CONTACT Colorado, put public health and safety first - Dr. Christian Thurstone

Because Colorado Gov. John Hickenlooper appointed me to serve on a task force charged with recommending to the state legislature how to implement a constitutional amendment making recreational marijuana use legal in this state, I have become more aware of potential harms to public health and safety Coloradans should know about.

In the interest of full disclosure, I have not hidden my thoughts about marijuana legalization. It is wrong not only for the health and wellbeing of Colorado, but for our nation — and I have every reason to believe many people will learn this the very hard way. I am working to help other states understand the myriad mistakes Colorado has made — and is on track to make — through my work on the board of a new national organization, called Smart Approaches to Marijuana (SAM). That group seeks, in part, to help Americans understand the dangers of marijuana use, and that they can reform marijuana laws sensibly without legalizing the drug — which drives more of our nation’s youth into addiction treatment than any other substance.

The disconnection between what science has told us about marijuana and what the burgeoning — but highly funded and organized — marijuana industry trumpets is painfully obvious in Colorado, where debates are far more focused on money than on matters of public health and safety. When members of the governor’s task force ranked eight primary “principles” on which our deliberations are to be focused, “Be responsive to consumer needs and issues” was placed second only to “Developing guidance for certain relationships, such as employer/employee …” Last on the list? “Promote the health, safety and wellbeing of Colorado youth.” What else ranked lower on the list than “consumer needs?” This principle: “Ensure our streets, schools and communities remain safe.”

The public needs more education and information — immediately

I remain unconvinced that many Coloradans who voted in favor of Amendment 64 fully understood what they were supporting. Though my evidence is anecdotal, it is significant. For example, last week, I participated in a professional meeting, where a Denver city official explained that an informal poll revealed Denverites want fewer marijuana shops, not more (residents will be very surprised by what Amendment 64 unleashes unless the Denver City Council steps in to ban retail shops and other pot-related “events” and entities as other Colorado cities have). Then there are dozens, maybe even hundreds, of Coloradans who have told me they had no idea the amendment would:

  • permit the “pot clubs” that already are springing up.
  • usher into Colorado the “pot tourism” much like the Dutch city of Amsterdam is now trying to rid itself. The marijuana industry in this state already is lobbying hard against a residency requirement that would limit the drug’s sale only to Coloradans. (Meet “dannycsn,” who is soliciting online donations to trek to Colorado for the upcoming Cannabis Cup, scheduled to be held in Denver April 20-21.)
  • allow for marijuana concentrates — which means there’s really no THC limit on the potency of marijuana and marijuana-infused foods and drinks, also called “edibles,” that could be sold in Colorado.
  • allows for a 1 oz. marijuana-possession limit that feasibly translates into hundreds — yes, hundreds — of THC-infused candies, cookies and other edibles. In other words, there really is no possession limit, either.

And that’s just for starters. I hope scientific polling of the state’s residents will begin in earnest because I strongly suspect many of them will say they wanted Coloradans age 21 and over to have the right to use marijuana in small amounts, in privacy (and in strictly private environments) and without fear of prosecution. I think many voters supporting Amendment 64 believed they were supporting far more stringent regulation that would clean up the mess they have come to know as “medical marijuana.” I think many voters thought the amendment would result in more rigorous analysis and inspection of the content of marijuana-infused foods and drinks.

Amendment 64 pretty much gives the state the opposite of all of those things.

Insisting on public health and safety first

As an addictions scientist and treatment provider, I am especially troubled that this cleverly worded amendment makes it very hard, if not impossible, for the public to control the THC content of marijuana and the potency of foods and drinks infused with it. Because Colorado already essentially has lost control of this aspect of marijuana legalization (the state legislature will not be able to change these allowances now carved into the Colorado constitution), it is vitally important for this state to devise a regulatory framework that protects public health and safety — and puts it far ahead of financial and political interests.

It is just as important for the federal government to act in the interests of the rest of the country because responsible drug policy is national policy, not policy decided for the nation by one or two states (and certainly not policy decided in the rushed manner and timeline Colorado is forced to honor — again because of Amendment 64’s clever wording ) . I join many other organizations, including the Colorado chapter of the American Academy of Pediatrics and the National Association of Drug Court Professionals, in calling on President Obama, Attorney General Eric Holder and other federal officials to enforce federal law, put an end to these slapdash state initiatives and engage the country in a reasonable and far more informed national discussion about marijuana use and the enforcement of marijuana-related laws.

