The Changing Face of Marijuana and Marijuana Policy (1/3)

In a long, well-documented paper,  Dr. Kevin Sabet looks back at the history of marijuna legalization and challenges a fledgling, profit-hungry industry ready to take advantage of the new green (gold) rush. Dr Sabet details the consequences that can be drawn from marijuana legalization while deploring the abuses of medical marijuana. This article will be published in three different parts, starting from today until Friday, February 14.

In 1979, at the height of the marijuana legalization movement in the US, the head of the pro-legalization National Organization for the Reform of Marijuana Laws (NORML) told a newspaper that “We will use (medical marijuana) as a red herring to give marijuana a good name.” And did they ever. Though marijuana was not to be legalized in any form for another 17 years, so continued the long journey to make marijuana more accepted and normalized. And then there were the billionaires. In the period since the 1970s, three big-money funders, currency speculator George Soros, Progressive Insurance founder Peter Lewis, and University of Phoenix founder John Sperling, decided to help NORML and other groups reach their ultimate objective: the full legalization of marijuana sales.

Dr Kevin Sabet

Since then, 20 states and the District of Columbia have legalized marijuana as “medicine” for anyone with a debilitating disease, back pain, or headaches, or…you get the picture. It didn’t seem to matter that the American Medical Association, Glaucoma Society, MS Foundation, or Cancer Institute do not recommend smoking marijuana as “medicine” (or otherwise), and look down upon the state-based, non-pharmacy distribution of marijuana. Voters in those states, bombarded with ads promising marijuana as a cure-all, have decided otherwise. And now two states that started with medicalization have legalized marijuana outright.

How Did We Get Here and Where Are We Going ?

First, it is clear that the American people’s understanding of marijuana’s potential for harm is completely inconsistent with the scientific consensus that marijuana use can indeed be dangerous. Because, like all psychoactive drugs (including alcohol), a small number of overall users constitute most of the overall harm (and consume most of the total volume of use), most people’s experiences with marijuana are benign. This has led to the general feeling that “pot is no big deal.” Since most people who use marijuana do not become addicted or exhibit serious harm to society, the perception of marijuana as a harmless plant has permeated America today. In fact, however, marijuana use is especially harmful for adolescents (and also for adults)[1]

Marijuana’s harm is found across numerous categories – including the potential for a significant reduction in IQ among young, heavy users[2], the onset and exacerbation of mental illness [3], poor learning outcomes [4], lung damage[5], and addiction.[6] Indeed, almost 400,000 emergency room mentions related to acute panic attacks and psychotic episodes[7]  occur annually related to the drug. And marijuana is the top reason people seek treatment[8].

Marijuana and driving also do not mix. A meta–analysis published in the peer-reviewed Epidemiological Reviews looked at nine studies conducted over the past two decades on marijuana and car-crash risk. It concluded, “drivers who test positive for marijuana or self–report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes. »[9]

How does marijuana’s illegal status affect policy outcomes? It is well established that illegal marijuana is more expensive than legal marijuana (prohibition artificially increases drug prices because of the risk associated with engaging in illegal activity). And that means marijuana’s price will go down and use will undoubtedly rise if it becomes legal. RAND researchers estimated that if California had legalized marijuana for recreational use in 2010 under a system that devolved control to localities, marijuana’s price could have dropped by 80 percent and use could have doubled (though precise projections on use and price were the subject of tremendous uncertainties).[10]

The first two governments in history to fully legalize marijuana were Colorado and Washington, where voters passed legalization ballot initiatives in 2012. Both laws aim to “regulate marijuana like alcohol.” Looking at alcohol consumption vs. marijuana consumption in these states might provide insight into just how much marijuana use might increase as a result of legalization if the drug actually is regulated like alcohol. Twice as many young adolescents (ages 12-17) use alcohol as marijuana. Three times as many older teens and young adults (ages 18-25) do so)[11]. Of even more concern, nationally six times as many 12 year olds used alcohol as marijuana in 2009.[12]

Dr. Sabet is the Director of the Drug Policy Institute at the University of Florida and an Assistant Professor in the College of Medicine, Department of Psychiatry. With Patrick J. Kennedy, he is the co-founder of Project SAM (Smart Approaches to Marijuana). He is the author of Reefer Sanity: Seven Great Myths About Marijuana (2013, Beaufort) and a consultant to numerous domestic and international organizations, including the United Nations, through his company, the Policy Solutions Lab. Dr. Sabet is regularly invited to give testimony to governments, and he is a frequent contributor to opinion-editorial pages worldwide.

