Americans are now more likely to use cannabis than alcohol on a daily basis. But as cannabis use continues to climb, are research and policies keeping up?

Today, On Point: The future of cannabis research and regulations.

Guests

Maia Szalavitz, reporter covering science, public policy and addiction treatment. Contributing opinion writer at the New York Times. Author of “Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction.”

Ziva Cooper, professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles. Director of the UCLA Center for Cannabis and Cannabinoids.

Mahmoud ElSohly, director of the Marijuana Project at the University of Mississippi, which, for more than 50 years, was the only grower approved by the National Institute on Drug Abuse for cannabis research.

Also Featured

Jonathan Caulkins, professor of operations research and public policy at Carnegie Mellon University.

Transcript

Part I

(MONTAGE)

DAN: I’m 76. I use the edibles every day, and I use it to combat frustration over being invisible as an older American, and also it just makes me feel really good.

AMY: I’ve never been a big alcoholic drinker. However, to help me fall asleep at night, I do take Delta-8. which has a small amount of THC in it.

WILLIAM: I have been a daily cannabis user for over 40 years. I have maintained good health, good business, everything functions well, I have no pain, I take no medications, I’m 62 years old, and I’m a happy guy. Weed gives you positivity.

MEGHNA CHAKRABARTI: That’s Dan in Charlotte, North Carolina, Amy in Milwaukee, Wisconsin, and William in Edgewood, New Mexico. Just a few of the On Point listeners who shared their experiences with cannabis use. And obviously, they are not the only ones in this country. In fact, daily marijuana use is now more common than daily drinking in America.

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JONATHAN CAULKINS: Back in 1992, there were about 10 times as many Americans reporting daily or near daily drinking as daily or near daily marijuana use. But since then, per capita rates of daily and near daily cannabis use have increased 15-fold and now actually exceed the rates for alcohol use.

CHAKRABARTI: Jonathan Caulkins is a cannabis policy researcher at Carnegie Mellon University, and he published these findings in a study in May. The study looked at cannabis use data from the National Survey on Drug Use and Health. And it looked over a 43-year span starting in 1979. Now, to be clear, there are still more Americans who drink alcohol in absolute numbers than those who use marijuana in absolute numbers.

The new thing about marijuana is that about 40% of those users are using it at least near daily, according to the study. That’s an estimated 17.7 million people. Professor Caulkins says there could be a few reasons why this change is happening.

Cannabis use is now more socially and culturally accepted. There are fewer legal risks as states have changed their laws around marijuana.

CAULKINS: But the other factor, very important that people talk less about, is an enormous decline in the price per milligram of THC. When we put together the data that we have, both from the illegal market, say from undercover buys and user self-reports on websites, and the official data that we have now in the legal markets, we’re seeing declines on the order of 80% without adjusting for potency, and when you factor in the greater potency, 90% between, say, 2008 and the present.

At the end of the day, cannabis is a consumer good, and when prices go down, people tend to consume more.

CHAKRABARTI: Okay, now specifically, when it comes to this daily use of cannabis, we’re talking about all forms of cannabis. As for smoking pot, specifically, about 15% of Americans say they smoke marijuana today, compared to just 7% back in 2013, according to Gallup.

That Gallup survey question specifically asked this, keeping in mind that all of your answers in this survey are confidential, do you, yourself, smoke marijuana? Okay, so given that question, the poll doesn’t actually have higher resolution detail on why people smoke and how much they’re smoking.

Now, Professor Caulkins says that while growth in daily cannabis use makes sense, it should also be cause for concern. Because relatively little is known about the behavioral and health consequences of consuming higher potency forms of cannabis or much larger amounts.

CAULKINS: There have been excellent studies done, randomized control trials in the laboratory exposing people to THC, but the doses involved in those studies are often on the order of 20 or 40 milligrams. And if you realize that the average daily user is consuming something like 1.6 grams of flower per day, that’s 20% potent.

