Half truth

Gil Kerlikowske:

Using marijuana has public health consequences, and the most responsible public policy is one that restricts its availability and discourages its use.

Well, sorta. Heavy cannabis use has health consequences; evidence that occasional, moderate use – the most common pattern – is bad for health remains elusive. Still, if legalization reduces prices and expands availability heavy use will almost certainly increase; why wouldn’t it?

But the identity of “the most responsible public policy” depends on a balance of effects. If legalizing cannabis eliminates an illicit market with $30 billion in annual revenues, that’s a benefit to set off against the health cost. If legalizing cannabis reduces heavy drinking – which it might, or might not – that’s a health benefit to set off against the direct health cost.

The world is full of tradeoffs. Good policymaking must always start from that simple proposition. Policy rhetoric rarely does.

FOOTNOTE Yes, I’m part of a team advising the Washington State liquor board on how to regulate cannabis. No, I don’t speak for them. I speak for me.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

15 thoughts on “Half truth”

  1. Yes, the world is full of tradeoffs. Mr. Kerlikowske apparently decided the truth could be traded off against yet another round of tough talk and bluster. All the Mr. K has in his pockets is 40+ years of failure, perhaps even insanity. Because the definition of doing something over and over and expecting different results is insanity. Mr. K and his troops were long ago appropriated by the cartels as a price support mechanism. That’s not policy rhetoric, despite Mr. K’s fondness for such things, it’s the unvarnished truth.

    Heavy cannabis use may have health consequences, but they are weak beer compared to — beer!

    In fact, the most common reaction to heavy cannabis use I’ve seen is the user simply quitting for the time being. Try prying a bottle or ciggie from the lips of an addict. A world of difference there. Despite the political effectiveness of seeking to “legalize and regulate marijuana like alcohol,” it is a mistake to assume that alcohol and marijuana are somehow the same in what they do to their users. Marijuana is objectively less harmful than alcohol or tobacco.

    There is nothing inherent to marijuana that justifies the Inquisitorial fervor of those like Mr. K who believe they are on a moral mission to…hard to tell, but it’s sure not keeping Americans from their reefer as that’s a complete and utter failure.

  2. Yep, there are real health consequences to heavy marijuana use — and quitting is just as difficult for the real addict, as quitting tobacco.
    However, the health consequences are about equivalent to tobacco, or, even closer, wine (where there are arguably some benefits for mild use; and serious social and health consequences for heavy use or abuse).
    All in favour of legalizing it as the social and health consequences don’t seem to warrant the high cost of maintaining its criminilization.
    High tarrifs and legislation against drugged driving (in the same was as for drunk driving) seem a better way to manage the resulting issues.
    However, the US (and/or the individual states) appear (to the outsider) to have a constitutional (pun intended) dislike for tarrif as a method of control and of fundraising to counter the public cost of the inevitable abuse that already occurs.

    1. Um, I see a few false statements in your comment. Firstly, you say that quitting marijuana is just as difficult as tobacco. I know for a fact that that is absolutely false. They even teach you that in college. Tobacco has, if I remember correctly, a 30% chance of addiction. While marijuana was a weak 7%. Also the level of addiction is incredibly less than that of tobacco or alcohol. I smoked marijuana for a year, several times a day. I did not feel that I was addicted, and most pot smokers, including myself, actually go on what we call a tolerance break. Every few months or so, after our tolerance has built up too much, we decide to take a week or two off. This disproves most addiction philosophies or at least that it is a serious addiction. I did end up quiting for about 5 months now. Didn’t have to ween off or anything. Just needed a new job, my situation changed, and I decided to halt my use temporarily. My “withdrawl” symptoms were loss of appetite. You can probably guess that one would lose appetite without that munchies hunger trigger. That lasted for about a week, and then I was fine. What are the withdrawl symptoms of tobacco? Incredible need for more nicotine, severe irritability, weight gain and dizziness. Alcohol? potential death. A much more unrealistic statement that you have made is that the health consequences of marijuana are equivalent to tobacco. That is absolutely an opinion, and any research done on the contrary will show you opposite results. As of now, we really don’t know much about the negative effects of marijuana. Studies done to prove the negative impact of marijuana are usually unsuccessful, and very disputable otherwise. By any means, if there are severe health and social consequences associated with marijuana, they are most certainly NOT equivalent to tobacco. I do agree with you about a law against drugged driving. However, I think the testing method should be a roadside sobriety test. This is because the non-psychedelic metabolites in your system may give you a false reading.. sending innocent people to jail for DUI. To put it into perspective however, the average increase in accident rate if you are stoned, is double. Not a very high increase in hindsight, as a person’s likelihood of getting into an accident with a BAC of .08% of alcohol (right at the legal limit) is about 11 or 12 times as high. Furthermore, cannabis acts much differently on the brain. to where the user typically knows that he/she is impaired and tends to compensate accordingly. (slowing down), (slow turns). Anyway, I’m glad you are for legalization, however I’m just disputing the details and am respectful of your opinions. If you wish to debate the subject, take it one point at a time and I would respectfully argue the point.

    2. Ann,
      You’ve obviously tried neither cigarettes or marijuana enough to plumb the “truthiness” of an equivalency between tobacco and marijuana. I have. Started out smoking hash as a military dependent overseas. After bumming out my friends by saying ciggies are bad for you and taking flak for something I was “knocking something without having tried it” I decided to test this principle.

