This November, Michiganders will be able to vote on Proposal 1, which would legalize the possession, consumption and sale of marijuana for recreational purposes. In a recent survey from The Detroit News, 56 percent of likely voters supported Proposal 1 and 36 percent opposed it, with only 6 percent undecided. Even opponents of legalization expect it to pass by a wide margin as voters, especially young voters, will be motivated to the polls by the spectacle of legalization. This is probably why the Republican Party in Lansing tried (and failed) to legalize marijuana in an effort to keep Proposal 1 off the ballot and tamp down on voter turnout in an election year that is looking increasingly bad for the GOP.

Recreational use of marijuana has been legalized in nine states and Washington, D.C. Thirteen other states and many of Michigan’s largest cities — including Ann Arbor, Detroit, Grand Rapids and Lansing — have decriminalized, but not legalized, recreational marijuana. Decriminalization means that someone caught with small amounts of marijuana will face a civil penalty, such as a fine, instead of criminal charges. Medical marijuana is also legal in Michigan, provided a person has one of 22 health conditions the state government has approved to qualify for treatment with medical marijuana, including autism, chronic pain and cancer. People with one of these conditions can apply for a state medical marijuana ID card.

While legalization and/or decriminalization of marijuana is a step forward in undoing the tangled mess that was the war on drugs, the hysteric anti-drug mindset of former Presidents Richard Nixon and Ronald Reagan still influences drug policy at the federal level. When Michigan votes to legalize recreational marijuana on Nov. 6, pot will still sit alongside heroin as a Schedule 1 controlled substance in the Drug Enforcement Agency’s eyes. In states like Colorado, where recreational marijuana is already legal, the mismatch between state and federal statutes means that while a person may be able to sell marijuana freely, they cannot open a bank account for their business. Comedian John Oliver does a great segment on this topic that I encourage everyone to watch.

But I am not a legal columnist. With the legalization of recreational marijuana use in Michigan seeming inevitable, it’s high time we have a real discussion about the public health solutions and challenges posed by marijuana.

The properties of marijuana come from naturally-occurring chemicals in the plant that interact with the endocannabinoid system. The ECS is a system of cellular receptors in the nervous system that normally bind the neurotransmitters AEA and 2-AG. The chemicals in marijuana are similar enough in structure to AEA and 2-AG to bind to the ECS receptors and activate the system which plays a role in appetite, pain, memory and mood. The two most well-known chemicals in marijuana are THC, the psychoactive ingredient, and CBD, though there are many more.

Marijuana has been said to possess all sorts of health benefits, chief among them as a non-opioid treatment for chronic pain. Michigan is in the jaws of a massive opioid epidemic and marijuana is often mentioned in discourses about solutions. Theoretically, opioids and cannabinoids (the class of chemicals in marijuana) treat chronic pain in much the same way. While cannabinoids stimulate the ECS, opioids stimulate the body’s mu-opioid receptors. Both lead to changes in perception of the chronic pain. They do not treat the underlying cause of the pain (e.g. inflammation or damaged nerves). The key appeal of cannabinoids over opioids is that no one has died of an overdose on marijuana, whereas thousands have overdosed on Oxycontin and other opioids. Despite this benefit and fairly solid evidence that cannabinoids can treat chronic pain, U.S. health care providers still prefer to prescribe opioids — a barrier that must be addressed if marijuana is to ever be widely used as an opioid alternative.

Marijuana has been shown to have other concrete health benefits, such as reducing vomiting in cancer patients and improving food intake in HIV-positive patients. However, there are also a fair number of fantastical claims out there about what pot can cure. Marijuana and its non-psychoactive cousin, hemp, have been shrouded in an aura of mysticism that leads some people to believe it can cure complex diseases such as cancer. The unfortunate truth is there is no evidence that marijuana cures or slows the course of cancer.

Health care providers, hospital and public health organizations in Michigan would do well to educate people about the reality of what marijuana can and cannot do, otherwise, we could see patients forgoing proper medical treatment and instead trying to smoke themselves, or their kids, healthy.

Speaking of smoking, let me bust one of the most common marijuana myths out there: Smoking pot is not harmless. While not as addictive as opioids, about 10 percent of chronic marijuana smokers will develop a dependence, with a higher likelihood of dependence the younger you are. Just like other substances, stopping marijuana can cause withdrawal that, while not deadly, can make it hard for someone to quit if they want to. Smoking any burning plant matter, be it marijuana, tobacco or even lettuce, exposes a person to nasty chemicals produced by the burning process. Regular marijuana use is also linked to heart and lung problems as well, as at least one type of cancer. 

None of this is to say that recreational marijuana should remain illegal, just that there is a need for widespread education about the risks of use when Michiganders gain far greater access to marijuana. Like alcohol and tobacco, marijuana will be tightly regulated under Proposal 1 which should put minds at ease.

Proposal 1 is by no means perfect. It does not erase marijuana convictions of people, especially people of color, who have predominantly been incarcerated under the old war on drugs policies. That is the next step. When Proposal 1 passes by a hefty margin, as I think it will, it will also send a message to Congress to act to end the federal prohibition on marijuana.

The war on drugs was based on hysteria and racism, not public health concerns. Now that we are crawling out of this failed era, it is time we treat marijuana the way it should be: as a drug with real potential to benefit people’s lives, but also with some real risks that need to be properly mitigated.

Ali Safawi can be reached at asafawi@umich.edu.

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