Legalize pot, but don’t normalize it

That is the topic of my latest Bloomberg column.  Here is one bit:

You might wonder why we should be so worried about public marijuana use. To put it bluntly, I see intelligence as one of the ultimate scarcities when it comes to making the world a better place, and smoking marijuana does not make people smarter. Even if you think there is no long-term damage, right after smoking a person is less able to perform most IQ-intensive tasks (with improvisational jazz as a possible exception). By having city streets filled with pot, pot stores and the odor of pot, we are sending a signal that our society isn’t so oriented toward the intellect or bourgeois values. Even if that signal is reflecting a good bit of truth, it would be better not to acknowledge it too openly, just as most advocates of legalized prostitution don’t want to allow brothels on Main Street.

Basically I want full legality, but in some locales (California, Colorado) stronger restrictions on its place in the public sphere.  Do read the whole thing.

Comments

Legalize pot, but don’t normalize it

And let's have cheap air fares achieved by the suspension of gravity.

And electric turbines driven by unicorn-powered treadmills.

I agree with Art. To legalize is to confer social respectability. We have been down this path with abortion - rare, safe and legal anyone? With divorce. With homosexuality. With gambling. In fact with pretty much the full range of behavior that used to be shameful.

You can legalize "medical" marijuana and pretty soon everything thinks they have a constitutional right to smoke it and it is bigotry to suggest otherwise.

Those were my thoughts. Advocates for de-criminalisation have to be honest that cannabis use would probably end up widespread in the public sphere and not generally "shameful".

Though not perhaps ubiquitous; smoking and drinking bans seem to hold for central parts of the commons. Here in the UK, councils also (successfully) restrict alcohol, gambling, and even fast food licenses around historic city centres to maintain an upmarket ambience. So perhaps, yes, Main Street would remain intact.

Legalisation is indeed no panacea for a stupidity drug....BUT... the costs of prohibition here are very heavy, both direct and indirect, as well as the transgression of individual freedom which rankles by itself. I'd appeal to conservative voices for an rigorous cost-benefit analysis; that the resources spent (weakly) enforcing cannabis prohibition could be more efficiently directed against more dangerous social harms.

That would be a hard calculation. There’s a lot we don’t know about pot or future technology.

Does it diminish long term cognitive function? (We don’t really know that yet for all but the highest levels of alcohol consumption. )

Are self driving cars going to take over in five years to minimize driving while high problems? Do we at least manage to develop a pot breathalyzer equivalent?

Has it been legal anywhere long enough to get a good sense of how much use will rise? Does legal pot usage substitute for drinking, go along with it or increase it?

Fine! Legalize it. BUT make it a requirement that you cannot receive any public aide if you use it. Clearly it does make you stupider! And it takes away your desire and ability to hold down a job. So, DUDE!, if you are going to smoke pot do it on your own dime.

Many legitimate medical uses... no 'public aide' if you are a cancer patient?

troll senses be tinglin'

I am a cancer patient. I know many cancer patients. None of them use pot. Could you be right that a very tiny subset of pot users are using it legitimately to deal with a health issue? Probably, but there are other options. It is far more likely that the medical pot user is a medical pot user because they want to use pot and this is their excuse.

If we don't know that yet for alcohol then that suggests that any effect would be fairly small.

Not necessarily. It’s just such a long-term process with so many confounding factors that it would be hard to detect anything other than a truly massive effect. People also lie to their doctors (and researchers) about how much they drink, and most people probably don’t even remember how much they drank 10 or 20 or 40 years ago — so data collection is hard.

How do you know if a dim 70-year-old has declined or was a dim 30-year-old?

A few of our long-term population studies — like like the nurses study – are getting old enough but I’m not sure they track cognitive function. Anyone know?

"pretty soon everything thinks they have a constitutional right to smoke it"

A legally enshrined right to do something that, at worst, harms nobody but themselves? Perish the thought. Pretty soon people might start thinking they have real freedom, and then who knows what sort of trouble will ensue.

We do closely regulate where and when things like gambling and drinking can take place. The point isn't to sham people-- that's impossible in a large society where most people do not know each other. The point is to limit the public penetration of some behaviors. With pot it would (and IMO should) be the case that public smoking of it is not allowed-- it's either consumed at home or in the equivalent of a bar-- and those establishments would have limited licensing and be zoned only for certain areas just as with bars.

I agree with you, Jon Fraz, smoking pot or THC should have the same restrictions alcohol is currently subjected to in the public sphere.

To put it bluntly....

This is basically Peter Hitchens' argument against marijuana legalization. He acknowledges that alcohol is likely more destructive than marijuana, but knows how hopeless it is to discourage its consumption given numerous previous attempts at prohibition and thousands of years of its integral history to social events. The same history does not apply to marijuana in most communities, where it is still stigmatized, so keeping it illegal will ensure the polite stigma exists.

Is it really stigmatized in most communities, though? Can't think of many people below the age of 45 who care, aside from maybe rolling their eyes a bit at stereotypical Cheech and Chong/High Times stoner culture.

Hard to do high-IQ tasks after playing an intense game of basketball, or eating a filling meal of delicious Mexican food. =)

Social norms are already working against pot! No one likes how it smells. Pot is no longer cool since it's not rebellious, not a social lubricant like alcohol, and it's done by lame middle-aged guys who complain about how potent all the hip new edibles are. Pot has always been lame, boring, and icky, but illegalization hid that fact, legalization brought it out.

Solution to the opioid crisis is full legalization btw, wait for the sick research to drop =)

xoxo

Is this comment some kind of performance art?

Hahahahaha that made me laugh out loud

Life is some kind of performance art.

There are social norms about what time of the day is okay for drinking alcohol and what time is not (e.g., the morning is not okay for drinking). In contrast, there don't seem to be strong norms among marijuana smokers against smoking in the morning if all the wake and bake videos are any clue.

You watch wake and bake videos why????

There are wake and bake videos why????

I suspect the people smoking pot in the morning are the same people who drink before the sun is below the yard-arm.

Do social norms require legalisation to strengthen? Dutch experience is that pot has simply lost its cool, and licensing and social norms seem to hold the line well enough there. It's not the apotcalyspe

Wake and bake with a good sativa isn't all that different from having a cup of coffee, though it's probably best saved for the weekends.

haha. youtube videos are not representative. From said videos it can be inferred that the social norm for beer is to drink directly from the hose of a keg while your buddies lift your feet in the air.

I recently had to pay a traffic ticket in the City of Atlanta. Nine o'clock in the morning and half the people in the courtroom smelled like weed.

I worked out with somebody at my dojang one morning and he had clearly had a healthy dose before coming over. I explained something to him and watched his eyes widen, mouth drop open at this MINDBLOWING biomechanics. It was pretty funny. What wouldn't have been funny is if he'd had paranoid feelings high people sometimes get. That's probably what was going on with Michael Brown when he decided to charge an armed cop.

Would Native Americans do better on weed than alcohol? Does weed make violent people less violent or more violent? Would it be a decent alternative for people who would otherwise end up insane from crack and meth? Does it make schizophrenic personalities more schizophrenic? What are the long-term effects? Can teenagers use it without compromising brain development?

Weed is here and is de facto legal in a lot of places, so I'd like to think somebody's researching these questions.

None of that matters. It's a plant that grows all over the place. Who, including agents of the state, has the right to tell someone that they can't light a common plant on fire and inhale the fumes? How about eating rutabagas? Maybe they can, sale of unpasteurized milk can get the vendor a jail sentence. Thank God we're protected by big brother.

That's not really the point I'm debating. I'd agree that marijuana criminalization is all out of proportion to the recited social ills. Or isn't it? Like I said, should teenagers still developing neurologically smoke it? Should schizophrenics smoke it? On the other hand, Native Americans would probably be a lot better off smoking weed than drinking alcohol.

Heroin use imposes a lot of externalities so there are good reasons for keeping it illegal. Then again, so does booze. It's a complex debate but I'd like to have it rather than just turning people loose.

As commenter Sure has ably pointed out on this thread, what seems perfectly okay for right-side tail bourgeois can be disastrous for proles, and until we abolish the welfare state we'll pay for those choices regardless.

Those who don't know anyone with schizophrenia perhaps do not realize how dangerous marijuana really is for some people. My brother has schizophrenia, and he smoked a lot of marijuana in high school and in his early twenties. His schizophrenia really began to manifest itself in his sophmore and junior year in college, after that he could not continue.

After several hospitalizations, it became really clear that whenever he smoked pot, the next day, like clockwork, his symptoms would become MUCH worse, even if he was relatively stabilized on medications at the time. His voices (which never really go away entirely even on meds) would worsen to the point that he could not have an actual conversation, because the constant voices were too distracting. He would begin having olfactory hallucinations to the point that he could not eat food, and would begin having severe paranoid delusions (people reading his mind, casting spells on him, etc.) One of the most pernicious things about this was that the marijuana does have a brief effect while it is being consumed that made him seem to feel more normal, so there was a temptation for him to self-medicate, and due to his delusional mind and inability to comprehend, it was difficult to impossible to get him to understand the true effects of marijuana on his illness (or even to recognize that he had a mental illness and that the voices were hallucinations rather than actual demons/mindreaders/etc.) The negative effects, however, would quickly overwhelm any benefits, and would last for days or weeks, or would cause a break that would require involuntary hospitalization to be stabilized. He is now 40 and finally understands and stays away from marijuana, but it took a lot of suffering to get to that point. And the word suffering really doesn't do justice to what he (and his family, especially my mother) went through for years.

I understand that we do not make peanuts illegal just because some people have peanut allergies, but having witnessed the results of schizophrenia first hand, I would sooner give a peanut to an allergy sufferer than give pot to someone with schizophrenia.

That seems like the most sensible response in this thread.

