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With Election Day just around the corner, voters in multiple locations will again be confronted with cannabis-related questions. Seven state legislatures appear to still believe that there is a medical use for marijuana despite a lack of agreement from the medical community. Legislation is pending in each of those states. “Medical marijuana” has simply been the camel’s nose under the tent, with the true goal of legalization covered up with a supposedly scientific approach.

Three states are now getting to the heart of the matter with outright legalization on the table. Colorado’s Amendment 64, the “Regulate Marijuana Like Alcohol Act,” will permit those over 20 to possess, use, display, purchase and transport limited amounts of marijuana. Washington’s Measure 502 would also allow limited possession of marijuana by those over age 20. The Oregon Cannabis Tax Act, Measure 80, would create the Oregon Cannabis Commission to regulate the sale and cultivation of marijuana for those over age 20.

In each case, there is a less-than-subtle approach to licensing and regulation, with excise taxes, fees and other revenue generating components representing a critical argument used in favor of passage. Proponents indicate that the Oregon Act will generate over $140 million in taxes, while Washington expects $350 million to expand state spending on drug education, prevention and treatment. Colorado’s bill indicates that the first $40 million raised each year will be credited to the public school and capital construction fund.

The legislatures in each state appear to have ignored the many associated costs which will quickly swallow the revenue described. This includes increased utilization of the drug at younger ages with associated addictive and physical illness, diminished productivity caused by cognitive abnormalities, and increased drugged driving and associated morbidity/mortality.

In July, the American Society of Addiction Medicine (ASAM) considered the question of marijuana legalization, concluding:

1)  That physicians lead efforts to oppose legislative or ballot initiatives that would result in the legalization of marijuana production, distribution, marketing, possession and use by the general public, and that all physicians incorporate screening and intervention for risky substance use, including marijuana use, as well as diagnosis, treatment and disease management for addiction into their routine medical practice;

2)   That public education campaigns be undertaken to inform the public that addiction associated with cannabinoids is a significant public health threat, and that marijuana is not a safe product to use, especially, but not only, by smoking;

3)   That parents be informed that the marijuana their children are exposed to today is of much higher potency than the marijuana that was widely available in the 1960s through the 1980s, and that the potential for the development of addiction and for the development and progression of psychotic conditions are enhanced when high-potency marijuana products are used by adolescents because of the unique vulnerability of the adolescent brain;

4)   That when cases of marijuana-related substance use disorders are identified and the diagnosis confirmed by professional assessment, carefully monitored treatment to establish abstinence be offered to afflicted persons and such treatment and insurance coverage for it be readily available;

5)   That drugged driving associated with marijuana use be subject to additional epidemiological research and research on the treatment needs of drivers. Increased efforts are needed to prevent its occurrence which should include substantial legal consequences at the level of the consequences for drunk driving;

6)   That, given the significant role the criminal justice system plays in discouraging marijuana use, states promote programs that enhance linkages between the criminal justice system and the addiction treatment system, using models such as Drug Courts and HOPE Probation.

ASAM asserts that the anticipated public health costs of marijuana legalization are significant and are not sufficiently appreciated by the general public or by public policymakers. Physicians and other health professionals must become more aware of the anticipated undesirable outcomes of marijuana legalization and encourage public education on these facts.

Stuart Gitlow MD MPH MBA is a member of the American Medical Association’s Council on Science & Public Health, and Acting President of the American Society of Addiction Medicine. This Op-Ed represents his personal opinion and does not imply any position or policy taken by either the AMA or ASAM.

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