If Marijuana Is Legal, Will Addiction Rise?
July 19, 2009 - New York Times
A New York Times article on Sunday discussed the
debate over whether
more and more potent types of cannabis affect the levels of addiction
to the drug. This particular issue has become part of the larger debate
over whether marijuana should be legalized or decriminalized.
Antidrug activists say that if the drug is legalized, more people
will use it and addiction levels, made worse by the increased potency,
will rise too. Legalization advocates note that pot addiction is not
nearly as destructive as, say, abuse of alcohol. What would be the
effect of legalization or decriminalization on marijuana abuse and
addiction?
- Roger Roffman, professor
of social work
- Wayne Hall, professor of
public health policy
- Mark A.R. Kleiman,
professor of public policy and author
- Peter Reuter, University
of Maryland professor
- Norm Stamper, former
Seattle police chief
More Honesty Needed
Roger
Roffman is a professor of social work at the University of
Washington.
Marijuana dependence occurs in 9 percent of Americans who have ever
used the drug, and between 33 percent and 50 percent of those who smoke
it daily. Approximately 3.6 million Americans are daily or near daily
users. In 20 years of marijuana dependence counseling studies at the
University of Washington, those who’ve sought help averaged 10 years of
daily or near daily use and had unsuccessfully tried to quit more than
six times.
Surveys indicate increasingly positive attitudes in the U.S. for
liberalizing marijuana policies. Two ways of doing this are: (1)
legalization, which would involve lawful cultivation and sale of
marijuana, and (2) decriminalization, which would retain criminal
penalties for cultivation and sale while removing them for possession
of small amounts.
Will more people use marijuana and become dependent if marijuana is
decriminalized? Probably not. A number of U.S. studies tell us
decriminalization would not likely have an effect on the rates of
marijuana use by adults or adolescents.
What if marijuana is legalized? No one can say for certain. Using
one country’s reform example to estimate what would happen in another
is very risky. How countries differ (cultural, social, political,
economic) makes a big difference.
However, the Dutch “coffee shops” example might give us a little
insight. The de facto legalization policy in the Netherlands did not,
in itself, affect rates of marijuana use among adults or young people.
But rates of use among young people increased when the number of coffee
shops increased and the age of legal access was 16. Then these rates
declined when the numbers of coffee shops was reduced and the age of
legal access became 18.
A cautious conclusion, as I see it, is that any consideration of
legalization should include careful planning for how those who are most
vulnerable to harm from marijuana use, children and adolescents, can be
protected.
I support finding alternatives to criminal penalties for marijuana
possession. Those penalties have costs (being jailed, having a criminal
record, barriers to employment, loss of scholarships, to name a few)
and may accomplish little in deterring use.
However, our debates need more honesty. Those favoring liberalizing
marijuana policy ought to stop inferring that marijuana is harmless; it
is not. Those who believe possession should remain a crime need to
acknowledge that most adult occasional users are not harmed, and should
be prepared to defend with data the belief that criminalizing
possession is the best way to avoid harm.
Mitigating Dependence
Wayne
Hall is a professor of public health policy at the School of
Population Health at the University of Queensland in Australia.
What effect would marijuana legalization have on dependence?
Some people remain skeptical about whether marijuana dependence
exists but let’s assume that it does and that it affects around 1 in 10
of those who use marijuana. The effects that legalization has on
marijuana dependence depend critically on what we mean by the term.
If we mean replacing imprisonment with a fine as the penalty for
using marijuana then legalization would have little effect on
dependence. Evaluations of this policy in 11 U.S. states in the 1970s
and 1980s found little or no effect on rates of use among adolescents
and adults.
There is more debate about the effects of allowing a de facto legal
marijuana market as the Netherlands has done since 1983 in tolerating
the sale of small amounts of marijuana in coffee shops. Marijuana use
increased in the Netherlands in the 1990s, but this was also the case
in the rest of Europe, and policy analysts disagree about whether rates
of use increased faster in the Netherlands than elsewhere.
