Mistakes are inevitable. Repeating mistakes is unnecessary. Commercial legalization of alcohol was a mistake; let’s try something different for cannabis.
Stop right now and read Rob MacCoun’s essay on cannabis legalization. Whether or not you’re actually interested in the issue – more exciting than it is important – Rob’s piece shows how policy analysis is done. In particular, he focuses on what advocates almost always deny: the fact that policy choices involve tradeoffs among competing values.
Let me offer one technical amendment to what Rob says: in my view, high taxes – as long as they allow prices close to current illicit prices – will decrease health risk and also increase revenue.
As predicted, the Wall Street Journal refused to correct the Bennett/White op-ed that strongly implied (without quite stating explicitly) that I believe cannabis legalization would sextuple the rate of cannabis dependence to 16.2 million. (My previous whining about that here.) However, the Journal did publish my letter, with only helpful edits and an accurate headline that’s a pretty good haiku-length statement of the case.
Like the original article, the letter is behind a paywall, so – on the off chance that some RBC readers don’t pay tribute to the Murdoch empire – I’ve pasted it in below.
Legalizing Pot Carries Risks, but So Does Prohibition
To the Editor:
William Bennett and Robert White (“Legal Pot Is a Public Health Menace,” op-ed, Aug. 14) cite my research as support for their claim that the legalization of cannabis would mean creating 16.2 million “marijuana addicts.”
Not only is the attribution false; the claim it purports to buttress is absurd. I made no such prediction, and the idea that legal cannabis could create more addicts than legal alcohol doesn’t pass the giggle test. It would be astounding if the actual number were one-third as high as Messrs. Bennett and White project
Cannabis legalization on the current alcohol model—low taxes and loose regulations—would indeed risk a large increase in the extent of cannabis abuse. That is why some of us are working hard for high taxes and sensible regulations on cannabis, as well as stronger controls on alcohol, which is after all a much more personally and socially dangerous drug.
Cannabis legalization in any form will create some harm; every drug policy has disadvantages. But against that must be set the enormous harms from cannabis prohibition: $40 billion a year in illicit revenue, some of it going to violent criminal organizations in Mexico; tens of thousands of people in prison; and more than half a million users arrested each year.
Our goal should be to eliminate as much as possible of the damage from prohibition while minimizing the harms that would result from a badly designed legalization.
In his latest anti-cannabis-legalization screed, (behind the Wall Street Journal paywall), written with a former federal prosecutor named Robert White, William Bennett writes:
Mark A.R. Kleiman, a professor of public policy at the the university of California, Los Angeles, has estimated that legalization can be expected to increase marijuana consumption by four to six times. Today’s 2.7 million marijuana dependents (addicts) would thus expand to as many as 16.2 million with nationwide legalization.
Now, if Bennett wants to make silly predictions, and if Rupert Murdoch wants to publish them, all I can say is, “It’s a free country.” But I think I’m entitled to protest when he attributes that silliness to me. It’s hard to count how many ways that short paragraph is wrong, but the central points are simple:
1. An estimate of the possible change in quantity consumed is not an estimate of the change in the number of dependent users. Consumption can also grow because the amount consumed per dependent user increases.
2. Even most dependent users are not, by any reasonable definition, “addicts.”
3. The large estimated impact on consumption depends the factor-of-ten price decrease (to about $1-2/gm. for moderately potent product) that would result if cannabis were treated like an ordinary commodity. If taxation or production limits prevent such a drastic decrease, the effect of legalization on consumption would be much smaller.
Here’s a nice chart from Andrew Sullivan on marijuana consumption in Colorado. It illustrates a point that has been made many times by drug policy analysts such as Mark Kleiman and Beau Kilmer: The total volume of pot consumption is accounted for almost entirely by users who smoke every day or nearly every day. Envisioning how different stakeholders would respond to this evidence can be helpful both for appreciating the impossibility of value-free evidence-based policy and for understanding one of the basic dilemmas of legal marijuana regulation.
