Marijuana: What the evidence shows at it relates to the impact of use and what can be learned from Washington State and Colorado.

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1 Kevin A. Sabet, Ph.D. Director, University of Florida Drug Policy Institute, Department of Psychiatry, Division of Addiction Medicine Director, Project SAM (Smart Approaches to Marijuana) Author, Reefer Sanity: Seven Great Myths About Marijuana Before the House and Senate Judiciary Committees, State of Oregon January 17, 2013 Written Testimony Marijuana: What the evidence shows at it relates to the impact of use and what can be learned from Washington State and Colorado. Chairman and distinguished members of the Committee, thank you for providing me with the opportunity to appear before you today to discuss marijuana policy and appropriate federal responses. I have studied, researched, and written about drug policy, drug markets, drug prevention, drug treatment, criminal justice policy, addiction, and public policy analysis for almost 18 years. Most recently, from , I served in the Obama Administration as a senior drug policy advisor. I am currently the co-founder, with former Congressman Patrick J. Kennedy, of Project SAM (Smart Approaches to Marijuana). I am also the author of Reefer Sanity: Seven Great Myths About Marijuana (Beaufort). In fact, in my new book, I outline the precise reasons why we in the Obama Administration rejected legalization time and time again when presented with it. Our experience, when talking with parents, prevention and treatment providers, medical associations, law enforcement, and others, was that opening up a legal market for any current illicit drug would be disastrous for public health and safety. Indeed, in the Obama Administration s inaugural and subsequent drug control strategies, marijuana legalization is explicitly rejected. That is why numerous groups and I found the recent guidance by the U.S. Deputy Attorney General (hereafter Cole 2013 ), deferring the federal government s right to preempt legalization Washington and Colorado, disturbing. Colorado and Washington are now implementing the first commercial, legal market for marijuana in the world. Here I go through some pertinent issues surrounding marijuana policy that seem to have further muddled the debate: (1) Marijuana s illegal status, under the Controlled Substances Act, means the drug is more costly and used less than if the drug was legal. By keeping marijuana illegal, its use is lower than the use of our legal drugs. About 52% of Americans regularly drink alcohol, 27% use tobacco products, and yet only 8% 1

2 currently use marijuana, though this number has been rising in recent years (by about 25% since 2007) as we have become more accepting of marijuana as a country. 1 I applaud the way the CSA has been so far used by the federal government not to go after low-level users with an addiction problem, but instead to target drug traffickers and producers. Now, with the new Cole memo, we are entering a whole new world where those drug traffickers and producers are getting a green light from the federal government to proceed. (2) A powerful industry has emerged off the heels of medical marijuana and now is transitioning to be ready for full legalization. We are on the brink of creating Big Marijuana in this country similar to Big Tobacco of yesteryear. I will illustrated some brief examples here: A September 16 th from Medical Marijuana Business Daily read: the prognosis for the future of the legal cannabis industry has greatly improved...and with that so has the opportunity for investing in what is fast-becoming the next great American industry. 2 Steve Fox, chief lobbyist for the National Cannabis Industry Association, recently remarked. Frankly, the real opportunity exists right now when commenting about marijuana and the banking industry. 3 AdWeek Magazine recently sponsored a Ted-talk like session featuring the selfproclaimed Martha Stewart of marijuana, 4 Perhaps most frightening of all, a multimillion dollar private equity fund has launched to support the marijuana industry, with its head commenting that after the Cole 2013 memo his phone has barely stopped ringing. 5 Already, an executive from Microsoft is teaming up with a former Mexican president to try and mint more marijuana millionaires than Microsoft in his goal to create a national brand, the Starbucks of Marijuana. 6 In states that have failed at creating any sort of robust regulatory framework for marijuana as medicine, the effects of retail marijuana sales are already known mass marketing and increased negative consequences. Additionally, the multimillion-dollar pro-legalization lobby in Colorado who financed Amendment 64 with upwards of $3 million has already placed a billboard promoting 1 Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on 2 from Troy Dayton via MMJ BusinessDaily, September 16 th. Produced upon request. 3 Medical Marijuana Business Daily Article: 4 See 5 The Economist, see 6 Ex-Microsoft exec plans 'Starbucks' of marijuana. (2013, May 31). United Press International. Retrieved from: 2

