Marijuana Legalization: Educating Risks and Costs

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Position Statement

The Hazelden Betty Ford Foundation has an important responsibility and is uniquely qualified to comment on the risks and effects of marijuana use, the consequences of which we see every day among the people we serve at our addiction treatment centers around the country.

While the Hazelden Betty Ford Foundation opposes the expansion of marijuana legalization, we support federal action to drive more research and regulation to protect against the public health consequences of current and future legalization efforts.

We know marijuana is dangerous to many users and addictive to some, and that young people are particularly vulnerable. As debates about legalizing recreational marijuana and medicinal marijuana have intensified during the past decade, many young people have come to view the drug as less risky. Not surprisingly, more of them are using marijuana (also known as cannabis). According to a study from researchers at Columbia University, the entry point for teen substance use has shifted away from cigarettes and alcohol and toward marijuana.

Early use of cannabis is especially troubling. The human brain develops throughout adolescence and well beyond. Marijuana use can harm learning, thinking and memory development, and use of the drug has been linked to mental health issues, including psychosis, as well as other physical health problems. According to one recent study, even a little cannabis consumed by a teenager can cause changes in the part of the brain involved in emotion-related processing, learning and memory formation. We also know the earlier a young person starts to use any mood- or mind-altering substance, the greater the possibility of developing a substance use disorder. Indeed, at our behavioral health center for adolescents and young adults in Minnesota, 89 percent of our 734 residential patients in 2017 had cannabis in their substance use history, and 84 percent were diagnosed with cannabis use disorder. Each year, we treat approximately two dozen young people who have cannabis-involved psychosis.

One of the recurring themes we hear from the youth we treat is regret—of wasted time, lost opportunities, squandered talent, impaired memory, reduced performance and disinterest in healthy activities. Since 2009, our prevention division, FCD Prevention Works, has surveyed more than 100,000 students in grades 6-12 about substance use beliefs and norms. According to our FCD Student Attitudes and Behavior Survey database, students who used cannabis in the past year, when compared with those who did not, were:

  • Thirty-one percent less likely to get 'A's;
  • Five times more likely to report feeling the need to also use alcohol or other drugs;
  • Twice as likely to have trouble concentrating on important tasks;
  • More likely to ride with an impaired driver (30 percent) than students who reported using alcohol (21 percent); and
  • Two to three times more likely to engage in physically, emotionally and academically risky behaviors.

According to patients from around the country who come to our treatment centers, prices for marijuana continue to drop in the current environment, making the drug more affordable, especially for young people. We also hear that young marijuana users are shifting more rapidly than ever into using dangerous concentrates of the drug due to new vaping technology and the explosion of high-concentrate cannabis products, including edibles, brought about by commercialization.

The recognition of these risks to the health and trajectory of our young people has been lost in the fervor to legalize marijuana. Too many people—including teenagers—think, incorrectly, that cannabis is a benign or harmless substance. Many parents have told us that it has become increasingly difficult to overcome such misperceptions when talking with their children about marijuana. Public dialogue has become so distorted that some young people who develop addiction to cannabis report that their condition isn't taken seriously, even when their lives are unraveling as a result.

Minimization of the risks—through expanded legalization and misinformation, propagated by profit-minded commercial interests that began their legalization campaigns many years ago—will have long-term public health consequences that will hurt our most vulnerable, high-risk people the most.

According to the National Survey on Drug Use and Health, the number of daily cannabis users has increased from approximately three million Americans in 2005 to eight million (about one in five cannabis users) in 2017. By contrast, only one in 15 drinkers consumes alcohol daily. While ten percent of the population is most vulnerable to any substance use disorder, it is reasonable to expect that the higher rates of daily marijuana use, as a norm, will only heighten the vulnerability to addiction faced by cannabis users. Among young people, daily cannabis use is at its highest rate in 30 years. More older Americans are using cannabis, too, and it's much more potent than the cannabis of their youth. Among all ages, cannabis use in the United States doubled from 2005 to 2015.

More than ever, we believe it is paramount to educate the public, especially young people and their parents, with objective information about the risks and potentially addictive dynamics of all drugs, including cannabis, and the availability of help. Many Americans are suffering because of cannabis use disorder, and it is important they know that recovery is possible.

While we oppose the use of the word "medicine" to describe cannabis because it has not been approved by the U.S. Food and Drug Administration (FDA), we understand that some non-psychoactive constituents of the cannabis plant might have medicinal efficacy; therefore we support further research to investigate whether or not medicines can be developed and evaluated through the FDA process. The FDA's approval in 2018 of a cannabidiol-derived oral solution to treat rare, severe forms of epilepsy is a good example of how the process ought to work. The eagerness in some states to approve medical cannabis based on hopeful signs rather than rigorous scientific scrutiny and FDA approval reflects a disregard for the importance of adequate research and the known risks associated with cannabis use. For example, some states have approved cannabis as a treatment for opioid addiction. The existing scientific evidence does not support such use and, instead, points to significant risks for some patients.

With regard to decriminalization, we support sensible criminal justice reforms that reduce the penalties for marijuana possession/use and that promote recovery and redemption. We are sympathetic to social justice issues—addiction itself is one—and do not believe harsh criminal penalties for possession and use are warranted, especially given the racial disparities in our criminal justice system. Such reforms, however, do not require legalization and commercialization of marijuana. In fact, promises of social justice gains appear to be falling short in states where legal cannabis is already a big business.

Other promises have fallen short too. In California, for example, cannabis sales were down a year after legalization, tax revenues were well below forecasts and the black market was thriving. In Colorado, we have seen a concerning rise in cannabis-involved traffic fatalities and hospitalizations.

Nevertheless, popular support for cannabis legalization has surged. Heading into 2019, 10 states and the District of Columbia had legalized recreational marijuana and 23 other states had implemented medical marijuana programs. Several more states—including New York, New Jersey and Illinois—also appeared poised to consider measures to legalize recreational marijuana soon.

