So … as professionals or students in training with a focus on substance use and addiction, I am certain that most of you have been asked some version of the following question by family, friends, or colleagues: Do you think marijuana should be legalized or decriminalized? You know that this is a very polarized issue, and, whatever your answer, you should think carefully about why you support that position? Are your reasons data driven, based on social or personal values, or based on projected fiscal impact? Does your past or present use of marijuana influence your views? Is your opinion swayed by your perceptions about the positive and negative effects of marijuana use? Are you confident in your knowledge base regarding published research on this topic? Do you feel that legislators know what they need to know to make informed decisions when drafting marijuana legislation that benefits their constituents and protects the public health?
To further tax your thinking on this issue, I’ll lob you a few more questions. If marijuana is legalized, have you considered what types of regulations should guide the manufacturing, distribution, marketing, possession, and use of marijuana? Do we even need regulations? Should regulations parallel those for alcohol, or maybe tobacco? How would we determine specific regulations and do we have the information needed to do so? For example, at what age would you make use of marijuana legal? What information would you use to make this decision? Do we even need an age cutoff? Who should be allowed to sell, produce or grow the marijuana products that are made available? How much quality control is needed to make sure that the label on the product accurately reflects what is being sold? Quality control would clearly benefit the public health. But what type of labeling (contents or warnings) should be required? Should warning labels even be required? If yes, what should they say and who would force producers to use such labels? Should we limit the potency (%THC) of the marijuana products that are produced and sold or just label them (equivalent to %ETOH in alcoholic drinks)? What would guide our decision on this? Should there be a limit on how much marijuana you can buy?
Let’s discuss marketing and packaging: Should there be any restrictions on marketing? If so, what should they be? Would packaging and advertisements be allowed to target youth? Would advertisements be allowed to make claims about the benefits of their products? The list of approved medical conditions for use of marijuana across States that have passed “medical” marijuana laws consists of well over 50 conditions and diseases. Would the “Industry” self-regulate marketing policies or should our government - State or Federal? Do we need to worry about secondhand smoke from marijuana? Perhaps we should only legalize vaporizing (vaping) and oral consumption, and keep smoking illegal - did you know that this stipulation is in New York’s compassionate care marijuana legislation? But how would we enforce that? Potential tax revenues, personal profit, and job creation are all expected benefits of the legalization of marijuana. How do these benefits impact and interact with the development of regulations designed to protect public health?
Sorry, I know I promised only a few questions, but I could not help myself. I expect that most of you do not have clear answers to these questions; I certainly do not. But unfortunately the questions do not end there. For example, who should be in charge of developing all these guidelines and regulations? Should guidelines and regulations be allowed to differ in each State? If yes (the direction we are currently taking), then each State would need to develop its own regulations and enforcement policies. So then how do we handle those caught possessing or using marijuana in a State that does not allow this, if their home State allows it? What should the penalties be for violation of the laws or regulations? Who will enforce these rules? How much effort and resources should be devoted to enforcement of a legal product? Do we use alcohol enforcement policies as our guide? Can we determine illegal intoxication levels from marijuana for driving? How good are our methods for doing so? Should we even worry about intoxication from marijuana?
Finally, how might legalization impact teens and young adults? How much focus needs to be on how policies will impact teen use? Will it increase use, lead to earlier initiation, or more problematic use? Does it matter when one starts using marijuana? Are the data that show teens are most vulnerable to addiction and that marijuana adversely impacts brain and cognitive functioning valid and of high concern? If we decide that it will remain illegal for teens, and I think that would appear a most likely outcome, what should the penalties be for teens that violate these laws (or vendors who sell to them)? How would legalization then ameliorate the current concern about discriminatory arrests of minority youth who violate marijuana laws?
If you are starting to feel overwhelmed by all these questions, you are not alone – I am as well, and I’m supposed to be an expert in this field. Maybe we should just decriminalize marijuana use? Wouldn’t that be easier? With decriminalization, most of the questions above do not have to be answered. Marijuana would remain illegal, but we would reduce the penalties for using or possessing it. Problem solved? But what do we do about sales (dealers)? Do we allow sales and use, but only in some places? Do we have dispensaries? If yes, who supplies them and how do we ensure quality control? Or do we turn a blind eye to manufacturing and product control? Seems like some of the same problems arise with decriminalization as with legalization, but not as many decisions or regulations are needed? However, is it too late for this approach to take hold? Also, aren’t decriminalization type practices already functionally being applied in many areas of the U.S.? If decriminalization was the way to allay concerns about the current way marijuana possession, use, and sales are handled, why isn’t this the direction we appear to be taking? Is it because we still have to deal with marijuana trafficking from border countries and from within our country? Will legalization stop black market concerns? So we seem to have circled back to the question of why we think marijuana should be legalized.
I will stop here. It is fairly easy to list the multiple issues, obstacles, contradictions, and decisions that should be considered and addressed in developing a policy on marijuana legislation and regulation. If you are able to synthesize and prioritize all these issues into some type of decisional algorithm, please step up and chime in. My working memory is no longer strong enough, if it ever was. Perhaps it doesn’t need to be so complex, and I am making a mountain of a mole hill. As professionals in the field of addiction, I think it is incumbent upon us to contribute to the resolution of these issues with the goal of coming up with policy and regulations that can best serve the public health. You can impact the macro decision of whether or not to legalize, but importantly, you can also impact the plethora of micro decisions that follow the decision to legalize. Please consider helping your local and State leaders figure out what to do. They have been dealt a bad hand, but they can’t just fold, they have to take action, and you are in a position to help them.
Before I go, a few important shout-outs:
1) Certificate of Proficiency in the Psychological Treatment of Alcohol and Substance Use Disorders. Repeat and Update: Clinical psychologists, please consider applying for this certificate! John Kelly, Nancy Piotrowski, Mark Schenker, Ray Hanbury and many others worked very hard to get this Certificate reinstated, but if only a few Psychologists apply for the Certificate, it will likely go away again. More importantly, as we try to make progress in advancing Psychologists as experts in Addiction and purveyors of the most effective interventions, this certification will provide a means for State Associations to recognize this expertise and more effectively utilize our knowledge base and talent. Info on the process of how to apply is easily accessed on the APA website: http://www.apa.org/divisions/div50/training_certificates.html
Go for it!
2) Huge thanks to Katie Witkiewitz, Jen Buckman, and the rest of the Committee in charge of putting t oget her the Col laborat i v e Perspectives on Addiction (CPA) conference. They put in many hours to make CPA happen, and at the time I am writing this column (preconference), the venue, program, participation rate, etc. all look fabulous. Please pass along your appreciation to them if you have a chance. If you attended, please send along your feedback. If you didn’t attend, please consider it next year! We gave out five student travel awards!! To view the program, go to: http://research.alcoholstudies.rutgers.edu/cpa
3) Through the efforts of Bruce Liese and the student committee, our Division’s membership committee recently launched a monthly forum for future psychologists (students and postdocs) interested in the psychology of addictive behaviors. These 1-hour conference calls provide students with an opportunity to network with other students interested in addictive behaviors and engaging with Division 50. A website has been set up for discussion and follow up. Over 50 students have already signed on. The link is http://www.cbtaddictions.org/d50/. Anyone interested in participating can contact Bruce Liese (firstname.lastname@example.org).
4) Big thanks and congratulations to Bettina Hoeppner. Thanks for continuing to produce our high quality newsletter, TAN. Congratulations on having a healthy baby boy (welcome, Brendan Alexander Sullivan!), and on miraculously getting the newsletter out during this exciting and exhausting time.