The New Hampshire Legislature is considering legalizing the sale and use of elective, or recreational, cannabis in the state.
The New Hampshire Medical Society and the New Hampshire Public Health Association do not categorically oppose legalization of cannabis for elective use. Pleasure, amusement, creativity and spirituality are important dimensions of healthy lives. The legal sale of a commercial product could contribute to a healthy economy, also a driver of community well-being. If legalization of cannabis supported these without adding to societal burdens of illness, trauma, addiction and other suffering, both organizations would almost certainly not be involved in the debate over legalization. Yet both organizations oppose the current bill under consideration for legalization.
Residents of New Hampshire currently have access to cannabis for health conditions through the Department of Health and Human Services therapeutic cannabis program. As scientific evidence evolves, new conditions are added to the list of qualifying conditions. Opioid use disorder is one of the conditions currently under consideration. Possession of small amounts of cannabis for personal use has been decriminalized in the state, beginning to address important concerns about justice inequities related to cannabis prosecutions. The focus of the current bill is on the commercialization of cannabis. It outlines a low level of regulatory oversight over a potentially harmful product.
The N.H. Medical Society recently developed policy guidelines under which it would consider support for legislation legalizing cannabis for elective use. These are:
1. When data from states with current recreational use indicates that the risks and benefits to public health, safety and well-being favor public health and equitable justice.
2. When an unbiased regulatory system is sustainably in place that both defines and assures cannabis and cannabis product safety and that prevents explicit or implicit marketing to children and youth.
3. When systems to accurately capture, evaluate and disseminate N.H.-specific data on the impact of cannabis legalization on public health, safety and well-being, including justice equity, are sustainably in place and used to inform revisions in the system.
The N.H. Public Health Association has also adopted recommendations for public policy concerning cannabis that captures similar concerns.
Research on the impact of different cannabis regulations on public health is growing rapidly. We are learning about managing the negative impacts of traumatic injuries, child poisonings, cardiovascular health, mental health, addictions and other issues. We are also learning about the potential for positive impacts. While the evidence is not yet clear, cannabis may serve as a substitute for other substance use such as alcohol and opioids resulting in neutral or net improvements in the public health. However, there is much we still know relatively nothing about.
For instance, we do not know the long-term biological effects of the new more potent strains of cannabis and extracts of nearly pure cannabinoids. There is risk of unanticipated public health consequences, like what we experienced with increased availability and potency of opioid products over the past two decades and cigarettes half a century ago. The potential for increase in serious mental health, addiction and physical health problems is real.
Despite the claims of both legalization advocates and opponents who confidently cite selective data to support their views, the reality is that we do not know the net public health impact of cannabis legalization. That is why no major respected national or state organizations dedicated to individual or public health actively advocates for legalization at this time.
With the current pace of research, a clearer and more consistent understanding of where the balance in terms of public health consequences lies is likely within 5 to 10 years. Why the rush to legalization in New Hampshire?
House Bill 481 would make cannabis available to N.H. citizens before the public health impact of legalization is clear. It does not guarantee a sound regulatory system to assure product safety nor collection and analysis of important health data to inform the system going forward. It is designed to put profits before the health of N.H. citizens and does not protect from commercialization aimed at children (billboard and social media advertising are not restricted).
In the interests of protecting the health of our neighbors and communities, NHMS and NHPHA oppose HB 481, and we ask the N.H. Senate to do the same.
(Dr. Tessa LaFortune Greenberg is president of the N.H. Medical Society. Marcella Bobinsky is president of the N.H. Public Health Association.)