It may be worth remarking that cannabis possesses curious laxative properties that do not necessarily require heavy dosage in the a. m.

You say *“medical” prescriptions in California are ridiculously easy to get.* But you don't need a medical prescription any more here in California, you can just walk into the marijuana store and buy marijuana.

IMO the real question is whether marijuana delivery will replace in-person stores. If you restrict the physical locations enough, it will just make the delivery companies (ie Eaze) stronger. And what will make it more normalized, if Telegraph and 19th smells like weed all the time, or if everyone has an app on their phone to reorder?

Liquor stores are restricted though, right? And it doesn't seem like people get much alcohol delivered to them.

JOKE

Man finds card in motel room drawer. Card says if you are an alcoholic and need help call 555-3245. Man calls number and finds it is a package liquor store that delivers.

Seems like you’re conflating location of sale (zoning) and public usage. You can buy alcohol lots of places in SF but you can’t walk out of the store and drink a bottle walking down the street. I care less about point of sale and more about banning all public smoking, including pot and cigarettes. Why should you be able to impose your smoke on others on the street? Drinking alcohol on the street wouldn’t directly impact others until you became drunk or disorderly, and that is not allowed, so why is public smoking allowed?

Why is public breathing allowed? Farting? BO? Why should you impose your SF Market St bum stink upon me? Make it all illegal and go away!

Add axe body spray to that list

This. Zoning and property licensing seems to work fine for alcohol, gambling, smoking, and even prostitution. Legalisation doesn't mean pot will invade main street.

Alcohol is responsible for around 2 million QALYs per year lost, most of that is due to misuse (the median American drinks about once per week). Typical QALY values being around $60,000 each that suggests that the costs of Alcohol is running up a tab of around $60 billion just on the medical cost front. There are additional social costs - like those for policing & incarceration against drunk driving, impaired workplace function, and relationship instability - that are much harder to price but are also going to run to major figures. Some estimates of full social costs run out to $250 billion. This compares to the $10 billion society nets from alcohol taxation and $220 billion in gross sales.

Far from "working fine" alcohol is a major drain on society and massive transfer of resources from the bottom 90% of drinkers (including 40% or so who simply don't drink) to the top 10% (who rack up the vast majority of the social costs.

Gambling, well, estimates are that society loses around $10K per annum for each problem gambler. Estimates also suggest that the US has around 6.5 million problem gamblers. So again we run into the $65 billion range for prima facie social costs. Society gets around $9 billion in taxes and the whole sector is around $240 billion in gross revenue.

Tobacco is worse. Prostitution does not have good numbers, not being all that legal outside of a few counties in Nevada. Of course if we include data from countries that had legal prostitution in the 80s, we get some truly terrible numbers from the cost of increased HIV spread.

Frankly, none of the vice regimes we have "work fine". They work well for upper-middle class and upper class folks who have sufficient margin and resources in their lives to support their vices without destroying their lives. Unfortunately, that is not most of society. The real cost of vices are found in fat tails from people who are marginally functional without them. The price is disproportionately paid by poorer communities.

I am sick and tired of legalization fairy tails. Just because the problems don't wash up inside your gated community does not mean I don't see them, daily inside my ER.

You want to make a legalization argument, fine. Tell me something about how this harm reducing. Tell me something about libertine absolutism. Just don't tell me everything else is "fine" for the majority of people who lack the abilities to graduate from community college.

"Frankly, none of the vice regimes we have "work fine". They work well for upper-middle class and upper class folks who have sufficient margin and resources in their lives to support their vices without destroying their lives. Unfortunately, that is not most of society. The real cost of vices are found in fat tails from people who are marginally functional without them. The price is disproportionately paid by poorer communities. "

I like this part of your argument, as a sub-set of your general point that the harms are not uniformly distributed but heavily concentrated in a sub-set of users. It is patronising, in a good sense.

I take away that average users are a (very) poor guide to expected harm; we need a proportion of "problem users" when assessing policy changes. We need to know expected harm (is a problem Pot user as costly as a chronic alcoholic?). And we should bear in mind what that problem users are already doing (could Pot displace alcohol for problem users?).

I would like to remain open to the numbers.

It is my guess that the problem pot users are less costly than the problem drinkers at the moment. This will likely change over time if pot goes the way of cigarettes, and I have zero belief that some conglomeration will not manage to make pot more addictive via chemical or psychological methods that result in increased smoke inhalation and cancer.

As far as displacement. The most recent data I have seen from Colorado is that increased pot use has lead to increased alcohol consumption. This is a very bad thing. The median alcohol consumer has about a drink a week, yet the average is over a drink a day. This modest increase in alcohol sales that appears to be from pot complementation is exceedingly likely to be driven by a number of people moving into the heavy alcohol use category. Small changes in mean result in large changes in the tails unless you start deviating more from the Gaussian curve.

Most people base their policy instincts on what people like them would do. People who can hold down full time employment in a cognitively demanding job. People who have cash or credit reserves. People who have basic impulse control. These people are the minority. How they respond to policy is basically worthless for estimating costs.

Instead it is the people who have poor impulse control (e.g. multiple petty crime convictions), who have no cash reserves, and whose employment is tenuous. They are already a net drain of fiscal resources, but it is relatively small. Converting some fraction of them into major resource sinks (i.e. those who need to be institutionalized if the data is correct that marijuana increases psychosis risk, transplant candidates) - that is where the real money lies.

Our society is generally terrible at this sort of thinking and awareness. These sorts of "debates" certainly do not help.

"The most recent data I have seen from Colorado is that increased pot use has lead to increased alcohol consumption"

Hmmm. 5 minutes literature review says relationship unclear. Most findings support substitutes, not complements. May be different for problem users.

https://www.ncbi.nlm.nih.gov/pubmed/27249324

Note that increased absolute or even problem consumption doesn't address the policy issue from a libertarian perspective. Would there be an increased toll on the public purse? Are they a cost to anyone but themselves?

The aggravated psychosis risk is small-ish, right? Treatment of psychosis is expensive. Modest degree of externality on Cannabis use can be recouped via Coasean taxes. Work numbers.

"Small changes in mean result in large changes in the tails unless you start deviating more from the Gaussian curve."

Also, consumption distribution in alcohol/cannabis is not remotely Gaussian. Terrible approximation. Not convincing part of argument. I'm post-grad stats in public policy.

What is your better model then?

I know the bell curve is terrible, but I use it as a safe lower bound for the harm. According to the figures they hand out for us to use for estimating patient alcohol consumption the decile break down in drinks per week is: 0, 0, 0, 0, 0.1, 2, 6, 15, 74. Without a change in relative consumption each 1 drink/wk increase in the mean results in .75 drinks/wk being consumed by the problem drinkers.

Worse, many problem drinkers are not physically or economically able to drink any more than they do already - they literally cannot afford more alcohol (e.g. I am told that the top centile spends more on alcohol than on rent).

Now maybe marijuana legalization has shifted the consumption curve, but I would need evidence to believe that. As is, we are not seeing major changes in alcohol ER admissions in CO. In our world, displacement isn't happening. We have seen drug displacement elsewhere (e.g. heroin has displaced a lot of cocaine admissions) but not with alcohol and marijuana. We have seen a rise in marijuana admissions so it is not that legalization has stopped acute overuse of marijuana either (I would give it a few more years before figuring out the meaning of this rise for a lot of reasons).

Prima facie, it does look like alcohol use is up with marijuana legalization and that is not a good thing.

Well, without digging through the data, my first guess would be a discrete distribution (for drinks per week) with a zero-bound, like a poisson.

But most-likely this sort of thing is almost certainly better represented with a 2-stage model; a binary drink/no-drink distribution then contingent drinking distribution with a strong right skew like a log-normal or an Erlang.

Thanks Sure,

Your experience is valuable, but the literature review has to weigh more heavily, right? That tentatively says "wash". I'm interested in that you can see substitution effects in some drug use. Of course, this could be simply relative price shifts dominating the system right?

Anyway, I think you have a really good case for the high externality cost of alcohol (kind a knew that already), but are far from establishing the same from cannabis, even on narrow public health grounds. It would be nice to form better estimates of how much externality could result from a surge in problem cases, including a psychotic component.

We then have to offset the current enforcement and indirect costs (how much does prison cost per annum?) , and recoup our potential coasean taxes. I suspect these will dominate the system.

I think your point is well said, but I hold a suspicion that the "fat tails" will find a way to destroy their lives regardless of which vices are legal.

You compare the total medical cost of alcohol against its revenue, but do you truly believe that eliminating alcohol would convert the bottom 10% into productive members of society?

The question is how costly is "destroying your life" to the rest of us?

A liver transplant (very typical for problem alcohol users) runs around $500,000 a pop. Then there is maintenance costs. Worse, because organs are in limited supply this often means that some non-abuser simply dies waiting for a transplant.

Problem alcoholics absorb huge healthcare costs and that is a direct cost on the rest of us. So to are the people killed by drunk drivers, those victims of petty crime to support booze habits, and a heckuvalot of intimate partner violence/child abuse.

Suppose they destroy their life with video games. Okay we have to subsidize their food and shelter, but we do that for problem alcoholics already. They get lonely, miserable, and ... have no greater health bills than the rest of us.

Or suppose they destroy their lives with KFC. They are unemployed and just live for gluttonous consumption of fast food. Sadly the worst calories you can imagine eating from food are likely healthier than excess alcohol calories. This, even with CABG, is cheaper than the problem alcoholics.

One of the first effects of alcohol is a diminishment of social restraint and reasoning. This gets worse with increased consumption. Of all the vices, ones which literally make it hard for you to accurately weigh risk and reward are inherently problematic.

