Many U.S. Adults Assume Cannabis Is Safer Than It Is

Jennifer Middleton, MD, MPH
Posted on September 11, 2023

I spent most of my recent vacation in a state where recreational marijuana is legal, and the number of billboards advertising cannabis stores far outweighed the number of billboards selling anything else. (By contrast, the state I currently live in has legalized marijuana only for medical purposes, although it’s likely to be on the ballot for recreational use this fall.) As marijuana use becomes more acceptable and normative in the United States, attitudes about its safety are changing as well. A longitudinal survey of U.S. adults has found that perceptions of marijuana safety have increased over the years.

In this longitudinal survey, 5,035 U.S. adults (mean [SD] age, 53.4 [16.2] years; 2,551 males [50.7%]) were surveyed from 2017–2021. The researchers asked questions about the perceived safety of cannabis/marijuana compared with tobacco for both personal use and secondhand exposure. They found that

...in 2021 compared with 2017, there were fewer people reporting that cannabis was somewhat or much less safe than tobacco (1213 participants [25.5%] vs 1601 participants [33.7%]) and more people reporting that cannabis was somewhat safer or much more safe than tobacco (2107 participants [44.3%] vs 1742 participants [36.7%]) (P < .001).

Regarding secondhand smoke exposure,

...[p]articipants were more likely to rate secondhand smoke exposure to cannabis vs tobacco as completely or somewhat safe in adults (629 participants [12.6%] vs 119 participants [2.4%]; P < .001), children 238 participants [4.8%] vs 90 participants [1.8%]; P < .001), and pregnant women (264 participants [5.3%] vs 69 participants [1.4%]; P < .001).

Depictions of marijuana use abound in popular culture. It’s easy to find lists of the best “stoner movies and TV shows,” including this list that celebrates one series as “the best of what cannabis has to offer—fun with friends, a relaxing break and humor at its purest.” [D]ecriminalizing marijuana use can stop “undemocratic, racially biased, ineffective, detrimental, costly, and wasteful” law enforcement efforts and the associated violent crime of trafficking marijuana. Marijuana use is likely safer for most adults than alcohol or tobacco use. Although the evidence base is limited, marijuana can help with “treating certain rare forms of epilepsy, nausea and vomiting associated with cancer chemotherapy, and loss of appetite and weight loss associated with HIV/AIDS.” 

But marijuana use is not without risk; marijuana addiction is real, and marijuana’s effect on developing adolescent brains can permanently harm future cognition and emotional regulation. Marijuana is more potent now than what was available in the 1960s, and a recent retrospective study found that even occasional marijuana users were 22% more likely to visit an emergency room or be hospitalized over a year’s time compared with non-users. Tobacco and marijuana both contain several known carcinogens. Nonregulated marijuana can be laced with dangerous substances, including fentanyl, cocaine, and heroin.

Family physicians need to provide our patients—adults and teens—with objective, factual information about marijuana use. This 2021 AFP article on “Cannabis Essentials: Tools for Daily Practice” includes an overview of cannabis products, a screening tool for cannabis use disorder, and a list of people at especially high risk from cannabis use. An AFP By Topic on Substance Use Disorders is available, and you can also find resources at the National Institute of Drug Abuse. Finally, the AAFP has a position paper on “Marijuana and Cannabinoids: Health, Research, and Regulatory Considerations.”