The authors bring a welcome degree of rigor to this helpful effort to analyze recent cannabis legalization efforts in California 1, especially considering the relative paucity of scientific data. Public support for making cannabis legal has shifted dramatically in the last two decades, particularly in the last few years. The gap in support, as measured by Gallup in regular polling, narrowed from 24 points (36 in favor; 60 opposed) in 2005 to a remarkable four points (46 versus 50) in 2010 2. The majority of liberals, 18–29-year-olds, voters in western states, Democrats, Independents, moderates and men now support legalizing cannabis. If this trend persists, which seems likely, a majority of Americans will soon support making cannabis legal. It is therefore incumbent upon public policy experts and public health advocates to think critically about optimal policies for regulating cannabis. Our organization advised the drafting of California Assemblyman Ammiano's far-reaching bills introduced in 2009 and 2011 to fully legalize cannabis (AB 390 and AB 2254), and we advocated for the passage of both proposals. Although AB 390 never came up for a floor vote, it was the first cannabis legalization bill to win a committee vote in a state legislature. Conversely, Proposition 19 nearly became law, winning 46.5% of the vote 3—and its approach to making cannabis legal merits greater scrutiny and clarification. This voter initiative represented a substantially narrower proposal than the Ammiano bill. Proposition 19 eliminated penalties for possession of up to one ounce by adults 21 and older, permitted cultivation by adults for personal use within a private 25-square-foot parcel and delegated all authority to cities and counties rather than mandating a state-wide system. Not widely recognized outside of California, this ‘local control’ provision would have ensured a slow and modest implementation of commercial cannabis sales. Most localities probably would not have permitted sales of recreational cannabis, at least at the outset. It is worth noting that 15 years since Californians legalized medical marijuana by passing Proposition 215, only 60 cities and counties have formally regulated cannabis dispensaries, while 276 have blocked their establishment or banned them outright 4. Even if Proposition 19 had won, commercial sales would have been far more limited than most people assumed. Ballot initiatives to legally regulate cannabis will probably appear on the Colorado 5 and Washington 6 ballots in 2012. Both are far more tightly drafted than the California proposals, reflecting public health concerns as well as the desire to reassure ambivalent voters who favor legalization in principle but are wary of how it will work in practice. The Washington initiative, for instance, does not allow for home cultivation of cannabis in any amount. While we agree with much of what the authors say regarding the potential risks of increased cannabis consumption, we question the authors' choice to disregard ‘subjective benefits derived from intoxication (pleasure)’ and other potential benefits. Millions of Americans use cannabis not just ‘for fun’ but because they find it useful for many of the same reasons that people drink alcohol or take pharmaceutical drugs. There is a growing body of evidence that moderate cannabis use not only poses minimal harms but provides substantial health benefits. These include anti-inflammatory, anti-anxiety and notably anti-cancer properties documented in many government-supported studies 7-9. The Lancet, Britain's leading medical journal, observed in 2003 that ‘we are only just beginning to appreciate the huge therapeutic potential of this family of compounds’10. Given the science that already exists, implicitly assuming that only harms are associated with increased consumption of cannabis does not seem right. Any model for legally regulating cannabis production and distribution must be compared not just with an ideal scenario but with the realities of contemporary cannabis prohibition. While the authors correctly identify tremendous uncertainties associated with alternatives to present-day prohibitions, they are insufficiently attentive to the probable consequences of persisting with the status quo—mass arrests for low-level possession, staggering race-based imbalances in cannabis law enforcement, out-of-control youth access, unregulated content and the crime, violence and corruption endemic to an underground economy of this size. The original criminalization of cannabis was grounded not in reasoned analysis but in racial prejudice and politics 11. We hope that the authors' fine analysis will inform current and future thinking regarding how best to regulate legal cannabis. It would be a shame, however, if the valid concerns they raise undermine momentum for reform by distracting attention from the very real and immediate failures and harms of current policies. Legalizing cannabis may be risky, but its benefits almost certainly outweigh its potential harms. Stephen Gutwillig is California director, Jag Davies is publications manager and Ethan Nadelmann is founder and executive director of the Drug Policy Alliance, a US organization promoting alternatives to the war on drugs.
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Jun 1, 2014
Bryce Pardo 
Open Access