Testimony before the IL General Assembly on Marijuana Legalization, Public Health and the Cannabis Regulation and Taxation Act (SB 316, HB 2353): David L. Nathan, MD, DFAPA

grygielny Decriminalization, Drug Education, IL

January 22, 2018 Good morning, Senator Heather Steans, Representative William Davis and esteemed members of the General Assembly. My name is David Nathan. Originally from the Philadelphia area, I graduated with high honors from Princeton University. I received my medical degree from the University of Pennsylvania School of Medicine and completed my residency at McLean Hospital of Harvard Medical School. I am a board-certified psychiatrist, and for the past twenty years I have maintained a private practice in Princeton, New Jersey, where I live with my wife and our two teenage children. I am the Director of Continuing Medical Education for Penn Medicine Princeton Health and the Director of Professional Education for Princeton House Behavioral Health. I am a Clinical Associate Professor at the Rutgers Robert Wood Johnson Medical School. On the topic of cannabis policy, I do not speak for the institutions with whom I have an affiliation. I am a Distinguished Fellow of the American Psychiatric Association, which is the highest membership honor bestowed by the APA. I have published numerous articles in the national psychiatric and lay press about a variety of topics in history and science, one of which is the legal status of marijuana. I am the founder and board president of Doctors for Cannabis Regulation (or DFCR). With a prestigious roster of physicians, including former Surgeon General Joycelyn Elders and integrative medicine pioneer Andrew Weil, DFCR is the first and only national medical association dedicated to the legalization, taxation and – above all – the effective regulation of marijuana in the United States. DFCR has members in nearly every state and US territory, including right here in Chicago. DFCR does not promote cannabis use. Rather, we advocate for the legalization of cannabis for adults, because effective regulation requires a legalized environment. We therefore support a core set of common-sense measures – our “Platform of Regulations” – to control the marijuana industry and protect public health. We believe that the government should oversee all cannabis production, testing, distribution, and sales. Cannabis products should be labeled with significant detail, including (but not limited to) THC and CBD levels, dosing information and ingredients. There should be restrictions on marketing and advertising of cannabis products. Cannabis packaging and advertising that targets or attracts underage users should be completely prohibited. All cannabis products should have child-resistant packaging. There should be harsh penalties for adults who enable diversion of cannabis to minors. Taxation of the cannabis trade should be used to fund research, education, and prevention, including public information for adults on the use and misuse of cannabis and youth programs that emphasize the risks of underage cannabis use. And since cannabis prohibition has worsened the poverty of the impoverished – particularly in communities of color – DFCR believes that the government has an obligation to rebuild the communities disproportionately affected by the war on marijuana. There are many ways this can be done, but if nothing else, we must expunge the criminal records of individuals convicted of minor cannabis crimes and ensure diversity in the cannabis industry. Esteemed members of the General Assembly: The time has come to end the failed and harmful prohibition of marijuana in the State of Illinois. This historic and beloved city of Chicago knows all too well the destruction brought by well-intended but sadly misguided efforts by society to control addiction through prohibitions. From the violence in the streets under Alcohol Prohibition, to the violence in the streets we see today, Chicago has paid a heavy price for the heavy-handed criminal approach to addiction, which is fundamentally a health problem, not a moral one. Alcohol Prohibition was repealed after just thirteen years because of unintended consequences: organized crime, increased use of hard alcohol, and government waste. So, what have we gotten from our eighty-year experiment with marijuana prohibition? Organized crime, increased use of stronger marijuana, and government waste. And yet, Alcohol Prohibition was a success compared to our war on marijuana. Alcohol consumption decreased during the 1920s, but marijuana use has increased drastically since its prohibition. Today, 22,000,000 Americans use cannabis each month, and even more partake on a less frequent basis. Marijuana prohibition began in the 1930s – over the objections of the American Medical Association – based on scare tactics and fabricated evidence that suggested that the drug was highly addictive, made users violent, and was fatal in overdose. We now know that none of those assertions are true. Cannabis is less addictive than alcohol and tobacco. It doesn’t make users violent, and there are no documented cases of fatal cannabis overdose. In short, from the medical standpoint, marijuana should never have been illegal for consenting adults. While Doctors for Cannabis Regulation firmly supports the legalization and regulation of marijuana for adult use, it emphatically opposes underage recreational use of marijuana. Evidence suggests that both marijuana and alcohol can adversely affect brain development in minors. Studies of underage users show that health effects are worse when kids start younger and consume more frequently. But cannabis prohibition for adults does not prevent underage use. For decades, preventive education reduced the rates of alcohol and tobacco use by minors, while underage marijuana use rose steadily