Label it Green

Should New Mexico conduct research and push awareness about the public health risks of cannabis?

Thinking of trying a THC/CBD gummie to quell your post-holiday stress but not sure how safe that might be? If the dispensary you visit follows state law, there’ll be a warning label instructing you not to drive or operate heavy machinery while under the influence and informing you of the long-term health risks, particularly for pregnant and breastfeeding women.

Here’s what the labels won’t say: Studies have shown links between cannabis use and behavioral health disorders, including psychosis. Yet, New Mexico’s laws that made medical, then recreational cannabis legal don’t require such warnings.

A University of New Mexico doctor says the research is clear that heavy cannabis use increases the risk of psychosis, and he believes officials should make the public more aware of this and other known risks. He also says there’s been a dearth of research on the efficacy and safety of cannabis for medical use.

Meanwhile, a Santa Fe-based lawmaker appears open to statutory changes to improve public awareness around risks—and to the possibility of pushing some of the massive revenues rolling into the state since passage of the Cannabis Regulation Act toward deeper research into the plant’s benefits, as well as its harms.

Warning labels on cannabis products are a primary mechanism for consumer education. Whereas alcohol and nicotine are regulated at the federal level, warning labels for cannabis vary from state to state. Dr. Brant Hager, associate professor of psychiatry and behavioral sciences at UNM, notes the risk of psychosis in heavy cannabis users—characterized by hearing voices, paranoia and delusional thinking—is around four times that of the baseline population, according to a review by the Maryland Psychiatric Research Center in 2015 that synthesized 18 studies that enrolled more than 66,000 people.

For people who have experienced cannabis-induced psychosis, the study showed, risks of developing a chronic mental illness such as bipolar disorder or schizophrenia are “extraordinarily high”—almost half the people with cannabis psychosis developed a chronic mental illness later.

A summary paper from the National Academy of Sciences published in 2017 also concluded that cannabis is “likely to increase the risk of developing schizophrenia and other psychoses,” although it’s worth noting that association does not equal causality and there remains disagreement about its findings. Social anxiety disorders, depression, suicide, worsening bipolar disorder and risks of problem cannabis use are also listed, among others.

New Mexico is not the only state where warning labels are sparse. California, for example, added cancer to its cannabis warning labels in 2020, but not psychosis. That surprises Hager because “the links between cannabis and cancer are very weak.”

Robert Sachs, legal counsel for the New Mexico Cannabis Control Division, which is responsible in collaboration with the Cannabis Regulatory Advisory Committee for warning label rules, says officials did not discuss risks specific to cancer or schizophrenia when drafting the initial regulations. Rules came about through meetings with the Cannabis Regulators Association, a multistate group, and recommendations from the Department of Health.

“All rules do have to be based in some sort of scientific background,” Sachs says.

On the therapeutic side, Hager also has concerns about some aspects of the state’s medical program, which features a growing list of qualifying conditions—anxiety disorder was added just a few weeks ago. He feels the data on the efficacy and safety of cannabis for many of these disorders is sparse.

“The regulations pertaining to safety from a health and particularly behavioral health standpoint are sorely lacking,” Hager says, adding that labels also don’t address dosages.

Dr. Dominick Zurlo, director of the Medical Cannabis Division, says doctors are “supposed to be talking about those [potential side] effects with the patient.” And the health department’s website includes educational materials.

Hager also notes the need to study cannabis’ benefits. While there’s ample data on the plant’s ability to treat pain, how it might benefit or harm people with post-traumatic stress disorder is less understood. Historical bias toward researching harms instead of benefits of cannabis in the US—a vestige of the War on Drugs—likely accounts for the disparity.

The Cannabis Regulation Act tasked a Public Health and Safety Advisory Committee to monitor New Mexico’s health outcomes related to cannabis legalization, and its first report is due Dec. 1, 2024.

“The committee is just starting to gather information, and to determine what types of information are really needed,” says Zurlo. But the committee isn’t focusing on specific behavioral health conditions.

“I think from a public health standpoint and monitoring standpoint, I think it would really behoove the state to have something in place for epidemiologic surveillance of [psychotic illness diagnoses and suicide] correlated with the increased availability of cannabis,” Hager says.

Zurlo says it would be up to the Legislature to add on psychosis and schizophrenia as a research topic.

State Rep. Andrea Romero, D-Santa Fe, a co-sponsor of the Cannabis Regulation Act, says the state could find more ways to “be a leader in mitigating risks” associated with cannabis use, and is “definitely open to anything that has to do with better public health awareness.”

Romero wants to use some funds this year to improve cannabis-related public health, which could include crafting new laws regarding warning labels and improving systems for longitudinal data-gathering. She is actively discussing options with experts from national organizations like the Drug Policy Alliance, but is still in the drafting phase.

She does not have any specific plans to legislate around the impacts of cannabis on behavioral health in the session that begins Jan. 17, but tells SFR “it’s definitely on my radar.” Romero would like to know more about why people use cannabis and to better define heavy use and responsible consumption. In the wake of legalization, people may be interfacing less with their doctors about use, too, which concerns her.

Sachs says the Cannabis Control Division is considering proposing changes to the law, too—kind of a “clean up bill”—but “there’s still kind of an internal discussion.” He would not provide specifics.

Hager, Romero and Sachs all like the idea of a program, like California’s, that diverts cannabis money to universities for cannabis research, which is getting easier to conduct nationally.

“We can always work more closely with our doctors,” Romero says. “We started from scratch…this is the first time we’ve ever gone from an illegal substance to a legal substance and there are so many implications. The more that we have these conversations, the better it is for me to be able to do better.”

Claire Wilcox is an addiction psychiatrist and has treated hundreds of patients with substance use disorders. She gives regular trainings on medication-assisted treatment for opioid use disorders across the country and is adjunct faculty at UNM.

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