A cannabis plant greets job seekers as they sign in at CannaSearch, Colorado's first cannabis job fair, on March 13, 2014 in Denver, Colorado. O.PenVAPE, the largest national brand in cannabis, held the first of it's kind Cannabis Job Fair hoping to match applicants with businesses in the Colorado marijuana industry.

A cannabis plant greets job seekers as they sign in at CannaSearch, Colorado's first cannabis job fair, on March 13, 2014 in Denver, Colorado. O.PenVAPE, the largest national brand in cannabis, held the first of it's kind Cannabis Job Fair hoping to match applicants with businesses in the Colorado marijuana industry.

Across the country, public attitudes towards legalizing marijuana have shifted and state legislatures are responding. No state has gone as far as Washington State or Colorado—where marijuana sales are legal—but many are moving to decriminalize the drug or make it available for medical use. And cash strapped states considering legalization are closely watching Colorado where the governor recently predicted a tax windfall. But while politicians are more eager to get on board, public health officials continue to raise alarm bells about the safety of lighting up. Guest host Susan Page and her guests discuss the business and changing politics of marijuana.


  • Dr. Robert Dupont President of the Institute for Behavior and Health and former director of the National Institute on Drug Abuse.
  • Eric Sterling President, The Criminal Justice Policy Foundation
  • Beau Kilmer Co-director, RAND Drug Policy Research Center and co-author of "Marijuana Legalization: What Everyone Needs to Know".
  • Dr. Nora Volkow Director, National Institute on Drug Abuse of NIH.


  • 10:06:54

    MS. SUSAN PAGEThanks for joining us. I'm Susan Page of USA Today sitting in for Diane Rehm. She'll be back tomorrow. In January, specialized licensed stores in Colorado began selling marijuana, this, despite the fact that marijuana sales remain illegal under federal law. Sales in Washington State begin in June and a handful of other states are considering legalization.

  • 10:07:17

    MS. SUSAN PAGETo discuss the business and changing politics of marijuana laws, we're joined in the studio by Dr. Robert Dupont of the Institute for Behavior and Health and Eric Sterling of the Criminal Justice Policy Foundation. Thanks for being with us.

  • 10:07:30

    DR. ROBERT DUPONTThanks for having us.

  • 10:07:30

    MR. ERIC STERLINGIt's a pleasure to be here.

  • 10:07:31

    PAGEAnd joining us from San Francisco, Beau Kilmer of the Rand Drug Policy Research Center. Welcome.

  • 10:07:38

    MR. BEAU KILMERGood morning. Thanks for having me.

  • 10:07:39

    PAGEWe're going to invite our listeners to join our conversation later in this hour. You can call our toll-free number, 1-800-433-8850. You can always send us an email to drshow@wamu.org or find us on Facebook or Twitter. Well, Beau Kilmer, it's possible that some of our listeners do not know what me meant in the introduction to this hour, I said that yesterday were the 4/20 observances. What are those?

  • 10:08:06

    KILMERWell, April 20th or 4/20 is sort of the national pot smokers holiday. You know, it's been part of the popular culture for more than 30 years and there are a number of urban legends about how it started. You know, the one I hear the most about is you've got five high school kids in Moran County who would meet at 4:20 after school and they would jump into their car and try to find an abandoned marijuana garden somewhere near Point Reyes. I guess they would get high along the way and rumor has it that they did this multiple times, but they never ended up finding the garden.

  • 10:08:38

    KILMERNeedless to say, it's unclear about how this actually made its move from five high school kids to being part of kind of a international discussion. Rumor has it that they ties with the Grateful Dead. But needless to say, every April 20th, you have these celebrations in various places across the country. And what happened in Colorado is fairly significant because it was the first time that there was a 4/20 celebration where individuals could actually walk into a store, if they're 21 and older, and buy up to one ounce of marijuana.

  • 10:09:08

    KILMERThey didn't need to have a medical recommendation. That was the first time.

  • 10:09:11

    PAGESo a lot of those -- tens of thousands of people in Denver were celebrating at the Civic Center yesterday, lots of smoking outside in public places. Is that legal?

  • 10:09:22

    KILMERNo. Public consumption is not legal and, I mean, they did end up giving out dozens of tickets, but how they selected those individuals, I have no idea.

  • 10:09:31

    PAGEWell, Eric Sterling, give us a sense of what's going on across the country when it comes to marijuana laws. What changes are we seeing?

  • 10:09:38

    STERLINGWe're seeing a move to expand medical marijuana. In Maryland, last Monday, Gov. O'Malley signed a law that will make Maryland a medical marijuana state. It becomes the 21st state and regulations are being developed in other states that have moved very quickly in this way. We're seeing ballot initiatives where signatures are being circulated in Alaska. Plans are being laid in Oregon and California to put those states into electoral play as well.

  • 10:10:18

    STERLINGState legislatures are considering legalization and decriminalization bills and so there's a great deal in interest in the country in ending marijuana prohibition.

  • 10:10:32

    PAGEAnd so a couple of separate and distinct things. Medical marijuana, decriminalization, which doesn't make it legal. It just makes it -- decriminalizes it for small amounts.

  • 10:10:42

    STERLINGFor adults.

  • 10:10:42

    PAGEFor adults. And actually allowing recreational use for anybody who wants it.