despite its prohibition for adults. The government’s own statistics show that 80-90% of eighteen-year-olds have consistently reported easy access to the drug since the 1970s. Opponents of legalization like to say: “This isn’t your parents’ marijuana.” And they’re right. Cannabis cultivation has led to the development of more potent strains, to the extent that illegal marijuana today is typically about three to five times stronger than it was 30 years ago. In states where marijuana is legal, the government requires potency labeling. Adult users can make informed decisions about their intake based on potency, much as people do with alcohol – say, drinking a small amount of vodka compared with two beers. But in Illinois, where it’s illegal and uncontrolled, marijuana products aren’t labeled and users consume an unknown product of unknown potency. Thus, the opposition’s claim is a medically sound argument… to legalize and regulate marijuana so that products are properly labeled with potency, ingredients and serving sizes. Opponents of legalization say – again without evidence – that marijuana legalization “sends the wrong message” to kids. In other words, they argue that if a drug or activity is legal for adults, then kids will think it’s safe for them. If there is an association, it is the opposite of what opponents claim. When cannabis is against the law for everyone, the government is saying that marijuana is dangerous for everyone, and kids know that’s not true. If adults can’t be trusted to tell the truth about responsible adult use of marijuana, why should kids listen to us when we say it’s harmful for them? By making a legal distinction between marijuana use by adults and minors, we demonstrate a respect for scientific evidence – and the sanctity of the law – that we would want our children to emulate. Whether in sex education or drug education, when kids know we’re being honest with them and trust the information we’re providing, they’re more likely to take that advice seriously. And we know that preventive drug education works—the rates of underage tobacco and alcohol use have been falling for many years, even though it remains legal for adults. During that same time, underage marijuana use – which until recently was illegal in all 50 states – has risen. Today, teen use has remained level across the nation, including in legalized states. While we cannot predict the future, there are good reasons to believe legalization may actually decrease underage use. Now I would like to address what may be the biggest misconception about marijuana – namely, that it is a “gateway” to the use of harder drugs. We hear this repeated over and over again, and always without supporting evidence. A study by the Institute of Medicine, the health branch of the National Academy of Sciences, concluded that marijuana “does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse.” While it’s true that users of hard drugs often tried marijuana first, they’re even more likely to have tried alcohol and tobacco. And the vast majority of those who try marijuana, alcohol and tobacco don’t go on to use harder drugs. Simply put, the fact that some people who use hard drugs also used marijuana in no way implies that marijuana causes people to use hard drugs. The marijuana “gateway” hypothesis is an archaic, misleading and oversimplified explanation of substance misuse, and it trivializes the serious discussion of how to address one of the greatest public health crises in history: our nation’s deadly opioid epidemic. Times are changing. In 2018, even physicians who oppose legalization generally believe that marijuana should be decriminalized, reducing penalties for users while keeping the drug illegal. Although decriminalization is certainly a step in the right direction, DFCR physicians believe it to be an inadequate substitute for legalization and regulation for a number of reasons. First, decriminalization does not empower the government to regulate product labeling and purity, which leaves marijuana vulnerable to contamination and adulteration. This also renders consumers unable to judge the potency of marijuana, which is like drinking alcohol without knowing its strength. Moreover, where marijuana is merely decriminalized, the point-of-sale remains in the hands of drug dealers who will sell marijuana – as well as more dangerous drugs – to children. Contrary to popular belief, decriminalization doesn’t actually end the arrests of marijuana users. Despite New York State decriminalizing marijuana in the 1970s, New York City makes tens of thousands of marijuana possession arrests every year, with continuing racial disparities in enforcement. Finally, under a decriminalized system the government continues to prosecute and constrict the supply chain. This drives up the price of marijuana, making the untaxed illegal market more lucrative, competitive, and violent. When we describe the days of Al Capone, we call it “Alcohol Prohibition”, but it was actually more properly called “Alcohol Decriminalization”. It was perfectly legal to obtain and consume alcohol for medical purposes or religious rituals, or if you made it at home for your personal use. So, when opponents tout decriminalization as an answer to prohibition, ask them what they think will happen if we remove penalties for consumers while prosecuting growers and sellers, and how this could be expected to work when Alcohol Prohibition didn’t. Ladies and gentlemen, I thank you for your time and attention. I would be happy to answer your questions. Respectfully submitted, David L. Nathan, MD, DFAPA dnathan@dfcr.org 609-688-0400 (phone) 609-688-0401 (fax) 601 Ewing Street, Suite C-10 Princeton, New Jersey 08540 Doctors for Cannabis Regulation. “Platform of Regulations.” Updated January 2018. https://dfcr.org/platform-of-regulations/

