When talking about cannabis use, there are two sets of controversial beliefs, which, after careful consideration, I believe are inter-related.

Is All Cannabis Medical?

The first set involves the debate over whether or not all cannabis use is medical. Those who support this notion claim that the primary reason for which you’re using cannabis, whether it’s recreational or medical, doesn’t matter. The fact is that even if you’re using cannabis to chill with friends, the cannabis you consume is nonetheless acting on your ECS, providing wellness benefits. 

Others disagree, claiming that there’s a fundamental difference between, say, using cannabis while playing video games and using cannabis to treat epilepsy, cancer, or chronic pain. As Codi Peterson, Pediatric Pharmacist and Chief Science Officer of The Cannigma, puts it, “I just do not consider a medical patient with complex medical needs as having the same needs or desires as a college kid smoking and playing video games.” Presumably everyone in this latter group within the cannabis community believes that cannabis can simultaneously be both medical and recreational, for example, if using cannabis for stress enables you to be able to enjoy an evening with friends. However, they dispute the notion that all cannabis is medicinal.

Can Medicine Be Fun?

The second set of controversial beliefs involves the debate surrounding the question: Can a substance that’s fun to use be legitimate medicine? Many traditionalists believe that if it’s enjoyable, then it’s recreation, not medicine. Figure 1 illustrates the division of the population by where they stand in the debate over whether or not medicine can be fun.

Figure 1

Cannabis vs. Can Medicine Be Fun?

As an aside, presumably no one in cannabis denies that cannabis has legitimate medical uses or that medicine can be fun (because cannabis is often fun). In this case, most everyone in the cannabis industry (consumers, producers, researchers, etc.) likely falls into the “medicine can be fun” category. At the same time, if all people who believe cannabis has legitimate medical applications also believe medicine can be fun, it follows that people who believe that medicine cannot be fun probably don’t believe cannabis (whole plant medicine) has legitimate medical applications (see Figure 2).

Figure 2

Where Did the Belief that Medicine Is Not Fun Come From?

I’ve encountered the notion that medicine shouldn’t be fun most often among providers in the traditional healthcare industry. Where does this notion come from? It appears that the idea follows from basic medical ethics that are deeply ingrained into healthcare providers, namely, the ethics of beneficence and nonmaleficence. Beneficence refers to the responsibility of providers to act in their patient’s best interests, that is, to do what’s best for the patient, while nonmaleficence refers to the responsibility to “do no harm.”^[1]

These two responsibilities lead providers to seek to provide the lowest doses of medication for the shortest durations that will address their patients’ medical needs, while minimizing the potential for adverse side effects, overdosing, and/or addiction. If medications are fun to take, then patients are more likely to consume higher doses for longer periods of time, which increases the chance of bad outcomes. Furthermore, patients are more likely to manage taking lower doses for only a limited duration if they understand: the gravity of their medical situation, the fact that the purpose of the medication is to address the situation, and the need to take the medication in a way that minimizes the risks of bad outcomes. All this is much harder to achieve if medicine is fun to take. 

In short, providers want to keep the focus of the medication as being a serious medical intervention, to make sure patients use the medications meaningfully and responsibly, so as to maximize their effectiveness (beneficence ), while minimizing the chance of harm (nonmaleficence).

What’s the Connection?

So then what’s the connection between these two controversial sets of beliefs:

• Is all cannabis medical?
• Can medicine be fun? 

Underlying both sets of controversies is the issue: Does intent matter? Intent drives focus, which, in turn, drives implementation. The issue thus reduces to the question: Does the way a user consumes a substance (cannabis or any other medicine) change the outcome, that is, the effects achieved?

Intent Matters

I would argue that in the case of cannabis, yes, the focus matters because it affects 

• Set (e.g., mental and physical state, expectations, genetics, history), 
• Setting (e.g., physical surroundings, social environment), and
• Sample selection, dosage, and frequency of use, 

all of which affect the achieved outcomes. 

Let’s dig a little deeper.

When using substances for medical purposes, doctors and patients generally focus on using the smallest dose and frequency needed to generate the desired therapeutic effects. This maximizes the probability of achieving the therapeutic benefits being sought, while minimizing the likelihood of experiencing unwanted side effects or developing tolerances or dependence. 

Conversely, when using substances for recreational purposes, consumers focus on using the dose and frequency needed to generate the desired recreational effects. This generally involves larger and perhaps more frequent doses than those involved when the focus is purely on achieving medical benefits. As a result, there are greater probabilities of experiencing unwanted side effects and/or developing a tolerance to and/or a dependence on the substance. 

In addition to these differences in dose size and frequency of use, there are also differences between medical and recreational consumption in set, setting, and samples. 

In the context of medical use, patients are generally screened for potential drug interactions, and perhaps also for certain biomarkers, to minimize the possibility of adverse outcomes. Furthermore, patients are generally monitored while taking medications to check for adverse effects, so that any bad outcomes can be addressed early on before they cause serious problems. Finally, products used for medical purposes are often non-flower products – to avoid the known dangers associated with smoking – supplied by sources who follow processes (e.g., GMP) or test products (COAs) to ensure that samples are pure or otherwise nontoxic. 

When consumers use substances recreationally, on the other hand, they are not screened for potential complications that might lead to bad outcomes, they are not monitored in their substance use to make sure they’re not experiencing bad outcomes, they tend to be more likely to smoke flower, and they often don’t obtain their samples from sources that minimize impurities or toxins in the products they’re selling.

In Short

Differences in implementation may very well lead to differences in consumer outcomes, depending upon whether the intent was medicinal or recreational. When the focus is on achieving recreational effects, consumers are more likely to 

• Experience unwanted side effects,
• Developing a tolerance to and/or a dependence on the substance, and/or
• Consume unsafe products.

Cannabis consumption that leads consumers to experience any of these problems is not therapeutic, in which case not all cannabis is medical.

Furthermore, the principles of beneficence and nonmaleficence lead doctors to keep patients focused on the therapeutic intent of the medicine, rather than the idea that it may be an enjoyable experience, to prevent overuse (nonmaleficence), to promote responsible use (beneficence), and to be seen to be focusing on the therapeutic needs, rather than the recreational needs, of their patients (beneficence).

^[1] Ethics in Health Care: Improving Patient Outcomes. Tulane University. 2023. https://publichealth.tulane.edu/blog/ethics-in-healthcare/