Marijuana Legalization with Dr. Mitchell S. Rosenthal and Steve Hawkins, Moderated by Richard Wolffe

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ROSENTHAL REPORT - APRIL 2021

The Rosenthal Report, published each month by the Rosenthal Center for Addiction Studies, brings its readers insights and commentary on current issues of drug use.

THE UNPRECEDENTED RUSH TO LEGALIZE MARIJUANA JEOPARDIZES PUBLIC HEALTH AND SAFETY

New York State has legalized marijuana, and New Mexico and Virginia are not far behind in the race to join the 15 states that have already sanctioned legal weed. Why the mad dash to commercialize cannabis? Politicians say legalization of adult-use marijuana is urgently needed to promote social equality and criminal justice reform—while shoring up pandemic-battered state economies. Yet legalization won’t contribute significantly to achieving any of these worthy goals. In fact, it will lead to more use, more addiction and actually hurt those communities already disproportionately harmed by the failed war on drugs—rather than help them, as supporters claim.

Equally troubling is how political leaders routinely ignore just how risky marijuana can be—especially for vulnerable populations, including young people. As states clamor to legalize the drug, a new study by the National Institute on Drug Abuse reveals that many adolescents and teenagers who use marijuana go on to develop substance use disorder, indicating that early experimentation had spiraled into addiction. In fact, a year after trying cannabis, almost 10.7 percent of adolescents age 12 to 17 met the criteria for addiction—similar to the 11.2 percent rate for prescription opioids. This adds to previous research clearly showing that regularly consuming marijuana can affect cognition in adolescents and impair learning and reasoning.

Nevertheless, the legalization bandwagon rolls on. A closer look at some of the details in New York’s legalization bill highlight how flawed the bill is. For example, while the bill includes an opt-out clause allowing municipalities to ban retail marijuana dispensaries—a provision supported by a majority of New York City residents, according to a recent poll—it also sanctions home-delivery services. This essentially means localities won’t be able to keep pot out of their neighborhoods, despite the residents’ wishes.

We can also see the influence of the increasingly powerful cannabis industry, which wants as few regulations and restrictions as possible, in what promises to be a highly profitable market for marijuana companies to thrive in.

Driving under the influence of marijuana also gets a pass, although traffic fatalities due to drug-impaired drivers have increased in most legalized states. Still, the legislation reduces this to a simple violation rather than a misdemeanor—hardly a deterrent to lighting up a joint and getting behind the wheel. In an unusual admission, the bill even acknowledges there’s no effective way for law enforcement to detect driving under the influence of drugs, so it calls on state health officials to “study” the problem and come up with a solution.

And finally, the bill changes the rules for medical marijuana, substantially expanding the list of qualifying conditions to include Alzheimer’s disease, although there’s little evidence the drug provides effective treatment.

Most importantly, the legislation ignores the experiences of other states that are now considering amending their legalization laws due to the negative impact of pot. Colorado, for example, may soon place limits on the amount of intoxicating, high potency THC in marijuana products, after physicians in the state reported an alarming spike in psychotic episodes among young users. By all means, decriminalize low-level possession of marijuana—but please don’t put our lives in danger.

Dr. Mitch Rosenthal on the Unnecessary Disaster of Marijuana Policy

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ROSENTHAL REPORT - MARCH 2021

MEMO TO GOVERNORS: TAKE A LEADERSHIP ROLE IN THE DEBATE OVER MARIJUANA LEGALIZATION

Governors and state lawmakers across the country are ramping up efforts to pass marijuana legalization—and in the rush to enact legislation, are backsliding on provisions that ensure public health and safety. New Jersey Governor Phil Murphy recently signed into law a legalization bill that eased penalties for low-level possession by minors, including a “warning system” that escalates from parental notification to a referral to community service. In New York, Governor Andrew Cuomo revised his cannabis reform initiative to reduce criminal penalties for selling marijuana to a minor. It would be a Class A misdemeanor punishable by up to a year in prison, rather than a Class E felony that typically constitutes up to three years. Cuomo also sanctioned home delivery—after first proposing to bar such services—although this would require community approval.

Today, the governors urging legalization appear to have adopted the pro-pot advocacy groups' playbook. First, they claim that taxing legal weed would generate significant revenue to create jobs, boost post-COVID economic development, and plug state budget deficits—although many states wouldn’t see any money until years after the market has become fully operational. That wouldn’t be much help for New York’s projected $15 billion shortfall.

