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As an active participant in the effort to stop commercial (recreational) legalization of marijuana (personal use has already been decriminalized), I read Neal Milner’s recent column with great interest (“How Both Sides In Marijuana Debate Blew Smoke Up Our Okole”).

There are a number of points that Milner got wrong in his article.

First, there is a lot of good research now from credible sources that show the negative consequences of using marijuana. There is also good research that concludes that legalizing the commercial (recreational) sale of marijuana increases usage. As a result, more usage would mean more negative consequences that would be harmful for Hawaii.

I have pointed to some of these sources in some of my past articles and testimony and I have included some of them later in this article. Milner is either unaware of or has ignored the existence of this research.

Second, Milner supports the Rand Corporation’s advice to rely on transparent, nonpartisan and impartial review processes to arrive at a shared set of facts to guide better policymaking. That is exactly what I am doing in citing sources such as the Journal of the American Medical Association, the New England Journal of Medicine and the National Institutes of Health.

More research is certainly needed on the cost/benefit effects of legalization, looking at a specific state with its unique features, like Hawaii, with our overwhelming reliance on the tourist industry.  We asked a committee chair at the legislature to do a cost/benefit analysis for Hawaii and he was not interested. I would argue that until that is done, there are enough red flags in the current research done by reputable organizations about marijuana that should give us all pause.

Third, while legislation and policymaking may be done by other people through feelings and beliefs, all of which is passed off as unadorned “real” facts, that is not the case with us here. Our criminal justice policy positions are based on facts and are backed up by well-researched studies.

I didn’t publicly comment on the marijuana legalization issue before or during the 2023 legislative session because I had not yet done my due diligence in researching it. I had an open mind when looking at the marijuana of today and in carefully considering the evidence, pro and con.

Currently, in Hawaii, medical marijuana is available and personal use has been decriminalized.

The pros that I identified include the following: First, there will be some tax money collected (although it may be negated by resultant social costs). Second, a number of people will be employed at the marijuana stores and in the grow fields. The more stores and fields, the more people employed.

Third, if testing is done at the stores, they should be able to control for harmful additives like fentanyl. At the same time, many people will still buy from the sources they have always bought their marijuana from, as the black market, without taxes, will always be cheaper.

Fourth, depending on what legislative bill might actually pass, possession of up to 30 grams (60 joints) would no longer be illegal. Now, possession of up to an ounce (28.34 grams) is a petty misdemeanor, typically punished by a fine. Possession of three grams (6 joints) or less is a violation.

Fifth, those favoring legalization might say it will remove the stigma and marijuana possession and use. Those opposed would say legislation of this new powerful drug would send the wrong message to kids that, if it is legal, it must be safe.

Finally, some would argue that “social equity” provisions would help disadvantaged individuals and communities that had been disproportionately impacted by marijuana laws.

Pot Lowers IQs

Next, I shall include but a small sample of the good research from reputable sources that I found compelling. Due to space considerations, I am not including research showing, for example, how the proportion of drivers involved in fatal car crashes who test positive for marijuana increases or how marijuana grows negatively impact the environment and water usage, or how the black market for marijuana actually increases after legalizing commercial (recreational) marijuana.

Studies point to a decline in IQ among cannabis users, especially in teenagers. In 2021, the National Institutes of Health, Substance Abuse and Mental Health Services Administration published a systemic review and meta-analysis of longitudinal studies of frequent and dependent cannabis use in adolescents. The researchers found an average decline of approximately two IQ points following exposure to cannabis in youth.

Further, a study published by the National Institutes of Health, Substance Abuse and Mental Health Services Administration in 2013 surveyed 1,037 people in New Zealand and found that those who were dependent on cannabis before age 18 lost an average of eight IQ points.

For this group, “quitting or cutting back their cannabis use did not fully eliminate the IQ loss.” The authors, from Duke University, King’s College London and The University of Otago said “their findings accord with other data that have suggested that cannabis use may harm the developing brain.”

Marijuana use also leads to a number of health problems. In February 2024, the Journal of the American Heart Association published a study by the Massachusetts General Hospital in Boston, which analyzed survey data from the Center for Disease Control and Prevention of 434,104 adults from 2011 to 2020.

Any use of marijuana was linked to a higher risk of heart attack and stroke, with daily users having a 25% increased likelihood of a heart attack and a 42% increased risk of a stroke.

Noted local physician, Dr. Scott Miscovich, has pointed to studies in Canada that looked at cannabis emergency department poisoning over two periods of legalization: when cannabis was legalized in 2018, and when the sale of cannabis edibles (e.g., gummies, chocolates, and baked goods) was legalized in 2020.

