The real question Harris and Trump should answer about marijuana

That means the question Kamala Harris and Donald Trump should answer is not whether marijuana should be legal, but what comes next. Contrary to assertions from cannabis advocates, the drug is far from a safe product. As president, how will they help people afflicted with wide-ranging consequences of cannabis use, and what strategies will they implement to reduce its harms?

With marijuana consumption skyrocketing, these concerns are urgent. The journal Addiction reports that the number of Americans reporting daily or near-daily cannabis use in 2022 was 15 times what it was 30 years prior. In 1992, there were 10 times as many regular alcohol drinkers as cannabis users; now, there are more regular cannabis users (17.7 million) than drinkers (14.7 million).

And many of those who aren’t daily cannabis users are still consuming at a high frequency. In 2022, the average drinker reported imbibing four to five days in the past month. The average cannabis consumer reported 15 to 16 usage days.

Legalization contributed to the rise in marijuana consumption, as did the belief that the product must be safe because it has medicinal properties. But although some people benefit from legitimate medical uses, such as cancer patients with intractable pain, hundreds of scientific articles have documented the short- and long-term dangers the substance poses to recreational consumers.

Cannabis contains a psychoactive substance, tetrahydrocannabinol (THC), which triggers the brain’s reward system to provoke pleasurable sensations. It also disrupts the frontal cortex and hippocampus, impairing motor skills, slowing reaction time and distorting judgment. That makes marijuana use a hazard for drivers and workers in many occupations. Yet, according to a 2023 survey, nearly 60 percent of drivers who use marijuana admitted to getting behind the wheel while under the influence. Nearly half of them reported impairments.

There is no clear guidance on how long people should wait to drive or work after consuming cannabis. There is also no mechanism to detect levels of THC in users the way there is for alcohol. Funding to develop a cannabis breathalyzer should be high on Trump’s and Harris’s marijuana agendas, as should enforcement efforts for all forms of impaired driving.

The next president must also reckon with the growing addiction crisis. Yes, marijuana use can cause addiction, just as alcohol, cigarettes and opioids can. Research published in JAMA Psychiatry shows that nearly 3 in 10 marijuana users develop cannabis use disorder, which significantly impairs quality of life and is difficult to treat. There are no approved drug therapies, and almost half of affected people are diagnosed with another psychiatric condition such as depression or anxiety.

Both Trump and Harris list addiction and mental health as top priorities. The ballooning number of cannabis users will soon translate to even more people suffering from untreated behavioral health needs. What is their plan to help these individuals on top of the millions of others who already face delays in care because of inadequate treatment capacity?

Addiction is not the only ailment that can befall cannabis users. A 2024 study in the Journal of the American Heart Association links daily cannabis use with a 25 percent higher risk of heart attack and 42 percent higher risk of stroke. Another study, in JAMA Otolaryngology, reported that heavy cannabis use was associated with an eightfold increase in laryngeal cancer. And a plethora of research has linked regular marijuana use with schizophrenia, psychosis, suicidality and worse cognitive function.

I would love to see presidential candidates acknowledging these negative health effects as they lay out a national educational campaign. They should explain that people exposed to marijuana smoke risk developing some of the same ailments that plague cigarette smokers. The American Lung Association is unambiguous: “No one should be exposed to secondhand marijuana smoke.” Ordinances already protect Americans from inhaling secondhand tobacco. When will leaders propose — and enforce — similar laws for marijuana?

Personally, I would much rather that marijuana was decriminalized but not legalized. From a public health standpoint, the last thing we need is another harmful substance that worsens health and strains societal resources. Realistically, though, recreational use is a genie that can’t be put back into the bottle. The health-care system needs to prepare for the consequences, and federal officials must use their authority to reduce the harms — not only to cannabis users but also to those affected by their choice.