Clearing Some Smoke

by David E. Smith and Steve Heilig, October 5, 2016

We write to provide some perspective on Proposition 64 from California's medical associations. The California Medical Association has endorsed Proposition 64, the Adult Use of Marijuana Act (AUMA). Our local medical association, the San Francisco Medical Society (SFMS) — usually the most "progressive" in the state — has remained neutral. The AUMA is thus controversial — although that should surprise few.

Under AUMA, adults aged 21+ will be allowed to possess marijuana, and grow small amounts at home for personal use. Sale of marijuana will be legal and highly regulated to protect consumers and kids, and taxed.

The CMA’s endorsement is not due to support of marijuana use. To the contrary, CMA supports the ever-growing evidence that cannabis smoking is a bad idea for young people, with deleterious impacts on neurodevelopment and other adverse behavioral effects, including dependence if not outright addiction.

Unsurprisingly, then, the primary opposition to legalization is that it might increase teen use.  But fortunately, use does not seem to rise with liberalization of marijuana laws. A *Lancet* sampling of over one million adolescents in 48 states concluded “The results of this study showed no evidence for an increase in adolescent marijuana use after the passage of state laws permitting use of marijuana for medical purposes... Concerns that increased marijuana use are an unintended effect of state marijuana laws seem unfounded.”  Adolescent use nationwide is actually on a long downward trend, including in states that have legalized. We expect that in California, where it seems few have problem finding it now, this would hold true.

The AUMA is at best seen as a harm-reduction proposal.  The “drug war” has clearly failed on most counts, including deterring use and dealing with addiction. The primary harm from the drug war is exposure to the criminal system. Every minute in the US, somebody is arrested for cannabis — about 50,000 occur each year in our state. There is much racial injustice involved in arrests, prosecutions, and prison sentences.  The "prison-industrial complex" thrives on drug arrests and thus representatives of law enforcement and incarceration are often the most outspoken against any lessening of punitive drug laws.

The California Legislative Analyst predicts AUMA will save the state tens of millions of dollars annually in reduced taxpayer costs — and raise up to $1 billion in new tax revenues annually, much to be used for teen drug prevention and treatment, training law enforcement to recognize driving under the influence of drugs, protecting the environment from the harms of marijuana cultivation, economic development in communities impacted by marijuana prohibition, and more.

Some informed critics have warned of the cannabis industry emulating "big tobacco" in pushing pot to young people.  We do share that concern. In states that have legalized, there are concerns regarding increased driving under the influence of cannabis, and of ED visits due to overdoses, particularly from ingested "edibles".  For these and other reasons, members of Lt. Governor Gavin Newsom’s Blue Ribbon Commission on Marijuana Policy are recommending some more tight regulations to be instituted should Prop. 64 pass. And Newsom reports that his own wife was initially opposed to AUMA, but has become supportive after seeing some of the evidence summarized above — mainly that youth use will still be illegal and marketing to them prohibited, with the bulk of tax funds generated going towards sounder cannabis education and treatment.

UCSF Professor Donald I. Abrams, MD, Chief, Hematology-Oncology Division at San Francisco General Hospital and and leading cannabis researcher, says * "This measure is first and foremost a public health measure. It will fundamentally change California’s approach to dealing with marijuana, generating necessary resources to improve public health, allowing for more clinical research, and strengthening the physician-patient relationship."*

The CMA, called for “rescheduling” and legalization, regulation, and taxation of cannabis in 2001. Current CMA President Steven Larson, MD, MPH, a longtime anti-tobacco advocate, says of AUMA that “*We oppose smoking marijuana or ingesting marijuana for nonmedicinal reasons. But we’re not so naïve to think it’s not going to happen….**the harm reduction in adolescents outweighs the risk..”*  He adds *“Right now, medicinal marijuana is terribly abused and misused and puts physicians in the middle.”*  He notes that much of the bogus “medical” market should wither with legalization, and concludes *“The California Medical Association believes the Adult Use of Marijuana Act is a comprehensive and thoughtfully constructed measure that will allow state officials to better protect public health by clarifying the role of physicians, controlling and regulating marijuana use by responsible adults and keeping it out of the hands of children.”*

We agree with the CMA, despite our concerns re "big pot" and other issues. The perfect is the enemy of the good — and that includes with respect to marijuana policy.

(David Smith is founder of the Haight-Ashbury Free Medical Clinics, a Past President of the American Society of Addiction Medicine, and has been medical director of treatment centers for cannabis abuse and dependency. Steve Heilig served on both the CMA’s task force on cannabis policy and Lt. Governor Newsom’s Commission on Marijuana Policy.  They are co-authors of a recent issue of the Journal of Psychoactive Drugs titled “Cannabis in California: Science, Policy, Prevention, Profits, and Perils.”)

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