Marijuana policy: Science matters

July 24, 2017

Susan R.B. Weiss, Ph.D.
Director, Division of Extramural Research

Eric M. Wargo, Ph.D
Science Writer
Office of Science Policy and Communications, Science Policy Branch 
National Institute on Drug Abuse

On August 28, 2017, the National Council for Behavioral Health, Advocates for Human Potential (AHP) and the ATTC Network are partnering to host the  2017 National Cannabis Summit in Denver: An objective national forum for changing public policy, public health, treatment and research. In today's blog post, plenary speaker Dr. Susan Weiss of the National Institute on Drug Abuse calls for science to lead our thinking about the complex subject of marijuana policy and public health. 

Laws around marijuana in many parts of the United States as well as around the world are rapidly changing. This is partly due to shifting attitudes: The public is becoming more supportive of policies that decriminalize or legalize marijuana, because prohibition has not prevented access to the drug and is seen as disproportionately harming minority lives and communities. Eight states plus the District of Columbia (DC) have now legalized recreational marijuana use for adults. There is also a widespread belief that marijuana may have therapeutic benefits, leading 29 states plus DC to legalize the medicinal use of marijuana. (Sixteen additional states have legalized a non-psychoactive component of the marijuana plant, cannabidiol).

In this rapidly changing environment, discussions around marijuana tend to be highly polarized, leading to simplistic black-and-white thinking, as well as attempts by those on both the “pro” and “anti” legalization sides to shoehorn this complex drug into the molds of other substances like tobacco and alcohol. The fact is, marijuana affects an entirely different signaling system in the body and brain from any other class of drug; and that system, the endocannabinoid system, is involved in a remarkably wide range of functions. Thus marijuana’s effects are largely not comparable to other drugs, nor are its health risks or potential benefits like those of other drugs. The more educated we are as a society around marijuana and its complexities, the less we will be tempted to draw unhelpful and misleading comparisons.

Although more research is needed and evidence is not yet definitive in most cases, marijuana is associated with specific harms:
  • It can certainly be addictive, for one thing; as many as 30% percent of heavy users have a cannabis use disorder. 
  • It raises the risk of car crashes roughly two-fold, according to most of the studies that have been conducted on cannabis and highway safety. 
  • Heavy marijuana use is associated with negative outcomes in various measures of achievement and life satisfaction
  • And because the endocannabinoid system plays an important role in brain development, marijuana poses specific risks for children and adolescents and babies in utero.
Whether or not these particular risks may be balanced or outweighed by broader societal benefits of changing policies, they are often minimized or denied by legalization advocates who often focus on the fact that users do not actually die from a marijuana overdose. That point, though true, distracts from the known health and safety harms.

At this point, very little research has been conducted on the efficacy of the marijuana plant for treatment of most medical conditions, and therefore minimal or no scientific evidence supports its safety or effectiveness. This is, in part, because of the difficulties of conducting research on Schedule 1 substances. There is however evidence that marijuana’s component cannabinoids may have some benefits in treating pain, as well as spasticity in multiple sclerosis, nausea, and wasting. The involvement of the endocannabinoid system in pain signaling makes marijuana’s ability to interact with that system a potentially important factor in today’s public health landscape dominated by a devastating opioid crisis. A handful of studies have recently found that states permitting the use of marijuana for medical purposes (specifically allowing dispensaries, in one study) have reductions in opioid prescribing as well as less steeply increasing overdose rates, forcing consideration of the broader public health context and unexpected implications of marijuana policy shifts.

Science, not emotion, needs to guide our thinking as society implements new policies related to marijuana, and we cannot pretend that it is like any other substance. 
Because of the high variability of marijuana products, the marijuana plant and its crude extracts are unlikely to be approved by the FDA, even if the therapeutic efficacy of individual cannabinoid compounds is supported by further substantive research and clinical trials. But policy decisions about marijuana for recreational or medical use still need to be considered in the context of other substances. If future research shows marijuana availability leads people to use fewer opioids, or less of other legal substances with well-established health and safety harms (e.g., alcohol, nicotine), which as of now has not been demonstrated, then that will need to be added to the policy equation.

Even though marijuana is fundamentally different from tobacco and alcohol, states crafting and implementing new legislation around marijuana should learn from past experience regulating those substances, and not allow policy decisions to be driven by short-term economic interests. Taking a public-health focus requires taking a long view, and proceeding cautiously with iterative course corrections based on objective outcomes data. Fortunately, as revealed in a recent RAND report prepared for the state of Vermont, a wide range of regulatory options is available to states that have legalized or are considering legalizing marijuana.

