Let's Not Go Off Half-Baked With Medical Marijuana Edibles

Two new articles in the New England Journal of Medicine (NEJM) attempt to explain the complex legal and public health implications of legalized marijuana “edibles”, given the lack of reliable data and patchwork regulation of the drug in the US.

The articles were published on Wednesday, a day after three high-profile US senators introduced legislation to legalize medical marijuana across the country. The move by Republican Rand Paul, of Kentucky, and Democrats Kirsten Gillibrand, of New York, and Cory Booker, of New Jersey, was greeted by some activists as merely symbolic.

“Many jurisdictions have legalized marijuana either for recreational or medicinal use,” said Dr Jeffrey Drazen, editor of the NEJM, in a statement emailed to the Guardian. “Health professionals should be aware of the effects of marijuana and its status as a drug.”

Marijuana for recreational use is sold in Colorado and Washington state, and was recently legalized in Alaska and Oregon. The authors of one of the NEJM articles see legalization as likely in at least seven more states, from Arizona to Vermont.

“We very much wanted to alert public health officials,” said Robert MacCoun, co-author of one of the papers, Half-Baked – the Retail Promotion of Marijuana Edibles, and a professor at Stanford Law School. “I mean, our essay is not a moral essay.”

The two articles pay particular attention to the “edibles” market – food products infused with marijuana’s psychoactive ingredient tetrahydrocannabinol, or THC – highlighting that such products can be especially dangerous to children.

The two papers point out that children seem to be attracted to the packaging of edibles, which are often sold as sweets and named with weed-related puns on existing candies, cookies or chocolate.

Some characteristics of edibles can be problematic for adults as well, the authors say, as doses in marijuana-infused foods can vary widely, serving sizes are not necessarily well-sectioned and individual metabolisms can affect resultant highs. Famously, in an essay for the New York Times, the columnist Maureen Dowd described the effects of sampling an “edible” candy bar she later discovered was “supposed to be cut into 16 pieces for novices”, but which had not had such information on the label.

“The caramel-chocolate flavored candy bar looked so innocent,” Dowd wrote, “like the Sky Bars I used to love as a child.”

After marijuana was legalized in Colorado in January 2014, a Denver hospital saw a dramatic increase in the number of children between ages three and seven being treated after accidentally eating marijuana, the Denver Post reported. Between 2005 and 2013, eight children were treated for accidental ingestion; nine were treated in the first five months of 2014.

Furthermore, the poison control hotlines of states with legalized medical marijuana are now more likely to receive calls about children younger than age nine unintentionally consuming marijuana.

Colorado and Washington do regulate edibles: the serving size must be indicated on labels, packaging cannot target children, and a label warns parents to “keep out of the reach of children”. But MacCoun and co-author Michelle Mello, a Harvard professor of law and public health, make further recommendations. Packaging of marijuana edibles should be clearly distinguishable from food, they say, and states should restrict the extent to which edibles can resemble well-known sweets, include clear dosing information and warnings about over-consumption on labels.

“[Our article] is just an argument about, ‘Hey, there are some pretty common sense things that could be done to protect kids from bad outcomes,” MacCoun said. “There are steps that could be taken that wouldn’t really infringe upon the freedoms of adults who want to use marijuana edibles, but having brightly colored candies and soda pops is a recipe for problems.”

Federal agencies such as the Justice Department and the Food and Drug Administration have so far taken a hands-off approach to the edibles market, leaving states to define regulatory methods.

The authors of the second NEJM paper, Medical Marijuana’s Public Health lessons – Implications for Retail Marijuana in Colorado, say public health outcomes are just beginning to come to light.

Data from hospitals and surveys is trickling in in states such as Colorado, for example, despite the federal government’s complete control over marijuana research. There is a near-total lockdown on marijuana research, because of its Schedule I classification by the Drug Enforcement Administration, a category which defines the drug as having no recognized medical value and puts it in the same class as heroin.

Federal refusal to recognize the medical value of marijuana also stops research dollars from reaching institutions which might normally rely on federal grants. The Carers Act, the marijuana bill introduced to the Senate, seeks to reclassify marijuana as a Schedule II drug.

MacCoun and Mello concluded that the courts may be the best remedy for any consumers who have recently been hurt by edibles.

“Because legal channels are available to address the problems with marijuana edibles, such issues are not an argument against legalizing marijuana,” they wrote. “Indeed, one potential advantage of legalization is that is provides more regulatory levers than are available under prohibition.

“As legalization of marijuana spreads, new adopters should ensure that their regulatory scheme for marijuana edibles is fully baked.”