  • 10:10:48

    STERLINGAnd then further legalization, which would be an attempt to control the production and distribution and take it out of the hands of organized crime.

  • 10:10:55

    PAGESo Robert Dupont, how big a change is this in drug policy?

  • 10:10:58

    DUPONTIt's huge. This is the biggest change in the last half a century in drug policy. Very few Americans know that the actions in Colorado made Colorado and the U.S. the first place in the world to have legal production, distribution, use of marijuana. It was a dramatic change that is going to have far-reaching implications in the United States and really all over the world.

  • 10:11:29

    DUPONTWhat we're seeing is the addition of a third drug to the two that we've had legal for a long time, alcohol and tobacco. Those two drugs are the leading cause of preventable illness and death in the country. We're now adding a third drug, marijuana, to that list. And we're watching this development in Colorado with much interest and high ambivalence and a sense that this is history being made, there's no question about it.

  • 10:12:04

    PAGEYou said the first place in the world. What about a place like Amsterdam?

  • 10:12:08

    DUPONTYes. Well, they had coffee shops where you could buy small amounts of marijuana there, but that was it and it was very limited in Amsterdam. And you don't have any...

  • 10:12:18

    STERLINGAnd it wasn't really legal. It was tolerated.

  • 10:12:21

    DUPONTIt was never -- there was never legal production. There was never advertising. What you see in Colorado is unbelievable. It's now put into cookies. It's put into drinks to be consumed. And there's a big interest in bringing it along with tobacco and alcohol, as major industries. People want to become the Anheuser Busch of marijuana. And behind all this is a presumption that it is really somehow safe, that it benign, that it's really not a serious kind of issue.

  • 10:13:01

    DUPONTYou know, the way we started this program it was kind of a joke about 4/20 and it's kids having fun. Well, I think it's more than that. It's really adding a very major drug, the drug that causes 60 percent of all the drug dependency in this country is from marijuana. It's more than all the other drugs put together. It's a serious step that we're taking with a kind of giggle and a wink and that's pretty scary.

  • 10:13:28

    PAGEWe're gonna talk later in this hour in more depth about some of the medical consequences of legalized marijuana, but first, Beau Kilmer, tell us why now? What is fueling these changing drug laws when it comes to marijuana?

  • 10:13:43

    KILMERWell, popular opinion about marijuana has been changing, you know. In the early 1990s, I think support for legalization was somewhere around 20, 25 percent. By 2000, it was closer to 30, 35 percent. And now, depending on what poll you look at, it's over 50 percent. Part of this is just kind of a changing demographic. I think there are a number of reasons and I don't think there's just one reason that accounts for this.

  • 10:14:08

    KILMERBut in both Colorado and Washington, this was passed through ballot initiatives, you know. If you have enough money, you can get the signatures, you can pay for the advertising and that's what largely drove it there in Colorado and Washington.

  • 10:14:22

    PAGEYou know, Colorado, politically speaking, has a lot of young people. And it has -- it's not such a Democratic state. It's really one of the nation's top swing states, but it also, even among conservatives, has some strain of libertarianism. I wonder if that's what's making it politically possible to get these ballot initiatives through, even when the politicians remain pretty cautious.

  • 10:14:45

    KILMERI could be and I would also add that the folks that were pushing this in Colorado, I mean, they did start a while ago. This wasn't just something that just kind of came out of the blue. They've been kind of pushing reforms, you know, beginning, you know, in the mid-2000s.

  • 10:14:59

    PAGEEric Sterling, it's been now legal to buy marijuana from licensed sellers in Colorado since January 1. What have we learned in the past couple months?

  • 10:15:07

    STERLINGWell, I'm sure the lessons are clear. We do know that people will buy marijuana more expensively if it's legal. We know that there are millions of dollars a week that are being spend in legal establishments and that the state is collecting taxes and that's money that's not going to organized crime. It's not fueling cartels. We know that law enforcement is somewhat hysterical about it. In Maryland, the chief of police in Annapolis testified before the senate judicial proceedings committee and said in Colorado, 37 young people died of marijuana overdoses the first day it was legal in Colorado.

  • 10:15:56

    STERLINGAnd he was testifying to this as a fact, believing it until it was pointed out to him this was from a mock news site called "The Daily Current." You know, we think...

  • 10:16:06

    PAGEThat's not true...

  • 10:16:06


  • 10:16:08

    PAGE...that 37 kids died the first day.

  • 10:16:09

    STERLINGIt's not true. His willingness to believe it was true, his willingness to testify that it was true shows you that when -- lots of people talk about this subject. They're willing to suspend their usual careful consideration of facts because their prejudices are so strong.

  • 10:16:36

    PAGEDo we know, Robert Dupont, in terms of the consequences of the legalized sale of marijuana, does this mean that just people who used to smoke marijuana now can buy it legally or does it mean that people who were non users before are now trying it? Do we know what kind of impact that's been having?

  • 10:16:52

    DUPONTLet's a look at some numbers. In the United States, in the last 30 days, 51 percent have drunk alcohol, 27 percent of Americans have smoked cigarettes in the last 30 days and 7 percent have smoked marijuana. Legalization is going to bring the marijuana numbers up to where we have alcohol and tobacco right now. Not only is dropping the price dramatically through the legalization and the competition that will occur or is occurring as a result of that, but it increases the number of users and the social acceptance of marijuana profoundly. You see the...