I have looked the actual data on crime and health from prohibition, both in the US and abroad. Cirrhosis rates dropped by 20% (better than any medication I can currently give you). Crime is mostly a wash with the major increases in crime coming between 1900 and 1920, not with prohibition itself. It is all highly suggestive of prohibition being cheaper to society than the current setup and with something like the mid-century Nordic model being the cheapest option overall for society (e.g. legal, but highly expensive alcohol through a variety of rationing mechanisms).

You've changed my view on the issue, although I must say your opinion is probably not politically correct.

This is more convincing. At least as far as alcohol goes. Are we taxing alcohol enough to cover the externality?

I must admit though, I'm struggling to see potential problem pot users as a creating this level of negative externality associated with the alcoholics.

Off the cuff, we would need to roughly triple the taxation on alcohol (or do something to bring down problem consumption commensurately).

As far as marijuana, to be blunt, when is the last time you dealt with a crazy person? By that I mean someone exhibiting full on psychosis? People where "the lizard people" is the shallow end of the weird beliefs?

In my world, I see them rack up $100K easily. Guy believes transmitters are imbedded in his arm. He cuts them out, with a dirty razor. He gets infected, goes into septic shock, comes to see me when a cop finds him half dead in the street and then I pack him off to ICU where he will cost $10K a day pretty easily. Or he gets convinced that the homeless guy next to him is having conjugal relations with Satan and proceeds to stab him in the chest and we now off and running on a tension pneumothorax. Or the guy who believed that the rat poison being set in "his" alley were offerings from his worshippers and promptly ate them. That would not even be an atypical week.

This is the world of un- or poorly treated schizophrenia. First pass data that I have seen suggests that heavy cannabis use sextuples your risk of developing schizophrenia. About 1.1% of the population will have a schizophrenic diagnosis. A BS estimate (but I know of no better) is that 50% of current schizophrenics will not receive medication until they encounter law enforcement. When they do, we are typically looking at major costs (a few murders easily wipe out the cost savings of the possession charges we mostly haven't been enforcing regardless). Even without those a certain percentage (ball parking at 20%) of schizophrenics will be resistant to treatment.

Those ones will either need continuous treatment and high percentage will be regularly institutionalized or they will end up homeless and vagrant.

But we still are not at the costly bit yet. When the untreated schizophrenic population rises (e.g. a rumor goes around the homeless community that we are harvesting their organs or something) we a concurrent rise in infectious disease. This can lead to epidemics. The higher the density of the at risk population, the more likely it is that we get something nasty and antibiotic/antiviral/antifungal resistant. Now we are talking about trillion plus dollar liabilities offset against small odds (expectation value being in the low billions).

So the magic question is: does marijuana use lead to increased risk of schizophrenia? The balance of evidence is enough for me to assume yes. Maybe I am wrong, this is after all the absolute worst patient population to get data on. But I am highly uncomfortable making that gamble on the fairytales normally discussed.

The other big issue here is what form will marijuana use take and how will that play out. Smoking is terrible and I fully expect some soulless cabal to use marijuana as the new cigarettes - finding some way to engineer their "joints" to be habit forming and needing a regular fix. At that point we are looking at tobacco 2.0 as inhaling phenols and nitrosamines is still going be carcinogenic and toxic.

Because ultimately the world of legalization will not be the proceeding 20 years. Some Mexican cartel cannot begin to replicate the addiction precision of a legal corporation. The use rates will change. We can take some data from the "medical" marijuana experiments and the local legalizations ... but much like Vegas there is a difference between being sin destination and opening a casino in Detroit. We are taking some awfully big steps in the dark and not admitting that we really don't have a clue what the long term social costs will be.

This is interesting. Back of envelope on your numbers:

Assume cannabis sextuples risk of schizophrenia (that seems to check out from the papers I read). So we get 5.5% extra cases from "problem" users (and a few more from regular users). How many of problem users? I don't know - I'll pick 20% as an arbitrary value (analogy; about 10% of drinkers have a problem). How many new users under legalisation? Well, currently 35m use cannabis regularly (almost as many as tobacco smokers!) and another have 98m have used at least once. Let's assume the user base doubles, to 70m, making it more popular than smoking, which seems generous.

So, back of envelope - 35m x 20% problem x 5.5% added risk = ~380,000 additional schizophrenia cases. But 3.2M Americans are already diagnosed with schizophrenia! So this back-of-envelope estimate suggests the effects will not be earth-shattering on public health, which is the strongest cost argument against.

How much would it cost? I note you don't grade schizophrenia by severity (I know many cases are treatable at modest cost), or tell me if cannabis-induced schizophrenia is worse than mean. I find 1 quick paper which puts the cost at ~$25k per patient year. Hence my rough estimate for legalisation public health cost is just short of $10B per annum.

Now, that's a fair chunk of money, but its not much in public health. And it is small compared to potential taxes (mid range estimates put those at well north of $10B per annum for the country). And of course once we add on enforcement costs for prohibition (single estimate - ~$9B) then it sinks to irrelevance (as I suspected).

So I have to say, on these admittedly crude numbers, the schizo risk element doesn't generate costs at anywhere near the level needed to sustain prohibition on a cost-benefit analysis.

An awful lot is riding on your assumptions of legalization only doubling the number of problem users. The user base for marijuana in Colorado more than doubled in the first year of legalization (per survey data). Marijuana consumption in Colorado has continued to grow since (per distributor data). So either the user base is growing to some amazingly high percentage or (more likely) the use curve is skewing more toward problem users (the reported marijuana sales cannot match survey use data without a greater skew towards heavy users).

We can handwave with just plugging in the numbers for drinkers ... except the pathogenesis for problem drinking is a much longer timeframe than pot. You normally need decades to kill your liver; the schizophrenia risks are much quicker. This means that we may be looking something more like the binge drinking (large consumption over short periods of time). If that is case then we are looking at more like 40-50% being problem users.

The other thing you are not calculating here is that unlike with alcohol, schizophrenia very typically takes people who are productive members of society and makes them less productive. This will both decrease their contributions to the public purse through taxation and increase the debits through social assistance (e.g. food stamps) or destructive behavior (e.g. crime).

We do not know how this will play out. How many people will start smoking pot because it is legal? How much will legality facilitate heavy use? Will the key risk factors be cumulative lifetime dose or will be it heavy acute use?

We just do not know. Most of the old data for marijuana is basically worthless. THC concentration has quadrupled in the last 20 years. God only knows what has been happening to the other thousand odd psychoactive compounds. Likewise, this data was all gathered when marijuana was illegal so the user mix and dynamics are not representative of what we will see going forward.

Lastly, exactly why are we assuming a zero enforcement cost for the legalization regime? Colorado has had no savings in their enforcement costs - with more marijuana crimes post legalization than before. Taxing marijuana will likely incur the same sort of pressures for tax avoidance that we see for cigarettes - where in NYC something like 60% of the cigarettes are contraband. Coaseian taxation only works when tax avoidance is more expensive than the tax; getting there requires some sort of enforcement regime. Why exactly should not buy that there will be an efficient market for tax avoidant marijuana? After all, with marijuana being generally legal it is much harder to establish a prima facie crime so we either see undershoots of tax revenue or an increase in tax enforcement costs.

Relatedly, schizophrenics are more likely to commit crimes and violent crimes (i.e. most are non-violent and non-criminal, but they have a four fold increase in being a perpetrator of a violent crime). Unlike most possession or even dealing charges, these are expensive crimes. Likewise these are crimes which are much more likely to hit the "innocent". About 10% of homicides are currently committed by those with severe psychiatric disorders. If we double the schizophrenic population of prime criminal age (your 3.2 figure including a lot people who have aged out) will that mean an extra 1500 deaths a year? Will that mean an extra 1500 expensive trials and incarcerations? Suppose it does. Google says that the average murder costs around $17 million. That would then mean we are looking at 25 billion in crime costs just from murder. Assault, theft, destruction of property, rape, etc. would all also be rising.

The medical side of things will bring huge costs to the table, easily in the billions. These are virtually never mentioned. Maybe we will recoup them because people will die of lung cancer or psychosis before they can pull social security. Maybe we will recoup them by taxing a market sufficient to offset the social costs, but not sufficient to lead to mass contraband. That is a lot of maybes to be gambling with people's lives over.

This is again where I think this sort of analysis is hard to do right. The average numbers are far less important than the outliers. Are the outlier drug dealers more violent than the outlier newly minted scizophrenics? I don't know.

I could be persuaded that legalization with taxation is less harmful than the status quo, but not by the "debates" or arguments I am seeing from the pro-legalization camp. A real cost benefit analysis is not going to be simple arithmetic but include some feedback terms and some good modeling - preferably modeling that reflects the outcomes of our last legalization (e.g. Iceland, Finland, Norway, and the US for prohibition).

Yes, it's all crude; apologies; I wanted to get rough order-of-magnitude effects down for us to consider.

As an analyst, I'd say the best way through these debates is often to specify a model and then let people argue about the specific numbers. It tends to improve communication and we can see where the important assumptions are, and conversely what is relatively unimportant. Even if wrong (it will be wrong) it can be useful to us.

The nice thing is we can play with the model - does tripling the new users matter? What if it's 50% problem users? Or 10%? How long do ill effects take to manifest (so discount for future costs)? Are the savings from petty crime reduction worth considering? What is the potential Coasean tax range?

You've argued well that problem, rather than "regular" users, are the key variable in much narcotic harm. I don't know the current % for problem cannabis users (I've taken 20%, by rough analogy with Alcoholics - I tried estimating a consumption curve from sample data but it's too crude). If I knew how many schizos were heavy pot users I could reverse estimate it that way.

I really think this is pessimistic. I'm not sure consumption doubled in the Netherland post legalisation. And I suspect (no data) many (most?) potential problem users for cannabis are already using it. People will find their fix. As you have well pointed out; these people are concentrated in the low SEC with associated self-control and other issues. I expect most new users will be higher SEC, with better self control and support networks etc. Hence a smaller proportion of new problem users.

