Commentary |State-Level marijuana legalization has been a stunning success

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Contrary to some critics’ claims, legalization states have not experienced any spike in either psychosis or mental illnesses.

by Paul Armentano

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It’s been over a decade since Colorado and Washington became the first two states to legalize marijuana for adults. With the benefit of hindsight, it’s fair to ask: Has this policy been successful?

Absolutely. A policy of legalization, regulation, and education is preferable to a policy of criminalization, stigmatization, and incarceration.

Let’s be clear. Legalization didn’t create or normalize the marijuana market in the United States. The market was already here.

Illustration by Gordon Johnson/Pixabay

But under a policy of prohibition, this market flourished underground — and those involved in it remained largely unaccountable. They didn’t pay taxes, they didn’t check IDs, and they didn’t test the purity of their products. Disputes that arose in the illicit marketplace were not adjudicated in courts of law.

By contrast, under regulation, cannabis products in many states are now available from licensed manufacturers at retail stores.

Cannabis is cultivated, and products are manufactured, in accordance with good manufacturing practices. Products are lab tested and labeled accordingly. And sales are taxed, with revenues being reinvested in the community. Since 2014, retail sales of adult-use cannabis products have generated more than $15 billion in tax revenue.

Most importantly, millions of Americans — many of them young adults — are no longer being arrested for possessing a substance that is objectively safer than either tobacco or alcohol.

According to data compiled by the Federal Bureau of Investigation, the annual number of marijuana-related arrests in the United States fell from 750,000 in 2012 to 227,000 in 2022, the last year for which data is available.

In short, these state-level policy changes have resulted in countless Americans being spared criminal records — and the lost opportunities that accompany them — in the past decade.

Teen use of cannabis has not grown with legalization. A CDC report says use has actually dropped among high school students.

Photo: Dimitri Bong/Unsplash

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And contrary to opponents’ fears, cannabis use by teens has not risen in parallel with legalization.

According to data provided by the Centers for Disease Control and Prevention, the percentage of high schoolers who use marijuana actually fell 30 percent over the past decade. Compliance check data from California, Colorado, Nevada, and other legal marijuana states show that licensed marijuana retailers do not sell products to underage patrons.

Also contrary to some critics’ claims, legalization states have not experienced any spike in either psychosis or mental illnesses.

According to findings published last year in the Journal of the American Medical Association, rates of psychosis-related health care claims are no higher in jurisdictions where cannabis is legal than in those where it’s not. Stanford University researchers similarly reported last year that residents of states where cannabis is legal exhibit no higher levels of psychosis than those in non-legal states.

Legalization is also successfully disrupting the illicit marketplace. According to a 2023 survey, 52 percent of consumers residing in legal states said that they primarily sourced their cannabis products from brick-and-mortar establishments. By contrast, only 6 percent of respondents said that they primarily purchased cannabis from a “dealer.”

Many consumers in non-legal states also reported that they frequently traveled to neighboring legal states to purchase cannabis products rather than buying from illicit dealers in their own state.

Twelve years into states’ marijuana legalization experiment, public support for making marijuana legal nationwide has never been higher. To date, 24 states have legalized the adult-use market.

None of these states have ever repealed their legalization laws. That’s because these policies are working largely as voters and politicians intended — and because they’re preferable to cannabis criminalization.

After a century of failed policies and “canna-bigotry,” the verdict is in. Legalization is a success, and the end of cannabis prohibition can’t come soon enough.

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Paul Armentano is the Deputy Director for NORML, the National Organization for the Reform of Marijuana Laws. This op-ed was adapted from an earlier version published at The Hill and distributed for syndication by OtherWords.org.

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Study suggests young marijuana smokers may be at greater risk of recurrent stroke

Photo courtesy American Heart Assoc.

American Heart Association

NEW ORLEANS -- Among younger adults who had a previous stroke or a transient ischemic attack (TIA) and were later hospitalized for any cause, recurrent stroke was far more likely among patients with cannabis use disorder, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2022, a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health to be held in person in New Orleans, and virtually, Feb. 8-11, 2022.

Cannabis use disorder is defined as dependent use of cannabis despite having a psychological, physical and social functioning impairment. According to the American Heart Association, stroke rates are increasing in adults between ages 18 and 45, and each year young adults account for up to 15% of strokes in the United States.

"Since marijuana use is more common among younger people and is now legal in several U.S. states, we felt it was crucial to study the various risks it may impose," said Akhil Jain, M.D., lead author of the study and a resident physician at Mercy Fitzgerald Hospital in Darby, Pennsylvania. "First-time stroke risk among  cannabis users is already established, so it intrigued us to investigate whether continued marijuana dependence also predisposes younger people to develop further strokes."

The researchers examined health information from the National Inpatient Sample, a large, publicly available database that compiles data on more than 7 million hospital stays annually across the U.S. For this study, the sample included 161,390 adults between 18-44 years of age who had been hospitalized for any reason between October 2015 and 2017, and whose health records indicated a previous stroke (either clot-caused or bleeding stroke) or TIA.

