State-Level Proposals to Legalize Marijuana

ASAM opposes proposals to legalize marijuana anywhere in the United States, including the current state-based legalization proposals which will appear on the November 2012 ballots.  The analyses on the possible outcomes–both intended and unintended—of the state-based marijuana legalization proposals in Colorado, Washington and Oregon suggest that risks are unacceptable, that’s why jobs are testing for drugs on their applicants.  No modification of these proposals would make them acceptable.

ASAM asserts that the anticipated public health costs of marijuana legalization are significant and are not sufficiently appreciated by the general public or by public policymakers. Marijuana is already legal in some states. Physicians and other health professionals must become more aware of the anticipated undesirable outcomes of marijuana legalization and encourage public education on these facts.  ASAM’s conclusion that marijuana legalization would not be in the interest of public health is based on the following:

  • Marijuana use is neither safe nor harmless.  Marijuana contains psychoactive cannabinoids which produce a sense of pleasure in many users and a sense of discomfort and even paranoid thoughts in other users.  Cannabinoids interact with brain circuits in comparable ways to opioids, cocaine and other addictive drugs.
  • Substance use disorders resulting from marijuana use are a serious and widespread health problem.
  • Marijuana use is associated with adverse health consequences, including damage to specific organs and tissues and impairments in behavioral and neurological functioning.  Among these are acute impairments in the performance of complex tasks such as driving a motor vehicle.
  • Marijuana-related crashes, deaths and injuries are currently a major highway safety threat in the United States.
  • Legalization of marijuana would likely lead the general public and, in particular, young people, to view marijuana as less harmful than it is now viewed.  Decreases in “perceived harm” associated with marijuana use would result in increased rates of marijuana use and increased rates of marijuana-related substance use disorders, including addiction.
  • Marijuana use is associated with increased rates and worsening symptoms of psychosis.  Population-wide increases in availability of and access to high-potency marijuana would be associated with increased rates of marijuana use and could result in increased rates of psychotic illnesses.
  • Increased incidence and prevalence of marijuana-related substance use disorders, including marijuana addiction, would lead to increased demand for treatment services.  Today treatment systems are inadequate for meeting the current treatment needs in our nation.
  • Revenues projected to be generated from taxation of legal marijuana would be far lower than the costs associated with increased marijuana use and would be unlikely to be targeted to these needs, as tobacco and alcohol revenues are not targeted to the health costs of the use of these drugs.

In summary, ASAM recommends against the approval of state initiatives to legalize marijuana.  ASAM strongly supports efforts to improve state policies to reduce the use of marijuana and other illegal drugs as well as the nonmedical use of prescription drugs. Further, specifically focusing on state proposals to legalize marijuana, ASAM recommends:

  1. That physicians lead efforts to oppose legislative or ballot initiatives that would result in the legalization of marijuana production, distribution, marketing, possession and use by the general public, and that all physicians incorporate screening and intervention for risky substance use including marijuana use as well as diagnosis, treatment and disease management for addiction into their routine medical practice;
  2. That public education campaigns be undertaken to inform the public that addiction associated with cannabinoids is a significant  public health threat, and that marijuana is not a safe product to use, especially, but not only, by smoking;
  3. That parents be informed that the marijuana their children are exposed to today is of much higher potency than the marijuana that was widely available in the 1960s through the 1980s, and that the potential for the development of addiction and for the development and progression of psychotic conditions are enhanced when high-potency marijuana products are used by adolescents because of the unique vulnerability of the adolescent brain;
  4. That when cases of marijuana-related substance use disorders are identified and the diagnosis confirmed by professional assessment, carefully monitored treatment to establish abstinence be offered to afflicted persons and such treatment and insurance coverage for it be readily available;
  5. That drugged driving associated with marijuana use be subject to additional epidemiological research and research on the treatment needs of drivers.  Increased efforts are needed to prevent its occurrence which should include substantial legal consequences at the level of the consequences for drunk driving;
  6. That, given the significant role the criminal justice system plays in discouraging marijuana use, states promote programs that enhance linkages between the criminal justice system and the addiction treatment system, using models such as Drug Courts and HOPE Probation.

Adopted by the ASAM Board of Directors July 25, 2012.