From Reefer Madness to Reefer Fadness

Rather than a single substance, it is best to conceptualize cannabis as a chemical soup with over 500 ingredients that can be served in countless different ways.,

It might be said that cannabis—not cocaine—is a hell of a drug. The reason for that statement is not to demonize cannabis, but rather to call attention to its remarkable complexity, both in terms of its composition and place in our current culture.

Over the past few years, I have had many opportunities to discuss both the potential benefits and harms of cannabis in the popular media, being careful to present the scientific consensus and most up to date research concerning cannabis addiction and its diagnostic picture; the complex relationship between cannabis and mental health; the potential therapeutic role of cannabis in the opioid crisis; and conversely, the danger of popularizing misinformation about cannabis as a treatment for opioid addiction.

As a result, I purchased a front-row seat to what might be called “the cannabis culture war” between pro- and anti-cannabis zealots, and I tasted the experience of receiving vitriol from both factions.

But here’s the rub: The cannabis culture war is futile because it is predicated on the false idea that cannabis can be pigeonholed into categories. The strange reality is that cannabis holds multiple truths at the same time because rather than a single substance, it is best to conceptualize cannabis as a chemical soup with over 500 ingredients that can be served in countless different ways. The two most studied of these ingredients are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), which can have very different effects on a person’s experience—for example, THC can be euphoria-, anxiety-, and psychosis-inducing, whereas CBD is largely non-intoxicating and can produce anti-anxiety and anti-psychotic effects. This means that cannabis is a paradoxical substance that does not lend itself to black and white, categorical thinking.

If you scour the scientific literature, you will find evidence that cannabis has been associated with benefits for a variety of conditions, ranging from nausea, to treatment-resistant epilepsy in children and multiple sclerosis, to opioid withdrawal and social anxiety disorder. Cannabis has also been associated with harms, including addictionanxiety, psychosiscardiovascular disease, and cognitive impairment. That said, all of these associations require further research to sort out what causes what (causal pathways), exactly how that might be the case (mechanisms), and what else might explain the associations (confounds).

The problem with the propagation of inaccurate, one-sided, ideologically possessed beliefs about cannabis is that it fuels polarization and stifles discussion, rather than move forward cannabis-related discussions in a humble, honest, and data-driven way. Not only is the spread of misinformation and polarized views ignorant at best, but worse, it can be harmful to vulnerable populations on both sides of the aisle.

For example, while investigations into the use of cannabis as a potential treatment for opioid addiction remains promising, elevating cannabis to the status of a cure and using it in lieu of already established treatments (e.g., methadone and buprenorphine) could be life-threatening. Similarly, withholding cannabis as a treatment for chemotherapy-induced nausea due to holding anti-cannabis sentiments is equally nauseating.

While decades of research have focused almost exclusively on the harms associated with cannabis, the pendulum has started to swing the other way as more investigations into the potential benefits are being funded and explored. While this movement towards more balanced research is positive, one unfortunate by-product of a shift in attitudes towards cannabis has been an explosion in cannabis-related hype and misinformation. As a result, our current cultural milieu still contains remnants of Reefer Madness that now co-exists with what might be dubbed Reefer Fadness.

Nothing about the topic of cannabis is straightforward. The cannabis culture war is a false schism. Messages involving cannabis should reflect its complexity, highlighting that its use is relatively safe for the majority of people, and that it holds the potential to be both a medicine and a danger depending on a variety of factors. The most helpful way forward for policy and practice is to acknowledge and integrate this nuanced reality.

A version of this article was originally published by Scientific American.

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