Marijuana Legalization and Decriminalization: A Review of the Literature

Approved with changes by the IABH Board of Directors April 20, 2017

With the introduction of HB2353 and SB316 in the Illinois General Assembly, the IABH Board of Directors has been asked to declare a position on the legalization of marijuana. The Board directed IABH's Prevention Committee to develop a document that examines the impact of this potential policy and summarizes the arguments for and against legalization and/or decriminalization. This paper will examine the potential benefits and drawbacks of legalization across several areas of interest to legislators and policymakers. These areas include economics, public health and safety, criminal justice and youth development. It is important to emphasize in our advocacy efforts that decriminalizing or legalizing marijuana, regardless of the available information, is not a panacea to address issues or problems in any of the areas described below. Finally, the Committee reviewed multiple data sources in the development of this briefing paper, most of which had already taken a proponent or opponent stance on the issue. Thus, the reader should critically review all information and sources when determining a position.

Executive Summary of Key Impacts

Benefits Drawbacks Discussion

ECONOMIC

(tax revenues and expenditures, job creation or loss)

Increase in tax revenue.

Job creation (retailers, cultivation sites, related industries).

Lost productivity.

Increased risk for workplace accidents, injuries due to impaired worker.

Employee absenteeism.

Workers’ compensation costs.

Revenue projections to consider:

Marijuana is still illegal at the federal level. State tax revenue from marijuana sales may not be available to agencies that receive federal funds. Thus, may not be able to be earmarked for addiction or mental health services.

Considerable costs involved in creating a regulatory agency to oversee licensure and compliance.

Over half of tax revenue generated in Washington that was

Page 2 of 16

promised for drug prevention, education and treatment never materialized.

PUBLIC HEALTH

(unintentional injuries, health care costs)

Reduces stigma of using marijuana.

Potentially effective in treating depression, addiction, anxiety, other health conditions.

Increase in smoke emissions.

Increase in cases of child accidentally poisoning.

Though there are studies claiming the benefits of marijuana under certain conditions, there are no long-term studies to substantiate these claims. Issues pertaining to dosage, THC content, delivery method make this issue complex and highly controversial.

PUBLIC SAFETY

(traffic safety, crime)

Resources used to enforce marijuana laws, can now be used for addiction and mental health services.

Increased impaired driving incidents, unintentional injuries.

Increased violence and crime around cultivation sites and retailers and due to black market conditions.

Increased costs associated with impaired driving accidents and unintentional injuries.

CRIMINAL JUSTICE

(costs of law enforcement and incarceration)

Lower incarceration rates for marijuana possession.

Increased revenue from avoided jail time.

Increased cost of DUI enforcement.

Cost of enforcement for black market sales.

Additional resources needed to test impaired drivers.

Potential increase in resources needed in the criminal justice system.

Legalization does not eliminate illegal sale of marijuana. In states that have legalized marijuana for recreational use and imposed a tax, the legal marijuana costs

Page 3 of 16

more than marijuana available on the black market. States with legalization have seen an increase in incarceration of Hispanic and African Americans for purchasing marijuana illegally.

YOUTH

(impact on social, emotional and cognitive functioning)

No known benefits.

Increased youth access and availability.

Decreased perceived harm or risk associated with regular marijuana use.

Increased risk for SUDs.

Decreased cognitive functioning.

The research is overwhelming in documenting the negative impact of marijuana use on adolescent development.

Legalizing marijuana will likely increase the number of youth that use it, placing them at greater risk for developing SUDs and other health conditions.

Page 4 of 16

Summary of Assumptions and Policy Considerations

Legalization vs. Decriminalization

Decriminalization means that a state has either repealed or amended a law that once

made a certain act criminal, but is no longer subject to criminal prosecution. Regarding

marijuana, this means individuals caught with small amounts of marijuana for personal

consumption will no longer be considered a criminal offense.

Illinois has largely decriminalized marijuana. In 2016, Governor Rauner approved SB

2228 which decriminalizes possession of up to 10 grams of marijuana making it a civil

offense.

Legalization of marijuana means an individual cannot be arrested, ticketed, or convicted

for using marijuana if state laws are followed regarding age, place, and amount of

consumption. However, an individual can still be arrested for selling and trafficking

marijuana if they are not following the state laws regarding licensure.