But yes, we should seek more data for big decisions!

From my own experience with addicts, a lot of problem users are limited in just how much they consume by economics. I can make a decent guess about when new, cheap heroine is hitting the streets based on who I see come in. For the criminally incompetent users, price has a major effect on when I see them.

Legalization will change price and I suspect it will make it much easier for people to maintain problem binge type smoking on the weekends. Likewise, commercialization has started to change marijuana delivery such that we are starting to see more (though still rare) acute marijuana visits (e.g. kids eating gummies). I am hopeful that commercialization results in less smoking and more vape/ingestion, but that is not what my recollection of the data suggests. I am worried that commercialization will allow for heavier use and that this more concentrated binge type use will overwhelm body detox and compensation pathways with synergistic increases in schizophrenia risks.

Potential problem users may already be using, but they may be constrained by price. E.g. high school kids have to hide their use far more heavily than alcohol, they don't have the money of regular jobs/crime, and the dealer's that service them exact a premium for evading school and other targeted enforcement. Thankfully, we are not seeing gross increases in high school use post legalization (there has even been a mild drop), but as always I have seen zilch for data about the fat tail of high school users. A drop in the average is meaningless to cost/benefit if there is an increase in the amount of problem use. Likewise legalization would remove the hurdles a number of states have put between drug use and welfare. This would again open up a large body of people to being less economically constrained (to date none of the jurisdictions that have legalized have done drug screening on welfare).

Legalization has the potential for some very non-linear effects on problem consumption (and some of these could be non-linear to decrease it).

I prefer the Colorado data to the Netherlands because there is a lot of confounding cultural and legal stuff across the water. The Netherlands had a much better position to be "Las Vegas" and they have a vastly more robust welfare state with very different cultural approaches to addiction. When survey data shows a doubling and distribution data shows more than that, I need some good data to tell me that nonetheless all will be well.

I've trawled through some Dutch data, and it suggest 25% of (monthly) users take it daily. (less than 1% of general population), so a 20% estimate for "problem" users might not be so unreasonable.

I'm surprised how much lower Dutch monthly cannabis use is than the US (2.5% vs 8.3%, at peak Netherland use). Interestingly, the data also shows much stronger effects for local availability than legalisation, per se. (i.e. having a nearby coffee shop > legalisation ).

The data is frustratingly unclear on the growth in regular users post decriminalisation. Tentatively, given generational effects, it could be as high as tripling the user base, but is probably a lot smaller as all the assumptions you have to make with the data are in one direction.

You need to expand the Prohibition analysis properly. It's badly incomplete.

Direct Public health effects do look good-ish. But you need to include indirect effects from contaminated black market supply. These were large (1000s deaths per annum, apparently).

Most importantly, social costs of crime and law enforcement do need to be directly accounted for. I suspect these dominate costs. You can't handwave them away under "general trends"; it is sloppy analysis. Enforcement costs and imprisonment ran to $100s of millions per annum in 1920's dollars. And crime added extra social costs on top as criminal fought for a slice of the black market pie.

A couple of things:

First, while I have some training in public health and stats, my formal education is mostly in medicine. I cannot do proper analysis on a comment board and will eventually be out of my depth regardless.

Second, yes there were lots of deaths from contaminated booze; but that is no longer a particularly salient issue in the era of fomepizole. More directly we also had thousands of deaths averted due to fewer drunk drivers (as virtually all of the illicit booze was either consumed at home or in places with short drives).

Third, general trends though are important. Was there a major discontinuity with prohibition or just following a previous trend line? Did repeal actually decrease crime all that much? I just don't see either of those in the data. Absent good evidence I have to go with the null hypothesis that prohibition was not a major factor (e.g. the octupling of murder rate in the previous 20 years vs the not even 50% reduction in the 20 after repeal).

Fourth, this is not just the US. This is also other countries (or states) that prohibition at different times with different circumstances ... I just don't see massive spikes in crime from dry states or counties.

Lastly, I am not seeing it now. I just don't see a huge drop in law enforcement costs in states that have lose "medical" marijuana or legalization. Likewise, I don't see major cost savings overseas in Portugal or The Netherlands. Crime is less about markets and more about people. This is why the BBC had an article a couple of days back about how criminals in Sweden are doing fewer bank robberies (less cash on site) and more endangered animal trafficking.

I'm sure I don't have to remind you that a 50% reduction after an octupling is the same as undoing a quadrupling...

Sorry was just going from recall. Per Google the murder rate in 1920 (Volstead Act) was ~8/100K. The murder rate peaked around repeal just south of 10. While it began going down with repeal, it did cross back below 1920 until rearmament began. It went definitively below the 1920 rate only with WWII at the 5/6 range, spiked immediately after WII and then bottomed out through the 50s. In the early 1900s it was around 1/100K.

So more aptly the murder rate octupled in the 13 years prior to prohibition, went up by 25% during Prohibition, and then fell by about 20% of that until WWII when it fell by around 25% from the rearmament era.

The much bigger story is not the rise from 8 to 10 during prohibition, but from 1 to 8 in the period prior.

I keep hearing this story - legalization reduces crime. Great, show me the data. When historically did legalization drop crime rates? By how much? For how long?

Sure,

Well, that's fine, we value you for your medical input. I'm just trying to show that the medical data itself is only a part of a larger cost-benefit analysis, and that direct public health costs may only be a minority of the total costs. Alcohol is a good example - the direct pharmacological effects are shadowed by DUI's, domestic violence, etc...

You have to make an honest estimate of everything, as well as pointing out the areas of uncertainty where we could be most badly wrong. I've done a quick work-through of the cannabis public health costs above, to give a crude example and to give a sense of its scale relative to other costs.

If we want to promote intelligence, stop spending public money on sports stadiums, spend it on Math Olympics, chess clubs and robotics clubs etc.

Thus, revealed preference shows there is no preference for brains.

None of this increases IQ. Eugenics on the other hand does.

Less weed, more acid!

LSD is back in vogue after some trials indicate for people who are mentally ill, it's better than some anti-psychotic drugs on the market.

Both Nobelian Kary Mullis (PCR DNA sequencing) and chess IM and best selling author Jeremy Silman admitted to taking LSD for a creativity boost.

As for TC's post, once post-scarcity economics kick in, there'll be no need to work.

"Turn on, tune in, drop out" - Dr. T. Leary

This feels a lot like an opinion held by an intellectual who's probably never smoked, and at most smoked a handful off very awkward times with lots of coughing and confusion and no enjoyment at college. IOW, an uninformed opinion?

Maybe I'm wrong. Generally very appreciative of Tyler's public intellectual work.

Weed is trash and dumb to smoke.

Alcohol is nothing but poison to the human organism.

Cannabis is practically non-toxic.

Stupidity comes with avid drinking perhaps more than with avid smoking

Do normalize weed, actually. Most people need a vice, and alcohol's externalities are massive and underappreciated.

It's a reasonable point; alcohol is definitely dangerous. Maybe pot as a substitute would lower social harms at the margin.

I'm not sure pot wouldn't be safer from a public health perspective, per-effective-dose or hour of enjoyment, or however we might metric such things.

There is no particular reason to think alcohol is dangerous. It is based on the usual made-up claims by people with an axe to grind. As it turns out alcohol is good for your health. Most of us should be drinking more. A lot more. Someone who drinks more than six units of alcohol a day is about as healthy as someone who drinks none. So anyone who drinks more than none but less than seven is benefiting.

The problem from drinking comes from things like car accidents. As marijuana become more socially acceptable expect the death toll to equalize.

Alcohol, given its widespread use and social acceptance, is probably the drug that causes more problems to modern society. It destroys families, causes higher absenteeism rates, stimulates violence (administrative initiatives ordering bars to be closed at night in violent neighborhoods dramatically lowered crime rates in São Paulo State -- it was the alcohol making people commit murders), and reduces civic spirit.

Of course alcohol is dangerous for you. Alcohol depletes B1 which in turn causes full on Wernicke-Korsakoff syndrome. It is so common from chronic alcoholics to be B1 deficient that you can kill them by hanging glucose without supplemental B1. It also mucks around with your GABA receptors in the central nervous system such that if you are unable to drink your usual "six" beers a day (e.g. you develop acute gastritis) you go into withdrawal and eventually get delirium tremens which is lethal for a large amount of patients.

I routinely see patients who cannot keep down their normal six (or fewer) beers a day who have lapsed into withdrawal. They normally don't come see me right away, so by the time they get to me they are often beyond a quick benzo and instead rack up thousands of dollars for hospital care managing delirium tremens.

As far as drinking being safer, oh please those sorts of numbers came from unblinded studies that did not differentiate between never-drinkers and former drinkers. The latter having such high rates of alcoholic liver disease it dwarfs the former. The best meta-analysis shows no "J-shaped curve" for all cause mortality. At best moderate drinking is a wash with never drinking. At worst it has a small drop in life expectancy.

But don't kid around. The median American drinks once a week or so. The vast majority of booze is bought by people who drink more than once a day and they are by far less healthy than average. For every vice the tails dominate the costs. The evil thing about the Gaussian distribution is that the tails are most sensitive to the mean so even small shifts in the mean have large shifts in tail size. Anyone who bases their policy analysis on what happens to the average user with a policy change is an idiot or a liar.

I am really enjoying your posts here, even though your conclusions don't at all square with my priors. Clinicians, by virtue of having to deal directly with real people and real consequences, have a lot more interesting things to say than toadstool philosophers on either side of the spectrum. Please come by more often.

I agree. Thanks for contributing intelligently to an important topic of discussion.

Useful stuff, Sure, thanks.

I'd just add that $60,000 per QUALY possibly confounds costs on the abuser (which I don't care about) and costs borne by society (which I do care about).