Unfortunately, the federal government has ceded its authority to enforce the current federal law against cannabis. Two successive Administrations—representing each of our major political parties—have chosen not to enforce it. As a result, the status of cannabis as an illegal Schedule 1 drug under the federal Controlled Substances Act means very little, and federal inaction is sending mixed messages to the public and to our youth about the known and scientifically-validated and public health impact of marijuana.

Given the confused and complex state of the nation's cannabis policy, the federal government's most pressing responsibility is to drive more research and robust regulation to protect against the public health consequences of current and future legalization efforts. It is unclear whether "rescheduling" under the Controlled Substances Act is necessary or whether other Congressional and Administration actions can accomplish the same. In either case, it is especially critical to redouble federally funded research efforts to rigorously analyze the impact of existing community-and state-level policies on a wide range of outcomes, including school attendance, employment and health impacts, among others. Doing so, and establishing timelines for the dissemination of such research, would provide a more compelling rationale for other states to delay further legalization efforts. The findings of such research should be included in a robust review of all known evidence and published in a federal public health report identifying both the risks of marijuana use and the impact of expanded availability.

In the current legal environment, private companies have generally been unwilling to subject their medicinal products to FDA scrutiny or to incur the costs of such a process, and scientifically unsubstantiated claims have gained popular acceptance. At the same time, the debates about medical marijuana and recreational marijuana have become blurred, which has worked in the favor of legalization supporters. The federal government, in the absence of enforcing its own laws against cannabis, should now assume the responsibility of funding and potentially conducting the robust research needed to determine if any of the non-psychoactive constituents in cannabis have medical value and to provide guidance into the development of pharmacy-obtainable medications that are safe and effective, with reliable dosage and known composition. Such research should also clarify the constituents of cannabis that do not have any efficacy in treating various ailments.

To protect public health and safety, the country's current patchwork of state policies also needs regulatory guardrails at the federal level. We encourage the federal government to explore creative ways to ensure more effective, consistent regulations in those states where cannabis is legal. Such regulations should include, at a minimum:

  • Sufficient funding for robust, evidence-based research on the public health effects of community- and state-level policy changes;
  • Educational campaigns to publicize the recent scientific findings of rigorous research studies that point to cannabis-related harms;
  • Compliance checks at points of sale to prevent illegal sales to young people;
  • A ban on cannabis advertising;
  • Restrictions on where cannabis can be sold and used;
  • Restrictions on the development of new products, especially those that target children and adolescents;
  • Restrictions on cannabis outlet density to prevent concentration in some areas;
  • Drugged-driving statutes and tools to implement enforcement, as difficult as this may be given limitations in the available methods for measuring THC concentration in drivers;
  • More routine cannabis misuse screening and counseling interventions in primary care settings;
  • Implementation of specific evaluations and treatment for youth who misuse cannabis and those who become addicted to it;
  • Clear requirements and guidelines regarding potency, dosage information and labels; and
  • Dedicated revenue to support the above strategies.

In today's patchwork policy landscape, taxes on legal cannabis have actually driven demand for cheaper, untaxed black-market cannabis. Therefore, while higher alcohol taxes have been shown to reduce alcohol use and related public health consequences, relying too much on cannabis taxes may be counterproductive in the current landscape. For now, it is best to fund public health strategies from multiple revenue sources.

The dialogue around cannabis legalization has been muddied by the federal government's neglect of this issue. It is time for Congress and the Administration to course-correct in a responsible, necessary and politically viable way—by driving more regulation and research. Such actions would help protect against the public health consequences of current legalization efforts, better inform the dialogue moving forward, and, ideally, slow down legalization efforts nationally—aligning with the Hazelden Betty Ford Foundation's clear and singular aim of reducing the harmful impact of addiction.

What Can You Do to Build Marijuana Awareness in Your Community

The Pew Research Center reports that a slim majority of Americans now support legalization. At the same time, opponents are beginning to step up community-based efforts. Regardless of which side you’re on, the reality is that your voice is needed in this debate.

Consider what you have learned about the topic. Assess your own thoughts. What are your values? What are your positions? What are your priorities? How would you like to weigh in?

The following represent just a few of the possible priorities you might identify for yourself and your community.

  • Prevent or promote marijuana legalization
  • Repeal legalized marijuana
  • Provide more public education on marijuana
  • Include more education with marijuana prescriptions
  • Intervene and treat more of the people who develop cannabis use disorder
  • Prepare schools to provide more prevention education and counseling related to marijuana
  • Promote more marijuana research
  • Regulate marijuana more effectively

Once you’ve identified your own priorities, you may want to engage others in your community. Here is a general game plan for doing so.

Community coalition building is a key strategy for increasing awareness of marijuana-related issues. In addition to increasing public awareness, the process of forming a coalition creates new relationships in communities and can strengthen ties between local governments and community members. The basic steps are:

  • Identify coalition members
  • Hire or assign a local coordinator
  • Conduct a local visioning session
  • Gather relevant information and data
  • Develop an action plan for increasing awareness of marijuana issues and battling addiction
  • Implement the action plan

Consider involving schools, treatment providers and others in the health care field, recovery support resources and local law enforcement, among others.

Effective publicity is important to any marijuana awareness campaign. You might want to provide marijuana statistics and information about your coalition’s efforts to daily newspapers, television and radio stations, and other local media, such as weekly community newspapers, school and faith-based newspapers, and organization newsletters. You could do so by writing press releases, submitting letters to the editor and opinion columns, and creating public service announcements, for example. Social media should be part of your coalition’s strategy as well, and a community marijuana awareness website might also be helpful.

