Feature Review

Legalization, Decriminalization & Medicinal Use of Cannabis:
A Scientific and Public Health Perspective by Dragan M. Svrakic, MD, Patrick J. Lustman, PhD, Ashok Mallya, MD, Taylor Andrea Lynn, PhD,
Rhonda Finney, RN & Neda M. Svrakic

Abstract

Empirical and clinical studies clearly demonstrate significant adverse effects of cannabis smoking on physical and mental health as well as its interference with social and occupational functioning. These negative data far outweigh a few documented benefits for a limited set of medical indications, for which safe and effective alternative treatments are readily available. If there is any medical role for cannabinoid drugs, it lies with chemically defined compounds, not with unprocessed cannabis plant. Legalization or medical use of smoked cannabis is likely to impose significant public health risks, including an increased risk of schizophrenia, psychosis, and other forms of substance use disorders.

Introduction
In recent years, there has been a strong pressure on state legislatures across the US to legalize or decriminalize use and possession of specified amounts of cannabis and/ or to pass laws that allow smoking of crude cannabis plant
(also known as marijuana, weed, Mary Jane, pot, reefers, ganja, joint and grass) for prescribed medical purposes
(so called “medical marijuana”). Advocacy groups claim that smoking cannabis is a safe and effective treatment for various psychological and medical conditions, ranging from stress and anxiety to Alzheimer’s dementia and Parkinson’s disease, even though cannabis is not approved for such use by the Food and Drug Administration (FDA).
Legalization of cannabis is the process of removing all legal prohibitions against it. Cannabis would then be available to the adult general population for purchase
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and use at will, similar to tobacco and alcohol.
Decriminalization is the act of removing criminal sanctions against an act, article, or behavior. Decriminalization of cannabis means it would remain illegal, but the legal system would not prosecute a person for possession under a specified amount. Instead, the penalties would range from no penalties at all, civil fines, drug education, or drug treatment. No state has legalized cannabis thus far. It remains a
US federally-controlled substance, which makes possession and distribution illegal. However, at the time of this writing,
26 states in the US have passed either medical cannabis laws, cannabis decriminalization laws, or both. See Table 1. A major concern of this commentary is that both the medicinal use of smoked cannabis plant and legalization/decriminalization of cannabis are being advocated in a way that circumvents the normal testing and regulatory processes by the FDA that is otherwise required for all drugs marketed for human use in the US. By circumventing this process, advocacy groups put state legislatures and/or voters in the position to decide on proposals with a certain impact on public health and medical treatment without necessarily being qualified to understand the pertinent scientific evidence.
Taking advantage of the obscure legal status of cannabis
(i.e., federally banned illicit drug but approved by local governments for medical and/or recreational purposes), businesses involving sales of cannabis are flourishing and even stock-market investments are available. For example,
CannabisInvestments.com provides information on ways one can invest in hemp-related and medical marijuana products and companies. These business interest groups are ratcheting pressure on state legislatures to decriminalize or medicalize cannabis, counting on support of millions of

Feature review addicted users and politicians looking for re-election votes and unaware of the dangers of such a legislative act.

History and Legal Status of