  • 10:17:31

    PAGEHow do you know it increases the number of users? Do we know that already from Colorado or are you asserting this?

  • 10:17:36

    DUPONTNo. It's hard to imagine any behavior that is illegal that you make legal that it doesn't go up. It's like saying, you know, do we need to know that if we don't enforce the speed laws people will speed more. I mean, it's obvious. And I think that it's a good point that we need a lot of careful analysis of the effects. One of the ones that I'm very interested in is what's the effect on the illegal market?

  • 10:18:00

    DUPONTOne of the reasons to do this is to reduce the illegal market in drugs. And I am persuaded that the legal market is going to actually build the illegal market, rather than put it out of business because the legal market will have age requirements. The legal markets will have taxes place on it. The legal market will have limitations on the dose, all those things that the illegal market doesn't worry about.

  • 10:18:24

    PAGEWe're gonna take a short break and when we come back, we'll talk with Dr. Nora Volkow. She's director of the National Institute on Drug Abuse at the NIH and we'll take your calls, 1-800-433-8850. Our phone lines are open. You can always send us an email to drshow@wamu.org. Stay with us.

  • 10:20:03

    PAGEWelcome back. I'm Susan Page of USA Today sitting in for Diane Rehm. And we're joined in the studio by Dr. Robert Dupont. He's the former director of the National Institute on Drug Abuse. He's now president of the Institute for Behavior and Health. And Eric Sterling, president of the Criminal Justice Policy Foundation. He was formerly council to the House Judiciary Committee, where he helped write the nation's drug laws.

  • 10:20:25

    PAGEAnd joining us from California, Beau Kilmer, co-director of the RAND Drug Policy Research Center. He's co-author of the book "Marijuana Legalization: What Everyone Needs to Know." But first we're going to talk with Dr. Nora Volkow. She's director of the National Institute on Drug Abuse at the NIH. Thank you so much for joining us.

  • 10:20:44

    DR. NORA VOLKOWThanks for having me.

  • 10:20:46

    PAGEI want to ask you from a public health perspective, how do you look at the liberalization of marijuana laws? What’s your perspective on it?

  • 10:20:54

    VOLKOWWell, my perspective is a simple one and it's based on the evidence that we have on comparing the consequences from legal versus the consequences from illegal drugs. And what the data shows is that morbidity and mortality is much, much greater for legal than for illegal drugs. And this is not because the legal drugs are more dangerous than the legal ones, but basically because of the availability that you have with them.

  • 10:21:27

    VOLKOWAnd as a result of that, when you decide on making a policy change of transferring an illicit drug into legal, you have to contend with what the evidence shows, that you're going to see a significant increase in morbidity and mortality associated with a much greater rate of use by people.

  • 10:21:47

    PAGENow Bob Dupont made the point that this would be a third legal drug after alcohol and tobacco, adding marijuana to that list in some states. Do you think that marijuana is as dangerous to health as alcohol and tobacco?

  • 10:22:02

    VOLKOWI think it's very difficult to make that comparison directly because they have different effects. Tobacco is very bad for the pulmonary function and for cancer. Alcohol is very bad because associated car accidents. Marijuana interferes with cognitive function when you are intoxicated. And these effects are longer lasting than those that you see with alcohol. So -- but it's less -- it produces -- less associated with cancer than tobacco.

  • 10:22:34

    VOLKOWSo on the other hand too it's very difficult to compare the medical adverse effects of a legal drug to those of an illegal drug, and thus we see more people dying of alcohol. That is correct. But you have a drug that's legal. So the issue is, are we going to -- for example in car accidents, how will the legalization of marijuana translate in the number of car accidents? Are they going to be at the same rate as those that we have observed with alcohol for example?

  • 10:23:06

    VOLKOWIt's very difficult. It's not a fair comparison.

  • 10:23:10

    PAGESo what is the NIH going to do now that there is this trend toward legalization of marijuana use? Will this affect the kind of studies that you do for instance?

  • 10:23:21

    VOLKOWIt has to. One of the things that are usually -- were very interested is to promote research that can evaluate the consequences of these changes in policy. And across multiple domains, for example, how will it affect educational achievement? How will it affect dropouts? How will it affect car accidents? How will it affect the consumption of other drugs? And we can predict in general that it will have adverse effects but we need to provide the data to document that. And that data in turn should be able to hopefully guide policies where we have more knowledge as opposed to doing policies that are driven by beliefs.

  • 10:24:10

    PAGENow this is happening kind of pell-mell, one of those trends that's really taking across in a variety of other places. How long does it take to do kind of serious studies into some of the questions that you're raising?

  • 10:24:21

    VOLKOWWell, I guess that's an important question. And it depends on the depth at which you are addressing them and the breadth of what you are going after. For example, how do you evaluate the consequences in school performance? Is it going to be something that you see immediately? I doubt very much because education is something that you build through several years. So that information may not be readily available.

  • 10:24:52

    VOLKOWOn the other hand, we may start to see, for example, indicators showing whether the school dropouts are going up or down. That may be a more immediate one. Car accidents may also be a more immediate one. So some of the information may become available within one or two years.

  • 10:25:13

    PAGEWe saw a study from Northwestern University recently that talked about the impact of marijuana use on adolescent brains. What did the study find?

