February 2, 2016

Stanton A. Glantz, PhD

Legalized Marijuana in California Could Hurt Public Health, Analysis Says

We just released a new report that evaluates the retail marijuana legalization proposals in California from a public health standard.  While the specific initiatives are in California, the issues apply everywhere.  Here is the UCSF press release on the report.  The full report is available here.
 
EMBARGOED FOR RELEASE
11 am (ET), Tuesday, February 2, 2016
To coincide with publication in eScholarship Initiative
 
UC San Francisco
Jennifer O’Brien, Asst. Vice Chancellor/Public Affairs
Source: Elizabeth Fernandez (415) 502-6397
[email protected] | @EFernandezUCSF

 

Legalized Marijuana in California Could Hurt Public Health, Analysis Says

 
UCSF Study of Proposed State Initiatives Could Create a New “Tobacco Industry” If Unchecked 

 

 
Pending ballot proposals to legalize retail marijuana in California could lead to the development of a powerful new industry, akin to the tobacco business, that could thwart public health measures for the sake of building revenues, according to a policy analysis by researchers at UC San Francisco.
 
The analysis compares two major initiatives, which have been approved for signature gathering which may appear on the November ballot, against lessons learned from California’s successful tobacco control program. The two marijuana measures seem to have the best chance of qualifying for the ballot due to their financial backing and political support.
 
The paper will be published at 11 a.m. (ET) Tuesday, February 2, 2016 on the University of California’s eScholarship Initiative www.escholarship.org/uc/item/4qg8k9wz.  (It is also available here if there is a problem with the preceeding link.)
 
The analysis is based on the premise that lessons from tobacco and alcohol control can be applied to the marijuana initiatives in order to prevent the growth of another large industry that would cause serious public health consequences. California has long been a global leader in tobacco control.  
 
The authors found plenty of concerns in the proposed legislation:
 
“The initiatives are written primarily to create a new business and only include minimal protections for public health that are unlikely to prevent public health harms caused by the burgeoning marijuana industry,” they cautioned.   
 
“Evidence from tobacco and alcohol control demonstrates that without a strong public health framework, a wealthy and politically powerful marijuana industry will develop and use its political clout to manipulate regulatory frameworks and thwart public health efforts that would reduce use and profits,” the authors wrote.
 
The initiatives assign regulatory authority to agencies whose primary mission is the promotion of business, the authors said. Moreover, the initiatives would establish advisory committees that would include industry members who have a vested interest in maximizing business opportunities instead of protecting public health, said the researchers.
 
“Many state officials so far seem to be more focused on working alongside the marijuana industry to develop a robust marijuana business rather than on public health concerns,” said first author Rachel Barry, MA, a researcher at the UCSF Center for Tobacco Control Research and Education and Philip R. Lee Institute for Health Policy Analysis.
 
“At hearings in January by the California State Assembly Joint Hearing to plan statewide implementation of California’s new medical marijuana laws, the Dept. of Consumer Affairs and Dept. of Food and Agriculture showed more attention on collaborating with the marijuana industry and business development and paid less attention to the effects on public health or to controlling the growth of a large marijuana industry similar to the multinational tobacco industry,” Barry said.
 
The authors noted other significant issues with the ballot measures:
 

  • The proposed marijuana tax would not cover the regulatory and public health costs of legalizing marijuana, and it would require taxpayers to subsidize the new industry by paying for the adverse consequences and health-related costs associated with increased marijuana use and secondhand exposure, as they now do for tobacco;

 

  • The initiatives do not provide funding or sufficient time to conduct scientific research to gain a comprehensive understanding of the evolving adverse health effects of legalizing marijuana on population health;

 

  • The advertising and marketing restrictions spelled out in the initiatives would not prevent the targeting of underage youth, defined as under age 21, or other vulnerable populations;

 

  • Proposed warning labels are based on ineffective warnings on alcohol products and would ignore extensive research on the effectiveness of using plain or dissuasive tobacco product packaging to prevent and reduce tobacco use;

 

  • The California Legislative Analyst’s Office, in its fiscal impact estimate reports on the proposed initiatives, failed to consider the economic impact of marijuana legalization on increasing health costs in California;

 

  • Product safety and testing standards would be based on voluntary codes established by industry organizations, not independent public health agencies, which could lead to public health protections being compromised for the sake of business promotion. 

