Whether or not you agree with legalizing marijuana, it is happening. So far, at least nine countries have legalized cannabis for medical purposes. Uruguay has also made it legal for recreational use, and Canada is expected to follow suit. In the USA, cannabis products remain illegal under federal law. But at least 23 states and D.C. have legalized medical cannabis under their laws, with four states and D.C. also legalizing recreational use. The legislatures of additional states and countries are considering legalization, and other legalization proposals will be on the ballots in the coming U.S. elections.
Medical legalization is promoted to make potentially helpful cannabis products available for the treatment or amelioration of medical conditions that do not respond well to more conventional treatments or medicines. More extensive legalization, for recreational use, is proposed to eliminate the violence, corruption and other harms from the existing illicit trade, and to stop criminalizing non-violent, victimless behavior relating to cannabis sales and use (which disproportionately incarcerates Blacks and Hispanics from poor communities). Legalization measures also typically include provisions to reduce unintended consequences, such as increased cannabis use among youth or increased abusive use.
Nevertheless, there are significant public health concerns. Medical legalization could make cannabis products more readily available and acceptable for purely recreational use, risking increases in youth initiation, abusive use, and related harms. The legal advertising and marketing of recreational cannabis could increase abusive and youth use and related harms even more directly. There is also a fear that legalization will lead to the development of a new legal cannabis industry that, like Big Tobacco, will work to block or weaken effective regulation while aggressively designing and marketing its products to increase overall use and maximize profits.
These concerns might lead some to oppose any form of cannabis legalization. But that train has left the station. Legalization is happening. Regardless of our views on the propriety or morality of legalization, itself, we need to figure out how those states, countries and other jurisdictions choosing to legalize cannabis products for medical or recreational purposes can do so in ways that will best protect and promote the public health.
Toward that end, the O’Neill Institute for National and Global Health Law at Georgetown University’s law school (where we work) and the Washington Office on Latin America (WOLA) are hosting a meeting in late March of public health leaders and experts to try to develop consensus public health guidelines and recommendations for cannabis legalization wherever and whenever it occurs. Without taking a position on legalization itself, this project will work to identify those specific restrictions and requirements that could be placed on the production, marketing and sale of the legalized cannabis products (consistently with the primary goals of legalization) to maximize the public health benefits and minimize the public health risks and harms.
Given existing evidence on cannabis use and abuse, the public health recommendations will likely include making the legalized cannabis products as minimally harmful as possible (e.g., by minimizing contaminants and prohibiting toxic or addictive additives), which should directly promote the recreational legalization goal of eliminating the illicit market through legal competition. But figuring out how to prevent or at least minimize any legalization-caused increases in either youth use or abusive use – while still enabling the legal market to compete successfully against illicit sellers – will be a more complicated endeavor.
Nevertheless, building on lessons learned from past public health successes and failures in the regulation of tobacco products, drugs, alcohol and food will enable us to identify certain provisions that any cannabis legalization laws or proposals could include to avoid unnecessary public health harms and risks, while still promoting the potential public health and other benefits.
This effort will provide a useful framework both for informing and evaluating new legalization proposals and for improving those already in place. Indeed, supporters of legalization efforts generally understand that robust public health protections will be central to realizing the full potential of cannabis legalization and avoiding undesired impacts that could produce a negative backlash. Similarly, thoughtful opponents realize that, where legalization appears to be inevitable, including strong provisions to avoid unnecessary public health risks and harms from the start makes more sense than trying to fix or repeal a seriously flawed new law after it is put into place.