On at least one front, however, Sessions’s new war on drugs is likely to fail. In taking on cannabis — particularly the medical uses of cannabis — he is staking out a position that is at odds with powerful interests and an overwhelming majority of Americans from nearly all walks of life. This tide is too strong to swim against.
The first obstacle is that the medical community has largely resolved the question of whether cannabis is clinically useful. In January, the National Academies of Sciences, Engineering and Medicine (NAS) reported that there is “conclusive evidence” that cannabis (both whole plant and extracts) is clinically effective at treating some diseases, including chronic pain. Cannabis may prove to be a pain management strategy that could substitute for opioids for many desperate patients, and the National Institute on Drug Abuse (NIDA) acknowledges that cannabis may be an effective tool to combat the opioid crisis. Researchers studying the relationship between medical cannabis laws and opioid use have found that states with such laws have nearly a 25 percent reduction in opioid-related deaths. The contrast between opioids — which killed more than 33,000 Americans in 2015 — and cannabis could not be more striking. As NIDA states on its DrugFacts — Marijuana Web page: “There are no reports of teens or adults fatally overdosing (dying) on marijuana alone.”
Further, medical cannabis may also save lives in unexpected ways. Data published in the American Journal of Public Health in February suggests that laws allowing it were associated with fewer traffic fatalities. While we always have to be careful about making claims that a policy caused an outcome, evidence from multiple studies, with careful statistical analyses, is building a case that medical cannabis has real, beneficial, spillover effects.
State governments are a second major hurdle for Sessions. States are sharply opposed to his moves to crack down on their cannabis policies. Eight states (with nearly one-fifth of the U.S. population) have legalized recreational cannabis use by adults. Even more striking, 29 states and the District of Columbia have approved the medical use of botanical cannabis, with 17 more having cannabis extract laws in place. This doesn’t just save lives; it also saves money.
In two studies, we find substantial reductions in a broad array of prescription spending for both Medicare and Medicaid in states that have medical cannabis laws in effect. Medicare and Medicaid don’t cover cannabis, but it nevertheless appears to substitute for many prescription drugs that the programs do cover. Nationally, the savings could be in the billions of dollars across the two programs if all states would adopt medical cannabis laws.
States benefit directly. Our work on Medicaid spending shows that they saved money — as much as $98 million in the case of California in 2014 — when they implemented medical cannabis laws in an environment in which the federal government took a hands-off attitude.
And it’s not just about savings: Cannabis generates substantial economic benefits as well. In 2016, Colorado saw the cannabis industry grow to about $1.3 billion in sales. Colorado levies substantial taxes on cannabis; as a consequence, it generated almost $200 million in tax revenue. Recent estimates suggest that states will collect nearly $655 million in tax revenue from cannabis sales nationwide. Not only are those direct contributions to stressed state budgets, but those taxes represent tens of thousands of jobs and the associated economic activity. At least four state governors recently wrote Sessions to ask him to let states pursue their own policies without federal interference.
Because state budgets would suffer if Sessions reversed the current federal position, state attorneys general would have standing to sue the Justice Department to force Sessions to actually implement the 1970 Controlled Substances Act, which insists that a drug can be listed as Schedule I only if there is “no currently accepted medical use.” The January NAS report, recent revisions to the NIDA position, and literally hundreds of peer-reviewed clinical research articles make clear that cannabis has many medical uses. This, finally, could end conflicts between state medical cannabis laws and federal law: Physicians could legally prescribe cannabis and patients could get medical supervision for their care. (Of course, states would still be free to restrict access to medical cannabis if they chose to do so.)
If Sessions does target cannabis as part of his new war on drugs, there is one final reason to believe the states would win and he would lose. The American people want access to medical cannabis. The most recent Quinnipiac Poll found that 94 percent of Americans support medical access when directed by a physician (including 96 percent of Democrats and 90 percent of Republicans). That poll found 73 percent of respondents oppose enforcing federal cannabis laws against state laws.
Nearly three-quarters of the U.S. population lives in states that have legalized medical cannabis, and states have powerful incentives to preserve their laws. There is almost universal popular opinion in favor of the availability of medical cannabis. The tide has already turned.