The cannabis business is flying high in New Jersey.
Recreational cannabis products raked in $24 million in just one month since going on sale April 21.
“When doors opened on April 21st, over 12,000 cannabis consumers celebrated the excitement of the first day by going to stores,” observed Headset, a cannabis industry analytics firm, predicting New Jersey’s total annual market will range between $1.3 billion and $2.9 billion.
Dispensary operators are expecting demand to soar over the summer, prompting some in the business to stockpile.
But the commercial zeal concerns some health experts, who have warned that the lure of revenues to be made from legal cannabis sales tends to eclipse the danger that weed — in certain doses and forms of consumption — can pose. They have urged state leaders to balance the commercial focus with steps to monitor marijuana’s impact on mental and physical health.
Several studies on recreational cannabis have shown it can contribute to heart and lung problems and temporarily cause or exacerbate mental illness. And New Jersey’s state government website notes: “Physical and psychological effects of cannabis use vary from person to person. These effects can be impacted by underlying health conditions, physical health, interactions with other substances.”
Some studies, however, arrive at different conclusions. A 2020 New Zealand study indicated that cannabis’ effect on lungs was often brief and not serious.
But recreational weed remains illegal at the federal level, where it is classified as a Schedule 1 substance. (THC — tetrahydrocannabinol — is the primary psychoactive compound in marijuana.) Federal restrictions have hampered research studying its effects.
NJ Advance Media spoke with Lewis Nelson, chairman of emergency medicine at the Rutgers New Jersey Medical School in Newark, and Rob Mejia, an adjunct professor teaching about cannabis at Stockton University, addressing weed’s potential impact on health.
This interview has been edited and condensed for clarity and length.
In a 2019 op-ed on cannabis, Lewis Nelson called legalization of recreational weed “a grand public health experiment.” A lot has changed since then. Is it a potentially dangerous health experiment?
LN: I stand by that statement — that it’s a grand public health experiment.
I don’t understand how we’ve gotten to this, being giddy about it. Some of it is relativism. You’re comparing the risk and benefits — so to speak — of cannabis compared to alcohol and heroin and cocaine. And it’s hard to say, if you’re looking at it in that light, that it is a dangerous drug. You tend to be much less impaired when you’re using cannabis than when you’re drunk. You don’t really die from a cannabis overdose if you take a little too much, like you would from heroin or perhaps cocaine. So in the scheme of things, it’s safe, but it certainly doesn’t mean it’s safe.
There are a lot of other medical complications — both medical and psychiatric complications — associated with it. And then there’s a lot of the social issues. Certainly, there’s social use, but if there’s a point where social use becomes an addiction, it becomes disruptive to your life, and it becomes disruptive to society.
I’m an emergency physician, but I’m also a medical toxicologist. I’m involved with managing people who overdose on substances. I definitely have a bit of a dark-side view of a lot of these substances. I’m not blind to the fact that many of these things do have an upside. But it’s a slippery slope.
Let’s just say we make the argument that cannabis was quote-unquote safer than alcohol. But we’re not going to replace alcohol with cannabis. We’re going to add cannabis to alcohol. We’re adding this through legalization, and I’m not convinced it’s the right thing to do.
RM: I would actually say cannabis is addictive, but at a pretty low rate, and very briefly. It’s much more like if you’re a habitual coffee drinker and you stop — you’re going to be restless, have trouble sleeping, you might be irritable and have a headache. That’s going to be the same kind of thing if you stopped using cannabis and you’re a heavy user. Studies show that it could be anywhere from 8% to 11% of people who can get addicted to cannabis. And those are people who will do things like stop seeing their friends, stop doing activities they enjoy and put themselves in risky positions. They don’t feel well if they don’t use it.
I do think that people who drink alcohol have a very big overlap with people who also use cannabis. But we’ve also seen statistics in Colorado and Washington where recreational weed is legal, for example, that showed that alcohol consumption was down, which is one of the reasons some alcohol producers have expressed interest in cannabis and started to get into the cannabis-infused beverage industry.
Your brain is developing until about age 25, so the sooner you start smoking, or using cannabis, when you’re younger, potentially the worse it can be. Between 14 and 18, your brain is still growing at a very rapid rate. One of the big things that can be done is to try to tell them, “Use later, then it’s not going to be as harmful.”
And the second thing is to try to keep them away from concentrates, which are a relatively new form of consumption. Essentially, in a lab, they’ll take the flower and some sort of solvent — alcohol, butane, propane — and make it into a product that looks like a very thick honey. Those concentrates are potent. New Jersey did not allow that until a couple of months ago, so that is a new form of consumption that people need to be educated about how powerful it is. If you’re a cancer patient, or somebody who has severe pain, it can be an excellent way for you to get pain relief without taking opioids. Unfortunately, if you look at the demographics and concentrate users, it’s mostly people on the younger side, 30 and under.
