As the debate on recreational and medicinal legalization of marijuana continues throughout the United States, an expert argues the discussion is much more complicated than the simple conclusions the opposing sides promote.
Jonathan Caulkins, a drug policy researcher and professor of operations research and public policy at Heinz College at Carnegie Mellon University in Pittsburgh, joins us on "Take Care" to talk more about the aspects of legalization. He's one of the authors of the book “Marijuana Legalization: What everyone needs to know.” Caulkins said some of the common arguments used both for and against marijuana legalization are oversimplified.
Caulkins calls marijuana a dependence-inducing intoxicant, which means it can produce substance use disorder and similar behavioral issues in its users. Though its effects are different from that of substances like alcohol and tobacco, it is wrong to compare pot to other drugs in the way supporters often do, Caulkins said.
“It’s a mistake to think that you can rank-order substances on some univariate scale of which one’s most dangerous and which one is least dangerous,” Caulkins said.
When properly analyzed, Caulkins said, several drugs affect the body in different ways. Tobacco poses almost no risk of overdosing but a large risk of developing long-term health problems like cancer that can shorten life expectancy. Heroine, on the other hand, does not pose the same risk to long-term health but does have a large risk of overdose.
"It's the behavioral effects where it has its challenges."
“Cannabis is way better on those medical consequences -- very low risk of overdose, the chronic health problems are not that bad,” he said. “It’s the behavioral effects where it has its challenges.”
The National Institute on Drug Abuse suggests that 30% of those who use marijuana may have some degree of “marijuana use disorder,” meaning a person feels withdrawal symptoms when not taking the drug. Caulkins said it is important to look out for negative effects of the drug, but there are still plenty of benefits that come with cannabis use.
"Legalization is not like a binary switch ... there are many different ways legalization could play out, and exactly how it plays out will affect how available it is for treating pain."
Legalization of recreational pot could help make it more accessible to those who suffer from pain, Caulkins said, but there is a lot more to consider. Legalization would involve removing the drug from the Controlled Substances Act, but there is still the issue of how the Food, Drug and Cosmetic Act would then apply.
“It is still a drug, and you really aren’t supposed to just go selling drugs that are not FDA approved, and cannabis – meaning the botanical product, the flower – it’s really hard to make that meet good manufacturing practices that we insist that any drug maker meet,” Caulkins said.
Handling those legal issues is part of why legalization is not as simple as the debate often makes it seem, he said. Policy would have to include regulations for where marijuana use is allowed, if employers can forbid its use, how impaired driving will be enforced, who can sell it and so on.
“Legalization is not like a binary switch -- a yes/no thing -- there are many different ways legalization could play out, and exactly how it plays out will affect how available it is for treating pain,” Caulkins said.
Law enforcement is another logistical issue to be considered for both sides of the debate, he said. If pot were legalized, there is still the problem of impaired driving, which is far more difficult to measure for pot than it is for other substances like alcohol. This is due to the way THC works and stays in the body.
Concentrations of THC in the brain can be different from concentrations in the blood, and THC is fat soluble, not water soluble like alcohol. In addition, there are metabolic byproducts of THC that also cause impairments.
“Even if you have a perfect measure of THC in the blood, that does not correlate with impairment,” Caulkins said. “THC is a complicated chemical with complicated metabolic byproducts.”
Legal pot use could have beneficial effects regarding law enforcement as well, Caulkins said. One common concern with supporters of legalization is that the criminalization of pot disproportionally affects African Americans, which is connected to the greater issue of increased police interactions in African American communities. However, Caulkins said, turning pot into a business is not a necessary step in tackling this issue.
“You don’t need to legalize the drug. You don’t need to invite in a for-profit industry in order to deal with the racial disproportionality in arrest,” Caulkins said. “You could, for instance, just legalize personal possession and use and not legalize for-profit production by a large industry.”
The for-profit production many proponents support would be similar to the way alcohol is currently treated in today’s economy, but Caulkins said that is not a good thing. High-frequency users dominate marijuana consumption despite only 1 in 5 people using it at a daily or near-daily rate, which Caulkins said makes those heavy users highly marketable for big companies.
“The dose is radically different in 2019 than it was in 1999, and that small number of daily or near-daily users, they dominate the market,” Caulkins said. “That’s what the companies make their money off of.”
The solution, then, Caulkin argues, is not to use the alcohol model as a guide for cannabis legalization. Instead of for-profit companies dominating and expanding the industry in a harmful way, he said, the supply should be controlled by nonprofit organizations that will meet existing demand but not exceed it. Unfortunately, he does not see that as a realistic outcome of the current debate.
“We could do better than the alcohol model if we slow down and were more thoughtful about it,” Caulkins said. “I fear that we will not.”
As far as the future of legalization, Caulkins sees recreational pot legalization at a federal level possible by 2024, though it may take longer due to the complications he discussed slowing the process. In the meantime, with some states already legalizing recreational and medicinal use and others, like New York, considering doing the same, he expects other states to follow suit.
“If your neighbor legalizes, that undercuts a lot of the benefits of your own prohibition, so there is a domino effect,” Caulkins said. “The states movement, as well as Canada’s action, are part of why I think that it is a matter of time before the federal law is changed. I do think it’ll still take a little while.”
