By R. Scott Rappold
WebMD Health News
Reviewed by Brunilda Nazario, MD
Nov. 6, 2014 -- When the first legal sales of recreational marijuana in modern history began Jan. 1 in Colorado, it was a bold experiment fraught with unknowns.
Would kids get easy access to the drug? Would stoned drivers make the highways more dangerous? Would drug addiction problems increase?
While there isn't enough data yet to answer some of those questions, one thing is clear: There is a rising tide of public support for marijuana legalization in America. Voters in Washington State approved it in 2012, and earlier this week, voters in Alaska, Oregon, and Washington, D.C., approved legalizing recreational marijuana.
Some of the lessons being learned in the Rocky Mountains could be instrumental in other states, as public health officials figure out how to regulate a drug that has been illegal for 8 decades.
Commercialization of Marijuana
Even before the first recreational stores opened in 2014, marijuana storefronts were a presence in most Colorado communities.
Since 2009, a loosening of regulations led to a growing medical marijuana industry, in which residents who received a doctor's recommendation and applied for a state license could walk in and buy marijuana. There are today nearly 500 such dispensaries in Colorado.
Since Jan. 1, another 212 recreational stores have opened. In these stores, state residents 21 and over can buy up to an ounce of pot at a time. Out-of-state residents can buy a quarter-ounce. While some cities, including Colorado Springs, have banned the stores, in the Denver and Boulder areas and most resort towns, marijuana is visible and available.
Not everyone is happy about that. The mainstreaming of marijuana led Gina Carbone to co-found Smart Colorado, which calls for stricter regulations on the marijuana industry.
"What we've seen in the roll-out of this is the mass commercialization and the mass marketing of marijuana," Carbone says.
"The more stores you have around, the more visibility, the more normalized it becomes, the greater the youth use is, because the perception of harm at the same time is plummeting," she says.
Carbone would've preferred for Colorado to have followed the Washington model, where the number of marijuana stores are limited. Seattle, for example, will have just 21 stores.
When an adult comes to the University of Colorado Hospital complaining about ingesting too much marijuana, the symptoms are usually anxiety, nausea, or vomiting, but it's not life-threatening unless associated with another substance or an injury.
But when a child comes in, emergency department head Richard Zane, MD, has observed instances of a breathing problem called respiratory depression, which can be life-threatening.
Since legalization, he has seen a sharp increase in such cases, and he points the finger at edibles infused with THC, the psychoactive ingredient in marijuana.
"I think the way in which marijuana became legal in Colorado was pretty careless, specifically around the total lack of regulation or control around edible products, which have been causing the most impact on health," Zane says.
Edible items available in marijuana stores run the gamut from sodas to chocolates and many other kinds of candies. Adults who take too much are often novice users who perhaps didn't read or understand the label indicating the amount of THC, or ate some and didn't wait long enough for it to take effect before having more.
But children usually have no idea what they're eating, whether they got the item from a friend or from their parents' stash.
"To an 8-year-old, a gummy bear looks like a gummy bear," Zane says. "It's unconscionable to make a THC product that looks like a child's sweet."
The concern led the Colorado Department of Public Health and Environment (CDPHE) to recently propose a ban on almost all edibles.
"We had some pretty strong recommendations," says CDPHE head Larry Wolk, MD. "If the industry isn't going to do a better job on how they package and make this stuff not appealing to kids, our position has to be the only edible we can endorse are drops, where you can make your own, and single-serving tinctures." The proposed edible ban, though only an idea, caused an outcry in an industry where 45% of marijuana sales are from edibles.
"A total ban defies logic," says Mason Tvert, who spearheaded the legalization effort in Colorado and now is spokesman for the Marijuana Policy Project. "Voters ended marijuana prohibition because they wanted to take marijuana out of the underground market. To go back to prohibiting a very popular product would simply result in it being produced and sold illegally."
A state task force looking at the issue has yet to make a decision. Other ideas include requiring child-proof containers for edible products, stronger labeling and dosing recommendations, a symbol on edibles, and limiting their THC content.In Washington, edibles are regulated much more toughly. Candies and lollipops are banned. And while cookies and brownies are allowed, they must be divided into doses and can't be marketed in a way that makes them similar to a non-marijuana product.
