A growing number of states, healthcare providers, and individuals are calling for the legalization of marijuana. Marijuana is currently classified as a Schedule I Controlled Substance. A Schedule I classification means that the substance is illegal with no currently accepted medical use and a high potential for abuse. This illegal status has consumed billions of dollars in criminal justice resources while also promoting an illegal drug market and hampering research efforts. However, the 1982 and 1999 Institute of Medicine research consensus reports conclude that marijuana does have medical benefits that can be used in treatment such as for chronic pain, antiemetic properties for chemotherapy-induced nausea and vomiting, reduction of high intraocular pressure in glaucoma, anticonvulsant properties in epilepsy, appetite stimulation in patients with advanced cancer, and more. The Health Effects of Cannabis and Cannabinoids is a 2017 landmark report from the National Academy of Sciences, Engineering, and Medicine currently cited by the Center for Disease Control; this report declares that there is conclusive evidence that marijuana can be used as medicine, and suggests that marijuana does not increase risk of cancers, unlike tob.

Background

Marijuana has a long-standing history in the United States. Early colonists of the 1600s first grew hemp to make rope, sails and clothing, and by the 19th century doctors were using extracts of marijuana for treatment of various ailments. Marijuana tinctures were even widely available over-the-counter at pharmacies. It was not until after the Mexican Revolution of 1910 and the subsequent influx of Mexican immigrants that recreational marijuana use was introduced into the United States. Jazz music of the 20s and 30s, and most notably musician Louis Armstrong, further popularized the use of recreational marijuana. Regulation of marijuana did not begin until the Great Depression heightened fear and resentment of Mexican communities. Harry Anslinger, the first commissioner of the Federal Bureau of Narcotics, began a crusade to associate marijuana with degrading stereotypes of Mexicans and other minorities. This culminated in the 1937 Marihuana Tax Act which imposed stringent regulations and prohibitive taxes that effectively outlawed marijuana. Though this was overruled in 1969, it was soon replaced by the 1970 Controlled Substance Act which once again outlawed marijuana and remains in effect to this day.

The illegal status of marijuana has had significant financial and social repercussions. $3.6 billion dollars a year is spent on enforcing marijuana laws, even though more than half of US adults have tried marijuana—a testament to the continued prevalence of marijuana in communities across the country despite aggressive law enforcement. Much of these efforts have not achieved their intended effect but rather have worsened existing problems and even created new ones. Marijuana prohibition laws have fostered an illicit market that benefits organized crime and violent drug cartels and gangs. Further, nearly 600,000 people are arrested per year for marijuana related offenses, with blacks being arrested at nearly four times the rate as whites despite nearly equal rates of use.

These issues that have resulted from marijuana prohibition have seen relief with legalization. A study done in 2017 found that when a U.S. state on the Mexican border legalized medical marijuana, violent crime fell on average 13%, with the greatest effect seen in the counties closest to the border. Further, a recent study by Gruzca et al.  demonstrated that marijuana decriminalization was associated with a 75% reduction for youth and adult arrests with no increase in prevalence of youth marijuana use. In addition, marijuana legalization can stimulate economic growth. Colorado saw an increase in 18,000 full time jobs since marijuana legalization, and Alaska collected more than $11 million in marijuana tax revenue, exceeding projections by $2 million.

By decreasing marijuana-related incarceration, §3040 can also impact healthcare access and cost. When analyzing data from 1980 to 2004—a period with some of the highest rates of incarceration for marijuana possession—DeFina and Hannon found that increasing incarceration rates significantly increased poverty. Poverty reduces access to healthcare by making healthcare cost-prohibitive due to inability to pay out-of-pocket medical costs and copays. Further, this bill can help reduce healthcare costs associated with violent crime. According to the American Hospital Association, violent crime cost U.S. hospitals and health systems $2.7 billion dollars in 2016. Additionally, a study analyzing all prescriptions filled by Medicare Part D enrollees from 2010 to 2013 found that after state marijuana legalization, use of marijuana as an appropriate clinical alternative significantly decreased prescription drug use, with “national overall reductions in Medicare program and enrollee spending...estimated to be $165.2 million per year in 2013”. These findings suggest that marijuana legalization may improve healthcare access and decrease healthcare costs.