AT THE PUBLIC HEALTH CONFERENCE: “Colleagues, you can see from this chart that not all marijuana users are of equal concern to us. Some people use the drug rarely, and we know that such users tend to be high social capital individuals who could set their lives right in the unlikely event that they did develop a drug problem. So we should focus instead on these heavy users in the bottom two bars of the chart, who tend not incidentally to be people with less education, less income and poorer access to health care. The evidence we have shows that the primary risks of this drug, for example marijuana dependence, mental health problems and poor school and work performance, are concentrated in the subset of people who use every day or almost every day. Let us therefore resolve to keep the size of this group as small as possible through high taxes that discourage heavy consumption, caps on THC content that reduce the ability of the drug to promote dependence and limits on advertising and points of sale in vulnerable communities.”
AT THE CORPORATE BOARD MEETING: “Well friends, you can see from this chart that not all of our customers are of equal concern to us. We can’t make much money from the people in the top few bars of the chart, so we should focus mainly on the heavy users who provide us the bulk of our revenue. We need to move as much of the population as possible into this high-revenue bracket. So let’s all agree to press for lower taxes, higher THC content and as much advertising and as many retail locations as possible in the communities where our best customers tend to live.”
AT THE STATE LEGISLATURE: “Fellow committee members, as you know we have seen this chart twice today, once when the public health advocates visited and again when the marijuana industry lobbyists visited. Both groups agreed on the evidence but they wanted us to respond to it in opposite ways. And that’s not the end of what we have to consider. The state budget analyst’s office has calculated that almost 90% of the marijuana tax revenue we wanted from legalization comes from the people in the bottom bars of this chart. We care about public health but if we implement policies that make too many of those heavy marijuana users quit, the tax revenue hit we will take might force us to sacrifice other important priorities.”
A CNN interviewer asked Hillary Clinton about cannabis policy.
On medical use, she replied that we need more research, including research about drug interactions, but in the meantime people with serious medical conditions where there’s “anecdotal evidence” of efficacy ought to have access.
On non-medical (“recreational”) use, she said that the states are the laboratories of democracy, that two states are trying legalization, and that we should wait and see how that goes.
Perfectly reasonable answers, as far as they went, and perhaps a little bit more pro-cannabis than I might have expected from such a cautious candidate.
But they cried out for follow-up questions:
1. As President, what would you do to promote medical research on cannabis and cannabinoids? Would you tear down the barriers to research now created by federal policy: in particular, the UMiss monopoly on cannabis for research purposes and the requirement that every study receive a “grant” of cannabis from a special committee within HHS?
2. While the states are doing their experiments, to what extent should the federal government help, or at least get out of the way? Colorado and Washington are now issuing state licenses to commit federal felonies. Current banking regulations make it difficult-to-impossible for cannabis stores to have bank accounts or to take credit cards, creating a huge all-cash business that is therefore an attractive robbery target. A state that wanted to experiment with state-monopoly retailing (arguably the best approach) would currently be barred from doing so by federal law. As President, would you propose changes in the Controlled Substances Act to make state-level experiments legal?
Instead, of course, the CNN interviewer asked her whether she intended to inhale. Arrrgggghhhhhh!
How long is it going to take for the press corps to stop giggling about cannabis policy and start reporting on it?
My post about Americans for Safe Access drew the expected outraged response from its target, but it also drew an unexpected note from someone I hadn’t met before, Muraco Kyashna-tocha, who runs the Green Buddha Patient Co-Op in Seattle. With her permission, I’m posting it here.
I am the anthropologist who runs the state of Washington’s oldest medical cannabis collective. I loved your wonderful blog post on ASA. Actually, I have really enjoyed all your writings for the last year plus. You hit the nail on the head!
I made sure to pass your recent blog to Senator Jeanne Kohl-Welles who I expect to write a bill for submission early next year which will regulate medical cannabis and align the two systems into the I502 system. I have been a strong supporter of this, as well as an open strong supporter of I502.