Policy Considerations for Decriminalizing Marijuana

Marijuana should be added to the existing smoking ban in Illinois.

The current decriminalization law in Illinois does not include an age. We recommend

adding an age, ideally 21 years, as other states that have legalized marijuana have used.

Decriminalization of marijuana decreases the number of offenders arrested for minor

possession, which in turn will result in fewer offenders entering the criminal justice

system. Decriminalization will also free-up resources that were once spent on those

offenses, including police time and the resources used to move the case throughout the

court system. Those resources could now be diverted to other criminal offenses.

An education campaign to inform the public about the potential risks and the law

regarding driving under the influence of marijuana should be added to current law.

Policy Consideration for Legalizing Marijuana

Policy strategies should be passed to add marijuana to existing smoke-free policies. In

addition, public and open consumption of marijuana, including edibles, should be

prohibited to promote a healthy environment and prevent modeling of substance use in

front of children.

Tax revenue should be earmarked for substance abuse and mental health prevention,

treatment and recovery support services, as well as projects to expand system capacity,

continue research on marijuana, develop an education campaign regarding marijuana's

potential risks including drugged driving, etc. However, it is important to keep in mind

that, due to the ambiguity of laws with marijuana, specifically federal law, program’s

receiving federal funding may be prohibited from accepting marijuana tax funds.

Page 5 of 16

An age should be clearly established for purchase and consumption, ideally 21, which

coincides with other states that have legalized marijuana. Additionally, no one under the

age of 21 should be permitted into a marijuana retail store.

Implement a responsible vendor compliance program (similar to responsible beverage

training for alcohol) to educate store employees on the health effects, safety practices,

and importance of restricting youth access to marijuana and related products.

Establishment of rules on packaging, labeling, and product safety equal to rules that

tobacco products must follow. Images or verbiage on packaging should not appeal to

youth under the age of 21. Advertising should be banned from all television, internet

pop ups, radio, and print where a youth market is the target audience.

Legalization may create additional job opportunities, but it may also create an increase

in workers compensation claims or issues of being under the influence during work

hours.

Marijuana is metabolized differently compared to alcohol. The human body processes

one alcoholic beverage per hour. Marijuana can be detected in the body up to 30 days

after one use. The standard established in other states is 5 nanograms or any amount

that causes impairment. However, the amount that causes impairment can vary

significantly depending upon the person, as well as the latency period for a blood test to

determine the concentration of THC. Thus, it is critical to take this information into

account when developing workplace standards.

Legalization is thought to decrease the illegal sales of marijuana but in some cases, as in

Colorado, marijuana is still sold illegally due to the retail price. This, in turn, has led to a

disparity in criminal offenses for illegal sales and purchase of marijuana among

minorities. Therefore, do not assume legalization will eradicate the illegal sale of

marijuana.

The State of Illinois currently does not have the systems in place to properly monitor,

research, and address the various forms of marijuana products, specifically edibles and

the proper serving size to prevent overconsumption. In addition, the State of Illinois

currently does not have testing facilities and protocols regarding THC potency and

contamination testing on plants, edibles, and concentrates, data collection, etc.

Recommendations from experts from a variety of state agencies including public health

and environmental agencies, transportation, human services (including child protective

services), health care, law enforcement, States Attorney, economists and educators is

crucial to address the wide variety of concerns regarding legalization and to implement

a system of consistent messaging on the law.

Once medical marijuana was passed in Colorado, poison control received an increase in

calls for accidental poisoning regarding children ingesting an edible marijuana product.

Since recreational use has been passed in Colorado, there has been an even higher

increase in the number of calls to poison control. In 2015, there were 231 human calls

for exposure to marijuana in Colorado. Of those, 91 cases were related to ingestion of

an edible marijuana product. Of the 231 total calls, 117 (51%) involved children ranging

Page 6 of 16

in ages from 0 to 18 years old. (Rocky Mountain Poison and Control Center, Colorado

Marijuana Statistics for 2015). Addressing edible products is critical to the health and

safety of children and youth.

