President Biden pardoned individuals convicted of marijuana possession under federal law and said marijuana’s classification as a Schedule I Controlled Substance—as is heroin—would be reviewed. The NYT reported the pardons will clear everyone convicted on federal charges of simple possession since it became illegal fifty years ago. They will not apply to individuals convicted of selling or distributing marijuana. Soon afterwards, the Pew Research Center conducted a survey in October of 2022 on whether or not marijuana should be legal for medical or recreational use. Not surprisingly, 59% of Americans thought it should be legal for medical and recreational use and 30% said it should only be legal for medical use.
The Pew article also noted two additional states legalized the use of marijuana for recreational use, bringing the total number of states to 21 which have already done so. There are clear differences demographically by age and party affiliation. Seventy-two percent of adults aged 18-29 favored legalizing medical and recreational marijuana, while only 46% of adults 65 and over did. Seventy-three percent of those who said they were Democrats or Democratic-leaning independents favored legalizing medical and recreational marijuana use, while only 45% of Republicans and Republican-leaning independents. See the following graph taken from the Pew article.
In Pennsylvania, the Democratic support to legalize recreational marijuana received a boost at the midterms, even though it was not one of the two states to legalize it. John Fetterman, who just won the Senate race of 2022, has been vocal about his support for legalization from the beginning of his tenure as Lieutenant Governor of Pennsylvania in 2019. He said on his web page, “Weed should be legal, nationwide.” He thought we needed to “move our views on this subject out of the Stone Age.” See “Should Pennsylvania Go ‘Full Colorado’ with Marijuana? Part 1.”
Rescheduling and decriminalizing marijuana are two reform measures that do not require Pennsylvania to also go “full Colorado” with legalizing recreational marijuana. Pennsylvanians should know that Colorado has had problems after legalization and passed state bill H 1317, which applied to the state’s marijuana industry. Note the measure passed with strong bipartisan support. Purchases of high-potency marijuana were limited to one-fifth the original level. “The bill requires warning labels, real-time monitoring of sales, and stiffened medical recommendations from physicians.” It also called for research into the mental and physical health effects of marijuana.
Supporters of legalization in Colorado said creating a regulated market would drive out the “criminal element” and end the violence driving the black market, but the opposite has happened. The Black market still dominates the marijuana business, “as has happened everywhere state have legalized marijuana, from California to Illinois.” It was supposed to end corruption, but actually spread it more widely. “Not only did the promised benefits, both financial and on behalf of public safety, not come to pass, but in multiples areas of daily life the metrics have worsened.”
Colorado traffic deaths have increased 24% overall. Deaths in which drivers tested positive for marijuana increased 135%. “The percentage of all Colorado traffic deaths that were marijuana related has risen from 15 percent in 2014 to 25 percent in 2019.” More marijuana calls are coming into poison centers. Adverse marijuana-only exposures have quadrupled since legalization. Emergency-department events and marijuana-related hospitalizations increased sharply.
As the years since legalization have passed, the public health and public safety impact has grown, year over year. The effect on families, on pediatricians, on educators, on emergency departments, on the workplace, on law enforcement, and indeed on the general quality of life in a once thriving state, has been strikingly negative.
We should not be surprised to learn that there is a high cost to making an addictive and dangerous substance a commercial product. Nor should we enable this public policy mistake to take root elsewhere. Taking stock, we can now say that the so-called legalization experiment has, at least, produced one positive impact—it has issued a clear warning about the path we are on.
Then there was the publication of a study published on November 15, 2022 in the journal Radiology that found airway inflammation and emphysema were more common in people who smoked marijuana and cigarette smokers and nonsmokers, “Chest CT Findings in Marijuana Smokers.” The lead author of the study was quoted in Medical News Today as saying, “93% of the marijuana smokers had emphysema rather than 67% of the tobacco-only smokers.” The researchers also found cannabis smokers had higher rates of airway inflammation. The CT imaging showed greater mucus buildup in the airways, thickening of the bronchial wall, and sometimes irreversible enlargement of the airways, all of which can lead to more congestive symptoms and infections.
While the public impression is that cannabis is relatively safe and may be safer than cigarettes, “the newly identified link between cannabis use and irreversible lung damage could mean that cannabis is potentially more harmful than many people may realize.” A possible explanation between marijuana and irreversible lung damage could be because marijuana is usually smoked unfiltered, where tobacco cigarettes are generally filtered. When marijuana is inhaled, more particulates are deposited in the airways, likely acting as irritants. Compared to tobacco, the way marijuana is inhaled (a longer time and a higher volume when holding your breath) may lead to microtrauma with the airspaces causing emphysema.
The researchers said the small sample size of their study (56 marijuana smokers, 57 nonsmoker controls, 33 tobacco-only smokers) precluded them from drawing strong conclusions from their findings. Nevertheless, the research may have implications for patients who smoke marijuana for pain relief and other reasons. A critical care medicine specialist and pulmonologist who was not involved in the study told Medical News Today:
The findings of the research point towards confirming a trend we have observed with younger patients presenting with more breathing difficulties. Any inhalation of particulate matter, whether tobacco smoke or marijuana, causes inflammation within the airways.
President Biden’s actions with marijuana are constructive and will allow solid scientific research into the adverse effects and the medical benefits of marijuana to move forward. Hopefully, the piece-meal, state-by-state backdoor way of legalizing recreational marijuana will slow down. Pennsylvania needs to wait and see what that research will show before it goes “full Colorado.” And it seems the evidence will be a mixed bag.
Attempts to legalize recreational marijuana in PA with Senate Bill 350, the “Adult-Use Cannabis Act,” failed. But efforts to do so have not stopped. In September of 2021, State Representatives Jake Wheatley and Dan Frankel sponsored H.B. 2050, which would legalize adult-use recreational marijuana. Not to be outdone, State Senators Dan Laughlin and Sharif Street introduced Senate Bill 473 to legalize recreational marijuana in October of 2021. Laughlin and Street believe their bi-partisan bill has the best chance of ultimately legalizing recreational marijuana in Pennsylvania, and could generate between $400 million and $1 billion of new tax revenue. But what are the risks of such legislative action?
Larry Weigand, who was running for sheriff in Delaware County, said he understood that social views on marijuana use have changed and polls report most Pennsylvanians support legalization. “But the social views of intoxication and driving under the influence have not; to the contrary, they have become more stringent.” He thought the legislature needs to be considerate of both sides of the issues, considering all who would be affected, “including the non-users of marijuana and law enforcement.”
Negative Consequences in Colorado
Consider the negative consequences of legalization in Colorado reported in The New York Times, “Reefer Madness or Pot Paradise?” Legalization coincided with a 20 percent rise in violent crime rates in Colorado, while marijuana-related arrests fell by half. Although low-level marijuana charges dropped, racial discrepancies in drug arrests persisted. African-Americans were still being arrested on marijuana charges almost twice as often. One of the state legislators who endorsed the Colorado ballot measure that legalized recreational marijuana said: “You don’t see drug-addled people roaming the streets, but we haven’t created a utopia.”
Since recreational sales began in 2014, more people in Colorado are going to emergency rooms for marijuana-related problems. Hospitals report higher rates of mental health cases associated with marijuana. An emergency room physician and researcher with the University of Colorado Hospital, Andrew Monte, analyzed hospital data that showed more people were arriving at ERs for marijuana-related reasons. He said, “There’s a disconnect between what was proposed as a completely safe drug.”
Other researchers in “Marijuana and acute health care contacts in Colorado” reported that marijuana-related ER patients were five times as likely to have a mental-health issue as those with other cases. “As more states legalize marijuana, it is important to address public education and youth prevention, and understand the impact on mental health disorders.” The most frequent primary diagnosis of ER visits with marijuana-related billing codes compared to those without marijuana-related billing codes was for mental illness.
