Marijuana in Canada

Dispensaries selling various strains of marijuana and high-potency extracts, called budder and shatter, have opened on main streets. Regular pop-up markets like the one in Hamilton have sprouted, to the point vendors can attend five a week in the Toronto area.

Cannabis lounges have expanded, offering not just a place to smoke and take hits, but classes on growing cannabis at home and making cannabis creams. Cannabis-infused catering has gone so mainstream that the national association of food service businesses, Restaurants Canada, is hosting a seminar on it. Cannabis tour companies have opened, as have cannabis “bud-and-breakfasts.”

Universities and colleges across the country have introduced courses on cannabis business, investing, retail and cultivation.

Newspapers, which have hired full-time cannabis reporters, have published cannabis sections, filled with editorial ads by government-licensed producers advertising lines of cannabis-infused beverages, coffee and dog chew toys they are developing for when such products become legal.

…Ms. Roach see cannabis becoming almost like corn in its derivative form, threaded through everyday Canadian consumer products. Although people eat a minimal amount of corn each day, she said, “there’s corn syrup in everything.”

That is from Catherine Porter at the NYT.  I increasingly believe that decriminalization will prove a more stable solution than outright legalization.

Comments

The "legalization won't increase consumption" argument is certainly being out to test.

You can’t say whether this is a long term trend or a short term fad. Decades and decades of demonization helped turn it into a cool thing and now a lot of people want to try.

It's like Americans turning 21 and getting shit faced all the time just because they can; eventually it reverts back to its mean. Except it's happening with pot, everywhere, to people of all ages.

Except of course that reversion to the mean didn't happen with alcohol.

Alcoholism rates basically doubled from the 90s to the 2010s. Death rates on alcohol have been increasing even while the main related proximate causes of death have been ever less likely to kill an affected individual (e.g. liver failure, MVCs).

What the data actually show is that there was a lifetime effect on people who came of age during prohibition. Their lifetime consumption rates were lower than the generation before or after. This is true not just in the US, but also in other countries that tried prohibition. Accounting for this generational effect and the changes in population over time (e.g. the baby boom) and we continue to see a long term secular rise in per capita alcohol consumption.

Frankly, if it weren't for the opiates which are killing Americans in record numbers, the number one change in public health risk would easily be increased alcohol consumption.

Not seeing it -
This study shows the rate of consumption wiggling up and down over time.

Your comments seem to copy verbatim a Forbes article from last year.

Here's Wonkblog:

https://www.washingtonpost.com/news/wonk/wp/2017/08/11/study-one-in-eight-american-adults-are-alcoholics/?noredirect=on&utm_term=.bfbdc4615ce8

One in eight people is an alcoholic? That seems highly questionable, at least based on my social milieu.

The DSM criteria are based on the drinking levels at which people start to see social or medical sequella at rates above the normal population. 1/8 is pretty low. For instance they did an ~50,000 person study in Europe that matched people's drinking habits to the number of days they missed worked. Those who drink at levels or in manners the DSM says are pathological miss more work.

On the medical side, the DSM limits are far too liberal. We start seeing long term medical effects even with lower rates of use. Cirrhosis, cancer, and a host of other disease processes show no safe level of use for alcohol, but also drastically elevated rates in people who meet use disorder criteria.

1/8 is a touch low from what I see. The number of people who go into withdrawal and need me to give them a benzo before they hit 48 hours of sobriety is well over 25%. Correcting for my patient population being a non-random selection process and it is undoubtedly lower, but I would wage closer to 1/7 or 1/6 of the general population has some form of alcohol use disorder.

You can argue that "alcoholic" should mean something indicating more dependence, but we treat all the addiction pathologies as close to the same as we can manage. The numbers that fall out of the end of that process do say that a truly huge minority of people meet criteria. It is the same process we use for seeing who has trouble with cigarettes or narcotics so it is not just some special pleading for alcohol.

How the other half lives, I guess.

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I just look at the NIH data and our ED patient data.

