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While more states are legalizing marijuana for non-medical use, a “complex web of questions” persists, including potential impact on young people and limited available research on one of the most consequential health actions since the legalization of alcohol, according to the new APHA Press book Cannabis: Moving Forward, Protecting Health.
“Nearly 90 years later, America is again struggling with the legalization of a previously illicit substance,” writes co-editor Brian C. Castrucci, DrPH, president and CEO of the de Beaumont Foundation. “Much like the years following the end of alcohol prohibition, there are different opinions and beliefs about the wisdom of nonmedical cannabis use.
As of November 2020, only three states — Idaho, Nebraska and Kansas — fully prohibited public access to cannabis, according to the National Conference of State Legislatures. Last December, the U.S. House of Representatives approved a legalization bill, but the full Congress has not acted on it.
Because legalization will not wait for evidence, “protecting the public’s health and well-being may mean erring on the side of caution rather than on the need to catalog future harms,” the book’s authors say.
The book is an important source of information about evidence, issues, challenges and experiences with legalized cannabis, and lessons learned from America’s long history with alcohol and tobacco control, Castrucci said. It offers guidance to policymakers weighing health, social and economic implications of nonmedical cannabis legalization.
Taking a broad public health perspective as the debate intensifies about cannabis control, the book does not take a position on whether expanded medical use of marijuana should continue. Rather, the text seeks to provide guidance “for those who are and will continue to be in a position to struggle with the issue of cannabis control.”
The book also calls for a public health approach to the regulation of cannabis as a psychoactive and potentially addictive substance.
The obvious economic benefits to legalizing nonmedical use include increased tax revenues, more jobs and savings from a reduced number of arrests, trials and incarcerations. But the book states there are also concerns such as:
- the potential impacts of long-term, heavy use;
- the potential effects on children through exposure to passive marijuana smoke; and
- the dangers from unregulated growing, production and testing.
Citing available data, the book states that there is “general agreement that cannabis use is not healthy for young people. There is also a consensus that overconsumption of cannabis is unhealthy for users and those around them.”
In 2019, an estimated 48.2 million Americans age 12 or older had used cannabis in the past year, according to the National Survey on Drug Use and Health. About 3.5 million had used cannabis for the first time in the past 12 months.
In 1933, as the 21st Amendment to the U.S. Constitution was passed, repealing the 18th amendment and ending the prohibition of alcohol, authors Raymond B. Fosdick and Albert L. Scott published “Toward Liquor Control,” a blueprint for alcohol regulation commissioned by John D. Rockefeller.
“We can only hope that Cannabis: Moving Forward, Protecting Health will have even the most modest portion of the impact of Toward Liquor Control by contributing to the creation of effective, fair, and safe state-based regulatory systems,” Castrucci wrote.
The book’s other editors are:
- David H. Jernigan, PhD, a professor in the Department of Health Law, Policy and Management and assistant dean for practice at the Boston University School of Public Health, senior policy advisor to CityHealth, and advisor to the Maryland Collaborative to Reduce College Drinking and Related Problems;
- Rebecca L. Ramirez, MPH, a consultant on improving alcohol and cannabis-related policies and systems and former executive director of the National Liquor Law Enforcement Association;
- Catherine D. Patterson, MPP, co-director of CityHealth; and
- Grace Castillo, MPH, program associate at the de Beaumont Foundation.
Book information: Cannabis: Moving Forward, Protecting Health, ISBN: 978-0-87553-317-9, softcover, list price: $35 (APHA member price $24.50). To order, call toll-free 888-320-APHA or visit the APHA Bookstore. Requests for a review copy should be sent by email to David Hartogs.
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