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Under prohibition, all data collected on cannabis consumers by the National Institute for Drug Abuse (NIDA), the Drug Enforcement Administration (DEA), the International Narcotics Control Bureau (INCB), and the United Nations Committee on Narcotic Drugs (UNCND) was categorized as “abuse.”  Any  “use” of illicit substances is viewed as abuse under a prohibition model, think cocaine, methamphetamines, etc. Through NIDA, the United States has funded billions of dollars to prove the harms of cannabis while underfunding studies that explore its’ therapeutic utility. So, it should be no surprise that data from this vantage point (i.e., looking at cannabis harms) dominates the number of research findings in comparison to those exploring its benefits. This can also be seen in how these agencies are responding to the increase of individuals “using” cannabis.

Consumer vs. Abuser

A new approach to determining cannabis' 'actual or relative potential for abuse” is needed that includes a definition for cannabis consumption that separates those who are choosing to use cannabis to enhance their life similarly to how alcohol is viewed and the 6 million+ Americans who are successfully using medical cannabis, from those that may demonstrate issues defined under the controversial Cannabis Abuse Disorder.

Using the Centers for Disease Control and Prevention’s (CDC) 2019 statistics, which reported 48.2 million people used cannabis at least once that year, the breakdown of consumers could look like this:

• 12.4% (6 million) medical cannabis patients - Medical cannabis patients are living with a medical condition or experiencing symptoms for which cannabis or a cannabinoid-based therapeutic is the only treatment option (often of last resort), a more suitable option to even more dangerous alternatives (e.g. opioids), or works as an adjunct treatment including side effect mitigation to other available care options as recommended by a medical professional.
• 30% (14.5 million) individuals potential use disorder - While it is very unlikely that 3 out of 10 reported consumers that have used cannabis once in the last year have cannabis use disorder, this calculation highlights the fact that a majority of cannabis consumers should not be in the “abuse” category.
• 57.6% (27.7 million) healthy cannabis consumers – Adults 21 years and older who choose to consume cannabis for non-medical purposes as desired and without a physician’s recommendation.

Public Health and Media Perspectives

The September 2024 National Academies' report, "Cannabis Policy Impacts Public Health and Health Equity," has been frequently cited by designated participants in cannabis rescheduling hearings. This report also fueled public health discussions, further amplified by the New York Times' October 4, 2024 article, "As America’s Marijuana Use Grows, So Do the Harms." While the piece offered valuable consumer information, it primarily portrayed cannabis as harmful without investigating the sources of complaints or exploring alternative public health approaches.

Similarly, the Washington Post’s October 16, 2024 editorial by Dr. Leana S. Wen, "Marijuana Use is Rising. The Government Needs to Correct its Mistake," focused narrowly on a drug-abuse perspective. These narratives often overshadow the nuanced realities of cannabis use, which include its therapeutic benefits and the importance of addressing contamination and misinformation in the cannabis market.

 “Cannabis” Consumption and Public Skepticism

Due to a near complete lack of federal oversight and data collection, it is unclear if the negative experiences Americans are having with “cannabis products” are from cannabis products or hemp products, synthetic products, or contaminants such as heavy metals, pesticides, and residual solvents often found in unregulated or poorly regulated cannabis/hemp products. Thanks to decades of the federal government’s “reefer-madness” propaganda and prohibition, Americans still do not have a source they can trust when it comes to information about cannabis.  This means efforts to spread health warnings, educate on contaminants and cannabis harms, and even guidance on drug interactions are viewed by the public with immense skepticism.

Misleading Comparisons

Framing “Cannabis Use Surpassing Alcohol Use” in the U.S. is misleading. Comparing a non-medical substance like alcohol to a medical one like cannabis is an apples-to-oranges comparison. Cannabis's medical applications and the healthcare savings in states with medical cannabis laws highlight the need for a more accurate narrative. Many Americans turn to cannabis for conditions that traditional healthcare options cannot address. A study in ACR Open Rheumatology, "Substituting Medical Cannabis for Medications Among Patients with Rheumatic Conditions in the United States and Canada," found that 62.5% of participants substituted medical cannabis for medications, with 54.7% replacing NSAIDs, 48.6% opioids, 29.6% sleep aids, and 25.2% muscle relaxants. Following substitution, most reported a reduction or cessation in their use of these medications.*

Rethinking Cannabis Use Disorder

Classifying daily cannabis use as Cannabis Use Disorder (CUD) and promoting abstinence-only treatments fail to recognize self-medication as a legitimate motivation. Many medications induce tolerance and dependence without being categorized as “abuse”  or qualify as a “use disorder.” Research and education are needed to provide guidance rather than blanket assumptions about cannabis use.

Addressing Research Gaps

The National Academies’ 2017 report, “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research” called for comprehensive research into cannabis benefits and risks. However, the federal government has continued to focus disproportionately on harm, diverting resources from initiatives like the Medical Marijuana & Cannabidiol Research Expansion Act of 2022. While both areas deserve funding, and no substance is without its risks and harms, an understanding of the benefits of cannabis is likely to yield a better understanding of why people use cannabis and the best approach to address risks.

* Boehnke, K.F., Scott, J.R., Martel, M.O., Smith, T., Bergmans, R.S., Kruger, D.J., Williams, D.A., & Fitzcharles, M.-A. (2024). Substituting Medical Cannabis for Medications Among Patients with Rheumatic Conditions in the United States and Canada. ACR Open Rheumatology. https://doi.org/10.1002/acr2.11717