Long and the short of it is I'm guessing your study looks at gross drinking rates and ignores the fact that drinking is a young (wo)man's game. Stable per capita consumption with an aging population means that people are drinking more at some stage of life than they used to. Worse, with falling youth alcohol consumption we must be making up the difference somewhere else.

Worse still, we have an epidemic of opiate use going on and we are not seeing alcohol consumption decrease. Okay, so alcohol is complementary and not competitive to other drugs. Nonetheless the number of people dying from opiates should be putting a dent in the per capita consumption - people who (for whatever reason) have a hard time maintaining responsible use of some vice tend to have trouble with responsible consumption of any vice (drugs, alcohol, infidelity, and money problems are massively confounded).

We refer to this sort of result as "inappropriately unchanged" in medicine. Like a "normal" PSA in a post-prostectomy male, seeing things stay the same with large underlying changes is often very, very bad.

If you look at alcohol use data for people born ~1910 to ~1925 in the US they drank far less than their parents did or their kids do. When you look at other places that tried prohibition (e.g. Finland) you likewise see drops in lifetime consumption that correlate with people who came of age during prohibition.

Whatever the steady state lifetime consumption rate for ethanol is, we have not hit it yet (and yes I realize that in the 1700s we drank more than ever before or since).

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And what a stupid argument it is. Of course consumption will increase, just like it would with any other product (not to mention that we can use alcohol as a clear example).

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How does decriminalization differ from legalization? Under decriminalization, if I'm a marijuana retailer and a wholesaler fails to deliver his product according to our contract, can I sue him and have the legal system force him to obey our contract?

The easiest option is to adopt the Swedish prostitution model. Make one side decriminalized (e.g. no prosecution for buying) and the other not. You then can freely report the more socially deleterious actors without fear of prosecution. This then results in an equilibrium where sellers are highly incentivized not to create problems (e.g. selling to minors, selling to the point where drug habits foster petty crime, cutting with toxic substances), social stigma is maintained to some degree, and the race to the bottom is slowed.

Wouldn't this just incentivize competitors to rat each other out to the police?

Quite possibly, but the cops and the DA can also use their discretion of when to enforce. The data from prostitution in Sweden suggests this has the highest harm avoidance so I need some data showing me that an alternate approach would be more valid here.

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I think DC shows what a decriminalization model looks like. Use, and possession of non-wholesale amounts for personal use, and growth of a few plants, are all perfectly legal, as is medical marijuana. What is not legal is selling marijuana for recreational use. So you cannot open up a shop to sell to the public, you cannot advertise, etc. Of course, such a system will allow for small timers to cheat by growing their own marijuana and then selling small amounts to customers. But that is actually a somewhat desired outcome- those small timers won't be getting their marijuana from the cartels or paying tax to them, and the market will likely be way too open for the cartels to compete. I mean, how can the cartels stop someone from buying, say an ounce that their neighbor? What will law enforcement do to stop that? But for the small timers, it will just a side hustle, not a full time gig, unless they want to risk breaking the rules in a way that will get them prosecuted. But I think that six plants, properly cared for, can produce around 4 pounds a year. Maybe I am underestimating how much my neighbors partake, but I am pretty confident that 4 pounds would be more than enough to keep my block supplied for an entire year.

4 pounds is 64 ounces, is 512 1/8 ounce units.

A moderate-ish consumer might consume an 1/8 ounce in a week or two.

Assume two weeks, arguendo, and we have 26 1/8 ounce units per consumer per year.

20 consumers, thus, will use up four pounds in a year.

(Frankly, I don't even know what Tyler means by "more stable solution", since decriminalization combines much of the annoyance and black marketing of criminalization with none of the goods of an open and free market.

He ought to know this, and equally if he thinks there's some greater offsetting good involved, that he ought to explicate that.)

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There's something of a decriminilization model in the state of South Australia. Possession of up to 1oz and cultivation of two plants attracts a civil penalty equivalent to a parking ticket. It's been this way for more than 25 years, but I don't think there has been an in-depth analysis of the impacts. Commercial quantities and trafficking still attract criminal penalties.

