The Public Health Concerns of Weed Legalization

There are some serious public health concerns about the legalization of marijuana, but they’re probably not what you might expect.

Regarding marijuana legalization, “opinions range from regarding this as a landmark human rights advance granting access to a miracle medication, to one of a disastrous, anarchic profiteering sham.” Most may agree, though, that the trillion-dollar war on weed has been a failed policy, “a vehicle for the hideous expression of American society’s racism,” diverting law enforcement resources away from violent crime, yet having “no appreciable effect on the availability of illegal drugs.” Yes, legalization might free up law enforcement, but opponents “argue that it will increase marijuana use among youth”—not because they couldn’t get it before, but because legalization “will make marijuana more available at a cheaper price and reduce the perceived risks of its use.” Less expensive and more socially acceptable. In other words, the argument goes, think about the children.

What happened in states like Washington and Colorado after they legalized marijuana? Among teens in Washington state, “perceived harmfulness of marijuana use decreased and marijuana use increased,” doubling from 2 to 4 percent. In contrast, there was no change in Colorado, but, presumably, that’s because Colorado had five years of commercialized medical marijuana before recreational use became legal. And, indeed, with the original liberalization in Colorado, perceptions of risk among teens dropped more than elsewhere and rates of dependence went up, as you can see at 1:24 in my video Will Cannabis Turn Into Big Tobacco?.

“A frequently cited concern with legalization is that it will allow the rise of Big Cannabis, similar to Big Tobacco and Big Alcohol.” After the cannabis industry successfully beat back pesticide regulations in Colorado, public health advocates experienced a feeling of déjà vu trying to “mitigate the adverse public health consequences” in the face of an industry that just “aims to maximise profit.”

The biggest concern, however, may not be Big Cannabis turning into Big Tobacco, but rather Big Tobacco turning into Big Cannabis. “Marijuana legalization advocates have not considered the potential effects of the multinational tobacco companies entering the market,” and, indeed, internal memos show that Big Tobacco has just been waiting in the wings for the right time to strike. The fact that Big Tobacco created cigarettes, perhaps the leading cause of preventable death in the world, shows how much they care about people compared to profits—so that should raise some red flags.

Big Tobacco is expected to profit from marijuana legalization whether or not it takes over, though, as frequent cannabis use is a predictor of future cigarette addiction. “For teen non-smokers…weekly cannabis use in the teens predicted a more than eightfold increase in the odds of later initiation of tobacco use”—moving from just joints to joints and cigarettes. This may be because “tobacco is mixed commonly with cannabis in large part to ensure it burns more smoothly. Thus, cannabis use may indirectly bring exposure to tobacco,” which may be seven or eight times more addictive than cannabis.

Or, it may just be that teens who use marijuana hang out more with a crowd that tends to smoke more cigarettes. But, even after controlling for peer use, cannabis does still seem to be a gateway drug to tobacco, perhaps as a way to deal with cannabis withdrawal. Either way, “one of the most potentially harmful and under-appreciated effects of cannabis use is the ‘reverse gateway’”—that it may lead to nicotine addiction, which wipes out nearly 5 million lives every year, about 24 times more than all illegal drugs combined.

For more on cannabis, check out my entire video series on marijuana here.

KEY TAKEAWAYS

The marijuana legalization debate features opinions ranging from it being “a landmark human rights advance granting access to a miracle medication, to one of a disastrous, anarchic profiteering sham.” Opponents also argue it will increase cannabis use among young people by making it less expensive and more socially acceptable.
After legalization in Washington state, marijuana use among teens increased and “perceived harmfulness” decreased. In Colorado, medical marijuana was legalized five years before recreational use, and perceptions of risk of use among teens dropped while rates of dependence went up with the original liberalization.
A common concern with legalization is the possible rise of Big Cannabis, like Big Alcohol and Big Tobacco, but a larger issue may be Big Tobacco turning into Big Cannabis.
Frequent use of cannabis is a predictor of future cigarette addiction. Indeed, weekly marijuana use in non-cigarette-smoking teens predicted a more than eightfold increase in the odds of later using tobacco, which may be seven or eight times more addictive than cannabis.
Even after controlling for peer use, it appears that cannabis does still seem to be a gateway drug to tobacco. In fact, “one of the most potentially harmful and under-appreciated effects of cannabis use is the ‘reverse gateway’”—leading to nicotine addiction, which takes nearly five million lives every year, about 24 times more than all illegal drugs combined.

In health,

Michael Greger, M.D.

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