That’s 320 milligrams of THC, just vastly more than has been studied in most of the studies that we have available to us now.

CHAKRABARTI: Oh, in other words, it’s something like at least eight times more than the studies have had a chance to research. So today we’re going to talk about this rise in daily cannabis use in the United States.

Again, it’s superseding daily alcohol use, and we’re going to take a look at whether there are dangers in the gap between increased cannabis consumption and research and regulation. So we’re going to start with Maia Szalavitz. She’s a reporter covering science, public policy, and addiction treatment.

She’s also a contributing opinion writer at the New York Times and author most recently of Undoing Drugs: The Untold Story of Harm Reduction and The Future of Addiction. Maia, welcome to On Point.

MAIA SZALAVITZ: Thank you so much for having me.

CHAKRABARTI: So what’s your first thought on this this increase in daily use of cannabis amongst Americans?

SZALAVITZ: So there’s a lot of complexity here, unfortunately. One is that a lot of people use marijuana for medical reasons. And if you’re doing that, you are likely to be doing it daily. So that’s one thing that’s different from alcohol, although I will note that during alcohol prohibition, there was actually medical alcohol, as well.

The other thing that I’m not sure Dr. Caulkins has looked into, but I’d be really curious to know about, is recently health recommendations have changed around alcohol. It used to be considered the case that if you have one or two drinks a day, that’s actually good for your heart. And that has changed.

So the amount of daily alcohol users may also be going down. So there’s that complexity. The other thing that we see is that older users are the people who are using more. The people we tend to be worried most about when it comes to marijuana is teenagers. And astonishingly and amazingly and greatly, teenage use has not risen during the falling price of marijuana or during the legalization of it, which is good.

Teen use has actually stayed steady or even declined.

CHAKRABARTI: Yeah, that is so interesting, and we’re going to talk about that more a little bit later in the show. Can you take me more into these nuances? And you said it’s unfortunately complex?

I think it’s fortunately complex and nothing is ever truly straightforward, which is why we have experts like you on, Maia.

I wonder if there is also a social and legal aspect to the increase, particularly amongst older Americans, as you’re saying. Because, as we talked about earlier, because of legalization in many states and the social de stigmatization that comes along with it, it was very easy for us to just put one notice out to listeners asking if they were daily users of cannabis and we got a lot of responses back.

People, it’s not something that, unlike 20 years ago, you felt like you needed to hide.

SZALAVITZ: That is true. And there’s definitely, when you’re doing these surveys, it’s very hard to tell about things, because oftentimes people will tell you what you want to hear. But the ongoing surveys seem to be pretty reliable.

What’s interesting to me about the older people is that, for example, women in perimenopause and menopause tend to have an enormously difficult time sleeping. This may be accounting for that. I don’t think those users are using anything more than 5 to 10 milligrams of edibles. They’re not even smoking.

And so when you ask the question about smoking, you are leaving out these people potentially, also. And that’s a large population.

CHAKRABARTI: Yeah, no, point taken. And I think that’s why we separated out the smoking figure, just to get a sense of how much smoking was going on versus the other forms of consumption.

And Professor Caulkins, I think his overall study was overall all forms of consumption. So we don’t exactly know what the breakdown is, internally to that. But to your point, or also about women. Do we know if the gender gap, is there a gender gap in cannabis use now?

SZALAVITZ: That’s an interesting question and I have not looked at that lately. Historically there has always been a huge gender gap in terms of addiction, where two thirds of people with addiction tend to be male. This, in terms of alcohol, it has been that gap has been closing and also in terms of other drugs, to varying degrees.

But when you look at the extreme end of the spectrum, which is people with addiction, it tends to be dominated by men. And in terms of social acceptability, it has always been more acceptable for men to use substances to get high than it is for women.

CHAKRABARTI: Can we turn our attention just for a second to the drinking part again, because I think you raised a really important point there.