There is continued controversy surrounding the legalization of marijuana, but according to a 2017 Gallup poll, 64% of the American public now favors legalization. As of March 30, 2018, thirty states and the District of Columbia have laws broadly legalizing marijuana. Of those states, eight states and the District of Columbia have laws legalizing marijuana for recreational use. According to Linley Sanders from Newsweek, 'at least 12 states are poised to consider marijuana legalization this year.' A poll conducted by Emerson College surveyed 600 registered voters and shows that 62 percent of New Yorkers support legalizing marijuana for adults 21 and older.

Political Supporters and Opponents

The Marijuana Policy Project has identified several States that have legalized, taxed, and regulated marijuana. Four figures supplied in Appendix compare New York Senate Bill §3040 and current marijuana legislation enacted by Colorado. The impact of marijuana legalization in Colorado is discussed below.

Currently, New York Senate Bill §3040 has several supporters. These include: Assemblyman Dick Gottfried, State Senator Liz Krueger, Gubernatorial candidate Cynthia Nixon, United States Senate Minority Chuck Schumer, Drug Policy Alliance of New York, Dr. Malik Burnett, and public advocate Leticia James. While majority of New York State  supporters of marijuana legalization are Democrats, several Republican also support marijuana legislation. Republican associations such as Republicans Against Marijuana Prohibition consider marijuana to be low risk of harm and have found that prior efforts to reduce access have failed and contributed to racially disparate arrests. They favor marijuana legalization to generate revenue through regulation and taxation similar to alcohol and criminal justice resources can be focused elsewhere. As of July of 2018, the New York State Department of Heal also support of legalizing marijuana stating that the benefits of legalizing marijuana outweigh the risk. Supporters predict that approximately $248.1 million can be generated through taxation of marijuana.

Supporters of the bill unanimously identified that a disparate amount of resources is spent in marijuana related arrests primarily affecting minority communities further contributing to disparate poverty among racial divides and preventing social mobility of American minorities. In addition, there have been many positive outcomes such as decreased in marijuana related arrests, associated judicial costs, and increased funding for research and addiction medicine programs that have possibly attracted political support to marijuana legislation. Regulations intend to carefully monitor the process of manufacture and distribution to ensure that the product is unadulterated prior to sale and consumption. In addition, specific violations are listed to prevent the unintended consequences seen in Colorado.

Opponents to the legalization of marijuana include: Conservative Party Chairman Mike Long, Former New York City Mayor Michael Bloomberg, and Sheriff Barry Virts. Opponents of §3040 tend to be Republican who are concerned about the lack of research for long term health effects and favor more limited reforms than legalization, such as not incarcerating non-violent marijuana users or only supporting legalization for medical use while excluding recreational use. Opponents are concerned about potential long term health consequences that remain unknown. There is also concern that marijuana can be a gateway drug to “harder” drugs. Senate Bill §3040 argues to regulate marijuana like alcohol, but alcohol has led to increased DUIs, health issues such as liver cirrhosis, and addiction programs. Li et al meta-analysis research indicates marijuana use by the driver is associated with a significant increased for motor vehicle accident. However, Aydelotte et al research concludes that “three years after recreational marijuana legalization, changes in motor vehicle crash fatality rates for Washington and Colorado were not statistically different from those in similar states without recreational marijuana legalization.” With increased access, there may be increased incidences of unintended ingestion by children. Additionally, there is growing concern over the unintended outcomes seen in states that have already legalized marijuana, such as how Colorado is experiencing an increased juvenile use, marijuana related school suspensions, increase marijuana related DUI, hospitalizations, and marijuana related fatalities that could lead legislators to oppose such legislation. With profit to be made in new marijuana-derived industries, there may be unintended hyper concentration of cannabis or dilution with toxic ingredients.

Further, the Affordable Care Act indirectly supports the aforementioned bills through declaration that there needs to be comparative research to study the effectiveness of various medical treatments. Under NYS compassion act medical marijuana is considered a medical treatment; however, since medical marijuana and recreational marijuana are federally classified as Schedule I drugs, funding cannot be allocated to support research of medical marijuana to evaluate the short or long term effects of recreational marijuana. Legalization of marijuana on the national level can remove this barrier to research.

The intended and unintended outcomes of passing §3040 would potentially mirror those seen in Colorado. Such outcomes would ideally be assessed according to state population density and resources. Increased revenue from an untapped market would create employment opportunities in cultivation, security, scientific study, mechanical, biological, and botanical engineering, and other marijuana related activities. Revenue generated through taxation could increase funds for addiction medicine programs whose budget in recent years have been cut. Law enforcement can thus shift their focus from low level marijuana offenses to large scale crime. Revenue loss through due process from marijuana related arrests will decrease allowing allocation of funds to marijuana education, addiction medicine, and research of marijuana for medical purposes. The identified untoward outcomes in Colorado, can be mitigated in New York with proper planning.

