In support of S.B. 16
Dear Chairman Winfield, Chairman Stafstrom, and members of the Judiciary Committee:
I recently retired after 23 years as the Distinguished Professor of Alcohol and Drug Abuse Research at the University of Texas Southwestern Medical Center and over 30 years as an addiction psychiatrist in the Department of Veterans Affairs, having served as the director of substance abuse programs at both the Charleston, South Carolina and Dallas VA Medical Centers. I have published and spoken widely on the biological effects and treatment of addictive disorders, with over 160 peer-reviewed publications and chapters (1) and I am the Editor-in- Chief of The American Journal of Drug and Alcohol Abuse. My research has been funded by the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Department of Veterans Affairs and I am a Distinguished Fellow in the American Academy of Addiction Psychiatry.
Through my extensive clinical work and research with individuals with substance use disorders I have come to believe that cannabis prohibition has done far more harm than good, and that it should be replaced with thoughtful, science-based regulation for adults 21 and older. Laws against cannabis possession used to be far harsher. These laws did not stop cannabis use back then and they do not stop it now. I have never had a cannabis user tell me that the penalty for cannabis possession influenced their decision as to whether to use it or not. What influences cannabis use or addiction is its cost, the perception of harm, and availability, as well as a user’s genetic make-up, personality, environment and co-occurring medical and psychiatric problems. The penalty for use plays little role in this decision. Yet these penalties [including $2000 fine and 1 year incarceration for ½ ounce or more in Connecticut (2)] can cause lifelong problems in employment, housing, receiving student loans, and child custody (3).
As the California Medical Association (CMA) explained in its 2011 white paper endorsing cannabis regulation (4):
“Thus far, the criminalization of cannabis has proven to be a failed public health policy for several reasons, including:
a) The diversion of limited economic resources to penal system costs and away from other more socially desirable uses such as funding health care, education, transportation, etc.;
b) The social destruction of family units when cannabis users are incarcerated, rather than offered treatment and other social assistance;
c) The disparate impacts that drug law enforcement practices have on communities of color;
d) The continued demand for cannabis nationally, which supports violent drug cartels from Mexico and other international sources;
e) The failure to decrease national and international supplies of cannabis from criminal and unregulated sources;
f) The failure of the federal government’s limited actions through the ‘War on Drugs’ in mitigating substance abuse and addiction.”
Voters in California agreed with the CMA, and California is now one of nine states — including Massachusetts — where voters have chosen to regulate cannabis (In two other states – Vermont and Illinois – adult use cannabis has been legalized thru the legislative process). In Connecticut, there is no citizen’s initiative process, so state cannabis policy is in your hands. I urge you to support and advance S.B. 16, so that Connecticut can replace eight decades of prohibition with regulation.
Marijuana Is A Relatively Safe Drug
From a pharmacologic perspective, botanical cannabis is a relatively safe drug. In the U.S., tobacco kills almost 500,000 people last year (5) and alcohol almost 90,000 (6). The opioid epidemic was responsible for over 47,000 overdose deaths in 2017 (7). In Connecticut alone, there was a record high 1200 (primarily opioid-related) overdose deaths, a 20% increase over the previous year (8). In contrast, to my knowledge, even though medical cannabis was legalized in the first state 23 years ago and the full plant is now legal (for medical purposes) in 33 states, nobody has ever died from a cannabis overdose. A review of over 60 studies reported, “Research suggests that people may be using cannabis as an exit drug to reduce use of substances that are potentially more harmful, such as opioid pain medication” (9). It is also important to note that cannabis is already widely consumed in Connecticut (11); 12.4% of Connecticut residents over 18 used marijuana in the past month.