3 marijuana use along the main boulevard leading to the Denver Sports Authority Field. The marijuana industry also sued Colorado when the state sought to place marijuana publications behind a counter in public retail stores where persons under twenty-one years of age are present. 7 The state eventually changed the law and now magazines such as High Times and The Daily Doobie will be sold within reach of children there. We can expect further first amendment challenges to advertising restrictions. Finally, we have also seen the proliferation of marijuana vending machines generating millions of dollars in revenue dispensing medicine. As Bloomberg Businessweek in May reported: We are in the right place at the right time, says Bruce Bedrick, a 44-year-old chiropractor, occasional pot user, and chief executive officer of Medbox, maker of one of the world s first marijuana vending machines. We are planning to literally dominate the industry. 8 After spending decades trying to rid America of tobacco vending machines because of the obvious effect on increased access to children, it seems we are about to repeat history by creating the next big industry that will profit from increased use and addiction. (3) The experience of Colorado and Washington thus far should give anyone who cares about public health and safety pause about legalization. Colorado allowed the retail sales of marijuana to start on January 1 st, Last week, Colorado made history as the first jurisdiction in the modern era to license the retail sales of marijuana. To be sure, there were no bloody fistfights among people waiting in line and, as far as we know, no burglaries or robberies. Legalization advocates cheered. And while it is true that most people who use marijuana won t become addicted to heroin or otherwise hurt society as a result, Colorado s experiment with legal pot can be called anything but successful. What didn t make the news were some troubling developments. Multimillion-dollar private investing groups have emerged and poised to become, in their words, Big Marijuana; adding her name to a list of dozens of other children, a 2-year-old girl ingested a marijuana cookie and had to receive immediate medical attention; a popular website boldly discussed safe routes for smugglers to bring marijuana into neighboring states; and a marijuana store owner proudly proclaimed that Colorado would soon be the destination of choice for year-olds, even though for them marijuana is still supposed to be legal. Popular columnists spanning the ideological spectrum, from the New York Times, Washington Post, and Newsweek/Daily Beast, soon expressed their disapproval of such policies as contributing to the dumbing down of America. As I mentioned in my testimony last October to the US Senate Judiciary Committee, since states have proven they cannot handle the task of regulating medical marijuana, why would we expect them to deal deftly with full legalization? Mass advertising, promotion, using items that are attractive to kids like medical marijuana lollipops, Ring Pots, Pot-Tarts etc. are all characteristics of current medical marijuana policy. 7 Trans-High Corp v Colorado (Denver) 8 See 3

4 What has been the result of this de facto legalization for kids? For one, drug-related referrals for high school students testing positive for marijuana have increased. During an average of 5.6 students tested positive for marijuana. Between 2010 and 2012, the average number of students who tested positive for marijuana increased to 17.3 students per year. In 2007, tests positive for marijuana made up 33 percent of the total drug screenings, by 2012 that number increased to 57 percent. A member of the Colorado Taskforce charged to regulate marijuana who also works for a drug testing company commented to the press that A typical kid (is) between 50 and 100 nanograms. Now we re seeing these up in the over 500, 700, 800, climbing. 9 It has also already been documented by Justice Department officials that the sales of marijuana for supposedly medical purposes are in some cases going to criminal enterprises and foreign drug trafficking groups. 10 Also, as mentioned in a recent law enforcement report 11, the diversion of medical marijuana from medical-states to nonmedical states is rampant. Finally, though most marijuana users do not commit violent crimes, the retail sales of de facto legal marijuana has been linked to violence, firearms, illegal activity, and other illegal drugs. 