The Legalization of Marijuana in Colorado: A Prescription for Trouble?

Abstract

Despite many decades of warnings about the safety and effectiveness of marijuana for medical treatment, public policy in recent years has moved steadily towards loosening restrictions on its use. In 2000, a ballot initiative to change Colorado's constitution was passed by 54% of voters in the general election, thereby legalizing marijuana for specific disabling conditions. After the Obama administration indicated in 2009 that medical marijuana prosecution would have a low priority and arrests would not be sought, provided medical marijuana users and providers conformed strictly to state laws, the issuance of cards for the medical use of marijuana in the state increased dramatically. By 2013, the state had changed its laws to allow not just medicinal use of marijuana, but recreational use as well. Since that decision, a variety of public health and safety trends and statistics have been published, raising questions about the long-term impacts of marijuana use in the state on health care, medical regulation and public safety. Medical regulators and policy makers in other states should review data from Colorado as they assess their own states' approaches to marijuana, including carefully balancing physicians' responsibilities to their patients with the need for wise public health and safety decision-making. Three factors are particularly important as regulators develop policy: 1) the impact of liberalized marijuana laws on public health and safety; 2) limitations in the scope and availability of evidence-based research on the efficacy of marijuana; and 3) the wide gulf between federal and state laws and procedures regarding marijuana use. By being cognizant of trends and developments in all three areas, regulators can make better decisions regarding their own policies. In today's rapidly changing marijuana policy environment, medical regulators should encourage their licensees to follow practical steps aimed at ensuring that when medical marijuana prescribing does occur, it is based on established standards of care and adherence to the basic tenets of the patient-physician relationship.