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November 2, 2013

Might public health be significantly improved by marijuana legalization?

The provocative question in the title of this post is prompted by this notable op-ed by Jacob Sullum at Forbes headlined "Economists Predict Marijuana Legalization Will Produce 'Public-Health Benefits'."  Here are excerpts:

In their 2012 book Marijuana Legalization: What Everyone Needs to Know, Jonathan Caulkins and three other drug policy scholars identify the impact of repealing pot prohibition on alcohol consumption as the most important thing no one knows.  Are cannabis and alcohol complements, so that drinking can be expected to increase along with pot smoking?  Or are they substitutes, implying that more pot smoking will mean less drinking?  For analysts attempting to calculate the costs and benefits of legalizing marijuana, the question matters a lot, because alcohol is considerably more dangerous than marijuana by most measures.  If the two products are complements, states that legalize marijuana can expect to see more consumption of both, exacerbating existing health and safety problems.  But if the two products are substitutes, legalizing marijuana can alleviate those problems by reducing alcohol consumption.

Reviewing the evidence in the Journal of Policy Analysis and Management, Montana State University economist D. Mark Anderson and University of Colorado economist Daniel Rees find that “studies based on clearly defined natural experiments generally support the hypothesis that marijuana and alcohol are substitutes.” [Study Here] Increasing the drinking age seems to result in more marijuana consumption, for instance, and pot smoking drops off sharply at age 21, “suggesting that young adults treat alcohol and marijuana as substitutes.”  Another study found that legalizing marijuana for medical use is associated with a drop in beer sales and a decrease in heavy drinking.   These results, Anderson and Rees say, “suggest that, as marijuana becomes more available, young adults in Colorado and Washington will respond by drinking less, not more.”

That conclusion is consistent with earlier research in which Anderson and Rees found that enacting medical marijuana laws is associated with a 13 percent drop in traffic fatalities. [Study Here]  That effect could be due to the fact that marijuana impairs driving ability much less dramatically than alcohol does, although the fact that alcohol is more likely to be consumed outside the home (resulting in more driving under its influence) may play a role as well....

Anderson and Rees note that UCLA drug policy expert Mark Kleiman, who co-wrote Marijuana Legalization and has been advising Washington’s cannabis regulators, recently described a worst-case scenario for legalization featuring an increase in heavy drinking, “carnage on our highways,” and a “massive” increase in marijuana consumption among teenagers.  “Kleiman’s worst-case scenario is possible, but not likely,” they conclude.  “Based on existing empirical evidence, we expect that the legalization of recreational marijuana in Colorado and Washington will lead to increased marijuana consumption coupled with decreased alcohol consumption.  As a consequence, these states will experience a reduction in the social harms resulting from alcohol use.  While it is more than likely that marijuana produced by state-sanctioned growers will end up in the hands of minors, we predict that overall youth consumption will remain stable.  On net, we predict the public-health benefits of legalization to be positive.”

Notably, this commentary and the research it emphasizes appears only to consider the public health benefits that could result from folks substituting marijuana use for alcohol use.  I have long thought that another possible public health benefit could flow from marijuana legalization if some heavy cigarette smokers end up smoking less in total because they sometimes substitute a few joints for a few packs of cigs.  Similarly, one might further speculate that there might be a positive "reverse gateway" effect from marijuana legalization with respect to other dangerous drug use and abuse: perhaps fewer folks will try using, or end up harmfully abusing, harder drugs like ecstasy and heroin and meth and oxycodone if they can get always get a cheap and legal buzz from marijuana.

Of course, a lot of research about the use and abuse of various drugs will be needed in order to come to dependable conclusions about the full public health impact of modern marijuana reform developments.  Still, especially when everyone is understandably all worked up about the Obamacare roll-out and broader health care reform realities, it is fun to speculate that modern marijuana reforms could end up being the most consequential and positive public health development of the Obama era.

I have long been drawn to the marijuana legal reform movement due to my general affinity for expanding personal freedom and my generally disaffinity for big-government programs like the war on drugs that seem very costly and mostly ineffective.  But I have always respected the concerns expressed by serious people that pot prohibition is a public health necessity and that even modest moves toward marijuana legalization could prove costly and harmful in various ways.   Without getting too much into the weeds of an empirical debate, I wonder if those who are vigorously opposed to (or even just generally resistant to) marijuana reform movements would still oppose reform if (and when?) empirical evidence starts to show that (some? many? all?) US public health measures and metrics are improved in the wake of marijuana legalization reforms.