Let’s put public health and safety first this time. Let’s put taxpayers’ interests ahead of private business owners’ interests. If our nation truly wants to launch another industry peddling another addictive substance for recreational use, we must not repeat the mistakes we have made with Big Tobacco and Big Alcohol — whose products are responsible for our nation’s No. 1 and No. 3 causes of preventable death, respectively.


The question of state control

Unfortunately, the regulatory frameworks presented to the governor’s task force so far don’t reflect much concern for Colorado’s health and safety, much less the nation’s. One regulatory framework — loosely referred to as the “open model” — is essentially a free-for-all that could, feasibly, allow marijuana to be sold in convenience stores and encourage tobacco behemoths champing at the bit to dive into the marijuana business to set up shop in the Rocky Mountain state.

Because the governor’s task force on marijuana regulation has been asked to consider one of the loosest regulatory frameworks imaginable, I decided to try to identify a far more conservative framework — which has led me to question a model that is either partly or fully controlled by the State of Colorado.

Yes, state control — a model that has scientific merit, at least where alcohol regulation is concerned (marijuana-legalization advocates insist “regulation works,” and they say weed needs to be regulated like alcohol, right?). After researchers at the Centers for Disease Control examined 37 state-run models in the United States and other countries, they concluded in a peer-reviewed paper published in 2012 in the American Journal of Prevention Medicine (See: Hahn_2012_American_Journal_Prevention):

“The maintenance of government control of off-premises sale of alcoholic beverages is one of many effective strategies to prevent or reduce excessive consumption, which is one of the leading causes of preventable death and disability.”

The researchers further noted that “there was strong evidence that retail privatization of alcohol sales leads to increases in excessive alcohol consumption.” (Side note: We’ve certainly seen how the privatization of “medical” marijuana in Colorado has failed to serve the public’s interests. That supposedly well-regulated market is a joke — and has resulted in trafficking in 23 states and counting, according to the Rocky Mountain High Intensity Drug Trafficking Area.)

In other words, as destructive as marijuana use is, directly involving the state in marijuana production and/or sale might reduce some harms to public health and safety. If people want to live with marijuana legalization, they also should consider a regulatory framework that stands to serve in the state’s financial interests and protect the greatest number of people. They should demand that their elected officials give it serious consideration, too.
At this point, I am not calling for a state-run model. I only am calling for more research and thoughtful analysis of a state-controlled framework — which could assume many forms. 

Among my considerations of this model:

1. When it comes to the legalization of addictive drugs for recreational use, the government should put the interests of public health and safety far ahead of the interests of industry and politics.

2. The marijuana industry is like tobacco and alcohol: it is working aggressively to privatize profits and socialize costs — and that is very unfair to taxpayers. A partial or fully state-run regulatory framework would certainly stand to cut out a lot of middle men and allow the State of Colorado to collect a much greater portion of the revenues that would come from marijuana sales. That’s certainly money the state is going to need to address a vast array of social problems marijuana use will cause (for every $1 our nation recoups in federal and state taxes on alcohol and tobacco, it spends $10 to address problems caused by their use — and there’s little reason to believe marijuana will be any different).
When Coloradans voted to support Amendment 64, many of them mistakenly believed (because they were repeatedly told by the Yes on 64 campaign) they were helping to raise $40 million to support schools and generate fantastic financial windfalls for the state. Certainly many of these same Coloradans would be interested to learn more about a regulatory framework that could help the state capture more money from marijuana.

3. A state-run model would reduce a lot of profit motives that the privatized marijuana market has aimed — and would continue  to aim — directly at young people. A state-run model would control — and could sharply limit — the commercialization that rightly worries so many Coloradans. It could also do what the current privatized medical-marijuana industry in Colorado does not: track the number of purchases made by one person to limit diversion of the substance to minors — and to people in other states.

4. A state-run model could ensure product content and quality — and THC limits. As things currently stand in Colorado, people have no idea what they’re really smoking (see how researchers at National Jewish in Denver recently explained this, and check out this story, too). In debates before the governor’s task force, marijuana producers even have argued that not all marijuana products need to be sold in childproof packaging — with some producers even complaining about the expense such packaging would incur. A state-run system could help ensure childproof packaging — and product labeling that is far less glamorous than what private industry pushes into the marketplace.

