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 Prozac.”
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 that.
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 are bad.
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 mother.
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.