Legislators in Colorado have gathered data illustrating the impact of legalization of marijuana legalization, taxation, and regulation and should be able to work preemptively with this foreknowledge to develop an infrastructure that is able to placate these unintended outcomes. New York Senate Bill §3040 proposes that the NYS Liquor Authority is the oversight agency for the manufacture, sale, and regulation of marijuana; however, additional protocols and staff need to be organized and allocated specifically to safeguard against foreseen increases in burglary, juvenile utilization, increased cases of marijuana related DUI and potential for organized crime to gain illegal distribution practices within the State. A policy highlight from Colorado that should be adopted by NYS §3040 is the local role of the public in its ability to control commercialization within individual communities. Ethical considerations in legalizing marijuana that should be considered is the decrease in juvenile perception of untoward effects on health and lack of studies of long term effects of marijuana.

In order for §3040 to pass in New York State, it must survive Governor Andrew Cuomo’s ability to veto §3040. He has maintained a relatively conservative stance against marijuana legalization. In order to make a prudent decision, Governor Cuomo directed the NYSDOH to consult with other state agencies to determine the health, economic, and criminal justice impact, as well as consequences from marijuana legalization in NYS and surrounding states with existing marijuana legislation. In response, on July 2018, the NYSDOH released a 75-page executive summary, concluding that the benefits outweigh the risks. On August 2, 2018, Governor Cuomo 'announces his plan to legalize and regulate adult marijuana by establishing a working group of 20 experts in the fields of public health, safety and economic to draft a bill over the next five months, to be presented to the state legislature when it convenes in January. Whether this implies Governor Cuomo drafting a new bill or Krueger revising of the existing §3040 to reflect the NYSDOH’s recommendations, New York is inching closer to legalizing marijuana.

Recommendations

We support §3040 and the proposed legalization, regulation, and taxation of marijuana in accordance with the NYSDOH’s recommendations. There are many benefits to legalizing marijuana when combined with regulations and harm reduction strategies. The NYSDOH states that 'regulating marijuana reduces risks and improves quality and control consumer protections.' Having a regulated marijuana market will enable the government to have oversight of the production, testing, labeling, distribution, and sale of marijuana, which aims to reduce the risk of having unsafe contaminant entering the market. A regulated environment also provides consumers with assurance of quality, product choice, and education at the point of sale from a trained employee.

We recommend revision of §3040 of marijuana enforcement to raise the legal limit of marijuana consumption to 21 rather than under-18 purchasing ban so that it is in accordance with other states such as in Colorado and Massachusetts where the age limit is 21. We also recommend the creation of guidelines to ensure that marijuana products are not attractive to children to increase the likelihood of §3040 bill being passed.

We recommend decriminalization of marijuana and investment of taxation revenue into at-risk communities to increase health literacy, healthcare access, education, and workforce opportunities. Increased education on marijuana will also help address DUI related motor vehicle accidents even while the existing research on the impact of marijuana use on motor vehicle traffic crashes remain inconclusive. The NYSDOH states that it is essential that law enforcement enhances the State's successful anti-DUI efforts to include impaired driving and educate the public the potential risks of excessive use of marijuana. The NYSDOH advises that a 'regulated marijuana program should furnish education about the health benefits and risk of marijuana and provide guidelines to reduce the potential harms of marijuana use'.

One of the most significant benefits of marijuana regulation is generating tax revenue. We recommend regulatory committees so that these funds can be properly stewarded. According to the Colorado Department of Revenue, Colorado generated $2.4 million from marijuana taxation in 2017; the Marijuana Tax Cash fund was then appropriated to different sectors to improve Colorado program initiatives. Similar to Colorado, revenue generated from taxing marijuana in New York State can fund public health education, transportation, research, law enforcement, and more.

Legalizing marijuana for New Yorkers has benefits that outweigh risks. “The positive effects of a regulated marijuana market in NYS outweigh the potential negative impacts. Areas that may be a cause for concern can be mitigated with regulation and proper use of public education that is tailored to address key populations. Incorporating proper metrics and indicators will ensure rigorous and ongoing evaluation”. We firmly believe that §3040 should be passed with the aforementioned recommendations listed above and that congressmen should vote affirmatively on this bill.

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