These studies do rely on self-reports, and I actually wonder if there’s been a flip, right? Perhaps now, to your point earlier about recommendations on alcohol, perhaps the social stigma now is on self-reporting of daily drinking, and that might be suppressing those numbers.

SZALAVITZ: That’s always possible and it is really difficult to tell.

One thing we do know is that self-report is reasonably reliable when you have statements like this is completely confidential, and when people will not be punished for telling the truth. But, again, it’s difficult to know.

CHAKRABARTI: Okay. So then tell me overall, what do you think about, at least as far as we can understand, increase in use means, including medical use of marijuana, is it a risk-free activity?

A lot of the people who called us to leave their stories seem to believe that it is.

SZALAVITZ: I don’t think anything is risk free. And I think a lot of people balance risks that they take. For example, it is definitely less risky than daily drinking. And if you are taking it by means of edibles, it’s way less risky than smoking.

The statistics on smoking marijuana and lung cancer have long been interesting, because they didn’t find any correlation, which obviously is not the case for cigarettes. So it would be concerning if people were consuming massive amounts of smoke with tar in it. If they were smoking marijuana the way they smoke cigarettes.

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But again, we now have vaping and there’s a lot of other things going on. So it makes it very difficult to tell. The issues related to marijuana use have historically been ones that we worry about in teenagers are they doing well in school? Are they driving? And driving could be an issue here, but again, the research is pretty clear that if you drive on marijuana, not that you should, it is less safe than driving sober, but it is more safe than driving while on alcohol.

Although if you mix the two, that’s more dangerous.

Part II

CHAKRABARTI: Let’s listen to a couple of On Point listeners who called in with their stories of cannabis use. Here’s Anna Ruth Shipman in Silver Spring, Maryland.

ANNA RUTH SHIPMAN: I’m not surprised by the findings. When I was young, back in the ’70s, at the age of 15, I started using both alcohol and cannabis and found both had bad side effects, but I find the side effects of cannabis to be less than the side effects of alcohol.

CHAKRABARTI: That’s Anna Ruth Shipman in Maryland, and here’s Evan in Ames, Iowa, with a very similar feeling.

EVAN: I’m a cannabis user because it’s much preferable to the effects of alcohol, still be somewhat functional, I don’t wake up feeling terrible. And it doesn’t come with all those added calories.

CHAKRABARTI: That’s Evan in Ames, Iowa, and we’ll hear from more On Point listeners in just a moment. I’m joined now by Ziva Cooper. Ziva Cooper is a professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles, and director of the UCLA Center for Cannabis and Cannabinoids.

Professor Cooper, welcome to you.

ZIVA COOPER: Thank you so much. It’s a pleasure to be here.

CHAKRABARTI: Okay you heard Maia at the beginning of the show, raise the first wrinkle here, which is really important. That with this new finding of daily cannabis use, we don’t yet have information on how many people are using it for medical purposes versus recreational purposes.

And we also don’t know the breakdown in terms of types of consumption. Smoking, edibles, etc. Why would it be important to know these things, Professor Cooper?

COOPER: So we know that the effects of cannabis in the short term and the long term are impacted by the reasons why people are using, and the ways that they are using it, including the numerous emerging types of products that I think Dr. Caulkins mentioned before with the increased potency.

So the increased THC concentrations of these products, the increased variety of products that are available. So Maia mentioned the vape pens, the different types of oral products, but also another important point here is that when we think about daily use, one critical variable to consider is not just how people are using it or why they’re using it, but also the frequency.

How often are they using it every single day? In our own experience, there are people who are using cannabis daily, but they’re taking a puff or taking an edible once before sleep. But then there are also people who are using or smoking many joints per day, and so you would imagine that the effects are going to be quite different in the short term and long term.

CHAKRABARTI: What are the obstacles to getting that kind of data on use patterns in this country?

