Advocacy: Doctors for Cannabis Regulation

Although two-thirds of Americans support legalization of cannabis, the American Medical Association continues to oppose it, spurring Doctors for Cannabis Regulation to take them on.

In 2014, David Nathan, MD, a psychiatrist based in New Jersey, was asked to join the New Jersey Coalition for Marijuana to help rally support for cannabis legalization among physicians. To his surprise, two groups of physicians whom he thought would be on board—oncologists and psychiatrists—weren’t. “They looked askance at the idea, saying this wasn’t their fight,” Nathan recalls. “I then tried to find a national organization of physicians that supported cannabis but found none. It was then that I took it upon myself to create Doctors for Cannabis Regulation.”

The organization, often referred to as DFCR, focuses on making a strong case for cannabis legalization and regulation by writing op-eds, letters, and articles; speaking in public settings; educating health care professionals about the value of cannabis; and advocating before the US Congress and statehouses to change the laws surrounding cannabis use.

“In particular, we look for testimony from individuals who have been fired from their jobs for testing positive for cannabis even with a medical card,” says Byron Adinoff, MD, an addiction psychiatrist and retired academician based in Colorado who is executive vice president of DFCR. “As an organization, we’re starting to take a drug warrior stance for legalization of cannabis, with an emphasis on ending the war on drugs. That misguided policy played a significant role in causing systemic racism; by incarcerating large numbers of African American men, their families in turn lost financial and emotional support. Unfortunately, however, the social justice aspect of this is not on doctors’ radar.”

As part of a traditionally conservative group, many doctors are concerned about the damage caused by heavy, frequent use of cannabis. But effective regulation, coupled with legalization, represents a safe, effective way to proceed.

DFCR envisions a policy by which the illicit drug market is eliminated by removing all penalties associated with the production, distribution, and possession of cannabis. At the same time, the market would be regulated to address the harms associated with misuse. “There is a delicate balance between these two issues,” Nathan says. “By keeping the criminal justice system only minimally involved in reducing the illegal market and instituting moderate regulations, we believe that this balance can be maintained.”

Although the majority of physicians support legalization, the American Medical Association (AMA), a powerful lobbying group for physicians, has continued to oppose it. As recently as 2020, the AMA announced its opposition to legalization on the grounds that cannabis is a dangerous drug and a serious public health concern. “This position is indefensible, especially in light of the fact that tobacco and alcohol—two drugs that are potentially more harmful—are legal,” Nathan says. “For this reason, we are striving to present our case in as many media outlets as possible.”

AMA Policy Challenged in CNN Opinion Piece
Nathan, along with coauthors H. Wesley Clark, MD, retired director of the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration, and Joycelyn Elders, MD, the 15th US Surgeon General, wrote a compelling argument for cannabis legalization, which was published on CNN’s website in April. The article was precipitated by a tweet by the longtime editor of the Journal of the American Medical Association (JAMA), Howard Bauchner, MD. The tweet said, “No physician is racist, so how can there be structural racism?” The tweet was intended to promote a podcast elaborating on this position.

Following the tweet, Bauchner was placed on administrative leave and the podcast was taken down. Physicians also spoke out against the failure of JAMA to diversify its editorial staff. The AMA has since shifted its position; the organization now supports decriminalization of cannabis, a policy that removes penalties for cannabis possession while still supporting prohibition. The problem with this approach, however, is that it encourages the illegal cannabis market, continues to allow for arrests for cannabis possession, and makes it harder to institute appropriate regulation. According to Nathan and his coauthors, the AMA’s position “sends the message that we are better off with an untested cannabis supply, vulnerable to contamination and adulteration. By opposing regulation, the AMA stands against standardized labeling of cannabis products with health warnings, ingredients, and potency.”

The data about cannabis prohibition and its consequences illustrate the negative impact of this approach. An American Civil Liberties Union (ACLU) report from 2018 found that Black people are nearly four times more likely than white people to be arrested for cannabis possession despite similar usage rates between the two groups. An earlier ACLU report about race and cannabis prohibition stated that low-income people of color face disproportionate consequences from cannabis arrests due to their inability to pay fines and inadequate access to counsel, making them vulnerable to a potential loss of housing and employment.

Ironically, the AMA’s policy hasn’t been successful in curbing access to cannabis for underaged individuals. Government statistics show that 80% of American 12th-graders have easy access to cannabis. Interestingly, however, a downward trend of use has been noted as legalization has increased across the country. According to Nathan, a recently published report from the Centers for Disease Control and Prevention showed that the number of high school students in the United States who had never tried cannabis increased from 2009 to 2013 and decreased from 2013 to 2019. The turning point was in 2013, a year after legalization and regulation of adult cannabis use began in earnest.

Hope for the Future
Despite the current position of the AMA, Nathan is optimistic that its views will change in the future. Already, the California Medical Society and the American Heart Association (AHA) have come out in support of legalization. Although cannabis consumption could be related to rapid heartbeat, the AHA is convinced that with an effective regulatory scheme, the potential harms of cannabis use could be addressed.

“The country is marching toward legalization,” Nathan concludes. “As we move in this direction, good regulation will come with it. It is inevitable and the right way to go.”

— Marilyn Fenichel is a health and science writer based in Hamden, Connecticut.