Implementing legalized marijuana needs to give protecting public health higher priority

This letter, sent to the San Francisco supervisor who is sponsoring legislation on how to implement legalized marijuana in San Francisco, urges her to keep public health issues in mind.  So far, the health community has been all but absent from the public discussion (except Americans for Nonsmokers Rights).  (A PDF of the letter on letterhead is here.)
 
November 3, 2017
 
Supervisor Malia Cohen
City Hall
San Francisco, CA
c/o [email protected]
 
Dear Supervisor Cohen,
 
After working with you on your path-breaking tobacco control legislation, we have been surprised that the cannabis legislation that you are carrying forth is not addressing the serious public health issues raised by legalization.  We urge you to broaden the focus of the discussion beyond the business of cannabis to consider the public health implications of this legislation before it is finalized.
 
We applaud the awareness around ensuring  equity access and the inclusion of the perspectives of communities who have been disproportionately affected by federal drug enforcement policies as embodied in San Francisco’s draft ordinance File No. 171042.  However, we urge you to consider the following when considering cannabis regulation within the City and County of San Francisco. 
 

• Cannabis is not without risk; marijuana smoke was identified as a human carcinogen by the State of California since 2009, when it was put on the Proposition 65 list.
• Cannabis has immediate adverse effects on cardiovascular and pulmonary function.
• Work done here at UCSF shows that just 1 minute of exposure to secondhand cannabis smoke, like secondhand tobacco smoke, blocks normal functioning of arteries, with the adverse effects of marijuana secondhand smoke lasting much longer than tobacco smoke.
• Conversely, cannabidiol, or CBD, has been found to have moderating effects on inflammatory responses caused by THC and other preexisting inflammation, as well as on the psychoactive effects of THC.  CBD’s anti-inflammatory properties militate against selective breeding of plants for high THC potency which could be damaging to cardiovascular function.
• Absent strong oversight, the new cannabis industry will be incentivized to replicate tobacco industry marketing and public relations approaches to low-tar/lights, smokeless, heat not burn, and e-cigarettes with similar types of new cannabis products.
• The tobacco industry has considered entering the cannabis business since the 1960s.
• Characterizing flavors, including menthol, likely to contribute to youth initiation and, like tobacco, could be used to target youth, LGBTQ, and communities of color.
• If the City permits commercialized indoor smoking there is no way to regulate smoking of any consumer product, including nicotine, which will reverse the Clean Indoor Air and social norms achievements that have resulted in the lowest smoking rates ever in San Francisco.

 
We urge you will consider the broader health issues embodied in this legislation as well as the hard fought lessons from the tobacco fights so to ensure that, as part of remedying past social injustices around marijuana use the Board does not undermine public health. 
 
As always, we would be happy to provide any additional information that would be helpful.
 
Best wishes,
 
Stanton A. Glantz, PhD
Professor of Medicine
Truth Initiative Distinguished Professor in Tobacco Control
Director, Center for Tobacco Control Research and Education
 
Encl:   
 
Wang X, Derakhshandeh R, Liu J, Narayan S, Nabavizadeh P, Le S, Danforth OM, Pinnamaneni K, Rodriguez HJ, Luu E, Sievers RE, Schick SF, Glantz SA, Springer ML One Minute of Marijuana Secondhand Smoke Exposure Substantially Impairs Vascular Endothelial Function.  J Am Heart Assoc. 2016 Jul 27;5(8). pii: e003858. doi: 10.1161/JAHA.116.003858
 
Barry RA, Hiilamo H, Glantz SA.  Waiting for the opportune moment: the tobacco industry and marijuana legalization.  Milbank Q. 2014 Jun;92(2):207-42. doi: 10.1111/1468-0009.12055
 
Pacher P, Steffens S, Hasko G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2017. doi: 10.1038/nrcardio.2017.130