COOPER: So there are a number of obstacles, and it really depends on how you’re going to approach answering the issue. And one way that we’ve just heard about in approaching this question is where Dr. Caulkins looked at large survey data, population data. Where we’re able to look at behavioral patterns in millions of people. And that is really powerful.

But as you discussed before, there are certain gaps. There are nuances that are not captured, that have really important implications. Another way to study the effects is look directly at the impact of cannabis and those different constituents of the cannabis plant, and the different ways that people are using them to actually study it.

So to give it to people, and compare it to a placebo, so a inactive drug or a sugar pill. And look to see if in people who are using it every single day, are the effects going to be quite different than people who are not using it regularly, both for potential medicinal effects. So the reasons why people might be using it for medicinal reasons, such as pain or sleep, as well as some of the adverse effects that Maia touched on, including, you know, attention, memory, intoxication, things like that.

CHAKRABARTI: So Maia, this brings us to one of the major hurdles in terms of gathering that research or doing the research and gathering that data. Because as far as I understand, as of this broadcast, marijuana is still a Schedule I drug in the United States, correct?

SZALAVITZ: That is true.

CHAKRABARTI: And so that means what kinds of restrictions are placed on the research of marijuana?

SZALAVITZ: Yeah, so it’s as though you’re doing nuclear research, because you have to track every tiny bit of it. You have to have special safes, you have to have all kinds of special procedures, and you have to obtain the marijuana from only specific sources. So doing this type of research can be really difficult and expensive because of all the restrictions.

It is as though, like the way methadone clinics have that drug locked down, you have to lock down the marijuana, which is, it’s ridiculous in both cases, but it ends up creating a real hassle for everybody who tries to do it.

CHAKRABARTI: Okay. My understanding is though that, I can’t remember exactly when, but there was very recently, the DEA made some noises about taking it, taking marijuana off of Schedule I and rescheduling it to, I don’t know, another level where it could be easier to perform research, and you could actually get the research materials, the cannabis from different locations, rather than like the one federally approved grower.

SZALAVITZ: Yes. President Biden actually ordered the rescheduling. And so it is in the process of doing so, because it’s an enormously complex bureaucratic process. Nobody has ever really done this before. And there were a lot of measures for scheduling drugs and making them illegal and very few processes for doing the opposite.

And the DEA’s role is complicated here, because it obviously wants to protect its turf and have control over as many substances as possible. Meanwhile, that may not necessarily be in the interest of the general public. And unfortunately, it’s not the health agencies that make the decision about whether something should be legal or illegal, or about how to regulate. It is the law enforcement agency that does.

CHAKRABARTI: Professor Cooper. Did you have some thoughts on this?

COOPER: Yeah, so it is a really interesting turn of events. And in May 2024, the Department of Justice issued a draft ruling moving cannabis marijuana. So that’s cannabis with a certain amount of THC, from Schedule I to Schedule III. And it signified a couple of really important shifts in how the government is thinking about marijuana.

So in that report, it talks about how, as a Schedule I substance, there was no accepted therapeutic use for the drug. But with a movement to Schedule III, there is a acknowledgement of the therapeutic effects of marijuana, of THC and marijuana. And so that was really important. Now, whether or not it eases research, I think it really remains to be seen. Because there are many other variables, not just the Schedule I classification, that limits the restrictions or the obstacles for research.

CHAKRABARTI: Yeah. So we’re going to go down a little bit of a rabbit hole on what you just said, Professor Cooper, because to be clear to folks, it was back in 1968 that the federal government finally allowed research on cannabis, but they limited it to just one grower. That grower is at the University of Mississippi.

And one grower can’t grow enough to satisfy just research needs. But as you guys have both been talking about, in 2016, there’s signals from the federal government that would change. By 2019, DEA decided to move forward on applications, because they were actually facing a lawsuit for not expanding the number of federally approved growers.

And in 2022, DEA finally registered those additional growers for research. Let’s go to the original place where researchers can get cannabis/THC for study, and that is at the University of Mississippi, and Mahmoud ElSohly joins us now. He’s director of the Marijuana Project at the University of Mississippi, and previously the only approved grower by the National Institute on Drug Abuse for Cannabis Research.