My (limited) understanding is that the criminal commercial market still operates perfectly well and is reasonably profitable; and because criminal routes are still the main suppliers into general consumption, aggregate consumption hasn't increased significantly.

[I don't have an opinion on whether this is a good model or otherwise].

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I have no idea what a "stable solution" is...what TC means by it. There are 3 issues that I am concerned about:1) DUI - it is possible for an assay to determine when someone is DUI? Assuming cops won't be taking blood, I'm not sure it's possible. A corollary to this is being stoned at work. Might be ok for a customer service rep, but not so cool for a surgeon or forklift driver. 2) How do we prevent our kids from abusing it? Is there an effective way to limit their use, given their brains are apparently much more sensitive to its negative effects? 3) MJ has are both physical and mental health effects. Will it actually decrease the total amount spent on health care? dubious. Personally, I'm for regulation similar to Alcohol and Tobacco as well as taxation to subsidize addiction/abuse prevention/treatment.

Do you realize that you should be very concerned about those 3 issues in relation to alcohol consumption?

It's easier to catch and punish alcohol consumers, though. I agree with Li; I like marijuana, but the risks can't be ignored.

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And who says people are not concerned with alcohol??? Actually, I truly don't understand how people can look at the way we deal with alcohol and not understand that it is terrible. Look at the damage it does!

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The DUI problem is rapidly being reduced by the auto manufacturers with lane departure technology and automatic braking. We may be a long way from autonomous cars but they are getting better at avoiding crashes.

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1) Field sobriety test. Test abilities and outcomes, not "magic levels of something"; there's indeed a similar problem with alcohol - some people can be dangerously inebriated at .07BAC, and some hardcore alcoholics can be ... reasonably functional at .10BAC, more or less.

2) Around here you gotta be 21 to buy weed, just like vodka and beer. How do we keep kids from doing anything bad? We sort of don't, and sort of do, same as anything.

3) Who cares? I'm serious - "this will increase health spending" is a completely illiberal argument against something. Literally, the same logic leads to mandatory exercise and dietary changes.

I reject its premise entirely.

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I'd personally like to see a slow roll-out. Remove it as a federal crime, and let the States figure it out. I don't think the empirical evidence (do economists care about that?) is sufficient to conclude what is best here. I've got a moral objection to "decriminalization". Why should 49 grams (say) merit a ticket and 51 grams merit a felony conviction? Or I should say how do you morally justify different punishments for different amounts of the same stuff? And if it's "ok" to have, why should it be a criminal offense to sell it? Isn't this contrary to a basic principle of a capitalistic society?

This has been a messy process, maybe even remarkably messy compared to other legalizations. But it has been slow, starting with "medical" laws way back.

But I am afraid, for better or worse, that when Tyler only hopes for decriminalization he is not solving for the equilibrium.

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I'm worried about the public health consequences of widespread marijuana usage, especially among the young. But if people simply use marijuana as a substitute for alcohol and tobacco, it's probably a significant net public health win.

good point!
but the theory that people simply substitute marijuana for alcohol
is a popular meme pushed by highly paid
marijuana industry meme zombies
the reality looks like a lotta people are using alcohol and marijuana
concomitantly not substituting marijuana for alcohol

They may not substitute marijuana for alcohol, but if they substitute it for opioids it's definitely a win.

your hypothetical if is iffy considering the sustained high incidence of opiod use and overdoses
it doesn't look like a lotta people are switching opiods for marijuana

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Even better, people substitute it for opiates

What is the data behind that?

This is not been my professional experience.

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All law are violent, remember? Barring a extreme public health threat (e.g. meth, heroin, alcohol?!?) legalization IS the most moral of the many options.

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Some notes from the Globe and Mail newspaper:
-According to Statistics Canada, 42.5 per cent of Canadians have tried cannabis at some point in their lives and 16 per cent have partaken in the past three months.