If alcoholics cost me $60k per annum in publically funded dialysis, or car-accidents, or crime, or cleaning streets with drunk tanks, or whatever, then you may fairly account for such. If alcoholics just destroy 15 years of their lifespan, then that's not a cost for policy accounting purposes, as far as I am concerned.

Mostly it ends up being paid by society through insurance premiums and taxes. How is a QALY lost by an alcoholic? Rarely do they just drop dead a year sooner.

Instead they develop alcoholic fatty liver disease, cirrhosis, liver failure, and only then die (there are, of course, other fun options like chronic pancreatitis, Wernicke-Korsakoff dementia, etc. but I am going with one of the cheaper play outs). Along that track we start saying that treatment X will give them back Y QALYs. Medicaid pays for an awful lot of Xs with very large price tags (e.g. portosystemic shunts, liver transplant).

Most likely, my calculation above is an underestimate of the social costs as those are likely the irretrievably lost QALYS. These are almost always smaller than those we rescue with (expensive) treatment.

When looking at healthcare expenses, over 50% of everything avoidable (i.e. not old age) is due to precisely three causes: tobacco, obesity, and alcohol. Number four was motor vehicle accidents but with all the heroin floating around it is now in a dead heat with drug abuse.

Imagine every possible savings you can find from every proposal ever to restructure the healthcare world. Add them up. Double them. And you still have not touched the expenses of the big three.

And that is just on the healthcare side.

But tobacco saves us money. Is alcohol different? Everyone has to die of something.

Not me, prole!

I am not convinced that tobacco saves us money anymore. The cost of treating lung cancer has been rising. Monoclonal antibodies both improve life expectancy and increase workup costs let alone actual treatment costs. The question comes down to how cheaply do you die.

Saving 10 years of social security and whatever the current odds are of a chronic disease are very nice looking. $150,000 for one round of biologic lung cancer treatment puts an awfully large dent in this savings.

Likewise, we are starting to catch COPD earlier and improve survival curves. With new treatments on the horizon, like small airway coiling, tradeoff between pension and medical liabilities is set to keep getting worse.

We are also have fewer patients who have compounding risk factors (e.g. less coal miner's lung, less asbestosis) so we are not getting as many people with the really aggressive quick death versions of lung disease.

Morally, I find this sort of "savings" repugnant. After all the most cost effective thing for me to do for the public purse would be to murder the majority of my patients. Of course, not being a Nazi doctor (who literally would follow this logic), this is not an acceptable analysis to me.

" After all the most cost effective thing for me to do for the public purse would be to murder the majority of my patients. "

Don't tell the NHS....wait, too late...

"As it turns out alcohol is good for your health."

The point is not "your health" - it is the effect over third parties: drunken people sometimes are violent and/or do impulsive things; in contrast, pot usually makes you apathetic, then, with less probability of harming other people.

If the goal is to reduce marijuana usage without expending law enforcement resources and without throwing people in jail, then just ensure that it's easy to sue sellers for damage done to and by users. Plaintiffs' attorneys will have lots of incentive to come up with ever more creative rationales for why sellers are responsible for this or that wrongdoing caused by users, whether to users themselves or to others, which will in turn restrict supply.

That line of thinking would make sense if were extended to public high schools and their teachers that were hosing the students. If the Catholic church is responsible for pervert priests why isn't the Fairmont High School in Kettering, Ohio on the hook?

Then California and Colorado need to have more Mormons. It'll solve that and many other problems.

There is a dispensary in our city, it's way out of the way near a highway interchange in this odd ivy covered building. Quite innocuous, except for this ambiguous billboard. it seems like the doors are locked from the inside and there are guys opening up when people stand outside.

I have to say I smell the stuff less on the street since the start of the year when the legal sales started. Maybe people are going with the edibles. Or perhaps it's lost a bit of the mystique.

Your countrys most popular sport causes brain damage , while still played and massively supported at universitys, i do not think American culture values intelligence as much a you. Even removing lead in pipes seems an up hill fight. The cost of intelligence raising perhaps should go to things that have a real effect, like reducing violence in sport or lead in the environment rather then public shaming of a legal behavior.

You know the other "football" also causes brain injury. Both from heading the ball and from having straight up skull-to-skull contact. Very few sports can manage to be both violent enough to satisfy the combat instincts and safe enough to not seriously harm athletes who do it for years at maximal exertion.

As far as lead piping goes, both Europe and the US still have major lead use. This is because in many cases we do not and cannot know which pipes either used lead solder. Until we replace the pipes, which takes over a 100 years at natural replacement rates, we will always have lead solder in the system. This is why we treat our water such that testing verifies that it is indeed below the lead threshold.

In reality, legalizing pot will all but certainly go the way of alcohol where the social costs are far higher than the revenue generated. This will result in far less resources for lead abatement being out there.

Most of the costs fall on the individuals concerned in these examples. They're not social costs. I don't have to pay for large public support schemes for brain-damaged ex-footballers.

I have to play devils advocate too; social costs from current harm must also be accounted; would associated crime decrease with the end of prohibition? Almost certainly.

No sarc; I'm genuinely open-minded on what a rigorous cost-benefit would show from a public accounting framework.

Why would we expect to see crime reduction with the end of prohibition? We didn't last time.

If memory serves the murder rate after prohibition was repealed in 1933 did not drop below Volstead levels until '38 when had begun to rearm. The rise of prohibition was far smaller than that found from 1903-1920 and is frankly comparable to the rise and fall in murder rates in the 70s. Organized crime grew throughout the 30s and 40s.

I have not seen a notable decrease in law enforcement costs in Colorado, The Netherlands, or any other legalizing jurisdiction. Why would we expect national legalization to be any different?

Ah; post hoc ergo propter hoc fallacy. Logically SOME contingent gangster activity must have ceased, so what was it?

It may be small (perhaps) but it strains credibility to say there was zero reduction using the gross crime figures. It's like the "min wage doesn't cost jobs" rhubarb.

Why most the activity have ceased?

Suppose I am a petty crimelord in prohibition. I have a small set of goons to protect my booze racket. They have guns, knives, and willingness to commit violence. Suddenly legalization hits. My stock of contraband booze is worthless and my payroll has not dropped.

So I put the capital to good use. Tommy guns that can keep my turf safe can also be used for carjacking or bank robbery.

There was an article on MR not too long ago about how one Mexican territory had the gangsters diversifying into stealing grain and tapping oil pipelines.

We have seen this before. South Africa (Pretoria IIRC) had a carjacking problem. The police cracked down on carjacking with stings and the like (also someone developed an under the door flame thrower). Suddenly carjacking was no longer profitable. Carjackers did the sensible thing ... and starting mugging. Of course most people do not carry anywhere near enough cash to make this a one to one thing, so there was a spike in muggings with about a 3:1 ratio for increased muggings : decreased carjackings.

This all makes sense. Sure criminal organizations follow some variation of the efficient market, but all that would tell us is that legalization would drop the overall profit to be had from crime. It tells us nothing about the number of victims, the incarceration costs, or the other social ills.

It is quite possible to get more crime from repealing prohibition. I am not saying that will, does, or always happens - just that in some circumstances it can. Ultimately, crime is about people and it is much harder to stop criminals without locking them up or waiting for them to grow out of it than fiddling with some market.

My belief is that this is much more about society and norms. After all, what changed from 1903 to 1920? We had the worst rise in murder rate in US history and it is not like law enforcement was terribly different nor policy. What I think might be the answer was culture. This was the first generation with movies. This was a generation cut off from the home country. This was a time when America was riven by ethnic fault lines. This was a time of massive rural displacement. Culture seems much more likely than some anticipation of prohibition.

This would also explain why there are large variations in crime rates between states, countries, and cities. Why does Chicago have more murders than NYC? Why does Canada have fewer than the US? Culture seems like a potent explanation.

Which comes back to legalization. If we think legalization will not change the culture we are deluding ourselves. Maybe it will be better, but I highly doubt that. Suppose marijuana use just displaces a bit church attendance though any of dozens of mechanisms, then we can expect a lot more people to die and societal costs to rise (e.g. the country looks less like Utah, but not enough to flip to the other pole like Mass). Cultural changes are very risky and this one is being sold off fairytales and a giant Things Seen fallacy.

"Safe, legal and rare". Sure. This time it will work.

Dispensaries in a rough neighborhood have that countercultural vibe which is catnip for young people. Entrepreneurs growing a business, young and healthy people in the shops, cool music.....it seems Tyler wants pot to be super sexy.

I wonder why Tyler did not consider pharmacies as possible retailers. Waiting in line to buy pot in the pharmacy along the sick and the old is a stronger deterrent than bourgeois values.

I agree on the smoke. It is nice to breathe air with less tobacco smoke, it's a step back if marijuana smoke replaces tobacco smoke.

Finally, perhaps I live in a bubble but I don't see intelligence (the IQ definition) as a scarce resource. What's scarce is the will to work 40 hour weeks, work on a project until completion, be nice to clients and colleagues.

"To put it bluntly..."

I like TC but file this under "old baby boomer." I smoke pot daily, I'd say almost constantly. Well I don't actually smoke it. It's THC oil that is vaped. No smell in the air or on me. I think when people realize that legal pot is not a plant anymore they will go, "oh my God make it illegal again we can't tell who's smoking and whose not."

See, because when you smoke pot constantly it doesn't affect you like someone that smokes it once a day or less. FWIW it really helps with my Crohn's and constant anxiety I used to have before that actually made me do hurtful things to my life.

Everyone makes "stoner jokes" and has this impression that its someone ordering pizzas and listening to Pink Floyd. But I work a coding job and the anxiety relief of THC helps me do my job better. Before this, I hated my job and it seemed boring as crap. Now, its manageable and I feel like I could do this job for 5+ years.

