Recreational and medical marijuana are legal in 38 states. Several more states will likely vote on legalization in 2024. Political pressure to approve legalization is high, fueled by public polling and lobbying from cannabis growers, distributors, and users. Unfortunately, much of that lobbying message is based on distorted and false information, including the pipe dream that tax revenue will be a windfall for states. Here are some of the false arguments used to sway legislators opinion:
FALSE: Cannabis Is Not a Gateway Drug
Not all users of cannabis progress to a Substance Use Disorder (SUD), but many with a SUD began with cannabis. Cannabis increases the vulnerability for SUD, in part because it decreases dopamine reward centers in the brain, and THC enhances the effect of other drugs. The risk has swelled as THC content has increased since the 1960s from 5 percent THC in Woodstock weed to potency of up to 90 percent in some products. This “no risk” argument is reminiscent of the marketing of OxyContin. Claims that it was not addictive contributed to rampant overprescribing and hundreds of thousands of overdose deaths.
FALSE: Legalization of Marijuana Decreases Drug Overdose Deaths and Opioid Misuse
Some early studies reported an initial reduction in opioid use, leading to a plethora of billboard ads sponsored by cannabis companies. However, Stanford University research called these claims “spurious” and noted opioid use did not decrease. Another study found the use of non-medical opioids doubles on days when cannabis is used.
FALSE: Teen Use of Marijuana Decreased After It was Legalized
Abuse and misuse of marijuana has increased 245 percent from 2002 to 2022 and now impacts one in five youth. The percentage of youth who start using marijuana doubled between 2002 and 2020. Only 34 percent of teens (age 12-18) perceive risk of harm from marijuana. Teen use is associated with poor grades, truancy, and criminal behaviors. Some cannabis marketing is designed to appeal to children and teens, using young models, cartoon characters, and promotions — even though the drug is illegal.
FALSE: Cannabis Is a Safe and Effective Treatment for Nausea in Pregnant Women
An increasing number of women have begun using marijuana to fight nausea and other side effects during pregnancy, according to the New York Times. However, marijuana use during pregnancy is linked with an increased risk for low birth weight and reduced cognitive development in the child. Recommending its use during pregnancy recalls the days when smoking was targeted at women, and tobacco companies encouraged cigarettes to calm pregnant mothers’ nerves. Despite a clear risk to the developing fetus, almost 70 percent of Colorado cannabis stores recommended its use to mothers in their first trimester. An average of 20 percent of women from Colorado and California tested positive for marijuana at delivery. Such recommendations are tantamount to medical malpractice.
FALSE: Cannabis Is Good for Mental Health, Such as Reducing Depression and Anxiety
This claim is déjà vu for tobacco companies that dismissed the risk of cancer posed by smoking.
Depression increases among regular cannabis users and is a common side effect of Cannabis Use Disorder. Among teens, depression and suicide can quadruple. Psychosis risk is very high for use of just twice per week through ages 12-25 as the developing brain is very vulnerable. Cannabis advocates claim this risk only applies to those who were already predisposed to schizophrenia, but multiple studies note regular users are five times more likely to develop psychosis, 35 percent of those with cannabis-induced psychosis develop schizophrenia (a rate three times higher than for alcohol, and higher than methamphetamines). The age of onset is earlier, and cannabis use is associated with more severe symptoms, violence, and longer hospitalizations.
False: Marijuana Taxes Are Good for State Income
Cannabis adds significant expense to state and local governments in the form of auto accidents, emergency first responders, drug rehabilitation, remedial education, lost tax revenue from lower employment, medical care in the ER, long-term mental health care, increased health insurance, and more. Those with schizophrenia/psychosis have a much higher risk of unemployment, disability, incarceration, and chronic disease. A study by the Schizophrenia and Psychosis Action Alliance reported schizophrenia alone costs over $450 billion per year in the U.S. for over 2 million cases. Increasing the number of cases in the USA by only 1 percent costs an additional $4.5 billion. States hope decriminalizing marijuana will reduce incarceration costs, however, the expenses listed above are for those who are not incarcerated. Those costs are growing significantly. Total state tax revenue from marijuana is currently only $3 billion with an anticipated rise to $8.5 billion if all states legalized marijuana. The ratio of revenue to cost is so unbalanced and it is highly misleading to portray marijuana as a cash cow for states. Currently, the federal government does not tax marijuana but pays heavily for its impact.
Driving under the influence of marijuana is dangerous and costly. Auto accidents following nationwide legalization in Canada rose 475 percent between 2010 and 2021, the seriousness of the accidents increased, and nearly 90 percent required ambulance transport, 50 percent required hospital admission, and 22 percent were admitted to an ICU (compared with only 2 percent to an ICU for those not under the influence of alcohol or marijuana). Emergency room visits associated with cannabis also grew 233 percent. U.S. accidents involving cannabis or cannabis with alcohol have doubled, while accidents for alcohol alone have not increased. The cost is borne by governments, hospitals, innocent victims, and the health insurance system.
When carefully analyzing the total expense of legalizing recreational and medical marijuana (the financial and the human toll), tax revenues fall far short of expenditures. While voter popularity may be the driving force behind legalization, elected officials should make sure the full cost is assumed by those who use, purchase, and sell cannabis products, and not pass it on to the rest of the population. Popularity should not sidestep responsibility.
Responsible legislative action regarding new and existing legalization should include:
- Following the tobacco use model, ban all cannabis advertising. At the very least, carefully scrutinize questionable health claims, and vigorously enforce prohibitions against marketing to youth.
- Require warning labels on all products and in stores to inform users of the full medical and psychiatric risks of cannabis use.
- Require a strong and continuous public health information campaign on the risks, with a particular emphasis on educating youth.
- The federal government and states should prioritize comprehensive unbiased research on the physical, psychiatric, and social impact of marijuana use.
- States should dedicate sufficient funds to treat schizophrenia, psychosis, and mental illness associated with cannabis use.
- States should conduct regular independent audits of all costs associated with marijuana use including treatment, learning problems, emergency services, criminal justice, and health care.
- States should review tax rates for cannabis that at least match the total cost impact of cannabis use.
Tim Murphy, Ph.D., is a psychologist specializing in trauma recovery. and the author of three books, including The Christ Cure: 10 Biblical Ways to Heal from Trauma, Tragedy and PTSD (2023). He served as a psychologist in the U.S. Navy Medical Service Corps, was elected eight times to the U.S. House of Representatives, and authored major mental health reform legislation receiving wide bipartisan support. His weekly podcasts on mental health are available at DrTimMurphy.com and LinkedIn.