Science, not emotion, needs to guide our thinking as society implements new policies related to marijuana, and we cannot pretend that it is like any other substance. While it is difficult to develop policies that take into account these complexities and gray areas, the science of marijuana thus far does not allow us either to paint it black or to imagine that it will ride in on a white horse and cure the world’s ills. Marijuana is unique and complex, and its complexities call upon us to think in new ways about drugs, policy, and public health.

Find out more about the science, policy and best practices related to marijuana use: attend the 2017 National Cannabis Summit, Denver, August 28-30, 2017.

Related Resources

ATTC Network: Marijuana Lit: Fact Based Information to Assist You in Providing SUD Services

National Institute on Drug Abuse: Drugs of Abuse: Marijuana

National Council for Behavioral Health
Linda's Corner Office Blog:
Arguments Amongst Friends: A Conversation on Marijuana

Related Blog Posts

Marijuana Legalization is a Process and We Haven't Reached the Midway Point

Cannabis News Roundup: June 2017

About our guest bloggers

Dr. Susan Weiss will be a featured speaker at the 2017 National Cannabis Summit. Dr. Weiss is the Director, Division of Extramural Research at the National Institute on Drug Abuse (NIDA), which oversees extramural programs, research training activities, operations planning and trans-NIH initiatives, such as the Adolescent Brain Cognitive Development Study.

Dr. Weiss also serves as a senior science advisor to the NIDA Director and as scientific liaison to other federal agencies. During her 13 years at NIDA, Dr. Weiss has served as Chief of the Science Policy Branch and Acting Director of the Office of Science Policy and Communications. Before joining NIDA, Dr. Weiss was Senior Director of Research at the National Mental Health Association (now Mental Health America) and previously directed a translational research program that studied the evolving nature of psychiatric and neurologic illnesses in the Biological Psychiatry Branch of the National Institute of Mental Health. Dr. Weiss has received multiple awards, including NIH Plain Language Awards, NIH and NIDA Director’s Awards and an Emmy for her contributions to HBO’s Addiction Project. Dr. Weiss has published more than 150 scientific articles and book chapters. She graduated from the State University of New York at Stony Brook and received her doctorate in psychology from the University of Maryland.

Eric Wargo, Ph.D., currently serves as a Science Writer in the Science Policy Branch (SPB) of NIDA’s Office of Science Policy and Communications. Before coming to NIH in 2012, he was Editorial Director at the Association for Psychological Science in Washington, DC. There he managed two top-ranked journals: Current Directions in Psychological Science and Psychological Science in the Public Interest. In SPB, Dr. Wargo writes and edits a variety of materials for a range of audiences, including fact sheets, blog posts, and other web materials; treatment guides for clinicians; and responses to congressional inquiries and other special projects. He received a Ph.D. in Anthropology from Emory University in 2000.

The quickest way to reduce time to treatment

July 17, 2017

Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx

What's the quickest way to reduce waiting time to treatment?

Two NIATx coaches, Scott Gatzke and Elizabeth Strauss, were quick to offer the same answer:

"Stop scheduling appointments."

Throwing out your appointment book might seem an unlikely solution to the wait-time problem. But walk-in appointments or "open access" have helped transform organizations like The APT Foundation in New Haven, Connecticut. In the first year of offering same-day service, average time to treatment decreased from 22 days to 8 days. 
"By the second year, it was down to 2 days, and today most people receive their first treatment or medication, or both, on the same day they walk in.”
Offering same-day service had a ripple effect at APT. Reducing waiting time to treatment increased admissions and revenue. Read the full blog post (one of the first posts we published in this blog way back in 2013!)  No appointment necessary

Other agencies have had similar experiences.

In Maine, the Addiction Resource Center was able to reduce wait time for patients seeking medication-assisted treatment for opioid addiction to three days or less.

Read all about it in this NIATx E-news story, NIATx tools improve access and efficiency at Maine's Addiction Resource Center

How to stop scheduling appointments 

"Consider easing into it," says NIATx coach Elizabeth Strauss. "Try walk-in assessments for just one day a week for just two weeks. That way, staff can get used to the idea and weigh the pros and cons of this approach over scheduling appointments."

Remember, in the NIATx approach, you only embrace a change after you have proof (data) that it is an improvement.

Strauss helped develop many of the NIATx Promising Practices that you can find on NIATx website. Check out  Establish Walk-in Hours.  It offers step-by-step instructions and sample forms that you can use for testing walk-in hours in your agency.