Among primary diagnosis categories, mental illness was more prevalent in ED visits and hospitalizations with marijuana-related billing codes. Examination of the role marijuana plays in mental health driven healthcare encounters is critical given the relationship between drug use disorders and mental health disorders. While it is unclear whether this finding is reflective of changes due to a legal market, it clearly prioritizes the consequences of marijuana use within a mental health population as a priority area for further research.
Psychosis and Marijuana
While political rhetoric in favor of legalization is calling for the end of marijuana “prohibition,” scientific research is forming a consensus that THC, the psychoactive cannabinoid in marijuana, induces psychotic symptoms. A research article published in The Lancet Psychiatry, “Psychiatric symptoms caused by cannabis constituents,” included additional evidence for that consensus. The authors readily acknowledged that cannabis was one of the most widely used psychoactive substances worldwide, with 6-7% of Europeans and 15.3% of Americans using it each year. Decriminalization and legalization trends were happening globally, with Canada, Uruguay and a growing number of US state permitting the sale and recreational use of marijuana. However,
Given the projected increase in rates of cannabis use, the increasing potency of cannabis and cannabis-based products, and the burgeoning interest in the therapeutic potential of cannabinoids, it is timely to assess the psychiatric effects of cannabis constituents.
The researchers demonstrated that THC induced significant increases of symptoms as they were reported on psychiatric scales, the Brief Psychiatric Rating Scale (BPRS) and the Positive and Negative Syndrome Scale (PANSS). Positive symptoms included delusions and hallucinations; negative symptoms included blunted affect and amotivation; and general symptoms included depression and anxiety. Effect sizes were greater for positive symptoms than negative symptoms, but not for general symptoms. This finding suggested that THC induced positive symptoms like psychosis to a greater extent than negative symptoms.
Speaking with Healio Psychiatry in “THC linked to psychiatric symptoms with large effect sizes,” Oliver Howes, one of the co-authors, said: “These findings highlight a potential risk of taking THC-containing cannabis products, and, importantly, show that THC can lead to short-term psychotic symptoms even in people with no history of mental illness or other risk factors.” While there has been previous evidence for the association of positive psychiatric symptoms and marijuana, Howes said he was surprised that THC induced other psychiatric symptoms like social withdrawal.
In conclusion, these findings demonstrate that the acute administration of THC induces positive, negative, and general psychiatric symptoms with large effect sizes. By contrast, CBD does not induce psychiatric symptoms, and there is inconclusive evidence that it moderates the induction of psychiatric symptoms by THC. These effects are larger with intravenous administration than with inhaled administration, and tobacco smokers have less severe positive symptoms. These findings highlight the acute risks of cannabis use, which are highly relevant as medical, societal, and political interest in cannabinoids continues to grow.
In a related editorial published in the same issue of The Lancet Psychiatry, “THC: harmful even in low doses?”, Carsten Hjorthøj, and Christine Merrild Posselt said there was a growing scientific consensus that marijuana does have a causal role in the development of psychosis. And they thought the association seems to be bidirectional. “In some people, cannabis leads to incident psychosis, whereas in other people, psychosis leads to incident cannabis use.” However, they noted this consensus was not reflected in mainstream public discourses, “which have a major effect on the political agenda to decriminalize cannabis.”
Referring to “Psychiatric symptoms caused by cannabis constituents,” Hjorthøj and Posselt said finding large effect sizes for general psychiatric symptoms, even with low doses of THC, was “extremely important and worrying.”
Moreover, the authors failed to find any clear evidence that concurrent administration of cannabidiol (CBD) reduced these symptoms. Indeed, such an ameliorating effect was observed in only one of four included studies. This finding is notable because CBD in particular is being touted as a potential wonder drug with antipsychotic, anxiolytic, and other properties. . . As Hindley and colleagues have clearly demonstrated, there are at least transient psychiatric symptoms associated with even relatively low doses of THC. Of course, this result should not be extrapolated as meaning that single doses of THC will eventually lead to schizophrenia or other severe disorders. However, it might be prudent to extrapolate and paraphrase the words of Moore and colleagues from their 2007 meta-analysis to apply to both recreational and medicinal use of THC-containing cannabis: “there is sufficient evidence to warn people that using THC could increase their risk of developing psychiatric symptoms or even a psychotic illness”.
So, pointing to the potential for increased tax revenue, the opportunity for new jobs in the marijuana industry, and all the other supposed benefits of ending the so-called ‘prohibition’ of recreational marijuana is not enough. Pennsylvania also needs to consider the risks to its citizens if it legalizes recreational marijuana. And one of them is people who use cannabis increase their risk of experiencing psychosis and other psychiatric symptoms.
Brass big marijuana coin with cannabis leaf near business inscription.
In the midst of our national political news, there was an announcement by John Fetterman, the Lieutenant Governor of Pennsylvania, that he is formally exploring a run for the U.S. Senate in 2022. According to Marijuana Moment, legalizing weed is a central part of his political platform. Fetterman said: “We’re going to get there. There’s never going to be a time when that’s not true. It’s inevitable. They know it, I know it, everyone knows it.” He even placed a marijuana flag on the balcony of his office in the Pennsylvania Capitol building as lawmakers were sworn in ahead of the 2021 legislative session.
If he decides to run, this will be his second try for the U.S. Senate. In 2016 Fetterman lost in the Democratic primary, but earned 20 percent of the vote in a four-way race. Two years later, he ran for Pennsylvania Lieutenant Governor and won. Weeks after taking office, he began a listening tour through all 67 counties of the state “to engage with Pennsylvanians about legalizing marijuana.” He said: “We want full legalization. I mean, that’s really the net goal.”
Given Fetterman’s commitment to full legalization, which means legalizing marijuana for recreational use, Pennsylvanians should know more about the potential consequences of this proposed marijuana legalization. If HB 2050 is passed, adults 21 and over could possess any amount of cannabis. Public consumption is prohibited. Adults 21 and older could cultivate 50 square feet of mature, flowering cannabis plants within a private residence. And adults could gift up to one ounce from cannabis grown in their private residences.
Going “full Colorado,” as Fetterman has called it has had negative consequences in Colorado, with the crime rate increasing 11 times faster than the rest of the nation since legalization, according to the Colorado Department of Public Safety. SAM, Smart Approaches to Marijuana, reported the number of drivers intoxicated with marijuana and involved in fatal accidents increased 88% from 2013 to 2015. The proportion of Colorado youth who reported marijuana use in the past 30 days was higher than the national average. Fuller discussion of these facts and more can be found in, “Should Pennsylvania Go ‘Full Colorado’ With Marijuana?” Part 1 and Part 2. Also see, “From The Frying Pan Into the Fire With Recreational Marijuana in PA.”
There are also concerns with the potential consequences with high-potency marijuana. Today’s cannabis is much more powerful than it was in the past. The U.S. Surgeon General published an advisory on Marijuana Use and the Developing Brain. Citing a study published in Biological Psychiatry, “Changes in Cannabis Potency over the Last Two Decades,” he said the THC concentration in commonly cultivated marijuana plants increased three-fold from 1995 through 2014, 4% to 12%. Researchers of a different study of legal cannabis sold in Washington State dispensaries found that the median THC levels varied from 17.7% to 23.2%.
Concentrated THC products, known as “dabs,” “wax,” “budder,” are becoming more widely available to recreational users and were found in yet another study, “To Dab or Not to Dab,” to range from 23.7% to 75.9% THC. The authors also cited published case reports that showed significant psychosis, neurotoxicity and cardiotoxicity with dabs. They described three males in their teens or twenties who used some form of dab. Two of the subjects had paranoia-like symptoms and one subject had seizure-like activity. Analysis of the dab sample used by one of the subjects was 20.5% THC without any detectable level of cannabidiol (CBD). The Surgeon General said the risks of physical dependence and other negative consequences increase with exposure to high concentrations of THC. “Higher doses of THC are more likely to produce anxiety, agitation, paranoia, and psychosis.”
