Buying marijuana Ruse

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Buying marijuana Ruse

T he revolution in the legal status of marijuana has been rapid and dramatic. Four decades ago, there was a universal prohibition against buying, selling, using, and possessing marijuana. Three decades ago, large-scale production for profit was banned essentially everywhere. But that, too, began to change. In the s, several states introduced 'medical marijuana' programs. Though marijuana use was made legal only for medical purposes, the regulations were often so loose that essentially anyone could get a physician's 'recommendation,' authorizing that person to purchase marijuana. Suppliers were euphemistically called 'caregivers' even though some never met the 'patients' they were caring for , and they sold out of brick-and-mortar retail stores known as 'dispensaries. The medical ruse was superseded only in , when voters in Colorado and Washington state passed propositions allowing large-scale commercial production for non-medical use, and the Obama administration announced an official policy of non-interference within broad limits , despite the fact that all such activity violates the federal Controlled Substances Act. In , Alaska and Oregon joined Colorado and Washington, and several more states are expected to legalize marijuana within the next year. The change has been amazingly swift, in large part because of the effectiveness of the core argument of the pro-legalization lobby. Advocates of legalization observe that the majority of people who have used marijuana have not been harmed by it in any meaningful way, that intoxication does not produce violence, and that in contrast to heroin, prescription opioids, and even alcohol lethal overdose is almost unknown. Opponents of legalization have less successfully countered that responsible scientific reviews in the United States and abroad conclude that marijuana smoke contains known carcinogens; prolonged marijuana use is causally associated with pulmonary problems, dependence, and some mental health problems; and it is correlated in disconcerting ways with a wide variety of other behavioral, mental, and physical health outcomes. All these statements are true, but they also miss the point. The essential problem with marijuana is neither death from overdose nor organ failure from chronic use. Marijuana might better be described as a performance-degrading drug and, more dangerously, as a temptation commodity with habituating tendencies. The drug's misleading reputation for harmlessness is based largely on two defining patterns of marijuana use. First, most people who try marijuana never use much of it; perhaps only about one-third of those who try it go on to use it even times in their lifetimes, the common threshold for determining whether someone has ever been a cigarette smoker. Trying marijuana is not dangerous, but using it is. Those who use marijuana on an ongoing basis face a much higher likelihood of becoming dependent than lifetime smokers do of developing lung cancer. Marijuana dependence is neither fatal nor as debilitating as alcoholism, but it is real, harmful, and far more common than is generally acknowledged. Second, marijuana use is highly concentrated among the growing minority who use daily or near-daily. More than half of marijuana is consumed by someone who is under the influence more than half of all their waking hours. Most marijuana users are healthy; most marijuana use is not. In the resulting confusion, advocates of legalization often argue effectively that 'marijuana is safer than alcohol. Seeing the matter this way can help policymakers think more clearly about legalization. But there is more to this matter than just contemplating legalization or preparing for it; it is essential that policymakers, public-health officials, and the larger public get beyond the lobbyists' talking points and gain a clear sense of the harms of marijuana. The best data concerning the scope and effects marijuana use come from the National Survey on Drug Use and Health. NSDUH is a very large and well-run survey with about 70, respondents annually roughly 70 times larger than the average opinion poll. Perhaps surprisingly, many people freely admit to using marijuana. Indeed, so many do that customary concerns about out-of-sample populations, while pertinent when estimating rare behaviors like heroin or other injection-drug use, are not a major concern. Under-reporting by people who are within the survey's sample, by contrast, remains an issue. But our focus here will be on proportions of avowed users who report various problems with their use, not estimating the total number of users. The custom is to define 'current' users as those who report consumption within the last 30 days. The surveys estimate that 20 million Americans admit to past-month use. Another 13 million report use within the last year, but not the past month. The surveys ask about problems users believe they have experienced because of their use. The Substance Abuse and Mental Health Services Administration consolidates the answers to estimate how many would meet the clinical criteria for dependence 2. SAMHSA makes these calculations for all substances in an effort to estimate the nationwide need for treatment for each substance. Since 4. The NSDUH surveys ask parallel questions concerning alcohol, and the criteria for assessing dependence are almost identical. Marijuana dependence is defined as reporting three or more of six problems; for alcohol it is