You can also try out some of the other NIATx Promising Practices that build capacity for walk-in appointments. Three that Strauss recommends include:

Has your agency stopped scheduling appointments?  How has it changed the way you offer services? Share your story in the comment section below! 

Project ECHO LGBT: Making System Change to Address a High-Risk Population

Artist/photographer: Lavinia Solano
June 27, 2017

How can you effectively treat a high risk population without knowing which patients make up the population? The answer is: you can’t. 

To treat the complex needs of LGBT patients, it is necessary to remove the veil hiding this population from their health care providers. This removes stigma and increases the availability of treatment options based off of the specific needs of this population.

In collaboration with the Centers for Disease Control (CDC) and the National Association for Community Health Centers (NACHC), Dr. Wanda Montalvo of the Weitzman Institute at Community Health Center, Inc. led an initiative entitled “Transforming Primary Care for LGBT People” to improve the quality of care LGBT patients receive at 10 Federally Qualified Health Centers (FQHCs). 

This initiative took place over the course of a year, beginning in March of 2016. The primary focus of this initiative was the identification of the Sexual Orientation and Gender Identity (SOGI) of patients and the integration of this information into the electronic health record (EHR). Through the documentation of SOGI in the EHR, health care providers can make informed decisions about how to provide much needed care. 

Project ECHO LGBT 

The 10 FQHCs engaged in the initiative were provided access to Project ECHO LGBT and a Practice Improvement Collaborative (PIC) hosted by the Weitzman Institute’s online learning network. Project ECHO LGBT featured expert faculty from the Fenway Institute, who provided didactic presentations and facilitated and addressed case-based questions from providers attending ECHO. Project ECHO LGBT didactics addressed the full scope of relevant clinical topics to improve the knowledge and competency of providers.
  • Within one year, the 10 FQHCs engaged in the initiative were able to implement system change and identify the SOGI of 50.8% of their patient population (205,738). 
  • Of the 10 FQHCs, nine were able to integrate SOGI into the EHR. 
  • Throughout the year, each FQHC was able to improve risk-based screening and STD and HIV screening rates within this population, due to the increased visibility of at risk patients. 
National HIV Testing Day June 27This initiative yielded insight into how the engaged sites were able to make system change within the elaborate environment of an FQHC. The lessons learned across the 10 FQHCs provide an accurate account of the necessary steps and tools needed to unveil and begin population-specific treatment of LGBT patients. 

Culture First, Data Second

While documentation and data are critical to the big picture treatment of this population, the necessary first step is to consider the culture of your staff and patient population. The FQHCs found that alienation of both providers and patients was more likely if system change was disseminated without first considering the culture of staff and patients. 

It Starts at the Top

All FQHCs endorsed that the most important factor in the success of organization-wide system change was buy-in from leadership. Regardless of how important the work was to staff, patients, or the community, it was difficult to make change without the support of key leadership members. These include the CEO, CMO, and departmental heads in key departments like Human Resources, Communications, and Business Intelligence. 

Let’s Get Behavioral (Health, that is). 

Considering the societal stigmatization of LGBT people, it was not surprising to find that many of the case presentations on Project ECHO LGBT surrounded the behavioral health needs of LGBT patients. Whether the patient struggled with suicidal ideation, substance abuse, or sex addiction, it was evident that it’s necessary to treat each patient as a whole person and not only focus on their physical health through screening for STDs and HIV. System change cannot only accommodate physical health, but must address the mental health of patients to reduce incidence of chronic disease and other long-term health conditions that create poor quality of life for the patient.

The efforts of the 10 engaged FQHCs, with the guidance and assistance of the CDC, NACHC, the Weitzman Institute, and the Fenway Institute, cumulated in a critical understanding of how to make high-level system change to improve access and quality of care to an at-risk population. 

For more information on this work, please visit You can also contact Agi Erickson, Director of Project ECHO, at or (860) 347-6971 ext 3741.

Kelly Gagnon graduated from Hobart and William Smith Colleges in 2013 with   Bachelor of Arts degree in Psychology and French. During her undergraduate career, she conducted research on how to improve the quality of life of adolescent mothers and their children. This inspired her interest in research in sexual health. The needs of these mothers also opened her eyes to the needs of a widely underserved population. Her goal is to continue to work with these underserved populations to improve health disparities. Kelly is currently enrolled in a Master of Public Health program at Southern Connecticut State University. Kelly joined the Weitzman Institute in 2016 to assist with the LGBT ECHO and Pain research projects. She hopes that through working on these projects and others she can gain valuable research experience. After graduating from her Master’s degree program, she plans on continuing her education and pursuing a PhD program.