A systematic review and meta-analysis published in the Lancet found that acute administration of THC induced increased positive (psychotic), negative (i.e., poor rapport) and general (depression) psychiatric symptoms. “These findings demonstrate that the acute administration of THC induces positive, negative, and general psychiatric symptoms with large effect sizes.” However, CBD did not induce psychiatric symptoms and there was inconclusive evidence that it moderated the initiation of psychiatric symptoms by THC.
These findings highlight the acute risks of cannabis use, which are highly relevant as medical, societal, and political interest in cannabinoids continues to grow.
In addition to mental health concerns with the legalization of marijuana, there are physical health concerns. Marijuana smoke contains some of the same toxic combustion products in tobacco smoke, which raises the possibility that exposure to some smoke-related toxicants could have adverse effects on the health of heavy cannabis users.
In another Lancet study, the plasma and urine levels of exclusive marijuana smokers, exclusive tobacco smokers, dual users of both substances and non-smokers were compared. Participants were classified as marijuana or tobacco smokers based upon self-report and detection of nicotine or THC metabolites in their plasma or urine. Marijuana smoking was independently associated with smoke-related toxicants including acrylamide and acrylonitrile metabolites, which are known to be toxic at high levels. But levels were lower when compared with those associated with tobacco smoking. Researchers also found elevated levels of an acrolein metabolite that may identify adults at risk of cardiovascular disease. The senior author of the study told Science Tech Daily:
Marijuana use is on the rise in the United States with a growing number of states legalizing it for medical and nonmedical purposes — including five additional states in the 2020 election. The increase has renewed concerns about the potential health effects of marijuana smoke, which is known to contain some of the same toxic combustion products found in tobacco smoke.
While there is less of a risk of cardiovascular disease when smoking marijuana than tobacco, there is a clear risk of experiencing psychiatric symptoms of psychosis and depression. This occurs as a result of the psychoactive substance in the cannabis plant, THC. However, another of the 66 chemicals (cannabinoids) in cannabis, cannabidiol (CBD), does not induce psychiatric symptoms. This distinction is crucial when considering whether or not to broaden the existing use of medical marijuana in Pennsylvania to include recreational use.
The FDA has approved only one CBD product Epidiolex, a prescription drug to treat two rare, severe forms of epilepsy. It is also illegal to market CBD by adding it to a food or drink; or currently to label it as a dietary supplement. According to Marijuana Moment, the FDA is in the process of developing regulations for hemp-derived cannabidiol products and is actively exploring ways to permit lawful sales of CBD as a dietary supplement. In 2019 the World Health Organization (WHO) said hemp-derived CBD did not contain more than .2 percent THC and was not under international control.
In a 2017 report to the WHO, the Expert Committee on Drug Dependence said in humans, “CBD exhibit no effects indicative of any abuse or dependence potential.” It is generally well tolerated and has a good safety profile. Reported adverse effects were thought to be a result of interactions between CBD and patients’ existing medications. “CBD has been demonstrated as an effective treatment of epilepsy in several clinical trials. . . There is also preliminary evidence that CBD may be a useful treatment for a number of other medical conditions.”
The evidence that CBD may be a useful treatment for a number of other medical conditions is not as scientifically sound as the research for treating epilepsy. For most indications, there is only pre-clinical evidence. Consistent with its properties, the range of conditions for which CBD has been assessed is diverse. Why can’t there be changes in how CBD from cannabis is scheduled and regulated to facilitate further research into these preliminary findings? The following table in the WHO report represents a review of the various therapeutic applications for CBD found in “Cannabidiol: State of the art and new challenges for therapeutic applications.”
The WHO commented that since CBD was not considered a drug of abuse (as was THC) and at the same time was legal and not regulated, a market for CBD-based products for medical purposes (such as CBD oil, tinctures and vapors) has rapidly expanded. It flourishes “in a no man’s land with potential health dangers for patients and all end-users.” The WHO cautioned that the lack of regulation with these products cannot guarantee the patient “the quality of the product itself, the effective dosage of CBD that is fundamental for its therapeutic effectiveness, the purity and the absence of chemical or microbiological contaminations, thus raising critical public safety concerns.”
Regulatory changes with regard to CBD are needed in the U.S. At the end of December 2020, the FDA announced it had issued five more warning letters to companies selling CBD products in ways that violated the Federal Food, Drug and Cosmetic Act (FD&C Act). “All five warning letters address the illegal marketing of unapproved CBD products claiming to treat medical conditions. In addition, they address violations relating to the addition of CBD to food, and the impermissible marketing of CBD products as dietary supplements.” Under the FD&C Act, any product intended to diagnose, cure, treat or prevent a disease and any product intended to affect the structure or function of the body of humans or animals, is considered to be a drug.
In “FDA is Committed to Sound, Science-based Policy on CBD,” the FDA said the Agriculture and Improvement Act of 2018, the Farm Bill, removed cannabis and cannabis derivatives that are very low in THC from the definition of marijuana in the Controlled Substances Act while specifically preserving the FDA’s responsibility over such products. If a product is being marketed as a drug, meaning it is intended to have a therapeutic effect as in treating a disease, then it is regulated as a drug. Over the past several years the FDA has issued several warning letters to companies for marketing unapproved new drugs claiming to contain CBD, including for uses such as treating cancer or Alzheimer’s disease. “These products were not approved by the FDA for the diagnosis, cure, mitigation, treatment, or prevention of any disease.”
Legislative action is needed, but not to legalize recreational marijuana. An official distinction between THC and CBD should be made that permits research into the therapeutic potential of CBD, while keeping THC as a controlled substance at a less restrictive Schedule. Marijuana was listed as a Schedule I Controlled Substance in 1970. This has hampered the scientific investigation of the therapeutic benefits of CBD as well as the potential harms (or lack thereof) from THC to be done.
There is enough evidence of the therapeutic potential of CBD to research the above-noted therapeutic benefits and we desperately need legislation that permits this. There is also evidence that high levels of THC can be a catalyst to the emergence of psychotic symptoms in some users—and we need to protect those users from this danger. The science is clear enough to stop the push towards legalizing recreational marijuana in Pennsylvania while we permit the scientists to do their research into the potential benefits of CBD and the adverse effects of THC. Activists and those in favor of legalizing recreational marijuana like Lieutenant Governor Fetterman are really seeking to legalize THC, a psychoactive chemical in cannabis with serious adverse effects and significant profit potential for some. We need to clearly see this.
In Part 1, we began to examine some of the potential impact to Pennsylvania if the state were to go “full Colorado,” unreservedly legalizing recreational marijuana as the state of Colorado has done. We started out with the September 3, 2020 call by Governor Tom Wolf for the legalization of marijuana use for adults in Pennsylvania. Lieutenant Governor John Fetterman, who stood beside him, also voiced his unreserved support of legalization. But as we looked at the hope for legalization in Pennsylvania, we saw the reality of what had already happened in other states that legalized recreational marijuana was dramatically different.
On the Facebook page for the “Pennsylvania Family Council” dated September 25, 2019, is a shot video that presents a quick series of sound bites and facts about going full-on Colorado: “Lt. Gov. Fetterman wants ‘full Colorado’ with marijuana.” He thinks the legalization of recreational marijuana is “the right thing for Pennsylvania.” You can also view the video on YouTube. We’ll look at most, if not all of the information that this short video throws at you. If there was something I failed to cover, it can be found within the links presented in either Part 1 or here in Part 2 of this article.
According to a 2018 state report, “Impacts of Marijuana Legalization in Colorado,” seizures of Colorado-sourced marijuana were most likely to occurs in states bordering or near Colorado: Kansas, Nebraska, and Wyoming. At least 3 made it to Pennsylvania. Seizure used to be almost exclusively marijuana flower, accounting for over 90% of the reported seizures in 2012. By 2017, 58% of seizures were for flower, 26% were for concentrates/hash and 16% were for edibles. See the following table from the report.
