California Blue Ribbon Commission on Marijuana Policy report released: Mostly good advice on how to proceed

On July 21, 2015 Lt. Governor Gavin Newsom’s Blue Ribbon Commission on Marijuana Policy released its report “Pathways Report: Policy Options for Regulating Marijuana in California,” which provides broad policy recommendations on legalizing marijuana in California. The report recognizes the potential problems of a wealthy profit-motivated marijuana industry and the potential damage to public health.
 
Overall, this report is thoughtful and contained several strong recommendations on local control, public usage, health messaging, research priorities, and marketing/advertising restrictions supportive of tobacco control. 
 
It recognizes that big money and corporatization of marijuana poses serious problems for public health.  This is probably the most important conclusion in the report.
 
 “Develop a highly regulated market with enforcement and oversight capacity from the beginning, not an unregulated free market; this industry should not be California’s next Gold Rush.”  (P. 23)
 
“Consider options that limit the size and power—both economic and political—of entities in the marijuana industry, through limits on the number and types of licenses that are issued to the same entity or owners, limits on the size of any one license, encouragement of non-commercial options and incentives for smaller players. The goal should be to prevent the growth of a large, corporate marijuana industry dominated by a small number of players, as we see with Big Tobacco or the alcohol industry.” (P. 23)
 
While I completely agree with these sympathies, I am skeptical that the policies in the report will keep big money and corporatization out of marijuana in the long run.  (The best option would be for the state to control legal sales through state stores (that would not actively promote marijuana).  As the report notes, however, "Given the federal prohibition against marijuana, a state monopoly, whatever its virtues and drawbacks, would require many of its employees to systematically commit—and document that they had committed—federal felonies." (P. 28))
 
This fact makes it even more important that there be a strong public education campaign and other public policies that denormalize marijuana use just as we have denomalized tobacco use.  The goal of legalization should be to end the incarceration crisis that the War on Drugs has created while not creating a new public health crisis.
 
Here are some other highlights (emphasis is mine):
 
Local Control: “The experience of tobacco and alcohol regulation points to the need to authorize local government to enact measures responsive to community public health, safety and economic development concerns. In these industries, state preemption of local laws was often used to maintain low levels of regulation and enforcement, by preventing local government from enacting stronger regulations. The ability of local government to adopt innovative policies to control over-consumption through retail licensing laws is important in any marijuana regulatory regime. Many industries exercise more power at the state legislative and regulatory level than they can in local government.” (P. 48)
 
Smokefree Laws: “Exposure to smoke from marijuana is harmful to health just as exposure to tobacco smoke is.” (P. 44)
 
“Comply with public smoking, smoke-free, and public consumption laws.” (P. 101)
 
Market Structure to Limit Corporate Takeover: “It is appropriate and probably wise for the state of California to adopt a path that limits the size and power—both economic and political—of any one entity in the marijuana industry. The experience of tobacco and alcohol control shows that large corporations with resources for political influence (legislative lobbying, campaign contributions, regulatory interference) and marketing muscle will promote widespread and heavy use to increase sales and profits. Legislative behavior in this context is often incongruent with public health goals.” (P. 48)
 
Dedicated Funds: “…a drawback to leaving the revenue in the general fund is that the specific areas needing funding in order to implement and regulate marijuana legalization may not receive adequate investment.” (P. 78)
 
Public Education Campaign: Experience from tobacco control also shows that a complementary strategy to reach youth is broad based education of the public as a whole, through which youth hear public health messages that are also aimed at adults. (P. 68)
 
“…public education campaign that is aimed at the general population, which can also reach youth effectively. If the experience of tobacco control applies, limiting media campaigns to youth may have counterproductive effects.” (P. 80)
 
“Topics for a public education campaign can include: risks of smoking and secondhand smoke (including to youth/children health), the health risks associated with marijuana use (including heavy use) and dual use with other substances…” (P. 80)
 
This is all good and could form the framework for effective public education.  At the same time, I am concerned that the specifics of the education programs reflect a strong bias toward “informed decision making” for youth (P. 38, 79), a strategy that the tobacco companies have co-opted to promote ineffective programs that actually promote tobacco use.  The themes of "responsible use (P. 5, 12, 44, 46) and "avoiding excessive use"  (P.72) also echo ineffective messages used by the alcohol industry to promote alcohol use and avoid regulation.  A broader based denormalization campaign based on the California Tobacco Control Program would be better for public health.
 
Licensing:  “Licensing fees should be set at reasonable levels to cover the cost of regulation, certification and oversight by state and local government. They should not be so onerous as to limit smaller actors from participating in the industry.”  (P. 23)
 
This recommendation is potentially problematic if the licensing fee is not high enough for enforcement (the situation for tobacco), which could lead the Legislature to appropriate funds for marijuana prevention and other health programs, to cover administration, as it has done with tobacco tax administration.
 
Marketing and Advertising: “As was adopted in tobacco restrictions for the cartoon character, Joe Camel, no product should be packaged in a way that would especially appeal to children or be confused by children as a product meant for them. One way to avoid attracting the attention of young people is to sell products in plain packaging in order to reduce their visual appeal.” (P. 53)
 
“Place limits on advertising and marketing of marijuana, in accordance with constitutional standards, with the particular aim of limiting or prohibiting tactics aimed at youth or that encourage heavy and problematic use.” (P. 57)
 
“Limit in-store sales and marketing to only those retail locations or dispensaries where adults aged 21 and over can enter.” (P. 58)
 
Ongoing Research:  “The state should sponsor scientifically valid studies on the level of use, substitution and poly product use of marijuana and other substances, including alcohol, tobacco, other illegal drugs, the illegal use of prescription drugs, and method of ingestion (smoking, edible, e-cigarette, hookah, etc.)” (P. 75)
 
“Conduct research and collect data on…health risks of marijuana (including cardiovascular, respiratory and brain development/function).” (P. 76)
 
Other Issues:  There is an extensive discussion of tax policy, law enforcement, agricultural, and employment issues, which (except for tax policy) have little direct public health impact.
 
Overall Comment:  Other than the two points noted above, the Blue Ribbon Commission did an excellent job in taking lessons learned from tobacco control to provide authors of a marijuana initiative, policymakers, and regulators with a strong foundation. The focus on local control, respecting smoke free laws, and mass media campaigns aimed at the general population with messaging related to health risks of marijuana and poly-product use are important and broadly consistent with the letter that the California Tobacco Education and Research Oversight Committee sent the Commission last week (July 17, 2015, likely too late to directly influence this report).
 
The Commission has specifically invited further public input.  Here is their invitation:

Invitation for Further Public Comment
The Blue Ribbon Commission invites further public comment. In particular:
1) Are there some things that this report gets wrong? The report covers many topics, and we were not able to research the full dimension of each topic. If we got something wrong, please tell us.
2) Do you think the report presents the core approaches and the goals correctly? If yes, why? If not, how would you look at it differently?
3) Do you agree or disagree with any of the recommendations in the report? If so, why?
4) The report lays out a range of policy options to achieve those goals. What policy options would you pick? Why?
Please submit comments to [email protected]. (P. 71)

The public health community should continue to engage this process.