The American Journal of Drug and Alcohol Abuse Encompassing All Addictive Disorders ISSN: 0095-2990 (Print) 1097-9891 (Online) Journal homepage: https://www.tandfonline.com/loi/iada20 How will cannabis legalization affect health, safety, and social equity outcomes? It largely depends on the 14 Ps Beau Kilmer To cite this article: Beau Kilmer (2019): How will cannabis legalization affect health, safety, and social equity outcomes? It largely depends on the 14 Ps, The American Journal of Drug and Alcohol Abuse, DOI: 10.1080/00952990.2019.1611841 To link to this article: https://doi.org/10.1080/00952990.2019.1611841 Published online: 02 Jul 2019. Submit your article to this journal Article views: 173 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=iada20 THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE https://doi.org/10.1080/00952990.2019.1611841 REVIEW How will cannabis legalization affect health, safety, and social equity outcomes? It largely depends on the 14 Ps Beau Kilmer RAND Drug Policy Research Center, Santa Monica, CA, USA ABSTRACT ARTICLE HISTORY Jurisdictions considering or implementing alternatives to cannabis supply prohibition will con- Received 16 December 2018 front several decisions that will influence health, safety, and social equity outcomes. This essay Revised 18 April 2019 highlights 14 of these design considerations, which all conveniently begin with the letter P:1) Accepted 23 April 2019 Production, 2) Profit motive, 3) Power to regulate, 4) Promotion, 5) Prevention and treatment, 6) KEYWORDS Policing and enforcement, 7) Penalties, 8) Prior criminal records, 9) Product types, 10) Potency, 11) Cannabis; legalization; Purity, 12) Price, 13) Preferences for licenses, and 14) Permanency. For each factor, the paper health; safety; social equity explains why it is important, describes the various approaches, and highlights how some of the jurisdictions that have legalized have addressed these choices. The primary audiences are decision makers considering alternatives to prohibiting cannabis supply and analysts making projections or conducting evaluations of these changes. Introduction what are the various approaches, and highlight how some of the jurisdictions that have legalized have Canada, Uruguay, and 11 jurisdictions in the United addressed these choices. States have removed the prohibition on cannabis and have legalized supply for adults. This is very different “ from the more common approach known as decrimi- Production nalization” which typically removes the criminal penal- ties for possessing small amounts but keeps supply The cost of producing cannabis will plummet with a criminal offense. Many of these jurisdictions allow legalization (7). Removing the prohibition means large-scale production and retail sales, but this is not producers no longer need to hide or be compensated the only way to legalize cannabis. Those considering or for their risk of arrest or incarceration (8). These implementing alternatives to cannabis supply prohibi- costs will further decline if governments allow pro- tion will confront several decisions that will influence ducers to compete and grow on industrial-sized out- health, safety, and social equity outcomes. door farms (9). We see price declines happening now This essay highlights 14 of these design considerations inColoradowheretheaveragepriceforapoundof which all conveniently begin with the letter P.Itbuildson high-potency cannabis in the licensed wholesale mar- previous efforts to highlight the various supply architec- ket declined more than 60% from January 2015 to tures and regulatory decisions surrounding cannabis lega- October 2018, from $2007 to $759 (10). Some suggest lization (e.g., 1,2,3,4), and two publications using a similar the wholesale price drop in Oregon has been even alliterative framework (5,6). The primary audiences are more severe (e.g., 11). decision makers considering alternatives to prohibiting How quickly the wholesale prices decline will cannabis supply and analysts making projections or con- depend on how much cannabis is allowed to be pro- ducting evaluations of these changes. duced and the regulations imposed on producers. Jurisdictions could be strategic and control the amount of cannabis (or THC) produced, or they could simply The 14 Ps give production licenses to anyone who applies and passes a background check. This not only has implica- For each decision, the paper will generally follow tions for what happens to the size of the illicit market, a similar structure: Why is this an important factor, but also for the economic opportunities in the licit CONTACT Beau Kilmer [email protected] RAND Drug Policy Research Center, 1776 Main St., Santa Monica, CA 94607 This article has been republished with minor changes. These changes do not impact the academic content of the article. © 2019 Taylor & Francis Group, LLC. 2 B. KILMER market. If licensed growers make a serious investment Profit motive to grow in the licit market and the wholesale prices