2020 Rosenthal Center Cannabis Perceptions Poll
Politicians must recognize Americans' changing perceptions of marijuana
ROSENTHAL REPORT - JULY 2020
Rosenthal Cannabis Study Highlights Changing American Attitudes Toward Marijuana
Amid growing concerns over the risk marijuana poses to public health, the 2020 Rosenthal Cannabis Study finds strong public support for slowing the rush to legalize marijuana and tightening controls on commercialization and sales—even as more and more Americans consume the drug. This issue of the Rosenthal Report provides an in-depth look at the results of our exclusive marijuana survey in the context of the COVID-19 pandemic and the movement for much-needed criminal justice reform.
An unexpected consequence of both the corona virus outbreak and Black Lives Matter protests has been the spotlight they have put on the nation’s evolving—and often contentious—marijuana policy. Cannabis consumption during the COVID-19 lockdown led to debate over whether retail sales of the drug should continue as an “essential service.” Meanwhile, many are using marijuana decriminalization/legalization as a way to promote racial justice in communities of color—which have suffered disproportionately high incarceration rates as a result of the war on drugs. And with increasing economic losses, many states are looking to plug budget deficits with tax revenue from marijuana sales.
Marijuana’s increasingly prominent role in American society, and therefore in shaping public policy, raises important questions concerning what Americans really think about cannabis—and in line with these shifting perceptions, how we should move forward as a nation with legalization and subsequent commercialization. Our Cannabis Study, conducted by Schoen Consulting, offers surprising insights into these attitudes—especially concerning the risks and dangers such legalization poses.
For example, more than half of the respondents in the Cannabis Study believe today’s more-powerful marijuana—including edibles, and other intensely concentrated forms of the drug with high levels of THC—are potentially harmful, especially to adolescents. Furthermore, 60 percent are certain or at least somewhat sure cannabis is addictive, and 6 in 10 are concerned about its effects on pregnant women. The study also found that nearly half of those surveyed favor pausing legalization until more research can determine the long-term effects of use.
These findings dovetail with a growing number of clinical studies that detail the downsides of marijuana use, and the consequences of legalization. These include the negative impact of the drug on adolescent cognitive abilities and fetal development, and the difficulties of withdrawal for those diagnosed with cannabis use disorder. In addition, a recent report by the University of Michigan found an increase in cannabis-related hospitalizations and emergency room visits since medical marijuana was legalized 14 years ago in the state—as well as a tripling of fatal car crashes in which the driver was under the influence of marijuana.
It was no surprise then that our survey found two-thirds of Americans support curbs on the commercialization of marijuana, and 78 percent want to see warning labels (similar to those on alcohol and tobacco) on pot products.
Respondents also favor local-level control, with more than 40 percent saying communities should have the right to opt out of allowing medical and recreational cannabis in their neighborhoods. And roughly 80 percent endorse mandating marijuana dispensaries be located at least 1,000 feet away from schools, parks and playgrounds.
Given these growing doubts and fears, the Rosenthal Center again urges policymakers to pause the legalization process in order to better assess both the risks and possible benefits of marijuana. And as legalization invariably moves ahead—in one form or another—we must make sure there are proper, fact-based rules in place to regulate the marijuana market and access to it.
Reforming the criminal justice system and helping cash-strapped states raise tax revenues in the post-pandemic period are worthy goals. But they should not come at the cost of safeguarding public health and well-being. The notion that marijuana legalization could be an antidote for a number of the nation’s most pressing problems is not only overly simplistic—it’s potentially harmful.
ROSENTHAL REPORT - JUNE 2020
The death toll from the corona virus recently surpassing 100,000 marks a grim milestone, as states grapple with reopening the country while protecting the public from further spread of the pandemic. In the shadow of this tragedy is another deadly epidemic that must be addressed—the opioid crisis that has killed more than 400,000 Americans over the past two decades. In this edition of the Rosenthal Report, we look at major issues surrounding the opioid crisis and the pandemic.
“Deaths of Despair” Expected to Rise
Drug overdoses and fatalities are increasing in many regions of the country, as those struggling with substance abuse during the pandemic face the challenges of sheltering in place and obtaining drug treatment—as well as economic hardships. These can be categorized as “deaths of despair,” a term broadly defined by Princeton University economists Anne Case and Angus Deaton as resulting from long-term social and economic decline.