Testimony Before Illinois General Assembly Committees on Marijuana Legalization: Rev. Alexander E. Sharp

grygielny Decriminalization, Drug Education, IL

January 22, 2018 I am the Rev. Alexander Sharp, Executive Director, Clergy for a New Drug Policy.  We reach out to clergy nationally to end the War on Drugs and seek a health, not punishment response to drug policy.  Because we are based in Illinois, and I have been doing faith-based education and advocacy work for over 20 years, a substantial number of clergy and lay leaders in Illinois are aware of our work. It might seem unusual for clergy to be advocating for marijuana legalization.  I am not advocating for marijuana use, although I don’t think it is wrong, any more than using alcohol, a far more dangerous drug, is wrong. Many clergy support marijuana legalization because of our sense of how best to influence and even change behavior, especially of our youth.  What the failed War on Drugs has taught us over the past 45 years is that prohibition does not work. Why?  Prohibition refuses to accept reality.   Drugs are a reality in our society.  Cigarettes, alcohol, and potentially addictive behaviors like gambling are with us.  The issue, therefore, becomes how to prevent not use but abuse.  I wish someone would make this point to U.S. Attorney General Jeff Sessions when he appears to say that all drug use is bad. Instead of prohibition, we need to focus on preventing abuse though regulation and education.  Cigarettes are legal, but smoking has gone down by 50% in the last 25 years.  Alcohol is legal, but that we have made progress here as well.  Marijuana is illegal, and use has not gone down.  What’s wrong with this picture is that with marijuana, we have persisted in mindless prohibition. I stress to my clergy colleagues that “legalization” is the wrong word.  We seek the “regulation” of marijuana.  That means that marijuana now obtained in the illicit market will be clearly labeled and packaged. People will know what and how much they are using.  That is far from the case with back alley and school yard purchases. I’ve used these policy arguments with clergy across the country, and they get it. But beyond these policy wonk arguments, at the end of the day, we must educate each other, especially of our young people.  We must communicate with them in a way that makes sense to them.  They need to trust us.  I don’t see how that is possible when we equate marijuana and prohibition. Our youth didn’t believe us when we preached “Just Say No” in the 1980’s.  When it comes to marijuana, they do not believe us now. The DARE programs where a law enforcement officer stands in front of a classroom and says “this is your brain on drugs” didn’t work when they were first tried.  These programs have adjusted since the 1980’s but they are still not effective. I have attended many conferences where medical experts have described in elaborate detail how marijuana if heavily used can be harmful to young, still developing brains.  It can affect motivation.  I believe them. The problem is not that these facts are wrong.  Our kids should hear and take to heart every one of them.  The problem is that it is very hard to communicate them in the context of a policy – namely prohibition – rooted in abstinence. Further, the very concept of harm reduction is impossible if abstinence is the only response to drug use.  To deny the goal of harm reduction is immoral.  The best in our faith traditions tells us that persuasion, with compassion, mercy and forgiveness; rather than punishment – in the form of jail and incarceration – are the best paths to changing hearts and minds. All of this gives us a response to one final question that is frequently asked:  We’ve got alcohol and cigarettes, but why marijuana?  Do we really need another legal drug? My response: if really believe regulation and education are the best way to shape individual moral behavior, we should legalize marijuana even if alcohol and cigarettes had never happened. Marijuana legalization stands on its own merits.  That why I urge your support for SB 316.