In summary, the legalization of marijuana is a very complex issue and requires, prior to

implementation, an establishment of a regulatory system and the application of the public

health framework including assessment, policy development, and quality control. One of the

successes in Colorado was the collaboration of public health officials in the development of

marijuana legislation which allowed for a proactive prevention approach to ensure the safety of

children and the community.1

1 Ghosh T, Van Dyke M, Maffey A, Whitley E, Gillim-Ross L, & Wolk L. The Public Health Framework of Legalized

Marijuana in Colorado. American Journal of Public Health. 2016; 106(1):21-27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695936/

Page 7 of 16

Review of Literature by Key Topic Area

Questions to consider when developing a law are noted in red under the corresponding data

point.

Economic Information

According to a 2016 report by Henchman and Scarboro, the following outcomes have occurred in states that have legalized marijuana to date:2

Colorado and Washington have collected more in taxes than originally anticipated. However, Colorado, Washington, and Oregon are reducing their marijuana tax rates as legalization has not helped to reduce the black market sufficiently. The rates are ~30%. Proposed rates are looking at 10% to 25%.

Medical marijuana is not taxed as much as recreational marijuana. Time and money are critical to set up new frameworks and regulatory structures. Anticipated tax revenue was $70 million per year (first $40 million to school construction,

$30 million to enforcement and general state funds). Year one (2014) revenue was $56 million / $304 million sales Year two (2015) revenue was $113 million / $568 million sales Year three revenue for the first six months of 2016 was $64 million. It is

anticipated to be $143 to $185 million. Data shows Colorado retail sales have steadily increased while medical sales have remained

stable. Retail tax revenue had steady growth.

At least 44% of retail sales have come from out of state visitors. Washington has designated 40% of revenue to go to state general funds and local budgets

with 60% going towards substance abuse prevention, research, education, and health care. In Oregon, the tax revenue is distributed as follows: 40% to schools, 20% to mental health,

alcoholism and drug services, 15% to state police, 10% to cities, 10% to counties, and 5% to the Oregon Health Authority.

A 2016 report by the national organization Smart Approaches to Marijuana noted the following outcomes after four years of legalization in some states:3 Over half the revenue promised for drug prevention, education and treatment in

Washington never materialized. Some Colorado school districts, such as Denver’s, haven’t seen a single dollar of new

funding from the state marijuana taxes. Marijuana legalization has had a significant impact on businesses, as they have had to

recruit employees from out of state as so many residents have failed pre-employment drug tests.

Quest Diagnostics, a major drug testing firm, which analyzes the results of millions of workplace drug tests each year, has reported a 47% increase in oral marijuana test results in the U.S. from 2013 to 2015. There has been a 178% increase between 2011 and 2015.

2 Henchman, J. & Scarboro, M. Marijuana Legalization and Taxes: Lessons for Other States from Colorado and

Washington. Taxfoundation.org, 2016. Web. 12 May 2016. https://taxfoundation.org/marijuana-taxes-lessons-colorado-washington/ 3 SAM: Lessons Learned After 4 Years of Marijuana Legalization. Web. October 2016

https://learnaboutsam.org/wp-content/uploads/2016/11/SAM-report-on-CO-and-WA-issued-31-Oct-2016.pdf

Page 8 of 16

An investigation by the Denver Post showed that a disproportionate share of marijuana businesses are located in lower-income and minority communities in Denver. These communities often suffer disparate impacts of drug use. One of Denver's lower-income neighborhoods has one marijuana business for every 47 residents.

An August 2016 study in the Journal of Drug Issues showed there has been a rapid growth in the amount of people who smoke marijuana daily. Many of those frequent users are poor and lack a high school diploma. 29% of all marijuana users come from households with incomes less than $20,000 per year.4

An investigation by the Denver Post found that recreational marijuana businesses are rapidly growing in poorer neighborhoods. These business owners are saying "they are in those parts of town because that is where the city regulations have restricted them to be". They also found that landlords in these areas are more willing to lease their properties to federally illegal businesses. Many low-income neighborhoods are next to industrial areas which are prime locations for marijuana businesses. In Colorado data shows there has been an increase in marijuana related crimes in areas dominated by marijuana businesses.5

A study done by the University of Colorado Denver found there is a lot more land available for pot shops in Denver's low-income, minority areas than in wealthier areas under current city zoning rules. The pot shops are opening in areas where people are more likely to abuse the drug. Their research showed that 46.1% of land was available for marijuana dispensaries in low income areas while 28.9% was available in other areas.6

Driving Under the Influence

Some states have determined that it is illegal to drive under the influence at more than 5 nanograms of THC per ml of blood.7

o How can that be tested on the spot? o How can you determine if it is in their system from previous consumption versus

being under the influence at that moment? o Who pays for the test?

