The Cannabis Question

By A.C. Shilton
Illustrations by WASCO

The Seegers Union Event Space went quiet when a Latina mother of four took the floor to share her story. Her eldest son had been arrested for growing a handful of cannabis plants. He used cannabis to ease his anxiety, a condition not approved for treatment with medical marijuana. Having an approved condition is currently the only legal way to obtain the drug in Pennsylvania. Police officers handcuffed all four of her children before searching the property. She recounted how traumatic that was—and later, how devastating it was to have her son sentenced to a year in jail.

Like many states, Pennsylvania is considering a future in which access to cannabis doesn’t depend on having a specific medical condition and of-age users don’t fear legal consequences. In early April, Lieutenant Governor John Fetterman spent an afternoon in Seegers Union as part of a statewide “listening tour” on recreational marijuana. His visit drew about 100 Lehigh Valley residents, from senior citizens with chronic pain to veterans with PTSD.

By mid-May, Fetterman had traveled to all of Pennsylvania’s 67 counties to hear constituents’ opinions on whether recreational marijuana should be legal. (Medical marijuana was legalized in the state in 2016.) It was easy to parse the results of an informal poll at Muhlenberg: When Fetterman asked the room who opposed legalization, not a single hand went up.

Cannabis—a drug that’s often referred to as marijuana—is having a moment. With home-grown plants and/or full-fledged recreational dispensaries legal in 11 states and D.C. and bold pronouncements that the industry may be worth $75 billion by 2030, the hopes for cannabis are, well, high. As the statewide legalization conversation continues, Muhlenberg professors from a variety of disciplines are looking to what the research says about the potential benefits and harms of such a change. And students, both past and present, are thinking critically about the issue, too.

What the People Want

For the past decade, Professor of Political Science Christopher Borick has been tracking public sentiment on cannabis. Borick is the director of the Muhlenberg College Institute of Public Opinion (MCIPO), and he and his students regularly take Pennsylvania’s temperature on pertinent issues.

“Rarely do you see something as linear in public opinion [as cannabis],” he says. Six years ago, just 33 percent of Pennsylvanians favored “the complete legalization of the use of marijuana for any purpose,” according to a poll from the MCIPO. Today, that number is 51 percent.

However, while more people than ever support recreational cannabis, that doesn’t mean that it will become legal anytime soon. “Often there’s a lag between public opinion shifts and actions in government,” he says. One reason for this lag is gerrymandering, the practice of the party in power drawing district lines in its own favor. In heavily gerrymandered states, very few districts are competitive in any given election, which means incumbents will likely keep their seats regardless of whether their actions reflect their constituents’ desires. While reforms are pending, Pennsylvania historically has been heavily gerrymandered.

One thing the legalization movement has going for it is energy: “Sometimes we ask how much or how strongly you approve of legalization, and the intensity is on the side of legalization,” Borick says. In general, the status quo doesn’t garner as much enthusiasm as the new thing. Borick calls this the “intensity gap,” and it explains why only one undecided person came to express concerns at Lt. Gov. Fetterman’s Muhlenberg listening tour stop.

The Potential for Patients

There are many reasons why proponents feel energized about legal cannabis, and Dylan White ’14 has seen the plant’s promise firsthand. White works as a product specialist for the Bethlehem-based Keystone Canna Remedies, the first medical dispensary in Pennsylvania. While living in Colorado, which legalized recreational cannabis in 2012, White began using cannabis to treat PTSD and is now a medical marijuana patient in Pennsylvania. “I really believe in this. That’s why I do this,” he says.

Keystone Canna Remedies is led by a cardiologist and employs pharmacists and medical professionals to counsel patients. White says the changes he sees in clients can be astounding. “We have epileptic patients who use it to manage their seizures, and cancer patients who, when used with traditional therapies, have eased the symptoms related to their treatment,” he says. According to a 2016 Current Oncology paper, cannabis may also help cancer patients by improving appetite, relieving nausea and reducing pain and numbness (i.e. neuropathy) caused by chemotherapy.