Community events, no matter how large or small, can go a long way toward building awareness and keeping marijuana issues in the forefront of public dialogue. They also help generate media coverage. Best of all, events connect neighbors, empower families and acquaint citizens with valuable resources. Events can help create community solidarity by engaging community members, including young people, in a common purpose. Sometimes they also provide the opportunity to collaborate with neighboring communities. Your coalition might want to host a marijuana education forum, for example, or mock drug courts, regular evening discussions, online chats or even community webinars and video meetings. You could invite people in recovery to speak, ask local artists to create relevant pieces, involve a youth improv troupe, convene a panel of experts and so on. The possibilities are limited only by your coalition’s imagination.

The nation is divided on marijuana policy, and researching policies in other areas of the country can help you develop an approach for your own community. Look for policies that align with your community’s priorities and have proven successful elsewhere.

Acting as a lobbyist is one way that you can effect policy change. You and others from your community may want to schedule visits with local, state or national lawmakers to voice your views on marijuana legalization and related issues.

It may be easiest to start with local community representatives—your mayor and members of your city council and school board. They may, in turn, be willing to help you set up meetings with state legislators, who in turn could help you set up meetings with members of Congress, if applicable to your objectives.

If you schedule a meeting at a congressional office in Washington, D.C., expect to interact primarily with busy legislative assistants. It’s best to have a brief, well-organized presentation prepared that addresses specific concerns in the senator’s or representative’s district. Members of Congress tend to appreciate personal stories from and about the people they represent.

Whatever level of government you’re trying to affect, it’s helpful to do some background research before approaching public officials. Find out about their interests, the committees on which they serve and their known policy positions. You also may want to check with other local organizations for relevant data, studies and resources that support your objectives. You’ll want to make sure that your request is specific and that you are armed with accurate information as well as local anecdotes and examples.

What Is Happening with Medical Marijuana Policy?

In the United States, marijuana has been a controlled substance for the lifetime of most people living today. But there has been a movement for several decades to bring back medical applications of the drug. Many states have now legalized marijuana for medical purposes, although restrictions regarding its use vary from state to state.

For example, Dr. Sanjay Gupta, a neurosurgeon who has served as a chief medical consultant in broadcast journalism and was vetted for the position of Surgeon General by President Barack Obama, publicly chronicled how his viewpoint changed on medical marijuana through documentary research. “When it comes to marijuana…there are very legitimate medical applications…. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research.” He further specified, “There is now promising research into the use of marijuana that could impact tens of thousands of children and adults, including treatment for cancer, epilepsy, and Alzheimer’s, to name a few.”

Many medical professionals disagree, however. There is also a strong position that the evidence for medical marijuana is unclear and that alternative treatments exist with fewer risks and unknowns.

Another view is that different people react differently to the same medication, and that different people face different risks when it comes to using a particular drug. Therefore it can be useful to have options. In this view, as a medicine, cannabis may be a good choice for some people and a bad choice for others.

Some medical professionals have prescribed cannabis for cancer, anorexia, AIDS, glaucoma, chronic pain, arthritis, insomnia, migraines, anxiety, depression, headache, nausea, epilepsy, asthma, premenstrual tension, drug withdrawal and other conditions.

When we examine the historical statements about the drug, contemporary medical uses are very similar to ancient ones. However, medical professionals do not universally agree that medical marijuana is beneficial, and those who are willing to prescribe it acknowledge that it is not an FDA-approved medication and that it is still classified as a Schedule I narcotic by the federal government. If a state has approved medical marijuana, it is generally recommended that the state medical association develop standardized physician criteria for writing medical marijuana recommendations and share the criteria with law enforcement and the public.

In the United States, a synthetic cannabinoid, “dronabinol,” was approved for use in 1986. It is marketed as Marinol capsules and is indicated for treatment of anorexia associated with weight loss in patients with AIDS, and for the nausea and vomiting associated with cancer chemotherapy for patients who have failed to respond adequately to conventional drugs aimed at suppressing those symptoms.

Some medical marijuana opponents point to Marinol as an alternative to medical marijuana in its smoked form. On the other hand, proponents of medical marijuana note that Marinol can lead to death, while smoked marijuana has never caused a documented overdose fatality. Medical marijuana supporters also argue that Marinol takes one hour to reach full effect, while smoked cannabis acts within minutes.

In Canada in 2005 and in the United Kingdom in 2010, a prescription medicine called Sativex was released. It is a mouth spray for treating spasticity in patients with multiple sclerosis. It contains a synthetic version of THC. Sativex is currently under review by the FDA for use in the United States.

U.S. research trials for medical marijuana must follow a strict process that has considerably limited the amount of federally approved research activity. A proposal must first gain approval from the FDA. After that, a marijuana permit must be obtained from the Drug Enforcement Administration. Last but not least, a supply of medical marijuana must be obtained from the National Institute on Drug Abuse (NIDA), which controls all approved medical marijuana grown for research purposes in the United States.

While the Obama administration removed the earlier need for marijuana research proposals to be approved by the Public Health Service, the application process remains difficult and lengthy. That is largely because of marijuana’s federal classification as a Schedule I narcotic.

Despite the hurdles, some research is happening, leading to developments like a new federal patent on cannabinoids for their use as antioxidants and neuroprotectants. A number of bills have also been introduced to reduce the red tape and expand research. And NIDA has vowed to “build farm capacity flexible enough to accommodate various levels of demand for research marijuana and marijuana products over the next five years.” NIDA, in fact, renewed a contract with the University of Mississippi (where the marijuana is grown) for up to $68.7 million through 2020.

Research studies are also taking place elsewhere. At the end of 2014, the Colorado Board of Health announced that it would spend over $8 million to study the efficacy of medical marijuana. Three of the studies need federal approval and therefore require marijuana supplied by NIDA. Five other observational studies involve participants providing their own marijuana.