Complications currently exist on assessing drivers under the influence of marijuana as it can be detected in the body for hours/days after the high from smoking has dissipated. A high typically peaks within 30 minutes and is gone within three hours after ingestion.8

A recent study showed a 48% increase in marijuana-related traffic deaths in the three-year average since Colorado legalized marijuana, compared to prior to legalization.9

4 Study: Poorer marijuana users smoking the most. Web 2016. http://www.denverpost.com/2016/08/14/study-

poorer-marijuana-users-smoking-the-most/ 5 Migoya, D. and Baca, R. Denver’s pot businesses mostly in low-income, minority neighborhoods. Web 23 January

2017. http://www.denverpost.com/2016/01/02/denvers-pot-businesses-mostly-in-low-income-minority-neighborhoods/ 6 Harvey, N. Research uncovers inequities in zoning rules, health impacts of pot shops. Web. 13 August 2014.

http://www.healthnewscolorado.org/2014/08/13/research-uncovers-inequities-in-zoning-rules-health-impacts-of-pot-shops/ 7 Chen, A. Why Is It So Hard To Test Whether Drivers Are Stoned? Npr.org, 2016. Web. 9 February 2016.

http://www.npr.org/sections/health-shots/2016/02/09/466147956/why-its-so-hard-to-make-a-solid-test-for-driving-while-stoned 8 Stoned Driving on the Rise, But is it as Risky as Drinking and Driving? CBSnews.com, 2015. Web. 11 February

2015. http://www.cbsnews.com/news/stoned-driving-on-the-rise-not-as-risky-as-drinking-and-driving/

Page 9 of 16

In 2009, 10% of all traffic fatalities in Colorado involved a driver testing positive for marijuana. By 2015, that number more than doubled to 21%.10

The National Highway Traffic Safety Administration (NHTSA) conducted a survey in 2013 and 2014 showing that the number of drivers with marijuana in their systems grew by nearly 50% since 2007, rising from 8.6 percent in 2007 to 12.6 percent in 2014.11

The report from the NHTSA also cited evidence that marijuana use impairs psychomotor skills, divided attention, lane tracking, and cognitive functions (all essential skills for safe driving) as well as impairs judgment, reaction times and awareness.12

A 2012 study published in the peer-reviewed journal Psychopharmacology showed that only 30% of people under the influence of THC failed a field sobriety test.13

The study further noted that it is harder to identify a driver under the influence of marijuana, especially if the driver is accustomed to being high. While a breathalyzer can reliably test blood-alcohol content on the side of the road, THC levels can only be measured by blood or urine samples. These samples are typically taken hours after an arrest. A urine test can return a positive result weeks after someone smoked. Because THC builds up in fatty tissue and is released slowly over time, frequent users may come up over the limit even if they haven’t smoked in days.14

The average time to collect blood from a suspected driver is usually two hours or more because a blood sample requires a warrant and transport to a police station or hospital. 15

Varying State Laws As of April 2017, 28 states have passed comprehensive medical marijuana laws. Eight of these including the District of Columbia have legalized recreational use for adults 21 and older. California – Recreational use on private property became legal immediately after the 2016

election. There is no system in place to sell or purchase recreational marijuana – which means that for now it has to be shared free of charge by someone who legally grew or obtained it. The licensing system for recreational sales is supposed to be in place by January 2018. State agencies are still developing regulations for licensing and taxing sales, and an extensive study of the new industry’s environmental impact is required.16

