Remember What You Were Taught About Assumptions?

A while ago, I was helping to write an application for license to cultivate and dispense in Clark County, NV (license granted), and the application posed the following as a question:

5.3.7.1. The likely impact of the establishment in the community.

I wrote an answer that I didn’t use. Here’s the response I would have preferred to give.

Problems to Overcome in Addressing the Question

With the obvious exception to the changes to joblessness rates and tax revenue, which are both easily measured by counting employees and tabulating tax remittances (it scarcely needs to be pointed out that both increase with the introduction of commercialized marijuana to a community), the impact of any new business on a community is difficult to measure. This is because there is no scientific way of doing this since experiments are not possible; one cannot set up control and intervention groups against which to test outcomes.

The approach must be observational and comparative between groups. The problems here lay in confounding factors—other differences between the groups, such as differences in socioeconomic background, educational attainment, affluence, demographic makeup and the like. Furthermore, sample size is an issue when they are particularly small and, in this case, the sample is small: one business in one community with poorly defined delimiters (i.e., where is the border of the community?) Small samples are difficult to draw conclusions from because with small populations single outliers have inordinately large impacts on the mean. Furthermore, conclusions based on comparative observation are necessarily inductive and therefore are inherently unreliable. Nonetheless, in the absence of experiment, they are the best we have.

Methodology

Given the problems inherent in answering the question, “What is the likely impact of the establishment in the community?” cohort studies are best suited to the task. Cohort studies compare two populations, one exposed, one unexposed to the variable being studied—in this case commercialized medicinal marijuana. Confounding factors (statistical “noise”) are taken into account and controlled-for in statistical analysis such that a reasonable “all-things-being-equal” conclusion may be drawn.

We have surveyed the literature available on Google Scholar and PubMed that has been published from 2013 onward that has examined various impacts of medical (and adult-use) marijuana operations on communities where such operations exist. Discarding opinion pieces (which tend towards the unrealistic both in-favor-of and against the decriminalization of marijuana), we reviewed only peer-reviewed, scientifically-conducted epidemiological studies. These studies have examined the impact of changes in marijuana law on the change in the rate of incidence of:

  • violent crime
  • property crime
  • stoned driving/driving accidents involving marijuana
  • use of marijuana and other (illicit) substances by adults
  • illicit use of marijuana and other substances by adolescents
  • pediatric exposure

In all, we reviewed 17 studies published since 2013.

Crime – Violent and Property

Almost universally, overall rates of crime, including violent and property crime, have been shown to either remain unchanged or to decrease in communities in which legal, regulated access to marijuana has been introduced.[1]

One study reported:

“…the impact of MML on crime was negative or not statistically significant in all but one of the models, suggesting the passage of MML may have a dampening effect on certain crimes. The second key finding was that the coefficients capturing the impact of MML on homicide and assault were the only two that emerged as statistically significant. Specifically, the results indicate approximately a 2.4 percent reduction in homicide and assault, respectively, for each additional year the law is in effect.”[2]

Note that this reduction appears contrary to the empirically obvious increase in opportunity for property crime to occur (i.e., one cannot rob a marijuana business if none exists.) We hypothesize that the high levels of police presence, increased security measures and the existence of surveillance technology in areas where marijuana operations exist account for these reductions. This effect has also been reported by the Denver Police Department[3] and has received muted press attention.[4] [5] [6] [7]

Interestingly, the obvious increase in opportunity for violent crime has not manifested in actuality. Instead, the presence of marijuana businesses has, counterintuitively, resulted in reduced rates of violent crime (rape, homicide, aggravated assualt).[8] [9] Whether this is the consequence of rigorous security measures established for the safe transport of product and cash, and for the secure operation of such business, or is a salutary effect of the increased availability of marijuana itself, remains a matter for speculation or further study. Nevertheless, the results, adjusted for statistical error, are unequivocal: the presence of marijuana businesses reduces both property and violent crime rates in the host community.

We expect that our community will enjoy a decrease in the rate of violent and property crime rates.