 
Barry and coauthor Stanton A. Glantz, PhD, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education, published research last year documenting how the tobacco industry has considered entering the marijuana market since the 1960s.  
 
In the new paper, the authors pointed out ways to mitigate and prevent public health problems associated with marijuana use – including youth usage, indoor use, social normalization, and health disparities -- by preventing through a strong public health regulatory system the growth of another large industry similar to the tobacco or alcohol industries.
 
But accomplishing this goal would require that a public health education and regulatory framework, modeled on the California Tobacco Control Program, be established concurrently with legalization -- before a marijuana industry fully develops in the state, the researchers said.
 
“The two proposed initiatives don’t do that,” said Glantz. “They just replace a criminal justice problem with a public health problem.”   
 
Both initiatives build upon the Medical Marijuana Regulation and Safety Act passed last year by the California state legislature by assigning the same regulatory agencies the authority to regulate the medical and retail marijuana markets. The Adult Use of Marijuana Act also includes medical marijuana provisions to strengthen privacy protections for medical users. 
 
This work was funded in part by National Cancer Institute Grant CA-61021 and UCSF funds from the FAMRI William Cahan Endowment Fund and Glantz’ Truth Initiative Distinguished Professorship.

About UCSF: UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area. Please visit www.ucsf.edu/news.

 

Comments

Comment: 

I have heard from several reporters that the supporters California's Adult Use of Marijuana (AUMA) initative were making the rounds to the media and public health organizations criticising our report before it came out.
 
They were basing these criticisms on a/sites/tobacco.ucsf.edu/files/u9/Ltr%20to%20Glantz%20and%20Barry%20%28dated%201.29.2016%29.pdf" target="_blank"; letter that their lawyer sent me last Saturday (Jan 30; the letter is dated Friday Jan 29) transmitting a /sites/tobacco.ucsf.edu/files/u9/UCSF%20Report%20Responses%201.29.16.pdf" target="_blank";detailed critique of a draft of the report that we distributed widely -- including to initiative supporters -- three weeks earlier on January 6,
 
We distributed the January 6 draft precisely because we wanted criticism so that we could get the facts right in our analysis.  We received a lot of feedback from people around the country who were public health experts, including lawyers who were experts in tobacco and alcohol regulation. 
 
We repeatedly asked initiative supporters for their criticisms several times before we finished the report.  Until we got the lawyer letter no one responded.
 
Rachel Barry and I spent the weekend reviewing the critique and, figuring that the initiative campaign would be using it in an effort to discredit our work, prepared a /sites/tobacco.ucsf.edu/files/u9/Olsen%20letter%20response-Feb%202.pdf" target="_blank";detailed point-by-point response.  In doing so we asked several lawyers who are experts in tobacco and alcohol regulation look at our responses to make sure that we were not misunderstanding the initiative or its provisions.
 
For people who want to dig even more into the details, it is worth reading this back and forth, since it further illustrates how the techicalities of the initiative fail to protect public health.
 
In the end we did make a few additional technical corrections to our final draft; none of these materially affected the major point of our report: The initiative prioritizes creating a new marijuana industry that could well end up being a "new tobacco industry."

Comment: 

In the http://www.washingtontimes.com/news/2016/feb/2/public-health-critique-of... target="_blank";AP wire story on our analysis of the California marijuana initiative, Dr. Donald Lyman, a co-proponent of the initiative and former chief of the California Department of Public Health’s Division of Chronic Disease and Injury Control, said, “With due respect to Ms. Barry and Dr. Glantz and their unquestionably proud legacy in the field of tobacco research, their analysis is not just factually inaccurate in several key areas but its fundamental premise - that marijuana must be regulated exactly like tobacco - represents an awkward minority opinion not widely shared within the public health community.”
 
