Pot and public health

Since January 1, the sale and recreational use of marijuana has been legal in Colorado, and more than $15 million in taxes and fees have been raised from sales. The question now is not whether marijuana use will be legal but how the new industry should be regulated. From a public health standpoint, it clearly needs regulating.

Many problems arise from the variety of forms in which marijuana is sold. A fourth-grader recently came to school with a marijuana-laced chocolate bar to share with his friends. He had stolen the candy from his grandmother. Hospitals and emergency rooms report seeing a growing number of children and adults who—perhaps inadvertently—had eaten marijuana-laced cookies or candy. There have been 31 explosions in Colorado so far this year from people cooking marijuana with butane in their homes in order to extract the mind-altering chemical THC from the plant. This is three times the number of explosions in the previous year, when recreational use was not legal.

Steps to ensure public health and safety can be taken. For example, rules can be set for how THC-infused edibles are produced and packaged and to limit the amount of THC permissible in any product. Edibles with THC should not be allowed if they look like candy. Policy makers also need to regulate how marijuana is advertised and marketed. Some rules are needed to prevent advertisers from targeting children.

To be sure, the “war on drugs” approach to marijuana has had major public health costs as well. It has led to the mass incarceration of nonviolent offenders, causing deep harm at the community level. It has helped fuel epidemic levels of violent crime in some places. In terms of public health, this enforcement approach has been shown to be not only expensive but counterproductive. However, as Luke Bretherton ("Conditioned to consume") and Benjamin Dueholm ("After prohibition") both point out, the dawning era of legal marijuana presents its own set of public health problems.

Like any drug, marijuana can and will be misused. The public health challenge is to enact regulations that minimize the misuse and to invest in treating those who abuse it rather than in punishing them. When the Washington State Institute for Public Policy analyzed the cost and effectiveness of various responses to the misuse of substances, it concluded that treatment is four times more effective than punishment, at one-fifth of the cost.