Driving Accidents Involving Marijuana

Background: “The most commonly detected nonalcohol drug was cannabinol, the prevalence of which increased from 4.2% in 1999 to 12.2% in 2010”[10]

Given the background of a nearly 300-percent increase in the presence of THC in the blood of those who died in traffic accidents from 1999 to 2010, it would be easy to conclude that increased availability of marijuana therefore increases traffic fatality, but, this is not the case. In fact, while it is true that marijuana is more common in traffic fatalities, traffic fatalities overall have declined following the introduction of legal marijuana businesses. How much? “…legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption.”[11]

These authors propose that this overall reduction is due to the fact that marijuana is treated by many users as a substitute for alcohol. While it is a well-established fact that alcohol decreases reaction time and motor function while simultaneously increasing user confidence, the impact of marijuana on driver ability is much less severe (but not non-existent), especially among experienced users. Furthermore, when one adjusts for the combination of THC and alcohol in traffic fatalities, the number of traffic fatalities involving marijuana alone is shown to be vanishingly small.

Another explanatory observation is that in a general population where marijuana use has increased over time, one would expect to see a parallel increase in marijuana-positive toxicity tests. To put this another way, if red shirts were suddenly to become popular in a community, one would expect to find a higher number of traffic accident victims wearing red shirts. Causality is not to be implied. Finally, it is well-known that THC remains in users’ blood well after the acute effects of the substance have worn off, making such toxicity tests of dubious value to begin with, and may even send uncritical policy makers on a wild-goose chase.

One study author sums it up thusly:

“Although overall, drugs contribute to crash risk regardless of the presence of alcohol, such a contribution is much lower than that by alcohol. The lower contribution of drugs other than alcohol to crash risk relative to that of alcohol suggests caution in focusing too much on drugged driving, potentially diverting scarce resources from curbing drunk driving.”[12]

Drunk driving remains the single largest contributing factor to traffic fatality rates,[13] and legal marijuana businesses, by providing a safer substitute, have been shown to decrease traffic fatality rates in communities where they are permitted to exist.[14]

We expect that our community will enjoy a decrease in rate of traffic fatality.

Adult Illicit Drug Use

Several studies have been conducted to examine the so-called (and, it turns out, purely imagined) “halo-effect” of marijuana on the use of other, illicit, “hard drugs” on communities that permit the use and sale of marijuana. These studies invariably employ language that reveals authorial bias. For example, one study concludes, “Our results show that commercialization of marijuana in Colorado has been associated with lower risk perception.”[15] Implicit in the statement is that such lowered risk perception is a problem.

To the contrary, such reduced risk perception is one anticipated result of informing populations about the proper use of anything. Chainsaws, sex and motorcycles could be anticipated to follow a similar risk-perception curve following the deployment of safe use, safe sex and motorcycle-licensing programs. If cannabis is, in fact, beneficial for certain ailments and conditions, which the State of Nevada has agreed it is, then lowered risk perception is a good thing in that such perception would help to promote its use in alleviating such conditions among the affected population. In other words, what these researchers call “lowered risk perception” could also be termed “education about the legitimate medicinal uses of cannabis”.

Even among the skeptics, though, we find that such studies invariably conclude three things:

“First, we conclude from the current literature that the rescheduling of marijuana and provision of it through typical highly regulated medical channels would not lead to widespread increases in its use or harms. Second, legalization would generate savings in terms of reduced criminal justice costs and improve social welfare by eliminating criminal sanctions for minor marijuana offenses (Gieringer, 2009; Kilmer et al., 2010). These savings will far exceed the probable regulatory cost of implementing even a highly regulated marijuana market…

Third, marijuana use will rise under legalization in large part because legally sanctioned production and competition will drive down prices.”[16]

Therefore, yes, a community can expect that marijuana use will increase among it constituent members. One study points out that “average levels of marijuana consumption are higher in states with medical marijuana laws (MMLs).”[17] But, these same communities can expect that marijuana use is the only drug the use of which will increase in that community and that its use will, indeed, increase among only those who most need it. Another study makes this expectation explicit: “MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21… but there is no evidence of spillovers to other substance use.” [18] Moreover, among the general population, not only do we see no halo effect with respect to the use of other drugs, “…it is possible that broad medical marijuana policies do in fact generate lower marijuana use, and possibly alcohol use,”[19] perhaps because of the substitution effect.[20] [21]

We expect that marijuana use will increase in the community in general, but only in proportion to the number of qualified patients who live there and who, in fact, are able to benefit from its use. We further expect that no other drug use will increase, and that marijuana use among the non-patient population may even decrease.

