There are so many questions. Is it safe? Does pot smoking lead to the use of hard drugs? What is the risk of pot smoking during pregnancy? Does marijuana have medical value in treating disease? Does smoking pot relieve the side effects of cancer treatment?

On each of these questions we have information — and a lot of opinion. The reality is that on none of these questions do we really have clear cut answers. In spite of decades of experience there is still a serious shortage of reliable, scientifically valid research on the effects of marijuana on the human body.

This deficit has resulted primarily from two factors. First, marijuana has been classed by the government as a Schedule I drug, meaning that it does not have a legitimate medical use (same category as heroin and LSD). This means that it has not been readily — or legally — available to medical researchers who are interested in trying to answer these questions. Secondly, the pharmaceutical industry has not shown interest in trying to develop marijuana into a traditional prescription medication.

So what is the public to do, especially when the issue of “legalization” is on the ballot?

Regarding safety, the impression among the public has been that marijuana is relatively safe, safer than alcohol and tobacco. Today we are learning, however, that such impressions are largely unreliable. This is partly because the marijuana on the market today tends to be significantly more potent than what was previously available. Furthermore, studies are emerging which show that risks are greater than previously recognized. The American Heart Association recently published a survey showing marijuana use, especially prolonged use, may be associated with an increased risk of both heart disease and stroke. An article in the Journal of the American Medical Association in 2023 showed that marijuana use during pregnancy, especially if continued throughout pregnancy, was associated with adverse outcomes.

What about “medical” marijuana? As a physician with 40-plus years of experience, my impression is that there probably are some medical benefits from the components in marijuana. The problem, and it is a major one, is that here again we have an abundance of claims and very little good science on which to evaluate those claims.

How do we put all of this together? Bottom line — marijuana use may well have some benefits but there clearly are risks — risks that are being more clearly defined and are probably greater than previously appreciated. As all too often happens, the politics has gotten ahead of the science.

Tom Dean, MD of Wessington Spring is a contributing Prairie Doc columnist who has practiced family medicine for more than 40 years. He served as a member of the Medicare Payment Advisory Commission. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc on Facebook featuring On Call with the Prairie Doc, a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m.