Overall crime rates for property remained stable from 2012 to 2017, but violent crime increased 20%. An increase in the number of aggravated assaults was primarily responsible for the increase in the violent crime rate while larceny was responsible for the increase in property crime rates. SAM (Smart Approaches to Marijuana) reported the crime rate in Colorado has increased 11 times faster than the rest of the nation since legalization. “Marijuana arrests of young African-American and Hispanic youth have increased since legalization (Colorado Department of Public Safety [CDPS], 2016).” See the table below.
SAM reported that in Colorado, the number of drivers intoxicated with marijuana and involved in fatal traffic accidents increased 88% from 2013 to 2015. “Driving under the influence of drugs (DUIDs) have also risen in Colorado, with 76% of statewide DUIDs involving marijuana” (Colorado State Patrol [CSP], 2017). Washington State had a doubling of drugged driving fatalities. In Oregon, 50% of all drivers assessed by drug recognition experts (DRE) in 2015 tested positive for THC. See “Driving Under the Influence of Cannabis” for more information on DUIDs.
The proportion of Colorado youth who reported marijuana use in the past 30 days was significantly higher than the national average. This held true from 2008/2009 through 2015/2016. Colorado was in the top 20% of states for youth marijuana use. See the following figure. Smart Approaches to Marijuana (SAM) reported that since legalization, Washington, Oregon Alaska and Washington, DC have had past-month use of marijuana above the national average among youth aged 12-17. See the chart below.
“Reefer Madness or Pot Paradise?” also noted how politics was infiltrated by marijuana legalization. With a new, marijuana-friendly governor in office, Colorado legislators passed six marijuana laws in 2019 that included approving marijuana-delivery services; out-of-state investment and publicly traded cannabis companies; the creation of pot lounges—“marijuana hospitality establishments”—where marijuana could be consumed without violating the state’ indoor clean-air laws. As the industry expands, some of marijuana’s earliest supporters and entrepreneurs have raised concerns about being left out as pot companies in the US and Canada chase billion-dollar projected incomes and hire powerful politicians like John Boehner, the former Speaker of the House.
Luke Niforatos, the Executive Vice President for Smart Approaches to Marijuana (SAM), said despite claims of states not allowing child-friendly pot products, marijuana shops sell products like “Pot Tarts,” “Kush Pop,” and pot-laced gummy bears. Edible and drinkable products are becoming the direction the marijuana industry is going. “How many people think this is for 21 and up?”
The industry has prospered in selling marijuana-infused “edibles” that come in the form of cookies, candy, ice cream, sodas, and other sweet treats that are particularly appealing to children. These edibles comprise approximately 20 to 50% of the market in legalized states (where data is available), thereby increasing their availability to children and youth who are normally unaware of consumption serving sizes and consequences (Colorado Department of Revenue, 2015; O’Connor, Danelo, Fukano, Johnson, Law, & Shortt, 2016).
So, where does this leave the supposed success of other states implementing marijuana legalization and what Pennsylvania can look forward to?
The concern expressed for the danger to children in PA from candy-like edibles was legitimate. But it does not seem in states where recreational marijuana is legal that the marijuana industry has any interest in attempting to limit or restrict the sale of edibles that could appeal to children. 53.5% of high school students in Colorado feel it would be easy to get marijuana if they wanted, not more difficult, as Sharif Street said would happen after legalization (see Part 1). Financial assistance for restorative justice programs and historically disadvantaged businesses is roughly 1.5% of the projected tax income from marijuana sales; .065% of the total state budget. It seems to be more of a political carrot to gain public approval than real restorative social justice.
As the marijuana industry expands, the economic benefit to legalization seems to be primarily to the cannabis corporations, not the small, locally owned and operated businesses which are concerned about being left out. “Reefer Madness or Pot Paradise” in The New York Times said marijuana is starting to look like the next Silicon Valley. Vehicular accidents and driving under the influence of drugs (DUIDs) increased dramatically in various states that legalized marijuana. Legalization has led to increased black-market activity, not less; especially in rural areas that border states where marijuana is still illegal. Drug trafficking organizations and Mexican cartels have begun growing marijuana illegally in the US.
Marijuana-related emergency room visits have increased drastically since legalization. According to the Colorado Department of Public Health and Environment, the rate of marijuana-related ER visits increased 35% between 2011 and 2015. SAM reported these ER visits included a growing number of Butane Hash Oil (BHO) burn victims. “BHO is a marijuana concentrate that yields a THC potency of 70–99% and is highly lucrative. Production involves forcing raw marijuana and butane into a reaction chamber, which creates a highly combustible liquid that easily explodes when introduced to an ignition source.” See: “A Little Dab Will Do Ya” for more on BHO.
There is a clear negative effect on teens and youth in states that have legal recreational marijuana, even though it has always been legalized for adults and not teens. SAM reported the average rate of regular teen marijuana use is 30% higher in Alaska, Colorado, Oregon, and Washington than the US rate as a whole. Almost one-third of all 18 to 25-year-olds in legalized states said they’ve used marijuana in the past month, up from around one-fifth 10 years ago. See the research of Stacey Gruber detailed in “From the Frying Pan Into the Fire with Recreational Marijuana in PA,” “Double Whammy of Teens Vaping Marijuana,” and “Listening to Marijuana Research” for further concerns with teens using marijuana.
The research into whether or not marijuana is a gateway drug is mixed, but it does seem to have been a “stepping stone” of sorts with individuals who go on to use other drugs. See “Marijuana as a ‘Gateway’ Drug” and “Rebirth of the Gateway Hypothesis,” for more on the gateway hypothesis.
Cannabis may be safer now, but its strength is increasing under legalization. SAM reported the average national THC potency of flower is 11.04%, but in Colorado it is 17.10% and it is 21.24% in Washington State. In the 1960s and 1970s, cannabis contained less than 4% THC. And there is emerging evidence of a strong link between high-potency marijuana and psychosis. “The odds of psychotic disorder among daily cannabis users were 3.2 times higher than for never users, whereas the odds among users of high potency cannabis were 1.6 times higher than for never users.” See “Gambling with Cannabis and Psychosis” and “Cannabis and Psychosis: More Reality Than Satire” and “Psychosis and Adolescent Marijuana Use” for more information on the link between marijuana and psychosis.
One final piece of information came in mid-September of 2020. The Pittsburgh Business Times reported that two of the largest Pittsburgh-area medical marijuana startups, Solevo and PurePenn, have been acquired by a Florida company, Trulieve Cannabis Corp., based in Tallahassee, Florida. Solevo ranks second on the The Pittsburgh Business Times’ list of the region’s largest medical marijuana dispensaries and growers/processors; PurePenn is fourth. In addition to Florida, Trulieve has operations in California, Massachusetts and Connecticut.
Do Pennsylvanians really want to go “full Colorado?”
On September 3, 2020, Governor Wolf renewed his call for the legalization of recreational marijuana use for adults in Pennsylvania, which he originally announced his support of in September of 2019. Pointing to a presumed economic windfall such a legislative act would bring to the Commonwealth, he said: “Now more than ever, specially right in the middle of a pandemic, we have a desperate need for the economic boost that the legalization of cannabis could provide.” Lieutenant Governor John Fetterman also highlighted the economic impact to come from legalization. He said he could pitch marijuana legalization as a jobs bill. “Legalizing marijuana would create tens of thousands of jobs that require no subsidy.” This is a complete about-face from Wolf’s position two years ago, when he said, “I don’t think Pennsylvania’s actually ready for recreational marijuana.”
His rejection of legalization from August of 2018 was followed by a statement on Twitter in December of 2018 that signaled an evolving position, where Governor Wolf said more and more states were implementing marijuana legalization and we should keep learning from their efforts. “I think it is time for Pennsylvania to take a serious and honest look at recreational marijuana.” In an article I wrote in January of 2020, “From the Frying Pan Into the Fire with Recreational Marijuana in PA,” I said I hoped PA would learn from the long-term consequences of marijuana legalization in other states. We should not allow the political pressure to legalize marijuana to outpace learning from the consequences to other states and the science from research into marijuana.