Adolescent Illicit Drug Use

The question of impact on adolescent drug use—whether marijuana or other illicit drugs—is a key one in the implementation of medical marijuana laws. It is a question the answer to which every member of a community has a vested interest in because it has the potential to so inordinately impact not only the well being of a vulnerable population, but because the future well being of the community is so dependent upon this population. It is a question that we take seriously.

The largest survey we were able to find—a survey of over 11.7 million students published in the Journal of Adolescent Health—showed that “There were no statistically significant differences in marijuana use before and after policy change for any state pairing. In the regression analysis, we did not find an overall increased probability of marijuana use related to the policy change (marginal probability .007, 95% confidence interval −.007, .02).”[22]

Another study in the American Journal of Public Health reported: “Our results suggest that, in the states assessed here, MMLs have not measurably affected adolescent marijuana use…”[23]

This, taken in the context of the studies on overall drug use changes, is an expected outcome of the introduction of medical marijuana businesses to our community.[24]

We expect that, in line with the studies above, our business will have no impact on the use of drugs by the adolescent population of our host community.

Pediatric Exposure

This is a serious potential problem that must be acknowledged by any responsible operator of a marijuana business. The single biggest black-eye on this new industry has to be the early failure of medicinally-infused products manufacturers to suitably enclose their products in child-proof containers. This has had an undesirable and wholly unnecessary effect on an innocent population.

In the Journal of the American Medical Association, study authors Wang, Roosevelt and Heard report:

Although the number of pediatric exposures to marijuana reported to the National Poison Data System was low… We found a new appearance of unintentional marijuana ingestions by young children after modification of drug enforcement laws for marijuana possession in Colorado. The consequences of unintentional marijuana exposure in children should be part of the ongoing debate on legalizing marijuana.[25]

We agree. We believe that the prudent consideration of such events by the State of Nevada in the formation of their packaging rules will prevent the vast majority of such incidents in the State of Nevada.

These packaging rules, in combination with our own educational initiative designed specifically for those patients of ours who live with small children, will drasticaly reduce or eliminate pediatric exposure to marijuana.

We expect that, while we cannot control for all factors, our business will have little to no impact on the incidence of pediatric exposure to marijuana among the population of our host community.

In short, we’re the solution, not the problem you have assumed we are.


 

Works Cited

  [1]       Morris, R. G., TenEyck, M., Barnes, J. C., & Kovandzic, T. V. (2014). The effect of medical marijuana laws on crime: evidence from state panel data, 1990-2006. PloS one. Retrieved from http://dx.plos.org/10.1371/journal.pone.0092816.g001

  [2]       Ibid.

  [3]       http://www.denvergov.org/Portals/720/documents/statistics/2014/UCR_Citywide_Reported%20_Offenses_2014.pdf

  [4]       http://guardianlv.com/2014/05/colorado-marijuana-sales-up-crime-down/

  [5]       http://reason.com/blog/2014/03/27/more-pot-less-crime-medical-marijuana-st

  [6]       http://www.huffingtonpost.com/2014/06/16/marijuana-crime-denver_n_5500611.html

  [7]       http://rt.com/usa/163644-colorado-marijuana-crime-drop/

  [8]       Morris, R. G., TenEyck, M., Barnes, J. C., & Kovandzic, T. V. (2014). The effect of medical marijuana laws on crime: evidence from state panel data, 1990-2006. PloS one. Retrieved from http://dx.plos.org/10.1371/journal.pone.0092816.g001

  [9]       Freisthler, B., Kepple, N. J., Sims, R., & Martin, S. E. (2013). Evaluating medical marijuana dispensary policies: spatial methods for the study of environmentally-based interventions. Am J Community Psychol, 51(1-2), 278-288. doi:10.1007/s10464-012-9542-6