three or more of seven problems the six used for marijuana, plus withdrawal. So in a sense it is easier to meet the criteria for alcohol dependence because there is one more category of problems that can contribute to meeting the threshold. Abuse is likewise defined as reporting certain problems, but not enough to be classified as being dependent. These formulae have recently been updated by the fifth edition of the DSM, but the household survey still uses the fourth edition's criteria. It turns out that million people self-report current alcohol use, and These findings pertain to population-level use in the United States at this time. They are not statements about individual risks as they do not come from experiments that randomly assign some people to use marijuana and other, otherwise-identical people to use alcohol. One could speculate that legalization might make marijuana abuse and dependence less common, because generally healthy people will start to use occasionally, and that influx could dilute the proportion who abuse or are dependent. But one could just as easily speculate that legalization will bring more marketing, more potent products like 'dabs' , or products that are more pleasant to use like 'vaping' pens , any of which could increase the risk that experimenting could progress to problematic use. This is all speculation, of course. But what can be said empirically is that, within the context of aggregate use in the United States at this time, the best available data suggest that marijuana creates abuse and dependence at higher rates than does alcohol. Likewise, in the Treatment Episode Data Set recorded , treatment admissions for which the primary substance of abuse was alcohol and , for which it was marijuana or hashish. That works out to 15 admissions for every 1, current marijuana users versus only 5 for every 1, alcohol users. Fair comparisons are not possible for those over 21 because DAWN does not record alcohol-only episodes for adults, but DAWN counts about the same number of emergency-room mentions involving marijuana , as alcohol , among those under the age of 21, even though past-month alcohol use is substantially more common than is past-month marijuana use. Part of the difference may be that most people who use marijuana do so with the express purpose of getting intoxicated, whereas many people drink occasionally just to quench their thirst or to complement their dinner. As mentioned above, SAMHSA assesses abuse and dependence based on about 20 questions that ask about particular problems the respondent might attribute to his use of the substance. We can compute ratios of rates for these individual questions the same way we computed the 1. For technical reasons, we do this with the data from and not , but the basic findings have been stable year after year since the current batch of questions was first implemented in Indeed, one finds the same basic results in even older surveys in which questions differed in particulars but were similar in spirit. For example, the recent surveys ask the following question, along with a completely parallel question for marijuana:. During the past 12 months, did drinking alcohol cause you to have serious problems like this either at home, work, or school? More people reported that alcohol caused such problems 3. The differences across questions suggest a pattern. Marijuana also appears to create problems with self-control at a greater rate than alcohol does, though the margin was smaller. Alcohol was scored as more dangerous on the question 'did you regularly drink alcohol and then do something where being drunk might have put you in physical danger? Given these data, it is hard to imagine how marijuana's reputation for harmlessness has persisted for so long. Two related observations can help explain that persistence, however: Most people who try marijuana do not use it much, and most usage is highly concentrated among a small proportion of users. It is worth taking a closer look at these patterns. First, most people who try marijuana do not suffer adverse consequences for the simple reason that they do not use it much. For example, up until , the surveys asked about the number of times respondents had used in their entire lives. By comparison, tobacco researchers often don't count someone as ever having smoked unless they have used on at least occasions. If marijuana researchers followed that example, statistics concerning the likelihood of progressing to dependence would sound very different. This point is so important it is worth diving into specific numbers. In particular, James Anthony and colleagues found that, among all respondents surveyed by the National Comorbidity Study in , From these numbers, they calculated that 'only 9. Since most people who try marijuana today do so as teens, the In short, merely trying marijuana isn't very dangerous, but using it on an ongoing basis can be risky. Second, marijuana use is highly concentrated among the small proportion who use daily or near-daily defined conservatively as reporting use on 21 or more days in the past month, which excludes the lump of people who report using on 20 days. Only one in five past-year marijuana users report consuming that often. However, because they use the drug so frequently and because they consume a lot when they do use, they consume most of the marijuana consumed in America. The best data pertain to days of use. This concentration of consumption means that the typical session of marijuana use involves someone who is not the