If by legalization we mean making it legal to use, grow and sell
marijuana then our task becomes more speculative because no modern
country has adopted this policy. It seems common sense that legalizing
marijuana use and sales would lead to more people using it regularly
and this would probably mean more marijuana dependence.
Nonetheless it is difficult to say how much use may increase because
there are options for reducing use under a legal market that are not
now available. For example, we could tax marijuana to set the price at
a level that discourages casual use, regulate its THC content, restrict
sales to minors, include a health warning on packs and advise users on
ways to reduce dependence risks (e.g. by using less than weekly). These
possibilities make it difficult to predict the effect that a legal
market would have on rates of marijuana dependence.
Marijuana dependence should be taken into account in considering
whether we should legalize marijuana in any of these ways. But this
concern also needs to be weighed against the costs of current policy,
that is, the creation of perverse incentives to produce more potent
marijuana, the widespread disregard of legal prohibition on marijuana
use that could contribute to a decline in respect for law and policing;
the unregulated access of minors to marijuana; and the social and
economic costs of a large marijuana black market.
Not Your Grandfather’s Pot?
Mark
A.R. Kleiman
is a professor of public policy at U.C.L.A., the editor of the Journal
of Drug Policy Analysis and the author of “Against Excess: Drug Policy
for Results.” His new book, “When Brute Force Fails: How to Have Less
Crime and Less Punishment,” will be published later this summer.
One of the standard arguments against the legalization of cannabis
is that “this is not your grandfather’s pot”: cannabis, say the drug
warriors, is much stronger now than it was a generation ago. It is,
therefore, much more dangerous, and must remain prohibited.
That argument is a few bricks shy of a full load. Here are some of
those bricks.
1. The average gram of cannabis sold today contains much more
Δ-9-trahydrocannabinol (THC) than the average gram sold in 1970, though
there has always been some highly potent product available.
2. Emergency-room visits and treatment admissions related to
cannabis have increased, though the number of self-reported cannabis
users hasn’t.
3. If the only change were in potency as measured by THC content,
users could (and do) compensate by smoking smaller quantities.
4. But contemporary cannabis also has a much higher ratio of THC
(which tends to induce anxiety) to cannabidiol (CBD, which tends to
relieve anxiety). That would be expected to create a higher rate of
panic attacks.
5. Whether high-THC, high-ratio pot is also more habit-forming than
other pot remains unknown. Increased treatment admissions might come
from increased enforcement pressure against users. Or perhaps a
cannabis habit is harder to live with than it used to be because the
cannabis experience is more disturbing.
6. If cannabis were made legal, restrictions could be put both on
potency and on the THC/CBD ratio. So rising potency makes no sense as
an anti-legalization argument; if anything, less-potent legal pot would
be expected to substitute for the more-potent pot that would remain
illegal.
7. Any sort of flat-out legalization would risk a large increase in
the number of very heavy users. A legal cannabis industry, like the
legal alcohol industry, would derive more than half its revenue from
people with diagnosable substance abuse disorders. Telling marketers
they can get rich by creating disease is dangerous.
8. Instead we could choose a “grow your own” policy that would allow
production for personal use or by small nonprofit cooperatives, but
forbid commercial sales.
Cannabis policy is fascinating because so many people smoke the
stuff, but whatever we do about cannabis will leave us with most of the
nation’s drug abuse problems, which center on alcohol, and most of the
nation’s drug-market and drug-enforcement problems, which center on
cocaine, methamphetamine and heroin.
Lessons From the Dutch
Peter
Reuter is a professor at the School of Public Policy and the
Department of Criminology at the University of Maryland.
Experimenting with marijuana has long been a normal part of growing
up in the U.S.; about half of the population born since 1960 has tried
the drug by age 21. Perhaps one out of six has used it for a year or
more. This statement is increasingly true of other Western countries
such as Australia and Britain.
