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Let’s Hash This Out: General Questions About Cannabis

October 20, 2020

As Missouri gears up for medical marijuana to possibly become available this month (with one licensed dispensary already doing a “dry run”), the nation has been slowly addressing the legality of marijuana. Just last month, the Marijuana Opportunity Reinvestment and Expungement (“MORE”) Act was slated to be on the House floor, only to be delayed by urgent COVID-19 measures. This bill would remove marijuana from the list of scheduled substances under the Controlled Substances Act and decriminalize manufacturing, distribution, and possession of marijuana. And no one batted an eye when the most recent stopgap spending bill again prohibited the Justice Department from spending federal funds to interfere with state marijuana laws. See Continuing Appropriations Act, 2021 and Other Extensions Act, Pub. L. No. 116-159, Div. A, § 101(2) (2020); see also Consolidated Appropriations Act, 2020, Pub. L. No. 116-93, tit. V, § 531, 133 Stat. 2431 (2020). This is in stark contrast to the original version of this provision, which was rejected multiple times before passing and then deemed “landmark,” “historical,” and “impressive.” With the increasing normalcy in cannabis use, we address below some frequently asked questions about marijuana. In particular, we address cannabis products containing Δ9-tetrahydrocannabinol (“THC”), the primary psychoactive component. These answers are not intended to be a comprehensive review of the available scientific literature, and readers looking for advice or guidance on compliance with state-specific regulations are encouraged to consult an attorney.

What are the differences between smoking marijuana and consuming marijuana edibles?

Where legal, cannabis may be smoked by burning the cannabis flower, itself, or by heating an oil-based liquid containing cannabinoid extract. Many medicinal cannabis patients prefer to smoke cannabis, and some users have reported that the “high” from smoking is qualitatively different from the “high” from eating a cannabis-infused edible. Notably, users who smoke cannabis typically feel psychoactive effects within minutes after inhaling, with a peak “high” at around 20-30 minutes and noticeable tapering by 3 hours. While it is well-established that smoking tobacco can result in severe health issues, the evidence regarding smoking cannabis is less clear. However, it appears that smoking marijuana can affect the lungs in a similar manner, as it is associated with lung inflammation, bronchitis, and possibly an increased cancer risk. And as many know, smoking marijuana will cause a distinct lingering odor.

Cannabis-infused edibles, on the other hand, may take the form of candies, cookies, brownies, crackers, or other foods. Because these products are digested instead of inhaled, studies uniformly find that it takes significantly longer for a user to feel any effects of the THC. In fact, the initial effects of edibles are typically felt within 30-90 minutes, with a peak “high” occurring up to 4 hours after ingestion and tapering sometimes not occurring until 8 hours after ingestion. Incidents of overconsumption and overdose have been linked to edibles, as users may be unaware of this delay and therefore consume higher doses in an effort to experience psychoactive effects. Moreover, ingestion of edibles can result in a stronger and longer-lasting “high” than smoking may produce; once metabolized by the liver, THC is transformed into a metabolite that is more potent than THC and may appear in higher quantities in the user’s blood.

Can someone overdose on marijuana?

Yes. Although it appears unlikely that cannabis, alone, can directly cause death, it is possible to consume an amount of cannabis that can cause severe impairment. Symptoms may include cognitive and motor function impairment, increased anxiety and agitation, severe sedation, cardiac stress, dizziness, nausea, and vomiting. Some studies have found that extremely high levels of THC can produce psychotic symptoms like hallucinations and delusions. While these symptoms usually last while the user is intoxicated, there is evidence that they may continue for up to several days.

In addition, studies have shown that marijuana use among teenagers, despite remaining illegal, has become more common in recent years. Many teenagers consume cannabis-infused edibles rather than smoking it because the edibles are more discreet and less likely to produce an odor. However, teenagers may not understand the scientific implications of marijuana use, including the unique aspects of consuming edibles. For that reason, they may be at greater risk to overdose. As such, several studies have encouraged substance abuse education programs to include more detailed education on marijuana.

Is marijuana really not addictive?