What Legalized Marijuana Has Done for Education: It’s Not What You Think

Sanya Singh Drug Education, Marijuana Legalization, Tax and Regulate

Sarah Grippa is a high school teacher in Colorado, a state that legalized marijuana in 2012.  In 2015, seeing the need for better ways to educate teens about the risks of marijuana use, she and educator Molly Lutz co-founded the Marijuana Education Initiative to “put the most current, research-based information in the hands of parents, mentors, and educators.” You may assume I am talking about money—specifically, marijuana excise taxes to fund education—but I am not. I am talking about actual education, the kind that takes place between teachers and students, youth-serving organizations and participants, and parents and children. That kind of education is changing—in a good way—as a result of legalized marijuana. Here’s why. During the 1980s and early 1990s, the Drug Abuse Resistance Education (D.A.R.E). a program, a product of the ill-fated War on Drugs whose educational philosophy was “Just Say No,” was the drug education curriculum offered to schools and youth programs. It typically sent uniformed police officers into schools to talk about the dangers of doing drugs. D.A.R.E was accompanied by mandated zero tolerance policies, contributing to a “school to prison pipeline.” A 1998 report from the National Criminal Justice Reference Service stated, “D.A.R.E. does not work to reduce substance use. The program’s content, teaching methods, and use of uniformed police officers rather than teachers might each explain its weak evaluations.” In all fairness, those who created D.A.R.E in the 80s lacked the information about effective teaching that we have today. Educators and curriculum writers had not yet learned that students need to hear prevention information from a trusted adult, that it’s better to keep nonviolent offenders in school than to suspend them, and that protective factors play a large part in preventing drug use. Earlier educators also lacked the technical understanding of how adolescent brains develop that we have today. Though some employed “abstinence-only” programs like D.A.R.E. out of complacency, more often it was because they lacked better options. The legalization of recreational marijuana has forced educators to rethink their approaches to preventing young people from using marijuana. Schools and youth-serving organizations now realize that they can’t talk about marijuana in the same breath as heroin, methamphetamine, or cocaine. There is a clear and concise call for a change in dialogue and approach. Prevention programs like D.A.R.E. are not only ineffective, they are an insult to young people’s intelligence. Youth are fully capable of understanding how their brains are developing, the functioning of the endocannabinoid system, and the differences between recreational and medicinal marijuana use. Today’s youth endure countless standardized tests in their academic career, can navigate the complexities of social media, and can even teach adults how to use SnapChat. They deserve to be told how recreational marijuana use during adolescence can affect their still-developing brain, rather than being told to “Just Say No.” They have the right to develop a compassionate understanding of the differences between medicinal needs—for example, of youth for whom medical marijuana can help manage childhood epilepsy—and recreational use. One of the unexpected outcomes of recreational marijuana legalization has been a positive change in educational practices. Across the US, educators are seeking programs that use reality-based education to empower youth to make informed decisions.  Educators, including me, have reinvented, upgraded, expanded, and collaborated to devise new and improved approaches. This would likely not be happening if not for legalized marijuana Regardless of how one might feel about marijuana legalization, we can all agree that best practices in adolescent prevention, intervention, and diversion programs are in the best interest of youth. Unexpected outcomes are not always negative outcomes. Sometimes they can turn our thinking on its head and transform complacency into action.

