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Why Public Health Experts Say Cannabis Should Be Treated Like Tobacco

Policy advocates say that treating the cannabis industry like the next alcohol industry could be a huge mistake. Instead, they point to a different substance for regulatory guidance: tobacco.
Photo by J Danielle Wehunt via Stocksy

Health policy advocates at the University of California are concerned that the waves of cannabis legalization across the United States could be leading us down a dangerous path. In a paper published in Plos Medicine, the researchers, led by Stanton Glantz, argue that the drug should be legal—but they say that weed distribution policies, both proposed and in place, are putting business interests over public health.


The conversation has been prompted by California's ballot initiative to legalize recreational cannabis. The New York Times published an article—"In California, Marijuana Is Smelling More Like Big Business"—around the time that the state decided on a framework that would allow growers and dispensaries to profit from the sale of cannabis. The initiative, Proposition 64, would further allow for a corporation to apply for unlimited license types, including for grows over one acre after a five-year period elapses.

Read more: The Women Making California's Weed Industry Less White

Small growers told the Times that they were wary of a corporate takeover, celebrity branding, and the changing culture as investors, anticipating full legalization in November, rushed to set up a stake in the crop. Those investors and corporations, conversely, see the cultural change as a good thing. "We're transitioning out of the complete free-for-all, wild West," Aaron Herzberg, the general counsel for a company that invests in cannabis real estate, told the publication. "It will be like alcohol—you can't just set up a still and produce it in your garage. You have to apply for permits and pay taxes."

Glantz is similarly wary of the corporate influence that will arise if Proposition 64 passes, but it's not because he will mourn weed's hippie culture. After analyzing the legalization policies in Colorado, Alaska, Washington, and Oregon, he doesn't think it's necessarily good that California's cannabis industry will be regulated like the alcohol industry. Glantz says that treating marijuana like alcohol would leave consumers susceptible to a rich and powerful industry that would be able to manipulate regulation against their health interests.


He points to the alcohol industry itself, which he says has been quietly able to get around restrictions on advertising to children and to generally normalize a substance that contributes to disease, violence, and mental health issues. (In Colorado, for example, the rules around advertising cannabis on television, radio, the internet, and in print are roughly the same as for alcohol: It's fine if no more than 30 percent of a show's audience are under 21.) A better framework, he says, would be comparable to that of tobacco, an industry he has studied closely for 20 years: harsh warnings on packaging, bans on advertising, and high consumer taxes that would fund marijuana prevention programs. Essentially, a protectionist framework that would send the message that cannabis is "legal but unwanted."

This is opposite, really, of what cannabis advocates are trying to do with the drug's image. In order to bring weed and weed users out of the shadows, the cannabis industry has aggressively tried to normalize its use, in part by trying to bring attention to the horrible and unhelpful criminalization of cannabis users. But Glantz says the downside of this is that the normalization of cannabis also gets used in marketing speak and as a tactic deployed with pure profit motives. "People are praising the fact that marijuana is going to go from hippy-dippy farmers and potheads to the corporatization of the market. But that's a bad thing. What you're going to see is mass marketing and national and international branding," he tells Broadly.


The goal isn't to prohibit people from using it, but to convince them that it's not a good idea.

He doesn't deny that the war on drugs has been a failure, but he says that policies to legalize marijuana should also look to the future of what the industry could become. He says there's a lot to learn from the early days of unregulated cigarette conglomerates and the subsequent struggle to correct the public health crisis that the tobacco industry caused. "We looked at what are considered best practices in tobacco control and compared those best practices to the way marijuana has been legalized in the four states that have done it so far. How are they doing? The short answer is not very well," Glantz states.

"The war on drugs has been more than a failure. It's been a disaster. We can solve the social justice issue with legalization, but we need to put in place a strong public health framework—or a demand reduction framework—based on tobacco control. You can have it where people stop getting thrown in jail. The goal isn't to prohibit people from using it, but to convince them that it's not a good idea," he said. "I think it's very important that this is done now, concurrent with legalization. Marijuana is already a very powerful, multi-billion dollar business. But the fact that in most places it's still illegal has inhibited its ability to exercise raw political power."

He adds that tobacco companies are certainly not disinterested in the legal marijuana market. The University of California, San Francisco, keeps an archive of internal corporate documents from tobacco industry that have either leaked or have been made public through litigation. "A few years ago, we stumbled into some documents about how in the 60s and the 70s two of the biggest multinational tobacco companies in the world—Phillip Morris and British American Tobacco—were seriously looking into getting into the marijuana business. It was to the point where they were doing product testing and things like that. But then the drug war happened and they didn't want to get involved in that," Glantz notes.


It's true that, since Colorado has legalized pot, adult use has jumped up by five percent. In Oregon, pot use is up since legalization, as is the number of drivers who have been suspected of driving while high. The central question, however, is if cannabis actually warrants this much preemptive fear and oversight.

Glantz has a lot of valid points. Currently, marijuana retailers can make any number of claims on the products they sell and there's no regulation, which he compares to the fraught supplement industry. Foria, the makers of weed suppositories, can claim that their products have a unique ability to provide menstrual cramp relief without any type of clinical trial to prove its efficacy. There's a branded strain of weed that claims to be an aphrodisiac for women. When I went to a cannabis conference in Colorado, there were countless products that each claimed to do very specific and disparate things, even though it was all just weed. It's not hard to imagine a future where it's not just small start-ups making these claims. The scale of marijuana businesses will continue to grow as more states legalize weed and states allow for larger operations that could very well have the capital and political influence to fight back against any valid efforts to regulate them.

Read more: New Bill Could Hurt Families Who Use Cannabis to Treat Their Children's Autism

But Glantz also insists that places where cannabis users can gather to buy and smoke weed should be illegal alongside all public smoking to minimize the effects of secondhand smoke. Right now, however, it's not completely clear whether cannabis poses cardiovascular risks, and new research has been consistently debunking old fears associated with the drug. It's been shown that cannabis isn't physically addicting, isn't tied to birth risks when consumed by pregnant women, and has no long-term effects on motivation.


He also thinks that separate statutes and regulations for medical cannabis shouldn't exist, and in an ideal world he says that people with prescriptions would simply be able to get cannabis from a "real" pharmacy. "Good public health practice would be to have a unitary market," he says. "For example, if Proposition 64 passes in California, the legal age for recreational use would be 21 and the legal age for medicinal use would be 18. They have completely different tax structures. Every kid knows that you just have to get a medicinal card to go get high. So maintaining the medical market is just going to lower the legal age and complicate regulation."

And ultimately, he says, marijuana should be under a state monopoly that would allow growers to sell directly to the government. "If the sales are done through the state, they could set policy that would limit marketing and control the retail channels. They could do it in a way that would minimize harm," he explains.

Read more: Smoking Weed Helps You See Better in the Dark

Advocates of Proposition 64 have a less dire view of industry regulation. Paul Armentano, the deputy director of NORML, points out that it's hard to discuss the possibility of a government monopoly on cannabis when the federal government will hardly acknowledge rescheduling the drug. Even Glantz admits that federal policy so far has been disadvantageous to public health when it comes to marijuana.

"Like with regulatory policies governing the use and marketing of alcohol and tobacco, regulatory schemes governing the legal marijuana market will evolve and adapt over time, and to some degree they will likely reflect regional and cultural mores. As a result, measures like Proposition 64 represent a starting point, not an end point," Armentano says. "Only in an environment where the adult use of cannabis is legally codified under the law can we then begin to engage in rational discussions regarding how best to sensibly regulate the commercial marijuana market."