Legalized Marijuana In California Could Hurt Public Health, Analysis Says

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, Feb. 2 on the University of California’s eScholarship Initiative escholarship.org/uc/item/4qg8k9wz.

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.

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 top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.