What Principles Govern Virginia’s Approach to Tobacco, Vaping, Marijuana?

What’s she smoking? Is it anybody’s business? In an era in which health care costs are socialized, it’s everybody’s business.

Well, at least General Assembly Republicans are consistent. In the words of the Richmond Times-Dispatch, the House of Delegates “snuffed out” a number of marijuana bills this week, including a proposal backed by Gov. Ralph Northam to decriminalize pot. Meanwhile, they propose tightening the vice on vaping products and raising the legal age for purchasing tobacco from 18 to 21.

Republicans, it appears, are hostile to marijuana, tobacco, and indeed the inhalation of any foreign substance into the lungs. Tobacco, we know, can cause cancer. Vaping amounts to a nicotine delivery system. Nicotine is addictive, but it’s less clear that it represents a national health emergency. Indeed, my 20-year-old son, a vaper, argues that vaping substitutes for smoking tobacco, and that nicotine poses less threat to human health than the toxic brew resulting from combusted tobacco leaf.

And marijuana? Defenders of the weed say not only is it not dangerous, but it’s a cure for everything from epilepsy to Tourette’s syndrome. While Republicans have held back the tide of decriminalization — the gateway to full legalization here in Virginia — it seems as though it’s just a matter of time before Virginia joins the stampede to legalize the leaf.

Marijuana has a psychoactive ingredient, THC. The health effects of this substance are not well understood. Had it been packaged by Pfizer, Merck or Eli Lilly as a medication for pain, A.L.S., Huntington’s, Parkinson’s, dementia, glaucoma, or any of the other maladies for which it is said to have benefits, THC would have been subject to exhaustive Food and Drug Administration (FDA) clinical trials and protocols. There have been no such trials. The state of medical knowledge regarding THC is akin to that of herbal medicine and vitamin supplements: guided by anecdote, supposition and wishful thinking, not systematic science.

Writes Malcolm Gladwell in The New Yorker:

Figuring out the “dose-response relationship” of a new compound is something a pharmaceutical company does from the start of trials in human subjects, as it prepares a new drug application for the F.D.A. Too little of a powerful drug means that it won’t work. Too much means that it might do more harm than good. The amount of active ingredient in a pill and the metabolic path that the ingredient takes after it enters your body—these are things that drugmakers will have painstakingly mapped out before the product comes on the market, with a tractor-trailer full of supporting documentation.

With marijuana, apparently, we’re still waiting for this information. It’s hard to study a substance that until very recently has been almost universally illegal. And the few studies we do have were done mostly in the nineteen-eighties and nineties, when cannabis was not nearly as potent as it is now. Because of recent developments in plant breeding and growing techniques, the typical concentration of THC, the psychoactive ingredient in marijuana, has gone from the low single digits to more than twenty per cent—from a swig of near-beer to a tequila shot.

Are users smoking less, to compensate for the drug’s new potency? Or simply getting more stoned, more quickly? Is high-potency cannabis more of a problem for younger users or for older ones? For some drugs, the dose-response curve is linear: twice the dose creates twice the effect. For other drugs, it’s nonlinear: twice the dose can increase the effect tenfold, or hardly at all. Which is true for cannabis? It also matters, of course, how cannabis is consumed. It can be smoked, vaped, eaten, or applied to the skin. How are absorption patterns affected?

Clinical trials also would identify unwanted side-effects of THC such as schizophrenia and other psychoses. Marijuana may well have side effects that warrant FDA rejection were it proposed as a prescription drug.

The FDA regulates cigarettes and e-cigarettes. Shouldn’t it also be studying and regulating marijuana? As for the regulation of tobacco, nicotine and THC here in Virginia, shouldn’t legislators apply a consistent set of criteria? I have yet to see anyone articulate a set of principles for how access to these harmful/potentially harmful substances should be restricted and controlled. Virginians’ approach seems to be governed by evolving cultural prejudice.