Source: J W Boyd

by Nikhil “Sunny” Patel, MD, MPH and J. Wesley Boyd, MD, PhD

reform is on the ballot in a number of states around the US, and as physicians and citizens we believe it ought to be fully legalized.

Marijuana is safer than tobacco or , but that hasn’t stopped the tobacco and alcohol industries from lining up against legalizing cannabis. Apparently these industries view marijuana as a direct competitor. The reality is that marijuana is safer from a health perspective: Tobacco is the biggest killer by far, doing in over 1000 Americans a day. And alcohol is our third biggest killer through both its direct adverse health effects but also by drunk drivers or alcohol fueled fighting and abuse.

Marijuana is also safer from an addiction perspective: The best estimates are that 9% of marijuana users are dependent. That is less than the number of users of tobacco (32%) or alcohol (approximately 10-15%) who become dependent on those substances.

But these are not the only industries that have lined up against legalization. The pharmaceutical industry is also firmly against legalizing marijuana, and a recently published study shows why. The study, published in Health Affairs, found that in those states that approved medical marijuana legislation, there were significant decreases in prescriptions filled to treat a number of disorders, including , , nausea, and sleep disorders. Additionally, there were dramatic decreases in the number of prescriptions written for painkillers.

Given that 3 out of 5 individuals who overdose on have legitimate prescriptions for pain, we strongly suspect that the number of opioid overdose deaths will decrease if Massachusetts legalizes marijuana. Indeed, three recent studies have shown that in states where medical marijuana is legal, opioid overdoses decrease. And one of the studies found that the longer marijuana had been legal, the greater the decline in overdoses.

These data illustrate why that industry has repeatedly fought increasing access to cannabis, and also why big pharma has funneled money to prominent academic psychiatrists to voice opposition to legalizing marijuana.

Pharmaceutical, alcohol, and tobacco companies have one other very big ally in the fight against legalizing marijuana—the private for-profit prison system. The reason for their opposition is obvious. Legalize cannabis and suddenly there will be far fewer individuals—overwhelmingly and disproportionately minorities—caged in our jails and prisons.

You can’t tell everything about someone by knowing who their enemies are, but you can learn a bit. The forces lined up against legalizing marijuana—including prominent academic physicians—should be challenged and their true motives exposed.

This is not to say that we believe that marijuana is harmless. Heavy use can pose real risks for some users, especially teens and other younger users, whose developing brains are adversely affected by marijuana use, but we do not think legalizing marijuana will cause increases in use.

Why? Consider the case of Portugal, where drug use was decriminalized in 2001. After that, instead of being thrown in jail, drug users were offered access to treatment and rehab. The result was that a decade later, was cut in half. And specifically among Portuguese teens in grades 10 through 12, lifetime prevalence rates of marijuana use decreased from 26% in 2001 to 19% in 2006. The the early data from Colorado and Oregon—where marijuana has been fully legal for several years—show similar results, given that marijuana use among teens in those states has continued the slow decrease that started before marijuana was legalized.

The fact is that whether it is legalized or not, kids who are so inclined are going to continue using cannabis. Do we really want those kids to continue seeing the police as an enemy, as a force to be avoided? Do we really want to jail those who are caught ?

So, for a plethora of reasons, we support full legalization of marijuana. There is no legitimate reason why it should be illegal if tobacco and alcohol aren’t. It is also very likely that legalizing marijuana will lower our country’s collective costs for pharmaceuticals and also reduce the number of opioid overdoses.

It is probably only a matter of time before marijuana is fully legal around the US. We should all accept this, vote for legalization now, tax marijuana, control its distribution, and educate the public about the dangers of overuse, especially among young people.

Nikhil "Sunny" Patel is a Clinical Fellow, Department of , Cambridge Health Alliance/Harvard Medical School