Jurisdictions considering legalization need to decide collapse, some of the producers – especially the smaller whether to allow profit-maximizing firms to enter the ones – may find it unprofitable to operate. Indeed, market. It is unclear how legalization will play out and some may go bankrupt and end up worse off than if allowing business and their lobbyists to gain power will they had not entered the cannabis business in the first make it more difficult to make course corrections as the place. There is already anecdotal evidence of this hap- industry develops. Allowing innovative firms will lead pening in Washington, where license values are drop- ping and it is estimated that only about half of the to a proliferation of new products which could improve licensed canopy allocation for production is being consumer welfare over other more restrictive models. ’ used (12). On the other hand, Pareto s Law is in effect when it Initially, Uruguay limited its two licensed produ- comes to cannabis: It is the daily and near-daily canna- cers to grow no more than 4 metric tons, but this bis users which account for about 20% of past year approach is not the norm. Except for Washington, users and about 80% of expenditures (15). To be profit- none of the US states allowing commercial production able, most firms will need to maintain and encourage set a cap on the total amount of cannabis (or THC) heavy use which could have serious implications for that can be produced and sold in the licit market. rates of cannabis use disorder and other public health (Washington initially limited production to 2 million outcomes (16). square feet of canopy, but this cap was eventually Much of the cannabis debate in the US is focused on “ lifted and now it is reported that the state now a false dichotomy of keeping supply prohibited or reg- ” licensed more than 12 million square feet; but as ulating cannabis like alcohol. Figure 1 displays several noted, not all of it is being used.) Canada has licensed alternatives to status quo supply prohibition, showing more than 120 producers for its non-medical market that there are many middle-ground options jurisdic- and has not formally limited production (13); how- tions could pursue, ranging from home production to ever, their model allows each province and territory to government monopoly to allowing socially responsible control the wholesale and retail markets which, in businesses that do not exclusively focus on profit (3,17). essence, gives each government the power to control Cautious jurisdictions may want to consider some of how much can be sold at the retail level and at what these other approaches before embracing the commer- price (14). cial, profit-maximization model. It is also the case that So far, jurisdictions allowing non-medical retail jurisdictions could choose different options for differ- cannabis sales limit production to domestic sources. ent market levels (e.g., for-profit production and state- If this changes and importation of cannabis produced controlled retail stores; also see 18). in other countries is allowed, this will accelerate the While most of the jurisdictions in the US have gone price decline and dramatically change the cannabis- the commercial route, both Vermont and Washington, related economic opportunities in the importing and DC have limited supply to home grows and gifting. exporting countries. Canada’s new model is a hybrid where the federal Figure 1. Twelve alternatives to status quo prohibition of cannabis supply. Source: Caulkins and Kilmer (17) THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 3 government licenses producers (most are for profit and and as discussed earlier, most profit-maximizing firms some are publicly traded), and the provincial govern- will focus on creating and nurturing heavy users. While ments serve as the sole wholesaler, allowing the state to an advantage of the state monopoly approach is that the control products and prices if it wishes. Some provinces government can control advertising, that does not are also limiting retail sales to government-run stores. mean it will. In the US, many government agencies Outside of the home-grow only models, Uruguay heavily market state-sponsored lotteries to boost reven- has imposed the most restrictive legalization model to ues (26), and the Liquor Control Board of Ontario – date: Adults must register with the government to one of the world’s largest buyers and suppliers of alco- obtain legal cannabis and must choose from one of hol –“is widely regarded as the leader in liquor retail- three supply options: produce at home; join ing and marketing” (27). a cannabis co-op, or purchase from participating phar- Jurisdictions have to choose whether they want to macies (19–21). Only two firms are permitted to pro- allow advertising, and if so, which kinds. Uruguay has duce cannabis for the pharmacies and the state banned all advertising while US states allow it. Indeed, determines the price and product availability.