Health and Behavior
The persistent concern about the health-related effects of marijuana requires both an immediate and a continuing response. First, as the report of the Institute of Medicine (1982:5) recommends, there should be "a greatly intensified and more comprehensive program of research into the effects of marijuana on the health of the American people." An important goal of this research program should be the identification of subgroups at high risk for physiological and psychological damage in relation to patterns of use and doses of marijuana. The report presents a detailed agenda of needed research. Second1 to the extent that potential health hazards are identified, policy research should address possible safeguards and precautions to protect the user.
If marijuana use can be scientifically shown to entail grave risks--to the brain, the cardiovascular and respiratory systems, or to reproductive functions, for example--that are currently not known, it can be argued that, as was the case with cigarette smoking, knowledge of those effects will be more effective than criminal enforcement as a deterrent to use.
Drug Markets
Research on the price elasticity of demand in legal and illegal markets is a clear priority. The result of such research will be important in determining the likelihood of controlling heavy use through price mechanisms and in computing the amount of money--if any--that could be realized in taxation of marijuana.
Present knowledge of the structure and activities of drug markets and networks is insufficient to allow prediction of the effects of policy changes on them. Research in this area is difficult but the questions are important. If many dealers who sell cocaine, PCP, amphetamines, and barbiturates as well as marijuana would be put out of business if marijuana were available through legal channels, it might result in a curtailed market for a variety of other drugs. On the other hand, it is also possible that the market structure is so loosely organized, and dealers so transiently involved, that removing marijuana from the illegal markets would have little effect. To be sure, much research on some of these questions could not be conducted unless a regulatory system were in place in some state. Nonetheless, some research, particularly ethnographic and economic studies, should be undertaken now to discover the importance of marijuana profits to drug-dealing networks; the transiency, size, and nature of such networks; etc. It is essential for research in this area to be supported by appropriate government agencies.
Effects on Use
Although many questions remain to be answered before the most informed choices can be made between prohibiting and regulating supply, there are many things that cannot be known unless some jurisdiction tries a regulatory policy. Although adoption of a regulatory policy is likely to result in increased use, little is known about changes in patterns of use that are likely to result. If federal laws prohibiting supply are changed to allow states to license marijuana sales, epidemiological research programs must be ready to monitor any changes in use and their consequences. To do so, research should be organized and operating well in advance of any such policy changes in order to determine rates of use before the change. Although the shift in the law from complete to partial prohibition in 11 states has apparently had little effect on consumption patterns there, we do not know the degree to which legally available marijuana would attract a larger market. The impact on use of educational campaigns, health warnings, and informal social controls under a regulatory system should be investigated.
In the absence of the opportunity for states to adopt regulatory policies, there can only be educated guesses about which age groups are likely to increase use or whether individuals who now use marijuana will use more, etc. Meanwhile, every bit of analysis to predict the answers to these questions, by surveying public attitudes, assessing past experiences with the spread of drug use in society (e.g., alcohol use following the repeal of Prohibition), and critically reviewing the experience of other societies in which marijuana is more readily available, will be valuable.
Marijuana regulation would permit systematic provision of comprehensive, clearly communicated health warnings on package inserts or covers, in public health education, by medical practitioners, and by public health interest groups as well as by the government. The extent to which such warnings would have more credibility for users than current health warnings, generated in an atmosphere of prohibition, is an important subject for research. Despite widespread pessimism about the failures of drug education campaigns, there are encouraging results in educational approaches based on the Stanford Heart Disease Prevention Program experience. With appropriate, research-based models and techniques, public health education may be an attractive means for limiting excessive use (see, e.g., Maccoby, 1979).