This week, Drug Policy Institute's Kevin Sabet and Drug Policy Alliance's Ethan Nadelmann debate marijuana politics.

Today's question concerns the push for more lenient treatment of marijuana in the context of a broader push for smoking bans, fatty food and drink restrictions, and other regulations ostensibly aimed at promoting public health.

Previously, Sabet and Nadelmann debated state marijuana initiatives

At the same time many states are pursuing more liberal cannabis policies, many are also becoming more strict on other health issues, including tobacco. Does this make sense?

Ethan Nadelmann:

The increasing convergence of tobacco and marijuana policy makes a lot of sense in terms of both public health and public safety.  On the one hand, reasonable measures to discourage tobacco consumption among the general population and especially among youth can prevent and reduce addiction to nicotine, a drug that heroin addicts routinely describe as tougher to quit than heroin.  

Raising taxes on cigarettes—while trying to avoid the illicit smuggling that results from significant differences in tax rates among neighboring jurisdictions—is an effective means to do that.  On the other hand, we can anticipate a public safety disaster if ever Americans decide to prohibit tobacco production, sale and consumption as we do now with marijuana and once did with alcohol. With regulation comes quality control, and restrictions on sales to minors, advertising directed at minors and locations where marijuana could be distributed. This would take it out of parks and neighborhoods and into licensed stores.

Ethan Nadelmann is Executive Director of the Drug Policy Alliance.

Kevin Sabet:

Cannabis and tobacco are both harmful to the human body and their use causes billions of dollars in social costs every year. So it makes as much sense to get strict on tobacco and lax on cannabis as it does to institute seat belt laws but give little regard to highway speed limit laws. Attention to both is required to ensure safe driving. Similarly, we should prevent both cannabis and tobacco use—especially among youth—to promote public health.

Cannabis and tobacco are, of course, harmful in different ways. For example, according to the British Medical Journal, which conducted the most exhaustive review of the literature to date, driving while high on cannabis doubles the risk of a car crashes. Tobacco use does not affect driving. On the other hand, few doubt that tobacco directly causes lung cancer; the link between cannabis and lung cancer is still controversial. We also know that cannabis is linked to mental illness—like psychosis and schizophrenia—in ways that tobacco is not.  

Finally, science has shown that tobacco addicts more people than any other drug (including heroin). One in three people who ever start using tobacco will become addicted. The number for cannabis is similar to that for alcohol—about one in 10 (though that number rises to one in six if one starts using cannabis in adolescence). Although their risk profiles are certainly different, there are some similarities too: cannabis and tobacco both contain many of the same ingredients including carbon monoxide, tar, and carcinogens (like "benzanthracenes" and "benzpyrenes").

A great incongruence of our time is that as science has gradually revealed new and disturbing conclusions about the role of today’s high-grade cannabis (it contains much more of its psychoactive ingredient today than ever before), support for lax policies has also risen. But with tobacco, learning about its dangers has led to stricter policies. If tobacco teaches us anything about cannabis, it is this: Legalization results in more availability, use, and addiction than we would otherwise have. And importantly, any taxes we collect on tobacco pale in comparison to that drug’s social costs. Indeed, for every $1 in tax revenue that states and the federal government take in, $10 are lost on the social costs of tobacco use.

When tobacco established itself in the United States, an entire legal industry erupted and downplayed any negative effects of the drug. Big Tobacco continually deceived the American public by targeting to kids, too. Subsequent court cases against the industry revealed that tobacco companies have said these things:

The Liggett Group: “If you are really and truly not going to sell [cigarettes] to children, you are going to be out of business in 30 years.”

R. J. Reynolds: “Realistically, if our company is to survive and prosper, over the long term we must get our share of the youth market.”

Lorillard: “The base of our business is the high school student.”

Phillip Morris: “Today's teenager is tomorrow's potential regular customer… Because of our high share of the market among the youngest smokers, Philip Morris will suffer more than the other companies from the decline in the number of teenage smokers.”

American-style commercialization will undoubtedly accompany cannabis legalization. Commercial speech is free speech in the United States. We would do well to learn from our experience with tobacco and focus our efforts on preventing both tobacco and cannabis use.

Kevin A. Sabet, PhD, is Director of the Drug Policy Institute at the University of Florida. He served as a senior advisor in the Obama Administration from 2009 to 2011.

Ethan Nadelmann responds: 

There is no scientific basis for suggesting that the dangers of cannabis compare to those of tobaccoor, for that matter, alcohol – and no basis for implying that the costs of cannabis use would approximate those of tobacco or alcohol if cannabis were legalized.