Odd position, you might think, for a dispensary, but we’ve been trying to hold the line and deal with only authentic patients, the ones the media sees – the ones with cancer, MS etc. They aren’t easy to find among all the riff-raff. Half my clients are cancer patients who have found the “medical marijuana” explosion frightening, and they don’t tend to find themselves nor the products they really need in the current medical cannabis scene.Sincere patients are few and far between.
ASA has been a nightmare for my state. They rally “patients” – collecting their funds from those selling the medicine to those patients. Early this year they worked against all reasonable attempts to get mmj regulated. They spoke constantly to the media about “safe access” which is a euphemism and rallying cry for “Save the dispensaries.”
Dispensaries do not need saving in Washington State (as I have said frequently at hearings in Olympia) – even as patients’ rights do need securing – affirmative defense, arrest protection, small home grow allowance, etc.
I see ASA willing to throw out patients’ rights in order to secure legal dispensaries for the real folks they speak for. I feel like I bang my head against the wall all the time, so I loved this line:
accuses ASA of “relentlessly talk(ing) about the interests of patients while single-mindedly serving the interests of the sellers.
You are correct – this is what ASA does. Green Buddha looks forward to closing very shortly. (Gawd, please will the stores open and can we get serious about licensing producers? We’re at 50 as of last Tuesday)
Green Buddha is the last of the original collectives. We have no paid employees. We’re all volunteer. Average age of our patients is my age, 56.
I view ASA as one of the major impediments to my state rewriting its mmj laws and regulating the system – align it with I502. Stay the course and keep pounding on them.
So far, the only thing I see that counts as a downside surprise is the problem of misuse of edibles: little children getting into Mommy’s cannabis-laced candies and winding up in the emergency room, older kids bringing those same candies to school, and grown-ups (plus, of course, aging juveniles like Maureen Dowd) getting way, way too stoned and experiencing a very unpleasant few hours.
The problem wasn’t unexpected, in that it’s obvious that sweets are attractive to children and it’s been known for years that the “overdose” risk is higher when the latency between ingestion and feeling the effects is very long. The surprise is that edibles seem to be grabbing a very large market share, and that – for reasons unknown to me – the promised rules about dosage labeling (which could make edibles actually safer than inhaled versions once consumers learn to manage their intoxication levels) weren’t in place when the stores opened.
There has been one undoubted disaster: Levy Thomba, a 19-year-old Congolese student at a college in Wyoming, came to Denver on spring break, bought a high-dose cookie, and (apparently despite a warning issued by the retail clerk) ate the whole thing. He then jumped or fell from a balcony to his death.
That ought to – but of course won’t – silence the pot advocates who argue that “No one has ever died from taking cannabis.” Accidents are a statistically predictable consequence of any sort of intoxication, and inevitably some of those accidents will be fatal. So one identified death doesn’t count as a surprise.
In response to a reporter’s query, I looked up the comparable statistics for our primary legal intoxicant, alcohol. CDCR reports 7500 deaths per year due to alcohol-related falls (out of a total of almost 50,000 acute alcohol deaths per year, in addition to another 40,000 alcohol-related deaths from chronic disease).
Now, Colorado has 1.6% of the population of the U.S. So, assuming the rate of alcohol-induced fatal falls in Colorado is typical, in the five months since Colorado legalized commercial cannabis sales something like .016 x 7500 x 5/12 = 50 Coloradans have died from falling while drunk. So if Levy Thomba is the worst the advocates of legal availability have to show, I’d advise them to pack up their traps and go home.
On the other hand, very few of the likely bad results from cannabis legalization – all of which come down to an increasing number of adolescent and adult problem users – were ever likely to show up immediately after commercial availability began, especially in a state such as Colorado which has had virtual legalization under the “medical marijuana” mask for years. The problems to look out for will show up – if they show up – slowly, not quickly. We’ll get some indications within the first couple of years on the key question whether cannabis substitutes for alcohol or instead complements it, but even that result might not be the same in the long run as it is in the short run.