I dispute the intelligence hit that Tyler references. It may be true for someone you pull off the street and give a brownie (don't do that!) but for someone that smokes it like cigs, the feeling I get is more akin to a strong cigarette.

So marijuana may make everyone else stupid but not you? Am I following you correctly?

There have been studies of people who smoked really heroic amounts of hash or marijuana per day. Mostly Jamaican Rastafarians and Greek dock workers. I think most people exposed to marijuana smokers would agree it makes people stupid.

Cannabis hardly confers stupidity, as Tyler erroneously suggests. The most galling psychological effect is memory impairment--but that is only an acute effect and wears off as THC, etc., are metabolized out of the body (in about seventeen days).

Cannabis does not confer intelligence, either: but no permanent impairment of cognitive function results from cannabis use, and Tyler needs to face this fact before he writes another line on the subject.

Heavy cannabis use is associated with a six-fold increase in schizophrenia risk. This is a dose response risk with smokers of higher potency marijuana having higher schizophrenia risk. All comers, smoking pot is a 60% increase the risk of developing major psychosis. Through a lot of statistical analysis it is exceedingly unlikely that those with psychiatric illness are just using marijuana before being formally diagnosed. Every single confounder tested to date has not explained the relationship.

In short, cannabis harm is not evenly spread. Those who suffer the largest harms tend to be invisible because major psychosis typically results in them no longer being part of society. They either receive treatment and withdraw from education and employment until they go into remission or they have their lives fall apart, often become homeless, and are generally ignored by society.

As always the upper echelons of society do not see this. They go to expensive schools that require some level of functioning to stay. They work in cognitively demanding jobs where the bottom half of the bell curve are simply not seen. They live in communities with ample police and the ability to displace homeless individuals out of sight.

Long term issues with memory are reported in a minority of patients and it seems to be an age dependent phenomena. But I am sure if we legalize pot it will only be individuals over 21 who consume it in accordance with the law.

A source would be welcome for the data you report.

I generally rely on Understanding Marijuana by Dr. Mitch Earleywine (OUP, 2002), a comprehensive survey.

His conclusion: "(Cannabis) can exacerbate symptoms of some mental illnesses, particularly psychotic disorders like schizophrenia. Yet it does not appear to cause these mental health problems. Cannabis's impact on brain structure is minimal . . . marijuana is neither completely harmless nor tragically toxic."

I continue to hope that Earleywine will one day soon publish a second or revised edition to treat interim research and legalization protocols.

If memory serves, JAMA had a good metanalysis a few years back; I believe there was another good one from one of the British professional associations (e.g. psychiatry). I don't think Cochrane has done one yet, but if not they would be a likely be my favored source.

More directly a colleague was telling me that this was on his Boards; when things reach that level I kinda stop keeping track of where I read it.

"A number of studies have suggested that cannabis use can have negative implications for mental health, and from their scientific review, the National Academies of Sciences, Engineering, and Medicine conclude that this is the case."

"The researchers uncovered "substantial evidence" that cannabis use is "likely to increase the risk of schizophrenia and other psychoses," and the more the drug is used, the higher the risk. "

https://www.medicalnewstoday.com/articles/315240.php?sr

Although this comes from 2011, it suggests that Earleywine stayed on top of research in the decade following publication of his comprehensive survey Understanding Marijuana (OUP, 2002):

http://blog.norml.org/2011/02/09/dr-mitch-earleywine-ph-d-responds-to-latest-marijuana-causes-early-psychoses-claim/

That's mistaking youth for health.

Also, researchers say cannabidiol (CBD) is the good one for anxiety, THC is euphoria and bad long-term consequences.

"No smell in the air or on me."

Here we go... I know a lot of pot smokers, and perhaps the most common symptom of pot use is the persistent and inexplicable delusion that they don't constantly reek of pot. If you think non-pot users can't smell your vape pen, you're... well, you're high.

Jazz is not an exception.
Good improv requires a clear and prepared mind.

"As in modern times, our college authorities justify the brutalities of football and prize-fights, so in ancient times the great moralists of those ages justified their gladiatorial games." -- Boris Sidis

I live in the heart of Denver, walking distance to a half dozen dispensaries -- seriously, there are far more dispensaries than Starbucks.

I smell marijuana out in public twice a year at most. I smell vomit and piss from drunks in the 7-11 parking lot far more often than I smell marijuana.

This pearl clutching demonstrates such profound ignorance by TC that it makes me question his knowledge of other issues.

If the population that drinks switched to marijuana, we could fire half the police department.

So what are we going to do if 1/8th swap and 1/2 add on? Somehow I doubt the answer is hire more cops.

What the research in Colorado so far shows is that marijuana legalization has lead to increases in alcohol consumption. It appears that marijuana and alcohol function as complementary goods rather than rival ones. One of my bigger worries with legalization is we will see this sort of effect long term, everywhere with alcohol and cigarettes.

For me, I don't worry about upscale anywhere with drugs. The upper classes have enough resources to control their vices or remove those who cannot. Like bars, expensive rent districts tend not to have intractable problems, go over the tracks to the poor areas, walk into a bar, and I am about 100% likely to see a frequent flyer from the ER. The social costs of pot or booze are never felt in a vibrant downtown; out in the areas where crime is high and people are poor, that is where the real costs are incurred.

There are studies that show pot use CAUSED increased alcohol use?

The are discontinuities in alcohol sales that track reasonably well with marijuana legalization. If that is not sufficient statistical rigor for using the word "cause" then, no there are not. Which is why I said "appears".

What we do know is marijuana has not yet displaced booze consumption.

"marijuana legalization has lead to increases in alcohol consumption"

Could you cite that please. My admittedly cursory search came up with the opposite.

Colorado department of revenue is the simple source:

https://www.colorado.gov/pacific/sites/default/files/December%202013_0.pdf

https://www.colorado.gov/pacific/sites/default/files/Liquor%20Excise%20Tax%201214.pdf

https://www.colorado.gov/pacific/sites/default/files/Liquor%20Excise%20Tax%201215.pdf

In short, 12.3 million gallons of alcoholic beverages were consumed the year before legalization, 12.9 million gallons the year of legalization, and 12.9 million again the following year. There is a small drop in gross beverage sales from 2014 to 2015, but that appears to be substitution from 3.2% beer to harder spirits. This was flagged in a study I read a year or two back, but this is the primary data.

The study that you will find on Google being flogged by NORML is looking at grocery store sales. I have only skimmed the study but I would first be suspicious of the methodology as that may not reflect the overall alcohol trends.

Looking at the most recent primary tax data, it looks like there has been some reversion to the mean, still not below pre-legalization levels though. That could be consistent with a drop in marijuana tourism related alcohol consumption (lack of novelty, more competing jurisdictions), but we absolutely did not see gross drops in alcohol consumption. The new study lowers my confidence in complementation but is not likely to be sufficient to make me believe substitution will dominate.

What is particularly worrying to me is that sales of hard liquor continue to rise. That is normally the best proxy for problem drinking particularly for people in the > 10 drinks/wk category who are the main cost generators for alcohol.

Maybe there is a model out there which shows that increases were less than expected with some control group, but I would trust tax data over surveys most of the time.

It is possible that both data sets are correct - moderate drinkers are consuming less alcohol (as shown through grocery data) while heavy drinkers are using more (as shown through gross alcohol sales). That would still be a net loss for social welfare in my world.

Either way this does go against the rosier predictions I recall about legalization where there were worries that alcohol consumption would be substituted so heavily that tax revenue would fall.

Thanks.

Those are just sales trend data though, not a study. Not even enough to substantiate correlation, let alone causation.

There was a full study that looked at this data some for nearby states as I recall. This just the easier source of data.

We do so discontinuous jump from trend with legalization. I am comfortable saying that is suggestive of or appears to imply causation. I have read some analysis that is stronger than that, but I don't have that handy.

Do you support bringing back Prohibition?

There is a huge difference between trying to outlaw a substance that is hugely ubiquitous and tied into all sorts of social traditions, and trying to prevent something that doesn't have such a foothold from developing one. One requires a huge change in the behavior of many individuals. The other is maintaining the status quo.

Are you suggesting that pot doesn't already have a foothold in use and distribution, and in culture and traditions?

Alcoholic wine consumption is an absolute religious requirement for north of 20% of the population; this has been the case for thousands of years.

That is not a foothold or even a beachhead. That is a pier with loading cranes and containerized shipping.

Marijuana use is likely past the tipping point, though I am only about 60% certain on that, but it is not in any way, shape, or form as deeply entrenched as alcohol use.

I see no reason why a human weakness for one toxic substance necessarily means we should endorse using others.

"I see no reason why a human weakness for one toxic substance necessarily means we should endorse using others."

ok, let's go after prescription meds and junk food first then.

I am on board for both. We should not lessen the such social barriers as exist against misuse of either.

"I see no reason why a human weakness for one toxic substance necessarily means we should endorse using others."

Why imply that cannabis is "toxic"? Its toxicity is virtually non-existent, especially as compared with alcohol.

Earleywine, p. 143f.: ". . . cannabis is essentially nontoxic. No one has ever died of THC poisoning (Iversen, 2000). Extrapolations from animal research suggest a lethal dose of THC would require 125 mg of the drug per kilogram of body weight (Nahas, 1986). A 160-pound (73-kilogram) person would require 9,125 mg of THC to receive a fatal dose. Most marijuana cigarettes weigh one gram and contain 20 mg of THC. Thus, this 160-pound person would require all the THC in over 450 joints to reach a lethal dose. At least 50% of THC, however, is lost to sidestream smoke. Therefore, a lethal dose would actually require smoking 900 joints. . . . In contrast, alcohol and aspirin poison thousands of people each year (Doweiko, 1999)."