-Whether cannabis or tobacco, smoking is not good for your health. But few people smoke joints as frequently as cigarettes, so the harms are lesser.
-Cannabis is not a gateway drug: Your kids will not go from chewing gum to smoking pot to shooting up in an alley.
-Pot is not addictive, but it can be misused and problematic. Smoking recreationally every day or smoking alone are not good signs.
-There has never been a fatal overdose of cannabis, but smoking or vaping or eating too large a dose (technically known as poisoning) can cause unpleasant symptoms such as anxiety, paranoia and a racing heart. Keep your stash locked away so your kids and pets don’t get poisoned.
-Everyone experiences cannabis differently. If you indulge, find your comfort zone. Big tokers can experience cannabinoid hyperemesis, a condition characterized by intense nausea and vomiting.
-The impact on mental health, particularly the triggering of psychosis and schizophrenia in young people, is the most hotly debated health issue. While this is rare, it is not to be dismissed.
-Consuming cannabis, especially with a high THC level, makes you impaired. You shouldn’t drive or operate heavy equipment or do other things that require your full attention while high.

"...few people smoke joints as frequently as cigarettes."

That's about to change!

Not in North America - nobody smokes 20 joints a day.

In Europe, where hashish is much more common, people mix tobacco and hashish, which is considered a joint. Clearly, that sort of consumption could come closer to normal tobacco use in terms of varying the mix, along with the fact that since you already have tobacco and rolling papers, the amount of tobacco consumption is unlikely to be reduced, while the amount of hashish being smoked is unlikely to increase significantly.

Nah I see a few who hit the 30/day mark (at that point we ask them about grams and I have a few who hit 10g/day of admitted use). The heaviest users consume truly massive amounts of marijuana, just like any other vice industry. Even people who see themselves as frequent drug users rarely meet the true top end users - that level of consumption makes it all but impossible to operate in society.

These levels of use are currently rare, but they are increasing according to the data.

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Pot is habit forming and like a lot of habits that can meet some criteria for "addiction". It does not cause strict chemical dependency, though by some standards neither does heroine.

How much you smoke is greatly mitigated by the manner in which you smoke. Typical marijuana use results in deeper breathing (more chances of lodging micron scale particles in fine branches of the pulmonary tree) with longer breath holding (more absorption of carcinogens). I don't know which way the data will fall when we finally get around to a Framingham level study, but I would be real cautious about making long term safety claims at this point. After all the sort of data we have now was used to prove that alcohol caused lung cancer.

There have been a case report or two of marijuana overdose fatalities. This gets complicated because few patients have a single insult that kills them and these were all (IIRC) toddlers with extremely high THC/body weight consumptions. On the other hand a lot of the time I put down death due to heroine overdose is not a single agent death either, an awful lot of my heroine regulars also have compromised FVC from lung disease. Did lower respiratory drive from opiates kill them? Or was it their longstanding lung disease helped along by lower ventilation rates? Granted the LD-50 and other tox measures for marijuana are very high as these things go, but "none" is a awfully high bar.

Odds ratio for cannabis use and schizophrenia is 3.9 on meta analysis. That is high enough that we would pull drugs from market over it; however it is an order of magnitude lower than lung cancer and smoking (~40 OR). Maybe its all reverse causation or confounding, but I would need some bloody good data telling me that before I would be confident saying that it is "rare" or remotely safe for my patients.

I'm guessing that motorcycle riding is right out for you, nor would you ever advise anyone to ever ride a motorcycle.

The logic seems applicable to just about anything outside of the mundane averages for doing basically anything which could ever have a damaging effect on health.

So, how is the idea of a sugar tax?

'“If it was all about opioids, we might focus our efforts on [that issue],” said Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice. “But we see that strokes, heart disease, and chronic lower respiratory disease deaths are rising as well, suggesting the problem is even more widespread than we thought.”

Much of the increase in mortality can be explained by obesity. In 2015, weight problems accounted for more than 10 percent of all American deaths, according to Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, but just 7 percent in the U.K. and 3 percent in Japan.' https://www.theatlantic.com/health/archive/2016/12/why-are-so-many-americans-dying-young/510455/

I personally would never do it off a closed track. I would suggest patients use helmets and get good riding gear and ride in good weather. Frankly I find little appeal from motorcycling that have not had going airborne or driving a high end sports car, but that is me.

