By Michael Frank

At a time when the Attorney General of the United States wants to harden prosecution of pot use in the United States, even in states that have legalized medical marijuana, it’s reasonable to ask: at what cost?

That’s part of the focus of a recent Benjamin Center Discussion Brief by Dr. Eve Waltermaurer, Senior Research Scientist for the Benjamin Center and a PhD epidemiologist. Waltermaurer looked at the history of categorizing pot as a gateway drug, as the Attorney General continues to do, despite significant evidence to the contrary. In fact as the brief points out, there’s just as much efficacy to the idea that tobacco is a gateway drug to alcohol use, and in 2016 the National Institute on Drug Addiction announced it could not conclude that pot use led to the use of harder drugs.

Lacking scientific evidence, however, has never stood in the way of politicians wanting to grandstand about getting tough on crime.

But Waltermaurer says this in itself is a kind of criminal negligence. It ignores both the financial and social cost of cracking down on the non-crisis of pot use, diverting funds from stemming the actual opioid addiction crisis. And it also ignores scientific evidence that in states with successful medical marijuana programs patients are turning to pot instead of harmful opioids to manage chronic pain.

“It’s very clear that in states that have these laws,” Waltermaurer says, citing a recent 2016 study, “that patients suffering from everything from nausea to depression have successfully used medical marijuana.” She says there’s a direct correlation to a fall in the number of prescriptions for FDA approved drugs for a range of symptoms in those states, including ailments like seizures and anxiety. But nowhere was the correlation as strong as for the treatment of pain—the leading reason patients are first treated with opioids.

“Opioid addiction has been growing and the very idea that the medical profession might have an alternative to prescribing these highly addictive drugs and reducing this epidemic so patients don’t become addicted in the first place is what we should be discussing,” Waltermaurer says. However, part of the problem is the persistent fallacy of pot as a gateway drug, when in fact the far greater threat today is the danger leading from say, prescribed oxycodone for pain, to heroin and then to deadly fentanyl.

This scenario has led to a dramatic rise in overdose deaths caused by opioids, from 10,000 in 2010, to 47,000 in 2014.

And not one death associated with cannabis use, according to the CDC.

So Waltermaurer suggests policy makers step away from implicating pot as a gateway drug and toward looking at the potential of medical marijuana. Waltermaurer says the dollar savings for states is significant. According to the brief, savings for the shift from Medicaid funded drugs to medical marijuana almost doubled from $260.8 million in 2007 to $475.8 million in 2014. If all states had medical marijuana laws in 2014, the brief finds, there could have been $1.01 billion in savings for fee-for-service Medicaid.

“But we have this cultural baggage about pot,” Waltermaurer suggests. “If it came in a pill, ironically, like painkillers, we might look at it differently.” Waltermaurer says luckily our norms do change over time, citing how we targeted drinking and driving, as well as cigarettes. But she says a big hurdle, even where medical marijuana is legal, is in getting doctors to prescribe fewer opioids and potentially to use cannabis instead. And concomitantly, she says, we need to prioritize education about the dangers of opioids as a clear gateway risk.

Lastly, Waltermaurer says we have to work to break the stigmas that lead us to blame the victims of opioid addiction—and people who would seek pot as an alternative. She says veterans and the poor frequently fall into both camps. “It seems easier to toss pills at the problem and easier to say pot is a gateway when there’s just no evidence that it is.” Waltermaurer says this attitude by Jeff Sessions’ Justice Department has a long history dating back to the 1930s, when similarly specious logic was used to demonize pot as a gateway drug, and then used again by Nixon in the 1960s to target supposed hippies.

What’s missing is a more complete understanding of the actual drug epidemic in the United States—the opioid crisis, not marijuana use. Even if the White House hasn’t connected the dots on the depth of the crisis, both states, and instead, at least some Republicans in Congress, including both Rand Paul and Orrin Hatch are pressing for action.

Norms don’t change easily. But angry constituents and mounting medical and societal costs do have a way of opening previously closed political minds.