To endorse marijuana consumption is NOT to endorse a toxic substance, since as Earleywine, et al., have shown, cannabis is virtually non-toxic.

Because I am smart enough to know that LD-50 is just one measure of toxicity. Chronic and sub-acute toxicities exist, are real, and should be noted.

For instance, the acute lethal toxic dose of radiation (1 day) is around 30 Gy whole body. 1-2 Gy will kill you in a couple of months. Nonetheless taking in a mGy at a time on X-ray is enough to cause cancer, hence why I use shielding precautions with X-ray sources.

Taking something in 1/1000th of the acute toxicity dose often is a good way to get subacute or chronic toxicity.

In any event, THC is far from the only thing in marijuana. Other things found in combusted marijuana include hydrogen cyanide, nitrosamines, and ammonia ... all known toxins. And of course there is the well established fact that combustion particles, regardless of source, are pneumotoxic. Shockingly the micron range particles that clog your airways from cigarettes also clog your airways from smoking marijuana.

Just because we smoke on batch of toxins does not mean we should endorse smoking a different batch.

I could be persuaded to bring back prohibition if there was a fair popular vote for it.

Given that it is more likely for Nancy Pelosi to endorse Trump, my preferred option would be to softly ration alcohol consumption, preferably with a progressive consumption tax such that each drink gets pricier. Barring that I would accept a simple increase on the alcohol tax until it is at least proportional to the cigarette taxes for social costs.

The best historical example would be the mid-century Nordic model where things like state monopolies limited how easily and cheaply you could consume alcohol. It does not show as dramatic of reduction in mortality and healthcare costs as say Finnish prohibition, but it seems to be a much better tradeoff between normalization, revenue, and public illegitimacy.

I like your analysis and I agree. There are strong externalities from alcohol. By no means tax it heavily.

We have normalized the consumption of fats, sugars (including alcohol), and processed foods which also negatively impact IQ in large quantities. Why would marijuana be any different?

It won't be. The upper classes will do fine (you can tell class with very good odds just by BMI, add in skin quality and I bat over 80%) and they will have fun new things to do.

The lower classes will lack the self-control (hence why they cannot hold good jobs), resources, or whatever to manage their intoxication. This will result in the lower classes "overconsuming" and reaping the vast bulk of the ill effects.

Throwing away billions in healthcare costs on cigarettes and booze is par for the course (multiplicatively more than the direct tax revenue) so I expect to see the same waste with legalized marijuana.

Do you have data on this? From the UK, I believe smoking is relatively fiscal-positive for HM treasury. It kills in a fairly cheap way (as far as medical treatment goes) and save decades of pension costs. I've heard figures on 7 to 1 in taxation to medical costs ratio?

Has the UK finally approved using monoclonal antibodies for elderly lung cancer patients? I cannot recall if NICE has bit the bullet yet, and if they did if they extorted enough price reduction off pharma to not make it bank breaking?

The days of lung cancer being a quick, cheap death are themselves dying out in the US. We image a lot more than the NHS so we catch a lot more early stage lung cancers as incidentalomas; this means that people over here who would have been diagnosed at IIIb or IV or coming in at II or even I. That really lowers the pension payout.

Secondly with the rise of biologics lung cancer is becoming expensive to treat. Opdivo is something like $150,000 a shot now. Other things are more expensive. Pricing data from the rest of the world does not apply in the US - we don't extort price discounts from pharma and we don't refuse people coverage on the basis of cost openly. So Medicaid will pay for an extra six months of life on a cost basis that the NICE will simply deny.

The other thing to recall is that smoking makes a lot of metabolic syndrome diseases worse and more costly, which again makes things different in the UK.

The last thing I would mention is that the UK did not end WWII rationing until the mid 50s. This, and the general economic hardship of the post-war years, depressed cigarette smoking amount. The US has the dubious honor of being the first adopter of the cigarette (vastly worse for your health than other tobacco), the first mass producer of cigarettes, the first adopter of women's smoking, and sustained smoking throughout the World Wars and with large increases during the 50s and 60s boom economy. I suspect Britain was not so fortunate on all fronts.

If you are willing to withhold care on cost concerns, like happens with the NHS, then you can basically control costs of vices easily and come out ahead. We don't do that here and frankly it seems awfully harsh to say we have a functioning system that only achieves fiscal stability when people have to die.

Yes, you may have greater treatment costs in the US without NHS monopoly power, plus better screening and greater public expectations. Over here, NICE is pretty brutal and reasonably consistent on a good day. I'd be surprised if £ / QUALYS for lung cancer was a factor of 2 or more beyond other cancers. However, the general trend for lung cancer costs isn't changing that much? This is a condition that kills relatively quickly in late middle age. A lot of saving is in pension costs here; its been suggested jokingly that the government may wish to distribute free cigarettes to pensioners!

You are quite right that there is the framing issue that we're assuming the public purse bears the costs of treatment, and hence makes it an externality for consideration in our analysis. As you say, we can leave them to die (or at least fall on the resources of their private insurance), beyond which point we can't add treatment costs to the public policy analysis (we can still bill for lost-work, but that is slight, given the age and SEC of ill smokers).

Lung cancer treatment costs are rapidly rising because we are starting to get functional biologics online. With a full court press can basically double your life expectancy once you have been diagnosed with cancers related to cigarette use. This is still short, but it is something.

Unfortunately these drugs are very expensive. Biologics just cost more to manufacture and even when the patents are gone, biosimilars do not reduce price.

In short, a full court press will more than double your QALY gain, but I think it is something like 5x or 10x more expensive than the old options. Last I had heard, NICE said "hell no" that is far too expensive (somewhere around $300 - 500K/QALY at American prices) but I don't follow such things closely.

Over here I have plenty of patients who are burning off the better part of a decade of Social Security on pricey drugs paid for by Medicaid.

I do not know the actual numbers, but lung cancer here stopped being cheap for sure unless the patient says "eff it", takes hospice, and hits Vegas or whatever.

OK, that makes sense. I can see Medicaid is driving costs.

New treatments are always expensive at the margin. In the absence of more specific data I suspect we will get the slow long-term cost reduction in them.

Sure,

My 5-minute numbers don't match your claims. Tobacco at least looks to be fiscal positive for public purse. For the UK:

Tobacco revenues: £9bn
Cost of Tobacco related illnesses to NHS : £2.5B to £5B

Life expectancy for smokers is also >10 years less than non-smokers. But a lot of those years are pensionable, (and even for the non-pensionable ones, smokers are low SEC and mostly net-drains on treasury anyway). Again, back of envelope suggests that very large savings in order of ~£10B per annum...

Overall, it looks like (licensed and taxed) smoking is a big fiscal win for the public purse.

Seems to me the whole making the world better thing is about making lives more worth living. And it seems pretty elitist to ask Marijuana be less visible when only a very small fraction of the population have jobs where a bit more intellectual speed or memory will advance the human race.

Besides, for the casual user the residual impact over the next few days is no more than one sees from the moderate sleep deprivation, stress and anxiety our long working hours, commutes, and other aspects of our modern world create. Indeed, I know of a number of academics for whom the relaxation and unwinding benefits of weed seem to be sufficiently more beneficial than whatever small intellectual slowdown that is caused for them to find occasional use substantially boosts their productivity.

Finally, what weed signals isn't about it's chemical effects but it's social role. Either the people with intellectually demanding jobs will stay away from weed or they won't and we'll adjust our sense of what it signals. I mean somehow drinks with colleagues at an academic conference does anything *but* signal a lack of regard for intelligence despite the obvious negative effects on cognition.

I take it the column didn't have enough room to talk about D.C. or the political economy of having business sell addictive substances.

Fortunately, opioid pain meds are legal and well-regulated. Thank God we don't need to worry about those.

I favor tough laws against drug such as cocaine, marijuana, alcohol, tobacco and other products like those. Full prohibition, lenght sentences for both sellers and consumers. No parole. Life sentences for repeat offenders.

Yes!

That's worked, like, never.

We need stronger efforts. It is like a war. One does not give up at the first setback, one sends reinforcements.

Yes!

Just like Afghanistan

No, it is like WWII. Using full state power to liberate people from totalitarism.

Yes!

We should mobilize the nations of the world to kill millions of people and decimate entire countries, in order to wipe out pot use.

To free people from vice, save families, children from drug-inspired violence and restore the civic spirit.

"drug-inspired violence"

You've obviously never smoked pot or been around anyone who has.

And like Vietnam?

It is different. The South Vietnamese wouldn't fight. And attempts to cut the Vietcong supplies fsiled despite full scale bombing. But drug lords don't have the Vietcong's popukar prestige and it will not be necessary to bomb civilians.

"The South Vietnamese wouldn't fight."

The ARVN is estimated to have suffered 1.4 million casualties.

"We are sending a signal"? Collectivist B.S.!

Isn't wine and now whiskey drinking considered cultured?

BOOOOO Tyler. I can appreciate that you want to minimize (without state intervention) the societal harms inherent in anything. Unfortunately, you seem to let that moral cause excuse harmful stereotypes and stigmas, in large part generated by the state.

Like anything, there isn't a black and white, right or wrong answer to this question. There are clear and tangible harms of marijuana use just as there are clear and tangible benefits. I'd say it falls somewhere between "a large slice of chocolate cake" and "crystal meth" on the "reward now/harm in the future" scale. And yes, we have societal norms that people not over indulge in chocolate cake, but you'd be a fool to suggest that we refrain from eating dessert in public in the name of upholding civil sanctity.