9 Rocky Mountain High Intensity Drug Trafficking Area. The Legalization of Marijuana in Colorado: The Impact.

September 2016. Volume 4. National Institute on Drug Abuse. Marijuana’s Lasting Effects on the Brain. Drugabuse.gov. Web. March 2013. https://www.drugabuse.gov/about-nida/directors-page/messages-director/2012/09/marijuanas-lasting-effects-brain 10

Ibid. 11

Stoned Driving on the Rise, But is it as Risky as Drinking and Driving? CBSnews.com, 2015. Web. 11 February 2015. http://www.cbsnews.com/news/stoned-driving-on-the-rise-not-as-risky-as-drinking-and-driving/ 12

Ibid. 13

Koerth-Baker, M. Driving Under the Influence, of Marijuana. Nytimes.com. Web. 17 February 2014. https://www.nytimes.com/2014/02/18/health/driving-under-the-influence-of-marijuana.html?_r=0 14

Ibid. 15

Rocky Mountain High Intensity Drug Trafficking Area. The Legalization of Marijuana in Colorado: The Impact. September 2016. Volume 4. National Institute on Drug Abuse. Marijuana’s Lasting Effects on the Brain. Drugabuse.gov. Web. March 2013. https://www.drugabuse.gov/about-nida/directors-page/messages-director/2012/09/marijuanas-lasting-effects-brain 16

Nagele-Piazza, L. In Focus: What Is Legal Under New Recreational Marijuana Laws? Shrm.org. Web. 6 February 2017. https://www.shrm.org/ResourcesAndTools/legal-and-compliance/state-and-local-updates/Pages/What-is-Legal-Under-New-Recreational-Marijuana-Laws.aspx?

Page 10 of 16

Maine – Recreational use of marijuana went into effect on January 30, 2017. This law barely passed with only 50.3% of the vote. Adults can possess up to 2.5 ounces. Retail sales have been delayed until February 2018. There are some towns in Maine that have decided to become “dry towns” to keep out retail sales and social clubs altogether.17

Massachusetts – As of December 15, 2016, residents could grow up to 12 plants and possess up to 10 ounces of marijuana in their homes. Retail sales are set to begin in July 2018. There is a proposal right now though that would delay retail sales and limit residents to growing only 6 plants and possessing only 2 ounces in their homes.18

Nevada – As of January 1, 2017, it became legal to use marijuana on private property, but it will still be illegal to sell until recreational dispensaries are up and running. They are looking to have regulations to allow licenses to retail stores by January 2018.19

Alaska – In early 2015, it became legal for residents to use, possess and transport up to an ounce of marijuana for recreational use.20

Colorado – Legalized recreational marijuana in 2012. Residents and tourists can buy up to one ounce of marijuana. There are more marijuana dispensaries than Starbucks and McDonald combined.21

Oregon – Legalized in 2015. Residents can carry up to an ounce of marijuana and grow up to four plants at home. It’s also legal to give edibles as a gift if they are ingested in private.22

Washington – Legalized recreational use in 2012. People can carry up to one ounce of marijuana, but must require the drug for medical purposes to get a grower’s license.23

Washington, DC – Legalized in November 2014 but took effect roughly one year ago. People can possess up to two ounces of marijuana and “gift” up to one ounce if neither money nor goods or services are exchanged.24

While state laws are changing in regards to medical and recreational marijuana use, it is still illegal at the federal level. Employers have the right to continue enforcing drug-free workplace policies and are under no duty to accommodate the use of medical marijuana by employees or the off-the-job use for recreational users.25

Impact on Prevention/Treatment, Mental/Behavioral Health

Legalization may facilitate introduction of new formulations with higher potencies.26

17

Ibid. 18

Ibid. 19

Ibid. 20

Robinson, M. It’s 2017: Here’s where you can legally smoke weed now. Businessinsider.com. Web. 8 January 2017. http://www.businessinsider.com/where-can-you-legally-smoke-weed-2017-1 21

Ibid. 22

Ibid. 23

Ibid. 24

Ibid. 25

Nagele-Piazza, L. In Focus: What Is Legal Under New Recreational Marijuana Laws? Shrm.org. Web. 6 February 2017. https://www.shrm.org/ResourcesAndTools/legal-and-compliance/state-and-local-updates/Pages/What-is-Legal-Under-New-Recreational-Marijuana-Laws.aspx 26