Except for the Tobacco Education Research and Oversight Committee, which oversees the California Tobacco Control Program, the public health community <em;has </em;been very quiet.
&nbsp;
It is time for the public health organizations, particularly the American Heart Association, American Cancer Society, American Lung Association, Breathe California, and Americans for Nonsmokers' Rights, to get off the fence, read the initiative and our analysis of it, then take a public position.
&nbsp;
Right now, silence is agreement (with Dr. Lyman).

Comment: 

Don Lyman's comment that we are the only people advocating a public health approach to marijuana legalization that is widely appearing in the media (because it is included in the AP story on our report) is easily demonstrated to be incorrect.&nbsp;
&nbsp;
He said:
&nbsp;
With due respect to Ms. Barry and Dr. Glantz and their unquestionably proud legacy in the field of tobacco research, their analysis is not just factually inaccurate in several key areas but its fundamental premise – that marijuana must be regulated exactly like tobacco --- <strong;<em;represents an awkward minority opinion not widely shared within the public health community</em;</strong;. [emphasis added]
&nbsp;
Rachel Barry did a simple Google search using the terms “public health approach” and “marijuana” and will found:
&nbsp;
<strong;Oregon Department of Health </strong;report: https://public.health.oregon.gov/PreventionWellness/marijuana/Documents/...
&nbsp;
<strong;American Public Health Association</strong; statement: http://www.apha.org/policies-and-advocacy/public-health-policy-statement... target="_blank";http://www.apha.org/policies-and-advocacy/public-health-policy-statement...
&nbsp;
<strong;LA County</strong; statement: http://publichealth.lacounty.gov/sapc/PolicyBrief/PublicHealthApproachMa... target="_blank";http://publichealth.lacounty.gov/sapc/PolicyBrief/PublicHealthApproachMa...
&nbsp;
<strong;Canadian Medical Association</strong; statement: http://www.sciencedaily.com/releases/2015/09/150921133428.htm" target="_blank";http://www.sciencedaily.com/releases/2015/09/150921133428.htm
&nbsp;
<strong;O’Neill Institute at Georgetown University</strong; project: http://www.oneillinstituteblog.org/marijuana-legalization-and-the-public...
&nbsp;
<strong;Tobacco Control Legal Consortium</strong; report: http://publichealthlawcenter.org/sites/default/files/resources/tclc-syno... target="_blank";http://publichealthlawcenter.org/sites/default/files/resources/tclc-syno...
&nbsp;
<strong;Nation's Health</strong; statement: http://thenationshealth.aphapublications.org/content/44/7/1.3.full" target="_blank";http://thenationshealth.aphapublications.org/content/44/7/1.3.full
&nbsp;
<strong;Center for Addiction and Mental Health</strong; report: http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/docu... target="_blank";http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/docu...
&nbsp;
And also a <em;quick</em; review of the literature finds:
&nbsp;
Ghosh T, Van Dyke M, Maffey A, Whitley E, Gillim-Ross L, Wolk L. <strong;The Public Health Framework of Legalized Marijuana in Colorado</strong;. American Journal of Public Health. 2015; 106(1):21-27 doi:10.2105/ajph.2015.302875. Available at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302875" target="_blank";http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302875
&nbsp;
Rosalie Liccardo Pacula, Beau Kilmer, Alexander C. Wagenaar, Frank J. Chaloupka, and Jonathan P. Caulkins.&nbsp; <strong;Developing Public Health Regulations for Marijuana: Lessons From Alcohol and Tobacco</strong;. American Journal of Public Health: June 2014, Vol. 104, No. 6, pp. 1021-1028. doi: 10.2105/AJPH.2013.301766. Available at: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301766";http:...
Rehm, J. and Fischer, B. (2015), Cannabis legalization with strict regulation, t<strong;he overall superior policy option for</strong; <strong;public health</strong;. Clinical Pharmacology & Therapeutics, 97:&nbsp;541–544. doi:&nbsp;10.1002/cpt.93. Available at: http://onlinelibrary.wiley.com/doi/10.1002/cpt.93/full" target="_blank";http://onlinelibrary.wiley.com/doi/10.1002/cpt.93/full
&nbsp;
Haden M, Emerson B. A vision for cannabis regulation: <strong;a public health approach based on lessons learned from the regulation of alcohol and tobacco</strong;. <em;Open Medicine</em;. 2014;8(2):e73-e80. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085088/" title="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085088/";http://www.ncbi.nl...
Fischer, B., Rehm, J., & Hall, W. (2009). Cannabis Use in Canada: <strong;The Need for a 'Public Health' Approach</strong;. <em;Canadian Journal of Public Health</em;, <em;100</em;(2), 101–103. Retrieved from http://www.jstor.org/stable/41995216" title="http://www.jstor.org/stable/41995216";http://www.jstor.org/stable/41995216
&nbsp;
We would hardly call this an awkward minority.
&nbsp;

