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Cannabis Legalization – Point | Counterpoint

August 8, 2019

Written by Clay Smith

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We need to understand arguments for and against full legalization of cannabis for recreational use. This has not only public health implications but has direct impact on the ED, with increased volume, trauma, and burden of psychiatric illness.

Why does this matter?
We see the immediate fallout when policy change impacts human behavior. Cannabis legalization has consequences, including some negative health consequences. We need to be in the know about the pros and cons, specifically the impact on health and emergency care.

Rollin’ on a river…
Here is a perspective in BMJ on the pros and cons of cannabis legalization.


  • Use is increasing, regardless of whether it is legalized or not.

  • Legalization means regulation, which may make use safer.

  • In Colorado, teen use has gone down since legalization. This may be due to education and the legal age restriction.

  • Regulation would reduce variability of THC concentration in various products through mandated labeling and inspection. It would also allow mandated age restriction.

  • Buying via legal dealers would reduce exposure to illegal dealers, who often also deal in heroin, cocaine, etc, potentially minimizing the “gateway drug” effect seen with cannabis.

  • Tax revenue could be reinvested in drug treatment. (There is some irony in this, I must point out.)


  • Effects on young, developing brains are largely unknown. What evidence we have is not encouraging, and this is a big gamble.

  • They emphasize the health risks: psychosis and dependence, and to a lesser degree of certainty, depression and suicide.

  • The mental health concerns are paramount and widespread. “Indeed, if no one smoked high potency cannabis, 30% of cases of psychosis would be prevented in London, and 50% would be prevented in Amsterdam.”

  • The authors do not see need to legalize full recreational use, as medical use of cannabis is already legal in the UK.

  • Most of the revenue would go not to support drug treatment but to large companies, which have invested heavily in the cannabis industry.

  • There has been a tripling in ED visits related to cannabis.

  • This is not specifically mentioned in this BMJ opinion piece, but there are numerous other health risks to consider as well.

Should the supply of cannabis be legalised now? BMJ. 2019 Jul 3;366:l4473. doi: 10.1136/bmj.l4468.

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Reviewed by Thomas Davis

What are your thoughts?