Cross-posted at Marijuana Law, Policy and Reform

November 2, 2013 at 10:08 AM | Permalink


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"The provocative question in the title of this post is prompted by this notable op-ed by Jacob Sullum at Forbes headlined "Economists Predict Marijuana Legalization Will Produce 'Public-Health Benefits'."

Economists would do better to continue to make false predictions about the economy instead of branching out to make false predictions about public health.

Speaking of which.........has the AMA, which consists of doctors rather than economists, said that recreational consumption of marijuana will improve public health? I must have missed that. What I'm recalling is that the AMA, while supporting research and review of pot's status as a Schedule I drug, has explicitly REFUSED to call for legalization or any other form of increased use. To quote their statement on the subject:

"[The call for further review] should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product."

So I guess I'll stick with that bunch of right-wing, Puritanical freaks in the AMA, and leave it to others to seek their health-related advice from economists.

Posted by: Bill Otis | Nov 2, 2013 11:12:50 AM

Bill Otis , your arguments are entirely unpersuasive, but keep up the fight. It's good to go down swinging!!

Posted by: anon | Nov 2, 2013 12:20:54 PM

anon --

"[Y]our arguments are entirely unpersuasive, but keep up the fight. It's good to go down swinging!!"

I agree that the view set forth in my comment is "entirely unpersuasive" to people puffing on the bong. But that really isn't my audience.

I will concede, however, that it helps to be stoned in order to think that legalization has won when pot in all forms is illegal in the vast majority of states and in federal jurisdiction.

BTW, speaking of the feds, how's the famous Hinchey Amendment doing this year? Did it even get introduced?

P.S. They're not really "my arguments." What I quoted was the AMA statement, which I had nothing to do with. But if you know more about the health effects of pot than the AMA, do tell!

Posted by: Bill Otis | Nov 2, 2013 12:47:07 PM


Posted by: Cheech | Nov 2, 2013 1:19:12 PM

Bill, a couple of follow-up question in light of your apparent affinity for AMA views in this (and other?) contexts:

1. Do you share the AMA's views "supporting research and review of pot's status as a Schedule I drug"? Do you favor/encourage the Prez and members of Congress moving forward on these fronts ASAP?

2. If the AMA were to support other legal reforms to existing federal drug laws in the name of public health, would you be inclined to accept those, too?

3. I believe the AMA is opposed to the death penalty and especially the involvement of any medical professionals in executions on public health grounds, and I also believe it favors ObamaCare on that ground too. Do you respect/agree with those views, too, or do you just champion the AMA position if and only when it gives you some support for your pre-existing views?

4. If there is not a (significant?) public health benefit from current marijuana laws, what other rationales do you think provides real support/benefits from the costly and liberty-reducing regime of criminal prohibition?

I ask all these question, Bill, because I am truly eager to know/understand what kinds of arguments and benefits defenders of the status quo embrace beyond those directly connected to public health.

Posted by: Doug B. | Nov 2, 2013 1:33:38 PM

I know the questions are directed to Bill Otis, but a couple of points:

1. There should never be any question of researching any potential drug's benefit, regardless of the drug's street legality. I would, however, decrease the politicization process by increasing the the number of private (RE: for profit) organizations that are involved in the researching and approval process for such drugs.

2 (and 3). The AMA is a two-edged sword. Any organization that has supreme authority, regardless of its professional mission, is always subject to the whims of those in power with agendas, and not necessarily to the actual professionalism of its intent. In addition, the AMA's purview's expansion to the logistics of medical care (AKA Obamacare vs. private health care) should be irrelevant; alas it is quite the opposite, and therein lies the straw man arguments that are so pervasive in this issue.

4. Where Bill and many others may disagree is the jurisdiction in which recreational drug use is administered. I have no qualms with local controls regulating its use with regard to community safety (crime, driving buzzed, child endangerment, etc.), but this should not be a federal criminal issue because a centralized power has no ability to determine local consequences as well as the localities themselves. Constitutional issues aside, the arguments need to be pinpointed rather than generalized before any form of consensus, legal or otherwise, can be obtained.

Posted by: Eric Knight | Nov 2, 2013 2:49:23 PM

Doug --

I was interested in getting your response to the five questions I asked you on this thread...


