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Friday, June 28, 2013

CPDD Annual Meeting Public Policy Forum: Part II: Considerations for Regulating Marijuana to Achieve Public Objectives

The second part of the Public Policy Forum focused on marijuana regulation, now that it has been legalized in Colorado and Washington State and now that there are moves toward legalizing it in other jurisdictions, including at the federal level.

Drs. Beau Kilmer and Rosalie Pacula, Co-Directors of the Rand Drug Policy Research Center (Rand Corporation, Santa Monica, CA), outlined a number of considerations relevant to regulating marijuana sales that could help achieve public health objectives.  They also described the current regulatory climate in Colorado and Washington State.

Dr. Kilmer began his presentation by describing design considerations for regulating marijuana sales, including Production, Profit motive, Promotion, Prevention, Potency, Price, and Permanency, or as he referred to these issues, the "7 P's".  He indicated that Colorado and Washington State have focused primarily on taxation policy but have yet to study other relevant issues and how regulations could be instituted to promote public health objectives.

He noted that with legalization, marijuana Production (including delivery and sales) risks will be substantially reduced, and thus it is anticipated that the free market price of marijuana will decline.  This could both increase the numbers of users and increase heavy marijuana use.  If price controls are not instituted and Profits are allowed to be maximized, this also could stimulate marijuana sales and use.  In terms of Promotion, if for-profit companies are allowed to enter the market, countering their marketing activities could be difficult based on free speech issues, and increased marketing likely would result in increased use.  And, currently, there are no plans articulated for Prevention efforts, which again could contribute to increased initiation and chronic use.

Since the tetrahydrocannabinol (THC) content in street Mexican marijuana currently is on the order of 4-8%, much lower than THC levels in marijuana available in dispenseries (10-25%), if THC Potency is not regulated, users may be exposed to THC levels much higher than to which they are accustomed, which could result in unanticipated side effects or other health consequences.  Pricing considerations can have important effects on initiation, as studies suggest that each 10% decline in price results in a 3% increase in initiation.  The degree of Permanency of regulations also may be critical, as if initial policies are flawed and result in suboptimal public health outcomes, a failure to include escape or sunset clauses might make it very difficult to revise regulations down the road.  Dr. Kilmer asserted that all of the 7 P's should be included in any serious discussion of marijuana regulatory policy.

Dr. Pacula followed by again stating that many of these issues are not being discussed or considered by policymakers.  She indicated that if there is a desire to protect those who could be harmed by having increased access to marijuana, that it is important to have a good policy discussion.

She pointed out that we already have good models for alcohol and tobacco regulation that enable their legal use by adults while reducing harm, and these standard practices could be modified and applied to regulate marijuana.  The Rand Corporation convened a meeting in February 2013 both to identify helpful alcohol and tobacco control regulations and to develop consensus public health and other goals for marijuana regulation.

The consensus public health goals for marijuana that emerged from the meeting were to:
- prevent youth access and use
- prevent intoxicated driving
- regulate potency
- minimize use along with alcohol

Regulatory methods that could help attain those goals include setting prices high (to discourage consumption) but not so high as to foster a black market, as well as having either a governmental monopoly option that oversees sales and marketing activities or a strong licensing system that could regulate the types and densities of sales outlets to limit availability (reducing access) and limit competition (to preserve higher prices).

She also noted that as more jurisdictions legalize marijuana, that other public health issues may emerge including clean air concerns (tobacco smoking laws may not apply) and drugged driving concerns (as there is no rapid field test capable of measuring breath or blood THC levels and even if there were, there is no consensus on the threshold level for THC intoxication).

Dr. Pacula finished her presentation by reiterating that marijuana policy aims need to focus on a broader array of questions than taxation and must include public health objectives, and that now is the time to begin discussing these issues.

CPDDBLOG welcomes CPDD member's thoughts on these issues.

Coverage of Part I of the Public Policy Forum can be found here.

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