12 And two independent reports released within days of each other last month documented how Colorado s supposedly regulated system is not well regulated at all. Indeed in these two states where officials have vowed to go after public use and sales, nothing of the sort has yet to transpire. At a rally in Colorado last month, the co-drafter of the state s marijuana law joined others in passing out thousands of free marijuana joints to try and kill the new effort to tax marijuana. He was not charged until he was found smoking publicly some weeks later. During a Seattle-area marijuana event in mid-september, it was reported that Hundreds of vendors are giving out free hash oil hits like the weed world is ending tomorrow. It is a bit amazing, really. I've never seen so many propane torches in one place. They are also 9 See Conspire! Drug Testing Results and Drug Testing Company Sees Spike in Children Using Marijuana found at 10 Mexican Gangs Linked To Colorado's Pot: Drug Enforcement Chief Says 'Organized Crime' Here. (2010, January 7). ABC 7 News, the Denver Channel. Retrieved from: 11 Rocky Mountain HIDTA. (August 2013). The Legalization of Marijuana in Colorado: The Impact, Preliminary Report (volume 1). 12 White Paper on Marijuana Dispensaries, California Police Chiefs Association. (2009). 13 Colorado Office of the State Auditor. (June 2013). Medical Marijuana Regulatory System Part II Performance Audit. Retrieved from: E/2194B%20MedMarijPart2%20June% pdf 14 Office of the Auditor, Audit Services Division, City and County of Denver. (July 2013). Medical Marijuana Licensing Performance Audit. Retrieved from: udit_report_ pdf 4

5 giving out free pot, and despite the official rules against sales selling concentrates at many a booth. Even California dispensaries are up here hawking herb to anyone over 21. What a difference a year makes! 15 Keep in mind that hash oil hits or dabbing refers to essentially freebasing THC concentrates of up to 80% THC, made with isopropanol and butane, and then lighting and quickly inhaling the substance. It is extremely dangerous but has been spreading in popularity dozens of YouTube videos showing how to do it can be accessed by anyone with an internet connection. Interestingly, no one was arrested at the marijuana event. (4) Marijuana use is considered harmful by most major medical associations and the scientific community. As mentioned by some of my fellow witnesses, marijuana use is harmful, especially for adolescents. Marijuana s harmfulness is not a subject of scientific debate most major medical associations and scientific institutes have acknowledged marijuana s potential for harm. 16 Since most people who use marijuana, however, do not become addicted or exhibit serious harm to society, the perception of marijuana as a harmless plant has permeated America today. The fact that a small amount of users constitute a great amount of harm in the form of a reduction in IQ 17, mental illness 18, poor learning outcomes 19, lung damage 20, and addiction, 21 emergency room mentions related to acute panic attacks 15 See 16 American Medical Association. (2009). Report 3 on the Council of Science and Public Health: Use of Cannabis for Medicinal Purposes; Joffe, E. & Yancy, W.S. (2004). Legalization of Marijuana: Potential impact on youth. Pediatrics: Official Journal of the American Academy of Pediatrics, 113(6); American Psychological Association. (2009). Position Statement on Adolescent Substance Abuse; California Society of Addiction Medicine. (2009). Impact of Marijuana on Children and Adolescents.; American Society of Addiction Medicine Statement Retrieved here: 17 See Meier, M.H.; Caspi, A.; Ambler, A.; Harrington, H.; Houts, R.; Keefe, R.S.E.; McDonald, K.; Ward, A.; Poulton, R.; and Moffitt, T. Persistent cannabis users show neuropsychological decline from childhood to midlife.proceedings of the National Academy of Sciences 109(40):E2657 E2664, Also Moffitt, T.E.; Meier, M.H.; Caspi, A.; and Poulton, R. Reply to Rogeberg and Daly: No evidence that socioeconomic status or personality differences confound the association between cannabis use and IQ decline. Proceeding of the National Academy of Sciences 110(11):E980-E982, See for example: Andréasson S., et al. (1987). Cannabis and Schizophreia: A longitudinal study of Swedish conscripts. Lancet, 2(8574); Moore, T.H., et al. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370(9584); Large M., et al. (2011). Cannabis Use and Earlier Onset of Psychosis: A Systematic Meta-analysis. Archives of General Psychiatry, 68(6); Harley, M., et al. (2010). Cannabis use and childhood trauma interact additively to increase risk of psychotic symptoms in adolescences. Psychological Medicine, 40(10); Lynch, M.J., et al. (2012). The Cannabis-Psychosis Link. Psychiatric Times. 19 Yucel, M., et al. (2008). Regional brain abnormalities associated with long-term heavy cannabis use. Archives of General Psychiatry, 65(6). 20 See for example: American Lung Association. (2012, November 27). Health Hazards of Smoking Marijuana. Retrieved from: Tashkin, D.P., et al. (2002). Respiratory and immunologic consequences of smoking marijuana. Journal of Clinical Pharmacology, 4(11); Moore, B.A., et al. (2005). Respiratory effects of marijuana and tobacco use in a U.S. sample. Journal of General Internal Medicine, 20(1); Tetrault, J.M., et 5

