The public health community is not thrilled with the idea of marijuana’s emerging legalization in the United States, especially when it comes to the prospect that it could increase access to marijuana among teenagers. On the other hand, there is widespread agreement that prevention and treatment is a better policy than making arrests, and experts recognize that it’s time to give more thought to “Policy Strategies to Reduce Youth Recreational Marijuana Use,” or, in other words, how to child-proof marijuana legalization.
This was the subject of a column by Brendan Saloner, Emma McGinty and Colleen Barry in the May 2015 issue of Pediatrics, the Official Journal of the American Academy of Pediatrics from the Johns Hopkins Bloomberg School of Public Health.
The goal of these public health professionals and their colleagues is to protect the health of children and adolescents—a concern heightened by considerable research highlighting the risks of marijuana use in this age group. To their credit, they recognize that “legalization with strong regulation potentially provides greater scope for protecting children than decriminalization policies, which on their own reduce criminal penalties without controlling marijuana supply and price.”
Their recommendation is to learn from societal experiences with tobacco and alcohol and to use these lessons to create strong and effective regulations. To this end, they promote four priorities.
First, they want to keep the price of marijuana high through the use of excise taxes.
This is the most controversial of their four proposals. The argument is that excise taxes have lowered the use of alcohol and tobacco, especially with respect to adolescent use. Also, the idea here is that if marijuana is kept expensive in legal markets, it will be harder to resell on the black market, making it hard for legal marijuana to find its way into the hands of teenagers.
This is controversial because it suggests that adults should pay artificially inflated prices for marijuana as a way of preventing adolescent use. It is also flawed because it overlooks a key difference between marijuana and alcohol and tobacco—it’s a lot easier to produce marijuana outside the legal market, and high prices end up encouraging unregulated production.
Worse, it overlooks the profit incentive behind teenage marijuana distribution—hundreds of thousands of teenagers sell marijuana to their friends now, and an artificially inflated market will not have much of an impact on reducing this commerce. Finding an effective balance between equitable taxation and under-pricing the illegal market remains the most important challenge in devising regulatory frameworks for legal marijuana.
Furthermore, the authors concede that “it will be difficult to limit availability of marijuana to youth through home cultivation of marijuana.”
Otherwise, some of the remaining three policy priorities that Saloner and his colleagues recommend are reasonable, practical and worthy of wide support among legalization advocates.
The second proposal is that retail availability be tightly regulated.
There should be age-restrictions and strong enforcement of existing laws through such measures as compliance audits and stiff penalties for violations. In addition, these scholars recommend that locations of legal marijuana stores be regulated to keep them away from schools and playgrounds and that marijuana be kept out of stores that sell other products to minors.
A third concern is that regulations should address the potential problem of children accidently ingesting marijuana, specifically edible products such as marijuana-infused candy and baked goods. They seek child-resistant packaging, clear labeling and consideration of appropriate limits on THC dosage for individual edible products.
Finally, they propose that “youth exposure to marijuana marketing should be minimized.”
The problem here, from a public health perspective, is that alcohol and tobacco advertising “lowers adolescents’ perception of risk and increased social desirability, initiation, and substance use.” This proposal runs into some problems with free speech rights, as have similar proposals to ban various forms of advertising for alcohol and tobacco. However, restrictions targeting media sources that have large youth audiences have been allowed with respect to alcohol and tobacco, and similar restrictions regarding marijuana ads targeting teenagers are legally viable.
One special area of concern to Saloner and his colleagues is the need to regulate the marketing of marijuana-infused candies, “as research suggests that candy-flavored tobacco products are very appealing to adolescents.”
This approach is advocated in Pediatrics because it could substantially reduce the health risks of legal marijuana to teenagers and youths. The authors acknowledge that these risks cannot be eliminated but see the early stages of legalization as an opportunity to create strong and effective regulations—especially regulations that are more effective than current policies regarding the regulation of alcohol and tobacco.
“Future regulations will need to be coupled with credible enforcement and penalties; keeping children and adolescents safe means keeping those who sell and use marijuana for recreational purposes accountable,” the authors state.
Marijuana users and legalization advocates support policies and proposals that promote safe and responsible marijuana use, for individuals and for society at large. These are strategic proposals about broad objectives.
There are many ways to achieve these objectives, and for this reason, they represent good starting points for addressing public health concerns about adolescent marijuana use in a legal environment. More important, these proposals support the argument for legalization by demonstrating that it opens up new opportunities to pursue public health objectives by creating a “greater scope for protecting children” by providing more effective control of the marijuana market.
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