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The most convincing argument for legalizing LSD, shrooms, and other psychedelics

by German Lopez

I have a profound fear of death. It's not bad enough to cause serious depression or anxiety. But it is bad enough to make me avoid thinking about the possibility of dying — to avoid a mini existential crisis in my mind.

But it turns out there may be a better cure for this fear than simply not thinking about it. It's not yoga, a new therapy program, or a medicine currently on the (legal) market. It's psychedelic drugs — LSD, ibogaine, and psilocybin, which is found in magic mushrooms.

This is the case for legalizing hallucinogens. Although the drugs have gotten some media attention in recent years for helping cancer patients deal with their fear of death and helping people quit smoking, there's also a similar potential boon for the nonmedical, even recreational psychedelic user. As hallucinogens get a renewed look by researchers, they're finding that the substances may improve almost anyone's mood and quality of life — as long as they're taken in the right setting, typically a controlled environment.

This isn't something that even drug policy reformers are comfortable calling for yet. "There's not any political momentum for that right now," Jag Davies, who focuses on hallucinogen research at the Drug Policy Alliance, said, citing the general public's views of psychedelics as extremely dangerous — close to drugs like crack cocaine, heroin, and meth.

But it's an idea that experts and researchers are taking more seriously. And while the studies are new and ongoing, and a national regulatory model for legal hallucinogens is practically nonexistent, the available research is very promising — enough to reconsider the demonization and prohibition of these potentially amazing drugs.

Hallucinogens' potentially huge benefit: ego death

Mushroom, mushroom.

The most remarkable potential benefit of hallucinogens is what's called "ego death," an experience in which people lose their sense of self-identity and, as a result, are able to detach themselves from worldly concerns like a fear of death, addiction, and anxiety over temporary — perhaps exaggerated — life events.

When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.

That may sound like pseudoscience. And the research on hallucinogens is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried hallucinogens can vouch for experiencing. It's one of the reasons why preliminary , small studies and research from the 1950s and '60s found hallucinogens can treat — and maybe cure — addiction, anxiety, and obsessive-compulsive disorder.

Charles Grob, a UCLA professor of psychiatry and pediatrics who studies psychedelics, conducted a study that gave psilocybin to late-stage cancer patients. "The reports I got back from the subjects, from their partners, from their families were very positive — that the experience was of great value, and it helped them regain a sense of purpose, a sense of meaning to their life," he told me in 2014. "The quality of their lives notably improved."

In a fantastic look at the research, Michael Pollan at the New Yorker captured the phenomenon through the stories of cancer patients who participated in hallucinogen trials:

Death looms large in the journeys taken by the cancer patients. A woman I'll call Deborah Ames, a breast-cancer survivor in her sixties (she asked not to be identified), described zipping through space as if in a video game until she arrived at the wall of a crematorium and realized, with a fright, "I've died and now I'm going to be cremated. The next thing I know, I'm below the ground in this gorgeous forest, deep woods, loamy and brown. There are roots all around me and I'm seeing the trees growing, and I'm part of them. It didn't feel sad or happy, just natural, contented, peaceful. I wasn't gone. I was part of the earth." Several patients described edging up to the precipice of death and looking over to the other side. Tammy Burgess, given a diagnosis of ovarian cancer at fifty-five, found herself gazing across "the great plain of consciousness. It was very serene and beautiful. I felt alone but I could reach out and touch anyone I'd ever known. When my time came, that's where my life would go once it left me and that was O.K."

But Mark Kleiman, a drug policy expert at New York University's Marron Institute, noted that these benefits don't apply only to terminally ill patients. The studies conducted so far have found benefits that apply to anyone : a reduced fear of death, greater psychological openness, and increased life satisfaction.

"It's not required to have a disease to be afraid of dying," Kleiman said. "But it's probably an undesirable condition if you have the alternative available. And there's now some evidence that these experiences can make the person less afraid to die."

Kleiman added, "The obvious application is people who are currently dying with a terminal diagnosis. But being born is a terminal diagnosis. And people's lives might be better if they live out of the valley of the shadow of death."

Again, the current research on all of this is early, with much of the science still relying on studies from the '50s and '60s. But the most recent preliminary findings are promising enough that experts like Kleiman are cautiously considering how to build a model that would let people take these potentially beneficial drugs legally — while also acknowledging that psychedelics do pose some big risks.

