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As Some States Implement New Marijuana Laws, Science Should Guide Public Health Policy

December 08, 2016

Image of marijuana plants

After the election on November 8, marijuana is now or will soon be legal for adult recreational use in eight states plus the District of Columbia. These states, and those that may join them in the future, will have choices to make in how they enact and implement their policies. Careful thought should be given to creating regulatory frameworks that prioritize public health. Science needs to be the guide.

A 2015 report prepared by the RAND Corporation for the state of Vermont pointed out that marijuana policy need not be seen as a binary choice between maintaining the status quo (prohibition) or putting in place a for-profit commercial model, such as those that now exist in Colorado and Washington. The latter could create an industry that stands to profit from encouraging heavy drug use by aggressively marketing its product and lobbying for less regulation. Heavy users account for the majority of sales currently in both the alcohol and tobacco industry. But a broad spectrum of models exists, varying in terms of who can provide marijuana (the state versus private or not-for-profit entities), what regulations govern how they operate, what kinds of products can be produced and distributed, including potency of the products, and how they are priced.

Our country’s experience with other legal drugs provides useful lessons for states to consider. Alcohol is often seen as the most obvious comparison to marijuana, as it is a legal drug with wide range of health and safety risks but also a history of prohibition that is now viewed by most as having been a failure. There are definite policy lessons to be learned from our country’s experience with alcohol; raising the legal drinking age to 21 in the 1980s, for example, was associated with significant reductions in alcohol use and car crashes in young adults. But alcohol remains widely misused in all age groups, is cheap and readily available in most locales, and numerous adverse health and safety outcomes are attributable to it.  

The U.S. experience with tobacco offers a different set of important and useful lessons. We have seen continuous reductions in cigarette smoking and corresponding gains in public health for decades thanks to a number of efforts aimed at reducing demand for tobacco products, including significant increases in tobacco taxes, comprehensive smoke-free laws, hard-hitting media campaigns, and offering help for smokers to quit. In a recent article in PLOS Medicine, University of California San Francisco tobacco policy researchers Rachel Ann Barry and Stanton Glantz argue that a framework for marijuana that restricts demand by making marijuana expensive and its use socially non-normative, similar to current tobacco policies, would help prevent marijuana from playing the same deleterious role in Americans’ health and safety that alcohol misuse now does.

The degree of marijuana’s harms relative to alcohol and tobacco remains widely debated, but there is no doubt that harms exist. Marijuana raises car crash risk; in some studies it has been associated with neurodevelopmental problems in prenatally exposed children; and its use by adolescents has been linked to cognitive impairments and poor educational outcomes and well-being. Although we still don’t know whether marijuana raises lung cancer risk, we know it can adversely affect lung and heart health, potentially even via secondhand exposure. It is also addictive. Thus the wide societal perception that marijuana is a safe drug is not accurate. Absent appropriate regulation focused on protecting public health, the marijuana industry will capitalize on this misperception to increase demand for their product.

At this juncture, there is an opportunity to conduct research on the impacts of marijuana policies now existing in different states and countries, and examine the range of options that have not yet been tried. Research needs to explore which policy structures—beyond simply prohibition or free market—are most likely to keep harms to a minimum. Where the public health is at stake, policy should be guided by science.

This page was last updated December 2016

Comments

Marijuana policy

Tobacco use has been reduced dramatically, and despite its extremely addictive nature, not by raising prices, but by honest educatuon about health consequences of use. Marijuana is nowhere nearly as addictive, or deadly, as tobacco. We do not need to artificially keep the price high. That's exactly what criminal prohibition has done for several decades. That does not work. Honest education does.

Harms of Cannabis

I think this is a well written article that highlights the similarities between alcohol and cannabis's prohibition history. Currently the largest harm to law abiding cannabis users is sadly a criminal background that can have major consequences such loss of Federal Student Aid and less job opportunities along with social stigma. This actually creates more drug abuse and users as it has been well documented that those with college degrees and full time employment have much lower drug abuse rates. I applaud the NIDA on recognizing the nations failed drug policy and hope they act promptly to enact legislature.

Wouldn't it be nice?

I commend Dr. Volkow's very thoughtful proposal for public health policy. She accurately cites the data that raising prices as well as education and other measures like eliminating tobacco vending machines have helped to reduce tobacco use.
Tobacco still kills more Americans every year (>400,000) than all the other addicting substances combined. This is not because tobacco is necessarily more deadly or addictive for each individual user, but because so many more people use it, and its addictive and bad for our lungs, hearts, and brains.
As marijuana products become more potent and more widely used, the harms will become more evident. It would be wonderful,if just once in our history, we examined the science when creating drug policy rather than boldly plunging ahead with our wishful thinking that we've finally found a recreational drug that's harmless to our health.

Stop big Pot

The other commenters really need to do more research. Yes, we don't want to saddle kids with an arrest record, but treating MJ like alcohol or tobacco is terrible public policy.

