May 24, 2013, Atlanta, Georgia--Last Monday, Bill Keller asked in the New York Times "How to Legalize Pot." Ironically, that very weekend 50 state leaders and others met in Atlanta to work on that very problem, with a focus on preventing legalization from increasing use by youth. With inspiration from a keynote address by President Jimmy Carter and supported by leading academic experts, those assembled produced some answers, but at least as many questions.
Sponsored by National Families in Action, the workshop aimed to help Colorado and Washington leaders, whose voters fully legalized marijuana last November, conceptualize ways to prevent a commercial marijuana industry from targeting children, like the alcohol and tobacco industries do (although they vehemently deny it). The workshop also sought to help leaders from other states find alternative policies that neither legalize the drug nor criminalize possession.
When it appeared that California voters would be the first to legalize recreational pot in 2010, National Families in Action created But What about the Children and invited experts in preventing underage use to answer this question: "Knowing what you know now, had you been able to write the tobacco control law when cigarettes were first introduced or the law that repealed Prohibition, how would you have prevented these industries from targeting kids?" Their answers led to 12 Provisions that any law legalizing marijuana should consider including:
1. a complete ban on advertising
2. a penalty fee on the marijuana industry for every underage user
3. automatic repeal of legalization if underage use exceeds 2012 levels (but a tax break if it dips below them)
4. no marijuana product placements, sponsorships, point-of-purchase marketing, or depictions in entertainment venues
5. an industry-financed fund to pay for treating marijuana addiction, injuries, and health problems, so taxpayers won't have to pick up the tab
6. a state agency to tax and regulate the marijuana industry, including marijuana purity and potency
7. licensed growers, distributors, and retail stores that sell only marijuana and nothing else
8. until science establishes a level indicating marijuana impairment, a ban on driving with any marijuana in the systems of drivers or passengers
9. a ban on people coming to work or school with marijuana in their systems
10. no marijuana smoking where tobacco smoking is banned
11. marijuana controlled by the Food and Drug Administration like tobacco is now, and
12. a Surgeon General's report on the impact of marijuana on health and well-being.
President Carter, who supports all 12 provisions, stressed two in his remarks. "I hope that Colorado and Washington, as you authorize the use of marijuana, will set up very strict experiments to ascertain how we can avoid the use of marijuana. . . There should be no advertising for marijuana in any circumstances and no driving under the influence."
He said he believes these experiments will fail in Colorado and Washington and that he hopes other states will not legalize the drug. "I do not favor legalization," President Carter said. "We must do everything we can to discourage marijuana use, as we do now with tobacco and excessive drinking. We have to prevent making marijuana smoking from becoming attractive to young people, which is, I'm sure, what the producers of marijuana....are going to try and do."
Neuroscientists from Wake Forest University and Duke University medical schools explained why it is crucial to prevent young people from using pot. "Adolescence is a critical period of brain development," said Wake Forest's David Friedman, Ph.D., "and marijuana use has profound effects on brain development. Chronic use impairs short-term memory, attention, executive function, decision-making, learning, and in vulnerable individuals can produce psychosis, including schizophrenia," he added. "Duke's Rochelle Schwartz-Bloom, Ph.D., cited a number of recent studies reporting that adults who start smoking pot before age 18 are significantly more likely to have cognitive problems (including a drop in IQ), anxiety and psychotic disorders, and testicular cancer."
Tom McLellan, Ph.D., founder/director of the Treatment Research Institute and former deputy director of the Obama Administration's White House Office of National Drug Control Policy, said 23 million Americans are addicted to alcohol or other drugs, while 40 million engage in harmful use and are defined as having a substance abuse disorder (SUD). He pointed out that the treatment system for drug addiction is built on a false model (you become addicted, you get treated, you're "cured"). But addiction is a chronic condition like diabetes or hypertension and must be medically managed long term. The Affordable Health Care Act is changing the way addiction and SUDs are dealt with in recognition of this, he said.
Epidemiological research shows the younger children are when they initiate use, the more likely they'll become addicted--and lifetime customers. David Jernigan, Ph.D., associate professor at Johns Hopkins Bloomberg School of Public Health and director of the Center on Alcohol Marketing and Youth, cited eight lessons learned from alcohol that can be applied to marijuana:
1. Understand that marijuana is no ordinary commodity
2. Don't let governments get drunk on revenues
3. Build a control system based on the three "best buys" of economic availability via high taxes, social availability via constraints on marketing, and physical availability via licensure or monopoly systems
4. Control the size and power of the industry
5. Ban marketing
6. Create and safeguard state-run monopolies
7. Fund a robust policy research portfolio on the marijuana experiments
8. Support a social/popular movement for marijuana control.
University of Virginia Law School professor Richard Bonnie, L.L.B., stressed that "promoting marijuana is contrary to public policy. Do NOT concede that the First Amendment ties your hands unless and until the Supreme Court says so." Other speakers pointed to the aggressive efforts both tobacco and alcohol have made to market to children and how successful those efforts are: some 60 percent of new smokers and more than 80 percent of new drinkers every year are under age 18 and 21, respectively.
These industries target other vulnerable populations as well, noted Adewale Troutman, M.D., president of the American Public Health Association. "Like President Carter, our association also opposes the legalization of marijuana," he told participants. He said he worries that a commercial marijuana industry will saturate poor and minority communities with advertising the same way alcohol and tobacco companies saturate them.
Carnegie Mellon University Heinz College professor Jonathan Caulkins, Ph.D., and lead author of Marijuana Legalization: What Everyone Needs to Know, offered predictions about the uncertain future of legal marijuana: consumption will be concentrated among daily or near-daily users; production costs will fall sharply; taxes cannot offset the decline in price; the "exports" market could be 50 times greater than in-state sales; state and local police make more than 90 percent of marijuana sales arrests but there are not enough federal law enforcement officers to fill in for them; more states will legalize; and time will prove at least some of his predictions wrong.
President Carter pointed out that while he opposes legalization, he doesn't want people, especially young people, to be imprisoned for low-level marijuana offenses. That's why he called for decriminalization 35 years ago when he was president. He said he "opposes permanent records for people with marijuana use" but believes a marijuana arrest should have consequences.
Patrick Kennedy, former Congressman, and Kevin Sabet, Ph.D., former Obama administration drug policy senior advisor to the director, presented Project SAM (Smart Approaches to Marijuana). SAM maps out a middle road between marijuana legalization and incarceration, and President Carter endorsed it.
Seven times more Americans age 12 and older use alcohol than marijuana. If legalization states don't draw up regulations that are tougher than those regulating alcohol and tobacco, we can expect to see huge increases in marijuana use, especially among children. They have a daunting task.