The surgeon general is right about marijuana and its risks

Paul Armentano’s opinion in The Hill, “What the Surgeon General gets wrong about marijuana,” disputes several facts that Surgeon General VADM Jerome Adams discusses in Surgeon General’s Advisory: Marijuana Use and the Developing Brain Armentano asserts the surgeon general is wrong about the harms and risks of marijuana. He selects limited data in support of his argument about the benefits of marijuana use to further the goals of his organization, the National Organization for the Reform of Marijuana Laws.  

Examination of the scientific literature cited in the advisory emphasizes the importance of protecting Americans from the risks of use, specifically during adolescence and pregnancy. Sale or possession of marijuana remains illegal under federal law; however, states have been legalizing marijuana for medicinal and recreational purposes. Legalization gives the false impression that marijuana is safe and, research shows that perceptions of harm associated with its use have decreased. 

Data from the National Survey on Drug Use and Health (NSDUH) show that marijuana is the most widely used illicit drug in the U.S. and its use is increasing, with 44 million Americans (16 percent) using it during the past year.

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The percentage in 2018 that used marijuana was higher than those from 2002 to 2017. This increase in use among people 12 or older reflects increases in use between both young adults 18 to 25 and adults 26 or older. 

Although research consistently shows that use carries health risks, notably absent from any discussion on legalization are the potential harm and risks. The Surgeon General highlights the known risks that have been reported in the recent scientific literature for adolescents and pregnant women. 

Marijuana is the most commonly used drug by adolescents after alcohol and e-cigarettes. According to the most recent Monitoring the Future survey, an annual survey of drug use and attitudes among our nation’s middle- and high-school students — teens’ perception of harm and the risks of use have declined for years, such that it is now at the lowest level in four decades.

Adolescent use carries significant risk. Research has shown that chronic use in adolescence has been linked to a decline in IQ that does not recover with cessation, with poor school performance and with increased dropout rates that jeopardize educational, professional and social achievements. 

Use in adolescence is associated with increased risk for psychotic disorders in adulthood and is linked with suicidal ideation or behavior. Colorado and Washington, the two states to first legalize recreational use, have reported higher rates of school suspensions and expulsions, as well as higher rates of car crashes, among adolescents who use marijuana. Given these data, efforts are urgently needed to scale up prevention programming and science-based public messaging on risks to adolescents. 

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Armentano asserts in his article, “The majority of people who use marijuana do not go on to use other ‘harder’ substances.” Recent research, however, has refuted this, with adolescent use associated with other substance use, as well as with misuse of prescription pain medications. NSDUH data reports a significant increase in past-month use among adults 26 or older, from 13.6 million in 2015 to 18.5 million in 2018.

With regard to pregnant women, marijuana is the most widely used illicit drug during pregnancy. The NSDUH reported that use during pregnancy increased from 3.4 percent (78,000) in 2015 to 7.1 percent (161,000) in 2017. Updated national survey data reports a decline in use during pregnancy to 4.1 percent (111,000) in 2018. Use among non-pregnant women overall, however, has significantly increased from 12.2 percent (7.5 million) in 2017 to 13.7 percent (8.5 million) in 2018.

Many retail dispensaries recommend marijuana as an effective, safe treatment for nausea that commonly accompanies pregnancy, but there is no research that shows this is safe. Emerging data on the ability of marijuana to cross the placenta and affect the fetus raise concerns about pregnancy outcomes. Use during pregnancy may be associated with fetal growth restriction, stillbirth, preterm birth, and neonatal intensive care unit admission. Breastfeeding mothers and long-term consequences have also raised concerns about use for the infant or child. Marijuana exposure is associated with problems with neurological development, resulting in hyperactivity and poor cognitive function.

As the Surgeon General highlighted in his advisory, the American College of Obstetricians and Gynecologists recommends, “Women who are pregnant or contemplating pregnancy should be encouraged to discontinue marijuana use…. Women reporting marijuana use should be counseled about concerns regarding potential adverse health consequences of continued use during pregnancy." 

It is important to highlight that, although no states specifically list pregnancy-related conditions among the allowed recommendations for medical marijuana, neither do any states currently prohibit or include warnings about the possible harms of marijuana to the fetus when the drug is used during pregnancy.

The Surgeon General’s Advisory: Marijuana Use and the Developing Brain is based on extensive and irrefutable scientific evidence that no amount of marijuana during pregnancy or adolescence is known to be safe. As the surgeon general clearly stated in his advisory, “Further research is needed to understand all the impacts of marijuana on the developing brain, but we know enough now to warrant concern and action.” 

Elinore F. McCance-Katz, MD, Ph.D., is the assistant secretary for Mental Health and Substance Use and leads SAMHSA, where Patricia B. Santora, Ph.D., is a public health analyst and Thomas Clarke, Ph.D., directs the National Mental Health and Substance Use Policy Laboratory.