Rates of Cannabis Use in Adolescence Do Not Increase with Legalization
Some were concerned that the cannabis legalization would lead to an increase in use in adolescents. If anything, the opposite is true. Use by people ages 12-17 years old has remained relatively stable in the Monitoring the Future (MTF), Youth Risk Behavior Surveillance System (YRBSS), and National Survey on Drug Use and Health (NSDUH) surveys since the late 1990s throughout the liberalization of cannabis laws in the U.S. A large number of studies have now consistently shown that medical and adult use cannabis legalization is associated with no difference in adolescent use compared to non-legal states (12, 13). Several studies have even shown a decrease in adolescent use in association with legalization and/or decriminalization (14-16). These findings have been affirmed using state-specific data in Washington State (17) and in Colorado (18) following the legalization of adult use cannabis. This robust literature indicates that the outcomes predicted by legalization proponents—that cannabis regulation would make it more difficult for minors to obtain cannabis—has been successful.
These findings may be due, in part, due to the strict observation of age restrictions by cannabis dispensaries. One study of dispensaries in Colorado and Washington found 100% compliance with laws requiring checking identification cards (IDs) (19). A “sting operation” run by the Oregon Liquor Control Commission also showed 100% compliance with these regulations; all of the minors who attempted to buy cannabis products in their state were refused entry (20).
Concerns about the effects of cannabis upon the adolescent brain, particularly in younger adolescents, is understandable. While not as dangerous to the adolescent as alcohol and nor as detrimental as some posit, the use of cannabis in adolescents should be protected against. I believe the optimal approach to protect adolescents from cannabis is to limit their access through regulatory mechanisms. S.B. 16 wisely requires regulators to establish standards to ensure cannabis retailers verify the age and identity of consumers to prevent underage sales. S.B. 16 also requires warnings to accompany cannabis, such as those detailing any “adverse effects unique to younger adults, including those related to the developing mind.” In addition, prior to cannabis licensing, relevant state agencies — including those focused on health, addiction, and education — will make recommendations to the relevant General Assembly committees “regarding efforts to promote public health, mitigate the misuse of cannabis and the effective treatment of addiction to cannabis with a particular focus on individuals under twenty-one years of age.
Cannabis Impaired Driving
To date, a number of studies have reported that states with legal cannabis demonstrate an increase, no change, or a decrease in motor vehicle accidents and fatalities compared to states where cannabis remains prohibited. Thus, the effects of cannabis legalization upon traffic accidents remains uncertain. Regardless, driving while intoxicated from the effects of any substance (including prescription drugs) is potentially dangerous. S.B. 16 wisely protects public safety by increasing the number of trained drug recognition experts in state and local police forces, updating traffic safety laws including banning cannabis consumption in vehicles, reforming the administrative process that follows an impaired driving arrest, and freeing the state’s police, prosecutors, and other public safety officials to focus on more significant crimes.
Thank you for your attention to this important issue. I hope that you will join me in concluding that regulating cannabis for adults’ use — not relegating it to the illicit market — is the best approach to protecting public health while removing the damage caused by cannabis prohibition.
Bryon Adinoff, M.D.
Executive Vice President, Doctors for Cannabis Regulation
- Bryon Adinoff publications.
- Connecticut General States, § 21a-279(a)(1); Conn. Gen. Stat. § 53a-36, 53a-42.
- Adinoff B, Reiman A. Implementing social justice in the transition from illicit to legal cannabis. Am J Drug Alcohol Abuse 2019, 1-16.
- California Medical Association. Cannabis and the Regulatory Void, 2011. https://dfcr.org/wp-content/uploads/2020/01/CA-Medical-Assn_Cannabis_and-the-Regulatory-Void_White_Paper.pdf (accessed Feb 28, 2020).
- Center for Disease Control and Prevention. Smoking and Tobacco Use: Health Effects of Cigarette Smoking. 2020. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#smoking-death (accessed Feb 29, 2020.
- Center for Disease Control and Prevention. Excessive Alcohol Use. 2020. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/alcohol.htm (accessed Feb 29 2020).