Mahmoud ElSohly, welcome.

MAHMOUD ELSOHLY: Thank you. Good to be with you.

CHAKRABARTI: Okay, so first of all, tell me a little bit about what it’s like growing cannabis for research. How meticulous is it? What’s the process?

ELSOHLY: The process, first of all, the growing or production of cannabis itself, the process itself for doing that is really a rather simple process, because the plant is a very cooperative plant. It’s just very easy to grow, very easy to control, doesn’t really get affected that much by pests and things like that, so if you give it good environmental conditions and good fertilizing and good soil, it grows literally like weed.

So it’s a very easy plant to grow.

CHAKRABARTI: Professor ElSohly, does, what is grown at the University of Mississippi? What, is there variable potency in the THC in the plants that you grow?

ELSOHLY: Yes, we have every kind of material that any investigator around the country would like to use or would like to investigate.

Starting from, we, of course, we have to have a placebo material, which is cannabis plant material that has been, all the cannabinoids and all the other components have been removed, so that’s what we call the placebo. So from placebo material to maybe 1% THC content, 2%, 4%, 8%. And that has been, up to 8% has been traditionally what was available in the program, until maybe a couple, two, three years ago.

Now investigators started looking for materials that match what is available in the dispensaries or in the illicit market, which is materials that are maybe 14%, 15% and above. That would be considered as high potency. So we have actually produced those types of material. We have materials that are, go all the way up to 27%.

I just published a paper not too long ago. Where we compared the potency and the chemical profile of the materials that we have under the United Drug Supply Program, with materials available in dispensaries around the country, and in the illicit market, from all the different states, all the different regions of the U.S.

And we can definitely, certainly, no question, match any materials that any investigator would be looking for the use in their research, which this material was not available before, simply because there wasn’t really that much demand for it, that’s number one. Number two is, and this is a very important thing, the material that is produced in the national program, the drug supply program, is mainly used to manufacture cigarettes for smoking.

And the research shows, and these have to be standardized marijuana cigarettes. And the weight of that cigarette is somewhere between around eight tenths of a gram per cigarette. And so the subjects that are involved into a clinical trial, that is a randomized, placebo-controlled trial, will, everybody will have to get the same exact type, same shape, same form, same everything.

Only thing the difference would be the potency of the THC in that cigarette.

CHAKRABARTI: I just have to jump in here, forgive me professor, but I do have to just jump in here and say I’m Meghna Chakrabarti. This is On Point. Now I actually appreciate a great deal your detailed answer on the sort of variety of potencies that you can produce for research.

And earlier this year, a health care analytics company called Truveta found that rates of cannabis induced disorders grew more than 50% between 2019 and November of 2023. Dr. David Schreiber is a psychiatrist and CEO of Compass Health Center, and he told CBS News one of the reasons why.

Cannabis today is different than cannabis of previous generations.

DAVID SCHREIBER: In the 1990s, we had potency concentration of THC and cannabis hovering around 4%. Today, that number is closer to 20%. So 5 times the greater amount of potency. We know because of technology today that there are products being marketed out there that are able to achieve 90% potency. And there are a lot of studies that are shown out there that increase potency concentration also correlates with increased adverse events.

CHAKRABARTI: Professor ElSohly, I have one more question for you. And that is obviously you’re at the forefront of the source of materials for cannabis related research. Are there any specific additional policy changes you’d like to see around this research so that we can actually close the gap in our understanding of positive or adverse effects of the kinds of cannabis on the market today?

ELSOHLY: Thank you. I honestly think as hard as the regulations have been and as difficult as it has been, as Dr. Cooper indicated to deal with, the working with cannabis and doing research with cannabis, because of all the regulations, that everything has been and still is in place for anyone who is really interested and wants to put the time and the effort to do a particular study.

