Joseph McSherry: Rework all recreational drug regs along with cannabis

Editor’s note: This commentary is by Joseph McSherry, M.D., Ph.D., who is an associate professor of neurological sciences at the Larner College of Medicine at the University of Vermont.

You do not need to be a doctor to understand that if you remove someone’s liver and their problem is lung cancer, you have not helped their health. People are rightfully anxious about highway safety and adolescent addiction. All the regulation possible for cannabis will not fix the public concern for highway safety and adolescent addiction.

The Governor’s Commission on Marijuana made recommendations from the Health Impact Assessment of 2016, pages 49-60, which covered optimal regulation found for alcohol and tobacco. For instance, raising the age for nicotine purchase from 18 to 21 years reduced teenage smoking in one town even though the neighboring towns did not restrict sales to teenagers. Nicotine is the most addictive drug we have, in the sense that about a third of people who try cigarettes have difficulty stopping. For alcohol, cocaine, heroin it is about one in six have difficulty stopping, and about 1 in 11 for cannabis. But if the minimum age is 21, the risks of addiction are much less. I am not addressing withdrawal problems, which can kill you if it is opiates, alcohol or benzos. Withdrawal from nicotine is not very dramatic, but the desire remains for resumption.

The legalization of home production and use of cannabis is important, but it does not impact the illegal market where kids and adults purchase marijuana – some plant material with unknown chemical contaminants and perhaps no cannabis at all. Folk who home grow cannabis know there is no fentanyl or synthetic cannabinoids in their pot, a big benefit over purchasing illegal stuff. A regulated market should provide tested product of known chemotype, including levels of THC and CBD as well as other cannabinoids and terpenes which have distinct interactions and relaxing or energizing effects. With prudent flexibility on taxing and price regulation, the illegal product becomes less desired and eventually out of the market. Then the toxicity of fentanyl and dangerous synthetic cannabinoid agonists will be past, much as wood alcohol and other substitutes for booze disappeared (mostly) after the end of alcohol prohibition.

The silliness in the report includes ideas like cannabis impairs driving and urgently needs punitive measures by police to improve highway safety. Studies from around the world and excellent National Highway Traffic Safety Administration research suggest a 1.6 or 1.0 crash risk (something between 60 percent and zero percent increase) with cannabis alone compared to drug free. Alcohol at a blood alcohol concentration (BAC from the breathalyzer) of 0.08 is associated with a fourfold increased risk of crash, three or four times the risk of cannabis alone. The obvious and urgent need to improve highway safety is to reduce the BAC permitted for driving to a much lower level.

The people are right – we need to protect the youth from dangerous, harmful drugs and we need to reduce impaired driving. While debating and implementing legislation regarding the regulation of cannabis the Legislature and governor have the opportunity to do public health a great benefit, not only by reducing the dangerous illegal market in marijuana but also addressing child exposure to the most addictive substances, especially nicotine and improve highway safety by reducing permitted alcohol in drivers to near zero. Achieving this public health initiative of regulating all recreational drugs alike will be hard, harder than regulating cannabis. Legislators and the public are used to the compromise between public safety and the alcohol lobby of allowing a fourfold increase risk of crashing, a BAC 0.079. Other cultures, like northern Europe, have made the adjustment to very low tolerance for alcohol. Getting used to a designated driver is easy. Well easy enough. Those addicted to nicotine like the availability of nearly 1,000 outlets in the state with little regulation. Gas stations selling alcohol to drivers is bad for public health. Stores currently catering to the drug needs of the community will have to close off a portion of their establishment to sell the over 21 years of age legal drugs. Regulating recreational drugs will be hard, but it is the right thing to do. Cannabis regulation should be the impetus to fix the bad compromises made on prior drug regulation.