Sunday, August 22, 2010

Legal Pot. Public Health. Queers.

Pot is going to be legalized in California. No matter what your stance on the voter proposition, legal marijuana is coming, and Public Health will probably be in the mix in ways it has not been until now. I myself haven't decided how I will vote, but that's not the point. My point is that as marijuana slowly moves from the eagle eyes of law enforcement, public health is the natural next step for surveillance, monitoring, and control.

A couple weeks ago, I had a great conversation with a former (and future?) student about, among other things, what will happen once pot is legalized in California. He's been involved in the efforts to identify tobacco use as a health concern for gay men, lesbians, bisexuals and trans folks for many years, and we were wondering about how the activists who have built such a strong network around tobacco and smoking will react to legal joints in California.
Will the queer tobacco activists see themselves as primarily focused on tobacco (including smokeless tobacco like snuff & snus), or on smoking, which could potentially include pot, or both (which could possibly include vaporizers, brownies, etc.). Or will the idea of sounding like a negative Nancy on pot mean that we will just ignore the health consequences of smoking marijuana on queer folks?

Then, the other thing that got me thinking was looking into the environmental impacts of growing pot, because I'm looking for good material for my upcoming class on environmental health, and I figured that topic might engage some of the students.

At any rate, there are a lot of issues to think about there...
One can hope that the legalization of marijuana in California will lead to more environmental growing conditions - fewer diesel-powered generators, fewer diesel spills, less pesticides and more sustainable farming practices all around. But if there is an increased demand with no change in Federal enforcement efforts, there will still be a lot of pressure to grow pot in ways that are extremely damaging to the environment. What will the role of public health and environmental health be in developing policy and regulations? Will "organic" pot be certified by the same rules as USDA has developed for food?

For many years now, marijuana has been promoted as "medicinal". I'm sure it is for many people. But there are unintended consequences of promoting marijuana as medicine.
For one thing, a lot of people seem to be convinced that smoking marijuana is healthy, is good for you, even if you're not treating any health condition with it.
For another, a lot of people seem to think that smoking marijuana is just not dangerous compared to smoking tobacco.

If marijuana has been promoted as good for you, and now it becomes legal, it is complicated to modulate that message to be honest about ways in which it is not good for you, too.

So, where does public health come in on legal marijuana? We've gotten a pass because regulating marijuana has been the province of law enforcement. The "soft power" of Public Health has not been called on, and the research, as stunted at the field has been, is very polarized, with some researchers claiming that marijuana has virtually no down side, and others saying that marijuana smoke is more hazardous than tobacco smoke, and most researchers just not making much of it one way or another, because being illegal, it is assumed to be a bad thing anyway.

But that brings up another point - it is really hard to get any decent epidemiologic data on the health effects of smoking marijuana. On the one hand, the illegality of pot has led to the polarization above: the researchers are often so devoted to one side of the debate or the other that it is hard to trust their work. On the other, the illegality of pot makes asking questions about people's use a bit more ethically complicated, and also hard to trust people's self-reports of engaging in an illegal activity. And then on the third hand, there's the simple fact that most (but certainly not all) people who smoke marijuana also smoke tobacco, which makes teasing apart the effects of marijuana on health very tricky.

So where am I after thinking about all this?
Not much farther from where I began. I don't see myself likely to get very engaged in this debate. But, I will be interested to see what happens as the desire for society to somehow curb and contain the use of this substance moves from law enforcement to public health. And I will be curious to see how the message that "marijuana is medicine" gets tagged with the small print we're now familiar with from ads for pharmaceutical drugs, and tobacco products, for that matter. What will the Surgeon General's warning be? What will the breathless, low volume pitch-man sound like when rattling off the unpleasant side effects? And when will the large cohort studies needed to answer the fundamental health questions get funded?

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