Pennsylvania’s approach to alcohol vs. marijuana makes no sense

Growing up as a white kid in Philadelphia during the 1970s and 1980s, I learned to associate street drugs with criminality. It was a scary time. Crime was on the rise, fueled by institutional racism and economic inequality, and the War on Drugs became a focus of our collective anxieties.

Coming from that background, I remained a supporter of the drug war into my 20s. Only once I began my medical education did I come to realize that the criminalization of drugs created more problems than it solved. One fact, in particular, made me intensely uncomfortable: Alcohol, which was legal, was by almost every measure more harmful for adults than cannabis, which was illegal. Yet millions of otherwise law-abiding citizens — disproportionately people of color — were being arrested for choosing the less dangerous substance.

To me, that was morally, logically, and scientifically indefensible.

In terms of the evidence, this is not a close call. Alcohol is far more addictive than cannabis. A perfectly healthy adult can die from alcohol poisoning during a night with friends, while I haven’t seen any well-documented cases of fatal cannabis overdose. Cannabis use can certainly be harmful for at-risk populations, including minors and people living with particular psychiatric disorders. But alcohol use is associated with a far greater variety of life-threatening conditions, including heart disease, cancer, dementia, liver failure, accidents, and domestic abuse.

“In terms of the evidence, this is not a close call. Alcohol is far more addictive than cannabis.”

David Nathan

Today, the great majority of Americans believe that cannabis should be legal. Likewise, most physicians — including members of Doctors for Cannabis Regulation — recognize that we’re better off legalizing and regulating the cannabis supply than forcing it underground.

When cannabis is illegal for everyone, society sends the message that it’s dangerous for everyone. The trouble is, kids are informed enough to know that’s not true. But marijuana does pose risks to children that we don’t see in adults, including problems with motivation and cognition (such as memory or learning). If we want our children to believe that cannabis can be harmful for them, then our laws should distinguish between use by adults and minors.

Such a distinction may help explain why preventive education has reduced the rates of kids’ use of substances that are legal for adults (alcohol and tobacco) over the past 50 years, while underage use of a substance that is still illegal in most states (cannabis ) has increased. Today, even the head of the ever-cautious National Institute on Drug Abuse, Nora Volkow, acknowledges that underage cannabis use has not increased in legalized states.

As long as the nonmedical use of cannabis remains illegal in Pennsylvania, it cannot be regulated.

Regulation is an imperative consumer safety measure. With the regulation of adult-use marijuana products, the state can tax the industry, monitor dispensaries to prevent sales to minors, require proper testing for purity, ensure accurate labeling of potency and serving size, and enable product recalls if problems arise.

A simple example of good cannabis regulation is the use of a universal symbol to identify cannabis products to prevent accidental consumption and urge caution with their use. (My son Eli, a design student at the University of Pennsylvania, and I helped create one that is the world’s only consensus standard, and so far has been approved for cannabis products sold in New Jersey, Montana, and Vermont.)

People often ask me if cannabis should be regulated like alcohol and tobacco. My answer is an emphatic “No!” There are numerous problems with how we regulate alcohol and tobacco. Hard seltzer bottles are easily mistaken for nonalcoholic drinks, and cigarette packages don’t require labeling of ingredients.

We can and must do better with cannabis regulation. Building a regulatory framework from the ground up will set the bar higher for cannabis products. And who knows? Perhaps effective regulation of cannabis will serve as a model for improved regulation of alcohol and tobacco.

Pennsylvania’s choice about legalization is not between an unfettered industry and a mythical “drug-free America.” It’s been 85 years since the US declared cannabis illegal; at this point, we can safely conclude that prohibition didn’t work. What’s more, alcohol prohibition taught us that the only thing worse than poor regulation is at the regulation.

Cannabis consumption is safer than we have historically treated it, but it is not without risk. To address its potential harms, Pennsylvania’s best option is to legalize the adult use of marijuana, so it can be regulated.

David L. Nathan is a psychiatrist and educator in Princeton. He is the founder and past president of Doctors for Cannabis Regulation. @DavidNathanMD

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