The Sunday Baltimore Sun (December 1) ran a front-page article on progress made toward enacting recreational marijuana legalization in Maryland for adults. (Medical marijuana was legalized in 2014.) The article begins by acknowledging that the likelihood of legalizing recreational marijuana use for adults “is growing dim for 2020,” with the bipartisan work group still in “investigative mode.” The article goes on to explain that state lawmakers are looking into a variety of issues: 1) setting tax rates, 2) identifying marijuana-influenced driving, and 3) expunging old convictions (presumably of cannabis possession).
These are no doubt important issues, though it is interesting that nowhere on this list is the concern that marijuana legalization will increase marijuana-related problems. As we have noted before [see www.wherewhatwhen.com/authors/view/michael-kidorf] marijuana is not a benign drug. While occasional marijuana use poses only minor risks, chronic marijuana use is associated with a number of well-documented health concerns. Among these concerns are the development of cannabis use disorder, cognitive and memory difficulties, psychological and physical problems, diminished educational and employment achievements, and more motor vehicle accidents. Teenagers and adults with ADHD, psychiatric conditions, or a history of trauma are particularly vulnerable to experiencing these problems.
The Effects of Legalization: a Study
The question is whether legalizing marijuana use for adults will lead to more marijuana-related problems. A recent scientific paper, published in the Journal of the American Medical Association Psychiatry, addressed an aspect of this concern. The authors, well-respected epidemiologists from New York University School of Medicine, examined data from the National Survey on Drug Use and Health from 2008 to 2016. Essentially, they used sophisticated statistical approaches to compare rates of marijuana use and cannabis use disorder before and after the enactment of recreational marijuana legalization in four states: Colorado, Washington, Alaska, and Oregon.
The report had good and bad news for proponents of marijuana legalization. Teenagers (ages 12 to 17) reported only small (non-significant) increases in marijuana use following legalization. While this result was somewhat unexpected, it is understood that marijuana remains illegal in these states for those under the age of 21. The authors also wondered if the consistent use of marijuana before and after legalization reflected what is often called a “ceiling effect”: Marijuana is used so frequently by this age group that there is little room to show an increase in consumption. However, the data for this age group did show an increase in the percent of teenagers who develop cannabis use disorder, suggesting that changes in legislation had a disproportionate damaging effect on adolescents who are more vulnerable to addiction.
Because marijuana in these four states was legalized only for adults, most of the increases in marijuana use were observed for adults (i.e., 26 years or older), as was expected. For example, following legalization, adults were much more likely to use marijuana, to use marijuana frequently (i.e., at least 20 days per week), and to develop a cannabis use disorder. While it is not clear what in particular accounts for these changes, the authors considered a number of explanations that include increased marijuana availability and access, lower prices, and changes in perception of marijuana as a harmful drug. They also wondered if the enhanced potency of marijuana, together with the reasons listed above, may have turned more casual marijuana users into people with cannabis use disorder.
Black Market Worries
Back to the Baltimore Sun article, if I remember correctly, the newspaper allotted some space to a marijuana legalization advocate who expressed considerable worry that delays in legalization would only further strengthen the “black market.” We should recall that one of the strongest reasons advocated for marijuana legalization is that it will eliminate the illegal selling of marijuana and thus any violence that comes along with it. The general argument is that legal access to marijuana will remove the need for people to purchase it illegally. Police will be able to spend their time on more urgent matters and stop harassing pot smokers.
While this is only my personal opinion, and I am certainly not an expert in the area of drug use and black markets, it has never made sense to me that legalizing marijuana will eliminate the black market. My primary concern is that states with laws legalizing marijuana will see more people cultivating their own marijuana. People illegally growing and selling their own marijuana enjoy many advantages when compared to those licensed by the state. They do not pay licensing fees, they do not require regulation, and they are not taxed.
Why would a pot smoker want to buy marijuana on the black market if it can be purchased at a licensed dispensary? I can think of many reasons: First, not everyone wants to go to a dispensary. Some people who smoke marijuana, especially those with prominent positions in the community, might prefer to remain anonymous. Second, the black market can sell marijuana at a considerably lower price than dispensaries. People who develop cannabis use disorder, for example, value acquiring the drug as inexpensively as possible. Third, the black market can grow and offer marijuana with more potency, which provides an edge to the competition. If you do not think potency matters, take a stroll through Baltimore City, and you will see that Fentanyl has almost fully replaced heroin as the drug of choice for chronic opioid users. And finally, the black market offers clients an opportunity to mix marijuana with other drugs to enhance its intoxicating effect. In fact, I wonder if legalizing marijuana will actually strengthen the black market, rather than reduce it. My guess is that research is on its way to evaluate this issue.
There is no doubt that our legislative bodies are enamored by the enormous financial gains that come from taxing marijuana use. That Colorado recently surpassed one billion dollars in marijuana tax revenue was all over the news. Yet, while it is easy to measure the financial gain from taxing marijuana, it is relatively harder to assess the societal costs: higher rates of addiction and other psychiatric concerns, more motor vehicle crashes and hospital visits, and lower work productivity, just to name a few. There is a price tag to these problems. I truly hope that our bipartisan team has a formula to weigh the financial benefits with the societal costs. Based on this article in Baltimore Sun, however, I kind of doubt it.
Dr. Kidorf is Associate Director of Addiction Treatment Services and Associate Professor, Psychiatry and Behavioral Sciences, at Johns Hopkins University School of Medicine.
