How “Smart Approaches to Marijuana” Misses the Point

CANNABIS CULTURE – I was reading through a .pdf by “Smart Approaches to Marijuana” (SAM), where they review the apparent negatives of cannabis legalization. The organization’s byline is “Preventing another big tobacco”, so as you can imagine, there’s a lot of alarmist language used throughout the document.

There’s a lot of information to parse through, so I will try and break it down into its main claims. I will also focus mostly on the actual claims being made rather than the tone of the work. I will also go through the main claims, rather than all of the document. Now, being fair, there are some reasonable concerns in the document; but as with many of these things, the genuine concerns are masked by some unusual logical leaps. Sometimes there’s a grain of truth, but covered by a series of half-truths and misleading language. Anyway, onto SAM’s work …

“Preventing another big tobacco”

I just had to pick up on this and elucidate further. The idea that cannabis is similar to tobacco or even alcohol as a substance is pretty unscientific. This graph, which we published last week (‘Busting the Overdose Myth’), seems to illustrate this point quite well:

One of the reasons why tobacco, heroin, alcohol and cocaine are such profitable businesses is because they are physically addictive, or can become so with repeated, long-term exposure in the case of alcohol. Cannabis does not seem to have the same drastic, damaging biological effects many other drugs have. Also, the long-term effects of regular or even moderate cannabis use has not been studied (which is no different from many other drugs made by many big pharmaceuticals – OxyContin, anyone?), so making any broad claims is for the moment not a wise thing to do. However, the endocannabinoid system (ECS) works in a very different manner, and seems to break down natural phytocannabinoids very efficiently – so efficiently, that a poisonous overdose on cannabis alone is virtually impossible.

I am sympathetic to the idea of preventing the cannabis plant from becoming another big business and the cannabis industry looking a bit too much like the big pharmaceutical, tobacco and alcohol industries. I don’t know if making cannabis illegal or clamping down on its use prevents this from happening, but it seems to me that making cannabis illegal already puts it in the hands of monopolists. This means that only a select few drug companies can work on making cannabinoid-derived medications, as only they have the equipment and means to go through the regulatory hurdles that are required to work on the plant. Another argument is that making cannabis illegal and controlling cannabis it too much puts it in the hands of people who are willing to defend their share of the market violently – the ultimate big business barons, who hate competition.

As for cannabis arrests being mostly being concentrated amongst PoCs, perhaps it’s time for departments to stop arresting them for cannabis?

Selling to minors, p. 4

This is admittedly an issue, but one that can be solved mostly by joint-up regulation as we do with tobacco, alcohol and many other things. There are lots of establishments that have sold to minors, wittingly or not. Cannabis is no different in this regard.

“Alcohol consumption not decreasing”

To quote the two claims:

  • “Researchers from Oregon State University found that college students under the age of 21 who are binge drinkers have been one of the primary groups of marijuana users after legalization (Darling, 2017).
  • The gallons of alcohol consumed in Colorado since marijuana legalization have increased by 8% (Colorado Department of Revenue [CDR], Colorado Liquor Excise Tax, 2017).”

Now, the relationship between alcohol and cannabis consumption is complex, and there is a lot of conflicting data out there. I will quote liberally from the Lift News article, ‘Will legal marijuana lead to decreased alcohol sales?’:

Numerous sources over that past decade have dabbled with the concept of marijuana as a substitute to alcohol. The follow describe their methods and the evidence to back their claims:

Higher minimum drinking age increases marijuana use – By raising the minimum drinking age marijuana use increased among young adults who were forced to continue acquiring either liquor or marijuana on the black market. (T. Lemieux, 2001)

Nearly 5% decrease in beer sales following legalization – Mathematical modelling using 20 years of data from 1990-2010 has been analyzed to determine the economic relationship between marijuana and alcohol. The results suggest a nearly 5% decrease in beer sales should the estimation hold true. (D. Mark Anderson, 2013)

Marijuana use decreases at age 21 – This study from the Journal of Health Economics demonstrates the significant drop in marijuana use as individuals turn 21. This would suggest that individuals are choosing to drink alcohol instead of using marijuana. (Benjamin Crost, 2012)

Less traffic fatalities following cannabis legalization – These authors found a significant decrease (7.2-13.2%) in traffic fatalities related to the legalization of recreational marijuana. “The negative relationship between the legalization of medical marijuana and traffic fatalities involving alcohol lends support to the hypothesis that marijuana and alcohol are substitutes.” (D. Mark Anderson, 2013)

Marijuana and beer spending comes from the same budget – These authors note a correlation between purchases that demonstrates a shared budget between a consumers choice between alcohol OR marijuana. The gap is noticed mostly among casual users. (Clements, 2014)”

The article also mentions Colorado specifically:

Some reports are showing fluctuations between markets such as Colorado where beer and cannabis have been competing on a casual basis through the black market long before official legalization. This may suggest that the impact of cannabis legalization on liquor sales will not be heard in similar markets such as British Columbia (Larson, 2014).”