6 and psychotic episodes 22 and treatment entry should not make us discount the seriousness of marijuana use. This is the case for most of our addictive drugs today: a small number of users cause the greatest chunk of the harm. As for drugged driving, a meta analysis published in the peer-reviewed Epidemiological Reviews looked at nine studies conducted over the past two decades on marijuana and car-crash risk. It concluded, drivers who test positive for marijuana or self report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes. 24 Indeed, we already know marijuana and driving is a growing problem in states with loose marijuana laws. In Colorado, though traffic fatalities fell 16 percent between 2006 and 2011 (consistent with national trends), fatalities involving drivers testing positive for marijuana rose by 112 percent. 25 Marijuana advocates will claim that regulations surrounding legal marijuana will make it harder for youth to access marijuana, since they will have to produce identification to obtain marijuana. However, our experience with another intoxicant that can be deadly on the roads and also inhibit learning outcomes alcohol shows us that once a drug is accepted, normalized, and commercialized, youth will have an easier time accessing it than if it was illegal. For example, a study from Columbia University found that alcohol and cigarettes were the most readily accessible substances for youth, with 50% and 44%, respectively, of youth reporting that they could obtain them within a day. Youth were least likely to report that they could get marijuana within a day (31%) and 45% report that they would be unable to get marijuana at all. 26 al. (2007). Effects of marijuana smoking on pulmonary structure, function and symptoms. Thorax, 62(12); Tan, W.C., et al. (2009). Marijuana and chronic obstructive lung disease. 21 See for example: Anthony, J.C., Warner, L.A., Kessler, R.C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experiential and Clinical Psychopharmacology, 2; Budney, A.J., et al. (2008). Comparison of cannabis and tobacco withdrawal: Severity and contributions to relapse. Journal of Substance Abuse Treatment, 35(4); Tanda, G., et al. (2003). Cannabinoids: Reward, dependence, and underlying neurochemical mechanisms A recent preclinical data. Psychoparmacology, 169(2). 22 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). Drug abuse warning network, 2008: National estimates of drug-related emergency department visits. HHS Publication No. SMA Rockville, MD. 23 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration, Mu-Chen Li, Joanne E. Brady, Charles J. DiMaggio, Arielle R. Lusardi, Keane Y. Tzong, and Guohua Li. (2011). Marijuana Use and Motor Vehicle Crashes. Epidemiologic Reviews. 25 Colorado Department of Transportation Drugged Driving Statistics , Retreived driving/druggeddriving/drugged-drivingstatistics.html. 26 Adapted by CESAR from The National Center on Addiction and Substance Abuse at Columbia University (CASA), National Survey of American Attitudes on Substance Abuse XVII: Teens, Available online at and CESAR at 6

7 Marijuana advocates will also claim that we can learn from our tobacco experience no one has been arrested for tobacco use and yet fewer young people use tobacco compared to marijuana. But this claim completely neglects the social norm and media environment that has emerged in the past two decades against tobacco. Tobacco is looked down upon by many young people precisely because of government and non-governmental efforts to make it so. There is no multimillion dollar campaign to legitimize tobacco like there is today for marijuana, and certainly no one is making claims that tobacco is harmless, as advocates routinely do. By contrast, marijuana use is regularly glorified and promoted and since the defunding of the National Youth Anti-Drug Media Campaign there is virtually no well-financed voice getting the message out to young people that marijuana use is harmful. (5) Regardless of the law on the books, most jurisdictions in the US have already made it practice not to imprison marijuana users. Experience with marijuana laws in the United States has found that most marijuana smokers never see the inside of a jail or prison cell. Though there were over 800,000 arrests for marijuana offenses last year far lower than the number of arrests for nonviolent alcohol-related offenses most arrestees get off with a ticket or summons. Regardless of whether or not one lives in a state with a formal decriminalization law on the books or not 27, marijuana smokers who commit no other crime are rarely, if ever, imprisoned. In fact, researchers have reported that only about two-tenths of 1 percent of all prison inmates appeared to be incarcerated in prison simply for marijuana use. Analyzing data from the Survey of Inmates in Federal and Correctional Facilities 28 researchers have found that the number of marijuana users in prison [only] for their use is perhaps 800 2,300 individuals or on the order of percent of all prison inmates numbers consistent with prior analysis