The criminal justice approach to viewing drug use in the United States is associated with some interesting statistics:

  • In 2014, over 1.5 million arrests were made for violations of drug laws, and over 80 percent of these arrests were for drug possession. Over 700,000 arrests were made for the violation of laws relating to marijuana, and nearly 90 percent of these were for possession.
  • In the United States one person in every 111 adults is incarcerated, and nearly half of these people are incarcerated for violations of drug laws.
  • Over 200,000 college students have lost federal financial aid availability status due to being convicted of some violation related to drugs.
  • Estimated tax revenues that would be accrued if the distribution and sale of marijuana were legalized in the United States are in the billions.

Twenty-four states and the District of Columbia allow for the medical use of marijuana. Currently, four states have approved the legalization, taxation, and regulation of small amounts of marijuana for personal use. Other states have decriminalized the possession of small amounts of marijuana. In 2016, a number of other states will address the legalization or decriminalization of marijuana on the ballot in November.

legislativeNonetheless, at the time of this writing, according to federal statutes, possession of marijuana remains a criminal offense. The United States Drug Enforcement Administration continues to list marijuana as a Schedule I controlled substance, meaning that according to the federal government, it has no medicinal use and cannot be purchased legally by private citizens or dispensed by medical personal under any conditions. In fact, marijuana is classified in the same category as heroin. The current executive administration has maintained a hands-off policy regarding enforcing federal marijuana statutes in states where marijuana has been legalized or decriminalized; however, there is no guarantee that future administrations will do the same if the federal statutes are not altered.

The criminal justice policy initiated by the United States regarding possession of marijuana has resulted in a number of individuals who have probable drug abuse or substance use disorders experiencing harsh sanctions as opposed to receiving needed supports and treatment for their issues. These types of policies certainly hamper the substance use disorder treatment industry’s ability to provide support to individuals who are sanctioned or incarcerated with what are most likely relatively minor legal transgressions and more likely represent issues with substance use disorders.

On the other hand, proponents of the criminal justice approach note that:

  • Legalization of drugs will further increase the number of individuals with substance use disorders.
  • Legalization will result in a number of different legal issues in the same way that there are significant legal issues in each state with individuals who drive under the influence of alcohol.
  • Legalization will also send a message to younger people that using psychoactive substances is approved.

Legalization and Treatment

Colorado and Washington have legalized marijuana and model their approach to its sale and distribution after the regulation of liquor sales in those states. There is a concerted attempt by both states to make sure that individuals under the age of 21 cannot buy marijuana, and that businesses that sell marijuana should only be selling marijuana products and not be selling other commodities to limit underage traffic in these businesses. Businesses can get around this by formally having two businesses under the same roof, such that one business only markets marijuana products and the other markets something else. Colorado and Washington can serve as examples of how legalization affects the treatment industry.

According to the 2016 book Marijuana Legalization: What Everyone Needs to Know, some of the data from these states indicates that:

  • Tax revenue from marijuana sales is somewhat lower than expectations. As other states legalize marijuana, these revenues will drop even further as out-of-state competition contests with in-state growers and marketers.
  • Major issues have surfaced regarding the regulation of the potency of cannabis products, especially edible cannabis products. Many edible cannabis products have very high THC potencies (THC is the active ingredient in marijuana and cannabis products), and there are a number of instances where children have eaten these, mistaking them for cookies or candies, and ended up with serious medical issues. Calls to poison centers in both states increased significantly between 2013 and 2014, and many children wound up in intensive care with THC overdoses.
  • Legalization is associated with higher numbers of individuals reporting that they use marijuana. In 2013-2014, Colorado had the highest rate of marijuana use in the country, and Washington had the third highest rate. Over half of the top 10 states reporting the highest rates of marijuana use were states that legalized marijuana for personal or medicinal purposes as well as states that are seriously considering legalization and decriminalization. There is no denying that increased use of a drug is highly associated with an increased prevalence of substance use disorders for that drug. This means that treatment providers in the states will most likely find that:
    • They see an increase in the number of individuals coming into treatment for cannabis use disorders.
    • The diagnosis of cannabis use disorders will increase due to increased use in the state and to treatment providers being more prone to diagnose a substance use disorder in an individual with issues related to cannabis use.
    • Costs to insurance companies associated with substance use disorders increase.
  • On the other hand, legalization may be associated with a decrease in incarceration rates for individuals possessing and using small amounts of marijuana. In addition, higher prevalence rates may result in the implementation of new substance abuse prevention programs.
  • A decent proportion of marijuana users in the United States are individuals who are under the age of 21. There is still speculation that legalization will increase the black market for this group and result in an increase in cannabis use disorders diagnosed in this group. Legalization of marijuana has not been associated with significant increases in crime in either state, but it is still too early to tell if this new and expanded black market will be an issue as more states move to legalize marijuana.
  • With respect to the concern that there will be an increase in people being under the influence of cannabis in potentially dangerous situations, such as while operating a motor vehicle, in 2014, Washington observed an increase in individuals involved in traffic accidents (including fatal traffic accidents) who had tested positive for THC metabolites in their system. It is unclear if cannabis products were causal factors in these situations. At the time of this writing, there is no way to objectively test for unsafe levels of marijuana in an individual’s system in the same way that breathalyzers can test for blood alcohol concentrations. This is an issue that needs to be addressed as more states legalize marijuana.

Conclusions

The available data indicates that generalizations regarding how the state and federal government approach the issue of substance use disorders (e.g., criminal justice versus legalization and decriminalization) will affect many of the issues regarding treatment. Exactly how changing policies will affect treatment providers cannot be fully determined at this time. However, it can be hypothesized that:

  • Legalization will most likely result in an increase of the diagnoses made for individuals with substance use disorders, and this will increase the burden of treatment in the substance use disorder treatment industry.
  • Legalization may result in an earlier identification of substance use disorders in individuals and in fewer individuals with substance use disorders being incarcerated for their behavior unless they also break other laws.
  • Legalization may have actually a negative effect on keeping potential substances of abuse out of the hands of younger individuals.
  • It is uncertain how legalization or decriminalization of drugs will result in more state and federal aid being appropriated toward the treatment of substance use disorders. It can be speculated that legalization may result in the development of more state-sponsored substance use disorder treatment programs, as many proponents of legalization also support the notion that certain percentages of tax revenues accumulated from the sale and distribution of newly legalized drugs should be appropriated to formalized treatment programs. If legalization remains associated with rising proportions of the population using specific drugs, such a move would appear to be appropriate.
  • A number of states will most likely address the legalization of marijuana in 2016. Many of the questions regarding how legalization will affect the policies of treatment providers may be answered within the next two or three years.