Look I am fine with people doing things that reduce life expectancy if fully informed and paid for by the individual. What bugs me to no end is people doing things either without full information or without acknowledging, and preferably paying for the costs. When I cannot get a psych bed for a patient who is having frank hallucinations because they are full of schizophrenic patients I question really hard if letting the same companies that told us cigarettes were good for weight loss and did not cause cancer sell us things which most of the data suggests will cause major psychiatric illness in a minority of consumers is a good idea.

So when I see posts like this one I am very leery. No overdose deaths? Maybe, with a strict standard but that doesn't match a lot of other data. Being consistent, we likely have had a couple of pediatric OD deaths. Not addictive? I dunno I have a lot of patients who tried to quit but could not maintain sobriety.

Lung cancer? Okay this is just garbage. I'm hopeful that when we chuck all the data from illicit markets quality improvements that reduce the need to even smoke the stuff. That said, smoking is likely stronger for habituation and I would completely expect at least one large business to try to make this stuff addictive in some fashion. But going on the data we have right now, it just is not safe to say if marijuana will be better or worse for lung cancer. After all when we put filters on the cigarettes we saw minimal cancer benefit as the type of cancers just swapped due to more of the smaller particles being inhaled.

Sugar taxes, to date, have not shown a lot of good data. Sugar is not good as it appears to make it harder for the body to register satiety ... but I have not seen anything which suggests that simply cutting sugar increases longevity. Certainly we have populations that consume over 50% of their gross calories from sugars (e.g. honey) and have vastly lower rates of metabolic syndrome than we see in the West.

Current data suggest that doing marijuana, at least while the brain is still developing (e.g. <25 in males) is roughly a fourfold risk in developing schizophrenia with a strong dose response (higher estimates exist for heavy users who drive most of the true positives). I wouldn't give you antibiotics with those odds until I thought you had a good risk of dying without them; why again should I treat marijuana differently? Curing your pneumonia typically makes people vastly happier than getting buzzed or high when they've compared the two.

Whenever we have legalized vices: prostitution, gambling, alcohol we have seen some heavy user develop significant problems. The costs to society in medical bills and innocent deaths is pretty much always higher than the entire gross profits of the industry in question. And I have yet to see a single tax regime that would actually internalize these costs for everyone.

So yeah, I keep seeing the same silliness on a highly educated comment board. Pot has very few things wrong with and it will be fine because if we do a pathetic analysis and ignore the real numbers it somehow comes out happy.

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I still say legalize all drugs and we the citizens should discourage use. You have to give it some time for anti-intoxication norms to arise.

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I'm reminded of James Taranto's old running gag at WSJ, "So Much for the War on Drugs" -- highlighting bad headlines like "Raid Deals Blow to Cocaine Ring" or 'Struggling Pot Industry Takes Another Hit"

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If for every debate on marijuana you find yourself bringing up alcohol, and saying that marijuana is better or just as bad, you fail to understand that they are very very...very different. And you argument looks weak.

The legal policies around marijuana are their own issue. Many like to say how it's like alcohol or that alcohol is worse. The fact is, the ways in which most people think marijuana is similar to alcohol, actually better represent their differences (i.e. "some marijuana after work is the same as a weeknight glass of whiskey" well.... unlike alcohol, if you aren't getting high on marijuana, you are doing it wrong--and what does this mean for your mental health if you want to get high/stoned every night?)

And the ways in which most people say they are different, actually speaks to their similarities. i.e. both can be abused, and both have severe health repercussions when they are abused (marijuana more mental health, alcohol more liver health)

It's only the pro-marijuana camp that makes it seem like not only marijuana ISN'T bad for you at nearly any frequency, it's actually good for you, and part of a being good to yourself! Reminds me of pro-health cigarette ads back in the day, and it's completely ridiculous except in very very specific medical cases like epilepsy, and even that CBD is really more accurately derived from already legal hemp.