Is the pressure to legalize recreational marijuana use in Pennsylvania a consequence of “more and more states successfully implementing marijuana legalization,” as Governor Wolf said in December of 2018? Let’s look at some of the claims that have been made about legalization, especially in Colorado, to see what this supposed successful implementation could mean for Pennsylvania.
In his most recent call for legalization, Governor Wolf said the revenue from legalization would benefit restorative justice programs and historically disadvantaged businesses. Another factor in the proposed legislation is reform to the criminal justice system and the uneven enforcement of marijuana laws against Blacks and Latinos. Fetterman said: “If you go over the span of decades we are talking nearly a quarter of a million Pennsylvanians that now have some affiliation with the criminal justice system for nothing more than consuming a plant that’s actually legal in 12 jurisdictions across this country.” State Senator Sharif Street of Philadelphia, one of the co-sponsors of the “Adult-Use Cannabis Act,” added that marijuana would economically benefit farmers, who could rotate it with corn. He added that regulation would also make it more difficult for dealers to sell to minors.
In addition to these claims made during the September 3rd announcement, there were the results from a May 2019 statewide “listening tour” by John Fetterman to hear people’s opinions as to whether or not they were in favor of or opposed to legalizing adult-use recreational marijuana. The most commonly stated reasons cited in support of legalization included in the Listening Tour Report were: a perceived economic benefit with increase funding for education and infrastructure, the expungement of past non-violent cannabis convictions and the belief that cannabis is safer than alcohol and opioids. Common reasons stated by those opposing legalization included concerns marijuana is a gateway drug, increased vehicular accidents and problems measuring a DUI level, and potential negative effects on youth.
The Listening Tour Report also found there was a 65-70% approval of adult-use cannabis legalization. Residents were overwhelming supportive of decriminalization and expungement of non-violent and small cannabis-related offenses. There was near-unanimous support for removing marijuana from its classification as a Schedule 1 drug. Many residents said that if legalized, marijuana should be grown on Pennsylvania farms and should create jobs in Pennsylvania. People were also concerned about an increase of people driving under the influence of marijuana. Most people were opposed to candy-like edibles because of their potential appeal to children.
A Franklin & Marshall College Poll in Mach of 2019 found that 59% of Pennsylvania voters supported legalization, a dramatic change since May of 2006 when only 22% supported legalization. There was a dramatic upshift of approval between 2015 (40%) and 2017 (56%), with Pennsylvania’s approval of medical marijuana occurring in 2016. Many polls reporting on whether or not marijuana should be made legal did as the Franklin & Marshall poll did, by asking an either-or, yes or no question: “do you think the use of marijuana should be made legal, or not?” But when polls distinguished between the recreational use and medical use of marijuana, support, support for legalization dropped. See the following compilation of survey results on PollingReport.com. Look at a 2014 question by the Pew Research Center that begins with: “Which comes closer …”
It seems a legitimate question of the reported percentages of Pennsylvanians supporting adult-use cannabis legalization is to ask to what extent was it influenced by the previous approval of medical marijuana? I previously raised the question of a possible strategy in the long-term goal of gaining national approval for recreational marijuana legalization was to pursue it one state at a time; initially concentrating on the supposed medical benefits from marijuana (See “Marijuana Peek-A-Boo” and “Eating the Elephant of Marijuana Legalization in PA”). These touted medical benefits are difficult to replicate or refute since marijuana is currently a Schedule I drug, which makes reliable research into its effects—good or bad—difficult to do.
Governor Wolf said recently the revenue from legalization would benefit restorative justice programs and historically disadvantaged businesses. However, the original “Adult-Use Cannabis Act” said $9 million would annually be distributed from the fund annually to the Department to carry out its duties, which include grants and loans to “low-income permittees.” These departmental duties include up to $2 million annually “to provide financial assistance to growers, processors, dispensers, and microgrowers who were harmed by effects of cannabis prohibition.” Interest-free loans could be granted to individuals with a prior cannabis-related criminal conviction, whose annual income was below $80,000, and who had successfully completed an educational program and passed an exam; again, up to $2 million annually.
95% of the remaining annual tax income (projected to be $581 million) was supposed to go to school districts. The projected income was calculated from the 17.5% tax rate that would be imposed on cannabis sold by licensed dispensaries. Yes, there would be some benefit to historically disadvantaged businesses and restorative justice programs, but that is out of merely 1.5% of the projected tax income. The governor’s rhetoric seems to be a bone tossed in reaction to the economic crisis of the COVID pandemic and the social justice issues that have been sweeping the country the past several months rather than a serious proposal. That is, if the roughly $539.6 million would really go towards schools. $581 million sounds like a significant figure, but it is actually 0.65% of the total operating budget for Pennsylvania for fiscal year 2020-2021.
The same 2019 Franklin & Marshall poll mentioned above also found that legalizing marijuana for recreational use was a top priority for only 5% of Pennsylvanians surveyed, while increasing state funds for public education (23%) and improving the state’s infrastructure (18%) were viewed as more important top priorities. Proposing to spend the anticipated income from legalization on schools sounds like a strategic political move to increase the chances of getting the Adult-Use Cannabis Act through the state legislature.
The same can be said about the inclusion of social justice reform actions in Senate Bill 350. Decriminalization and expungement can be accomplished independent of legislation that legalizes recreational marijuana. While changing the scheduling is popular in PA, there is nothing really that can be done, as that would take federal action. And as long as cannabis is a Schedule I controlled substance, selling, distributing, possessing and/or using marijuana or marijuana-derived products is a federal crime. JDSupra ended their article on the Adult-Use Cannabis Act with a disclaimer that said while federal policy may recommend enforcement discretion, “it is important to understand that compliance with state law does not equal compliance with federal law, and that federal marijuana policy may change at any time.”
A New York Times article in June of 2019, “Reefer Madness or Pot Paradise?” looked at what has happened in Colorado since they became the first-in-the-nation to experiment with legalizing recreational marijuana. Let’s look first at the social justice issue John Fetterman was concerned about. While low-level marijuana charges have fallen dramatically, the racial divide in drug arrests has continued. State data shows that African-Americans in Colorado are still being arrested on marijuana charges at twice the rate of white people. Jonathan Singer, one of two state legislators who endorsed the Colorado ballot measure that legalized their adult use recreational marijuana measure, said: “You don’t see drug-addled people roaming the streets, but we haven’t created a utopia.” Once known for its wide range of outdoor activities, now Colorado is known as the state that has “great weed.”
Colorado’s first-in-the-nation experiment has reshaped health, politics, rural culture and criminal justice in surprising ways that often defy both the worst warnings of critics and blue-sky rhetoric of the marijuana industry, giving a glimpse of what the future may hold as more and more states adopt and debate full legalization.
Law enforcement officials say legalization caused the black-market cultivation of marijuana to expand and made the problem worse. While licensed growers harvest marijuana from fields and greenhouses, police and sheriff’s officers raid houses converted to illegal cultivations they say export marijuana to other states. People cover the windows of grow houses to have the glowing grow lights and rewire the electric and water lines to avoid the meters. In May of 2019 police and federal drug-enforcement agents raided 240 homes around Denver and Northern Colorado that were illegally growing marijuana. The US attorney in Denver said Colorado has become “The epicenter of black-market marijuana in the United States.”
Small rural, towns near Utah, Nebraska or New Mexico are opening marijuana shops and raising concern from officials about out-of-state trafficking. Smart Approaches to Marijuana (SAM) reported there has been a 50% increase in illegal grow operations across rural areas of the state. “In 2016 alone, Colorado law enforcement confiscated 7,116 pounds of marijuana, carried out 252 felony arrests, and made 346 highway interdictions of marijuana headed to 36 different U.S. states.”