According to a new report by the Well Being Trust, the massive unemployment, mandated social isolation and extraordinary uncertainty Americans are experiencing due to the pandemic will likely cause this level of “despair” to grow. The report forecasts an additional 75,000 “deaths of despair” from alcohol, substance abuse and suicide over the next decade—on top of nearly 70,000 deaths annually from drug overdose. Now, more than ever, we must address the root causes of these deaths by allocating significant funding for both economic development and the expansion of drug treatment and mental health services. Even if the corona virus winds down in the months ahead, the ongoing opioid crisis will test our commitment to those who have been forgotten about for too long.
Note to Congress: Fix the Drug Treatment Funding Snafu
More money could have been flowing to drug treatment programs through the nearly $2 trillion CARES Act approved by Congress for wide-ranging pandemic relief efforts. Unfortunately however, a technicality involving eligibility requirements for Medicare and Medicaid allowed only a small portion of the $175 billion in emergency aid earmarked for hospitals and other healthcare facilities to be set aside for drug treatment centers that serve nearly a million patients (Medicaid alone is the biggest payer of addiction services). Congress could easily fix this bureaucratic glitch—and thereby unleash millions of dollars for drug treatment as facilities anticipate a crush of new patients.
Opioid Lawsuits Target Pharmacy Chains
Despite the pandemic lockdown, opioid lawsuits are continuing nationwide with huge pharmacy chains including CVS, Rite Aid, Walgreens and Walmart coming into the legal crosshairs. After initially eluding close scrutiny, these chains—along with prescription pill manufacturers and major drug distributors—are now being accused of complicity in the opioid epidemic for failing to monitor or regulate the flood of painkillers distributed by their retail outlets. For example, one recently unsealed complaint charges that between 2006 and 2014 more than 64 million doses of oxycodone and hydrocodone painkillers were disbursed in one Ohio county alone—the equivalent of 290 pills for every man, woman and child residing there.
The complaint also details allegations of corporate greed and misconduct at an unprecedented scale. Pharmacy chains purportedly offered bonuses to pharmacists who filled a high-volume of opioid prescriptions, promoted extremely addictive opioids as safe and effective, and helped distributors avoid federal oversight. Whether the thousands of opioid lawsuits will eventually come to trial or end with a nationwide settlement remains uncertain. What is clear, from the latest revelations, however, is pharmacy chains must also be held accountable for the suffering and death they’ve helped to cause.
ROSENTHAL REPORT - May 2020
Pot and the Coronavirus Pandemic
Last month the Rosenthal Report examined the impact of the coronavirus pandemic on the opioid epidemic, looking primarily at how the lockdown has made drug treatment more difficult to obtain, thereby increasing the risk of relapse and overdose for those struggling with substance abuse. This issue focuses on the pandemic’s influence on marijuana consumption, public policy and the future of cannabis legalization.
It came as no surprise that pot sales spiked as states began issuing shelter-in-place orders. Across the country, both in states that have legalized pot and those that have not, consumers stocked up on enough cannabis products to see them through the quarantine. After many states took the unusual step of equating pot shops with grocery stores, pharmacies and gas stations in declaring them an “essential service,” marijuana enterprises ramped up online sales and home delivery options, to help customers avoid social contact.
Massachusetts was an exception. There, Governor Charlie Baker limited sales to medical marijuana, saying he didn’t want tourists flocking to his state specifically to buy recreational cannabis, thus increasing the risk of the virus spreading. As a result, registrations for medical marijuana rose 247 percent in just a few weeks. The marijuana industry also responded to Baker’s decree by suing to have the ban lifted. But a judge ultimately rejected their argument—a clear win for states to regulate markets to ensure public health and safety.
Such defeats have not stopped the industry from pushing its agenda. The cannabis lobby is urging Congress to allow federal coronavirus relief to aid cannabis-related activities, which is now federally prohibited. Such appropriation would be unwise, given the possible link between vaping and smoking marijuana—which can compromise pulmonary function—and negative respiratory outcomes from COVID-19, especially among younger patients.
Looking ahead, the pandemic will likely stall further efforts to legalize marijuana (currently, 22 states allow medical use and 11 states plus Washington, D.C. permit recreational adult use.) Before the virus struck, more than a dozen states—including New York—were set to vote on liberalizing medical and recreational cannabis laws by the end of the year; today, only a few are likely to go ahead. Social distancing rules have stopped petition-signing campaigns by pro-pot advocates, while politicians obviously remain preoccupied with the pandemic.
