The debate over whether to legalize marijuana is one of the
hottest topics in our current national dialogue. Several states
have legalized medical use of the drug, and two have decriminalized
recreational use. To help make sense of the many issues tied to the
debate, we reached out to Kenneth Leonard, director of UB’s Research
Institute on Addictions, and history professor David
Herzberg, author of “Happy Pills in America: From Miltown to
KENNETH LEONARD: Our approach to marijuana over the past
half century has been wrongheaded in many ways. It has created more
problems than people would have imagined. Legalization will
probably alleviate some of those problems, but we have to be
prepared for it to create others.
DAVID HERZBERG: I will add that seeing this in Manichaean
terms of good or bad is incredibly unrealistic. It’s widely
agreed that alcohol prohibition was a failure as a policy, but
drinking—and drinking-related harms—went down
dramatically. The reality is, life is messy, and we choose to do a
lot of things that carry risks. What we should be focusing on are
regulatory issues. Let’s think about how you make a drug
available to people in ways that minimize the harm that comes from
KL: David’s exactly right. We have lots of
experience with alcohol and tobacco. There are lessons to be
learned in terms of how we can go about regulating marijuana.
DH: We did have something close to a rational drug policy
with Nixon’s 1970 laws, which set up the DEA and the schedule
of controlled substances. The law included money for treatment, it
set up methadone maintenance, it put cocaine and barbiturates in
the same law, as opposed to saying some [drugs] are good and some
KL: That structure makes sense, but the specifics
don’t always make sense. Marijuana is a Schedule 1 drug,
which means it’s a high risk for psychological or physical
dependence. There is a risk, but I don’t know that it’s
a high risk. The overall abuse liability of marijuana is not up
there with the opiates or the amphetamines.
DH: I was just reading this morning that the American
Society of Addiction Medicine came out against medical marijuana.
One of their points was that there isn’t the kind of rigorous
clinical research that we need. I’m thinking, “Well,
it’s a Schedule 1 substance. That tends to put a hamper on
producing the kind of clinical research that you need.”
KL: We’ve only just started looking at potential
medical uses. I think that was a place where researchers
didn’t go easily. Sometimes they’re caught by both
sides of the argument, the “how can you possibly be looking
for any medical benefits from this Schedule 1 drug” and the
“how can you possibly think that any harm is associated with
something that is being used so widely.”
DH: That’s where you have the trouble with drugs,
in that so many of the decisions we make are not scientific but
cultural. The hard part I see for actors like you in history is to
try to persuade people that the information actually matters.
KL: There are harms we can anticipate with regard to
driving, for example. The evidence is fairly clear that it creates
perceptual cognitive problems that increase the likelihood of an
accident. And while we have a very good sense of how alcohol
influences driving—we know the time course, we know the
parameters—we don’t with marijuana. There are strain
differences as well. You know how much alcohol is in a shot of
whiskey, in a general sense. With regard to marijuana, it’s
kind of a crapshoot.
DH: It seems that what’s needed is the time to
develop a culture of understanding. I know what’s in a bottle
of whiskey, partly because of regulations, partly because it says
80 proof and I know what that means. This could be an argument in
favor of rolling out decriminalization very slowly to give the
culture time to catch up.
KL: There’s a paradoxical aspect to this, which is
that while regulations make the drugs safer, we also know that
people’s perception of harm inhibits their use. Lots of
people are taking prescription painkillers because they’re
given out by doctors. We’re seeing major increases in deaths
from that because people view them as harmless. There is this
paradox of making these things safer and then people ignoring the
fact that there’s still harm involved.
DH: This goes back to what we were saying earlier about
black-and-white dichotomies. What we want is a society where we
make decisions that make sense about what benefits we want from
drugs and what risks we want to guard against. And the errors come
on both sides. It’s either, this pill is totally safe, or
this weed is going to drive you insane and make you kill your
KL: At that level there’s no room for a rational
compromise. If we take this more rational approach, there will be
places where I think that we need more regulation and David might
think that we need less. Or the reverse. But we’re going to
be talking in this middle range and not at the extremes.
David: In extremely small doses: about a half-inch of
coffee, with milk and sugar.
Kenneth: I prefer a strong Italian roast with double cream and double sugar.