... but I didn't get any. I am, however, still interested in what you think. I believe you'll agree they are legitimate and important questions.

Nonetheless, being the Original Mr. Nicey, I'll respond to yours while hoping you return the favor.

1. As to the first sentence, sure. As to the second sentence, the Democrats had complete control of Congress and the White House for a full year after the AMA statement urging further review, and did zip, as in zilch. You're more influential with them than I by a fare-thee-well, so you're better positioned to do the prompting.

2. I might or might not be inclined to accept suggested AMA reforms. It would, of course, depend on specifically what they were. I won't be buying a pig in a poke, as no sensible person would.

3. Contrary to your view, the AMA does not take a position for or against the DP -- which is perfectly appropriate, since it has no special expertise in that area. I agree that doctors ACTING AS DOCTORS should not participate in executions. But they're not acting as doctors in that setting because executions are designed to kill, not heal. I also believe that private organizations do not trump the rule of law, see http://www.deathpenaltyinfo.org/north-carolina-supreme-court-overrules-state-medical-boards-ban-doctor-participation-executions.

As to this question: "Do you respect/agree with those views, too, or do you just champion the AMA position if and only when it gives you some support for your pre-existing views?", I would say three things.

First, you are remarkably quick to abandon the economists in favor of the doctors. That's a wise move in my opinion.

Second, I tend to give credence to the AMA in specifically medical areas, such as whether smoking pot is healthful, but not in other areas, such as moral questions (the DP) or predominantly political ones (Obamacare).

Third, let me turn the question back to you: Do you respect/agree with the AMA's refusal to endorse legalization, or do you sweep the AMA position under the rug when it undermines support for your pre-existing views? Is that why your entry cites the views of economists instead of doctors on the question of the public health effects of pot?

4. My answer to that is too long for halftime of the football game, but, preliminarily, I would refer you to the tape of our Ohio State debate a few years back. It's readily available on YouTube.

Posted by: Bill Otis | Nov 2, 2013 2:56:45 PM

Sorry for not being aware of your questions on the other thread -- 'twas a busy week for me. I will turn to them after this comment here.

More generally, I suspect we both agree that doctors, economists, law professors, elected officials have various distinct (and often self-serving) perspectives on these kinds of public health issues, especially when the question is NOT merely whether "smoking pot" is healthful, but rather whether, as my post title queries, overall public health might be significantly improved by marijuana legalization.

Especially as we both watch a sport we know is very bad for the health of its participants --- football --- it is critical to keep a clear eye on the distinction between public health issues and public policy issues more broadly. Indeed, given that there is good reason to believe that alcohol prohibition improved public health (at least at the outset in the early 1920s), and that we keep legal lots and lots of harmful materials and activities, all I am trying to do here is probe where and how public health fits in to the broader marijuana reform debates.

Finally, I think the pot legalization debate could/would be much more informed and could maximize benefits while minimizing harms as public policy evolves if the AMA's nuanced approach to public health research were adopted by the feds. Absent sound work on these fronts at the federal level, the almighty dollar --- rather than well-meaning doctors --- will end up driving policy reforms and practices.

Posted by: Doug B. | Nov 2, 2013 4:18:02 PM

There is a cannabis receptor in the brain. Why?

Posted by: Supremacy Claus | Nov 2, 2013 10:20:29 PM

Doctors:AMA = Lawyers:ABA; i.e. both organizations are run by "assholes", both in Chicago, both are whores in bed with Obama, both are run by Ivy indoctrinated staff, making them left wing organizations, totally unrepresentative of their constituents who are right centrist.

Most toxic effect of the AMA on the law? Roe v Wade was copied from an AMA resolution of 2 years before, resulting in the mass slaughter of innocent viable third trimester babies by the ton.

AMA and the law, not again. They will put on trial, and expel, as a quasi-government organization, any member who assists in the death penalty. They are way out left wing ideologues. That member then has to self publish the expulsion in all future license renewals, and job applications.

Posted by: Supremacy Claus | Nov 3, 2013 1:32:26 AM

Bob Marley is going to get his wish, his request, his demand. Were he alive to see the free pot states he would be singing Woo, Woo, Woo! Right here in Sweet Jamaica. Soooo, Legalizeee ....

Posted by: Liberty1st | Nov 4, 2013 6:01:41 PM

Love the title.. Improve or Not, keep us posted.

Posted by: The Mind Relaxer | Nov 5, 2013 10:46:53 AM

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