5. A state-run system would help keep multinational companies out of Colorado’s marijuana market.

6. State involvement could create efficiency and bring clarity that make law enforcement easier and more cost-effective.

7. The state is much more likely than private industry to respect the wishes of municipalities — and is far less likely to file suit against those towns that don’t want marijuana grows and retail. The state could place stores in the communities and/or counties that want them and honor the wishes of those that don’t. As we have already seen in recent weeks, marijuana advocates eager to open up shop have a hard time facing rejection — and threaten legal action against cities to get their way.

8. State control of marijuana sales would be consistent with our nation’s emergence from alcohol prohibition. Today,  18 states still have monopoly over the wholesaling and/or retailing of alcohol — and their regulatory effect on public health has led CDC researchers to conclude there is “strong evidence” we in Colorado would be wise to consider when determining how to proceed with marijuana legalization.

9. State control may continue to win the federal government’s blind eye. Then again, it might even force the federal government to engage directly in an increasingly important issue affecting national health and safety. “As we all know, Gov. Hickenlooper and (Colorado Attorney General) John Suthers have had conversations with (U.S. Attorney General Eric) Holder,” task force chairman Jack Finlaw said during the group’s Feb. 5 meeting. “I would say we are still not receiving any guidance from those folks (in the Department of Justice) … In the context of all these conversations, we … do have some tea leaves we can read.”

Those tea leaves amount to these, Mr. Finlaw said: Colorado would be smart to enact a seed-to-sale regulatory scheme that allows for tight tracking of the substance. Colorado should make sure that the marijuana it grows isn’t trafficked beyond its borders. Colorado should ensure its regulatory framework doesn’t result in a spike in access to the drug for people under age 21.

Colorado’s privatized medical marijuana industry already has failed miserably to meet these standards. A state-run system at least stands to be a far more responsible approach. If we’re going to do something unwise, let’s at least do it in a manner that could protect the health and safety of the most people — and the financial interests of taxpayers.

Let’s be honest. We need more research.

So far, some members of the governor’s task force have dismissed the idea of state control — and before a state-run model even has been defined and studied. This is unwise — especially if we care about public health and safety. Remember: every regulatory scheme presented for consideration is outside the bounds of federal law — so state control also deserves full and fair review, especially when science tells us it stands to be better for public health and safety than any of the other (also federally illegal) models Colorado legislators will be asked to debate and decide.

During its Feb. 14 meeting, the Regulatory Framework Working Group, a committee of the task force, crafted an explanation for its rejection of a state-run model — which came with little to no formal study of the idea. I invite you to read the full explanation, found on page 12. I remain unconvinced that the amendment’s language expressly prohibits the state from commercial activity — and I know some lawyers who have examined this matter are as well.

However, here is the passage that caught my eye because it brightly underscores the degree to which people are hard at work to create an industry that not only operates outside the bounds of federal law, but also operates in a manner that encourages the federal government to continue overlooking what is happening here.

“As an additional matter, we note that adopting a regulatory model which called for state-run retail stores would raise serious federalism concerns. Under such a model, the state would be actively violating federal law rather than mereley licensing others to do so. Such open defiance of the Controlled Substances Act might be seen by the federal government as an intolerable obstacle to the enforcement of federal law and could lead to a suit to enjoin such conduct. A state-run distrubition system is thus far more antagonistic to the federal government than one in which the state merely licenses private conduct and should be rejected for that reason as well.”

Even if something is politically inexpedient and inconvenient, I support doing the right thing.

Dr. Christian Thurstone’s wife,  journalist Christine Tatum, contributed to this paper. She believes the United States has far wiser, healthier, noble, more productive and more beneficial things to do than legalize weed and pay for the problems that result.  


About Chris Thurstone

Dr. Christian Thurstone is one of only a few dozen physicians in the United States who are board-certified in general, child and adolescent and addictions psychiatry. He is Director of Behavioral Health Services at Denver Health and a professor of psychiatry at the University of Colorado, where he conducts research on youth substance use and addiction and serves as director of medical training for the university’s addiction psychiatry fellowship program. You can read more about him here.

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