Everything is there for that person to do what they want to do. Now the increase in the potency that we’re talking about, and the fact that there’s so much THC in there, this is when you have, when the use of cannabis is what we call ad libitum, meaning you just use as much as you want to use to achieve the end point that you want to achieve.

That’s not what’s happening when you do standardized clinical research, and at the end of my previous talking, I was going to tell you that in the clinic, in the actual clinic, nobody, no one, no matter what their experience with the use of cannabis, was able to finish the 8% THC marijuana cigarette.

CHAKRABARTI: Ah.

ELSOHLY: When you have an 8% And you can’t use it, of course, you cannot use the same amount of material in a cigarette at 15% or 20% or more percent. So the increase in the potency just allowed the people to use a smaller amount of the cannabis material to reach the goal they’re trying to achieve.

The total amount is the same, whether you use a 4% or a 20%. You’re using the same amount of THC to reach the end point that you want. But now, because of the development of the vapes and all of that, people can use the higher potency material, small amount of THC plant material to reach the goal they’re trying to reach.

Part III

CHAKRABARTI: I just want to give our listeners a little bit more of a voice here.

This is Michael Allen from St. Paul, Minnesota, who tells us he’s been a daily cannabis user for about eight years, and it’s been incredibly helpful to him.

MICHAEL: When using cannabis, I use concentrate with an electronic vaporizer. And I only use it while I’m in my own home. For me, cannabis helps to slow down my mind when stressed and break intrusive thought cycles that have in the past led to severe depression and anxiety.

But I also enjoy cannabis as a recreational substance, because I can better control my consumption. And even if I do overdo it, I feel in control of my body and mind, which is something I have never felt with alcohol.

CHAKRABARTI: So that’s Michael in St. Paul. Here’s another on point listener, former member of the United States military, lives in Massachusetts.

He talked about his preference for marijuana over alcohol.

ON POINT LISTENER: I began to use marijuana as a civilian, and it became exceedingly a better alternative to alcohol. Obviously, there are consequences to using and smoking marijuana, but like I’m not blackout, belligerent, making stupid decisions. Your faculties are more there when you smoke.

Your judgment is present. It’s not debilitating in ways that alcohol is.

CHAKRABARTI: Professor Cooper, let me ask you, these two comments are very interesting to me, because how much do we know about what a cannabis user is feeling about their relative level of control or clarity of mind, versus what is actually measurable in terms of the level of control they have over their bodies while consuming cannabis?

COOPER: Meghna, I think this is a really interesting point that also points back to what Dr. ElSohly was talking about with respect to this idea that even though the products are higher potency, have more THC, people just take less. So they titrate to get to their desired effect. And so people like your listeners who are reporting in, overwhelmingly they’ve had, it sounds like they’ve had positive experiences, and they’re talking about why they’ve chosen cannabis over alcohol.

But there are people who have had uncomfortable and adverse experiences, and sometimes that has to do with the fact that there’s over intoxication, or they’ve taken an edible and it got them too high for too long of a period of time. So in the laboratory, we’re able to look at and ask people how they feel.

We asked them a range of feelings that they have. So we don’t just ask them how high they feel. We ask them about the type of high. Is it a good high? Is it a bad high? Would they like to take that cannabis again? We also ask them if they feel anxious, right? So feelings of anxiety are common, especially with people who don’t use cannabis all that often. When they use too much, feelings of anxiety can be perceived as a negative effect.

Some other researchers look at psychotic like experiences, and this is, I think, one of the primary health outcomes that people are becoming more and more concerned about, especially in youth or adolescence. But what’s interesting about the —

CHAKRABARTI: I’m sorry, I’m so sorry, I didn’t mean to interrupt, but with the question of youth, though, are there ethical restrictions around doing actual studies that involve young people who aren’t even legally old enough to purchase cannabis products?