Given the current state of affairs, the Rosenthal Center repeats its call for a pause on further marijuana legalization. This would provide an opportunity to closely study the effects on consumption patterns and users’ health in legalized states—and time to analyze the impact of existing regulations and restrictions, and determine what further precautions might be needed. If legalization does go ahead it is critical that sensible rules governing the marijuana market be established—based on facts that are unfortunately in short supply.
ROSENTHAL REPORT - APRIL 2020
Combat the coronavirus, but don’t forget the opioid epidemic
The coronavirus pandemic is a public health challenge of unprecedented proportions—one that requires massive resources to treat its victims and stop its spread. At the same time, we must not lose sight of the ongoing and deadly opioid epidemic facing our country, which continues to kill nearly 180 people every day, and has killed more than 400,000 over the past 20 years. Now, as we take on COVID-19, it’s critical for government and healthcare providers to adapt policies for controlled substances that will provide services to people battling substance abuse, a population that is particularly vulnerable at this time.
Social distancing in response to the pandemic is impacting the hundreds of thousands of Americans taking part in medication-assisted treatment (MAT), who must visit drug treatment clinics and other facilities every day in order to receive their addiction-withdrawal medication—primarily the drugs methadone and buprenorphine—as well as behavioral therapy and peer-based coaching. Patients are forced to travel to these sites to pick up their medicine, and then often face long lines and crowded waiting areas, thereby significantly increasing their risk of exposure to the coronavirus. These drug users are then likely to spread the disease among their communities of other drug users. Choosing not to receive treatment is also not a viable option, as doing so would lead to severe withdrawal symptoms. In many cases, access to outpatient care is being limited, and some patients are simply being turned away.
These issues are being addressed head on by the Drug Enforcement Agency and the Department of Health and Human Services. In a prudent move, these agencies have relaxed stringent, long-held regulations limiting access to these critical opioid-based addiction-withdrawal medications. For example, in order to reduce the number of return visits to the clinic, methadone patients are now being provided with four weeks’ worth of take-home doses, with no state or federal sign-off required.
Buprenorphine, a drug that must be taken daily, is now being treated more like a non-addictive medication that can be prescribed by any physician and simply picked up at a pharmacy by the patient. Or, after an initial consultation, the drug can be prescribed through telemedicine after an initial consultation, rather than through subsequent in-person personal evaluations. This also reduces patients’ potential exposure to the virus. In addition, signing up for Medicaid in New York State can now also be done online through telehealth, making it easier to participate in the program’s free drug treatment.
Overall, these critical policy decisions can keep substance abusers supplied with the medications they need while reducing the risk of exposure to the coronavirus. But, as we look ahead to a time when COVID-19 is no longer a threat, let’s seek to retain the regulatory changes that enable wider access to treatment, while also ensuring access to the full range of behavioral treatment services and peer support to reduce the incidence of drug overdose and aid lasting recovery.
Dr. Mitch Rosenthal on the Perspectives of Marijuana Legalization in the Democratic Primary
ROSENTHAL REPORT - MARCH 2020
Where the Democrats Stand on Marijuana Legalization: From Bernie’s Weed for All to Bloomberg’s We Need More Science
With 22 states now permitting the medical use of cannabis, and 11 states plus Washington, D.C., also having made adult-use of recreational pot lawful, the movement to legalize marijuana nationwide has clearly reached a turning point. Additional states, including New York and New Jersey, will address the issue this year as the presidential campaign unfolds. While legalization has so far been a peripheral issue—along with the opioid epidemic, which has killed more than 400,000 Americans—the wide range of proposals from the current field of Democratic candidates reflects a growing polarization between radical strategies and the go-slow approach favored by the Rosenthal Center.
In the progressive lane, Senator Bernie Sanders pledges to sign an executive order on his first day in the oval office directing the attorney general to declassify marijuana as a Schedule One drug, clearing the way for Congress to pass a bill to legalize the drug at the federal level. Next would come decriminalization and the expungement of past convictions. Senator Elizabeth Warren also wants to legalize pot, but would do so by appointing people who support legalization to lead the FDA, Department of Justice and the Office of National Drug Control Policy, and proceeding from there.