typical user. Adults who are in full control of their occasional use probably do not suffer many adverse consequences. Since daily users are thought to consume on average the equivalent of three to four joints per day, it seems literally true that the average gram of marijuana is consumed by someone who is under the influence of marijuana more than half of all their waking hours. So even though the average person who tries marijuana does not become a regular user, the average episode of use involves a daily user. And even though most people who use marijuana do not suffer problems, that does not mean marijuana is harmless. That proportion is only modestly greater than the risk that merely trying marijuana will lead to dependence, and is less than half the risk of becoming dependent if one has used enough marijuana to meet a tobacco-style definition at least occasions of ever having been a marijuana user. One of the most effective arguments of the legalization lobby is that marijuana is safer than alcohol. Indeed this idea has, to a large extent, set the terms of the debate over legalization. It is true that people using marijuana rarely take the physical risks that those using alcohol are sometimes inspired to take. And alcohol undoubtedly kills more people than marijuana does, and at a higher rate per user, not just in total. A common estimate of all-cause alcohol-related mortality is 88, premature deaths per year in the United States. That is sometimes contrasted with there being effectively no known lethal dose for marijuana. Unlike heroin, which could kill even a healthy person in a high enough dose, marijuana's safety ratio is so high that it cannot be effectively measured. Almost no one using exclusively marijuana has died by single-drug acute overdose. But that hardly means marijuana is safe. Furthermore, even if it were possible to ascertain that alcohol is more dangerous than marijuana or vice versa, that fact would be of no particular relevance. Very few people systematically research the pros and cons of various dependence-inducing intoxicants and then decide to consume just one. Most people who use marijuana also drink alcohol, and the two are often used together. The surveys ask what other substances were consumed the last time the respondent drank. The real trouble is not that marijuana is more or less dangerous than alcohol; the problem is that they are altogether different, and the comparison is simply unhelpful in informing the debate over marijuana policy. The country is not considering whether to switch the legal statuses of alcohol and marijuana. Unfortunately, our society does not get to choose either to have alcohol's dangers or to have marijuana's dangers. Instead of comparing the harms of marijuana when it is prohibited to the harms of alcohol when it is legal, an intellectually honest marijuana-policy analysis ought to compare all possible harms under marijuana prohibition to all possible harms under legalization. Unfortunately, there is very little in the way of intellectually honest marijuana-policy analysis. The loudest voices have been those of the billionaires George Soros and the late Peter Lewis, channeled through their organizations, the Drug Policy Alliance and the Marijuana Policy Project, respectively. Increasingly the industry itself is being heard, too, through its trade association the National Cannabis Industry Association and lobbyists. There are opponents to legalization. With the exception of the Drug Enforcement Administration, most opposition comes not from government but from non-profit groups like National Families in Action, Smart Approaches to Marijuana, the Institute for Behavioral Health, and the Hudson Institute. My colleagues and I in the academy have sought to inform public discussion of legalization by adjudicating the competing claims advanced by either side. Here, however, instead of dealing with the question of whether marijuana should be legalized, it may be a more fruitful exercise simply to view legalization as an important event, the likelihood of which makes planning for it prudent. Among my colleagues, the consensus is that, at present, the odds seem better than even that within 15 or 20 years the federal government and most U. There are many different 'architectures' for who gets to supply marijuana legally and myriad 'design choices,' such as what the tax rates will be and whether sales will be limited to stand-alone stores or extended to grocery and convenience stores as with cigarettes. So it is appropriate to ask not just whether but also how marijuana should be legalized, and not just in the technical, wonkish sense but more holistically. Marijuana has four defining characteristics that make dealing with it difficult from a policy standpoint. First, it is a performance degrader. Second, it is dependence-inducing. Marijuana is not crack, but marijuana dependence is nonetheless a real and not-uncommon consequence of prolonged use. This challenges the usual free-market presumption that consumers reliably maximize their welfare, particularly given that the vast majority of users start using before they are adults. Third, marijuana is, for the most part, not directly harmful to third parties. While impaired driving and workplace use are concerns, and 1 million children live with a parent or guardian who meets diagnostic criteria for marijuana abuse and dependence, most of marijuana's direct harms fall on its users, and the families and friends who care about them. And fourth, its health harms are, for