Medical professionals – doctors, nurses, pharmacists, and others – are among the most widely respected professionals in the United States. We are trusted, quite literally, with peoples’ lives. Aware of this trust, medical organizations frequently promote government policies that encourage good public health. Today, however, much of organized medicine is on the wrong side of history in its ongoing support for the War on Drugs.
While the American public overwhelmingly supports the legalization of medical and adult use cannabis, medical organizations – particularly physician organizations – by and large continue to either support the drug war or are silent on the topic. This is despite the enormous cost that the drug war, including the war on cannabis, has had upon our country – and particularly upon people of color.
We like to think that people no longer get arrested for using cannabis. But the war on cannabis is still with us. In 2019, there were 500,000 arrests for cannabis-related offenses in the U.S., mostly for the possession of small amounts. And getting arrested for cannabis possession can be more than a slap on the wrist. In many states, the penalties remain severe: months in jail, thousands of dollars in fines, the loss of one’s driver’s license, immigration status, student financial aid, child custody, and public housing, and lifelong problems in employment, obtaining loans and mortgages.
Although things are getting better, cannabis legalization in the U.S. is hardly inevitable and legalization is not the law of the land. More than 60% of the U.S. population live in a state where cannabis is illegal without a medical card. Even in the states with legal medical cannabis, few doctors are knowledgeable enough to prescribe it, most hospital systems forbid its use, and medical insurance will not cover it. Moreover, cannabis remains a Schedule I drug, meaning that the federal government insists that cannabis has no accepted medical use, an unknown safety profile, and a high likelihood for misuse – creating enormous barriers in doing medical research. Cannabis will not truly be legal until all 50 states and the federal government make it legal.
A broad majority of Americans now support the legalization and regulation of cannabis for both adult and medical use. This support crosses party lines, which is a rare example of bipartisan cooperation. Yet legislation is often stalled by the voices of an oppositional few. When this obstruction is expressed by authoritative figures, the damage can be enormous. Unfortunately, this resistance often comes from the medical profession.
With rare exceptions, physician organizations have either remained silent or argued for the continuation of the war on cannabis. These organizations pledge to “do no harm” yet disregard the damage to individuals and public health caused by the war on cannabis, the centrality of cannabis prohibition for perpetuating systemic racism, the absence of increased adolescent use in cannabis legal states, and the efforts of the federal government to limit medical research on cannabis. Their reasoning is based upon physicians’ misconceptions about cannabis, government regulations hindering medical research into cannabis’ effectiveness, and their unwavering confidence in the DEA and FDA as sole arbiters of drug safety (despite their shared culpability in the opioid epidemic). Doctors also are likely to have experienced an upbringing that insulated them from the harms of the drug war, as physicians disproportionately come from wealthy white families, while Black, Latinx, and poor Americans remain underrepresented in our physician workforce. Minority groups bear the brunt of the war on drugs and the consequent policing, incarceration, and poverty, severely hampering any dreams of academic success.
Over a decade ago, Dr. David Nathan, a psychiatrist and medical educator in New Jersey, noted that most of his peers were quietly supportive of cannabis legalization, yet these opinions were suppressed throughout most of organized medicine. Frustrated with this disconnect, David penned an op-ed for the Wall Street Journal, A Doctor’s Case For Legal Pot. He was encouraged by the overwhelmingly positive response to his perspective and, in 2015, David pulled together fifty prominent US physicians to find a middle ground between the failed policy of prohibition and unfettered legalization of cannabis. Doctors for Cannabis Regulation (DFCR) was formed, the first national physicians’ association dedicated to the legalization and effective regulation of cannabis in the US and around the world. Through the evidence-based regulation of cannabis, we can ensure the safe cultivation, distribution, sale, and use of cannabis without the risk of an illicit drug trade, contaminants, and unknown THC concentrations while avoiding the harms and expense of prohibition.
As medical professionals, we believe that we have to:
- Promote the public health benefits of science-based cannabis regulation, including medical cannabis.
- Promote the regulated production, distribution, and sale of cannabis to provide health protection to adolescents (from restricted access to restrictions on regulated advertisements) and adults (by providing access to cannabis that is uncontaminated, appropriately labeled, and inclusive of warnings).
- Undo the past harms to public health that medical professionals have contributed to by being on the wrong side of the war on drugs.
- Actively participate in the education of physicians and other health professionals to ensure that our patients and the public are provided unbiased information regarding the potential benefits and harms of cannabis.
- Engage with medical professionals who do not appreciate or understand the harm to public health caused by almost a century of cannabis prohibition.
- Support the use of cannabis-related tax revenues to benefit public health, including prevention education, treatment, and research.