Yes, cannabis is a “drug” (like alcohol and tobacco) to which some people become addicted and which can harm the health of those who use it recklessly or in abundance.  It is, however, dramatically less addictive and deadly than tobacco.  It lacks alcohol’s association with violent and other reckless behavior.  And addiction to marijuana is far less dangerous to self and others than addiction to alcohol, which experts consistently rank as the most dangerous substance, legal or illegal.  For the vast majority of people who consume marijuana today, the greatest harms associated with their consumption are the criminal and civil sanctions that can prohibit them from gaining employment, housing or an education in the future.

Youth use of alcohol and tobacco has declined over the past few decades, largely due to better education and regulation – not because of prohibition. Marijuana use rates, by contrast, have increased or have remained stable in recent years– in spite of arresting over 750,000 people each year for marijuana possession.
What is needed in the case of all three is responsible regulation of legal markets with the objective of minimizing the harms of both drug misuse and government policies.

Kevin Sabet responds:

As I said before, the harms of cannabis, alcohol and tobacco are different. All three are harmful. Two are legal, and therefore used, abused, and advertised with abandon. Using alcohol and tobacco as our examples of what legal marijuana would look like is hardly responsible. Why can't we make our current policies better before rolling the dice with marijuana legalization?

It's important to be honest about the mixed policy effects both in the Netherlands and here in the United States. Ethan gives us only half of the story on the U.S. decriminalization and Dutch de facto legalization experience. Indeed, the literature on early U.S. decriminalization effects on use is conflicting, according to a more updated review in 2009 done by the same researcher Ethan cites from 2001. Some studies found no increase in use in the so-called decriminalization states, whereas others found a positive relationship between greater use and formal changes in the law. In effect, in the U.S., we have de facto marijuana decriminalization in most of the U.S. today (New York City is a glaring exception). As the RAND Corporation pointed out in an exhaustive report about marijuana legalization, in no Western country is a cannabis user at “much risk of being criminally penalized. Analyses by Beau Kilmer and Robin Room found that the arrest rates for cannabis users who had used the drug in the past year are roughly 3 percent, and that none of those convicted of possession is incarcerated or receives an administrative fine of more than $1,000. Other independent research has shown that the risk of arrest for each “joint,” or cannabis cigarette, smoked is about 1 arrest for every 12,000 joints. Mark Kleiman, Jon Caulkins, and others have also previously concluded that "...almost all people imprisoned for drug-law violations were involved in drug distribution; they say so themselves in surveys. The roles may have been small, but they are not in prison just for using.”

The Netherlands experience is also interesting, nuanced, and the subject of active debate. First, it's important to remember that the Dutch—indeed most of Europe—have always had lower levels of use than the United States. But it is instructive to look inside the Netherlands to see what the result of their policy change has been. In 1976, the Dutch approved a formal policy to allow the possession and sale of up to about 90 cannabis cigarettes (30 grams). The government allowed “coffee-shops” selling cannabis to appear around the country and approved in 1980 guidelines allowing more local control discretion of commercial cannabis practices. As the Dutch got used to the idea of legal cannabis, coffee shops increased in prevalence and the number of them grew eleven-fold in eight years (nine in 1980 and 102 by 1988). In 2001, a lower-end estimate numbers coffee shops at about 1,200. MacCoun and Reuter point out that between 1976 and 1984, cannabis use remained about the same for adults and youth. Thus the early effect of this policy change seemed to have been minimal. From the mid-1980s to the mid-1990s, though, they observe that “surveys reveal that the lifetime prevalence of cannabis in Holland increased consistently and sharply.” They report 15 percent of 18-20 year olds used cannabis in their lifetime in 1984 turned into 44 percent by 1996—a 300 percent increase. Indeed, they also find cite past-month prevalence of 8.5 percent in 1984 to 18.5 percent in 1996. MacCoun and Reuter point to “commercialization” as the reason for this spike in drug use. That is, they contend that during this period between 1984 and 1996, the greater glamorization and more visible promotion of cannabis led to an increase in use. I've also suggested that the increase could also be due in part to a greater normalization of use, as anti-drug attitudes eroded among youth and use became more gradually accepted.

There has been a recent significant shift in policy in the Netherlands. The government is undertaking a massive policy turnaround. It continues to reduce the number of coffee shops, and though current cannabis use in the Netherlands is similar to other European countries, treatment admissions for cannabis are higher in that country than other European neighbors. Severe restrictions by the Dutch government continue to be implemented, including forbidding non-Dutch citizens from buying marijuana and continuing to zone areas forbidding coffee shops altogether.

The more recent discussion about state-level legalization may provide more insights into today's discussions of legalization. Two RAND Corporation reports provide a useful analysis of such a policy. The studies concluded that legalization would result in lower cannabis prices, and thus increases in use (though by how much is highly uncertain), and that “legalizing cannabis in California would not dramatically reduce the drug revenues collected by Mexican drug trafficking organizations from sales to the United States.”

Tomorrow, Sabet and Nadelmann will consider the Obama administration's drug enforcement policies.