Warren and Sanders are more concerned about social and economic justice than the health and well-being of those using the drug. To compensate certain communities that have been disproportionately harmed by harsh drug policies—such as those of color—the Vermont senator promises to use marijuana tax revenue for a $20 billion grant program for “entrepreneurs of color” to start their own pot businesses and growing operations, and $10 billion for victims of the war on drugs. Meanwhile, Warren would support women- and minority-owned cannabis businesses while reducing federal funding for law enforcement in non-legal states that fail to adequately address the issue of racial inequities in marijuana arrest rates.
Among the moderates, Joe Biden has flip-flopped from being an ardent marijuana opponent to grudgingly supporting some sort of legalization. This follows both the party’s general drift in that direction and his disavowal of previous support for criminal justice bills with tough penalties for drug offenses. Biden would now let states set their own policies on legalization while enabling more research to better understand the drug’s impact.
For his part, Mike Bloomberg has also “evolved” on legalization, from once calling it “the stupidest thing anyone has ever done,” to backing decriminalization for low-level offenders, expunging criminal records, and allowing legal states to remain so. Most importantly, Bloomberg is rightly concerned about the effect of pot on teenagers, stating during the South Carolina debate, “it’s just nonsensical to push ahead [with legalization] until we know the science.”
And what if President Trump gets re-elected? In 2016, he said legalization should be left up to the states. But now there are suggestions Trump might take a stronger anti-pot stance to counter the more liberal Democratic proposals, depending of course on whom his opposing candidate might be.
This leadership uncertainty among likely candidates comes as the pro-pot lobby is intensifying its efforts in many states at the same time parent and neighborhood groups are making clear their desire to keep pot out of their communities. The most reasonable approach therefore would be to seek consensus across party lines, acknowledging the reality that marijuana does in fact pose a risk to many individuals, especially young people. And as legalization invariably moves ahead—in one form or another—to protect children by, at the very least, implementing strict and regulations on how, where and to whom pot products are sold.
Dr. Mitch Rosenthal on Politicians' Lack of Attention to the Opioid Crisis
Dr. Mitch Rosenthal on the Realities of the Opioid Crisis
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ROSENTHAL REPORT - FEBRUARY 2020
The United States of Marijuana—What to Expect in the Year Ahead
Illinois rang in the new year by legalizing the sale of recreational marijuana. Long lines formed at dispensaries, and government officials began counting all the increased tax revenue from first-day sales that topped $3.2 million. Unlike most of the other states to legalize marijuana, which did so via referendum, Illinois took legislative action. The victory, along with consumer demand and overwhelming popular support, signals the likelihood that more states will loosen their laws or fully legalize pot in 2020—that is, unless more reasonable voices prevail.
The debate in New York State, which centers less on the well-documented potential health hazards and more on how to divvy up the spoils, illustrates the tactics guiding marijuana legalization. After failing last year to pass legislation approving adult-use recreational marijuana, Governor Cuomo is winning over lawmakers by addressing hot-button issues. One is social and economic justice for communities disproportionately penalized by past drug laws. The other is a commitment to spend tax revenue on the “social good”—ironically, for drug treatment and prevention programs—as well as educating people about the risks posed by marijuana.
Let’s consider each of these arguments. Certain communities, such as those of color, have indeed been unduly hurt by harsh drug policies. But ensuring low-income and minority entrepreneurs get a share of the soon-to-boom pot market will not “repair the damages…from the war on drugs,” as Cuomo’s new “Weed Czar,” Norman Birenbaum, has claimed. Rather, it would likely bring more drugs and despair to those communities, whether they are inner city or in rural areas upstate.
Recycling tax revenues from pot sales to treat drug addiction is also a flawed concept. While the lure of tax dollars animates support for legalization among government officials and politicians—including most of the Democratic presidential field—many states that legalized have so far failed to reap the expected tax windfall. Moreover, any additional revenues would no doubt be needed to pay for a host of increased costs—including drug treatment and law enforcement—related to a spike in cannabis use.
In addition, this false argument provides cover for the government’s current failure to adequately fund drug treatment. With the opioid epidemic still raging, and meth and cocaine use on the rise, there is no time to wait for tax money from weed sales to ensure treatment is available for people struggling with substance abuse.
Still, there is some hope for a more sensible approach that focuses on regulation. Birenbaum, himself, has said as much, noting marijuana-related products should not be “marketed or distributed to the most vulnerable members of our community, particularly children.” Cuomo also indicated that new legislation would, as before, include an opt-out clause for counties that don’t want pot stores.
