Faculty spotlight: Exploring marijuana’s impact on societal trends and health outcomes

Jennie Ryan’s very first assignment as a doctoral student changed the course of her career. She was an experienced clinical nurse and had planned to focus on teaching, however, a routine paper on health policy turned into a new career focus.

“Marijuana legalization was a hot topic and I wanted to write about that,” said Ryan. “I did the research and thought it was really interesting so I went to the head of my doctoral program and said I want to change my focus. She was very supportive, but she received a lot of pushback from people saying it was too controversial.”

Ryan quickly learned how complicated it is for researchers to study marijuana. She started exploring how and why parents make decisions about giving their children medical marijuana for conditions such as epilepsy. At first, she thought it wouldn’t be that difficult because she wouldn’t be in contact with marijuana; she would be interviewing parents about their experiences giving marijuana to their children.

“I wanted to interview all parents who were giving their children medical marijuana for treatment of epilepsy, whether they lived in a state with legal medical marijuana or did not,” explained Ryan. “I found out I couldn’t interview parents who were giving it illegally because it would be considered child abuse and, as a nurse practitioner, I would be mandated to report these parents. That’s when it hit me, this was going to be harder than I thought.”

Marijuana 101

“There are three species of marijuana, but only two are really common, sativa and indica,” explained Ryan. “From those two species, there are thousands of strains. The cannabis flower is where the cannabinoids are. People are most familiar with the cannabinoid THC [Tetrahydrocannabinol].”

THC is the psychoactive compound that produces the feeling often described as a “high.” In medical marijuana strains, there are usually lower levels of THC and higher levels of another cannabinoid, cannabidiol (CBD).  CBD has been shown to have several therapeutic properties, and patients are using it for a variety of ailments.  CBD does not have psychoactive properties, and therefore will not illicit the “high” from THC. 

“People are primarily using CBD for pediatric patients,” said Ryan. “If the percentage of THC in the marijuana strain is under a certain level (usually 0.05%), it’s considered hemp. That’s why people can buy CBD products online.” 

People do not need a medical marijuana card to buy CBD online and researchers believe its likely many people are experimenting with CBD.  However, to obtain strains with THC, patients need to acquire a medical marijuana card and only about half the country currently has access to medical marijuana programs.

Patchwork of legality

Throughout the country, some states have laws that allow people to use medical and/or recreational marijuana for personal use. However, according to federal law, it’s all still illegal.

“According to the federal government, when parents give medical marijuana to their child, they are dispensing a Schedule 1 drug to a minor,” Ryan said. “That’s up to 10 years in prison, a one million dollar fine and parents risk losing custody of their child. So, I understood why a lot of parents were reluctant to talk to me.”

Parents who did talk to Ryan emphasized that they do not fear prosecution as much as they feared to lose what they see as a lifesaving medication for their child. If federal policy limits or stops marijuana cultivation and sales, then parents will no longer have access to marijuana as a medication for their child.

Ryan says the fear is also leading to a disconnect in their child’s healthcare.

“Parents are relying on the internet for information, instead of health care professionals,” she said. “In some cases, if parents see results, they start to wean their child off traditional epilepsy medications without talking to their health care provider. That should worry all providers.”

The motivation

Ryan is undeterred by the complications of marijuana research and often thinks of a specific case as motivation. She was working in a Delaware hospital when a young girl came in with out-of-control seizures. The care team tried all the usual efforts but the seizures would not stop.

Even though Delaware allowed medical marijuana, Ryan’s federally-funded hospital did not. The team began to discuss the possibility of transferring the child across the nearby state line to Pennsylvania where she could be treated with marijuana as the last hope. However, the little girl was too unstable to be moved and she died.

“That case really stuck in my mind,” said Ryan. “We don’t know if it would have made a difference but it made me interested in the policy aspect. You should be able to get the same care and medicines in Kanas as in California. Patients aren’t getting access to the medication they want based on where they live. It could be argued this is a health disparity, driven by public policy.”

UMSN research

Seeing the discrepancies in marijuana policy between individual states and the federal government, and seeing the effects for patients made Ryan want to pursue marijuana policy as her current topic of research.  

“It’s essential that researchers study the effects of legalization on public health outcomes,” said Ryan. “This is a complex topic and it requires well-trained researchers.”

Ryan is now one of the University of Michigan School of Nursing’s (UMSN) newest research fellows under a National Institutes of Nursing Research-funded training grant, “Complexity: Innovations for promoting health and safety.” She’s also part of UMSN’s Center for the Study of Drugs, Alcohol, Smoking and Health (DASH).

“You’re going to have opinions all over the spectrum on this topic,” she said. “With the training grant and DASH, you have people from all sides voicing their ideas and concerns which is really helpful.”

Ryan says there is still not enough support for most researchers to pursue hands-on clinical trials of marijuana, but she can study the trends in states where marijuana has been partially or fully legalized.

“My goal is to mine national databases and to follow trends in public health outcomes that may be related to legalization,” she explained. “Are car crashes going down in states with recreational marijuana laws? Is alcohol consumption going up or down in these states? Is opioid use going up or down, or is polysubstance use increasing? What are the health outcomes of marijuana use when used as medicine?”

Ryan says it will be interesting to see how trends change if the State of Michigan law changes to allow recreational marijuana for adults. It’s on the November 6 ballot.

The research catch 22

While there are strong disagreements about whether or not medical and recreational marijuana should be legalized, most scientists agree that more research needs to done to better inform policy.

“It’s frustrating because everything you read in healthcare literature says we need more research, but the federal government is not rescheduling marijuana until we get the research,” said Ryan. “But we can’t do the research because it’s a Schedule 1. It’s very difficult.”

In the meantime, parents and patients are forced to make decisions without a lot of evidence.

“We have to look at what is happening, follow the trends and do our best to protect the youth from overuse,” said Ryan. “It’s going to be a long time before we have enough really solid evidence. It’s going to be really interesting to see what happens.”