A Second Look At Recreational Cannabis - Already?

I don't know how many other people are weary of the onslaught of pro-cannabis propaganda over the past two decades.  The goal was clear to me at the outset - legalize marijuana.  I have previously posted that I think there will be legalized marijuana in every state in the United States.  I have also posted that "medical" marijuana or cannabis is basically a front for the legalize recreational marijuana movement.  I am very weary of all of the arguments about how cannabis is a miracle drug, how it will lead to stunning new discoveries, how it will lead to less opioid use and misuse, and all of the permutations of these pseudoscientific arguments.  Many of the legal arguments are just straight off-the-wall.  Those include put all the cannabis dealing cartels out of business, create jobs, and tax it as a great source of tax revenue.  The considerable downsides of adding another intoxicant to the culture seems to be mentioned only by a few psychiatrists who are familiar with a great many of the downsides from treating patients who have been using it for a lot longer than the legalization arguments have been in vogue.

A few of those problems became more evident last week. Colorado Governor John Hickenlooper came on CNN and discussed several correlates of cannabis legalization in Colorado.  Property crimes and violent crimes are up.  The number of homeless in Denver is up and some believe this is a correlate of increased crime.  The number of lethal motor vehicle accidents involving cannabis are up.  He did not mention health care related phenomena including a doubling of cannabis related hospital billing codes, a five-fold increase in cannabis related mental health codes, and an 80% increase in cannabis related calls to poison control centers (3).  Unintentional pediatric exposure to cannabis was also observed (4) to increase.  None of the costs of this medical care has been calculated as an offset of the tax revenue from the cannabis.  Gov. Hickenlooper made the point that recent tax revenues were about $200 million relative to a state budget of $30 billion and about 1/3 of that revenue goes for associated law enforcement and educational activities.  He advised against any state making the decision to legalize cannabis based on a tax revenue argument (5).  The articles in the popular press seem to emphasize the need for flexibility with the great social experiment of recreational cannabis and the Governor seems all for that up to a point.  That point is if it is apparent that the social costs in terms of crime and motor vehicle accidents is really up. At that point he suggests that the current cannabis laws can be reversed. 

Rather than get caught up the old causation versus correlation argument, I can say unequivocally that it is naive to assume that the legalization of another intoxicant would not lead to more problems.  The suggestion that problems would be less and that society will be improved overall by the use of more intoxicants can only be seen as a blatant political ploy.  There will be more accidents, more acute toxicity, and more psychiatric morbidity due to cannabis.  I don't know if Colorado is adding up those costs and trying to compare them to any advantages of legalized cannabis, but I would not be surprised at all if Colorado taxpayers don't incur more liability from cannabis than revenue.

Before any cannabis promoters attempt to teach me about the costs of alcohol - read this blog.  There is more posted here on the costs of alcohol than you will find in most places.  My point is not that alcohol doesn't cost more.  My point is fairly obvious and that is every time you add an intoxicant to society it costs you something.  It is not free or a net benefit.   Once cannabis is legal in all 50 states it will be easier to estimate the total damage.

The other article that came out last week had to do with the 420 holiday and a very interesting plot by Staples and Redelmeirer (see Figure 1).  In this essay the authors look at the 420 holiday which is a celebration of cannabis.  The celebrants gather for mass consumption of cannabis. They studied 25 years of fatal crash data between the hours of 4:20PM and 11:59PM on April 20 and compared the crashes at that time to crashed on control days (April 13 and April 27 during the same time interval).  The Forest Plot below shows the findings across a number of comparisons.

The risk of fatal crashes was higher on 420 and significantly higher for younger drivers. On geographic analysis absolute risk of a fatal crash was highest in New York, Texas, and Georgia.  Relative risk (see original article) was decreased only in Minnesota.  The authors comment that even though the majority of the population does not celebrate 420 (or even know that it exists) the traffic accident risk is similar to what is seen on Super Bowl Sunday and policy makers might want to take this into consideration.  So might anyone interested in the drunken driving issue.  Is it possible that cannabis intoxicated drivers as a population are more impaired than alcohol intoxicated drivers?

Those are the considerations from last week.  I am sure that more will occur as the United States legalizes cannabis in very state and as it becomes a legitimate industry.  An issue flagged by the CDC several years ago was the use of synthetic cannabinoids in order to avoid occupation related drug screens, but their initial data was from a time before cannabis was legalized in Colorado.  And once again this post is not an argument for or against legalization.  I hope that I have been quite explicit in saying that I anticipate widespread legalization of cannabis.

This post and most of the posts on this blog are to document the expected fall out from increasing the amount of intoxicants consumed by the population. It is neither benign or beneficial as suggested by the advocates.   


George Dawson, MD, DFAPA



References:

1: Staples JA, Redelmeier DA. The April 20 Cannabis Celebration and Fatal Traffic Crashes in the United States. JAMA Intern Med. 2018 Apr 1;178(4):569-572. doi: 10.1001/jamainternmed.2017.8298. PubMed PMID: 29435568; PubMed Central PMCID: PMC5876802.

2: Colorado Attorney General Announces Indictment of Massive Illegal Marijuana Trafficking Conspiracy. June 28, 2017.

3: Wang GS, Hall K, Vigil D, Banerji S, Monte A, VanDyke M. Marijuana and acutehealth care contacts in Colorado. Prev Med. 2017 Nov;104:24-30. doi: 10.1016/j.ypmed.2017.03.022. Epub 2017 Mar 30. PubMed PMID: 28365373; PubMed Central PMCID: PMC5623152.

4: Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajaj L, Roosevelt G.Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015. JAMA Pediatr. 2016 Sep 6;170(9):e160971. doi: 10.1001/jamapediatrics.2016.0971. Epub 2016 Sep 6. PubMed PMID: 27454910.

5: All Things Considered.  Colorado Gov. On How Federal Marijuana Decision Could Affect State.  January 4, 2018.



Graphics Credit:

1.  Photo at the top is a commercial cannabis grower from Shutterstock per their standard licensing agreement.

2.  Figure 1 above is reproduced with permission from [JAMA Intern Med. 2017. 178(4):569-572. doi: 10.1001/jamainternmed.2017.8298. Copyright©(2017) American Medical Association. All rights reserved." from reference number 1. License number 4335700705440.