The incredible variety of cannabis plant strains makes it difficult to have consistency in medical marijuana products. Typically, medical marijuana also requires different doses and types for different ailments. This variability will no doubt be an ongoing complication to medical marijuana research, since the FDA drug review process requires exact quantities and composition of drugs for recipients.

Drug approvals in the United States take an average of 12 years from invention to market, and only one in 5,000 makes the cut. Many are paying close attention to the scientific discussions and the political positioning taking place among physicians, health insurance companies, health care organizations, policymakers, patients, parents, schools and communities. Influential medical institutions such as the Mayo Clinic and UnitedHealth Group recognize these conversations, the need for more research, and the increase in states supporting medical marijuana, but have refrained from taking a stance on the issue, instead publishing educational information and calling for more research.

The debate over the value of marijuana as medicine is an interesting and often heated one, with knowledgeable people weighing in on both sides of the issue. Regardless of one’s personal views, it is important to always keep in mind that marijuana is a potent drug deemed addictive by the National Institutes of Health (NIH) and illegal by the federal government. While it is important to stay updated on legal trends and ramifications, it is even more important to concentrate on efforts to prevent marijuana misuse and abuse—especially among youth.

  • Legalization of medical marijuana offers access to a medication that may effectively treat many health conditions.
  • Marijuana provides another alternative for those who have experienced unsuccessful treatment with other medications and modalities.
  • The passage of medical marijuana laws sets a precedent for medicinal usage of the plant and validates the need for medical research trials.
  • Medical marijuana may reduce powerful opioid prescriptions, if research proves its effectiveness for chronic pain.
  • Cannabinoids, chemical compounds in marijuana with apparent medical benefits, can be extracted, replicated and applied in ways that don’t involve smoking, thereby eliminating negative impacts of that methodology.
  • Marijuana dispensaries run by state governments, as opposed to illegal markets, should provide safer regulation, safer products and state tax profits.

  • Medical marijuana is not approved by the FDA, and research is lacking to support its use for many of the conditions for which it is prescribed.
  • Medical marijuana policies make marijuana increasingly accessible and reduce the perception of risk, which is particularly concerning for youth.
  • Medical marijuana increases the number of people using marijuana, which in turn increases the number of people at risk for addiction.
  • Addiction and other adverse health effects from using marijuana have individual and social costs.
  • Smoking marijuana can lead to a host of medical problems, similar to those that present in tobacco smokers and negative effects like lung cancer may outweigh potential benefits.
  • Medical marijuana could lead to decreased public perception of harm, and could thereby increase illicit use.
  • In some states that allow medical marijuana, medical professionals question the legitimacy of some prescribing physicians and their reasons for recommending medical marijuana.

What Is Happening with Recreational Marijuana Policy?

Many more states have legalized medical marijuana than those that have legalized adult recreational marijuana. In those that have legalized recreational marijuana, you cannot be arrested, ticketed or convicted for using marijuana as long as you follow the laws related to age, place and amount of consumption. However, you can still get arrested for selling or trafficking marijuana if you aren’t following state laws on licensure and taxation.

Recreational marijuana markets introduce more variables and policy considerations. While the Obama administration chose not to interfere with state recreational marijuana laws as long as states were abiding by their respective laws and keeping retail businesses within their own borders, current or future administrations could decide to challenge such laws. Recreational marijuana poses legal risk given that it is still currently against federal law to sell, use or possess marijuana.

The U.S. Controlled Substances Act is the relevant federal law, and it defines a controlled substance as a drug or chemical that is illegal or needs to be very strictly regulated. The law also establishes several categories, or “schedules,” of controlled substances that are used to determine penalties for possessing, using or misusing drugs, or selling individual types of substances. A drug is categorized in a particular schedule based on several factors:

  • Scientific knowledge about the drug and its effects
  • The likelihood that the drug will be misused or abused
  • How the drug is (and has historically been) misused or abused
  • How the drug poses a risk to the public
  • Whether the drug currently has accepted medical uses
  • Whether use of the drug can lead to addiction
  • Whether the drug is used or likely to be used in making another controlled substance

Schedule I drugs are considered the most dangerous; Schedule V drugs are considered the least dangerous. According to current federal law, heroin, LSD, ecstasy and marijuana are all classified as Schedule I drugs.

Although the Obama administration did not interfere with states that legalized recreational marijuana, the federal law does limit those states in certain ways. For example, marijuana in those states must be grown, sold, used and taxed within state borders without using federal land, federally-managed resources like water or federally regulated banks. Retail marijuana businesses also cannot deduct business expenses on their federal income taxes. In addition, colleges, universities and employers in states where marijuana is legal can still enforce alcohol and other drug policies that reflect federal rather than state regulations.

States with legalized recreational marijuana have generated handsome tax revenues as a result. Colorado, for example, reported $700 million in marijuana sales and nearly $70 million in tax revenue in 2014. These figures, of course, don’t include the costs that those states will incur from marijuana-related hospitalization, regulation and policing—figures that are still being quantified. Several more states are debating legalization, and could be attracted to the potential tax dollars. It’s worth restating, however, that state budgets with recreational marijuana revenue could be put at risk if stricter federal enforcement ever returns. Colorado and Washington are seen by many as testing grounds for legalization, and it is still too early to draw definitive conclusions about the impact on adult and youth usage patterns, crime rates, substance use disorder rates, vehicular deaths and other relevant financial and social effects.

As such states learn from their experience, they are also attempting to identify best-practice regulatory policies to address state versus municipal conflicts, the tenuous federal versus state conflict, research trials, cultural considerations, federal bank funding issues and more.