Next, lawmakers believe that legalization will promote criminal justice reform, social equity, and entrepreneurship in communities of color that were disproportionately harmed under cannabis enforcement laws. While decriminalizing low-level pot use is the correct policy, evidence from presently legal states shows that cash-rich big businesses, including tobacco and cannabis companies, and white-owned smaller firms, are gaining control of the industry.

And finally, these state leaders conveniently ignore the increased costs for law enforcement, healthcare and substance abuse treatment associated with legal weed. New studies show that underage use has increased in California since legalization. Also on the rise in many states, are fatal car crashes while under the influence of drugs, emergency room visits related to marijuana use, and cases of cannabis use disorder, especially among young people.

For all these reasons, I urge all governors considering legalization initiatives to take a strong leadership role and impose a temporary moratorium on further moves, providing time to study the impact so far in legalized states. And if they decide to go ahead with legalization, insist on strict rules and regulations to control the market—formulated in consultation with addiction professionals, treatment providers and parents of those struggling with substance use disorder.

The governors should make their voices heard far and wide advocating reasonable, evidence-based approaches to cannabis reform.

Letter to the Editor - Anatomy of Addiction

Letter to the editor of The New York Times Book Review. Read it below or click HERE.

Anatomy of Addiction

To The Editor:

In her review of Carl L. Hart’s book “Drug Use for Grown-Ups” (Jan. 17), Casey Schwartz is right to note that many readers might feel “discomfort” when hearing about the author’s “full-throated endorsement” of opiates for recreational use. That includes his own regular use of heroin, which Hart suggests he can easily control and also has benefits. The estimated more than two million Americans who are in need of treatment are not so lucky. For them, addiction has serious repercussions — the loss of friends and family and careers, and the unrelenting need to feed their habit by any means possible — that make life not only miserable but also very risky.

With drug fatalities in the United States at record levels last year and more than 450,000 deaths over the past two decades (a majority of them opioid-related), it is inconceivable how Hart can dismiss the “opioid crisis” in scare quotes, suggesting that it does not exist.

This crisis is real and a public health menace, especially for those who cannot access drug treatment, the most effective way to address the disease of addiction. I agree with Hart that the “war on drugs” has failed, but his war on the reality of addiction is far more dangerous.

Mitchell S. Rosenthal, M.D.
New York

Mitchell S. Rosenthal, M.D., is the founder of Phoenix House and president of the Rosenthal Center for Addiction Studies.

ROSENTHAL REPORT - FEBRUARY 2021

To President Biden and Governor Cuomo: Take Urgent Action Now on Drug Policy

President Biden’s call to put the nation on a war footing to combat the COVID-19 pandemic could also apply to the nation’s ongoing deadly drug crisis. Both Biden and New York Governor Andrew Cuomo now have unparalleled opportunities to do so. With Democrats essentially in control of Congress, there should be little resistance to Biden reversing the Trump administration’s failed drug policies. An initiative to combat the opioid epidemic that Biden outlined during the campaign would be a good place to start, as would plans to decriminalize drug possession in favor of treatment.

For his part, Cuomo could leverage a super-majority in the state legislature to secure increased funding for drug treatment and push forward a cannabis reform plan—one that both protects vulnerable populations and guarantees community control. Although the COVID-19 pandemic and vaccination program remain a priority, government officials cannot ignore last year’s staggering death toll of more than 81,000 Americans from drug overdose—the highest number of such fatalities ever recorded over a 12-month span.

We urge President Biden and Governor Cuomo to consider taking the following steps:

President Biden

• Immediately launch your all-out effort to combat the opioid epidemic. The $125 billion plan over the next decade should be sufficient to match the scale and scope of this “forgotten” epidemic, focusing on treatment, education and prevention, and providing adequate resources to hard-hit communities. With 46 states reporting a spike in overdose deaths last year, this should win bipartisan support.

• Move ahead with plans to end all incarceration for drug use alone and instead divert these individuals to drug courts and treatment programs. This would help reform the criminal justice system and ensure substance users have access to a range of affordable services.

• Maintain opposition to federal-level marijuana legalization, despite pressure from the progressive wing of your party. Taking a go-slow approach to drug policy reform—decriminalizing possession, expunging convictions and leaving it to the states to decide on legalizing recreational cannabis—will end onerous criminal penalties while allowing time to gather accurate data on the impact of legalization so far.