Marijuana and Teens
Teens using pot is nothing new, but one of the main concerns of legalization was that it would lead to a spike in use. But the state's Healthy Kids Colorado Survey, done every 2 years and released in September, showed 36.9% of high-schoolers had ever used marijuana, below the national average of 40.7%. The number who'd admitted using it in the preceding month dropped by 2% from 2011.
Still, law enforcement groups say marijuana problems are on the rise in schools. In one survey, 89 out of 100 school resource officers said marijuana-related incidents have increased in their schools.
Recreational stores are not allowed to sell to minors, and in a recent compliance check in Denver, not a single store sold to minors.
"I think we've kept it away from causing significant harm to kids, whether that's as a result of packaging or limitations that are put in place by the stores, or safety concerns, or heightened parental awareness," Wolk says.
The state spent as much as $2 million on an anti-marijuana education campaign aimed at minors in 2014, he says, and it will spend twice that much in 2015, funds derived from taxes on marijuana.
Driving while high is illegal in Colorado, but whether legalization has led to a rise in stoned driving is not yet clear.
The Colorado State Patrol, through September of this year, cited 497 people for driving while under the influence of marijuana -- though about half of those cases also involved alcohol or another drug -- out of 4,177 impaired driving citations.
But the agency only began keeping statistics separating marijuana from other drugged-driving cases this year. So, with no comparison data, both marijuana supporters and law enforcement agree more data is needed to learn legalization's impact.
It will also take several years of data so show whether legalization has led to a spike in marijuana addiction and rehab visits in Colorado. Legalization critic Ben Cort, director of professional relations for a Denver treatment center, believes it will.
"They've got to expand demographics, and they're not shy about this," he says of the marijuana industry. "You've got a need to get new people using the substance, and you've got to get current users to consume more."
Opponents to legalization in Oregon pointed to data that shows adult marijuana use has gone up in Colorado since medical marijuana became widespread, and warned that would happen in Oregon.
But, says marijuana activist Tvert, "there's nothing wrong with an adult consuming marijuana responsibly, just like there's really nothing wrong with an adult having a glass of wine with dinner or a beer while watching a sports game.
"For decades, law enforcement officials have been trying to scare the public into keeping marijuana illegal. This is just more of the same, but the public is seeing through that."
So can Colorado's experiment be called a success? While Tvert says it will take years to answer some questions about the results of legalization, he does believe so.
"We've got hundreds of businesses that are tightly regulated, collecting taxes and providing a substance that's less harmful than alcohol to adults who would otherwise get it in the underground market," he says.
Marijuana is expected to bring in more than $100 million in tax revenue this fiscal year and has created thousands of jobs in Colorado.
"We're on the right side of history, and if there are concerns about us being the first state or one of the first states, that is something that will inherently change in the next few years," Tvert says.
Cort says that while he respects the will of the voters, he doesn't think they knew what legalization would look like in reality. He says other states where legalization has passed could benefit from waiting to see what happens in Colorado.
"Lots of other states moving forward before Colorado has had an opportunity to showcase what's really happened-- that is rash," he says. "If everybody is calling Colorado an experiment, if we're the canary in the coal mine, then give us a minute to see if we're singing or we're dead."
Wolk, the state's public health director, expects to have a clearer picture of legalization by spring 2015, when the Retail Marijuana Public Health Advisory Committee will release its findings on the first year of legalization.
The report will look at hospital visits, impaired driving incidents, teen use, rehab visits, and many other metrics. In the meantime, he believes the state is doing all it can, given the mandate to allow and regulate legal sales issued by voters in 2012.
"It's been challenging, but I think it's been an interesting challenge for us," Wolk says. "I believe we're asking the right questions. I believe we're getting the right messages out and we're studying what we should be studying, and hopefully by next year we'll have some data and some answers."
But, he says, "I'm not sure we'll ever be able to say this has been an absolute success or a terrible failure."
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