  • 10:25:24

    VOLKOWWell, that was a study done on a small sample of subjects. It was 20 controls on 20 individuals that were abusing marijuana regularly but that were not heavy users. And this showed that the volumes of certain areas of the brain differ from the volumes of those individuals that had not consumed marijuana.

  • 10:25:48

    PAGEAnd one last question, it sounds as though you feel that you're -- that you feel that this is a bad idea, the fact that we're beginning to legalize marijuana use before some of these questions have been answered.

  • 10:25:59

    VOLKOWYeah, I mean, my question is always -- and I put it in a question -- can we as a society afford a third legal drug, right? Can we have apart from alcohol and tobacco that kill an enormous number of people a third one? I mean, that's to me the question. And that's why I've been very open about the opposing the legalization of marijuana.

  • 10:26:23

    PAGEAll right. Dr. Nora Volkow, director of the National Institute on Drug Abuse at NIH. Thank you so much for joining us on "The Diane Rehm Show."

  • 10:26:31

    VOLKOWThanks for having me.

  • 10:26:32

    PAGEThank you. Beau Kilmer, why, given these questions, which I know Dr. Dupont, the NIH and others have raised, why has that not slowed down or doesn't seem to have slowed down, the political move toward legalizing marijuana?

  • 10:26:49

    KILMERWe should step back to the health consequences. Most people that use marijuana, most people that use alcohol, they don't have any problems. They're able to -- you know, to fulfill their expected social roles. That said, there are problems associated with heavy use, and marijuana is not a benign substance, but the evidence is very clear. The social costs associated with heavy alcohol use are far greater than they are with respect to the heavy costs associated with heavy marijuana use.

  • 10:27:16

    KILMERAnd so, you know, there are some people that are opposed to Marijuana legalization because they're opposed to intoxication in general. There are others that are for marijuana legalization because they don't want the government telling them what they can put in their bodies. You know, those individuals, they're entitled to those opinions. But for those who actually care about whether or not marijuana's going to -- or legalization's going to improve or harm public health, that question's largely going to depend on how legalization influences alcohol consumption.

  • 10:27:43

    KILMERThat is, if there is this increase in marijuana use, are people going to be more likely to use marijuana and alcohol together, which we know increases the risk of traffic accidents or they can use them as substitutes. Because if we end up having a lot of heavy drinkers moving -- you know, if they move away from alcohol to becoming heavy marijuana users, in general that would be a net win for society.

  • 10:28:03

    KILMERAnd at this point we just don't have good research on whether or not they are economic compliments or substitutes. So with respect to the research, this is what we have to focus on right now, this question.

  • 10:28:13

    PAGEIsn't that interesting. You know, and that's a perspective that we're hearing from some of our listeners. Terry has sent us an email that says, "I disagree with the statement that marijuana is worse than all other drugs combined, for drug dependencies seem to forget about tobacco which causes more deaths and disease than all other legal and illegal substances combined. If we really need a cause, keep people from smoking and we'll save many more lives." Bob Dupont, is that true?

  • 10:28:38

    DUPONTWell, I think that there -- it's a very curious argument to look at the legal drugs and to say this one is less bad than those and therefore we should do it. That's a very weird argument to make. But I want to go back to what Beau said about alcohol use and marijuana use. There is no doubt in my mind how that's going to play out. The data -- we will see going forward.

  • 10:29:04

    DUPONTBeau says are they substitutes or are they complimentary? The data is extremely clear that the more a population -- a person uses alcohol the more likely that person is to use marijuana. The more the person uses marijuana the heavier their alcohol use, not the less. So I think that -- to me the -- it's clear to me what's going to be found but we need to see it, and there are others who are not so convinced, and that is they are not substitutes. They are complimentary. Increasing marijuana use will increase alcohol use and tobacco use.

  • 10:29:39

    DUPONTMarijuana is a gateway drug to cigarette smoking in the United States today. So rather than stopping smoking cigarettes, when you smoke marijuana the rates of smoking go up with marijuana use. But we'll watch that all and I agree with Beau, that's going to be a very important statistic to study.

  • 10:29:57

    PAGEEric Sterling.

  • 10:29:59

    STERLINGSusan, we've been talking about the public health issues. We have not talked about the more fundamental question, which is liberty. In our society, the default position for adults is that they have liberty. The constitution talks about securing the blessing of liberty. And I believe that one of the blessings of liberty in the United States is to use marijuana. The feelings that marijuana creates, the feelings of creativity, of relaxation, those are enjoyable and they are worth having. Those are benefits.

  • 10:30:33

    STERLINGAnd we should not lose track of the fact -- lose sight of the fact that 20 million Americans enjoy those effects. And they have a liberty interest. They have a liberty interest in doing that. The ability of the government to punish people is based on a finding that the people are doing something wrongful to others. Not that they are hurting themselves. The risks of using marijuana -- and there are no questions that there are risks, that's not in dispute -- the risks however are within the kinds of risks that we tolerate in our society of many kinds and that we're, in fact, a society that encourages risk. We run on risk.

  • 10:31:15

    STERLINGOur entire financial system is based on engaging in risk, measuring risk. The sports that we watch -- I have a daughter who's on the track team. I have to fill out the form that tells what hospital I prefer she goes to. You know, every parent in America knows that their kids are at risk when they play sports. To be -- in some tragic cases the kids are paralyzed for life or even killed.