the most part, minor. Yes, marijuana smoke contains carcinogens, and, despite vehement denials by legalization proponents, the evidence suggests that marijuana can trigger mental-health problems, including psychotic episodes. But the scale of those harms per unit of use does not distinguish it from other permitted recreations, including skiing and sky diving. A substance with all four of these attributes presents a policy challenge in a free society. The usual presumption that the government should not interfere with companies' efforts to cater to consumers' whims is challenged by the reality that so much marijuana is consumed by people with diagnosable substance-use disorders. These characteristics in combination violate the axioms classical economics uses to conclude that the unfettered free market will maximize social welfare. It is clear we would all be better off if marijuana did not exist. Given the abundance of alternative sources of intoxication and fun, the harm suffered by abusers probably outweighs the pleasure derived by its controlled users. On the other hand, the paucity of third-party harms or 'externalities' undermines the standard justification for government intervention. A modern secular state does not arbitrarily declare some items to be forbidden and others to be halal or kosher. We are accustomed to mandates that protect against immediate, tangible physical-health harms, such as seat-belt laws, but many bridle against taxes on sodas or other social engineering designed to fight obesity or promote exercise. And the threats marijuana does pose are obstacles to nebulous objectives like 'achieving one's potential' and bourgeois totems like academic and career success, not concrete harms like heart disease. So the question remains: How should a freedom-loving, market-oriented society respond to a dependence-inducing substance that degrades performance but doesn't much damage bodies or cause harm to third parties? Some policy scholars have offered approaches that may point the way toward reasonable policies. In , Thomas Babor and several colleagues wrote Alcohol: No Ordinary Commodity , which captured the idea that, even though alcohol is a commercial commodity, public policy should not default to treating it the way we treat avocados and anchovy pizzas. Alcohol is important and distinctive enough to craft a special set of rules particular to it. With regard to drugs and other activities gambling, for instance that are not dangerous enough to merit banning outright, Mark Kleiman has argued for 'grudging toleration. For example, Kleiman suggests that even adults should be required to pass a test to earn the right to use, the way one must earn the right to drive, rather than conferring that right universally upon reaching a certain age. And such licenses could be used to enforce limits on amounts purchased per week or per month. Marijuana is likewise no ordinary commodity but a temptation good that society should tolerate grudgingly. There are many ways of putting that philosophy into practice. One way is to start by restricting production and distribution to non-profits or for-benefit corporations whose charters mandate that they merely meet existing demand, not pursue unfettered market growth to maximize shareholders' returns and owners' wealth. It would also be wise to require these organizations' boards to be dominated by public-health and child-welfare advocates. Furthermore, regulatory authority should be put in the hands of agencies like the FDA whose loyalties are to the public welfare, not industry, and who maintain a healthy suspicion toward industry motives and practices. The particulars of such an effort, however, are not important at this stage. Most important is the principle: to grant only grudging toleration because marijuana is no ordinary commodity. Unfortunately, the prevailing sentiment in the legalization debates couldn't be further from this cautious stance. The legalization movement has celebrated its victories as though they were triumphs for civil rights. Regardless of whether legalization is good or bad policy, it is certainly not a cause for jubilation. Borrowing again from Mark Kleiman, choosing legalization over prohibition or vice versa just trades one set of problems for another. Choosing prohibition means choosing black markets; choosing legalization means choosing greater drug dependence. It is trite but true: A country can choose what kind of drug problem it wants, but it cannot choose not to have a drug problem. We are in the process of choosing the problem of greater drug dependence and smaller black markets. Even if legalization is a net win, it needs to be seen as the lesser of two evils, and informal social controls need to be developed to replace the formal legal controls that are being removed. By being honest about the risks and costs of marijuana use, sensible policymakers can ensure that future legalization, if it must occur, is managed in the safest, most responsible possible way. Correction appended: The text originally misstated the name of the non-profit organization Smart Approaches to Marijuana. We regret the error. Jonathan P. Forgot password? The Real Dangers of Marijuana. Previous Article. Next Article. Who Needs the FCC? Brent Skorup. Insight from the Archives. A weekly newsletter with free essays from past issues of National Affairs and The Public Interest that shed light on the week's pressing issues. Sign-in to your National Affairs subscriber account. Already a subscriber? Activate your account.