  • Marijuana is less physically harmful than the legal drug alcohol.
  • Efforts to forcibly control rather than permit the use of marijuana have alienated and incarcerated otherwise law-abiding citizens.
  • The U.S. government has failed to control the supply of marijuana despite high rates of incarceration for marijuana possession.
  • Universal access to treatment and educational programs can decrease the demand for marijuana (as it has for tobacco use).
  • Most people who use marijuana do not go on to use other drugs.
  • Legalization would permit tax income, some of which could be used to provide treatment and fund prevention programs.
  • Government regulation would permit oversight of the drug’s purity and provide a means for levying sanctions against those who divert marijuana to adolescents.

  • Marijuana is addictive, alters the natural chemical composition of the brain and affects physiological functions throughout the body.
  • Use equals risk—when more people smoke marijuana, more will develop cannabis use disorders.
  • While perhaps not as physically dangerous as some other substances, marijuana leads to a decline in cognitive skills and motivation that can affect opportunities, talent, memory, performance and interest in healthy activities.
  • Alcohol and tobacco are legal but also produce great societal consequences, and introducing yet another legal substance to mainstream culture could have unpredictable, harmful consequences.
  • Legalizing marijuana for adults would communicate acceptance of its use and likely decrease the perception of its harmfulness, including among youth.
  • Marijuana use complicates the diagnosis and treatment of a variety of underlying psychiatric conditions.
  • Frequent use of marijuana affects adolescent development; in adults, it often impairs maturation psychologically, socially, professionally and spiritually.

What Is Happening with Decriminalization Efforts, and How Are Changes in Marijuana Policy Impacting Law Enforcement?

You have probably heard the term “decriminalization” used in marijuana discussions. It is important to know that decriminalization is not the same as legalization. Decriminalizing simply means to significantly reduce the consequences for breaking marijuana laws.

For example, states that have decriminalized marijuana typically don’t prosecute people caught with small amounts of the drug intended for personal consumption (usually under an ounce), meaning they don’t go to jail, and the offense typically doesn’t go on their criminal record. They may still get a ticket and fine, however, much like one would for a minor traffic violation or an “open container” violation for alcohol. In some states that have decriminalized marijuana, people who get caught using or possessing small amounts could also be ordered to attend educational classes on substance misuse and addiction.

Decriminalization affects law enforcement efforts by lowering the priority of marijuana-related arrests. Legalization efforts have also affected law enforcement, sometimes in unanticipated ways. For example, Colorado has experienced an increase in homelessness due to people moving to the state hoping to find work in the legal marijuana industry.

While the creation of any new industry does lead to more jobs, there is a limit to the number of opportunities, and many of those seeking employment are not qualified. Another unforeseen challenge for marijuana businesses is that they must comply with federal banking restrictions that require them to deal in cash, creating targets for burglaries and robberies.

One of the biggest issues for law enforcement is the black, or illegal, market, which still exists even in states with legalized recreational and/or medical marijuana. States also describe a “gray” market, one in which legal producers sell inventory under the table to black-market suppliers.

Personal growing laws can present law enforcement problems because they may be unclear and open to interpretation. For example, residents of Colorado might grow their limit of six marijuana plants, but could conceivably grow additional plants for family members, friends or neighbors. Cooperative spaces such as warehouses or homes converted for growing operations cause problems as well. And states also must monitor street prices to ensure the price of the legal supply remains competitive despite the taxes they levy. Otherwise, price-conscious consumers will look to black- and gray-market inventory instead.

Ensuring that each cultivated plant has a license is time consuming and difficult to monitor without a warrant. Search warrants also can be difficult to obtain due to ambiguity around medical marijuana licenses and recreational laws. Seizures of illegal products are complicated as well, due to conflicting state and federal laws, and questions about what to do with the seized inventory. In addition, canines trained for drug detection may need retraining or replacement because often they have not been taught to discern between marijuana and other illegal substances.

Law enforcement must also deal with drugged driving. Obviously, people should not drive while impaired by marijuana and should expect legal ramifications if they are caught doing so. The problem is enforcement. Methods for testing the effects of marijuana produce ambiguous results since THC is fat soluble, which means detectable traces linger in the body even after users are no longer intoxicated. A marijuana “Breathalyzer” test does not yet exist, technology allowing oral fluid testing is still being developed and blood tests are prohibitively expensive.

In addition, current drugged driving laws run into legal obstacles when it comes to medical marijuana patients. In July 2015, Denver resident Melanie Brinegar was pulled over for an expired license plate tag, but the officer smelled marijuana and performed field and blood tests. Brinegar had a medical marijuana license and used cannabis daily for chronic pain, which meant the THC level in her blood was high. She was acquitted of drugged driving even though her blood test came back at nearly four times the legal limit.

Complicating the problem further is the combined use of alcohol and marijuana. The risk from driving under the influence of both alcohol and cannabis is greater than the risk of driving under the influence of either alone, and data from Colorado shows impaired driving related to marijuana is increasing. Authorities need to clearly define the behaviors that constitute impairment and determine consistent ways of identifying and measuring those behaviors.

Law enforcement also must tackle other public safety concerns, such as explosions or fires that result from home growers attempting to make marijuana extracts like hash oil—a dangerous process that requires proper equipment to ensure safety. As one might suspect, this issue also affects medical facilities and first responders. Other safety concerns related to growing operations include toxic mold, THC in the air and on surfaces, and unsafe carbon dioxide and carbon monoxide levels due to fertilizers, pesticides, and disconnected vents— methods used to enhance plant growth.

Edible marijuana products are causing medical issues as well, due to accidental ingestion and potency issues. In Colorado, hospitalizations related to marijuana have increased 218 percent from 2000 to 2013. “Marijuana tourism” also contributes to the problem because most tourists are novice users with, in too many cases, little education to guide their use.