Community Healing in the Aftermath of the War on Drugs: A Sermon by James Kowalsky

Sanya Singh Drug Education, Harm Reduction, Marijuana Legalization, Racial Inequality

In his sermon “Community Healing in the Aftermath of the War on Drugs” James Kowalsky reflects on drug use in our society and harm reduction as the most appropriate response.  James worked at Heartland Health Outreach in Chicago for seven years and is currently a graduate student at the School of Social Service Administration at the University of Chicago. The sermon was preached at Prairie Circle Unitarian Universalist Congregation.  We provide excerpts here with a link to the full text. I’m going to start this sermon with a few questions for you to consider. Many of these questions don’t have absolute answers. They are questions we should ask ourselves so that we know where we stand and try to figure out how these beliefs we hold, impact the action we are willing to take. What does a drug user look like?… For many of us when we picture what a drug user looks like we imagine someone looking dirty and disheveled, living on the streets with beer bottles or needles scattered around their body. We picture a desperate and dangerous criminal, willing to harm anyone in order to feed their addiction… In a study published in the Journal of Alcohol and Drug Education in 1995, a survey asked people to envision a drug user and describe that person. 95% of respondents described a black person. This is the case despite that fact that the majority of people who use drugs in our country are white. African-Americans make up about 15% of the people who use drugs, roughly equal to their proportion of the general population. When we picture who a drug user is, we don’t readily think of the successful people who have used drugs—executives, scientists, writers, musicians, politicians, Presidents. It would be inaccurate to say that people who use drugs or have used drugs are bad people, or are unproductive members of our communities. In fact, the overwhelming majority of people who try a drug—any drug—will not have a serious problem with that drug in their lifetime. Yet, this image of a drug user as a failure and threat persists… What is a drug? In general, we would define a drug as a substance that we put into our bodies that alters our mood or physiological state; the caffeine we use to help us get out of bed at the start of the day; the medicine we take to control our blood sugar, blood pressure, or moderate other symptoms that may prohibit us from taking care of business; the glass of wine we use to unwind after a long day at work. All of these are substances we put into our body to alter the way we think and feel… This does not mean that drugs are not harmful. Certainly, all drugs have the capacity to harm people. Partially, we have a skewed perspective of drug users because the people who are most negatively impacted by their use, are inherently more likely to need help and encounter systems like hospitals, treatment programs, and law enforcement. However, we’ve exaggerated the likelihood of harm in order to scare people away from trying drugs… Our relationship with any drug—legal or not—can range from harmful to helpful…Environment matters. Journalist Johann Hari talks about harmful use being a product of disconnection. Dr. Gabor Mate talks about addictions being rooted in painful experiences. Norman Zinberg points to the combination of three sets of factors he calls drug, set, and setting—factors related to the drug and how it’s used, the individual and their circumstances, and the environment they use in… We also know that experiencing trauma in early childhood increases the likelihood that people will have a harmful relationship with drugs. Yet, we live in a country that demonizes the drug user—they are a person who has made bad decisions and must live with the consequences. We see drug use as an individual choice and an individual problem. We try to interrupt that problem by punishing their bad choices and isolating people from everything that is familiar to them. But, what child chooses to be neglected or abused? What person chooses to be left without a support system when their parent or caregiver dies? Nobody chooses the circumstances that often precede harmful relationships with drugs. But, it’s far simpler to point to the individual and never consider the environment that they come from. That way, we don’t have to think about how poverty, a poor education system, a lack of economic opportunities, unstable housing, or growing up in a neighborhood where you regularly witness community violence, all make it more likely that people will have a harmful relationship with drugs. In fact, it is these circumstances, not drug use, where African-Americans are disproportionately represented… Much like drug use itself, punishment and isolation don’t just impact the individual. They damage the environment as well; they take the parent away from their child, remove brothers and sisters from families. By removing community members, we promote disconnection and thereby increase the likelihood of harmful drug use for the people left behind… We need to shift away from focusing our energy on trying to eliminate drug use altogether. That is and always has been an unrealistic goal. Drugs have been used for thousands of years, across continents and cultures. Drugs are a part of our lives and we all have relationships with them. We need to focus on the harms we consider most egregious and address them instead. We’ve tried, what some would call, a tough love approach for too long. It’s time we just try love. We need to shift from seeing harmful drug use as an individual problem that we solve with punishment, to a community problem that we solve with healing… One approach that does just that, and is gaining traction, is called harm reduction. Harm reduction is the practice of using drugs in less risky ways. When we drink responsibly, we are practicing harm reduction. We eat food before drinking, drink water, we practice moderation and limit our total number of drinks, we don’t drive when we’ve had too much to drink. These are all harm reduction choices we regularly make. As we make harm reduction choices with alcohol, we can make similar choices with other drugs… Beyond this individual practice, harm reduction is a philosophy—a belief in the human rights of people who use drugs. Harm reduction promotes the idea that regardless of what a person puts in their body, they should not be denied their basic human rights… As members of a faith community, your congregation has a unique opportunity to offer connection and healing to people in need. Matthew 11:28 tells us, Come to me, all you who are weary and burdened, and I will give you rest. The church has long been a place where people have sought out sanctuary. Extend an olive branch to the people who experience the severe consequences of drug use. Too often, people who struggle with their drug use don’t seek out help, because they think that love and support will only be available to them if they are ready to stop using altogether. We need to dispel the myth that belonging to this community is contingent on abstinence from all drugs. Because it’s not. We know that because we’re all here… Instead of focusing on trying to get people to stop using drugs, we can focus on trying to understand how and why they are using drugs. In order to understand people, we need to be willing to listen. Healing happens in relationships. We should focus on building a connection with people. Learn about their lives. Find out about their story, ask them about their hopes and dreams, ask them about what’s missing in their life. Almost certainly, one of the things they’re missing is someone who’ll ask those questions and respectfully listen. Remember, that person who is struggling is likely trying to disconnect from some source of pain. Give them love, give them connection, give them rest, help them heal, and you will help our communities heal. Amen

