The U.S. surgeon general issued an advisory Thursday on the risk of marijuana for adolescents and pregnant women — two groups increasingly using the drug that has been legalized in some form in 33 states.
"No amount of marijuana use during pregnancy or adolescence is safe," U.S. Surgeon General Jerome Adams said in a news conference, flanked by HHS Secretary Alex Azar and other top health officials.
New widespread access across the states, more highly concentrated strains of marijuana's psychoactive element THC and perceptions that marijuana is safe "endanger our most precious resource, our nation's youth," Adams said.
Marijuana use during pregnancy doubled over 15 years, to 7% of pregnant women in 2017.
The move by the Trump administration runs counter to the growing state level push to decriminalize and legalize pot, which has become a major industry in its own right.
"State laws have changed, but science has not and federal law has not," Azar said.
The secretary also announced that the surgeon general's advisory and administrationwide call to action includes a push for more research on the federal, state and local levels. Officials are already in discussions with the Justice Department and the Drug Enforcement Administration on how to open up more research on the risks of the drug.
Federal prohibition on marijuana stymies certain in-depth studies on effects of cannabis exposure on children in particular because child protective services could be called in if infants or kids test positive for the drug.
Despite the increased use and perception of marijuana's relative safety, Adams said as part of his job of the surgeon general that he needs to help the public understand the downside of trends. He also highlighted the potency of "professionally grown" plants, where the psychoactive element THC now ranges on average up to 12% in strength, versus 4% strength in 1995. Some state dispensaries offer cannabis with concentrations as high as 18% to 23%.
"This isn't your mother's marijuana," the surgeon general said.
"Once upon a time people thought tobacco was safe for you," until a surgeon general's report was published highlighting the health risks, he added. And he called on policymakers to consider the downsides of pot use while developing their laws and regulations.
Trump administration officials picked different aspects of the drug's health risks to home in on. Nora Volkow, director of the National Institute on Drug Abuse, referenced studies that show the danger on developing brains of infants, pre- and post-pregnancy, when their pregnant or nursing mothers use the drug.
Azar and Volkow talked about studies linking early marijuana use in adolescents to consequences like memory loss, depression and poor decision making, and decreases in IQ from chronic use that starts early.
"What you're doing when you're smoking marijuana is disturbing a very carefully orchestrated process where the endogenous cannabinoid system actually responds to stimuli and creates more connections," Volkow said. "There's an enormous amount of studies that shows your performance will be much worse if you smoke marijuana, and the younger you smoke, the worse it is."
Counter-arguments to those assumptions include the idea that kids who are already at a disadvantage in development are more likely to use marijuana, and so observed effects like depression or poor decision making may be more linked to their personal circumstances than to pot use.
In order to better understand "objectively" how marijuana influences brain development and behavior, Volkow said, her agency is currently running a large, prospective study to try to determine specifics of cause and effect.
Thursday's advisory is only the second surgeon general's warning on marijuana. The first came during the Reagan administration in 1982, after HHS submitted a report to Congress on the consequences of marijuana use and its implications for perception and skilled performance like driving.
Some in the OB-GYN and pediatrics community have been sounding the alarm about pregnant and nursing women's use of cannabis, and how it's grown, but for the most part policy momentum has been on the side of increasing access to the drug.
About 70% of Colorado's cannabis dispensaries recommended marijuana products to pregnant women to treat their first-trimester nausea, according to a study last year by the American College of Obstetricians and Gynecologists.
A study from March of this year in the Annals of Internal Medicine found that, five years after Colorado legalized pot, its bad side effects are sending more people to hospital emergency rooms.
Dr. Patrice Harris, president of the American Medical Association, applauded the advisory and reiterated that the group has been calling for research on the effects of long-term cannabis use by youth and pregnant and breastfeeding women.
"The AMA has urged legislatures to delay legalizing cannabis until further research is completed on the public health, medical, economic, and social consequences of its use," Harris said.
Earlier this month, President Donald Trump announced he was donating his second quarter's salary to the U.S. surgeon general's office. Adams announced the donation — $100,000 — will help fund the digital campaign to promote awareness of the advisory.