Disclosure of biased background: in my recent past, I worked for a series of technology companies providing services to the legal cannabis industry across several emerging markets in US states. I have never particularly enjoyed consuming cannabis products recreationally, and very seldom partake more often than once every few years. If I do consume it, I generally prefer non-smoking methods with very low THC. I have been in the company of people who enjoy cannabis much more than I do for most if not all of my life. My interest in the issue is largely about social impact, and I’m motivated by reducing/eliminating incarceration and other punitive social consequences which I think are generally inappropriate. Okay with that out of the way…

This is all good information to have, but I hope there will be studies that help contextualize it. This is a pretty good study of real world usage at an extreme, but it doesn’t reflect what I think is typical usage—at least over the long term, and at least given circumstances which allow more acceptable usage.

Sure, there are people who sit around and do hours-long wicked bong rips with their friends or at parties. How often they do, or how much non-users are exposed, or for how prolonged a period of their lives, or how they change their behavior in more permissive environments… all of these would color the meaningfulness of this study’s findings in terms of overall health impact. As would knowing whether, and to what degree, less extreme/reduced usage and cessation reduces long term risk—and how consistent that is with similar changes to tobacco smoking activity.

I know my anecdata isn’t more than that, but it’s been my experience that:

- this usage pattern is more common in youth, generally in a party atmosphere, and generally either when scrutiny is limited more than usual or in low scrutiny environments; it tends to be something many long term cannabis users reduce or eliminate entirely as they mature

- even among long term heavy users, this sort of extended social session becomes less common in more permissive environments (e.g. decriminalized or legalized, or even “lowest priority enforcement”)

- exposure to this kind of excessive, prolonged usage is exceedingly uncommon for people who aren’t also consuming it firsthand

It’s also a strong hunch but I’d need more information to be more confident that: reduction or elimination of this usage pattern likely tracks closely with the long term health outcomes of reduction/cessation of smoking tobacco.

Why does all of that matter to me? Studies like this are good and helpful, but if they paint an incomplete picture which can exaggerate risk factors, they will be used to push back momentum on efforts to reduce the other risk factors.

Incarcerating people for no good reason is not going to improve health outcomes. Continuing to do so disproportionately depending on social status (largely race and biological sex) won’t help either, for a probably unknowable set of other disparities. And it definitely won’t help addressing those disparities and the other harms they cause. Encouraging likely-to-be-safer casual users to hide their use probably won’t help either.

Not that this study, or any, should be directly held to a standard of helping all or any of those. But these are my thoughts upon reading this earnestly, and honestly glad to see high profile cannabis research happening at all.