Using hospital diagnosis codes, researchers identified patients within the sample who met the criteria for cannabis use disorder, excluding those with charts indicating their cannabis dependence was in remission. This divided the sample into 4,690 patients who had been diagnosed with cannabis use disorder and 156,700 who had not. The median age for both groups was 37 years.

The study found that when compared with patients without cannabis use disorder, patients with the condition were:

• More likely to be male (55.2% vs. 40.9%), Black adults (44.6% vs. 37.2%), or to smoke tobacco (73.9% vs. 39.6%).
• More likely to be diagnosed with chronic obstructive pulmonary disease (21.5% vs. 19.0%), depression (20.4% vs. 16.1%) or psychosis (11.2% vs. 7.5%).
• Significantly more likely to abuse alcohol (16.5% vs. 3.6%).
• Less likely to have high blood pressure (53.1% vs. 55.6%), diabetes (16.3% vs. 22.7%), high cholesterol (21.6% vs. 24.1%) or obesity (12.0% vs. 19.6%).

Compared to current hospitalizations, the analysis found:

• Among adults with cannabis use disorder, 6.9% were hospitalized for a recurrent stroke, compared to only 5.4% hospitalized without the disorder.
• After adjusting for demographic factors and relevant pre-existing medical conditions (age at admission, sex, race, payer status, median household income, type of admission, hospital bed-size, region, location/teaching status and other medical conditions including traditional cardiovascular risk factors), patients with cannabis use disorder were 48% more likely to have been hospitalized for recurrent stroke than those without the disorder.
• Cannabis use disorder was most prominent among males, young Black or white adults and those who lived in low-income neighborhoods or in the northeast and southern regions of the U.S. 

"Young marijuana users who have a history of stroke or TIA remain at significantly higher risk of future stroke. Therefore, it is essential to increase awareness among younger adults of the adverse impact of chronic, habitual use of marijuana, especially if they have established cardiovascular disease risk factors or previous stroke episodes," Jain said.

Possible mechanisms that have emerged from other research on cannabis use disorder include impairment of blood vessel function, changes in blood supply, an increased tendency towards blood-clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and the antioxidant defenses that neutralize them.

Results from this study may not be generalizable to older adults (ages greater than 44), who are more likely to have a greater number of chronic health conditions and cardiovascular risk factors. The study is also limited in that all data was collected at a single point in time, rather than following participants over time. In addition, while the hospital coding identified cannabis use disorder, the data did not include information on the exact amount and duration of cannabis use or medications used.

"Our study is hypothesis-generating research for future prospective and randomized controlled studies. More research work is required to look deeply into this concerning clinical question. Most importantly, the impact of various doses, duration, forms of cannabis abuse, and the use of medicinal cannabis on the occurrence of recurrent strokes are critical questions that need to be answered," Jain said.

According to an August 2020 scientific statement from the American Heart Association, preliminary studies have found that cannabis use may negatively impact the heart and blood vessels. Although cannabis may be helpful for conditions such as spasticity associated with multiple sclerosis, among others, cannabis does not appear to have any well-documented benefits for the prevention or treatment of cardiovascular diseases.

Co-authors of the study include: Rupak Desai, M.B.B.S.; Terry Ricardo Went, M.B.B.S.; Waleed Sultan, M.B.B.Ch.; Dwayne Wiltshire, M.B.B.S.; Geethu Jnaneswaran, M.B.B.S.; Athul Raj Raju, M.B.B.S.; Roshna Asifali; Aamer Mohammad, M.B.B.S.; and Bisharah Rizvi, M.D.

Illinois' sin taxes are some of the highest in country

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by Joe Barnas, Writer
Illinois Policy

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Many New Year’s resolutions may include kicking bad habits, but even when the government tries to curb smoking, drinking and caloric intake by imposing one of the heaviest tax burdens it’s still a matter of personal choice.

Excise taxes have failed to improve Illinoisans’ health while creating an undue burden for those with the least. But lawmakers have yet to kick the habit.

If Illinoisans’ celebratory excess this holiday season is to be followed by resolution to be better next year, maybe politicians, too, need to end the bender and cut back their penchant for excise taxes.

A 2019 study from the nonpartisan Tax Foundation found Illinois captured the sixth-highest amount per capita in excise taxes during fiscal year 2016.

Excise taxes are a “tax on a specific good or activity” and include “sin taxes” such as those on alcohol, tobacco, gambling and marijuana.

In fiscal year 2016, Illinois collected an average of $788 from every person in state and local excise taxes, according to the Tax Foundation. This exceeded each of Illinois’ neighbors by at least $100 per person.

Illinois’ myriad excise taxes are compounded by those imposed by municipalities at the local level. Chicago, for example, recently levied a 9% “amusement tax” on concerts and sporting events – which it expanded to streaming services such as Netflix and Hulu.

Illinois has seen many new and increased taxes since the study, including new taxes on recreational marijuana, legal sports betting, parking garages, as well as a doubled gas tax, increased tax on e-cigarettes, a new $1 per pack fee on cigarettes, a progressive tax on gambling proceeds – and that’s at the state level alone.