While marijuana possession should be decriminalized, there must be a regulatory structure in place to control how, where and to whom products are sold. In addition, the FDA needs to crack down on vaping devices that contain marijuana, as well as fraudulent claims for the marijuana derivative CBD. Ideally, imposing a national moratorium on further legalization would provide sufficient time to study its impact so far. But given the current political climate and powerful pot lobby, that is unlikely to happen.
Dr. Mitch Rosenthal on the Trump Administration Backpedaling on Vaping
Dr. Mitch Rosenthal on the FDA's Lackluster Response to the Vaping Crisis
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ROSENTHAL REPORT - January 2020
The Year in Review: 2019
The year began with a glimmer of hope for some progress combating the opioid epidemic, arguably our nation’s worst public health crisis. Thousands of lawsuits against the opioid industry were set to go to court with potentially large financial settlements ultimately being used to expand drug programs. There were also a number of innovative initiatives, launched by cities and states that were starting to reduce overdose deaths.
But as 2019 came to a close, the overall picture remains grim: Overdose fatalities nationally are expected to reach a near-record level, and settlement talks for the massive opioid litigation have stalled. This year has also seen an outbreak of mysterious vaping-related illnesses, which appear to be linked to marijuana use in illicit e-cigarettes and other vaping devices. In addition, the vaping crisis brought to light widespread teen nicotine use spurred by easier access to these products and their relentless promotion by the intertwined tobacco and vaping industries.
Despite these setbacks, I remain cautiously optimistic our efforts to address these issues—through the Center’s social media platforms, new podcasts and videos, publications and public outreach—will find broader support, and resonate with politicians and policymakers.
A Wall Street Journal editorial in December, for example, called for a pause in marijuana legalization in order to better ascertain the medical and social risks associated with increased use of the drug. This echoes our proposal, published in an Op-Ed in The Hill, for a two-year moratorium on further legalization—a stance that provoked a strong response from both sides of the marijuana debate.
It was also encouraging that, even as pot legalization seemed unstoppable, New York and New Jersey backed away from such legislation. At the same time, a growing number of communities in states with legal weed have protected their neighborhoods by exercising their right to opt out of sanctioning commercial pot shops. This came on the heels of numerous studies highlighting the dangers of increased marijuana use, especially for young people, and the vaping illness epidemic that has so far killed 54 and hospitalized more than 2,500.
Less encouraging is the Government response to the vaping crisis. Although some cities and states have imposed strict regulations on the flavored e-cigarettes that are so popular with teenagers, the Trump administration caved to industry demands and is likely to modify an initial sweeping countywide ban—leaving the measure weakened as more individuals become sick and die. We continue to press for strong leadership to contain e-cigarette use and teen vaping.
Leadership has likewise been lacking when it comes to opioids. With nearly 70,000 Americans expected to die in 2019 from drug overdose—mostly opioid-related—it is troubling that the crisis has received little attention from the Democratic presidential candidates—not to mention President Trump himself. The Rosenthal Center believes the opioid epidemic must be a policy priority; our proposal for $100 billion in government funding over the next decade is a suitable starting point if we hope to reduce overdose deaths and bolster addiction-treatment services.
Adequate support is more critical than ever because we cannot wait for a possible windfall from the opioid litigation. A substantial settlement, with ironclad guarantees the money will be directed exclusively to addiction services, would be appropriate. But efforts to reach a settlement with the companies that flooded the market with 76 billion prescription-painkiller pills between 2006 and 2012 have bogged down in conflict and infighting while the epidemic rages virtually unabated.
As always, the Rosenthal Center is concerned with the care of adolescents and other vulnerable individuals struggling with addiction. The reason for this was made quite clear to me when I visited young people at the Outreach facility on Long Island. What those teens, ages 14 to 17, told us about their experiences vaping the powerful marijuana component THC—often starting in middle school—is hard evidence the nation is facing a new and formidable drug problem that threatens to ensnare the next generation.
We have the knowledge, resources and determination to confront and overcome these challenges. Looking ahead to 2020, the Rosenthal Center will continue to advocate policies to help those seeking treatment to rebuild their lives without drugs. To achieve success, strong leadership is required at every level of government—city, state and federal—as well as the participation of the private sector to establish a comprehensive nationwide anti-drug effort.