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Why Public Health Efforts Lag Behind Cannabis Legalization

More effort is made to protect the health of the industry than public health.

Key points

  • Public health protections have lagged behind efforts to create a healthy cannabis industry.
  • Most policymakers' science literacy about cannabis is limited to botany and does not include neuroscience of THC's impact on the brain.
  • Structural changes are needed to include public health experts at every level of cannabis legislation and regulation.

Ever since California re-legalized medical marijuana in 1996, people have asked me why it seems the government has put more effort into protecting the health of the cannabis industry than the health of the public.

As an addiction psychiatrist, past president of the California Society of Addiction Medicine, chair of the Youth Work Group on then Lt. Governor Gavin Newsom’s Blue Ribbon Commission on Marijuana Policy Reform, and then as chair of the Youth/Public Health subcommittee for California’s Cannabis Advisory Committee, I have watched attention to public health issues consistently lag behind cannabis legalization in California and across the nation. I think I understand some of the reasons why public health concerns often have difficulty getting a serious hearing. And I know the remedy.

Why Public Health Concerns Are Lagging

To begin, unless states first develop a healthy legal cannabis industry, there is simply nothing to regulate. Law enforcement against an illegal industry is all that exists without legalization, and this has been notoriously ineffective.

The main strategy for suppressing the gray market (i.e., illegal growth, manufacture, and sales) is to license and regulate a legal industry. This provides at least the possibility of controlling cannabis advertising, marketing, product safety, and access. But this control will happen only if the legal industry dominates the market enough to suppress illegal sales.

Whether this is in fact possible still hangs in the balance. Thus, governments continue concentrating on the very complex task of converting a decades-old outlaw industry into a legitimate participant in traditional commerce. Creating sufficient regulation without adding excessive cost is proving difficult, and, yet, there is no reason a balance cannot eventually be reached, as it has been with the alcohol industry.

Second, the cannabis industry and its advocates have been organized for decades in pursuit of legalization. Once cannabis became legal, the industry’s organization blossomed further into legitimate trade associations and lobbying efforts. The organization of public health efforts, especially on the grassroots level, has lagged far behind. I witnessed this disparity during the public comment portion of Cannabis Advisory Committee (CAC) meetings. One after another, representatives of cannabis growers, manufacturers, and retailers came to the microphone, while only an occasional public health academician or concerned parent made comments.

Third, members of the cannabis industry are motivated by the financial gain necessary to grow their businesses and support their families. Lobbying efforts pay off. Public health advocates, on the other hand, receive little or no financial benefit from their efforts. Although highly motivated, parents need to take a day off work without pay to attend CAC meetings to make their concerns known.

Fourth, children and adolescents are the populations at greatest risk of harm from cannabis, but states’ legalization and regulation of cannabis for adults offer little leverage for direct action to protect the health of our youth. Cannabis remains illegal for those under 21, leaving enforcement, punishment, and ignoring more prevalent than prevention and treatment. Public health efforts on behalf of youth have no natural home in the apparatus of adult legalization.

Fifth, most people’s understanding of the science of cannabis is limited to botany (the plant) and does not include the far more important realm of neuroscience (the brain). Without the guidance of experts on the impact of cannabis on the brain (see "Who Is Responsible for Marijuana Product Safety?"), lawmakers end up legalizing products like 90-percent THC vaping cartridges without fully understanding their health consequences. Despite having the ultimate responsibility for maintaining cannabis product safety, politicians and state regulatory agencies lack the scientific literacy about cannabis necessary to protect public health.

A Simple Remedy

There is a simple remedy. We need to acknowledge that it is too heavy a lift for policymakers to also possess sophisticated neuroscience knowledge. Instead, structural changes need to be made to assure basic science researchers and public health experts are involved at every level of cannabis legislative and regulatory activity. Just as legislative bills need to be reviewed by legal analysts, proposed cannabis bills should also be required to pass through a team of scientists for comment. State regulatory agencies and their advisory groups should also be required to include a significant number of public health experts as integral members of their staff.

Big Marijuana will oppose the substantial inclusion of public health experts at all levels because they will see such expertise as a barrier to many things the cannabis industry would like to do. And so it would be. Good public health measures would prevent financial gain by the industry from unsafe products. That is the point. There will always be tension between the cannabis industry and public health concerns.

I think we can tolerate this tension because it will simultaneously benefit both the health of cannabis users and the health of the cannabis industry. Safety is in everyone’s interest. When the cannabis industry embraces public safety, it will finally achieve the legitimacy it desires.

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