have negative impacts on both physical and psychological well-being. A literature review in the journal Substance Abuse noted that both smoking and vaping marijuana result in dangerous combustion by-products that compromise respiratory safety. Additionally, the American Heart Association (AHA) suggests that cannabis can adversely affect the cardiovascular system, though the AHA does acknowledge that cannabis may have therapeutic advantages. Given that the Food and Drug Administration (FDA) has not approved cannabis products, CBD products undergo minimal quality and safety-control checks. According to the US Substance Abuse and Mental Health Services Administration, CBD can contain perilous biological and chemical contaminants, and it may lead to liver toxicity. It could also elicit detrimental drug interactions.

Nonetheless, a significant number of physicians find that the risks for cannabis use are overshadowed by the benefits, particularly for patients with severe or terminal illnesses. Such doctors have hope that with the combined efforts of medical researchers and physicians, legislators can review substantial and reliable research to provide manufacturers with clear guidance on how to safely use cannabis to treat various health conditions.