Do your research. Marijuana legalization is guided by one thing -- money for lobbyists and the industry. Wake up people. Tobacco is going down because of societal stigma -- the exact opposite of what the pot industry is promoting.

simplistic tax revenue tool

in spite of the ongoing research that supports a continuous social degradation, our "governors" LOVE the revenues that seemingly result in a ZERO net revenue once all social costs are taken to account. Medical researchers are continuously providing data showing the negative effect of marijuana legalization, as are economists and yet our leaders choose to ignore the facts. Where do we begin an effvective educational process?

Not if Jeff Sessions orders

Not if Jeff Sessions orders the DEA and others to enforce FEDERAL LAW and reeinstate Prohibition.

Hysteria

It is exhausting to continually have claims about marijuana thrown out unsupported. The second to last paragraph is almost entirely rubbish: no serious person that I know supports marijuana use among children. You claim that marijuana is addictive. Heroin is certainly addictive, perhaps even on first use. Cocaine is addictive after a good amount of abuse. Nicotine is highly addictive, as well. Marijuana simply does not share the same addictive profile as other drugs. The health risk profile of marijuana is also far lower than portrayed in this screed. No human has ever overdosed or died from marijuana use alone. Rehab for marijuana use not originating in the medical or judicial industries - "I have to go to avoid jail or other negative consequences" - is virtually non-existent. Alas, silly Americans have had a disastrous love affair with Prohibitionism - the sentiment, if we're honest, that is driving this "article" - for over a century now. America has more people in prison - mostly for drugs - than the twelve biggest nations in the world combined. There are scores and scores of deaths from opioids daily. To me, this is a public health crisis, not a crime spree. Until America learns to address drug use as a health matter - see Portugal's wild success after decriminalizing ALL drugs and moving the matter into the realm of public health - the dead bodies will just keep piling up, just as they are all over America, even today.

marijuana view from my teen

My son is in his 20s and done with college. He spent 9 months of his junior year in high school over in Thailand as an exchange student. He is a good student, did Mock Trial, played football and wrestled, was in orchestra. As a family physician I said that if he used illegal substance, he would take the consequences and I would encourage the coach to bench him.
When he returned from Thailand he went back to his senior year of high school. Later he commented to me that some students were doing well when he left and when he returned they had lost their way. Some due to alcohol and some due to marijuana and some due to methamphetamines, opiates, heroin.
He graduated college last year. We are in Washington state where marijuana is now legal at a state level but not at a federal level and not for under 21. He is now living in a state where marijuana is not currently legal.
So that is the view from my teen.

TWISTED

Comparing Cannabis to alcohol / cigarettes is like comparing a tricycle to an 18 wheeler just because they both have wheels.
To be more clear, alcohol and cig's combined KILL over half a million Americans a year.
Cannabis, ZERO, EVER.
Legal cannabis and "encouraging heavy drug use" are two completely different things.
YOUR BEST THINKING has led us to where we are today, which can only be described as a
CATASTROPHIC FAIL.

Do you think that ANYONE who wants to use cannabis today doesn't, because the NIH/ FDA/ DEA / NIDA think's they shouldn't? WRONG. For HALF A CENTURY Americans have been smoking cannabis with ZERO deaths and only speculation and propaganda showing EXTREME cases where any real harm is done.

You say you need more research on this PLANT, but as it stands, in category one, it's NON-RESEARCHABLE!
And you KNOW that!

100 opioid deaths A DAY, a market for POISON SPICE born from prohibition of a natural plant,
FREEDOM pretty much yanked out of what our country stands for anymore with millions of Americans in cages!
THAT's your idea of what "freedom" looks like?

You "experts" don't even call this plant by it's proper name!
It's CANNABIS, not REEFER, not MARIHUANA, CANNABIS.

Get it right, for ONCE.

Legalizing marijuana for recreational use

The above comments are better than most I have seen. Studies have shown that most abuse starts with marijuana because it is seen as not harmful. What it does is mess with the reward system in our brain. The system that tells us to do something over and over. It becomes sensitive and is greatly stimulated by other drugs even if used experimentally. Some drugs stimulate it 2-10 times the norm. Thus, 2-10 times the urge to repeat the behavior leading to addiction. It affects the brains ability to learn (memory), have good judgement and make good decisions once again leading to addiction. It's hard to isolate marijuana as the cause of bad judgement and decisions but it is known that those are the areas affected by it in the brain. If you add a little alcohol ( the great uninhibitor) to the immature brain, you have a perfect set up for addiction. Many do not go on to suffer from drug use. Parenting,environment, experiences and education have a great influence. Unfortunately the majority in society calls the shots and may care less what happens to the few.

Things are changing

Because we live in a democracy prohibition is quickly becoming a non-option and people need to realize that. It's not "big marijuana" passing laws. In the case of recreational use these were referendums, the direct will of the people.Years of rhetoric trying to dissuade the public opinion on legalization has failed as people base their opinions on experience. If you actually listen to people rather putting words in their mouths you'll find very few believe MJ is completely harmless, that's not why they support it. They support ending prohibition because experience has shown the consequences of prohibition are more harmful than the drug itself.

I hope to see more of a harm reduction approach. The focus should be on keeping it out the hands of children while allowing informed adult use with regulations based on scientific research, not conjecture.

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