  • 10:31:41

    STERLINGYou know, so let's not sort of say it's risk-free because it's not that. But the risks have to be balanced by individuals who choose whether or not those risks make sense. And our current laws magnify the risks and interfere with liberty. So there are 800,000 people who get handcuffs put on them every year and are taken to jail cells. Now they may not go to prison on sentences, but their liberty is significantly imposed upon. That's wrong. That's morally wrong.

  • 10:32:13

    PAGEHere's a Tweet that we got from Nick who writes, "I just visited Colorado and being able to buy pot without feeling like a criminal is such a nice thing. I can't wait for North Carolina to join them." You make the point that 800,000 Americans get arrested for marijuana use. And the argument that that is -- that laws are used with a lot of disparity -- racial disparity now is one of the powerful arguments behind legalization.

  • 10:32:39

    STERLINGIt's a -- arguments against and for legalization, of course, because when we've asked the police, you know, can you explain why this disparity, they can't explain it.

  • 10:32:51

    PAGEI'm Susan Page and you're listening to "The Diane Rehm Show." We're taking your calls, 1-800-433-8850. Let's go to Neftali. He's calling us from Valdosta, Ga. Hi Neftali.

  • 10:33:03

    NEFTALIHi, how are you?

  • 10:33:04


  • 10:33:05

    NEFTALIGood. You know, I was just wondering. I mean, as we talk about this, is one aspect of this is as time passes once the legalization happens, you're going to have a whole industry developed and a whole infrastructure packaging -- the whole packaging of the product, you know, in the same way that you have, you know, in terms of alcohol. You know, the Johnny Walkers and Jim Beams and the --you're going to have a certain marketing and a certain -- and it'd be -- that's going to be an interesting aspect to adopt. And that's it.

  • 10:33:36

    NEFTALIAnd, you know, probably -- you're asking the question of whether it'll increase. Of course, you have the -- the effects are going to be -- you know, we'll have to deal with those. Anyway, thank you.

  • 10:33:46

    PAGEAll right. Thanks very much for your call, Neftali. Well, Beau Kilmer, what about the kind of commercial aspects? Are there lessons that we're learning from Colorado's experience when it comes to that?

  • 10:33:57

    KILMERWell, if you're a jurisdiction and you're thinking about doing something besides prohibiting marijuana, you have a lot of choices. What Colorado and Washington are doing, they've essentially adopted the alcohol model. They're going to regulate it like alcohol. But you have to realize there's a lot of policy space in between prohibition and the alcohol model.

  • 10:34:17

    KILMERFor example, jurisdictions could allow home production. They could allow co-ops, nonprofit organizations. They could even think about having a state monopoly where you actually could have the state doing the production that meant -- that would mean that they could control the price and they could limit advertising.

  • 10:34:33

    KILMERAnd, you know, so far we haven't talked about Uruguay. So in December of 2013, Uruguay became the first country in the world to experiment with legalization. And there it's going to be very different. It will only be supplied through -- you could either grow at home, be part of a co-op or you'll be able to buy it from a pharmacy. But in that country they're going to be able to just ban advertising.

  • 10:34:55

    KILMERThat's really hard to do in the United States. The policymakers in Colorado and Washington, they're working really hard to try, you know, to control some of the marketing. But with the U.S. -- with our commercial-free speech doctrine that makes it difficult.

  • 10:35:10

    PAGEWhy Uruguay? Why are they moving toward legalization?

  • 10:35:15

    KILMERWell yeah, they signed it into law in -- or the president did in December, 2013. And they're doing it for different reasons. They're trying to -- or the main reason -- they're doing it partially for human rights. And they think that the public will be safer with legalization. And they're also trying to reduce the revenues that go to some of the criminal organizations that are selling it.

  • 10:35:35

    PAGEAnd do we have...

  • 10:35:36

    KILMERThose are some of the main reasons.

  • 10:35:37

    PAGE...and do we have any idea if it's going to work?

  • 10:35:40

    KILMERIt'll be interesting to see. I mean, it's a very different model from what's happening in Colorado and Washington. And as -- and, you know, right now they're in the process of kind of figuring out what the details are going to be. And I believe they're going to be announced at the end of the month. So, you know, while we're going to be doing all this research on Colorado and Washington, we should also pay attention to what happens down in Uruguay.

  • 10:35:59

    PAGERobert Dupont.

  • 10:36:00

    DUPONTThey haven't implemented it yet. That's why Colorado is the first. The law was passed but it has not been implemented there. I think the fact that Beau has brought up is that there are a lot of policy options that can be thought about. And many of my friends think about very subtle, very complex, very sophisticated ways of managing legal marijuana. But the forces at play are so powerful, they swamp all that subtlety. And you see that going on in Colorado right now.

  • 10:36:33

    DUPONTBeau was talking about free speech, limitations on activities for advertising, commercial activities. Bringing capitalism into this in a direct way has tremendous implications for the political process that's going on. I think the crucial question is, what is the public health goal for the country. Is it to have more or less marijuana use?

  • 10:36:59

    DUPONTAnd one of the things that's interesting to me about the alcohol and the tobacco is the thing about what are we trying to do with alcohol and tobacco? And I think in general we're trying to limit the use of those drugs. And here we've got something else that's coming on where it's going up through the roof.

