What the Surgeon General Got Right (and Wrong) on Cannabis Risks

Surgeon general cannabis risks

The Surgeon General’s cannabis bulletin mainly stressed health risks specific to adolescents and pregnant or breastfeeding women. Image Credit: By HQuality on shutterstock.

At the end of August, U.S. Surgeon General Jerome Adams issued a health advisory that focused on the evolving understanding of cannabis’s effects on the developing brain. The bulletin mainly stressed health risks specific to adolescents and pregnant or breastfeeding women, with a secondary emphasis on how a more normalized culture around the plant, greater access, and increased potency all serve to heighten these risks.

The advisory seems to have been prompted by statistics showing an increased use of cannabis by pregnant women, and a number of documented cases of cannabis dispensaries recommending the use of cannabis to combat morning sickness. Less clear is a link with adolescent cannabis use trends — several studies have shown that use among teens falls in states that have legalized.

Adams also issued a call to action for parents, youth, health professionals, and community organizers, urging them to educate themselves and others. 

U.S. Health and Human Services Secretary (and former pharmaceutical lobbyist) Alex Azar supported the advisory with a press conference, sounding a dire tone: “[Cannabis] is a dangerous drug,” he said. “For many, it can be addictive. And it’s especially dangerous for adolescents and pregnant women because of what we know about how it affects the developing brain.”

American Academy of Family Physicians officer Julie Wood addressed doctors in saying that they have both the opportunity and responsibility to educate their patients on cannabis — though her advice took more of a “wait-and-see” approach.

“Family physicians have an important and unique role to care for patients throughout the life cycle and should counsel patients and families about the information in the surgeon general’s advisory against marijuana use in adolescents and pregnant women,” she told AAFP News. “Marijuana research and evidence has been limited, and we must be vigilant to provide our patients the most up-to-date information.”

How Worried Should We Really Be About Cannabis Risks?

In Adams’ advisory, the first item of discussion addressed background issues such as heightened potency in the cannabis now available compared with that of decades ago and the increased normalization of its use. 

It’s hard to argue these points, even if they’re reliant on limited evidence. The tone and framing of some points is objectionable, however — when the advisory states, “The THC concentration in commonly cultivated marijuana plants has increased three-fold between 1995 and 2014,” it fails to mention that this finding is based on one study, which only looked at cannabis seized by the DEA in the stated period.

The section on the health risks of cannabis use during pregnancy seems to have been prompted by an increase in such use in recent years — doubling by one count. The normalization of cannabis and the decreased perception of its health risks seems also to be a reason behind this point, especially in light of increased knowledge of the impact of prenatal substance use on unborn children, as the advisory asserts, “Pregnant women use marijuana more than any other illicit drug.”

As for the evidence of adverse effects, the research remains unclear. The best evidence of negative effect came in a study showing that cannabis use in pregnancy was associated with a 50 percent increased risk of low birth weight. But researchers are still unsure whether this is a direct effect of cannabis — or a risk of smoking any substance, which reduces the oxygen that reaches the developing fetus.

A warning on the dangers of adolescent cannabis use follows, citing decreased perception of risk and widespread availability for its rationale. This is especially prescient considering new research shows teens are increasingly using highly-potent forms of cannabis like edibles and concentrates, which tend to have much higher THC concentrations than flower.

Yet while the correlations that the advisory cites all have research backing them, Adams fails to mention that none have been proven causal. However, that shouldn’t keep cannabis users and those around them from paying careful attention — mental health issues in adolescent cannabis users have an increasing body of evidence around them, such as a 2019 study in the American Journal of Psychiatry that found cannabis could lead to cognitive changes that may be “more pronounced than those observed for alcohol.”

As a result, the safest approach may be the one that the advisory suggests: “Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana.”

Ed Weinberg
Ed Weinberg
Ed Weinberg is an American journalist who’s written stories on everything from cannabis to textiles, architecture, urban exploration, and culture in Vietnam, where he spent seven years. Previous to freelance writing, he held senior editorial positions at Word Vietnam and the Vietnam Investment Review.


  1. Simone Blomdal says:

    I believe the same news story should be done with CBD, because CBD from hemp and cannabis are considered by most “the same thing, the same plant, therefore the same risks and effects”, when actually CBD from hemp is not addictive, non physicoactive and is known to actually help with addiction.
    When the general public read about cannabis news, they often associate with CBD from hemp as well and while people could get relief to many conditions, including addiction, the reputable and serious CBD /hemp companies are pushed back because of the constant comparison with marijuana. I just think that should be emphasized everytime because of the stigma surrounding CBD and because a lot of people still have no idea that they are different.
    Thank you

  2. Shaun Stark says:

    The weight issue at birth has been debunked. We have a neonatal Dr who has been suffering certain challenges and so put her on a FECO, high THC engineered extract. Not only was it instrumental in assisting her conception but also every phase in her pregnancy. She struggled to conceive for many years and only after 6 months she conceived.. Two months back she delivered a beautiful and perfect 3.5kg baby girl.
    Studies show that the right cannabis oil has the ability to heal damaged fetus tissue in the womb.