The New England Journal of Medicine published a study in August 2022 about the unintentional marijuana poisoning in children across Canada. Hospitalization rates were 2.6 times as high as before legalization. When edibles were legalized, the hospitalization rates were 7.5 times as high as before legalization.

“Our data indicates that legalization was associated with increases in hospitalizations for cannabis poisoning in children. Most of the increase occurred after legalization of cannabis edibles and despite strict regulations aimed at reducing poisoning in children,” according to the study.

More Emergency Room Visits

A study published by the Journal of the American Medical Association in May 2024 found that, for older adults, the rate of emergency department visits for cannabis poisoning was substantially higher than pre-legalization (15.4 versus 5.8 per 100,000 person-years.)

The rate of emergency department visits was even higher, at 21.1 per 100,000 person-years. During the eight-year study period, there were 2,322 emergency department visits for cannabis poisoning in older adults whose average age was 69.5 years.

Even some of the data from a resource that was touted by Milner is alarming. He points us, through a link, to a September 2023 publication by the Federal Reserve Bank of Kansas City, “Economic Benefits and Social Costs of Legalizing Recreational Marijuana.”

The authors said, “Given the significant increase in the number of states that have legalized recreational use over the past decade, this paper aims to fill a gap in the literature by considering both the potential benefits and costs using state-level data from every U.S. state.”

They found that “Post-legalization, average state income grew by 3%, house prices by 6% and population by 2%. However, substance use disorders, chronic homelessness and arrests increased by 17, 35 and 13% respectively.

The marijuana of today is much more potent than it was in the past. A study published in 2023 by Deepak Cyril D’Souza and Albert E. Kent, professors of psychiatry at the Yale School of Medicine, noted: “In 1995, the average THC content in cannabis seized by the Drug Enforcement Administration was about 4%. By 2017, it had increased to 17% and continues to increase.”

Beyond the plant, a staggering array of other cannabis products with an even higher THC content like dabs, oils and edibles are readily available — some as high as 90%.

States that have legalized commercial (recreational) marijuana have higher usage rates. A study published in the Journal of Addiction Medicine (July-August 2020), titled “Differences in Opinions About Marijuana Use and Prevalence of Use by State Legalization Status,” found that prevalence of past-year use of any form of marijuana use was more common among residents of recreationally legal states compared with other states (20.3% in recreationally legal states, 15.4% in medically legal states and 11.9% in non-legal states) is concerning.

This survey sampled a representative sample of U.S. adults, comprising 16,280 participants.

Additionally, in a study published in the Addictions journal in 2022, researchers from the University of Colorado’s Boulder Center for Antisocial Drug Dependence and the Minnesota Center for Twin and Family Research in Minneapolis found that usage increased with legalization among the 3,452 surveyed. The study looked at cannabis usage before 2014, when it was illegal to sell recreational cannabis, and after 2014, when it became legal to sell in Colorado. Only medical cannabis was legal in Minnesota during the post-2014 portion of the study.

The participants, many of whom were born in Colorado and Minnesota, but had since relocated, were surveyed pre- and post–2014 on the number of days they used cannabis in the previous six months. Researchers found there was about a 24% increase in usage in states that legalized recreational cannabis compared with ones that did not.

Based on where the subjects were living at the time of the surveys, nearly every state was represented, along with Washington, D.C., and Puerto Rico. The study included 111 pairs of identical twins, as well, with one twin living in a state that legalized recreational cannabis and the other in a state that did not legalize.

Among the identical twins, researchers found that marijuana usage increased about 20% in states that legalized recreational cannabis compared with ones that did not. As identical twins share so many similarities, that percentage is a more accurate estimate of the causal influence of commercial legalization on cannabis use, according to lead researcher Stephanie Zellers, now a researcher at the University of Helsinki. Co-author John Hewitt stated, “This is the first study to confirm that the association between legal cannabis and increased use holds within families in genetically identical individuals. That makes it much more likely that legalization does, in itself, result in increased use.”

Being cautious about legalizing commercial (recreational) marijuana is prudent in the face of these, and other studies. An action such as this would be extremely difficult, if not impossible, to reverse. It is not “overselling limited evidence or generating more heat than light.” Why expose ourselves to the potential harm shown in study after study, all for the sake of a few tax dollars?

I commend the Legislature for doing the right thing in declining to legalize commercial (recreational) marijuana in the 2024 session. I, and others, will continue our efforts to keep providing relevant research and information to assist the legislators in making research- and data-informed policies and decisions.