Trafficking of marijuana is another problem, especially in a state such as Colorado, which shares borders with seven other states. In 2014, law enforcement intercepted Colorado marijuana destined for other states 360 times—a 592 percent increase over the yearly average between 2005 and 2008. And driving across the border is not the only way the drug is being trafficked. From 2010 through 2014, the number of known parcels containing Colorado marijuana being mailed to other states increased 2,033 percent. Inventory tracking for marijuana outlets helps, but it has taken time to set up tracking systems. Colorado authorities did not have an established data collection system when marijuana laws changed—important for measuring crime rates, hospitalizations and so on. Suffice it to say, the nation is just beginning to understand the impact of changing marijuana policy on law enforcement.

History of Alcohol and Marijuana Policy

As marijuana policies are re-examined in the United States, it may be useful to look at our history of alcohol policy for guidance.

Alcohol has been a part of American culture for hundreds of years. Some Native American tribes used alcohol for ceremonial purposes during the precolonial era. In the sixteenth century, the pilgrims landed the Mayflower illegally at Cape Cod rather than at their chartered destination in Virginia because they were looking to replenish their supply of beer. By the 1820s, Americans of all ages were drinking more than at any point in our history—consuming on average about three times as much alcohol per day as their counterparts do now in the twenty-first century.

Widespread overconsumption and public drunkenness led to the temperance movement, which gained momentum through the formation of the American Temperance Society in 1826. Temperance groups called for abstinence from alcohol and gained cultural momentum, resulting in increased demands for government prohibition. Maine passed a law in 1851 prohibiting the manufacture and sale of liquor, only to repeal it five years later. The temperance movement eventually lost steam during the Civil War, but it was revived afterward. In 1881, Kansas made history when it amended its constitution to outlaw alcoholic beverages. Other states began to follow suit.

The outbreak of World War I in 1914 spurred calls for nationwide prohibition, due to the need for devoting the nation’s barley crop to bread rations for soldiers, rather than to beer production.

 In 1920, Congress ratified the Eighteenth Amendment to the U.S. Constitution, making the production, import, transport and sale of alcohol illegal nationwide. The separate Volstead Act (designed to enforce Prohibition) went into effect the same year. Estimates indicate alcohol consumption fell sharply during the first few years of Prohibition, and even though it rose a bit during later Prohibition years, overall consumption still remained 30 to 40 percent below pre-Prohibition levels.

At the same time, illegal activities rose during Prohibition. Illegally distilled spirits, such as moonshine and bathtub gin, were produced in mass. Speakeasies that served illegal alcohol gained popularity. Bootlegging, the dangerous illegal transportation of alcohol, became incredibly profitable. Organized crime groups grew in size, were well-funded and became increasingly violent. Law enforcement, overstretched by insufficient resources, struggled to carry out the laws associated with Prohibition. Lack of coordination between federal, state, and local authorities complicated enforcement efforts. In addition, methanol poisonings increased due to the poor quality of amateur homemade alcoholic beverages. And lawmakers who drank alcohol themselves were exposed as hypocrites.

Cries for repeal of the Eighteenth Amendment increased, particularly in urban areas. Prohibition laws were intended to curb violence and crime, but the opposite happened. And the black market for alcohol disrupted the legitimate economy, which also suffered from the rising costs of Prohibition enforcement and the collapse of the stock market in 1929.

With the onset of the Great Depression, state governments began looking again at the tax revenue that legal alcohol sales could generate. In 1932, Franklin D. Roosevelt secured the Democratic nomination for president and won on a platform that supported ending Prohibition. Soon after his election, in 1933, Congress proposed and the states approved the Twenty-First Amendment, which repealed both the Eighteenth Amendment and Volstead Act. A few states continued statewide prohibition, but by 1966 all of them had abandoned it.

While the federal government regulates production of alcoholic beverages, taxes alcohol sales and requires a Surgeon General health warning on alcoholic products, alcohol sales are now regulated primarily by state and local governments. As a result, there are differences throughout the nation regarding when alcohol is sold, where it is sold, how it is sold, what varieties are sold and so on. In fact, some dry communities still exist. After Prohibition, the drinking age in most areas of the country was eighteen. Eventually, all states adopted a minimum drinking age of twenty-one, encouraged to do so by the National Minimum Drinking Age Act of 1984, which tied the age requirement to federal highway funds.

Also of note: home brewing of beer and wine, unlike the federally regulated production of distilled alcohols, is now legal in all states (Mississippi and Alabama were the last to legalize this activity in 2013). However, home brewers are not allowed to sell the wine and beer they produce.

Varieties of cannabis plants are also known as hemp plants, although the word hemp is more commonly used when referring to fiber derived from such plants. Hemp, the fiber, has been used extensively throughout history for items such as rope, paper, fabrics and sail canvas. Hemp fiber also can be used to create concrete-like blocks for construction projects, bioplastics, jewelry and biofuels. In colonial America, hemp production was a requirement of English rule, and George Washington himself grew it as one of his main crops at Mount Vernon. At that time, hemp plants were low in tetrahydrocannabinol (THC), the active component of cannabis, and valued mostly for their role in industry.

Medicinal use of cannabis did not make its first appearance in America until the 1850s, when products with cannabis extracts were first produced and sold for the purpose of treating maladies such as pain and muscle spasticity. Soon after, pharmaceutical regulations were introduced in individual states. Products containing habit-forming substances like cannabis were often labeled poison and, in some cases, were available only with a physician’s prescription.

In the early 1900s, California passed the Poison Act, which was intended to make it a misdemeanor to be in possession of cannabis products not intended for medicinal use. However, it unexpectedly was applied to medicinal use as well. Eventually, similar laws passed in other states. The Federal Bureau of Narcotics was established in 1930 to enforce legislation that regulated and taxed products derived from opium and coca plants, and Harry J. Anslinger was appointed commissioner. Anslinger, a supporter of Prohibition, enforced criminalization of marijuana and publicized his belief that it incited violence and lewd sexual behavior. All states soon had laws regulating cannabis, and the Marihuana Tax Act of 1937 made possession or transfer of cannabis illegal on a federal level while imposing a tax on medical marijuana and industrial hemp.