The two big risks of hallucinogens: accidents and bad trips

Charles Grob, a UCLA professor of psychiatry and pediatrics, is leading the way in psychedelic research.

Hallucinogens aren't perfectly safe, but they're not dangerous in the way some people might think. As Grob previously told me , there's little to no chance that someone will become addicted to psychedelics — they're not physically addictive like heroin or tobacco, and the experiences are so demanding and draining that a great majority of people simply won't be interested in constantly taking the drugs. He also said that hallucinogen persisting perception disorder, which can cause the disturbances widely known as "flashbacks," is "uncommon, but you will see it, particularly among someone who has taken hallucinogens a lot."

Kleiman drew a comparison to marijuana to explain the risks. "The risk with cannabis is, primarily, that you lose control of your cannabis taking," he said. "The risk with LSD is primarily that you'll do something stupid to ruin the experience, or you'll have such a scary experience that it'll leave you damaged. But those are safety risks rather than addiction risks."

This gets to the two major dangers of hallucinogens: accidents and bad trips. The first risk is similar to what you'd expect from other drugs: When people are intoxicated in any way, they're more prone to doing bad, dumb things. As Kleiman explained, "People take LSD and think they can fly and jump off buildings. It's true that it's a drug warrior fairy tale, but it's also true in that it actually happens. People drop acid and run out in traffic. People do stupid shit under high doses of psychedelics."

Bad trips are also a concern. A bad psychedelic experience can result in psychotic episodes, a lost sense of reality, and even long-term psychological trauma in very rare situations, especially among people using other drugs or with a history of mental health issues. Just like psychedelics can lead to long-term psychological benefits, they can lead to long-term psychological pain.

These risks are why not many people are seriously discussing legalizing hallucinogens in the same way the US allows alcohol or is now beginning to allow marijuana. But the potential benefits of hallucinogens are leading some experts to consider how these drugs could be legalized in some capacity.

"I think it's a bad idea to treat hallucinogens like we treat cocaine or cannabis," Kleiman said. "They pose different risks and offer different benefits." He added, "But I don't think we're ever going to free these substances from careful legal control."

How hallucinogens can be legalized

Drop some LSD — but maybe only in a controlled environment.

So how can you maximize the benefits and minimize the risks? The most convincing idea so far is letting people take psychedelics in a controlled setting, in which multiple participants can be watched over by trained supervisors who ensure the experience doesn't go poorly.

So far, this is what the medical side has focused on: The typical medical trial involves doctors watching over a deathly ill patient or someone dealing with addiction who takes psilocybin. But if the concept is expanded to allow nonmedical users, then perhaps professionals who aren't doctors but are trained in guiding someone through a trip could take up the role. "I imagine someone who has training in managing that experience, and a license, and liability insurance, and a facility," Kleiman said.

Here's how it would work: A psychedelic user would go through some sort of preparation period to make sure she knows what she's getting into. Then she could make an appointment at a place offering these services. She would show up at this appointment, take the drug of her choice (or whatever the facility provides), and wait to allow it to kick in. As the trip occurs, a supervisor would watch over the user — not being too pushy, but making sure he's available to guide her through any rough spots. In some studies, doctors have also prepared certain activities — a soundtrack or food, for example — that may help set the right mood and setting for someone on psychedelics. Different places will likely experiment with different approaches, including how many people can participate at once and how a room should look.

The most convincing idea so far is letting people take psychedelics in a controlled setting

Kleiman also envisions a potential system in which people can eventually graduate to using the drug solo. "It's like Red Cross water safety instruction," he said. "You start out, you're a newbie. You don't go into the pool without a trained, certified person to watch you, guide you, and keep you safe. After a while, your teacher gives you a test to certify that you're safe to be in the water alone. And you might even get certified to become a trainer, so you can guide newbies yourself."

If pulled off correctly, this would maximize the best possible outcomes and minimize the worst. Supervisors could help prevent accidents, and they could walk people through good and bad trips, letting users relax and get something meaningful out of the experience.

There are risks to the controlled setting. If a supervisor is poorly trained or malicious, it could lead to a horrific trip that could actually worsen someone's mental state. This is why regulation and licensing will be crucial to getting the idea right.