[10]       Brady, J. E., & Li, G. (2014). Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, 1999–2010. American journal of epidemiology. Retrieved from http://aje.oxfordjournals.org/content/179/6/692.short

[11]       Anderson, D. M., Hansen, B., & Rees, D. I. (2013). Medical marijuana laws, traffic fatalities, and alcohol consumption. Journal of Law and Economics. Retrieved from http://www.econstor.eu/bitstream/10419/58536/1/690072864.pdf

[12]       Romano, E., Torres-Saavedra, P., Voas, R. B., & Lacey, J. H. (2014). Drugs and alcohol: their relative crash risk. J Stud Alcohol Drugs, 75(1), 56-64. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&listuids=24411797

[13]       http://www.dot.state.fl.us/safety/4-Reports/Bike-Ped/FDOT_BD050.pdf

[14]       Brady, J. E., & Li, G. (2014). Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, 1999–2010. American journal of epidemiology. Retrieved from http://aje.oxfordjournals.org/content/179/6/692.short

[15]       Schuermeyer, J., Salomonsen-Sautel, S., & Price…, R. K. (2014). Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003–11. Drug and alcohol …. Retrieved from http://www.sciencedirect.com/science/article/pii/S0376871614008424

[16]       Pacula, R. L., & Sevigny, E. L. (2014). Marijuana Liberalization Policies: Why We Can’t Learn Much from Policy Still in Motion. Journal of Policy Analysis and …. Retrieved from http://www.researchgate.net/publication/258219685MarijuanaLiberalizationPoliciesWhyWeCan’tLearnMuchfromPolicyStillinMotion/file/72e7e52757d5a1d6ff.pdf

[17]       Pacula, R. L., Powell, D., Heaton, P., & Sevigny, E. L. (2013). Assessing the effects of medical marijuana laws on marijuana and alcohol use: The devil is in the details. nber.org. Retrieved from http://www.researchgate.net/publication/256095147NBERMedicalMJw19302/file/3deec521b7a5909026.pdf

[18]       Wen, H., Hockenberry, J. M., & Cummings, J. R. (2014). The Effect of Medical Marijuana Laws on Marijuana, Alcohol, and Hard Drug Use. nber.org. Retrieved from http://www.nber.org/papers/w20085

[19]       Pacula, R. L., Powell, D., Heaton, P., & Sevigny, E. L. (2013). Assessing the effects of medical marijuana laws on marijuana and alcohol use: The devil is in the details. nber.org. Retrieved from http://www.researchgate.net/publication/256095147NBERMedicalMJw19302/file/3deec521b7a5909026.pdf

[20]       Subbaraman, M. S. (2014). Can cannabis be considered a substitute medication for alcohol? Alcohol Alcohol, 49(3), 292-298. doi:10.1093/alcalc/agt182

[21]       Anderson, D. M., Hansen, B., & Rees, D. I. (2013). Medical marijuana laws, traffic fatalities, and alcohol consumption. Journal of Law and Economics. Retrieved from http://www.econstor.eu/bitstream/10419/58536/1/690072864.pdf

[22]       Choo, E. K., Benz, M., Zaller, N., Warren, O., & Rising…, K. L. (2014). The impact of state medical marijuana legislation on adolescent marijuana use. Journal of Adolescent …. Retrieved from http://www.sciencedirect.com/science/article/pii/S1054139X14001074

[23]       Lynne-Landsman, S. D., Livingston, M. D., & Wagenaar, A. C. (2013). Effects of state medical marijuana laws on adolescent marijuana use. American journal of public health, 103(8), 1500-1506. Retrieved from http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301117

[24]       Wen, H., Hockenberry, J. M., & Cummings, J. R. (2014). The Effect of Medical Marijuana Laws on Marijuana, Alcohol, and Hard Drug Use. nber.org. Retrieved from http://www.nber.org/papers/w20085

[25]       Wang, G. S., Roosevelt, G., & Heard, K. (2013). Pediatric marijuana exposures in a medical marijuana state. JAMA pediatrics. Retrieved from http://wasavp.org/wp-content/uploads/2012/06/JAMApediatrics2013MedMj.pdf

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