Legalization has made it easier for the black market to thrive in rural areas due to the difficulties involved in distinguishing between legal and criminal marijuana farms. About $6.5 million worth of illegal marijuana was confiscated by federal agencies in the White River National Forest in Aspen, Colorado, and 9,200 illegal marijuana plants were found growing on islands in the middle of the Colorado River (Associated Press, September 29, 2017; Roy, 2017). The ability to hide black market activity in legalized states has encouraged drug trafficking organizations (DTOs) and Mexican cartels to begin growing marijuana illegally within the United States and there is now a strong presence of cartel activity in Alaska (ADPS, 2016).
Since recreational sales began in 2014, more people visited emergency rooms for marijuana-related problems and hospitals report higher rates of mental health cases tied to marijuana. Yet thousands of others make daily stops at dispensaries without any problems. Calls to poison centers rose 210% in Colorado after legalization. The annual rate of marijuana-related ER visits increased 35% between 2011 and 2015.
In Part 2, we will continue with our examination of whether Pennsylvanians can hope to successfully implement recreational marijuana legalization. There is a 2018 report by Colorado, “Impacts of Marijuana Legalization in Colorado” that has some interesting data on seizures of Colorado-sourced marijuana (some Colorado-sourced marijuana was seized in Pennsylvania). Violent crime increased, as did marijuana arrests of young African-American and Hispanic youth. Oh, and Colorado was in the top 20% of states for youth marijuana use.
On September 25, 2019, Governor Tom Wolf announced he supports legalizing recreational marijuana. Wolf and Lt Gov. John Fetterman called for three specific actions at their press conference: 1) a bill to decriminalize non-violent and small cannabis-related offenses; 2) developing a way to expunge past convictions for non-violent and small cannabis-related offenses; and 3) consideration by the General Assembly of legalization of adult-use recreational marijuana. He said: “We now know the majority of Pennsylvanians are in favor of legalization, and that includes me.” He added that he looked forward to seeing what could be accomplished, especially the criminal justice reforms.
His endorsement represented an about-face from August of 2018, when he told KDKA Radio Morning News the time was not right to legalize marijuana for recreational use: “I don’t think the citizens of Pennsylvania are ready for it.” He recommended waiting on the longer-term results of legalization in states such as Colorado, Oregon, Washington, where their different approaches could be helpful as PA weighs its own options. Then in December of 2018, Wolf said in a tweet: “More and more states are successfully implementing marijuana legalization, and we need to keep learning from their efforts.” He added any change would require legislation. But he thought it was time for “Pennsylvania to take a serious and honest look at recreational marijuana.”
Wolf’s support for legalization came after the completion of Fetterman’s “Statewide Cannabis Listening Tour” on May 19, 2019. Key takeaways from those who attended the tour included: 65-70% approval for adult-use cannabis legalization; near unanimous support for decriminalization and mass expungement of non-violent and small cannabis-related offenses; if legalized, cannabis should be grown on Pennsylvania farms; the removal of cannabis from its current classification as a Schedule I drug; and a provision allowing for six to eight homegrown cannabis plants for personal use. More than 10,000 individuals attended Listening Tour meetings and the online portal received more then 44,000 comments. The September announcement of support for legalizing recreational marijuana was followed by the introduction of the “Adult-Use Cannabis Act,” Senate Bill 350, by Pennsylvania senators Daylin Leach and Sharif Street.
If passed, the bill would legalize adult-use cannabis for individuals 21 years of age and older, and establish a permitting process for growers, processors, and dispensaries; the current measure would not place a limit on the number of permits that could be issued. The bill would also allow for cannabis delivery, consumption (i.e., “bring your own” or BYO) lounges, and home grow. Under the proposed legislation, the Pennsylvania Department of Agriculture would oversee the adult-use program.
Two days after the Adult-Use Cannabis Act was introduced, Governor Wolf met with governors from New York, New Jersey and Connecticut at a “marijuana summit,” where they agreed to a set of core principles for legal cannabis programs they would pursue. This seems to be part of a continuing strategy for legalizing recreational marijuana in Pennsylvania that I said was like eating an elephant one bite at a time (See “Eating the Elephant of Marijuana Legalization in PA”). Let’s see if we can digest some of what we are hearing from the “Statewide Cannabis Listening Tour,” the Adult-Use Cannabis Act, and what we can learn from the states who have gone before PA in legalizing recreational marijuana.
The first key takeaway in the Executive Summary of the Listening Tour was that 65-70% of those who attended tour stops approved of adult-use cannabis legalization. This seems to be the source of Governor Wolf’s statement that “We now know the majority of Pennsylvanians are in favor of legalization.” We know that 65-70% of those who attended tour stops approved of adult-use cannabis legislation, not that 65-70% of Pennsylvanians approve of legalization. The 10,000 or so individuals who went to the Listening Tour stops are not representative of the Commonwealth as a whole, and surveys of them should not haven been presented as “the majority of Pennsylvanians” by the governor. The Executive Summary made the distinction, saying a majority of attendees supported legalization—why didn’t the governor?
The Adult-Use Cannabis Act would issue permits to applicants seeking to legally become a Grower, Homegrower, Microgrower, Processor, open a Dispensary to sell cannabis retail to consumers, become a Deliverer of cannabis from a dispensary to consumers, or operate “use lounges,” where individuals may use cannabis which they have brought to the space. Cannabis use in public, except use in these consumption lounges, would be prohibited. See the “Adult-Use Cannabis Act” link for a further description of these permits. There would be a 17.5 percent tax rate imposed at the point-of-sale on cannabis by dispensaries.
There was “near-unanimous” support for decriminalization and mass expungement of non-violent and small cannabis-related offenses, and for removing cannabis from its current classification as a Schedule I drug. These social justice concerns and the rescheduling of cannabis are laudable and can be legislated independent of legalizing adult-use of recreational marijuana. Were they bundled into the Adult-Use Cannabis Act in order to garner support in the General Assembly for legalizing recreational marijuana?
There was concern expressed for an anticipated increase of people driving under the influence of cannabis, which has in fact happened in other states. The National Institute on Drug Abuse said several meta-analyses found the risk of being involved in a crash increased significantly and in a few cases doubled or more than doubled. “Two large European studies found that drivers with THC in their blood were roughly twice as likely to be culpable for a fatal crash than drivers who had not used drugs or alcohol.”
A 2009 article in The American Journal on Addictionssaid detrimental effects of cannabis use varied in a dose-related fashion and were more pronounced with highly automatic driving functions than with more complex tasks that required conscious control. Impaired drivers tend to compensate effectively when driving, but combining alcohol and marijuana eliminates the ability to use such strategies “and results in impairment even at doses which would be insignificant were they of either drug alone.”
In Colorado, where recreational marijuana has been legal since 2012, there has been a sharp increase in the number of marijuana-related automobile fatalities each year from 2013 to 2016. There were 77 marijuana-related fatalities in 2016, 51 of those drivers had levels of THC above the threshold for cannabis impairment under Colorado law. According to a survey by the Colorado Department of Transportation, over half of marijuana users said they had got behind the wheel of a vehicle in the last 30 days within two hours of using the drug.
After recreational marijuana was legalized in Washington in 2012, the proportion of marijuana-positive drivers involved in fatal crashes increased from 8 percent to 17 percent in 2014, according to AAA. The majority of drivers who had detectable levels of THC also had alcohol and/or other drugs in their blood at the time of the crash. “Of all THC-positive drivers involved in fatal crashes over the study period, an estimated 34.0% were positive for THC only, 39.0% were positive for both THC and alcohol.” 16.5% were positive for both THC and one more other drug, but not alcohol; and 10.5% were positive for THC, alcohol, and one or more other drugs.