COOPER: Absolutely. And as Maia said before, that when we’ve looked at the surveys, it’s actually been a relief that when you look at youth up to 18 years old, we haven’t seen changes and increases in use. But we’ve heard from emergency room physicians that there seems to be increased incidence of younger people coming in for psychotic like disorders that are associated with cannabis.

But in the laboratory, we can look at this emerging adult category. And actually, adolescence goes up to age 24. The brain is still developing until that time. And so we have a study where we’re comparing the effects of both oral and smoked cannabis. In 18- to 25-year-olds.

So the people that are in this vulnerable period, and we’re comparing them to middle aged adults, so 35 to 45, as well as those older adults, that weren’t, we know are increasing their use, but we know very little about the effects, and cannabis might have a very different effect in people who are 55 and older. And so we’re looking at that now.

CHAKRABARTI: Interesting. Maia, bring your experience to the table here, because what I keep hearing is that even though we’re actually in quite a new place, research wise, in terms of trying to understand the various effects, again, both positive and adverse, of cannabis consumption.

There are still significant restrictions. Some of them are ethical, which we don’t necessarily want to let go of. But at the federal level, do you see there being too many obstacles for the kind of follow up research that we would need to answer a bunch of the questions that both of you have actually even just raised in the context of this hour?

SZALAVITZ: Yeah. I think it was always bizarre to have cannabis and Schedule I anyway, because schedule, the whole scheduling system is irrational in the first place. Schedule I includes LSD, marijuana, and heroin. It’s hard to imagine three more different substances. And that schedule is a higher, more restricted schedule then the schedule in which fentanyl appears. And this is because fentanyl, we have decided, as a country, has legitimate medical uses, but heroin does not.

So it’s just a mess. The reason that things are classified the way they are is completely political and has nothing to do with science. I personally think we need to scrap the scheduling system and come up with a new one that actually reflects the real risks and the real benefits. And whether medical use is possible for all of the substances, because we just do this in a terrible way.

Taking marijuana out of Schedule I and putting it in Schedule 3 would be definitely progress. It’s difficult to know what’s going to happen in the next administration, and whether that change will actually go through now that the administration is changing. But yeah, we certainly need to deregulate this area.

CHAKRABARTI: Interesting. We’re going to come back to what may happen under the next Trump administration in a second, but the sort of the inconsistency that you’re talking about, that’s led to different things being scheduled differently. The fentanyl comparison is quite something. Are there other countries that you would point to that do this better?

SZALAVITZ: Not really. Unfortunately, the United States has had an incredible dominance over drug policy in the world. And part of that is because, for a while, it was the one thing that the Soviet Union and the United States could agree on. We all hate drugs. We’re all going to crack down on them. And they’re really, in terms of the scheduling system, it’s imposed by the U.N.

CHAKRABARTI: Okay. Interesting. Professor Cooper, what do you think about that?

COOPER: I think in general, it’s important to remind ourselves that the scheduling system is, there are serious issues with it. But the scheduling system also relates to drugs that have been approved, that have been rigorously studied for certain therapeutic endpoints.

So fentanyl and cocaine is also, it’s Schedule II, it’s not Schedule II. So cocaine has been acknowledged to have therapeutic use, and that’s because it’s used in a prescribed manner. Now, certain drugs are not scheduled at all, right? Alcohol, tobacco, they are not in the Controlled Substance Act.

And so this is another route to go. So here, we’re talking about moving marijuana, so cannabis with more than 0.3% THC from Schedule I. No accepted use, federally legal, to Schedule III, where it has accepted medical use, and can be used under federal law for that purpose. But it’s important to remember that even if it moves to Schedule III, only certain types of products will fall in that category, and it will still not be legal to use it outside of that Schedule 3 category.

So it will be different than alcohol and tobacco. And so there will still be restrictions and there will still be issues with that.

SZALAVITZ:  Well also —

CHAKRABARTI: Maia, did I hear you? Yeah, go ahead.