The potential of cannabis to help manage pain, as a safer alternative to opioids, was something many Lehigh Valley locals brought up during Fetterman’s visit. Patients with “severe chronic or intractable pain” are eligible for medical marijuana in Pennsylvania, but, unlike opioids, only certain providers are allowed to prescribe it, health insurance will not cover it (as long as it’s a federally controlled substance without FDA approval) and obtaining it requires a process that’s far more complex than picking up a prescription at a pharmacy (See "Step by Step," below). In 2017, Pennsylvania had the third-highest amount of opioid deaths per capita in the nation. “From a harm-reduction perspective, swapping to a less dangerous drug from a more dangerous drug is a good thing,” says Psychology Professor Jeff Rudski.

Cannabis is less addictive than opioids, which does not mean it is not addictive: Rudski says that it taps into the same brain circuits that are active with other drugs, and your brain can come to crave that high. When you feel you cannot sleep or relax or focus without cannabis, you have created a dependency, and according to research published in JAMA Psychiatry, about 30 percent of regular users develop a dependency.

However, “an addiction to marijuana is not a life-threatening addiction,” Rudski says. Opioid addicts can suffer withdrawal symptoms from insomnia to more severe symptoms like vomiting and diarrhea, and users quickly lose their tolerance, which can put them at risk of a fatal overdose if they relapse. Meanwhile, according to the United States Drug Enforcement Administration, “No deaths from overdose of marijuana have been reported.” Cannabis could cause impairment that leads to dangerous behavior, but the cannabis itself won’t cause a person to stop breathing the way opioids can.

"It's Complicated"

The potential for less opioid use and more tax revenue (in March of this year alone, Colorado took in more than $17 million from recreational sales and more than $800,000 from medical sales) makes full legalization seem like a win-win to some. But Assistant Professor of Public Health Chrysan Cronin says, at least from her field’s perspective, “when you do a cost-benefit analysis, it’s complicated.”

Every semester, each student in Cronin’s Issues in Public Health class must pick a public health policy, read the current academic literature on the subject and write an essay on whether they think the policy is sound. “To give them an idea of what I’m looking for, we all research marijuana together,” she says. While nearly every student in her class is pro-legalization at first, “almost unanimously after that they say no,” says Cronin. “It never fails, and I don’t tell them one way or the other what to think.”

The students read a study that followed incoming students for four years and asked them to track their cannabis use and the number of classes they missed and analyzed that information with their GPA and how long it took them to graduate. The researchers found that students who used cannabis missed more classes, had lower GPAs and were less likely to graduate in four years than students who did not. Still, Cronin cautions that more research is needed, and because cannabis is still illegal at the federal level, it’s hard to get funding to study the drug and its effects.

Laurel Mangelsdorf ’22, a public health major who took Cronin’s class, has many concerns about legalizing recreational cannabis. One is a lack of knowledge regarding how it affects people, both developmentally and immediately. For example, she says, “Is there a point that someone might reach after using marijuana that it becomes unsafe for them to drive, like a blood alcohol content limit? How do we figure this out and test it?”

Cronin has tracked Colorado’s legalization process and says that public health officials there were not well prepared. Things like increased incidences of driving while high, sharp upticks in emergency-room traffic and keeping edibles—which can be hard to distinguish from drug-free treats—out of the hands of kids are all challenges Colorado has struggled to navigate. In other words, this is not a drug without downsides.

Common Ground

While opinions vary on the risks and benefits of cannabis, one part of the legalization conversation is less controversial: “The way we enforce drug laws is just not working in a lot of ways, and marijuana is the poster child for that concern,” says Borick. His research has found that how we deal with drug offenders is one of the few issues with bipartisan support. “There’s almost no one who thinks that the way we’re doing it is right.”

“There’s clearly a racial element with the stigma of marijuana,” says Rudski, adding that when people of color are disproportionately charged with felonies, it affects their ability to vote. “In a way, it’s maintaining Jim Crow laws.”

Cronin, meanwhile, notes that sometimes bringing drugs out of the shadows can be a good thing: “I think we do have to think about the illegal drug trade and how many people are harmed through that,” she says. Legal weed would likely reduce the power of drug peddlers while also reducing the number of Americans we have behind bars.

Still, Cronin is on the fence about what’s right for Pennsylvania. “No policy is ever 100 percent perfect, and I do not know what the best answer is,” says Cronin. “But I don’t think it matters because I think it’s going to happen. And working in public health, it’s our job to be ready when this happens.”