  • 10:37:13

    PAGEWe're going to take another short break and when we come back, we'll continue our conversation. We'll continue to take your calls and questions and emails. Stay with us.

  • 10:40:01

    PAGEWelcome back, I'm Susan Page of USA Today sitting in for Diane Rehm. And we're joined in the studio this hour by Eric Sterling of The Criminal Justice Policy Foundation, and Dr. Robert Dupont from the Institute for Behavior and Health. And joining us from San Francisco is Beau Kilmer. He's co-director of the RAND Drug Policy Research Center and co-author of the book "Marijuana Legalization: What Everyone Needs to Know". We were talking, Eric Sterling, before the break about some of the health concerns that would come with marijuana legalization. What's your perspective on that?

  • 10:40:36

    STERLINGI don't think that marijuana is harmless. But I think the question of what kinds of harms to run are the decision that individual adults make. We engage in all kinds of risky behaviors and those are legal. People go skiing for the thrill of it, and yet it cleared Congressman Sonny Bono. Nobody stands up and says, well, if it will just save one life, we should outlaw skiing. We -- there are all, you know, these comparisons with alcohol and tobacco really beg the question. Those are legal because adults make choices about them. We've reduced the amount of tobacco use because we've educated people about the consequences.

  • 10:41:17

    STERLINGWhat we have here is a belief that the American people are too stupid to be educated. If marijuana is as dangerous as Dr. Dupont says, I think people will make those kinds of decisions, but just know they will all be the stooges of an advertising industry and that they will only respond, you know, to that. If, you know, if there are genuine studies, as opposed to studies which may indicate risks, you know, a lot of -- there's a great deal of exaggeration about this. And I'm, you know, our concern is that, you know, over 30 years we've seen government agencies repeatedly exaggerate the harms. So they've lost their credibility with lots of people about what the harms might really be.

  • 10:42:02

    PAGESo, Robert Dupont, what about this question about who decides, who makes the judgment on whether marijuana use is of such consequences that you wouldn't use it. Should it be the person? Should it be the government? Who decides?

  • 10:42:15

    DUPONTWell, we have effectively decriminalized marijuana for all practical purposes for decades in this country. And the number of people arrested is a substantial number but going to prison is essentially zero. And...

  • 10:42:30

    STERLINGIt's not zero.

  • 10:42:32

    DUPONTIt's close to zero.

  • 10:42:33

    STERLINGForty-thousand people, at least, in prison.

  • 10:42:35

    DUPONTIt's around one percent. And most of those people have other charges and histories of other offenses, and this is a plea-bargain arrangement. Any event, I think the question to me is how to look at what's happening in the government right now. It's very striking. The federal law is very clear that marijuana is illegal. Medical marijuana is illegal and recreational marijuana is illegal. The tipping point came in the politics very recently and it had to do with, Eric Sterling was talking about, the Libertarian argument. Once the Libertarians weighed in and essentially pulled away the conservative opposition to legalization of marijuana, we got a very interesting reality.

  • 10:43:25

    DUPONTAnd that is the political leaders in both parties, certainly including President Obama and Attorney General Eric Holder, have essentially walked away from the issue -- walked away from the federal law. And it's going to play out, I believe, in the courts. It'll be a very interesting question of how this plays out. But right now we've got a situation where two states have, through ballot initiatives -- in both states, it's interesting, the governors opposed those initiatives in Washington and Colorado -- we're going to see this play out. And it will be quite dramatic.

  • 10:44:01

    DUPONTThe reason it's happening is because both political parties are concerned about the politics of it and don't want to get the crossfire. So then, as you said, they're not supporting the legalization, they're just standing back and watching what happens. And I think the whole country -- really the whole world -- is watching what's happening in Colorado and Washington. And there will be a lot of new knowledge from it. And I'm one of those people watching to learn from it.

  • 10:44:23

    PAGEWell, they're standing back because voters have spoken, right? Because ballot initiatives passed.

  • 10:44:27

    DUPONTWell, I think it's less that they have -- but I think it's less that they've spoken that they're concerned about where it's going. It's unstable ground and they don't want to take a strong position on it. If they really thought the voters were going strongly in that direction, they'd jump on the bandwagon and say, let me lead. They're not doing that.

  • 10:44:43

    PAGETalk about what the federal government has decided to do. Now, the Obama administration announced they wouldn't act in Colorado, assuming certain conditions were met. Eric Sterling, tell us about that.

  • 10:44:54

    STERLINGRight. And it's important to recognize that the voters in Washington, more of them voted for marijuana than voted for the successful candidate of governor. More voted for marijuana than the successful candidate of attorney general, or indeed any of the contested races except U.S. Senate. In Colorado, more voters voted for marijuana than Barack Obama, who, you know, carried the state. This is an extremely popular issue among the voters in those states. And the federal government recognized they did not have the capacity to enforce it.

  • 10:45:26

    STERLINGIf they attempted to stop Washington and Colorado from setting up their regulatory systems, there would be an out-of-control situation. They don't have the resources. You also have to remember that the Supremacy Clause in the Constitution, you know, is -- has to be interpreted in light of the Tenth Amendment, which was adopted afterwards, which reserves powers to the states.