Effective Drug Education

Sanya Singh Drug Education, Marijuana Legalization, Tax and Regulate

Our November 17, newsletter argued that marijuana legalization makes possible “Drug Education That Students Will Believe.”  While Rick Steves did not address drug education explicitly, his comments confirmed this critical point – as these excerpts make clear: We need credibility for teachers, cops, and parents when it comes to the dangers of hard drugs. When we get the ‘reefer madness’ out of the system we have credibility.  When we take the crime out of marijuana, then we can address the serious problems of hard drugs, and we can do that effectively. This isn’t an issue of soft or hard on drugs. This is an issue of how can we be pragmatic? How can we be smart about a problem that we can’t just wish away?  Marijuana is here. People who are opponents talk like, “If you legalize marijuana, it’s going to mess up kid’s brains.”  Well, the kids are smoking marijuana. They’re going to smoke after legalization. The question is how can we gain credibility. In Europe, they talk about pragmatic harm reduction. For eight years during the Bush administration, if you proposed pragmatic harm reduction that would not even have been considered because that would have been code for “Let’s legalize it.” But what is wrong with pragmatic harm reduction when it comes to a moral issue? We are suffering from decades and billions of dollars of misinformation from the federal government on the need to make marijuana criminal.  When they finally legalized alcohol, there wasn’t a celebration.  There was recognition that the laws against alcohol were causing more harm to society than the alcohol itself. We can gain credibility by talking truth to our young people and to me it’s a huge issue. I was a parent of two kids and we had to navigate all those challenges. I want teachers and parents, and cops to have credibility with kids. They will when they speak the truth rather than mouthing government talking points. Let’s regulate instead of criminalizing it.  We’re learning that right now. Marijuana use is going down among adolescents, because now we have credibility, just like we’ve had success with tobacco and kids. You can advertise, you can educate, and you can make progress.