released by the Office of National Drug Control Policy. Researchers estimated that the resulting expected time served in prison per year of use for marijuana was.04 days. 29 Other federal data has shown that the median amount of marijuana for those convicted of marijuana possession is 115 pounds or 156,000 marijuana cigarettes It is largely understood that whether a state is labeled as decriminalized or not does not necessarily mean much for describing its policy. Several non-decriminalized states actually have lower penalties than decriminalized states. See Pacula, R., J.F. Chriqui, and J. King Decriminalization in the United States: What Does it Mean? National Bureau of Economic Research Working Paper # 9690; and Pacula, R., R.J. MacCoun, P. Reuter, J.F. Chriqui, B. Kilmer, K. Harris, L. Paoli, and C. Schaefer What Does it Mean to Decriminalize Cannabis? A CrossNational Empirical Examination, in B. Lindgren and M. Grossman, eds. Advances in Health Economics and Health Services Research, vol. 16: Substance Use: Individual Behavior, Social Interactions, Markets and Politics. Elsevier Press; and MacCoun, R., Pacula, R. L., Reuter, P., Chriqui, J., Harris, K. (2009). Do citizens know whether they live in a decriminalization state? State marijuana laws and perceptions. Review of Law & Economics, 5(1), Bureau of Justice Statistics. (2004). Data collection: Survey of inmates in state correctional facilities (SISCF) Retrieved from Caulkins, J. and Sevigny, E. (2005). How many people does the U.S. imprison for drug use and who are they? Contemporary Drug Problems, 32(3), U.S. Sentencing Commission. (2011) annual report. Retrieved from 7

8 (6) Marijuana rescheduling is a non-issue it would do little to ensure marijuana as medicine or legalize the drug. Marijuana rescheduling would simply serve as a symbolic victory for marijuana advocates. It would do nothing to make marijuana available at pharmacies, it would not legalize marijuana dispensaries in states, and it would not legalize the production or retail sales of marijuana. The reason marijuana hasn't been rescheduled is because no product of whole, raw marijuana has a currently accepted medical use in the U.S., which is part of the legal definition of Schedule I defined by the Controlled Substances Act. By contrast, Schedule II substances have a currently accepted medical use in the U.S. or a currently accepted medical use with severe restrictions (and, like Schedule I drugs, a high potential for abuse). More importantly, regardless of the schedule, any substance may be prescribed by physicians and dispensed by pharmacists only when incorporated into specific FDAapproved products. That is why Schedule II opioid products can be obtained in pharmacies by prescription, but raw opium, despite being in Schedule II, cannot be prescribed. Rescheduling marijuana is a non-issue that has been elevated far above its deserved place in this debate. (7) Marijuana has medicinal value, but it should not be used in its raw, smoked, ingested, or vaporized form to receive those medical benefits. Just like opium, marijuana is a potentially dangerous drug with a medical value. But also just like opium, we do not need to smoke, eat, or vaporize the raw plant in order to receive those medical benefits. Moreover, no approved medicine has ever been smoked. Instead, we can generate the benefits of the many components in marijuana without the harmful side effects of ingesting the whole, crude plant. Since 1985, Marinol, a pill derived from marijuana s psychoactive ingredient THC has been on the market, though it is not widely prescribed today. Other components have also been found to have medical properties and are currently being studied, like CBD. CBD does not get one high, and trials have found that it can be helpful for reducing muscle spasms and epilepsy. Currently, an extract of marijuana, primarily containing THC and CBD, is being tested on cancer and MS patients in the United States. This product, Sativex, has already been approved in 22 countries, including Canada. Other marijuana-based products are also being studied. I have long called for more research into marijuana s medical value. In fact, my organization, Project SAM, acknowledges that the government should provide yet-to-be approved non-smoked, non-psychoactive marijuana products to the seriously ill. Those truly suffering from MS or cancer, whose own doctor has determined that the benefits outweigh the risks of such drugs, and who has determined the inefficacy of FDA- 8

