Three eminent physicians present a compelling case for legalizing marijuana in the November issue of the American Journal of Public Health. The opinion piece, “The Physicians’ Case for Marijuana Legalization,” written by David L. Nathan, M.D.; H. Westley Clark, M.D., J.D.; and Joycelyn Elders, M.D., states that it’s time for federal law to change and make marijuana legal, as it is for medical purposes in 29 states and for any purpose, including recreational, in 8 states. More than 60 percent of Americans favor legalization. And most importantly, marijuana prohibition “has done more damage to public health than has marijuana itself,” they write. It has failed, just as alcohol prohibition failed due to “organized crime, increased use of hard alcohol and government waste.” Alcohol consumption did decrease during prohibition, but marijuana use has increased during prohibition.

You can’t fool children

And while prevention programs have reduced the rates of alcohol and tobacco use by youth, marijuana use has not been affected, they write. “Unfortunately, prohibition sends the message that marijuana is dangerous for everyone, because it is illegal for everyone, and children know that is not true,” they write. “If we want our children to believe us when we say that cannabis can be harmful for them, our laws should reflect the difference in health effects of underage and adult use.”

What the physicians don’t want is promotion of marijuana; they want marketing and advertising to be restricted. But they want what is sold to be safe.

Decriminalization inadequate

Even physicians who oppose marijuana legalization believe it should be decriminalized, with reductions in penalties even if the drug is illegal. Nathan, Clark and Elders write that decriminalization is “a step in the right direction” but still inadequate, partly because it doesn’t give the government the authority to regulate product labeling, which could result in contamination and adulteration. It also means people would not be able to judge the potency of marijuana, “which is like drinking alcohol without knowing its strength.” In addition, decriminalization means that drug dealers will be the ones who sell marijuana — including to children. And marijuana users continue to get arrested even under decriminalization. New York state decriminalized marijuana in the 1970s, but New York City still arrests tens of thousands of people for marijuana possession every year, targeting people based on race, the authors note.

Doctors for Cannabis Regulation

The three authors, along with more than 50 prominent physicians, last year founded Doctors for Cannabis Regulation, which is dedicated to the legalization and regulation of the adult use of marijuana (see ADAW, May 23, 2016). The group does not promote cannabis use, but does advocate for effective regulation, and for legalization, as regulation can’t exist with something that is illegal.

“The government should oversee all cannabis production, testing, distribution, and sales,” the authors write. In addition:

  • Cannabis products should be labeled with significant detail, including (but not limited to) THC (tetrahydrocannabinol — the principal psychoactive constituent of cannabis) and CBD (cannabidiol — an active cannabinoid in cannabis) levels, dosing information and ingredients.
  • There should be restrictions on the marketing and advertising of cannabis products.
  • Cannabis packaging and advertising that targets or attracts underage users should be completely prohibited.
  • All cannabis products should have child-resistant packaging.
  • There should be strong penalties for adults who enable the diversion of cannabis to minors.
  • Money from the taxation of the cannabis trade should be used to fund research, education, prevention and substance abuse treatment. These should include public information for adults on the use and misuse of cannabis and youth programs that emphasize the risks of underage cannabis use.

Lawmakers are already being advised by the marijuana industry on regulation, so it’s time for doctors to provide this advice as well, the authors write. “Informed physicians may disagree about the specifics of good regulation, but we cannot abstain from the discussion,” they write.

The authors

Nathan is with the Rutgers Robert Wood Johnson Medical School in New Jersey and is the founder and board president of Doctors for Cannabis Regulation. Clark was formerly director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration. Elders was the 15th U.S. surgeon general.