- Center for Disease Control and Prevention. Opioid Overdose: Drug Overdose Deaths. 2020. https://www.cdc.gov/drugoverdose/data/statedeaths.html (accessed Feb 29 2020).
- Altimari D. Drug overdose deaths increased by nearly 20% in Connecticut in 2019, reaching a record-high 1,200. 2020. https://www.courant.com/news/connecticut/hc-news-drug-deaths-increase-20200214-gqxzdint6rbqxcyroi2n4a735y-story.html.
- Walsh Z, Gonzalez R, Crosby K, M ST, Carroll C, Bonn-Miller MO. Medical cannabis and mental health: A guided systematic review. Clin Psychol Rev 2017; 51, 15-29.
- Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med 2014; 174 (10), 1668-1673.
- National Survey on Drug Use and Health, Connecticut (Table 24), 2014. https://www.samhsa.gov/data/report/connecticut-ct.
- Smart R, Pacula R. Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. American Journal of Drug and Alcohol Abuse 2019; 45 (6), ??
- Wall MM, Mauro C, Hasin DS, Keyes KM, Cerda M, Martins SS, Feng T. Prevalence of marijuana use does not differentially increase among youth after states pass medical marijuana laws: Commentary on and reanalysis of US National Survey on Drug Use in Households data 2002-2011. Int J Drug Policy 2016; 29, 9-13.
- Anderson DM, Hansen B, Rees DI, Sabia JJ. Association of Marijuana Laws With Teen Marijuana Use: New Estimates From the Youth Risk Behavior Surveys. JAMA Pediatrics 2019; 173 (9), 879-881.
- Coley RL, Hawkins SS, Ghiani M, Kruzik C, Baum CF. A quasi-experimental evaluation of marijuana policies and youth marijuana use. Am J Drug Alcohol Abuse 2019; 45 (3), 292-303.
- Hasin DS, Shmulewitz D, Sarvet AL. Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings. Am J Drug Alcohol Abuse 2019, 1-21.
- Midgette G, Reuter P. Has Cannabis Use Among Youth Increased After Changes in Its Legal Status? A Commentary on Use of Monitoring the Future for Analyses of Changes in State Cannabis Laws. Prev Sci 2020; 21 (1), 137-145.
- Brooks-Russell A, Ma M, Levinson AH, Kattari L, Kirchner T, Anderson Goodell EM, Johnson RM. Adolescent Marijuana Use, Marijuana-Related Perceptions, and Use of Other Substances Before and After Initiation of Retail Marijuana Sales in Colorado (2013-2015). Prev Sci 2019; 20 (2), 185-193.
- Buller DB, Woodall WG, Saltz R, Buller MK. Compliance With Personal ID Regulations by Recreational Marijuana Stores in Two U.S. States. Journal of Studies on Alcohol and Drugs 2019; 80 (6), 679-686.
- Angell T. Oregon Marijuana Stores Score 100% In Youth Sales Sting Operation. 2017. https://www.marijuanamoment.net/oregon-marijuana-stores-score-100-youth-sales-sting-operation/ (accessed 1/26/2020 2020).
Testimony before the Connecticut Judiciary Committee in support of S.B 16
David L. Nathan, MD, DFAPA March 3, 2020
I am writing today on behalf of Doctors for Cannabis Regulation (DFCR) in support of S.B. 16, which establishes cannabis regulation in Connecticut as an alternative to the failed policy of prohibition.
DFCR is the nation’s premier physicians’ association dedicated to the legalization, taxation and – above all – the effective regulation of cannabis for adults. DFCR has hundreds of respected physician members in nearly every US state and territory. DFCR physicians include integrative medicine pioneer Andrew Weil, former Surgeon General Joycelyn Elders, renowned public health physician and Johns Hopkins professor Chris Beyrer, and retired clinical director of SAMHSA, H. Westley Clark.
