Big Marijuana — Lessons from Big Tobacco

By Kimber P. Richter, Ph.D., M.P.H., and Sharon Levy, M.D., M.P.H., New England Journal of Medicine, June 11, 2014

The United States is divided over the legalization of marijuana. Arguments in favor include protection of individual rights, elimination of criminal sentencing for minor offenses, collection of tax revenue, and elimination of the black market. Counterarguments include the possible escalation of use, adverse mental and physical health effects, and potential medical and social costs.

indexSome steps have already been taken to reduce harsh and racially biased sentencing. There is growing support in Congress to eliminate federal mandatory minimums for drug offenses, and 19 states have either decriminalized or eliminated jail time for possession of small amounts of marijuana.

Furthermore, 21 states and the District of Columbia have legalized the medical use of marijuana.
Washington State and Colorado went further, authorizing the retail sale of marijuana and opening the door to a legal marijuana industry. Given the lessons learned from the 20th-century rise of another legal addictive substance, tobacco, we believe that such an industry could transform marijuana and its effects on public health. Like tobacco, marijuana harms health and is addictive; unlike alcohol, both tobacco and marijuana came of age after the Industrial Revolution. And although the United States has, since tobacco’s rise, adopted regulatory structures designed to protect consumers, they do not apply to marijuana, in part because marijuana use and sales remain illegal under federal law. Colorado and Washington are developing regulatory infrastructures to fill this gap, but the goals and potential effectiveness of their proposed regulations are unclear. No evidence exists regarding which regulations might minimize population harm from marijuana. The marijuana industry’s trajectory could therefore repeat tobacco’s.

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