Stricter punishments for marijuana offenses were put in place in the 1950s. And, although the U.S. Supreme Court ruled the Marijuana Tax Act of 1937 unconstitutional in 1970, passage of the Controlled Substances Act that same year placed cannabis in the Schedule I federal classification, where it remains today, making both medical and recreational marijuana illegal in the eyes of the federal government. The Drug Enforcement Administration (DEA) was created in 1973 to enforce federal drug laws.

Changes toward more lenient marijuana policy began in the 1970s, with some states decriminalizing it, or significantly reducing the penalties for illegal use. In 1996, California legalized medical marijuana, but the U.S. Supreme Court successfully upheld the ability of the DEA to enforce the Controlled Substances Act, even when it conflicts with such a state law. In 2005, the Supreme Court once again upheld the DEA’s authority in such conflicts.

Still, more states continued to reduce penalties for marijuana-related charges, and some continued to pass medical marijuana laws. Then, in 2012, Washington and Colorado legalized recreational marijuana, with intentions to regulate it like alcohol. Colorado created a Marijuana Enforcement Division, and Washington placed marijuana regulation under its State Liquor Control Board. Since then, other states have passed laws legalizing recreational marijuana, and several have approved medical marijuana programs.

In 2013, the Obama administration said the federal government would not challenge state legalization efforts. Two years later, the Obama administration eased some restrictions on cannabis research to study its potential as medicine. Meanwhile, various bills have been introduced in Congress to reclassify federal scheduling of marijuana, reduce or eliminate penalties for minor marijuana violations and legalize medical marijuana nationally.

Some have viewed marijuana as having medical value throughout history:

  • The Chinese emperor Fu Hsi referenced it as a popular medicine in 2900 BC, and the herb was included in the Chinese Pharmacopeia, the Rh-Ya, in 1500 BC. By 100 AD, the Chinese had more than one hundred medical uses for marijuana, including treating gout, malaria and absentmindedness. In 200 AD, surgeon Hua T’o performed a number of surgeries using an anesthetic made from cannabis resin and wine.
  • The original Hebrew version of the book of Exodus refers to a “holy anointing oil” that combined olive oil, fragrant herbs and kaneh bosm (cannabis).
  • The ancient Egyptians prescribed cannabis for glaucoma, inflammation, “cooling the uterus” and administering enemas.
  • Bhang, a drink that combined cannabis and milk, was used as an anesthetic and antiphlegmatic in India around 1000 BC. By 600 BC, Indians believed it could prolong life, improve thinking and judgment, reduce fevers, induce sleep, cure dysentery and cure leprosy.
  • The Persians of 700 BC listed cannabis as the most important of 10,000 medicinal plants.
  • The Greeks of 200 BC used it for earaches, edema and inflammation.
  • In 70 AD, a Roman army medical text declared kannabis useful for treating earache and suppressing sexual longing. Soon thereafter, Roman author Pliny the Elder noted that the roots of cannabis boiled in water eased cramped joints, gout and violent pain.
  • Across Arabia in the ninth century, cannabis was used to treat a variety of ailments, including migraines and syphilis.
  • In England in 1621, clergyman Robert Burton suggested using cannabis to treat depression in his book The Anatomy of Melancholy. Other British herbalists suggested cannabis for gout and joint pain. Later, in Victorian England, cannabis was used for muscle spasms, menstrual cramps, rheumatism and convulsions; to promote uterine contractions in childbirth; and as a sleep aid.
  • In colonial America, hemp was raised as a fiber crop; however, George Washington made notes in his diary of 1765 about his interest in the medicinal uses of the plant.
  • By 1840, marijuana had become part of mainstream Western medicine, and was added to the U.S. Pharmacopeia in 1850. It was also included in patent medicines. Newer uses included increasing appetites, treating opium withdrawal, and suppressing vomiting and nausea.
  • In the United States from 1900 to the 1930s, cannabis was included in many medications. The American pharmaceutical companies Parke-Davis and Eli Lilly sold extracts of cannabis for use as an analgesic, antispasmodic and sedative, while Grimault and Co. marketed marijuana cigarettes to treat asthma.
  • Cannabis was prohibited in the United Kingdom under its Dangerous Drugs Act in 1928. In the United States, all states had enacted laws regulating marijuana by 1936. Its use in medicine was replaced by aspirin as well as by morphine and other opiates. By 1942, it was removed from its place in the U.S. Pharmacopeia and was considered to have no therapeutic legitimacy.

Whether marijuana is medically legal, recreationally legal or completely illegal in your state, you still may be concerned about the dangers of use, particularly among youth, as well as the potential for addiction. You’re also likely to be interested in pursuing public education or perhaps marijuana prevention efforts, as well as making sure addiction treatment and recovery resources are available in your community.

If marijuana is legal in your state, you probably have additional concerns, such as where it is sold, how much individuals can possess, where it is legal to use the drug, where it can be transported, how to govern drugged driving and more.

It may be helpful to know that in states where recreational marijuana has been approved, individual communities still have the right to opt out. For example, shortly after the passage of Oregon’s Measure 91 (legalizing statewide recreational marijuana), the League of Oregon Cities proposed a bill allowing cities and counties to ban marijuana within their borders or to levy their own taxes on retail sales to make marijuana prohibitively expensive. Some communities have also banned use in public areas, established zero-tolerance policies at schools and encouraged local businesses to adopt drug-testing programs for employees. In another example, the Colorado Attorney General’s Office has supported employer policies that forbid employees from using marijuana, even when off duty.

Many are keeping a close eye on the impact of marijuana policies in states where it is already legal. Indeed, your community may look to existing policies elsewhere for lessons learned. Yet keep in mind that those communities are still learning. Community monitoring and involvement need to be ongoing in order to continuously improve regulations and education about marijuana, and to minimize the negative impact of marijuana on youth and public health.