9 approved medications, should be able to access non-psychoactive, non-smoked marijuana-based products through a compassionate research program administered by the National Institutes of Health. That would provide some temporary sanity to the current chaotic situation of so-called medical marijuana today. Medical marijuana as it stands today, in California, Colorado, Oregon, and many other states, has turned into de facto legalization. A recent study found that the average patient was a thirty-two-year-old white male with a history of drug and alcohol abuse and no history of life- threatening disease. 31 Further studies have shown that very few of those who sought a recommendation had cancer, HIV/AIDS, glaucoma, or multiple sclerosis. 32 Other studies, like a recent Journal of Policy Analysis and Management article also featured as a National Bureau for Economic Research paper conducted by RAND researchers, have found that specific dimensions of laws authorizing the use of marijuana for medical purposes, namely home cultivation and legal dispensaries two features found in Colorado and other states with similar laws are positively associated with marijuana use and have important implications for states considering legalization of marijuana. 33 The journal JAMA Pediatrics reported that unintentional marijuana poisonings among kids have risen significantly since marijuana as medicine has become available. 34 Other peer-reviewed papers are finding that medical marijuana is easily diverted to youth. The Journal of the American Academy of Child and Adolescent Psychiatry in 2012 surveyed 164 Denver-area teens in treatment, and 121 of them -- or nearly 74 percent -- said they had used someone else's medical marijuana. 35 The way to have medical marijuana is to do it right: through the scientific process, which includes proper research and investigation. Medicine via the ballot box puts public health at risk. (8) The legalization movement will not stop with marijuana and cocaine and heroin legalization would have drastic consequences. I wish I could say the legalization movement and the money behind it stopped with marijuana. Although I think marijuana legalization would be bad for America, it carries with it massively different implications than if we were to legalize drugs like methamphetamine, cocaine, and heroin. Unfortunately, though, many of the same 31 O Connell, T. et al. (2007). Long term marijuana users seeking medical cannabis in California ( ): Demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal. Retrieved from 32 Nunberg, H. et al. (2011). An analysis of applicants presenting to a medical marijuana specialty practice in California. Journal of Drug Policy Analysis, 4(1). Retrieved from 33 Pacula, R. et al Assessing the Effects of Medical Marijuana Laws on Marijuana and Alcohol Use: The Devil is in the Details. NBER Working Paper No , August 2013, JEL No. I18,K32,K42 34 Wang, S.G., Roosevelt, G., & Heard, K. (2013). Pediatric Marijuana Exposures in a Medical Marijuana State. JAMA Pediatrics, 167(7), Salomonsen-Sautel, S., et al. (2012). Medical Marijuana Use among Adolescents in Substance Abuse Treatment. American Academy of Child & Adolescent Psychiatry, 5(7), 5. 9

10 advocates who call for marijuana legalization are also interested in relaxing rules for other drugs. A media relations expert at the Drug Policy Alliance, an organization committed to legalization, commented in June of this year that We're at a tipping point where it's starting to feel like marijuana legalization is no longer a question of if -- but when. But what about the other drugs? My colleagues and I at the Drug Policy Alliance are committed to ensuring the decriminalization of all drug use becomes a political priority. To be sure, the statement was not just about offering treatment instead of prison for firsttime drug offenders, something most of us in this room would support. The author commented that many of the reasons why marijuana legalization makes sense can be applied to drugs more generally. This is not unlike how leaders of the medical marijuana movement thirty years ago were transparently interested in how medical marijuana would open the door to full marijuana legalization. Keith Stroup, the head of the National Organization of Marijuana Laws (NORML), told the Emory University school newspaper, The Emory Wheel, in 1978 that We are trying to get marijuana reclassified medically. If we do that, (we'll do it in at least 20 states this year for chemotherapy patients) we'll be using the issue as a red herring to give marijuana a good name. 36 Conclusion Legalization would be a public health and safety disaster. Though the Department listed some triggers that might spur federal action, we do not have to wait for these phenomena to occur they already are at alarming rates. Our experience with state laws authorizing the medicinal use of marijuana tells us that no matter what controls are put on marijuana stores (e.g. no advertising or selling to minors), these regulations are routinely violated, rarely enforced, and the sheer number of marijuana stores tend to overwhelm federal and state resources. We are at a precipice. Oregon can choose to legalize yet another intoxicant, paving the way for a new industry based on addiction or profit. Or Oregon can learn from our experiences with alcohol and tobacco, and early data from Colorado, to implement a smarter marijuana policy based on neither legalization nor mass incarceration. 36 See 10