So while I laugh at the drug warriors’ desperate attempts to portray Colorado as a disaster area, the pot advocates’ blithe assurances that everything is fine remind me of the guy who jumped off the observation deck of Empire State Building. As he passed the 42nd floor on his way down, someone yelled out to him, “How’s it going?” to which he replied, “So far, so good.”
Dishonest advocacy aside, what are the actual risks of stoned driving? The answer, from what seems to be a well-done case-control study, is that driving stoned is hazardous, but much less hazardous than driving drunk. (A relative risk of 1.83 – meaning that driving a mile stoned is about as risky as driving two miles sober – strongly suggests that cannabis-impaired driving is a problem, but also that it isn’t much of a problem; the relative-risk number for alcohol is over 13.) On the other hand, the same study shows that adding cannabis or other drugs to alcohol substantially worsens the odds: alcohol-and-something-else has a relative risk of 23.
Given those numbers, and the technical difficulty of identifying cannabis-impaired driving (because impairment doesn’t track cannabinoid levels in blood nearly as well as it tracks alcohol levels) I’d propose the following rule: anyone who tests positive for cannabis on a mouth swab (which detects use within the past few hours) should be considered guilty of impaired driving if that person’s BAC is detectably different from zero. All that means is that, if you’ve been toking and drinking, you need to wait as many hours as you’ve had drinks before getting behind the wheel.
Of course, if I were advising someone personally, I’d be much more cautious: driving within six hours of using cannabis is pretty damned stupid. But the same is true of driving after a sleepless night. The question isn’t what’s imprudent; the question is what’s hazardous enough to make a serious criminal offense. So far, the numbers I see about stoned driving (in the absence of alcohol) don’t bring it across that very high threshold.
Given the long latency of THC, the “zero-tolerance” rules now being passed in some states, which making driving with any detectable cannabis on board drugged driving per se, without evidence of actual impairment, are simply a backdoor way of recriminalizing cannabis use.
Footnote A case-control study – comparing a group of drivers responsible for accidents with a random sample of all drivers – is the only way to figure out what’s really going on. The observation that, as cannabis use spreads, more crash-responsible drivers have cannabis on board tells you precisely nothing. After all, if consumption of blintzes were to increase, more responsible drivers would test positive for ricotta. You neeed a denominator, not just a numerator.
As if on cue, the day after I blasted the dishonesty of a group of cannabis advocates, comes Radley Balko to report what appears to be an even more outrageous bit of bamboozlement from the anti-pot side. It now comes out that the “stoned driver” who plowed his truck into a pair of police cars with flashing lights had a blood-alcohol content of .268%, which Balko (or at least his headline-writer) correctly identifies, using the relevant technical vocabulary, as “drunk off his gourd.” (Sometimes read as “drunk out of his gourd,” or the shorter and more graphic “sh*tfaced.”) This driver was at more than three times the legal limit of .08%.
The involvement of alcohol is hardly surprising. Drunk driving is much more dangerous than stoned driving, and the combination is worse than either drug alone.
Yes, Keith Kilbey was also at about double Colorado’s legal limit for THC. But, as Balko points out, it’s virtually impossible to believe that the cops at the scene didn’t notice that the driver was blotto; a Breathalyzer would have been routine under the circumstances. So when state police Cpl. Heather Cobler told reporters that “we believe marijuana” caused the crash, she was almost certainly being … economical with the truth. If I were running the Colorado State Police, Cpl. Cobler would have a whole bunch of ‘splainin’ to do. The credibility of police as witnesses is a key resource for law enforcement; if they routinely lie to reporters, why should jurors believe them?
But the responsibility here goes way above a corporal’s pay-grade; the department should have come forward to correct the story as soon as the toxicology results were in, rather than waiting for others to notice the falsity of the original assertion. It seems to me that reporters in Colorado should be demanding an official explanation of how the misstatement was made, why it wasn’t promptly and frankly corrected, and what institutional steps are being taken to prevent the repetition of such misconduct. Whether reporters ask or not, it’s the responsibility of the department to make the necessary inquiries and take appropriate administrative action. Continue Reading…