SZALAVITZ: Oh yeah. I was just going to say that it, again, the insanity of the scheduling system is reflected in the fact that alcohol and tobacco are not scheduled.

The fact is that we really don’t have a good way of regulating recreational drugs. We have no way for somebody to get a new safe one approved if such a thing existed. And so it’s really difficult to do things like, okay alcohol is objectively more harmful than marijuana. How do we account for that in terms of advertising and regulation?

Tobacco is more harmful than all of them. How do we deal with this in terms of that? And how do we put them in context? Because these things can substitute for one another at various times. People throughout the show have been talking about how they prefer marijuana to alcohol.

CHAKRABARTI: Maia, since you did very aptly reference back to our listeners, who have been sharing their stories of cannabis use, here’s a couple more. This is Matthew Hernandez in Denver, Colorado. Matthew recently quit using cannabis. He’s in his mid 30s now, but he used to be a daily consumer.

MATTHEW HERNANDEZ: The culture in Denver specifically had always been friendly toward marijuana users. There was a time that it was assumed that you smoked unless you specifically said otherwise. I would, as they say, wake and bake, and would attend school, work, I felt like it really locked in my focus. It was a great social lubricant. That’s how I bonded with a lot of my friends. That’s how I met a lot of friends.

CHAKRABARTI: So that’s Matthew in Denver. Here’s Grayson in Cedar Rapids.

GRAYSON: I began smoking marijuana at 18, my senior year of high school. And at 65, I’m retired now and pretty much out of regular smoking in my mid-fifties. These days have turned to unprescribed CBD concentrations to ease arthritic pain.

I’m an avid bike rider, too, and also as an occasional sleep aid. To get out of the house and supplement my retirement income, I applied for a school bus driving position. But tested positive, of course, for THC. However, despite not having so much as a parking ticket since my 30s, my employment was rejected.

CHAKRABARTI: So that’s Grayson in Cedar Rapids. And here’s Michael Mirtica in Duluth, Minnesota.

MICHAEL: I have smoked cannabis, vaped, edibles, etc., for a good 15 years of my life now. I’m 30 years old and I started way too young. But the truth is that there is a lot of downside to daily weed use that I didn’t realize when I was that young. And if I could go back and change when I started to after 21, that would be great, but I can’t change it now.

I still vape once in a while. Moderation is key. I still have some problems with it if I go beyond your limit. You really just have to know your body, know your limit, and how it affects you individually. So there’s benefits and drawbacks to everything.

CHAKRABARTI: That’s Michael in Duluth, Minnesota.

Professor Cooper, I wonder if, in terms of the consumers point of view, in states where marijuana or cannabis has been legalized. Can we presume that it’s actually much more regulated, obviously, than a black-market purchase might be? And can people trust, getting back to the potency question, can people trust what’s on the labels in the places where they’re buying cannabis?

COOPER: Meghna, I think that this is a really important question, that we have to confront, as more than half of the states have legalized cannabis, yet there is no federal oversight related to the quality assurance and the testing of these products. And so every state is really left on its own to set up the testing facilities and to put forth the standards.

So yes, I do think that overall, regulated products in states are safer, they have less risks, less contaminants. The labeling is better. They’re being tested. Then products in those same states that are unregulated. So what some people call like the quote-unquote black market. So I do think that there are certain safety guards.

But, as we’ve seen in the state of California, where I think over half of the testing facilities were shut down by the California Department of Cannabis Control in the beginning of 2024. There’s only so much that the states can do to enforce the testing practices and to ensure that the standardization is there, and the labeling is there, to be able educate and protect consumers.

We heard early on, I think from a caller, Amy, who was talking about her use of Delta-8 THC and how she felt comfortable with it because there wasn’t so much THC in it. Delta-8 THC, which is generally not regulated, not tested for in most of the States. That acts like Delta-9 THC, that THC that people generally think is stronger than Delta-8 THC.

And it’s a good example of why we need better consumer education and better controls.