A bit about myself. I am originally from Philadelphia, graduated magna cum laude from Princeton University, received my medical degree from the University of Pennsylvania School of Medicine, and completed my residency at McLean Hospital of Harvard Medical School. I am a board-certified private-practice psychiatrist based in Princeton, New Jersey, a Clinical Associate Professor at Rutgers Robert Wood Johnson Medical School, and a Distinguished Fellow of the American Psychiatric Association.
In 1937, the American Medical Association sent Dr. William Woodward to the House of Representatives to testify against the proposed prohibition of cannabis.1 Refuting hyperbolic tabloid claims, he testified that cannabis is not highly addictive, does not cause violence in users, and does not cause fatal overdoses. He reasoned that cannabis should, therefore, be regulated rather than prohibited. Scientific evidence now confirms that Dr. Woodward was correct.2,3,4
As physicians, we believe that cannabis should never have been made illegal for consenting adults. It is less harmful to adults than alcohol and tobacco, and the prohibition has done far more damage to our society than the adult use of cannabis itself. However, cannabis is not harmless. People who are predisposed to psychotic disorders should avoid any cannabis use, as should pregnant or breastfeeding women and many people living with addiction.
Also, as with alcohol and other drugs, heavy cannabis use may adversely affect brain development in minors.5 But cannabis prohibition for adults doesn’t prevent underage use nor limit its availability. The government’s own statistics show that 80-90% of eighteen-year-olds have consistently reported easy access to the drug since the 1970s.6 For decades, preventive education has reduced the rates of alcohol and tobacco use by minors,7 At the same time, underage cannabis use rose steadily despite its prohibition. In the past several years – as more states legalize cannabis for adults – the rate of underage cannabis use has stopped increasing.
Some have argued that if cannabis is legal for adults, then minors will think it’s safe for them. But when cannabis is against the law for everyone, the government sends the message that cannabis is dangerous for everyone. Teenagers know that’s not true. By creating a legal distinction between cannabis use by adults and minors, we teach our children a respect for scientific evidence – and the sanctity of the law. This may be why teen use has remained level or decreased in legalized states.8,9
Cannabis use can impair driving, as can most psychoactive drugs – including antidepressants, antipsychotics, sedatives, opioids, and even stimulants – especially among inexperienced users. But driving under the influence of cannabis and other drugs is already a criminal offense in every jurisdiction, including in legalized states. Numerous scientific studies exist showing only a weak correlation between marijuana-positive drivers and accident risk.10 And in legalized states, studies show no adverse impact on traffic safety resulting from legalization.11,12
While a number of entities are trying to develop a blood, saliva, or breath test to assess impairment from cannabis intoxication, such a test is not presently available. The best method for assessing impaired driving is the use of specially trained police officers called Drug Recognition Experts (or DREs), and we support nationwide training of DREs in all jurisdictions.
There is a persistent misconception that cannabis is a “gateway” drug. While users of hard drugs often try cannabis first, they’re even more likely to try alcohol and tobacco. People generally try less dangerous drugs before trying more dangerous drugs, but the vast majority of those who try cannabis, alcohol and tobacco never go on to use harder drugs. The risk of drug misuse and addiction is now known to be largely due to pre-existing genetic and environmental risk factors, not the use of cannabis, alcohol, or other so-called “soft” drugs. As we learned in high school, correlation does not imply causation.
Quite sensibly, S.B. 16 requires robust public health regulations, including warning labels or inserts to advise of risks related to driving, cannabis use disorder, the developing mind, psychiatric disorders, and pregnancy and breastfeeding. Consumers purchasing cannabis on the illicit market are not given these health warnings.
Legalization opponents often say: “This isn’t your parents’ cannabis.” Over time, cannabis cultivation has, indeed, led to the development of more potent strains.13 In states where cannabis is legal, labeling enables adult users to make informed decisions about their intake based on potency. Where cannabis is merely decriminalized, the government cannot regulate the production, testing or labeling of products, which means that users consume an untested and potentially adulterated product of unknown potency.
