A CHOICE OF TWO EVILS

OPINION: California will vote next month on whether to legalise
marijuana. WAYNE HALL tries to predict what will happen if it does.

What will happen if Californians vote this November to legalise
marijuana use by any adult over the age of 21 years?

Let's ignore for now the vexed constitutional issues that will be
raised if a United States state enacts legislation that conflicts with
federal law. Let's focus instead on what may happen if the law changes
as the referendum proposes.

If we are to believe the referendum's supporters, all Californians
will be winners. The change will legitimise marijuana's de facto legal
status since passage of Proposition 215 in 1996.

It will thus reduce state expenditure on enforcing a widely violated
law; remove marijuana growing and selling from the black market;
enable any adult who wishes to use marijuana to do so; and introduce a
tax on legal marijuana sales that will fill state coffers with revenue
that formerly went to illegal growers (so long as there is no
large-scale tax evasion).

By contrast, opponents predict that the change will increase rates of
marijuana use, and thus magnify the harm arising from that use.

The adverse consequences of greatest concern include more
marijuana-related road traffic accidents and deaths; more psychoses
and other serious mental health problems among heavy users; and
heavier marijuana use by young people, negatively affecting their life
chances.

These effects, they argue, will more than offset any gains from tax
revenue and savings from law enforcement.

It is difficult to know who is right, because no other country has
adopted this policy.

The Netherlands, which is popularly believed to have legalised
cannabis use along these lines, has in fact tolerated only small-scale
retail sales of marijuana in a limited number of coffee shops in its
larger cities.

Marijuana cultivation remains illegal and coffee shop sales are
regulated - more strictly in recent years in response to complaints
from neighbouring countries about "drug tourism".

Nevertheless, some broad predictions can be made.

First, openly tolerating a market in a previously illegal commodity
will expand the number of users, especially if the retail price is
lower than the black-market price (as is proposed in the bill
currently before the California legislature).

Use may not increase immediately, but it will over time, because
marijuana will become more freely available, much cheaper (in order to
discourage the persistence of a black market), and its use will be
implicitly condoned.

Experience with alcohol suggests that marijuana will be available to
underage users (as it is now), whatever the minimum legal age.

Thus, legally available cheaper marijuana will probably mean more use
by more young people, and probably more daily use later into adulthood.

In general, the more people who use a drug, the larger the number of
problem users there will be (on the reasonable assumption that problem
users comprise a fixed proportion of all users).

If current estimates are correct, around 10 per cent of users (and one
in six who start in adolescence) may become dependent on marijuana -
that is, find it difficult to control or discontinue their use.

A minority of these problem users will seek professional help to
quit.

Dependent marijuana users are more likely to experience road and
workplace accidents (if they drive or work while intoxicated);
increased respiratory disease (if they smoke marijuana); exacerbations
of some serious mental disorders; and impaired school and work
performance.

It is uncertain how far these adverse effects can be mitigated by
preventive measures such as implementing roadside drug-testing
programmes, persuading users to use vapourisers rather than smoke
joints, discouraging young people from using marijuana, and
encouraging early treatment for problem users.

Experience with alcohol suggests that these approaches may modestly
reduce, but not eliminate, the harms associated with use, especially
if sellers are allowed to promote their wares.

Indeed, the scale of any increase in marijuana use will critically
depend on how tightly regulated marijuana sales are - how many
licensed growers there are, the number of sales outlets, their
locations and trading hours, eligibility requirements for use, content
of THC (marijuana's psychoactive ingredient), and how much promotion
and advertising is allowed.

If marijuana were allowed to be marketed much like alcohol is now, we
could expect more problem users than if it were regulated more like
pharmaceutical drugs (say, by requiring users to be licensed;
restricting the number of sales locations, hours of sale, and licensed
growers; and imposing high rates of taxation on higher- THC marijuana).

It will be a major policy challenge to get this balance right. Greater
restrictions would provide incentives for illegal operators to remain,
while less restrictive regulation would discourage black marketeers,
but at the price of increasing the number of users and problem users.

Marijuana policy involves a choice between the evils of current
repressive policies and the evils of increased use under a legal market.

Californians will have to decide how much weight to give to respect
for adult liberty, protection of minors, avoidance of a large-scale
black market, fiscal considerations, and protection of marijuana
users' health.

If they vote for legalisation, it will probably be 20 years or more
before anyone can say whether, on balance, they decided wisely.
Project Syndicate

- - Wayne Hall is a National Health and Medical Research Council
Australia Fellow at the University of Queensland Centre for Clinical
Research, Brisbane.