Public health benefits from legalizing cannabis: both sides of the coin
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* Ian Mitchell

Although Spithoff and colleagues mention some benefits of legalizing cannabis, they provide more details about the potential harms. The positives are limited to reducing stigma and “realization of therapeutic benefits.”1

It may be difficult for physicians viewing cannabis through the lens of addiction to see any silver lining from legalization. However, there are both individual and public health benefits that should be balanced against possible harms. The first and most immediate benefit is that patients who use cannabis for therapeutic purposes will no longer fear legal sanctions.

Both the US and Canada are currently dealing with an increase in addiction and death from fentanyl, oxycodone and other opiates. Two large studies have shown about a 25% decrease in deaths from opiate overdose associated with the legalization of medical cannabis and the availability of dispensaries.2,3 The recent COMPASS study found that the use of cannabis for chronic pain has a reasonable safety profile and that patients often used it as a substitute for other more harmful drugs, such as opiates, NSAIDS (nonsteroidal anti-inflammatory drugs) and alcohol.4 Harm reduction experts have also expressed concerns that professional societies are jeopardizing patient health by requiring a much higher standard for the prescribing of cannabis over the prescribing of opioids.5

Legalization of cannabis would remove research blockades to begin proper study of cannabidiol. This compound is not associated with a “high,” is not known to be addictive and has antiseizure, antianxiety and antipsychotic properties.6 Up to this point, proper study of cannabidiol and other cannabinoids has been restricted by their criminalized status.

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## References

1.  Spithoff S, Emerson B, Spithoff A. Cannabis legalization: adhering to public health best practice. CMAJ 2015;187:1211–6.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTg3LzE2LzEyMTEiO3M6NDoiYXRvbSI7czoyMToiL2NtYWovMTg4LzEvNjMuMi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Powell D, Pacula RL, Jacobson M. Do medical marijuana laws reduce addictions and deaths related to pain killers? Cambridge, MA: National Bureau of Economic Research; 2015 Jul. Available: [www.nber.org/papers/w21345](http://www.nber.org/papers/w21345) (accessed 2015 Oct. 15).
    
    

3.  Bachhuber MA, Saloner B, Cunningham CO, et al. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern Med 2014;174:1668–73.
    
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4.  Ware MA, Wang T, Shapiro S, et al.COMPASS study team. Cannabis for the management of pain: assessment of safety study (COMPASS). J Pain 2015;16:1233–42.
    
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5.  Lake S, Kerr T, Montaner J. Prescribing medical cannabis in Canada: Are we being too cautious? Can J Public Health 2015;106:e328–30.
    
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6.  The biology and potential therapeutic effects of cannabidiol. National Institute on Drug Abuse. Available: [www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/biology-potential-therapeutic-effects-cannabidiol](http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/biology-potential-therapeutic-effects-cannabidiol) (accessed 2015 Sept. 5).