Marijuana Legalization: Policy Recommendations for Maryland

These recommendations were informed by a multi-stakeholder harm reduction meeting held at JHSPH in October 2015 and were developed by meeting participants. They do not necessarily represent the views of The Johns Hopkins University.

our U.S. states including Colorado, Washington, marijuana use among high school students.7,8 Oregon, and Alaska, as well as the District of n In the US, there has been an overall increase in mari- Columbia, have passed laws legalizing the use of juana consumption since 2006, however, most of this Frecreational marijuana for adults. Uruguay is the increase can be attributed to an increase in the number only country to have legalized and regulated every level of of people who engage in daily or near daily use, and not the market for marijuana. to an increase in the total number of users.9 Summary of current Maryland state law n While taxation may pay for the costs associated with To date, Maryland has decriminalized, but not legalized, regulation of marijuana, it is unclear whether or not marijuana. As of Oct. 1, 2014 it is now a civil (no longer legalization will result in significant economic gains or criminal) offense to use or possess fewer than 10 grams of losses in the long-term.10 marijuana. The penalty is a fine not exceeding $100.1 A n second offense is a fine not exceeding $250. The third or In order to prevent marijuana distribution to minors, subsequent offense is a fine not exceeding $500 and possibly Maryland lawmakers can use strategies that have been a court ordered drug education program and/or assessment effective in reducing youth alcohol and tobacco use for substance use disorder and subsequent referral to including: enacting excise taxes to keep prices high, substance use treatment. regulating retail providers through frequent compliance The Natalie M. LaPrade Maryland Medical Cannabis audits accompanied with stiff penalties, requiring man- Commission promulgated final regulations for the legal use ufacturers to utilize child-resistant packaging similar to of marijuana for medical purposes, which became effective in that of prescription drugs, and enacting partial market- 2 ing bans to prevent retailers from creating advertising September 2015. The regulations cover patients, physicians, 11 growers, processors, dispensaries, independent testing labora- campaigns targeting youth. tories, inspection, enforcement, and license fees. Dispensing n There is uncertainty regarding whether or not marijuana of marijuana is now permitted at facilities called “cannabis legalization will lead to an increase or decrease in the use processors,” whereas previously it could only be dispensed at of alcohol, tobacco or illicit drugs such as heroin and teaching hospitals.3 Maryland’s shielding law prevents em- cocaine, which would impact the costs and/or benefits ployers and schools from accessing records related to non-vi- of legalization. Implementers should, therefore, moni- olent misdemeanors (i.e. marijuana and/or paraphernalia tor changes in in all types of substance use as a result of possession). Application for shielding can be filed 3 years marijuana legalization.12 4 after completion of sentence. Policy recommendations Research evidence 1) Legalize recreational use of marijuana for adults utilizing n Research suggests that marijuana may mitigate some forms 5 best practices from Uruguay and US states such as Colo- of pain and serve as a potential substitute for opioid rado and Washington. analgesics. One study, for example, found that the average annual opioid analgesic overdose rate is approximately 2) Utilize a justice reinvestment funding mechanism, which 25 percent lower among states with medical marijuana would use criminal justice-related savings from marijua- laws compared with states without medical marijuana laws na drug arrests to finance opportunities for communities and that this relationship strengthened each year most harmed by drug law enforcement. after implementation.6 3) Ensure communities most harmed by drug law enforce- n Research has shown that states with more liberal marijua- ment are not systematically excluded from the legal na policies have not seen increases in lifetime or current marijuana market. Implementation considerations carefully consider any employment restrictions based n Despite legalization at the state level, marijuana remains on prior criminal justice involvement. Some states with a Schedule I drug under the federal Controlled Sub- legalized and/or medical marijuana bar individuals with stance Act. The U.S. Department of Justice stated in drug possession misdemeanors or felonies in the past five 2013 that it is unlikely to aggressively enforce federal to ten years from working in a dispensary. Given racial marijuana laws in states with legal markets, provided that disparities in drug law enforcement, such restrictions legalization is accompanied by state-level regulatory and could further harm minority communities.14 enforcement efforts that achieve several goals, including n Maryland should consider a regulatory approach similar preventing marijuana distribution to minors.13 to that of Uruguay. Uruguay requires marijuana users n Implementers will need to consider the effects of mari- to register, limits the amount of marijuana a registered juana use on motor vehicle crashes. They will also need user can either purchase or grow, permits users to join to develop threshold values for measuring intoxication registered cannabis clubs or cooperatives with specified while driving and methods of testing for impairment. numbers of members, and allows only a limited number n In order to ensure that communities most harmed by of licensed pharmacies to produce and sell the drug. drug law enforcement are not systematically excluded Physicians are also allowed to prescribe medical marijua- 15 from the legal marijuana market, Maryland should na in monthly doses.

