Marijuana Legalization: What’s the Cost?         Marijuana is the most commonly used illicit substance. Marijuana abuse and dependence are widespread in the United States (American Psychiatric Association, 2000; Compton et al., 2007; Johnston et al., 2009, 2010; Office of Applied Studies, 2008). Marijuana is a topic of significant public discussion, and while many are familiar with the debates, there are many facets to examine further to determine if it should be legalized.  Moreover, there is not much evidence-based information that is relevant and readily available on the topic.  When trying to decide if our state legislature should legalize marijuana, it is important to highlight the stance the federal government’s take on this issue and consider which approach would make improvements to public health and safety in our community. The federal government opposes legalization of marijuana because it would “increase the availability and use of illicit drugs, and pose significant health and safety risks to all Americans, particularly young people.” (The White House, 2015)           Marijuana poses substantial risks to public health and significant danger to the health and safety of society.  (The White House, 2015) Close to 4.2 million people met the criteria for abuse or dependence on marijuana in 2011, which has been associated with addition, respiratory conditions, and cognitive impairment. In addition, research shows that increasing the accessibility of drugs can increase use and in turn, bring about greater consequences. Greater consumption of marijuana leads to greater public health and financial costs for the general public. It has been shown that alcohol and tobacco, which are legal and taxed, already cause much higher social costs than the returns they generate.        Benefits of legalization may include pain management and nausea control for cancer and HIV/AIDS patients, decreased costs of the criminal justice system, and tax revenue from sales (Levine and Reinarman, 1991; van den Brink, 2008; Wodak, 2002). It has also been pointed out that those with seizure disorders may benefit from marijuana. Marijuana may also contain an anti-inflammatory effect (Nagarkatti, et al. 2009) and may bring relief to some patients with inflammatory bowel disease.(Esposito et al., 2013). However, there is currently no consensus on the effectiveness of marijuana as a treatment for symptoms of pain, nausea, and other symptoms caused by sicknesses or treatment (Joy et al., 1999; MacCoun and Reuter, 2001a; Martín-Sánchez et al., 2009). Due to the lack of medical consensus at present means that both positive and negative promoters of medical marijuana laws can find research to support their positions. (Cerdá et al., 2012)       Colorado has experienced healthy system effects due to legalization. There has been an increase in visits to hospitals due to marijuana intoxication associated with anxiety, panic attacks, and vomiting to name a few.The legalization has also resulted in an increased prevalence of burns, cyclic vomiting syndrome, The most concerning health effects have the rate of ingestion among children. Fifteen children were seen for ingestion over the past two years at Children’s Hospital of Colorado. (Wang, Roosevelt, & Hears, 2013).      Although marijuana legalization has been shown by some to be successful, there have also been unfortunate and unpleasant health effects. There are many risks surrounding the use of marijuana. Additional research is needed to examine the benefits and hazards of marijuana use to determine if it is beneficial to healthcare before that can be a valid reason to examine legalization further. Cerdá, M., Wall, M., Keyes, K. M., Galea, S., & Hasin, D. (2012). Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and alcohol dependence, 120(1), 22-27. Compton, W.M., Conway, K.P., Stinson, F.S., Colliver, J.D., Grant, B.F. (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J. Clin. Psychiatry 66, 677–685. Esposito, G., Filippis, D. D., Cirillo, C., Iuvone, T., Capoccia, E., Scuderi, C., & Steardo, L. (2013). Cannabidiol in inflammatory bowel diseases: a brief overview. Phytotherapy Research, 27(5), 633-636. Johnston, L.D., O’Malley, P.M., Bachman, J.G., Schulenberg, J.E. (2009). Monitoring the future national survey results on drug use, 1975–2008. In: Volume II: College Students. NIH Publication No. 10-7586. National Institute on Drug Abuse, Bethesda, MD. Johnston, L.D., O’Malley, P.M., Bachman, J.G., Schulenberg, J.E. (2010). Monitoring the future national survey results on drug use, 1975–2009. In: Volume I: Secondary School Students. NIH Publication No. 10-7584. National Institute on Drug Abuse, Bethesda, MD. Joy, J., Watson Jr., S., Benson, J. (Eds.), (1999). Marijuana and Medicine: Assessing the Science Base. National Academy Press, Washington, DC. Levine, H.G., Reinarman, C. (1991). From prohibition to regulation—lessons from alcohol policy for drug policy. Milbank Q. 69, 461–494. MacCoun, R., Reuter, P. (Eds.), 2001a. Drug War Heresies: Learning from Other Vices, Times, and Places. Cambridge University Press, Cambridge, UK. Martín-Sánchez, E., Furukawa, T., Taylor, J., Martin, J. (2009). Systematic review and meta-analysis of cannabis treatment for chronic pain. Pain Med. 10, 1353–1368. Nagarkatti, P., Pandey, R., Rieder, S. A., Hegde, V. L., & Nagarkatti, M. (2009). Cannabinoids as novel anti-inflammatory drugs. Future medicinal chemistry, 1(7), 1333-1349. Office of Applied Studies ( 2008). Results from the 2007 National Survey on Drug Use and Health: National Findings. DHHS Publication No. SMA 08-4343, NSDUH Series H-34. Substance Abuse and Mental Health Services Administration, Rockville, MD. Monte, A. A., Zane, R. D., & Heard, K. J. (2014). The Implications of Marijuana Legalization in Colorado. JAMA. van den Brink, W. (2008). Forum: decriminalization of cannabis. Curr. Opin. Psychiatr. 21, 122–126. Wang, G. S., Roosevelt, G., & Heard, K. (2013). Pediatric marijuana exposures in a medical marijuana state. JAMA pediatrics, 167(7), 630-633. White House, Marijuana https://www.whitehouse.gov/ondcp/marijuana Wodak, A. (2002). For and against—cannabis control: costs outweigh the benefits. For. Br. Med. J. 324, 105–106.

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