Despite the belief that cannabis is not traditionally addictive (as other controlled substances may be), frequent marijuana users may experience a tolerance to THC and may report craving marijuana. Physiologically, THC has been found to affect production of the neurotransmitter dopamine, which is involved in reward and motivation. THC binds to particular receptors in the brain and stimulates dopamine production. This neurological phenomenon is believed to be responsible for the rewarding effect of THC. However, regular marijuana use (e.g., daily) has been linked to a decrease in the body’s natural dopamine production, and decreasing regular use may lead to addictive behaviors like stress reactivity and irritability. The dopamine system is also linked to psychosis, such that marijuana intoxication may exacerbate psychotic symptoms in patients with schizophrenia.

What are the long-term health risks of marijuana use?

Due to the historical illegality of marijuana, there are few studies on the long-term health effects of adult marijuana use. However, some studies indicate that consistently smoking marijuana over a long period of time may be associated with respiratory problems and exacerbation of mental health disorders (particularly psychotic symptoms). Because THC causes increased heart rate during intoxication, some suspect that regular marijuana users may be at greater risk for developing cardiovascular issues, but the evidence is not clear. Although some have suggested that regular marijuana use may be linked to an increase in anxiety or depression, more recent studies have noted that users may already be predisposed to these conditions.

Use of marijuana by teenagers, however, is more concerning. First of all, this use is illegal, even in states that have legalized recreational marijuana. Furthermore, adolescent use of marijuana may disrupt the development of the pre-frontal cortex. Besides interfering with cognitive development, this could result in development of psychotic disorders in later years.

Can I get employment benefits for medical marijuana?

It depends on your state. Although federal laws do not cover marijuana, as it is still illegal under the Controlled Substances Act, courts have recently been interpreting state laws as not prohibiting employers from reimbursing workers for their purchase of medical marijuana. See Appeal of Panaggio, 205 A.3d 1099 (N.H. 2019). In addition, some state regulations governing medical marijuana specifically include anti-discrimination provisions. See, e.g., Chance v. Kraft Heinz Foods Co., C.A. No. K18C-01-056 NEP, 2018 WL 6655670 (Del. Dec. 17, 2018). Where no provision is explicitly included, some courts have held that an employer should consider whether to reasonably accommodate an employee’s medical marijuana use. See, e.g., Barbuto v. Advantage Sales and Marketing, LLC, 477 Mass. 456 (Mass. 2017).

Is my boss required to let me use marijuana?

Maybe. Where an employee uses medical marijuana in compliance with state law, an employer may be required to permit off-duty use. Whitmire v. Wal-Mart Stores, Inc., 359 F.Supp.3d 761 (D. Ariz. 2019). However, it is unlikely that any employer will ever be required to permit possession or use of marijuana while an employee is working. Additionally, it is unclear whether employers would be required to permit use of recreational marijuana.

Resources:

Daniel G. Barrus, et al., Tasty THC: Promises and Challenges of Cannabis Edibles, RTI Press Publication No. OP-0035-1611 (Nov. 2016), https://doi.org/10.3768/rtipress.2016.op.0035.1611.

Jordan Bechtold, et al., Chronic Adolescent Marijuana Use as a Risk Factor for Physical and Mental Health Problems in Young Adult Men, 29 Psychology of Addictive Behaviors 3, 552 (Sept. 2015), published correction appears in 29 Psychology of Addictive Behaviors 4, ix (Dec. 2015), http://dx.doi.org/10.1037/adb0000103.

Michael A.P. Bloomfield, et al., The Effects of Δ9-Tetrahydrocannabinol on the Dopamine System, 539 Nature 7629, 369 (Nov. 17, 2016), https://doi.org/10.1038/nature20153.

Bettina Friese, et al., Teen Use of Marijuana Edibles: A Focus Group Study of an Emerging Issue, 37 J. of Primary Prevention 3, 303 (June 2016), https://doi.org/10.1007/s10935-016-0432-9.

Erin Schumaker, Marijuana Edibles Might Not Be As Safe As Thought, Health Experts Warn, ABC News (Jan. 7, 2020, 2:27 p.m.), https://abcnews.go.com/Health/marijuana-edibles-safe-thought-health-experts-warn/story?id=68117011.

Nora D. Volkow, et al., Decreased Dopamine Brain Reactivity in Marijuana Abusers Is Associated with Negative Emotionality and Addiction Severity, 111 Proceedings of the Nat’l Acad. of Scis. of the United States of Am. 30, E3149-E3156 (Jul. 2014), https://doi.org/10.1073/pnas.1411228111.

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