Comment: 

In an incisive column in the http:// http://sacb.ee/5plB" target="_blank";<em;Sacrameto Bee</em; on Sunday February 7, 2016, entitled "Doctors dance with a toasty partner" about the California Medical Association's endorsement of the marijuana legalization initative, editorial page editor Dan Morain observed, <strong;<em;"The initiative would place the bulk of the regulation in the hands of a new bureau within the Department of Consumer Affairs, which polices barbers, mechanics, morticians, nurses, mechanics, dentists, doctors and other licensed professionals, with varying degrees of aggressiveness. The new board would include marijuana entrepreneurs, like placing tobacco company executives in charge of limiting secondhand smoke."</em;</strong;
&nbsp;
As I have noted before, the major health groups' silence on this issue, despite the evidence that marijuana is a known human carcinogen and interferes with functioning of the cardiovascular system, is an effective endorsement.
&nbsp;
It is not too late for them to oppose <em;this particular initiative</em; while remaining neutral on the overall issue of marijuana legalization.
&nbsp;
Having said that, the most likely outcome is continued silence.&nbsp; Then, three or four years from now, when the full dimensions of the new public health disaster are evident. they will complain about how they just dont' have the power to undo the initative.
&nbsp;
As our http://www.escholarship.org/uc/item/4qg8k9wz" target="_blank";report notes, there is a pathway to legalization that would not create "a new tobacco industry.
&nbsp;
In any event, everyone should read Morain's column, which is available http:// http://sacb.ee/5plB" target="_blank";here.
&nbsp;
Read more here: http://www.sacbee.com/opinion/opn-columns-blogs/dan-morain/article587821... title="http://www.sacbee.com/opinion/opn-columns-blogs/dan-morain/article587821...... is
&nbsp;
&nbsp;

Comment: 

The American Cancer Society Cancer Action Network (ACS CAN), the American Cancer Society’s advocacy affiliate, has not taken a position on legalization of marijuana for medical purposes because of the need for more scientific research on marijuana’s potential benefits and harms. Nor have we taken a position on the legalization of recreational marijuana. However, ACS CAN opposes the smoking or aerosoalization of marijuana and other cannabinoids in public places because the carcinogens in marijuana smoke pose numerous health hazards to the user and others in the user’s presence. Consequently, ACS CAN reached out to all the proponents of proposed initiative measures to legalize recreational use of marijuana to advocate that each explicitly provide that all current and future local and state laws that regulate second hand tobacco smoke apply to marijuana as well. And that there be no local preemption for jurisdictions that might wish to impose stronger regulation. Beyond that, ACS CAN has no policy on whether or how marijuana should be regulated. The American Cancer Society did not take a position on the 1996 ballot initiative (Prop 215) to legalize medicinal marijuana and ACS CAN (which assumed the advocacy function of ACS in 2012) does not anticipate taking a position on any initiative to legalize recreational marijuana that might qualify for the ballot this year.
&nbsp;
&nbsp;
<strong;Jim Knox</strong; | Vice President, Government Relations - California
&nbsp;

Add new comment

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.