Hemp is legal?

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If the whiskey drinkers I know are any indication they aren’t precisely measuring out one unit of alcohol for their evening drink - 2-3 units would be more typical, ie. enough to get buzzed. So it’s exactly the same as taking a couple of hits on the vape, actually. That and cannabis is a far more effective sleep aid than alcohol.

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I’m amazed that the media moral panic about Juul hasn’t extended to the Pax Era. Exact same design, same manufacturer, except it’s for weed. Seems like everyone here in CA has one.

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It is sad to me that we really don't think things through before changing such important rules. Yes, we do have other drugs available (including harmful substances like sugar) but that does not mean we should add to our problems by creating yet another option for people (especially young!) to damage their lives.
We have a huge problem with people abusing medication (which is highly controlled but decriminalized) and yet people keep pushing for that model. At the same time, we keep making assumptions about things we don't know like long term damage (studies could not really be funded before right?).
We will pay the price for this, there is no doubt. Just like we already pay the price for alcohol and tobacco. By then will be too late to really do anything.

"Including harmful substances like sugar"
I hoe that you're kidding!

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It dominates beer as a social lubricant and daily unwinder, but without the violent side effects of alcohol. It’s interesting how technology, democracy, and the market are collaborating to “fill out” a new, non (domestic and other) violent world. Equilibrium mechanisms are still little understood so they still seem miraculous.

"as a social lubricant"?? Weed causes people to withdraw inwards, not become socially gregarious. Booze is still best for that.

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After November, it's likely that recreational marijuana will be legal on both sides of the Michigan-Ontario border...but not actually when crossing the border (at least not coming back into the U.S.) Should be some fun to be had there by some folks not paying attention.

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I live in Washington state, and am not a cannabis user. Legalization quickly becomes normal, and life goes on. People are no longer arbitrarily arrested for minor possession (and cops can't use it as an excuse to harass people), use is more or less flat, and there's no increase in crime. Thanks to the lack of legal places for people to gather and smoke, you do find people smoking outside more frequently (or more often, smell evidence of it without seeing it), but it's just not a big deal.

I don't see what evidence you are relying on to favor a non-legalization approach. And it's odd how remote the thinking of non-legalization states seems. It sounds like I'm receiving a telegram sent from the 19th century every time someone argues against legalization. It's just a non-event after it happens.

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I'm mostly on the side of decrim being better than outright legalization, but legalization has had an unexpected positive effect:

Technological innovation means people are consuming more in the forms of vaping, or candies, or tinctures. No one is smoking anymore, saving users' lungs and keeping the stench away from us bystanders.

how do we know vaping is
saving users lungs?

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Funny how so many small government so called believers in personal freedom love government intervention when feel frightened by the pace of change. Guns, weed, alcohol, and tobacco ( and many other goods and services) should be available for people to buy and sell as they see fit. Givernmnent is a failure in every market intervention!

I will buy this argument the day the government stops spending billions of dollars on healthcare for the effects of these substances. As is we face a choice we can seek to limit vice consumption, we can tax vice consumption to offset the costs to the public purse, we can tax non-users to pay for the effects of vice consumption, or we can divert healthcare resources from non-users to users (and have more non-users die than otherwise would be the case). Right now we are doing the latter two; that is by far more intrusive and a much greater impingement on freedom.

The same can be said if guns and any other activity. In healthcare the dollars spent for “vice” problems are usually borne by private payers so the tax is on your healthcare premiums. I also believe we should increase the supply of people providing healthcare services and remove government “markets” there as well. If you increase supply and reduce licensure, we should at the same time drop prices. This also implies we as consumers of healthcare will have to pay the full value of the care we consume, or stop consuming that level of care.

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Anyone who would rather live with an alcoholic than a pothead is nucking futs. Alcoholics are a nightmare to live with, whereas the most chronic potheads are merely unmotivated.

+1 Alcohol and depressants seem to bring out the worse behavior.

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