  • 10:45:51

    STERLINGThe power to regulate cannabis, you know, is not a power given to Congress. It's arguably one that's reserved to the states. And, you know, those are questions that the Justice Department had to weigh. They've never sued any of the states since 1996 to challenge their medical marijuana laws.

  • 10:46:09

    PAGEDoes that mean if it went to the Supreme Court, the court could reasonably decide that this is not a federal issue and it's left up to the states? And that federal drug laws, or at least federal marijuana laws, would be thrown out?

  • 10:46:21

    STERLINGI think this Supreme Court very plausibly could rule that the state regulation of cannabis is protected under the Tenth Amendment, and that Congress' interstate power jurisdiction doesn't go that far. When they're -- when the states, under the Tenth Amendment, have a regulated system of control -- and what the Obama administration then said in their memoranda is -- when the states have robust systems that are going to protect against sales to minors, that are going to, you know, largely protecting public safety, then only in cases where there is connection to international criminal gangs, use on federal property, distribution to minors, then the federal government says they'll step in.

  • 10:47:06

    PAGEBeau Kilmer, here's a comment we've gotten from Steve, who's posted it on our website. He writes, "My one great concern is the patchwork of laws that will result until some national policy is decided upon. One already sees draconian laws and enforcement in some states, while in others the same action is either legal or only a misdemeanor subject to a fine." Is it -- that's true, right? There's a patchwork of laws right now. And do you see that as a problem?

  • 10:47:31

    KILMERNo. You know, as I mentioned before, we are still learning about the consequences of these policy changes. What Colorado and Washington are doing is very different from what's being done -- what will be done in Uruguay. And as I said, there are a number of other options that states could pursue. So if we're trying to learn about the consequences of alternatives to prohibition, I would like to have as many examples as possible. But a lot of it is going to come down to what happens to marketing.

  • 10:47:58

    KILMERAnd Eric mentioned the memo that came out in August of 2013, which essentially said, for the time being the Obama administration wouldn't block implementation in Colorado and Washington, as long as they had strong enforcement and regulatory systems. But then that memo also listed eight different guidelines for federal prosecutors to help them make decisions about whether or not to take marijuana trafficking cases. And one of them was to, you know, if this is a store or business that's actually selling to kids, you know, you should go after them. You should target them.

  • 10:48:28

    KILMERBut in that memo, there was also a footnote after that particular bullet. And it said, and when we're talking about distributing marijuana to kids, it's not just physically selling it to them. If these are firms that are marketing in a manner that appeals to youth, they should be targeted as well. So it'll be really interesting to see how these different U.S. attorneys make decisions about marketing, because they could help control the situation if they wanted to.

  • 10:48:54

    PAGEAnd do we know anything yet about how the U.S. attorneys will interpret them?

  • 10:48:59

    KILMERI'm not aware of any official positions that they've taken.

  • 10:49:02

    PAGEWe'll have to wait and see. Let's go to the phones and talk to Mark, who's calling us from Pittsburg. Mark, hi. Thanks for joining us.

  • 10:49:10

    MARKHi. Yes, I'm an MD-PhD student studying chronic pain. And I just wanted to bring in a bit of a medical perspective, because it's not only casual users that are being hurt by a marijuana prohibition. It's very much chronic pain and also some patients that suffer from epilepsy. And these -- chronic pain is a very hard-to-treat disease and the drugs we use currently are the morphine-type drugs, the opiates, which are very highly addictive, have a big withdrawal potential, and also have a high potential for overdose. And then a subsequent cost to society when those pills are distributed out, I guess, in the black market.

  • 10:49:58

    MARKWhen you contrast marijuana to this -- and marijuana's special, because it's hitting a completely different set of receptors in the brain, so it has a lot of potential to be a great complementary therapy and reduce the amount of opiates that one might need to take -- and what you see is you see no potential for overdose and you see a controversial, whether it exists at all, withdrawal syndrome. So in terms of safety profile, there's no comparison. Marijuana is just so much safer. And yet, for patients that are being treated for pain, often a precondition to even get into pain treatment is that you test negative for marijuana.

  • 10:50:42

    MARKI think that's exactly the opposite, where we should really encourage people to lower the amount of the more dangerous drugs they are on and try this as an alternative therapy.

  • 10:50:53

    PAGEMark, thanks so much for your call. Robert Dupont?

  • 10:50:55

    DUPONTSusan, I was the chair of the group for the American Society of Addiction in Medicine, which is physicians specializing in treatment of addiction on the issue of medical marijuana. There's a kind of slight-of-hand going on here. You don't prescribe -- nobody prescribes medicines to take as much as you want any time you want it and to smoke it. We don't smoke medicines. We have specific doses.

  • 10:51:19

    DUPONTTo the extent that any of the specific chemicals in marijuana are therapeutic for any condition, the solution to the problem is to approve those specific chemicals in doses through the FDA and the normal process of establishing efficacy, safety and purity, none of which can be met by marijuana. So it is true that the cannabinoids have therapeutic potential. But it's not to be found in smoked marijuana. It's to be found in purified chemicals that are approved through the normal approval process in this country.

  • 10:51:51

    STERLINGBob, that position has been rejected by the voters and the legislatures of 21 states. The American people, you know, reject that position.