Research from the Insurance Institute for Highway Safety (IIHS) and Highway Loss Data Institute (HLDI) showed that crashes were up as much as 6 percent in Colorado, Nevada, Oregon and Washington when compared with neighboring states that haven’t legalized marijuana for recreational use: Idaho, Montana, Utah and Wyoming. IIHS-HLDI President David Harkey said legalizing marijuana was having a negative impact on the safety or our roads. “Despite the difficulty of isolating the specific effects of marijuana impairment on crash risk, the evidence is growing that legalizing its use increases crashes.”
The Adult-Use Cannabis Act seeks to take an illegal drug away from the black market and regulate its distribution through legislation and regulation. And hopefully develop a new revenue source for Pennsylvania. PA Auditor General Eugene DePasquale estimated legalizing marijuana would produce approximately $581 million in annual tax revenue. After funding a grant program ($2 million) and an interest-free loan program ($2 million) and $9 million to the Department of Agriculture to oversee the adult-use program, 95% of the remaining revenue would be distributed to school districts. Ironically, one of the top concerns noted in the “Statewide Cannabis Listening Tour” was the potential of negative effects on the development of youth and students.
The New York Times featured an article in April of 2019 on how the illegal marijuana market was booming in California despite legalization. The governor of California redeployed National Guard troops stationed on the border with Mexico to go after illegal cannabis farms in Northern California because the problem was getting worse, not better. In wildland areas, the California Department of Fish and Wildlife more than doubled its seizures of illicit marijuana in 2018, the first year recreational cannabis was legal.
Of the roughly 14 million pounds of marijuana grown in California annually, only a fraction — less than 20 percent according to state estimates and a private research firm — is consumed in California. The rest seeps out across the country illicitly, through the mail, express delivery services, private vehicles and small aircraft that ply trafficking routes that have existed for decades.This illicit trade has been strengthened by the increasing popularity of vaping, cannabis-infused candies, tinctures and other derivative products. Vape cartridges are much easier to carry and conceal than bags of raw cannabis. And the monetary incentives of trafficking also remain powerful: The price of cannabis products in places like Illinois, New York or Connecticut are typically many times higher than in California.
Politico also wrote about “How Legal Marijuana Is Helping the Black Market.” It said when Oregon legalized marijuana in 2014, the state tried to stifle its black market by making the path into the legal market was as easy as possible. “It did not limit licenses and it simplified regulations, creating a program with one of the lowest barriers to entry in the United States.” The strategy worked. An Oregon State Police Sergeant estimated there are more illicit marijuana growing in Southern Oregon than before legalization, with most of it going out of state. He said law enforcement is just inundated with illegal marijuana and exportation.
Now, Oregon is an easy place to find high-quality, cheap, legal marijuana. There are more than 650 licensed marijuana dispensaries in the state, or three times the number of McDonald’s restaurants (205). If you’re an Oregonian living in a town or county with legal pot and you want to buy marijuana, there is no reason to shop illegally.
Even The Motley Fool weighed in with “5 Reasons the Marijuana Black Market Won’t Go.” They noted how the legalization of recreational marijuana in Canada and U.S. states has not stopped black market cannabis, as initially expected. “In California, the largest legal weed market in the world by annual sales, illicit marijuana sales are projected to outpace legal pot sales in 2019 by a significant margin: $8.7 billion to $3.1 billion.” Estimates by Scotiabank are that the black market would be responsible for 71% of total cannabis sales in Canada in 2019. The problem noted by the Motley Fool included supply issues in Canada, tax issues in select US states, a slow dispensary approval process, jurisdiction issues, and spotty regulatory enforcement.
Staci Gruber, who is the director of the MIND (Marijuana Investigations for Neuroscientific Discovery) project, has published a series of studies that confirmed the heavy use of marijuana lowers the level of white matter in the corpus callosum region of the brain; and the earlier the age of marijuana use was associated with lower levels of white matter. White matter affects learning and brain functions, modulating the distribution of action potentials and acts as a relay and coordinates communication between different brain regions. Not surprisingly, marijuana smokers were also found to have higher levels of impulsivity. Adolescent marijuana users are also vulnerable to reduction in grey matter, which is responsible for information processing and decision making. See “Listening to Marijuana Research,” “Marijuana Policy Has Run Ahead of Science” and “Double Whammy of Teens Vaping Marijuana” for more on these concerns.
The Motley Fool noted where cannabis had been one of the fastest-growing industries on the planet. After sales more than tripled worldwide between 2014 and 2018, Wall Street forecasted a 5-fold to 18-fold increase in global annual revenue by 2030. But since May of 2019, many marijuana stocks have seen their share price cut in half or worse. Our neighbor to the north, Canada, hasn’t stomped out the black market as expected and supply shortages have been a persistent problem. And the regulatory enforcement designed to drive the black market out of business hasn’t been working. “Based on data from the United Cannabis Business Association, via an audit that was recently turned into California Gov. Gavin Newsom (D-Calif.), 2,835 of the 3,757 listings of marijuana sellers in California on website WeedMaps were unlicensed.”
Hopefully the core principles for legal cannabis programs the governors of Connecticut, New York, New Jersey and Pennsylvania agreed they would pursue at the so-called “marijuana summit” included a continued “wait and see” option. Legalizing recreational marijuana does not seem to have solved problems it was predicted to solve and seems to have generated new ones that weren’t anticipated or predicted. Let’s follow Governor Wolf’s older advice about waiting to see the longer-term consequences of marijuana legalization in Washington, Oregon, Colorado and California. If we acted on his endorsement in favor of legalization now, wouldn’t we be jumping from the frying pan into the fire?
On December 19, 2018, PA Governor Tom Wolf tweeted more and more states were successfully implementing marijuana legalization, and PA needed to keep learning from their efforts. Change would take legislation. “But I think it is time for Pennsylvania to take a serious and honest look at recreational marijuana.” Then on January 3, 2019 Pittsburgh state Representative Jake Wheatley proposed the commonwealth legalize recreational marijuana, saying House Bill 50 would provide for social justice reforms, incentivize cannabis businesses to partner with PA farmers, and well as invest in student forgiveness, after school programs and affordable housing. We need to do what is best for the people of Pennsylvania and legalize cannabis this Legislative Session.”
Governor Wolf said: “I’m just trying to be a realist, that this is something we really ought to be taking a look at in a way that maybe we haven’t before.” But he didn’t intend to make it a priority of his second term. However, he also thought Pennsylvania shouldn’t hide her head in the sand and say things aren’t happening in other states in the region.
I’m just saying I’m going to look at what’s going on in the neighboring states and see if we can continue to learn from them and other states that have, through referendum and legislative action, legalized it, and see what maybe we ought to be doing. I’m just keeping my eyes open.
The Republican-controlled chambers of the General Assembly are opposed to the bill. Senate Majority Leader Jake Corman called the idea “reckless and irresponsible,” while his counterpart in the House, Majority Leader Bryan Cutler, opposed the medical marijuana passed in 2016. Corman said, “As long as I as leader, I will do everything in my power to prevent legalization of recreational marijuana.” He added that it gives the wrong message to our youth.
Then on September 25th Governor Wolf announced that he was now in favor of legalizing marijuana for recreational use. Lt. Governor John Fetterman, who had spent months on a statewide recreational marijuana listening tour, stood beside him. Governor Wolf said, “I think it’s time for the General Assembly to sit down and craft a bill that actually recognizes that Pennsylvania is ready for this, and also takes advantage of what we’ve learned from other states in terms of what to do and what not to do.” On October 15th, 2019, two state senators introduced Senate Bill 350, which would allow for home delivery and the expungement of many previous criminal convictions related to marijuana. See the link for key high lights of the Bill.