Hopfer, C. Implications of Marijuana Legalization for Adolescent Substance Use. Substance Abuse: Official Publication of the Association for Medical Education and Research in Substance Abuse. 2014; 35(4):331-335 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308295/

Page 11 of 16

Claims that marijuana has medicinal benefits create challenges for adolescent prevention efforts as they contrast with messages of its harmfulness. 27

Prevention and treatment approaches will need to address perceptions of the safety of marijuana, claims of its medicinal use, and consider family-wide effects as older siblings and parents may increasingly openly consume and advocate for marijuana use.28

Adolescent marijuana use has been associated with impairment in several areas: o impaired cognitive functioning, o increased risk of developing marijuana dependence, o elevated rates of school dropout, o an elevated risk of developing psychotic illnesses, and, o an increased rate of engaging in risky behaviors.29

A 2016 Colorado study noted that youth marijuana use increase by 20% in the two years since they legalized recreational marijuana. Nationally, youth marijuana use declined by 4% during the same timeframe. College-age use increased by 17%.30

Two studies from Sweden (1987 and 2002) concluded that marijuana use strongly correlated with psychosis. Increased cannabis use correlates with higher rates of schizophrenia.31

Edibles Marijuana legalization has brought on a significant increase in pot “edibles”. Pot “edibles” are THC concentrate that is mixed into almost any type of food or drink, including gummy candy, soda, and lollipops.

Edibles make up at least half of Colorado’s marijuana market.32 Edibles’ potency is typically several times that of an average joint. Many are known to

contain 3 to 20 times the THC concentration recommended for intoxication.33 Because of its attractiveness to children, edibles have become a serious problem in legalized

states. This is evident as there has been an increase in usage among teenagers, emergency poison control calls for children 0 to 8 have tripled in Colorado, etc.34

When one smokes or vaporizes cannabis, they feel the effects almost instantly and can decide if they have had too much. However, with edibles this takes longer and can lead a user to ingest too much. The body needs to digest and metabolize the edible before feeling

27

Ibid. 28

Ibid. 29

Ibid. 30

Rocky Mountain High Intensity Drug Trafficking Area. The Legalization of Marijuana in Colorado: The Impact. September 2016. Volume 4. National Institute on Drug Abuse. Marijuana’s Lasting Effects on the Brain. Drugabuse.gov. Web. March 2016. https://www.drugabuse.gov/about-nida/directors-page/messages-director/2012/09/marijuanas-lasting-effects-brain 31

SAM Educational Briefs & Data on Marijuana Policy. Web. February 2017 https://learnaboutsam.org/wp-content/uploads/2017/02/06Feb2017-SAM-educational-briefs.pdf 32

SAM Educational Briefs & Data on Marijuana Policy. Web. February 2017 https://learnaboutsam.org/wp-content/uploads/2017/02/06Feb2017-SAM-educational-briefs.pdf 33

Ibid. 34

Ibid.

Page 12 of 16

the effects. The amount of time it takes for effects to 'kick in' depends on one’s metabolism.35

Edibles are typically made with highly concentrated cannabis. Many times, one edible is, in fact, two or more doses.36

Due to the plant’s federal illegal status, cannabis products are not subjected to FDA regulations, so a lack of standard rules could result in a lack of consistency in dosage from one product to another.37

In February 2017, Colorado Governor Hickenlooper testified to the California Senate, urging leaders to focus on setting standards for edible marijuana goods and driving under the influence of cannabis as soon as possible to avoid repeating the mistakes that Colorado made while legalizing recreational cannabis. He stated that some of their challenges included implementing new policies, taxing dispensaries, and keeping edible products away from children. After issues with children ingesting edible cannabis, Colorado now requires child-proof containers and has stricter regulations on labeling of these products.38

Unlike alcohol there is no real quantifiable, definitive impairment level that can be identified with marijuana use.39

According to the 2015 Colorado House Bill 14-1366 Marijuana Edibles Work Group Report the following permanent rules have been set forth in regards to retail edible marijuana products40:

Colorado has created a commercial marijuana symbol that must be marked on each

marijuana package and each individual edible product. This symbol also differentiates between medical and retail marijuana.