  • 10:52:01

    DUPONTThey don't know the facts when they do that. And when they do, they will support. The public health policies for the approval of medicines are protecting this country. And to go around them through approving medicines by ballot initiatives is an absolute violation of any principle of public health.

  • 10:52:19

    PAGEI'm going to have to say, one of the things that I think has fueled medical marijuana initiatives is people are familiar with friends or family members who are undergoing chemotherapy. And illegally obtained marijuana is one of the things -- one of the few things that provides real relief for them.

  • 10:52:35

    STERLINGSusan, you're right. And, you know, these get dismissed as mere anecdotes. These are case reports. This is medical evidence in the longest tradition of the study of medicine.

  • 10:52:46

    PAGEI'm Susan Page, and you're listening to "The Diane Rehm Show." Let's get another caller. We'll go to Indianapolis and talk to Mousa. Hi, you're on the air. Thanks for holding on.

  • 10:52:54

    MOUSAAll right. I have two questions. One, the first question is I'd like a definition of a drug. And the second question is what makes marijuana a drug?

  • 10:53:04

    PAGEAll right. That's a great question. Let's ask Robert Dupont.

  • 10:53:07

    DUPONTWell, a drug means many things. It's not a simple thing. In the context we're talking about, it's a chemical that is used in a context of drug abuse by drug abusers. It's the kind of chemical that -- this is what the Controlled Substances Act is all about. It's what drug addicts and alcoholics use. There are many chemicals, many medicines that have no interest to those folks and others that do. And marijuana is high on that list of abused drugs by drug addicts and alcoholics.

  • 10:53:35

    STERLINGThat's tautological and to call it -- to simply say it's abused and therefore it's an abused drug, people use the drug for its benefits.

  • 10:53:44

    DUPONTWell, some do, but take a -- any drug...

  • 10:53:46

    STERLINGMost do.

  • 10:53:46

    DUPONT...program, treatment program in the country -- any drug treatment program, ask those people, do they use marijuana?

  • 10:53:53

    STERLINGOf course, the people who need drug treatment go into drug treatment programs. If you're a drug treatment professional, those are the people you meet. You don't smoke pot, Bob. You don't hang out with people who use the drug socially and recreationally and perfectly appropriately in their lives.

  • 10:54:09

    DUPONTI'm not saying everybody who smokes pot is a drug addict or alcoholic.

  • 10:54:11

    STERLINGYou see -- but, of course...

  • 10:54:12

    DUPONTI'm saying how they get labeled drugs. That was the question, how it's labeled. It's labeled because drug addicts and alcoholics use it as part of their drug use.

  • 10:54:19

    STERLINGExactly. It's a stigmatizing term. It's a way of labeling...

  • 10:54:23

    DUPONTIt's a reality.

  • 10:54:25

    STERLINGIt's a way of labeling certain people who prefer to use this drug, these compounds, these medicines, these chemicals in ways that have historically been socially disapproved but, which for the last 40 years, have no longer been disapproved.

  • 10:54:40

    PAGEOne of the other aspects of this, of course, is the economic. We saw Governor Hickenlooper in Colorado predict that taxes from marijuana sales were going to exceed expectations. It's going to be kind of a boon to the state. Beau Kilmer, do we know yet what this is going to mean for Colorado's state coffers?

  • 10:54:59

    KILMERWell, actually the governor had to kind of retract that statement. And, no, actually the estimates are coming in lower. And, in general, look, if you legalize marijuana, money's going to come in. But most of the numbers you hear are inflated. We saw this in 2010 with Proposition 19. People were claiming that if it passed, it would bring in $1.4 billion a year. It turns out that number had absolutely nothing to do with Proposition 19. It was from other analysis of a legislative bill that had been introduced the previous year.

  • 10:55:31

    KILMERAnd the voters in Washington State were told that with legalization it could bring up between, I think, $1.5 to $2 billion in, in the first five years. Well, now that it's passed and they've actually done the numbers, it turns out that was off by an order of magnitude. Now that's not...

  • 10:55:46

    PAGEAnd is that because fewer people are buying marijuana than they had expected?

  • 10:55:52

    KILMERNo, well part of the story is, is the economics of this. So I just finished doing a report for the White House, where we estimated that Americans spend about $40 billion a year on marijuana. Now, some people will do these calculations and say, oh, wow, $40 billion. If we place a 10 percent tax on that, we're going to get this much money in. But it turns out, when you legalize marijuana, you dramatically reduce the cost, because a lot of what you're paying for is the risk.

  • 10:56:16

    KILMERYou know, right now, when you buy marijuana or cocaine or heroin, a lot of what you're doing is compensating the drug dealers and everyone else along that supply chain for the risk of arrest and risk of incarceration. That goes away with legalization. So those production costs can go down dramatically.

  • 10:56:31

    PAGEBeau Kilmer, he's been joining us from the studios of KQED in San Francisco. Also with us this hour, Eric Sterling from The Criminal Justice Policy Foundation, and Dr. Robert Dupont, president of the Institute for Behavior and Health. Thank you all so much for being with us this hour on "The Diane Rehm Show."

  • 10:56:47

    DUPONTThank you, Susan.

  • 10:56:47

    STERLINGThank you, Susan. This was great.

  • 10:56:49

    PAGEI'm Susan Page of USA Today, sitting in for Diane Rehm. She'll be back tomorrow. Thanks for listening.

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