What are the physical health consequences of using cannabis regularly? Does it affect your lungs if you’re smoking or vaping?
LN: It depends on the route by which you take it, the dose you take and the duration of time. And there’s your underlying health status.
There’s no question that smoking cannabis carries many of the same burdens as smoking cigarettes. I mean, you’re putting hot, dirty smoke into your lungs. Some will argue that you smoke 20 cigarettes a day vs. four joints a day. So it’ll have less of a health impact than cigarettes on your lungs.
But you are comparing apples and oranges, because they’re not the same smoke when one of them is filtered typically and one of them is not. One of them is grown, and the composition in tobacco is metered in terms of the dose, whereas cannabis tends to not nearly be as highly controlled as the tobacco you’ll have in your cigarettes.
Obviously, if you’re vaping you’re not smoking, but you’re still putting material into your lungs. It hasn’t been vetted for safety and effectiveness. And we don’t really know that heating up those solvents isn’t a problem.
RM: There’s been a study for over 20 years at UCLA about lung cancer and cannabis that so far hasn’t found any evidence that it causes it. If you’re near a barbeque or near a candle, you’re taking in particles that you don’t want to be taking in. So if you smoke, you are combusting and taking in elements that are not necessarily good for you. So there is some evidence that it’s not particularly good for your lungs.
Is that true of the vapes being sold in dispensaries?
LN: Because of the lack of real oversight, what’s being sold is a commercial quality that is not heavily regulated like the FDA would do for most of its products, or it’s completely unregulated.
Many vaping solutions are homemade. Or they’re not made by large commercial suppliers, but by some group or person who’s putting together a formulation that might be proprietary to that shop. There are some quasi-commercial manufacturers, but remember this is still a federally illegal drug. So getting funding, getting banks to take your money is a challenge. That really limits the ability of most these companies to exist in a legitimate way. So there’s a lot of quality control issues.
RM: Cannabis in vapes sold in dispensaries have fewer harmful particles as long as it’s tested by a lab and as long as it does not have any harmful additivies, like Vitamin E, which is one of the things that started a big crisis a couple of years ago. There were underground vapes that were found and people who were putting in some additives that when smoked damage your lungs. But if you get a vape from a tested, reliable dispensary, it’s healthier than smoking combustion, in part because it comes at a lower temperature and does not have as many harmful particles. At lower temperatures, you don’t get as much of the tar and other harmful products.
With vaping, if you’re using an untested vape product, you’re taking a chance because you may be getting metals, there might be Vitamin E additives, and that can be a huge problem for you. But the answer is getting a vape in a dispensary only where it’s been tested. Every cannabis product you get should have a certificate of authenticity and you should be able to see the testing results so you can be sure there are no heavy metals or pesticides. The dispensaries in New Jersey all have to have testing and often provide the results to their customers.
Are edibles a safer option?
LN: There are clearly acute — perhaps some lingering — effects of eating cannabis. Most of the problems we see are short-term, post-intoxication-related symptoms, but some of these can be long term.
Heavy cannabis users are susceptible to developing psychosis. It’s a chicken-and-egg question. Do people with underlying psychiatric illness medicate themselves by using cannabis, or is cannabis causing the psychiatric illness? I think it’s probably a little of both.
Most people who smoke pot don’t develop a psychiatric disease.
It’s the duration — are you smoking pot once in a while? Every couple of weeks? On the weekend while hanging out with your friends? Or smoking every day, several times a day, where it almost becomes a lifestyle? That’s addiction.
Today’s THC concentration is very different from when I was in college in the 1980s, when it was kind of crappy. A joint had 3%, 4% or 5% THC. Now the cannabis is 15%, 20% or 25% THC, which is more than eight times, possibly, the amount of THC in a given amount of cannabis.
RM: The tricky thing with edibles is that you must store them properly so that your pets and children don’t get to them. Regular edibles take from 30 minutes to two hours to take effect, and they stay in your system for four to eight hours, depending on your body. So it’s a very long experience which is going to last vs. vaping.
If you take a quick puff, you may only feel that for the next half hour. Then you might take another puff, then you wait a few minutes and if you feel it’s not enough, you take another one, until you get to your level of comfort. People should do research. For people who are brand new to edibles, they should go low and slow. If they start out with 50 milligrams or 100, they’ll feel anxious, paranoid, and they’ll feel it for a long time. The mistake people make is not waiting until it takes effect.
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Elizabeth Llorente may be reached at ELlorente@njadvancemedia.com. Follow her on Twitter @Liz_Llorente.
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