Politicians use sin taxes to generate quick tax revenue while looking to curb behavior advocates deem undesirable. But those objectives are at odds with each other: If a sin tax successfully discourages residents from purchasing the item it’s been applied to, tax revenues from those products and services are expected to decline.

Meanwhile, researchers at the Urban Institute and Brookings Institution’s Tax Policy Center found that, despite Illinois’ statewide alcohol tax hikes in 1999 and 2009, the increases had no significant impact on drunk driving fatalities.

Sin taxes are also some of the least reliable revenue sources. Tax Foundation research from 2017 showed inflation-adjusted net collections from cigarette taxes demonstrate a pattern of brief revenue spikes immediately after an increase, followed by significant long-term dips. Tobacco use has steadily and significantly declined since the 1960s, so cigarette sin taxes are extremely unreliable as a revenue source. Data from the Illinois Department of Revenue shows the Prairie State’s 2012 cigarette tax hike fell more than $120 million short of projections.

In another example, promises of new revenue fell short after Illinois legalized video poker and slots in 2009 – slapping it with a tax to help fund a $31 billion infrastructure spending program. State lawmakers projected state revenues to reach $1 billion by November 2013. In reality, the state brought in less than $70 million by then. Five years later, total state revenues were supposed to rise to $2.5 billion, but state coffers only saw $1.4 billion by November 2018.

Excise taxes are also largely regressive. While well-to-do residents may not need to tighten their belts to afford high excise taxes, low-income consumers suffer most under them.

Plus, Illinois’ exorbitant alcohol and cigarette taxes will surely move border-town residents this New Year’s to cross over to neighboring states for friendlier prices. According to at least one estimate, Illinois loses up to $30 million annually on cross-border alcohol sales.

Soda taxes have proven the regressive nature of sin taxes, according to the Tax Foundation – but that didn’t stop Cook County from imposing its own highly unpopular soda tax, while exaggerating its potential public health benefits. The tax was eventually repealed following backlash.

Not only has taxing Illinoisans’ appetites failed to rescue the state from its fiscal plunge, it’s also hurt those with the least.

This new year, Springfield lawmakers should look to real pension reform instead of regressive tax hikes to fix the state’s financial problems. Illinoisans should be left to fix their bad habits at their own discretion.

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Joe Barnas is a writer at the Illinois Policy Institute, a nonpartisan research organization that promotes responsible government and free market principles. Originally published December 23, 2020.

ViewPoint | Illinois political priorities are a wreck

Dear Editor:

Governor Pritzker considers marijuana "essential". He must believe that being high is fundamental to survival. Whatever his reasoning, he has done a great injustice to Illinois families, especially in light of the COVID-19 pandemic.

COVID-19 is a greater threat to those with a weakened immune system or impaired lung function. There’s ample evidence that regular use of marijuana lowers immunity and damages the lungs.

"There is evidence that marijuana smoke is genotoxic, immunosuppressive, and can alter endocrine function… Prolonged exposures to marijuana smoke in animals and humans cause proliferative and inflammatory lesions in the lung," research from California’s Office of Environmental Health Hazard Assessment.

"Cellular immunity is impaired, pulmonary immunity is impaired, and the impaired ability to fight infection is now documented in humans," according to research from the The Journal of Clinical Pharmacology.

A "multitude of toxic microorganisms, many of which are known causes of serious lung infections, including Cryptococcus, Mucor, and Aspergillus fungi and Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii bacteria" are found in so-called "medical" marijuana, according to UC at Davis. Clinical Microbiology and Infection, titled, "A microbiome assessment of medical marijuana."

There’s also the issue of increased risk of psychosis, increased risk of traffic fatalities, increased hospitalizations, increased use by children, and the consequences go on.

Illinois political priorities are a wreck.

Kathy Valente, Director of Operations
Illinois Family Institute

Letters: SB 7 is a bad idea

State lawmakers are pushing the legalization of “super weed.”

The 500-plus page bill (SB 7) that was introduced earlier this month in Springfield should greatly alarm parents and grandparents:

This is the substance that gets users intoxicated. The marijuana of the 1960s and 1970s only contained 1-3% THC. Today, the levels are 20% or more. The Dutch government walked back their marijuana policy and now considers cannabis with 15% THC a hard drug and illegal.

High potency marijuana use is linked to increases in addiction, psychosis, schizophrenia and violence.

SB 7 allows adults to grow up to five marijuana plants in their home(s). What good is a community opt-out when neighbors are legally permitted to grow it? Moreover, who wants to live near pot cultivation centers?

Cultivating excessive amounts of marijuana is not hypothetical. Conservatively, five plants could produce ten pounds of marijuana per year. That is more than 10,000 joints a year. No one can use that much marijuana. Where will the surplus go?

There are many other reasons to oppose this policy. In short, legalization is just not worth the social costs to our families and communities.

David E. Smith, Executive Director
Illinois Family Institute