In 2020, even those who oppose legalization generally believe that cannabis should be decriminalized. But as Connecticut has learned after years of decriminalization, this half- measure is an inadequate substitute for legalization. In legalized states, government licensed retailers scrupulously check IDs and only sell cannabis products to adults. But where cannabis is merely decriminalized, the point-of-sale remains in the hands of drug dealers who sell cannabis – along with more dangerous drugs – to children.
The only alternative for Connecticut consumers seeking regulated cannabis is the short drive across the border into Massachusetts, where regulated products are freely available. I don’t regard that as a fiscally or legally viable alternative to a regulated cannabis industry in Connecticut, and I think you’ll agree.
Informed physicians may disagree about the specifics of good regulation, but we can no longer support a prohibition that has done so much damage to public health and personal liberty.
Ladies and gentlemen, please understand that you aren’t deciding between “Big Cannabis” or “A Drug-Free America.” Your choice is whether to regulate or not to regulate a non-lethal substance that is already widely used throughout Connecticut.
I hope you will make the logical decision, and I encourage you to support passage of S.B. 16.
Thank you for your time and attention.
David L. Nathan, MD, DFAPA
Board President, Doctors for Cannabis Regulation
1 See Appendix B: “The Prescience of William C. Woodward.” Doctors for Cannabis Regulation, 2015. https://dfcr.org/the-prescience-of-william-c-woodward/
2 Joy, Janet E., et al. Marijuana and Medicine: Assessing the Science Base. Washington, DC: National Academy Press, 1999. http://medicalmarijuana.procon.org/sourcefiles/IOM_Report.pdf
3 “Learn About Marijuana: Marijuana and Aggression,” Alcohol and Drug Abuse Institute, University of Washington, 3/2015. http://learnaboutmarijuanawa.org/factsheets/aggression.htm
4 Collen, Mark. “Prescribing cannabis for harm reduction.” Harm Reduct J. 2012; 9:1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/
5 Schweinsburg, et al. “The Influence of Marijuana Use on Neurocognitive Functioning in Adolescents.” Curr Drug Abuse Rev.
2008 Jan; 1(1): 99–111. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825218/
6 Johnston, Lloyd. Monitoring the Future: National Survey Results on Drug Use, 1975-2008: Volume II: College Students and Adults Ages 19-50. Bethesda, MD: National Institute on Drug Abuse, 2009. http://monitoringthefuture.org/pubs/monographs/vol2_2008.pdf
7 U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. http://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/index.htm
8 Hasin et al. 2015. “Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys.” Lancet Psychiatry 2: 601-608. http://www.ncbi.nlm.nih.gov/pubmed/26303557
9 Colorado Department of Public Safety. Impacts of marijuana legalization to Colorado. 2018. https://www.colorado.gov/pacific/publicsafety/news/colorado-division-criminal-justice-publishes-report-impacts-marijuana-legalization-colorado
10 U.S. Department of Transportation, National Highway Traffic Safety Administration. Drug and Alcohol Crash Risk. February 2015. https://www.nhtsa.gov/behavioral-research/drug-and-alcohol-crash-risk-study
11 Aydelotte et al., 2017. “Crash fatality rates after recreational marijuana legalization in Washington and Colorado.” American Journal of Public Health 107: 1329-1331: https://www.ncbi.nlm.nih.gov/pubmed/28640679
12 Hansen, Benjamin, et al. “Early Evidence on Recreational Marijuana Legalization and Traffic Fatalities.” National Bureau of Economic Research. Working Paper No. 24417, March 2018. https://www.nber.org/papers/w24417
13 Mehmedic, Z. et al. “Potency trends of Δ9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008.” J. Forensic Sci 2010 Sep; 55(5):1209-1217. http://www.ncbi.nlm.nih.gov/pubmed/20487147.