They established a standard serving size of marijuana as no more than 10mg of active THC. Require the edible retail marijuana product manufacturer to create standard operating

procedures for each edible that it manufactures, including determination of the serving size of THC for each product and the number of servings in each product.

Requires the manufacturer to physically demark each serving of marijuana in edible products that exceed 10mg of active THC.

If demarcation is not possible, then the product must contain 10mg or less of active THC. The responsibility for packaging and labeling of edible retail marijuana products is on the

manufacturer. A single serving edible must be in a child resistant package for one opening. A multiple

serving edible must be in a child resistant package for multiple openings. It is a violation for retail marijuana stores to purchase, take possession of, or sell non-

compliant edible retail marijuana products.

35

Wilcox, A. Cannabis-Infused Edibles 101: What to Know About Dosing, Potency, and Labeling. Web. 2017. https://www.leafly.com/news/cannabis-101/medibles-101-everything-youve-ever-wanted-to-know-about-edibles 36

Ibid. 37

Ibid 38

Associated Press. Colorado Governor Talks Cannabis Challenges in California Capitol. Web. 15 February 2017. https://www.leafly.com/news/politics/colorado-governor-talks-cannabis-challenges-california-capitol 39

Ibid. 40

Brohl, B. House Bill 14-1366 Marijuana Edibles Work Group Report. Web. 2015

Page 13 of 16

Provides for process validation of single serving edible retail marijuana products as opposed to mandatory potency/homogeneity testing for every production batch, which is still required for products that exceed 10mg of active THC.

Page 14 of 16

Impact on Health & Safety What are the health effects of second hand marijuana smoke on children? What are the legal implications, if any, for pregnant women smoking marijuana? Research shows that prenatal marijuana exposure influences brain development and can

have long lasting impacts on cognitive functions. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 7.1% of pregnant women between ages 18 and 25 have used drugs while pregnant, with marijuana being the most prevalent. Prenatal exposure has been associated with fetal growth restriction, learning disabilities, and memory impairment.41

The Centers for Disease Control and Prevention (CDC) recently told physicians across the country to stop testing their patients for marijuana. The federal agency made the change to help patients who are typically required to test free of illegal substances (including THC) to continue a pain treatment plan, such as patients going from a family doctor to a pain management clinic. Meanwhile, the Supreme Court threw out a lawsuit Oklahoma and Nebraska filed against Colorado, which basically claimed the state was undermining federal law and hurting neighboring states. In the near future, the DEA is expected to reconsider marijuana’s Schedule 1 status.

42 The number of hospitalizations related to marijuana has steadily risen since becoming

legal.43 Emergency room visits related to marijuana use have increased 49% since becoming legal.44 Colorado highway patrol seizures on marijuana increased by 37% between 2013 and 2015.

Of these seizures, there were 36 different states destined to receive the marijuana with the most common being Missouri, Illinois, Texas, Iowa, and Florida. Colorado has also seen a 427% increase in seizures of marijuana being sent via U.S. Mail between 2013 and 2015.45

Youth arrests for marijuana related offenses have increased since legalization.46 The Colorado Attorney General reported that marijuana is still being sold on the black

market and that cartel activity and illegal activity has not decreased at all.47

41

Wu, C., Jew, C. & Lu, H. Lasting impacts of prenatal cannabis exposure and the role of endogenous cannabinoids in the developing brain. Future Neurology 2011; 6(4): 459-480. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252200/ 42

McWhinnie, E. What are the Side Effects of Marijuana on the Economy. Money & Career CheatSheet. 21 May 2016. http://www.cheatsheet.com/money-career/what-are-the-side-effects-of-marijuana-on-the-economy.html/?a=viewall 43

Rocky Mountain High Intensity Drug Trafficking Area. The Legalization of Marijuana in Colorado: The Impact. September 2016. Volume 4. National Institute on Drug Abuse. Marijuana’s Lasting Effects on the Brain. Drugabuse.gov. Web. March 2013. https://www.drugabuse.gov/about-nida/directors-page/messages-director/2012/09/marijuanas-lasting-effects-brain 44