Alcohol is generally far more accepted in Western societies, so it would stand to reason that many places with an established drinking culture would see no major decrease in alcohol sales, even if cannabis is legal. There is also likely to be a short-term spike in cannabis consumption, as the overall data is actually being measured thanks to cannabis being legal – it being on the black market tends to hide a lot of data in the first instance. This is likely to reflect on the ER visits stats as well – people are being more open and honest about their cannabis consumption.

I also wonder how many of these emergency ER visits were generally non-dangerous. “Marijuana poisoning” could mean someone who used a little bit too much, feels uncomfortable and paranoid, and ends up sitting with someone in a hospital with a hot drink of some sort. As this report by the Rocky Mountain HIDTA report states (in capital letters, no less) on page 79:

“POSSIBLE MARIJUANA EXPOSURES, DIAGNOSES, OR BILLING CODES IN ANY OF LISTED DIAGNOSIS CODES: THESE DATA WERE CHOSEN TO REPRESENT THE HD AND ED VISITS WHERE MARIJUANA COULD BE A CAUSAL, CONTRIBUTING, OR COEXISTING FACTOR NOTED BY THE PHYSICIAN DURING THE HD OR ED VISIT. FOR THESE DATA, MARIJUANA USE IS NOT NECESSARILY RELATED TO THE UNDERLYING REASON FOR THE HD OR ED VISIT. SOMETIMES THESE DATA ARE REFERRED TO AS HD OR ED VISITS WITH ANY MENTION OF MARIJUANA.” – COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, MONITORING HEALTH CONCERNS RELATED TO MARIJUANA IN COLORADO: 2014”

Medical codes are often arbitrary and assigned by billers rather than the actual medical practitioners. Cannabis may also increase the effects of other drugs, but on its own is unlikely to be dangerous for most people. Also, it seems that the “I was at college” effect is reflected in the data – cannabis consumption generally decreases for most people after the age of 21.

The data surrounding cannabis use and traffic accidents is murky at best. Remember, cannabis metabolites can show up in blood test reports even if the person who had a traffic accident was not consuming cannabis at the time. Many of those who also had traffic accidents may have also had other

The increase in butane hash oil (BHO) explosions and the black market, p. 5

When people in other states do not have access to a legal source of cannabis, it is not surprising if other states where cannabis is legal try to fulfill that demand. The only way to stop this from becoming a problem is by making cannabis legal throughout the U.S.. Letting Oregon’s cannabis producers do business with other states and importing their produce legally seems the more sensible option.

As for the increase in BHO explosions could be avoided by making concentrates more readily available – many states restrict their sales to a much greater degree than they do cannabis flower.

Increasing crime rates

Linking an increase in crime to cannabis use alone is tenuous at best. The study ‘No correlation between medical marijuana legalization, crime increase: Legalization may reduce homicide, assault rates’ tracked crime rates across the U.S. between 1990 and 2006, and it does not look like such a correlation can be claimed. Granted, the data in this study could be a little dated, but it seems that there are many other studies with more recent corroborate these findings.

An increase in school suspensions/expulsions, p. 3

Most data collected on drug-related school suspensions and expulsions looks at all drugs, and does not separate cannabis out into any category. We do not know if all of these expulsions are cannabis-related.

An increase in opioid deaths in Colorado since cannabis legalization in 2012, p. 8

This is perhaps one of the more contentious claims in the document. However, all the data I have seen suggests that the opposite is the case. The study, ‘Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010’ states:

Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P < .001). In secondary analyses, the findings remained similar.”

As for Colorado specifically, the state saw a massive increase in opioid overdoses between 2001 and 2016, a period when prescription opioid prescriptions were rife – cannabis has been legal in Colorado since 2012, and associating an increase in opioid overdoses to cannabis legalization seems stretched. Perhaps the increase is due to the explosion in the numbers of people being prescribed opioids rather than cannabis legalization. This graph, made researchers from the University of North Texas, University of Florida and Emory University, also shows a significant decrease in opioid overdoses in Colorado since cannabis legalization:

Source

Honestly, there is so much information missed out in the document that I would need to make an equally lengthy document to look at most of the claims, many of which seem to be half-truths at best. I have only gone over the beginning sections, and it would take more than a couple of thousand words to assess SAM’s report. The report also seems to take a negative view of not-so-wealthy people who use cannabis as an income stream, but that’s just one of many of concerns regarding this document. I do not think it’s entirely accurate to say, “There are no problems and things we have to consider with cannabis legalization whatsoever”, but I also do not wish to say “Cannabis legalization is all bad and horrible” when the data shows otherwise, or there is a huge amount of conflicting data. The report does not seem very even-handed in its presentation of the evidence, and it suffers very much because of this. There are also a huge number of potential medical applications for cannabis – neglecting them due to wrongheaded policies is just throwing the baby out with the bathwater.

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