Some have doubts that the proposed Adult-Use Cannabis Act will pass this year, especially in its current form, as there are no Republican co-sponsors at this time. The bill also faces an uphill battle in Pennsylvania’s Republican-controlled Senate, although Senators Leach and Street have indicated that they are optimistic the bill will pass and that many of their Republican colleagues will end up supporting the measure. Generally, the legislation is thought to stand a better chance than prior efforts in light of the Lt. Governor’s listening tour and the Governor’s recently announced support of legalization. With that said, in response to Gov. Wolf’s comments promoting legalization, House Republican leaders issued a statement less than one month ago criticizing Gov. Wolf’s position and stating that “[o]ur caucus has no plans or interest in legalizing recreational marijuana.” It is also worth noting that Senator Leach also co-sponsored Pennsylvania’s medical cannabis legislation, which reportedly also lacked any Republican co-sponsors initially.
Pennsylvanians are facing a purposeful and strategic scheme to get recreational marijuana legalized in their state. It began with Governor Wolf signing Senate Bill 3, legalizing medical marijuana on April 17, 2016. Initially, the approved conditions were limited to 17 “serious medical conditions.” Those conditions have expanded from 17 to 23 since then, as seen on the PA website, under Qualifying Conditions. Anxiety, Dyskinetic and spastic movement disorders, opioid use disorder, terminal illness and Tourette syndrome have been added; and a few have been relaxed, such as Cancer now has added “including remission therapy.”
At first, dried leaves, plant material and edibles were strictly prohibited. Only those forms of medical marijuana listed in Act 16 were permitted. They included: 1) a form medically appropriate to administer by vaporization or nebulization; 2) pills; 3) topical forms, including gels, creams or ointments; 4) tinctures; 5) liquids; or 6) oils. Also, a licensed practitioner or medical professional determined which form is appropriate for the patient.
At the World Medical Cannabis Conference & Expo held in Pittsburgh in April of 2017, Daylin Leach said he expected medical marijuana would be available in plant form (dry leaf, flower) in 2018. He said a section of Senate Bill 3 authorized an advisory board to make recommendations about whether to change the permissible forms of the drug. During a panel discussion at the Expo, he said the following about the advisory board:
But they will [approve sale of the plant form of marijuana], because we’re appointing people to do that,” Leach said as the crowd laughed. “They will recommend that at latest by April 17 (2018), which means when dispensaries open, it is likely that they will have whole plant on their shelves from day one.
On April 16th, 2018 Governor Wolf announced he supported changes to the existing state medical marijuana program that would allow dispensaries to sell dry leaf marijuana or “flower,” and the PA Health Secretary, Rachael Levine, announced she approved the recommendation from the state’s advisory board to permit the sale of dry leaf “for patients with a qualifying medical condition.” The rationale was their desire to offer a lower-cost option to the forms permitted in Act 16. PA law still prohibited smoking medical marijuana or using it in edible form, but it was unclear how that rule would be enforced once the marijuana was purchased and taken home. Cannabis consumer advocate Chris Goldstein said: “I’m sure patients are going to go home and smoke it, and there’s nothing wrong with it. . . This is how humans have used cannabis for 10,000 years and it’s how people should have access to it in Pennsylvania.”
Now there are six forms of medical marijuana available for consumption in PA: pills, extracts, liquids, topicals, patches, and flower. “Dry leaf/flower” went on sale at PA dispensaries on August 1, 2018. Daylin Leach was off on his time table, but accurate on his prediction that flower would be for sale in the first year.
In its first full year, Pennsylvania collected $2 million in tax revenue from growers and processors. Dispensaries reported $132 million in sales. Dr. Rachael Levine said: “Our goal for the next year and beyond is to increase the number of grower/processors and dispensaries operating, to register even more physicians and to continue the growth of our scientific, medically based program.” There are currently an estimated 72 medical marijuana dispensaries in Pennsylvania, with around 283 more applications for potential dispensaries as of the end of November, 2019. Writing for Law.com, Patrick McKnight said:
Pennsylvania’s medical marijuana program is noteworthy for its promotion of scientific testing. As part of the program, the state certifies eight academic clinical research centers. The mission of the clinical program is to conduct, “Research on the therapeutic or palliative efficacy of medical marijuana limited to the serious medical conditions defined by the act and the temporary regulations.” The state also has four approved laboratories for quality testing and sampling.
There are some serious researchers, like Staci Gruber, who are investigating the medical benefits of cannabis. She is an associate professor of psychiatry at Harvard Medical School and the director of MIND (Marijuana Investigations for Neuroscientific Discovery). She has done research on the effects of both recreational and medical marijuana. In an interview with The Harvard Gazette, Dr. Gruber said the science on the health effects of marijuana is not yet settled. “When we think about legalization we always like to have science inform policy. In this particular case, it seems to me that policy has outpaced science.”
Gruber said there is a lot we don’t know about the effects of marijuana. Most of what we do know comes from studies of “chronic, recreational marijuana users.” There are differences between recreational and medical marijuana use, with regard to what they use and how they use. She said there has been well-founded excitement about the potential for medical cannabis use. “[But] there’s a striking paucity of research on the use of medical cannabis.”
Dr. Gruber said her goal as a scientist was to provide truthful information so all people, regardless of their recreational or medical status, can understand what is in their cannabis. In pursuit of this goal, Dr. Gruber and her colleague Kelly Sagar continued a discussion of their research with “Marijuana on the Mind?” in Policy Insights from the Behavioral and Brain Sciences. You can also watch an archived webinar by Gruber and Sagar on the same subject, “Marijuana on the Mind: A Primer for Policymakers” on the website Social Science Space, where there are also written answers to some of the questions from the webinar. The presentation exists as an independent YouTube video as well. The audio cuts out a few times, but returns if you continue with the video.
In “Marijuana on the Mind?” Gruber and Sagar gave a helpful review of the history of medical use of marijuana, noting how it was included in the U.S. pharmacopeia (a list of medicinal drugs with their effects and directions for their use) until 1942. They also documented several areas of concern with marijuana, including its adverse effects on cognition, especially executive function and memory; brain development among adolescents; and safety concerns related to the frequency and magnitude of marijuana use as well as its potency. Based upon their discussion, policy recommendations given by Gruber and Sagar include:
age restrictions based upon evidence highlighting the developmental trajectory of the adolescent brain;
restrictions on targeting youths in advertisements;
safe packaging guidelines to prevent the accidental ingestion of edible MJ products by children;
place limits on THC potency as well as minimums for potentially beneficial cannabinoids in marijuana, like CBD;
more research on the impact of medical marijuana, which will likely require a lessening of marijuana as a Schedule I substance
PA medical marijuana research would do well to partner with researchers like Gruber and her organization. Let’s allow research and not rhetoric guide the medical uses of the cannabinoids in cannabis. But is Pennsylvania’s commitment to scientific testing real or just window dressing?
Over four years ago in “Marijuana Peek-a-Boo” I suggested a strategy for legalizing recreational marijuana would eat the elephant one bite at a time. Keep the battles going state-by-state and simultaneously keep the federal government out of the fight. Legislatures within the states where marijuana is not yet approved should hear about the income and health benefits of legalizing marijuana, but not the existing problems where it has been approved. Information on the different kinds of cannabinoids in marijuana and their varying medical benefits—some greater than others—needs to be suppressed. Let them think the medical benefits are all or nothing with marijuana and not contingent upon specific cannabinoids within marijuana. The known health problems from smoking marijuana should be minimized or ridiculed.
Gruber and Sagar’s policy recommendations should be seriously considered and implemented by Pennsylvania. Lawmakers should read “Marijuana on the Mind?” and/or watch “Marijuana on the Mind: A Primer for Policy Makers.” They could also read, “Marijuana Policy Has Run Ahead of Science,” which is a discussion of Gruber and Sagar’s article. The scientific testing and research of marijuana by the Commonwealth needs to be seriously and aggressively pursued. The benefits and problems with cannabinoids like THC and CBD need to be researched and described. So far it seems there are limited health benefits from THC. See “Listening to Marijuana Research” or “Marijuana & Adverse Health Effects” for more information on this. Then there are two previous articles I wrote on marijuana legalization in Pennsylvania: “Keep Marijuana Medical in PA” and “Marijuana Stepping Stones In PA?”