Ibid. 45

Ibid. 46

SAM Educational Briefs & Data on Marijuana Policy. Web. February 2017. https://learnaboutsam.org/wp-content/uploads/2017/02/06Feb2017-SAM-educational-briefs.pdf 47

SAM: Lessons Learned After 4 Years of Marijuana Legalization. Web. October 2016. https://learnaboutsam.org/wp-content/uploads/2016/11/SAM-report-on-CO-and-WA-issued-31-Oct-2016.pdf

Page 15 of 16

The Colorado Attorney General’s office noted that legalization “has inadvertently helped fuel the business of the Mexican drug cartels…cartels are now trading drugs like heroin for marijuana, and the trade has since opened the door to drug and human trafficking.”48

Legalization may be contributing to the increase in homelessness in Colorado. From 2012 to 2014, in Denver, homeless shelter usage grew about 50%, with one in three residents stating they were in Denver for the legal access to marijuana.49

A New Zealand study tracking users over many years found that chronic marijuana use starting in adolescence is associated with an 8-point drop in IQ in mid-adulthood.50

Studies show marijuana use is linked to reduced determination and drive, criminal behavior, unemployment, lower incomes, greater welfare dependence, and lower life satisfaction.51 52

The hippocampus (part of the brain responsible for long term memory) develops abnormalities in density, volume and shape in daily marijuana users and casual users.53

Marijuana use doubles the risk of developing psychotic disorders.54

48

Ibid. 49

Ibid. 50

Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S. E., … Moffitt, T. E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences of the United States of America, 109(40), E2657–E2664. http://doi.org/10.1073/pnas.1206820109 51

Fergusson DM, Boden JM. Cannabis use and later life outcomes. Addict Abingdon Engl. 2008;103(6):969-976; discussion 977-978. doi:10.1111/j.1360-0443.2008.02221.x. 52

Brook JS, Lee JY, Finch SJ, Seltzer N, Brook DW. Adult work commitment, financial stability, and social environment as related to trajectories of marijuana use beginning in adolescence. Subst Abuse. 2013;34(3):298-305. doi:10.1080/08897077.2013.775092. 53

Medina, K. L., B. J. Nagel, et al. "Abnormal cerebellar morphometry in abstinent adolescent marijuana users." Psychiatry Res 182(2): 152-9. 54

Campolongo P, Trezza V, Cassano T, et al. Perinatal exposure to delta-9-tetrahydrocannabinol causes enduring cognitive deficits associated with alteration of cortical gene expression and neurotransmission in rats. Addict Biol. 2007;12(3-4):485-495. doi:10.1111/j.1369-1600.2007.00074.x.

Page 16 of 16

Implications of Marijuana Legalization for Adolescent Substance Use by Christian Hopfer, MD,

whose research is funded by the federal National Institute on Drug Abuse.55

The issue of scientific clarity regarding the harms of adolescent marijuana use has substantial

implications beyond influencing the debate about whether marijuana should be legalized or

not. Consider a hypothetical environment where marijuana is legal for adult recreational

consumption, widely available, and widely believed to be harmless or even beneficial. How will

prevention efforts be conducted if there is not clear scientific, medical, and public consensus

that marijuana use is harmful? How will treatment be conducted when there is substantial

disagreement about the harmfulness of using marijuana? Will primary care physicians screen

adolescents for marijuana use as they do for alcohol and tobacco? How will counseling be

conducted and what guidelines for physician advice will be promoted? What if an adolescent

requests marijuana as a treatment for psychiatric or medical conditions? Legalization implies

that law enforcement efforts to control or reduce marijuana use will be limited, leaving public

health, medical, and scientific organizations to reduce harm and educate the public. These

stakeholders face major challenges in developing clear messages, particularly in an evolving

policy climate. If marijuana becomes widely legal in the United States or internationally, the

need grows to have current and rigorous scientific evidence about the effects of marijuana

consumption, particularly for adolescents. Claims of medicinal benefits need to be addressed

clearly and concerted efforts to develop a coordinated public health policy response to

legalization are needed.

55

Hopfer, C. Implications of Marijuana Legalization for Adolescent Substance Use. Substance Abuse: Official Publication of the Association for Medical Education and Research in Substance Abuse. 2014; 35(4):331-335. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308295/