Over the last decade most of these countries have seen three trends;
sharp increases in the number of marijuana users seeking treatment, in
the potency of the marijuana consumed and in the number of arrests. For
example, in the European Union the number of people entering treatment
programs for marijuana dependence tripled between 1999 and 2005. In the
U.S., the potency of seized marijuana has steadily increased since the
late 1970s, while arrests for simple possession have tripled since 1991
to 750,000.
Are these trends connected? Given that marijuana research is almost
as scarce as drug-free communities, all that is available is moderately
informed speculation. A recent book that I co-authored, “Cannabis
Policy: Moving Beyond the Stalemate,”
identifies five other factors that may play an influence in this. There
is also no direct evidence that potency makes a difference to how much
the drug hurts users’ health; most users titrate their dose with higher
THC.
What would happen if the drug were legalized? The Dutch de facto
legalization of sale through coffee shops is the closest available
experience. The most striking observation is that marijuana use in that
country is lower than in many other European countries and a lot lower
than in the United States; 6 percent of 15- to 64-year-olds in Holland
had used marijuana in the past year, compared to 11 percent in the U.S.
Legalization in the U.S. might be a much more commercial matter than
in pragmatic Holland, where the government created a legally ambiguous
regulatory system with minimal court oversight. The U.S. might find it
hard to prevent producers from using their First Amendment rights to
actively promote the drug. A way of avoiding this would be to remove
prohibitions on growing for your own use and for gifts to others. No
doubt there would still be a black market but it would allow access to
marijuana without creating a full commercialization. Probably this
would lead to a modest increase in the number of people who use the
drug, which needs to be weighed against the elimination of 750,000
arrests for simple possession.
The Tobacco Precedent
Norm
Stamper was Seattle’s
police chief from 1994 to 2000. He is a member of Law Enforcement
Against Prohibition and the author of “Breaking Rank: A Top Cop’s
Exposé of the Dark Side of American Policing.”
Any law disobeyed
by more than 100 million Americans,
the number who’ve tried marijuana at least once, is bad public policy.
As a 34-year police veteran, I’ve seen how marijuana prohibition breeds
disrespect for the law, and contempt for those who enforce it.
Let’s examine arguments against legalizing marijuana: use and abuse
would skyrocket; the increased potency of today’s marijuana would
exacerbate social and medical problems; and legalization would send the
wrong message to our children.
It’s reasonable to expect a certain percentage of adults, respectful
or fearful of the current prohibition, would give pot a first try if it
were made legal. But, given that the
U.S. is already the world’s leading per capita marijuana consumer
(despite our relatively harsh penalties), it’s hard to imagine a large
and lasting surge in consumption. Further, under a system of regulated
legalization and taxation, the government would be in a position to
offer both prevention programs and medical treatment and counseling for
those currently abusing the drug. It’s even possible we’d see an actual
reduction in use and abuse, just as we’ve halved
tobacco consumption through public education — without a single
arrest.
Potency? Users, benefiting from the immutable law of supply and
demand, have created huge market pressure for “quality” marijuana over
the past few decades. Legalization opponents are correct that “today’s
weed is not your old man’s weed.” But the fear-mongers miss the point,
namely that stronger strains of marijuana are already out there,
unregulated by anything other than market forces. It’s good that
responsible consumers know to calibrate their consumption; they simply
smoke less of the more powerful stuff. But how about a little help from
their government? Purchase booze and you have access, by law, to
information on the alcoholic content of your beverage, whether it’s .05
percent near-beer or 151-proof Everclear.
Perhaps the biggest objection to legalization is the “message” it
would send to our kids. Bulletin: Our children have never had greater
access to marijuana; it’s easier for them to score pot than a six-pack
of Coors. No system of regulated legalization would be complete without
rigorous enforcement of criminal laws banning the furnishing of any
drug to a minor.
Let’s make policy that helps, not handcuffs, those who suffer ill
effects of marijuana or other drugs, a policy that crushes the illegal
market — the cause of so much violence and harm to users and non-users
alike.