      That was easy, as I had my trusty US Forces Ration Card, where I could get 4 cartons of ciggies a month at a cost of IIRC $1.28/carton. Started off and within a month I was smoking more than the ration card would let me get at the lowest price, but IIRC the cost even then was only about twice what the ration card price allowed at the BX.

      I then came down with bronchitis, as I had a job working in cold storage on base. So which do you think of the three — hash, job, or ciggies — had to go to get better? Obviously, tobacco, which I dropped. I was getting cravings for a ciggie for _years_ afterward.

      For various reasons, I’ve had to stop smoking reefer several times and found it, errr, regrettable, but NOTHING at all like still wanting a cig 5 years after I’d quit them.

  3. Try replacing the word “marijuana” in Kerlikowske’s sentence with something else:

    Using alcohol has public health consequences, and the most responsible public policy is one that restricts its availability and discourages its use.
    Using private cars has public health consequences, and the most responsible public policy is one that restricts their availability and discourages their use.
    Using guns has public health consequences, and the most responsible public policy is one that restricts their availability and discourages their use.

    I’s certainly go for 3.

    1. What’s missing from this analysis is the impact on folks OTHER than the user of substance X.

      That is a rational basis for restricting the freedom of a person – when it harms others.
      Well, I will also grant that the seller of an addictive substance is part of this harm too.

  4. Kerlikowski has a point here, but — like many others who attempt to address this topic — he is afraid to state it forthrightly, so he hints and euphemizes his way around it, which is useless and tiresome. In this case, the key word is “public”, and the point that Kerlikowski is inhibited from making is this:

    Addicts are not sanctioned for their own sake, but for the sake of everyone else around them.

    Start here or you did not start.

  5. I totally agree with Mark Kleiman. Here is a question we all should ask Mr. Kerlikowske: what criteria/metrics should be met before you recommend ending the Prohibition regime and its criminalisation policies. Is there a tipping point?

    It seems to me that for the US Drug Tsar, Gil Kerlikowske, the UNODC director, Yury Fedotov, and for the majority of staunch supporters of Prohibition for that matter, criminalisation of drug consumption is a moral, ideological imperative, i.e. drugs are bad and their consumption ought to be prevented come what may, whatever the costs. No matter how hard he has tried to sanitise the ONDCP language, in the eyes of Mr Kerlikowske and the like, discouraging consumption and criminalisation go hand in hand.

    Gart Valenc
    Twitter: @gartvalenc

  6. Gil, a marijuana policy of legalize/tax/regulate is very much also “one that restricts its availability and discourages its use.” Criminal punishment need not be the primary means of discouraging drug use, especially for marijuana.

    1. I think that gets to the point; and put another way, “public policy . . . that restricts its availability and discourages its use” is too vague to be helpful. My general thinking is that both alcohol and marijuana should be “just barely legal”, and taxed and regulated as tightly as can be maintained consist with minimizing counterproductive black markets (leaving a trainload of details, of course). As to marijuana, that puts me squarely on the legalization side, but arguably also within Mr. Kerlikowske’s summary prescription.

    2. Gil sez: “All I got is a hammer. Everything looks like a nail. Not my job to figure out anything smarter.”

      And that is the problem with pseudo-science in the service of policy.

    3. We have just such a legalize/tax/regulate scheme with alcohol, but I wouldn’t describe that policy as one that “discourages its use.”

  7. Fair point Jake — I absolutely agree that tobacco is significantly more addictive than marijuana. However, there is still around 7-10% addiction rate (depends on which studies you use) for marijuana.
    For someone who is addicted — (that includes psychological as well as physical dependence) marijuana can indeed by as hard to kick as tobacco. Yes there will be fewer of them, but the problem is just as important for each one.
    Not a reason to avoid legalization, but a public health issue which will need management — the point I was trying to make.
    It seems to be clear that tobacco companies during the 20th century made a concerted effort to increase the ‘addictiveness quotent’ of cigarettes — a very strong commercial motive. Need to make sure that that didn’t happen with marijuana [just saying…]
    I agree that the health impacts are closer to wine, than to tobacco [though particulate effects in the lungs are still not well understood — and are unlikely to be good for you].
    Actually there are very sigificant circulatory isses with heavy long-term use of marijuana (ulcers, necrosis, amuptation)- [I’m not saying whether it’s the sole cause or a complicating factor — but there’s a very strong correlation] And there’s also evidence that there can be complications with mental health issues.
    Unlikely to be good quality research done, while use remains illegal — there’s a big inherant bias in your test subject database.
    Of course, these issues affect a small minority of users. Most can treat a reefer like a glass of wine. Take it or leave it.
    As I said, I’m in favour of legalization — but seriously addressing public health issues, is one good way to convince people that this isn’t going to result in armageddon…

  8. In the kindgom of one-eyed half-truths, the two-eyed Policy Professor argues in vain.

  9. Mark,

    Kerlikowske didn’t say what you are implying or perhaps inferring he said. He didn’t say anything about heavy or chronic marijuana so you are engaging him on a faulty premise. Kerlikowske said exactly what you quoted and didn’t qualify or limit his statement in any way elsewhere in the article. You are giving him credit for an argument he didn’t seek to make and evidently wouldn’t agree. He said there a public health consequences to the use of marijuana qua marijuana.

    It seems like an idiotic statement to me but it’s what he actually said and so I think you should engage with the argument he actually made and not with the one you think he could or should have made.

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