Using effect on IQ to weigh an activities public acceptableness is a bad idea for for 2 reasons:
First, it would give a negative response to perfectly acceptable activities including a hard work out in public, sharing a large meal with good company in public, and even possibly taking a rigorous economics exam in public. All of these activities can be shown to have a negative impact on ones ability to perform IQ-intensive tasks immediately afterward.
Second, it over emphasizes the role of IQ in societies' utility function. I agree, intelligence is a scarce resource, but its hardly the only thing that gives meaning to life. Marijuana consumption has been known to enhance enjoyment of the finer things. Used properly to destress, it can increase work productivity. As you noted with your Jazz example, marijuana has been associated with creativity and other non-IQ measures of intellect.

All in all, I'm not promoting glorification - there are clearly bad outcomes that marijuana can play a part in leading to. But there is a good deal of science that suggests marijauna is WAAYYYYY less harmful than alcohol. Sure, there are places in society where we could use a bit less alcohol consumption. But I think, as a general rule of thumb, marijuana should be no more limited by societal norms than alcohol. Unless you think alcohol has no place at the ball park or the symphony, a thought that seems absolutely ludicrous, you should reconsider your stance on marijuana's acceptance in these, and similar, arenas.

All this from someone who works a bourgeois white collar job, runs triathlons, volunteer coaches at a local high school, fosters deep relationships with family, has a passion for libertarian economics, and, on top of it all, happens to regularly indulge in marijuana use (even sometimes in public)..

>regularly indulge in marijuana use

Shocking.

Such a coincidence that so many Legalization Weenies are potheads.

Oh wow. Your Ad Hominems are quite convincing. I used to believe that marijuana had some benefits. But now, after being called a Legalization Weenie and a pothead, I have come to realize that I was totally wrong and marijuana is silently murdering our youth.

>>> It should be possible to visit Colorado without knowing that marijuana is legal there.

I'd say for cultivation, this is broadly true. The grow houses, where the smell does tend to be more pronounced, are mostly concentrated in the industrial north end and east end of Boulder (near Broadway and lee hill drive / along Arapahoe and 55th, respectively). Neighbors do tend to complain and fines are issued (http://www.dailycamera.com/news/boulder/ci_30555105/north-boulder-growhouse-fined-pot-stench-we-want). Boulder's zoning code limits these locations to greenhouse & manufacturing zoned locations. I'm not sure I've noticed I've been near a cultivation facility in my time in CO.

Re: dispensaries (retail side) - there are a couple of dispensaries on Pearl (one at the basement level around broadway, one on the west end near 7th street). But in general, most of the dispensaries are drive-to places. People don't smoke outside of the dispensaries however, and the design of the buildings is pretty low key (examples: https://goo.gl/maps/EQ5F6jDCRP92, https://goo.gl/images/ZHPMoJ).

Re: walking around, how much "weed is in the air" - In Boulder - I do occasionally smell some marijuana on the street, but it's not an everyday thing. I'd say I smelled it more in DC city streets when I lived there than I do on Pearl Street. I can't speak quite as well about Denver, as I don't visit it that often, but it doesn't strike me as any more troublesome than any other medium-large sized American city. Anecdotally, I don't smell pot on every city block in Denver.

In general, I just don't see marijuana use in CO as that big of a deal. The negative externalities (smell mostly) are kept at bay through zoning. In my experience, people are mostly following the rules - keeping their smoking inside their private residences. Anecdotally, it intersects with my life far less frequently than alcohol does.

Is this MR's crotchety boomer phase? I do see a lot of reluctant support of neocon ideas here.

I think marijuana requires both legalization and a temperance movement. It seems that there is little harm in weekly use of marijuana or so, indeed I can easily imagine that there are benefits from such use in life satisfaction appreciation of the arts and bursts of creativity etc. However many people who use marijuana end up using it significantly more frequently than this, and a few people will use it so often as to negatively impact their lives in significant ways. I think "normalizing" can be good. Sharing a joint with friends on the weekend can be normal while taking bong rips when you wake up can be abnormal and subject to judgement. I don't take for granted that we will reach such an equilibrium but it may well be the case that reaching this equilibrium is easier under a regime where marijuana is legal and not secret than where it is illicit.

There are few things more tiring than people who point out that alcohol is harmless (and even helpful!!!) when used "the right amount."

60% of the country barely touches it. 10% are chronic abusers who are dying and destroying their lives and killing others on the roads. But 30% are using it "the right amount" -- currently, as many of them work their way to becoming chronic abusers -- so everything is GREAT!!!

So it shall be with pot.

"10% are chronic abusers who are dying and destroying their lives and killing others on the roads... 30% are... working their way to becoming chronic abusers"

I'm guessing these figures are wrong

Not by much. He underestimates the number of problem users depending on the criteria you use (e.g. well over half of drinkers are binge drinkers) and the progression numbers are screwy (lots of different ways to measure "work their way") but in general, that is the rough shape of things. For every 4 units of alcohol consumed, 3 of them are consumed by the top 10% and over half the other one is consumed by the next 10%.

Now some of the abstainers are reformed alcoholics, often after developing life threatening disease. And a number of the problem drinkers are just idiots in college who will grow out of it ... but in the main this is the picture of alcohol use in the US.

It really is only particularly invalid for the wealthy, powerful, and highly educated.

With which drug or similar activity has this ever happened?

It is not alcohol where we have still not reached some stable state.
It is not cigarettes which grew relentlessly and then began dying out towards zero.
It is not pornography use which basically continues to grow.
Obesity? Racism? Violence?

There are very few steady states other than full acceptance and full prohibition. Maintaining any set of standards is exceedingly hard at the best of times. In the olden days you might manage something like this by having religious authorities condemn misuse and have them bring about social shunning ... but today ... I expect if we tried to establish some norm the liberals would shout in disgust if sounds conservative and the conservatives would do likewise if it sounds liberal. Good luck threading that needle.

And as always, whatever the majority of people does is pretty much immaterial to the social costs. Unless you lack a fat tail of problem users, you will always have major harm hidden in the less privileged areas where social norms cannot be maintained for whatever reason.

The question is not if there are things which are good in moderation. The question is are there things that reach a steady state anywhere between full normalization or full banning?

Sex has not reached a steady state. Teenagers are undergoing a dramatic shift toward less sex. This may be a good thing, but as a society we do not have a stable set of guidelines about how much sex should be had when yet. We are also declines in the frequency of adult sexual activity, this actually worries me as it suggests more social isolation and less of the many health benefits of regular sex.

Chocolate has also seen has dramatic growth in its consumption, after all within living memory it was not the go to staple for Halloween.

Coffee saw some pretty substantial declines in consumption in the 90s and then has been rising again. Particularly of note the age of coffee consumption has been getting lower.

In short we have no evidence of stable vice consumption via social norms except in places of full normalization and full disapproval in the modern era. Expecting marijuana to thread the needle to be something that people manage to ritualize or whatever is just plain silly.

"Make pot safe, legal, and rare" is a culture war improvement to be sure, but I think you are falling prey to the bad toupee fallacy. Alcohol is an iq dulling drug, but is typically consumed outside of business hours. Yes, a few people consume alcohol in a way that makes them unproductive, but this is the exception. You see both responsible and unresponsible alcohol consumers. When pot is not normalized, you tend to only see people who consume it irresponsibly, and this colors your view of all pot users. Once normalization occurs, people who hide their responsible use can come out of the shadows. You're also missing an important function of relaxation and escapism to maintaining long term productivity in stressful jobs, which increased pot acceptance could very reasonably be expected to boost, not detract from.

Of all the alcohol consumed in this country, 3/4ths is consumed by the top 10% of drinkers. All of these are medically defined as problem drinkers (they average around 10 drinks per day).

That other 1/4th? Over half of it is consumed by the next 10%. The majority of these drinkers are also problem drinkers due to their binging habits (i.e. >4 or >5 drinks in a night on the weekend).

People who "drink responsibly" are barely a blip on the radar of the alcohol companies.

What we can expect from normalization of marijuana is what we can expect from any vice: the upper class will use it enough to have fun, most of society will barely touch the stuff, and there will be a small slice of user who use the vast bulk of product (e.g. exactly what data from Colorado suggests). The negative impacts will be felt in neighborhoods not filled with the rich and powerful and the social costs will be just another kick to the teeth of the poor. Potentially doubling the number of schizophrenics in the country, well that is just another thing the rich and powerful will ignore.

"That other 1/4th? Over half of it is consumed by the next 10%. The majority of these drinkers are also problem drinkers due to their binging habits (i.e. >4 or >5 drinks in a night on the weekend)."

Those are called students. :-)

Serious thought; I wonder about the longitudinal factor. I know I drank about 50%-100% more when young, but now its a jolly week when I can even come close to breaching NHS guidelines.

(Seriously though, could some of "problem" drinkers just be a youth bulge? It would be nice to see the stats for 30+ where if you are still knocking them back, then there is a problem.)

25% of college-age Americans are binge drinkers. 25% are binge drinkers from 25-35. 20% from 35-45. 13% from 45-65 and 65. I am told that UK numbers are different; I do not know them.

These numbers have been rising over time though there has been stabilization of college-age and high-school may even have had a small drop.

Now there is a lot of reshuffling that happens here - people start drinking at work happy hours, when they date a problem drinker, when they move to a heavier drinking location (e.g. DC drinks something like 10 times more than Salt Lake City) while others stop when they exit the bar dating scene, when they have kids, or when they are diagnosed with alcoholic fatty liver disease. So it is certainly not the same percentage the whole way through life.

Suffice it to say that there are likely more problem binge drinkers who never went to college than ones who attended. A lot of this is reasonably functional drinking (e.g. drinking over the game every weekend) ... but it takes a long term toll via divorce (IIRC about as bad for your health as cancer), lost Monday productivity (and hence job progression), and of course liver disease.

As far as your own progression, well that is why you are extremely likely to be a card carrying member of the meritocracy. Your youthful indiscretions were nowhere near as bad as the ones that make kids frequent flyers to me and your moderation once in the workforce bespeaks self-control that many of my patients frankly lack.

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