WASHINGTON, D.C. — No amount of marijuana use is safe for adolescents or pregnant women, according to a new public health advisory released by U.S. Surgeon General Adm. Jerome Adams.
Adams issued the warning on Thursday, saying he was specifically concerned about the dangers of marijuana on the developing brain in light of increasing access and potency of marijuana as well as the increasing number of products containing concentrated levels of marijuana including edibles, oils and waxes.
"This ain't your mother's marijuana," Adams said. "The scary truth is that the actual potential for harm is increasing. The potency of today's marijuana is far more potent than days past."
The advisory comes amid a changing landscape of marijuana laws and attitudes in states across the U.S., as well as growing concerns about youth vaping. It is the first Surgeon General's advisory on marijuana since C. Everett Koop issued a warning in 1982.
Adams did not specifically address medical marijuana or recreational use among non-pregnant adults.
Officials said they were launching a national digital awareness campaign about the advisory that will be funded using $100,000 donation from President Donald Trump's salary.
During the announcement at the Department of Health and Human Services, HHS Secretary Alex Azar said the recommendation came in response to figures indicating growing use among at-risk populations. He cited the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2018 National Survey on Drug Use and Health study which found 9.2 million youth aged 12 to 25 reported using marijuana in the past month and 29% more young adults aged 18 to 25 started using the substance.
Marijuana was found to be the most widely used illicit drug among teens and pregnant women and "appears associated" with risks for opioid use, heavy alcohol use and major depressive episodes. "Despite the serious risks associated with marijuana, trends indicate that pregnant women and young people are growing more likely to use the drug—and less likely to recognize the risks," Azar said.
Azar acknowledged research limitations surrounding marijuana largely due to federal drug laws and said the administration was prioritizing the problem. "We want to make sure research can be conducted effectively and we know there’s significant barriers to the conduct of research," he said.
But as evidence of progress, he pointed to a Drug Enforcement Administration announcement released this week which to expand the number of suppliers that are able to produce more strains of marijuana that reflect more current levels of THC. For years, the Univeristy of Mississippi has held the sole federal contract for producing marijuana through the National Institute on Drug Abuse.
The DEA also announced, as the result of a recent amendment to federal law, certain forms of cannabis no longer require DEA registration to grow or manufacture such as some hemp and CBD.
The American Medical Association was among physicians groups that applauded the Surgeon General's advisory, even as it continued to push for an improved research environment for studying marijuana.
"We strongly support this effort as the AMA has long discouraged cannabis use by youth, pregnant women, and women who are breastfeeding and has called for research to determine the consequences of long-term cannabis use in these populations," said Patrice Harris, M.D., the president of the American Medical Association in a statement.
The AMA's recently voiced support for the ‘Cannabidiol and Marijuana Research Expansion Act’ to enable research that would assess the potential safety and efficacy of medicines derived from cannabis.
"The AMA believes that scientifically valid and well-controlled clinical trials conducted under federal investigational new drug applications are necessary to assess the safety and effectiveness of all new drugs, including potential cannabis and cannabinoid products for medical use," Harris said. "Due to legal and regulatory barriers to cannabis and cannabinoid research, physicians and patients do not currently have the evidence needed to understand the health effects of these products and make sound clinical decisions regarding their use.”
Even as more research would benefit public health, there is plenty of science to support the latest advisory, Gene Ransom, CEO and Executive Director of the Maryland State Medical Society, or MedChi, told FierceHealthcare.
"This is not a super new development. It's on target with what we know: Articles clearly show marijuana use prior to the age of 24 or 25 causes brain damage," Ransom said. "He's dead on."
Medical marijuana was legalized in Maryland and legalization of recreational use is expected to be considered in the future. MedChi has a task force of 15 doctors examining the science of marijuana to help inform policy and is considering whether to recommend that any attempt to legalize marijuana have an age limit of at least 24 or 25 years.
"There's a high probability we would ask for an age that aligns with the science," Ransom said.
The surgeon general's warning could impact the conversation in the broader medical community as physicians grapple with how to advise patients about the risks and benefits of a substance that many patients are actively seeking advice on, Ransom said.
"Recreation marijuana is going to be the new normal. People need to understand the risks when they are doing this," he said. "They understand the risks around tobacco, they understand the risks of alcohol. If this is going to be more mainstream, they need to understand the risk."