I read the ACP's 7000 word recommendation to decriminalize cannabis so you don't have to

The most important thing to take away from this document is that American College of Physicians calls for decriminalization for the possession of small amounts of cannabis. It does not support a legal market for the plant. In this paper, they do not argue that the benefits of cannabis outweigh the harms, but they do argue that criminalization itself is harmful, and disproportionately so toward people of color. 

In 2017, the ACP called for researchers to look into the effects of state-level cannabis legalization on public health. This paper outlines the results of some of that research. It’s a practical approach, but much of what they found is still inconclusive. For me, the most concretely alarming finding was that 3054 children went to the hospital for accidentally consuming edibles in 2021—nearly 15 times as many as in 2017, just four years earlier. They also found that adults over 65 were showing up to the ER more for reasons related to cannabis. 

Whether or not you agree with the ACP’s approach to cannabis, this paper is a helpful overview of the current landscape. It looks at the research on cannabis, the harms of criminalization, and current issues with the cannabis market. Some takeaways below: 

• There needs to be a lot lot lot more research on cannabis, including its health benefits, harms and consequences on legalization
• The Market for Delta-8 THC and other hemp derived products is a mess. There is little framework for regulation of these products, which often contain synthetic cannabinoids. And since these cannabinoids are so new, they’re very poorly understood. Contamination is also a risk.
• Vapes are also still a concern.
• Cannabis is getting a lot more potent. We need to understand what that does to people. The authors recommend limiting THC potency, based on some evidence that restrictions will reduce cannabis-related hospitalizations
• Biden's pardon of all federal cannabis possession convictions is largely symbolic. Only 7700 people were convicted of cannabis possession on the federal level between 1992 and 2021. Meanwhile, if the pardons had included state and local cases, more than 200,000 people could have received pardons in the state of Virginia alone, half of them are people of color. 
• Evidence on whether cannabis legalization has created increased public health risk is inconclusive
  • We still don't know for sure if legalization has led to more car accidents
  • One study found that legalization did not increase psychosis-related diagnoses
  • Another study found that twins in states with legalization used more cannabis, but did not experience more social, mental health or financial problems
  • One study found that 25% more teenagers were addicted to cannabis in states where it was legal than illegal 
• Treatment for cannabis use disorder should be easy to access and covered by insurance
  • The authors support treatment vs. incarceration for people who use cannabis
  • They recommend research on treatments and medication for cannabis use disorder
  • They mention that “low treatment rates make it difficult to identify barriers to care.” This made me wonder how many people actually feel like they need treatment for cannabis addiction, or that it’s a problem. 
• Doctors should learn about cannabis in medical school
• Researchers should have access to a greater variety of weed to study, more similar to what people actually use.
• We need to stop false claims on cannabis products. The FDA sent a warning letter to Nature Roots Hemp, a Wisconsin-based cannabis company that claimed it’s CBD could cure Covid.
• No more fun packaging for weed. It's too appealing to kids.
• There should be PSAs to inform the public about the risks of cannabis. The authors mention that the “My Anti-Drug” campaign might actually have made more teens start smoking weed, though, so we need to be careful. 

My two cents: This paper is honest about the areas where evidence is inconclusive when it comes to the harms of cannabis. Maybe this isn't the APC's prerogative, but I think it would make sense to look at how cannabis compares to legal substances, like alcohol and cigarettes, where evidence about the harms is absolutely conclusive. The ACP is right to point out the disproportionate damage of mass incarceration toward people of color. However, they only recommend decriminalizing the possession of small amounts of cannabis—when people of color and Black people in particular are also much more likely to be incarcerated for selling cannabis.

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