1 MD. CODE ANN., CRIM. LAW §5-601.1. 10 Caulkins, J.P., Kilmer, B., Kleiman, M., MacCoun, R.J., Midgette, G., Oglesby, P., Pacula, R.L., & Reuter, P. (2015). Considering Marijuana 2 MD. CODE ANN., HEALTH-GEN. §13-3301. Legalization: Insights for Vermont and Other Jurisdictions. Santa Monica, 3 MD. CODE ANN., HEALTH-GEN. §13-3309. CA: RAND Corporation. Retrieved from http://www.rand.org/pubs/re- 4 MD. CODE ANN., CRIM. PROC. §10-301(F)(8). search_reports/RR864.html. 5 Abrams, D.I., Couey, P., Shade, S.B., Kelly, M.E., & Benowitz, N.L. (2011). 11 Wong, K., & Clarke, C. (2015, September). The Legalization of Mar- Cannabinoid-opioid interaction in chronic pain. Clin. Pharmacol. Ther, ijuana in Colorado: The Impact. Denver, CO: Rocky Mountain High 90(6):844–51. doi: 10.1038/clpt.2011.188 Intensity Drug Trafficking Area. Retrieved from http://www.rmhidta.org/ html/2015%20FINAL%20LEGALIZATION%20OF%20MARIJUA- 6 Bachhuber, M.A., Saloner, B., Cunningham, C.O., & Barry, C.L. (2014). NA%20IN%20COLORADO%20THE%20IMPACT.pdf Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern. Med, 174(10):1668–73. 12 Saloner, B., McGinty, E.E., Barry, C.L. (2015). Policy Strategies to Reduce doi:10.1001/jamainternmed.2014.4005 Youth Recreational Marijuana Use. Pediatrics, 135(6): 955-7. doi: 10.1542/ peds.2015-0436 7 Ammerman, S., Ryan, S., & Adelman, W.P. (2015, March). The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update. 13 Saloner, B., McGinty, E.E., Barry, C.L. (2015). Policy Strategies to Reduce Pediatrics, 135(3):e769-e785; doi: 10.1542/peds.2014-4147 Youth Recreational Marijuana Use. Pediatrics, 135(6): 955-7. doi: 10.1542/ peds.2015-0436 8 Johnson, R.M., Fairman, B., Gilreath, T., Xuan, Z., Rothman, E.F., Parnham, T., & Furr-Holden. C.D. (2015). Past 15-year trends in 14 Lewis, A.C. (2016, March 16). How Black People are Being Shut out of adolescent marijuana use: Differences by race/ethnicity and sex. Drug America’s Weed Boom: Whitewashing the Green Rush. Buzzfeed. Retrieved Alcohol Depend, 155: 8-15. doi: 10.1016/j.drugalcdep.2015.08.025 from http://www.buzzfeed.com/amandachicagolewis/americas-white-only- weed-boom#.gtzqLr5xBV 9 Kleiman, M., Caulkins, J.P., Hawken, A., & Kilmer, B. (2012). Eight Questions for Drug Policy Research. Issues in Science and Technology, 28(4): 15 Walsh, J., & Ramsey, G. (2016). Uruguay’s Drug Policy: Major Innovations, 79-88. Major Challenges. Brookings Institution. Retrieved from http://www. brookings.edu/~/media/Research/Files/Papers/2015/04/global-drug-policy/ Walsh--Uruguay-final.pdf?la=en

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