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We have been led to believe that there are demon drugs, like marijuana and heroin, and angel drugs, like Ritalin and antidepressants. If a doctor prescribes an FDA approved pharmaceutical drug, apparently it’s as safe as houses, but if you buy an illicit substance on the street, it’s not. The opioid epidemic has disabused us of this clear distinction between the two types of drugs because it has become clear that the potential for addiction and harm is just as high with prescription drugs like opioids as it is with heroin.

Cannabis the angel drug

Enter cannabis, with a low potential for addiction and no risk of lethal overdose Too often the knee jerk response of the pro-cannabis side has been to compare its safety to that of smoking cigarettes and drinking alcohol. They say that smoking and drinking cause far more harm to health and society than marijuana, but this is oversimplifying the issue and yet another iteration of the demons and angels approach, which is unhelpful at best and dangerous at worst. We all know the harmful effects of tobacco and alcohol simply because these substance have been widely and openly consumed, but not so for cannabis. Cannabis has been illegal for so long that any one smoking it is highly unlikely to report any adverse effects. Doing so would be admitting to illicit use. Besides, who would they call? Adverse consequences may be underreported, and now unacknowledged by or unknown to the public.

Cannabis is complicated

Cannabis is not a single drug but a complex collection of hundreds of compounds. Some of these are terpenes and flavonoids and others are the cannabinoids, Δ9 THC being the main psychoactive ingredient. Adding to the complexity is that there are many different strains of cannabis with different ratios of cannabinoids. These ratios are just as important as the constituents themselves. The cultivation and preparation of the plant, along with the various ways of using it and the different doses available all add further layers of complexity. In short, there are many things about cannabis that we still don’t know.

Medical risks of cannabis

There is no doubt that cannabis has extraordinary medicinal value but we also have to be cognizant of the potential for harm in vulnerable individuals. It is not a one size fits all solution and for instance, certain people with pre-existing conditions can be pushed over the edge into psychosis, paranoia, depression, depersonalization or anxiety when smoking it. This seems to be a result of too much THC in relation to the other cannabinoids but growers have been deliberately breeding cannabis strains with higher levels of THC. This is a direct result of the plant’s illegal status because if buyers risked jail time for possession, they wanted stronger weed that could sell at a higher price.

The majority of cannabis users don’t experience serious side effects. If they do experience adverse effects they are usually mild. But that doesn’t mean we can ignore the safety issues altogether. As a multifaceted drug with psychoactive properties, cannabis can have powerful therapeutic outcomes so it is unrealistic to expect it to be universally risk-free. Claiming that it is and using cigarettes and alcohol as a comparison does a disservice to the plant. It hampers objectivity and encourages denial, which could ultimately affect the direction of research and end up hurting people.


Michael Morgenstern, MDDr. Michael Morgenstern is a double board certified neurologist who is also certified to treat addiction. He treats patients with medical marijuana at Morgenstern Medical at locations in Manhattan, New Hyde Park and Syosset. He is the founder of the NY Medical Marijuana Association. He can be reached at [email protected]