The Path Forward recently hosted drug policy experts Dr. Kevin Sabet and Will Jones of SAM (Smart Approaches to Marijuana), for a compelling presentation about the costs of marijuana legalization.

Rather than criminalize or legalize marijuana, they contend that a smart approach to policy is required, one based on science, public health, and public safety instead of fear and rhetoric. The facts are clear: marijuana legalization has had a dramatic, negative impact on communities across the country. The impact is most significant on communities of color.

BACKGROUND
The legalization and commercialization of marijuana is fueling the growth of a new generation of drug users. Legal marijuana is now a massive industry that resembles the tobacco and alcohol industries — driven by greed and profit, marketed and sold by Wall Street, Madison Avenue, and Silicon Valley. The same strategies that led to the growth of Big Tobacco are back in play with Big Marijuana as the industry seeks to downplay or deny health risks and glamorize, normalize, and encourage marijuana use. Like Big Tobacco, the marijuana industry has expanded and diversified product offerings to appeal to youth, has increased the potency (THC levels) of drugs, and pushed a false narrative about bringing positive economic impact to communities. The marijuana industry is disproportionately targeting their efforts (from brick-and-mortar pot shops to advertising) in the most vulnerable communities, where there is a higher concentration of heavy users.  

PUBLIC MISINFORMATION
“The gulf has never been greater between scientific understanding of marijuana’s harms and the public’s misunderstanding,” says Sabet. He explains that this is the result of a multi-billion dollar disinformation campaign by the industry that has obscured dangers and conflated issues. The three issues most often conflated:

Penalizing drug users/decriminalization. Dr. Sabet reminds us that decriminalization is not the same as legalization. “We don’t want people in prison for marijuana, but we don’t have to commercialize an industry to decriminalize,” he says. Legalization proponents argue (falsely) that decriminalization can’t happen without legalization.

Medical use of compounds derived from marijuana.  While there may be medicinal uses of compounds derived from marijuana that benefit a narrow group of patients, legal “medical use” is often used to suggest/imply incorrectly that marijuana is safe or beneficial for all people.

Legalization of marijuana for non-medical use. Ultimately, proponents of full legalization are looking beyond marijuana and seeking justification for legalizing other drugs. Full legalization of marijuana becomes a stepping stone to normalizing and commercializing other drugs like opiates and stimulants.

RISE IN USE
The results of mass commercialization, normalization, and legalization of marijuana are staggering. Over the past 20 years, there have been unprecedented increases in daily and nearly daily use of marijuana. In 1992, the percentage of marijuana and alcohol users consuming these substances on a daily basis was around 10%. While the number has remained consistent for alcohol, more than 45% of marijuana users now use it daily. There are more than ten times as many daily marijuana users now than in 1992 (900,000 vs. 10M). Marijuana use and addiction are on the rise among all age groups. Use among youth has increased significantly since legalization. In states where marijuana has been legalized, there has been a 25% increase in addiction among children ages 12-17 according to a recent study by the Journal of the American Medical Association (JAMA).

NEW DANGERS, A PUBLIC HEALTH CRISIS
Today’s commercialized marijuana is far more potent than what previous generations experienced. The industry has innovated, creating products that are almost 99% THC. Products like “green crack” and “earwax” are completely new — and accepted — because there’s a legitimized industry behind them. The new marijuana comes in slickly-packaged, brightly-colored edibles like sodas and candies. It gets consumed through equally colorful, easily obtainable devices like vaporizers and blow torches.

“But the industry says with a straight face: it’s not aimed towards kids,” observes Sabet. “The adolescent brain is especially susceptible to marijuana use. Young users have a greater chance of addiction because their brains are being primed.”

Multiple recent studies have shown links between marijuana use and mental health disorders. A 2019 Lancet study found that users of high potency marijuana are five times more likely to develop psychosis. Even those using lower potency marijuana are three times more likely to develop psychosis.

Marijuana use is also associated with:

• Long-term increases in anxiety 
• Lower IQ scores (an average of eight points among those that began use as adolescents)
• Poorer outcomes in educational attainment
• Increases in self-harm and suicide among youth
  

Says Sabet, “Marijuana, more than any other drug, is associated with these problems.”

The marijuana industry has also pushed the narrative that marijuana can help address addiction to opioids. But recent JAMA studies have found that opioid abuse increases with marijuana use and that medical marijuana is associated with a 23% increase in opioid deaths. The opioid crisis has worsened where marijuana has been legalized.

Other public health concerns related to legalization include a 400% increase in marijuana poisoning among babies consuming edibles, increases in health issues related to second-hand smoke, and an increase in marijuana hospitalizations (up 101% in Colorado since legalization).

BIG BUSINESS, FAMILIAR PROBLEMS
“All the things we learned were bad about Big Tobacco are showing up again with Big Pot,” says Sabet. “Joe Camel has returned.” He points out that the industry is using the same strategies of advertising and mass commercialization: “mascots, billboards, sex appeal, snob appeal — the promise of happiness.”

The trend goes beyond marketing tactics. The marijuana industry has seen significant investment from tobacco companies and the alcohol industry. And while the marijuana industry claims that legalization leads to greater regulation and oversight, Jones argues that as with tobacco and alcohol, the same problems persist, especially in vulnerable communities. These are industries, he says, that rely on addiction for profit.

“People say we’re going to regulate [marijuana] like tobacco, like alcohol — well if we do, that’s going to have a negative impact on communities of color, on disenfranchised communities that are least able to support the burden of an addictive industry, of an industry that makes the majority of their money off of people that are heavy users and addicts. That’s what we have with alcohol and tobacco where roughly about 80% of the revenue comes from 20% of the users. I don’t want to see a third industry that does that.”

Current regulation is minimal. Marijuana is not regulated by the FDA. There’s little to no consistency in testing of reliability and safety.

“States have little oversight,” says Sabet. “The industry runs roughshod over any kind of regulations.”

Finally, the promise of tax revenue from marijuana sales hasn’t materialized. It remains a small percentage of what was promised and projected in states that have legalized marijuana.

OUR POSITION
We are deeply concerned and disturbed by the growing public health crisis related to marijuana normalization, legalization, and commercialization. We believe that the crisis requires an immediate and comprehensive response. To that end, we support SAM efforts to educate communities about the science of marijuana and promote smart policies and attitudes that decrease marijuana use and its consequences. Our efforts will include:

• A March 2, 2021 press conference announcing our opposition to marijuana legalization
• A series of opinion pieces by TPF members to be shared in local and regional publications
• Educational activities in our communities around the dangers of marijuana legalization, including talks and forums led by SAM 
• Sharing informational resources with members to support conversations with lawmakers and policy leaders
  

RESOURCES
SAM Center for Marijuana Resources
Big Tobacco 2.0 (SAM/YouTube)
Quick Facts on Marijuana Legalization (SAM)
Marijuana Legalization in Communities of Color (SAM/YouTube)
Second-Hand Marijuana Exposure in a Convenience Sample of Young Children in NYC