If you live in a state with legalized marijuana and want to help prevent marijuana from negatively impacting your community, it’s best to start by familiarizing yourself with the state law that made marijuana legal. It should either provide information or lead you to information about the regulatory framework that was established to govern your state’s marijuana industry. These regulations might address any number of issues, including licensing and production, taxes and pricing, how marijuana is prepared and consumed, and packaging and marketing. What’s more, ongoing regulatory oversight will ensure that changes are implemented when necessary and additional concerns are tackled as they arise.

Let’s start with licensing and production. State regulations will govern who is licensed to produce and sell marijuana, guidelines for product safety and quality, and security requirements designed to limit diversion from legal production systems to illegal markets. Review the state statute to learn how your state is addressing these issues in its regulatory framework.

You also will want to review your state’s marijuana taxes and how they relate to retail pricing. Both are flexible regulatory tools that can swiftly respond to changing circumstances or new evidence. The legal price of marijuana has a huge impact on the size of the illegal market, levels and patterns of consumption, home-growing trends, use of other drugs that may be less expensive and revenue generated from production and sales.

In 2014, Colorado rang up $700 million in marijuana sales and garnered $70 million in tax revenue—almost twice as much as the state collected from alcohol taxes that year. Of that, $24 million was appropriated for building schools, $8 million for marijuana research, and $11 million for addiction prevention and treatment targeted to students. Additional funds were set aside for law enforcement.

Community involvement can help steer marijuana revenues to education, prevention programs and addiction treatment. It is worth noting, however, that marijuana-based revenue streams remain at some risk, should the current or a future presidential administration decide to enforce federal laws more strictly.

As you examine your state’s regulatory framework, you may find rules and guidelines specific to different forms of marijuana. The drug can be prepared and consumed in a number of ways. Most often, we think of marijuana in its smoked form. But the drug also can be prepared in pill form, as an oil to be vaporized, as an edible product, as a liquid tincture and in other forms. Some argue that non-smoked derivatives should be regulated, approved and promoted in policy as a healthier alternative to smoked marijuana.

At the same time, others raise unique concerns about edible marijuana products. Indeed, recent deaths related to the dosages in edibles have highlighted the need for increased regulation of such goods. Advocates have called for better warning labels on the packaging, uniform lab testing standards to ensure product consistency and education campaigns. Stricter regulation of edible products means better control over what’s available, better information for the general public and fewer accidental deaths. Meanwhile, the need to expand research on marijuana edibles parallels the need to expand all types of marijuana research.

Another important issue is marijuana potency. As you may have heard, the tetrahydrocannabinol (THC) levels in marijuana today are much higher than they were in decades past. While marijuana with higher THC levels poses more health risks, legal marijuana with low THC levels can fuel the illegal market for marijuana with higher THC concentrations. Regulations ought to be balanced accordingly.

Regulation of the tobacco and pharmaceutical industries has resulted in child-resistant packaging and other packaging requirements. Similarly, marijuana packaging should be child resistant, include general safety information and be targeted only to adults. That was not initially the case in Colorado. Edible marijuana products sold there looked so much like candy that Hershey won a lawsuit against an edibles company for trademark infringement. In response to this and other concerns, Colorado created a legislative task force dedicated to monitoring regulations on packaging of edible products and launched media campaigns to more effectively educate the public about cannabis consumption. In both cases, community advocates played a big role in raising concerns and bringing about change.

When it comes to marketing marijuana products, we can learn much from the alcohol and tobacco industries. Widespread marketing of alcohol has accompanied ever-increasing use, especially among youth. The same could once be said for tobacco marketing. However, with the advertising restrictions in recent decades, tobacco use has declined significantly. In light of this, banning all forms of marijuana advertising, promotion and sponsorship could significantly help with prevention efforts. Effective marketing restrictions can prevent problems, especially with underage use. Marijuana business interests may disagree with marketing restrictions, and in fact, they do in states like Colorado and Washington. For prevention-minded communities, this is an issue demanding early attention.

A related issue to licensing for marijuana producers is licensing of vendors, who must be trained to enforce and follow restrictions on sales relating to age, amount, intoxication and so on. Communities can also expect vendors to help educate customers about using responsibly, minimizing risks, and getting help or further information if needed. Vendors that fail to meet requirements should be penalized and, potentially, lose their license.

Also subject to regulation are the retail outlets where vendors sell their marijuana products. Most believe such stores should be only functional and should not include advertising, signage or product displays that promote marijuana use. Many also support restricting marijuana outlet locations to keep them away from places like schools, playgrounds, parks and homes, and to prevent them from becoming too concentrated in one area. Designated areas for consumption should be clearly marked and publicized to minimize public exposure and assist with law enforcement.

Purchaser regulations are another essential aspect of a state’s legal framework. Of course, age limits are important. Limits on purchasable amounts are critical, too, because they promote more responsible consumption and prevent resale to minors and others on the black market. In addition, drugged driving laws are vital to protecting the public from buyers who would drive under the influence of marijuana.

In the end, people’s well-being is the most important factor in the public discussion over marijuana, and establishing a regulatory framework is an important first step in reducing the negative impact of marijuana on the community. But the real work starts afterward. Regulations must be monitored for effectiveness and altered if necessary. That means data should be collected and measured to track progress toward policy goals—something that requires funding. As a community member, you may need to advocate for funding to support data collection, focus groups, research studies and more, all of which can be used to monitor use and addiction rates, demographic trends, drugged driving convictions, crash incidents, hospital visits, calls to poison control centers, public consumption violations and so on. Such data can inform local policymakers as they consider changes to laws, regulations and public investments. Ultimately, changes in public policy take place through community action—action that starts with you. So ask questions and be proactive.