Governor Cuomo 

• Despite a looming budget shortfall due to the coronavirus-related economic downturn, bring funding for drug treatment to pre-pandemic levels and eventually increase support as soon as possible. Providers are currently in a precarious position due to last year’s funding freeze, and are struggling to maintain services during the continuing COVID-19 lockdown.

• Cannabis reform measures in the 2021 budget proposal focus primarily on tax revenues and promoting minority-owned cannabis businesses. Make sure the bill includes both detailed provisions to regulate sales, marketing and distribution of cannabis products and protections for such vulnerable consumers as young people, pregnant women and individuals with mental health issues. In addition, legislation must allow municipalities to opt out of legalization and bar cannabis dispensaries—as a majority of communities have done in legalized states such as California, Colorado and Oregon.

Both COVID-19 and national drug crises are daunting public health challenges. They will test the limits of our healthcare system and political will to overcome unprecedented problems. But with the right leadership, resolve and resources, we are in a good position this year to make considerable progress.

Dr. Mitch Rosenthal on the Crossroad of Federal Marijuana Legalization

https://youtu.be/go2UZSStzuI

ROSENTHAL REPORT - JANUARY 2021

This past year the nation confronted daunting public health challenges. The COVID-19 pandemic killed more than 300,000 Americans and continues to strain our healthcare system. The subsequent lockdowns, social distancing and economic downturn severely impaired the work of drug treatment providers, while the loneliness and stress of the pandemic led to record levels of drug overdose deaths. At the same time, voters in more and more states disregarded warnings of marijuana’s harmful health impacts, and—swayed by such purported benefits as additional tax revenues and social justice that have not for the most part materialized—approved the drug’s legalization.

Throughout the year, the Rosenthal Center addressed these and other issues by offering insightful commentary and in-depth reports across our print and online channels. Our goal, as always, was to inform the public, policymakers and addiction professionals about ongoing drug crises—and to offer viable solutions. Here are a few highlights:

Telehealth and the Opioid Epidemic

As the pandemic worsened and overdose fatalities spiked, state and federal authorities loosened limitations on drug treatment. A special edition of the Rosenthal Report looked at how practices such as telehealth and telemedicine were providing services. The conclusion was that online treatment is beneficial for many individuals but is not a panacea for substance use disorder or a replacement for in-person treatment.

Reforming Law Enforcement and Drug Policy

The eruption of civil unrest this year over race, policing and incarceration led to calls for radical reform of law enforcement and drug laws. We examined two innovative programs in New York State: one in Albany that diverts individuals to drug treatment while they remain in jail (where services are often lacking), and another in Buffalo, in which the police and addiction professionals work together to help individuals in crisis and refer them to treatment rather than the criminal justice system.

Shifting Public Views on Marijuana Legalization

Overall, the movement to legalize marijuana gained ground, with supporters claiming widespread public approval of cannabis reform. But the 2020 Rosenthal Cannabis Report revealed some surprisingly different perspectives—namely that a majority of those surveyed favor curbs on commercialization of marijuana and even a moratorium on legalization until we know more about its impact. We continue to make these findings public in order to influence cannabis reform policy.

Justice for Victims of the Opioid Epidemic

 Efforts to resolve thousands of opioid lawsuits moved ahead, although some proposed settlements failed to adequately compensate victims and communities for the losses they endured during the decades-long opioid epidemic. I spoke out strongly in favor of a monetary settlement that reflects the vast scale of the crisis—and not only ensures justice for those who suffered, but also guarantees funding that goes directly to expanding drug treatment.

 As the year has come to a close, I am encouraged by the incoming Biden administration’s proposed drug policies. Most important is an ambitious $125 billion initiative over the next decade to combat the opioid crisis. Biden opposes federal-level marijuana legalization, but advocates decriminalizing drug possession and expanding drug treatment. The President-elect’s pick for Secretary of Health and Human Services Secretary, Xavier Becerra, has focused on anti-vaping initiatives among youth as California’s Attorney General. And finally, Biden might bring the nation’s “drug czar” back to the Cabinet, giving that position more prominence and power.

I look forward to seeing what happens in the New Year, and am cautiously optimistic about what lies ahead.