Question: Why would physicians support legalization of a potentially harmful drug?

Answer: Most adults who use cannabis occasionally are not harmed by it. Cannabis is unsafe for underage users and a small minority of adult users, but alcohol and tobacco pose a far greater threat to public health. America learned a lot from the failed experiment of Alcohol Prohibition in the 1920s. The societal problems created by it were so great that many Prohibition advocates changed their minds and supported its repeal. Physicians know that government regulation and public education have been instrumental in reducing tobacco use in America. Yet after 80+ years of cannabis prohibition, the drug is as popular as ever. In short, the war on cannabis has failed, and it is time for doctors to lead the nation through a moderate approach to legalization. Physicians don’t need to be pro-cannabis to oppose its prohibition.

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Question: Won’t kids have more access to cannabis if it were legalized?

Answer: That’s a very important question. For decades, 80-90% of American 18-year-olds have reported that they have access to cannabis if they want it, even when it was illegal in all fifty states. Prohibition clearly doesn’t keep cannabis away from kids. But where cannabis is legal for sale to adults, points of access for children and teens decrease. Smart regulation of cannabis ensures that the supply chain of cannabis is secure “from seed to sale.” In states where cannabis is now legal, it is only sold to adults who can document their age with government-issued identification. But in states where it remains illegal, cannabis dealers are perfectly willing to sell it to children and teens. And don’t forget that those dealers also push heroin, cocaine and other more dangerous drugs.

Today, regulation appears to be working. While adult use has increased in legalized states, underage cannabis use appears to remain unchanged overall and among younger adolescents the trend may actually be downward.

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Question: Doesn’t legalization send the wrong message to young people?

Answer: We don’t want children and teens to think that the legalization of cannabis for adults implies that it’s safe for them. But by making it illegal for everyone, we are most definitely sending the message that there is no difference in use by adults and children. By creating a legal distinction between use by adults and minors, and by investing cannabis tax revenues into sensible education of children and teens, we can make clear that what is a permissible activity for adults is neither safe nor legal for minors. And we know that funding of drug prevention education works—the rates of tobacco use among young people has been falling for many years, even though it remains legal for adults.

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Question: Why not just decriminalize rather than legalize cannabis?

Answer: While decriminalization of cannabis is a constructive step away from prohibition, it does not solve most of the problems that legalization would. Decriminalization does not permit the government to regulate the production, labeling, transport, or sale of cannabis. The supply chain of cannabis remains an underground economy, and the government loses millions or billions of revenue dollars that could be spent on drug prevention, education and treatment. With decriminalization, the continued illegality of the drug trade serves as a price support mechanism for cannabis, which only benefits drug dealers who can charge inflated prices without paying taxes on their income. You can read more about decriminalization here.

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Question: If cannabis prohibition made sense in the past, then what, if anything, has changed?

Answer: Nothing has changed. Cannabis prohibition began in the 1930s—over the objections of the American Medical Association—based on scare tactics and bad science that suggested that the drug was highly addictive, made users violent, and was fatal in overdose. We now know that none of those assertions are true. Cannabis is less addictive than alcohol and tobacco. It doesn’t make users violent, and there are no documented cases of fatal cannabis overdose. In short, cannabis should never have been illegal for consenting adults.

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Question: Why should we legalize cannabis when we already struggle with alcohol and tobacco?

Answer: Some would say that we shouldn’t make yet another recreational drug legal, but if the harm any drug causes is less than the harm we accept in other legal drugs and activities, then we, as a free society, have no right to prosecute consenting adults from engaging in that behavior. However, we do have a responsibility to regulate, tax, and educate the public about all potentially unhealthy activities. And we must do so with cannabis from the outset. Even experts who oppose cannabis legalization concede that it is less dangerous than other legal drugs. Some of those same opponents would make alcohol illegal if they could, despite the miserable failure that Alcohol Prohibition proved to be in the 1920s. By the time that social experiment was finally halted in 1933, even many of those who had initially worked to enact Prohibition supported its repeal.

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Question: How can ethical doctors endorse legalization when physicians are taught: “First, do no harm?”

Answer: Doctors should not promote behaviors that are hazardous to public health. It is for this reason that physicians often tell patients to avoid dangerous activities like boxing and to strictly limit or avoid the use of recreational substances like alcohol, tobacco and caffeine. But there is a big difference between condoning an unhealthy behavior and seeking to make it legal. When doctors see that the prohibition of an activity is hurting more people than it helps, and they have particular knowledge of the true level of risk of that activity, then those physicians have an ethical responsibility to speak out and help society correct its mistake. In short, you don’t have to be pro-cannabis to oppose its prohibition.