  1. American Medical Association. (2009). Report 3 on the Council of Science and Public Health: Use of Cannabis for Medicinal Purposes; Joffe, E. & Yancy, W.S. (2004). Legalization of Marijuana: Potential impact on youth. Pediatrics: Official Journal of the American Academy of Pediatrics, 113(6);American Psychological Association. (2009). Position Statement on Adolescent Substance Abuse;California Society of Addiction Medicine. (2009). Impact of Marijuana on Children and Adolescents.; American Society of Addiction Medicine Statement Retrieved here:
  2. ]See Meier, M.H.; Caspi, A.; Ambler, A.; Harrington, H.; Houts, R.; Keefe, R.S.E.; McDonald, K.; Ward, A.; Poulton, R.; and Moffitt, T. Persistent cannabis users show neuropsychological decline from childhood to midlife.Proceedings of the National Academy of Sciences 109(40):E2657–E2664, 2012. Also Moffitt, T.E.; Meier, M.H.; Caspi, A.; and Poulton, R. Reply to Rogeberg and Daly: No evidence that socioeconomic status or personality differences confound the association between cannabis use and IQ decline. Proceeding of the National Academy of Sciences 110(11):E980-E982, 2013. 
  3. See for example: Andréasson S., et al. (1987). Cannabis and Schizophreia: A longitudinal study of Swedish conscripts. Lancet, 2(8574); Moore, T.H., et al. (2007).  Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370(9584); Large M., et al. (2011). Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Archives of General Psychiatry, 68(6); Harley, M., et al. (2010). Cannabis use and childhood trauma interact additively to increase risk of psychotic symptoms in adolescences. Psychological Medicine, 40(10); Lynch, M.J., et al. (2012). The Cannabis-Psychosis Link. Psychiatric Times.
  4. Yucel, M., et al. (2008). Regional brain abnormalities associated with long-term heavy cannabis use. Archives of General Psychiatry, 65(6).
  5. See for example: American Lung Association. (2012, November 27). Health Hazards of Smoking Marijuana. Retrieved from:; Tashkin, D.P., et al. (2002). Respiratory and immunologic consequences of smoking marijuana. Journal of Clinical Pharmacology, 4(11); Moore, B.A., et al. (2005). Respiratory effects of marijuana and tobacco use in a U.S. sample. Journal of General Internal Medicine, 20(1); Tetrault, J.M., et al. (2007). Effects of marijuana smoking on pulmonary structure, function and symptoms. Thorax, 62(12); Tan, W.C., et al. (2009). Marijuana and chronic obstructive lung disease.
  6. See for example: Anthony, J.C., Warner, L.A., Kessler, R.C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experiential and Clinical Psychopharmacology, 2; Budney, A.J., et al. (2008). Comparison of cannabis and tobacco withdrawal: Severity and contributions to relapse. Journal of Substance Abuse Treatment, 35(4); Tanda, G., et al. (2003). Cannabinoids: Reward, dependence, and underlying neurochemical mechanisms – A recent preclinical data. Psychoparmacology, 169(2).
  7. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). Drug abuse warning network, 2008: National estimates of drug-related emergency department visits. HHS Publication No. SMA 11-4618. Rockville, MD.
  8. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012
  9. Mu-Chen Li, Joanne E. Brady, Charles J. DiMaggio, Arielle R. Lusardi, Keane Y. Tzong, and Guohua Li.  (2011). “Marijuana Use and Motor Vehicle Crashes.” Epidemiologic Reviews.
  10. Beau Kilmer, Jonathan P. Caulkins, Rosalie Liccardo Pacula, Robert J. MacCoun, Peter H. Reuter, Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets, RAND, 2010. And see Kilmer, Beau , Jonathan P. Caulkins, Brittany M. Bond and Peter H. Reuter. Reducing Drug Trafficking Revenues and Violence in Mexico: Would Legalizing Marijuana in California Help?.Santa Monica, CA: RAND Corporation, 2010.
  11. State Estimates of Substance Use from the 2008-2009 National Surveys on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Bethesda, Maryland, 2010.
  12. 2009 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Bethesda, Maryland, 2010.