Ethan Nadelmann, executive director of the Drug Policy Alliance, argued for a looser model that could, for example, allow psychedelics to be sold over the counter. "You dramatically decrease the black market. So long as you have people who have to go through some sort of gatekeeper, or who can be denied, you're going to continue to have a black market," Nadelmann said. "Secondly, this means the percent of consumers who got a product of known potency and purity from a reliable source would increase."

But the black market demand for psychedelics is very small, with only 0.5 percent of Americans 12 and older in 2013 saying they used hallucinogens in the past month. So allowing over-the-counter sales would likely have a tiny benefit at best on public health and criminal groups' profits from the black market.

The debate about which model works best will likely go on for some time, especially if different places test different approaches. There's no doubt it will be tricky to hash out exactly how to legalize and regulate these drugs, as some states are learning with marijuana .

But if we know the benefits to public health and well-being are real, it's irresponsible to let the potential go untapped. It may soon be time for America to seriously consider legalizing LSD, magic mushrooms, and other psychedelic drugs.

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What Students Are Saying About Decriminalizing Drugs, Conversation Skills and Favorite Cookies

Teenage comments in response to our recent writing prompts, and an invitation to join the ongoing conversation.

By The Learning Network

Welcome to another roundup of student comments on our writing prompts . This week we asked teenagers whether drugs should be decriminalized, if they are good conversationalists and what they’d put into their perfect box of cookies.

Thank you to all those who joined the conversation, including teenagers from Bishop McNamara High School in Forestville, Md .; Middletown, N.J. ; and Wekiva High School in Apopka, Fla.

Please note: Student comments have been lightly edited for length, but otherwise appear as they were originally submitted.

Should the United States Decriminalize the Possession of Drugs?

In light of the recent voter support for the legalization of marijuana and the decriminalization of other drugs in a number of states, we asked students to share their thoughts on drug possession laws.

Their responses represented a wide range of perspectives and captured the complexity of the topic, especially as it relates to the opioid epidemic and drug-related incarceration.

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Why are we so opposed to performance-enhancing drugs in sport?

Associate Professor in Political Science and International Relations, The University of Western Australia

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David van Mill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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The World Athletics Championships are currently in full flow. There was a collective sigh of relief earlier this week when Usain Bolt triumphed in the blue-riband men’s 100m event over Justin Gatlin , who has previously served two bans for taking performance-enhancing drugs. Three other athletes in the final – Mike Rodgers, Tyson Gay and Asafa Powell – had also received previous bans for doping.

Almost everyone seems to be in agreement that performance-enhancing drugs are a blight on competitive sport. Two major claims underpin the aversion to this use of drugs. The first is that it is cheating. The second is that performance-enhancing drugs threaten the health of athletes.

But is either claim persuasive?

Using drugs is unfair

The problem is not that athletes try to gain an advantage over their competitors by enhancing their performance. We praise them for doing so, and it is the main goal that athletes set for themselves.

The complaint is not against performance enhancement, but the method by which it is achieved. The real concern behind the cheating claim is that athletes who use drugs are gaining an unfair advantage by accessing something not available to those who follow the rules. Those who use drugs prosper at the expense of those who play fair.

But things are murkier than they seem. How interested are we in fairness in sport? Athletes try to enhance their performance in many ways: coaches, psychologists, dietitians, massage therapists, training at high altitude, skin-tight swimsuits. All of these are used to gain an advantage, which is often unfair because, like drugs, they are available to some – wealthy athletes rather than cheats – but not to everyone.

The Tour de France, a sporting event well known for drug use, would not suddenly become a level contest if drug use disappeared. The race winner has his performance enhanced by the quality of his team. The Tour would only be a true test of individual riders if teams were banned.

Performance is also unfairly enhanced when governments fund athletes. Australia spent more than A$300 million to prepare athletes for the last Olympics. One of the major reasons for the British squad’s success at the London Olympics was the large amount of financial support for the team.

The advantage gained through financial support might be different to that gained by drug use because it is not achieved through underhand means. But, if fairness is our goal, the source of the disadvantage is secondary.

So, if our objection to drugs is that they create an unfair advantage, consistency demands we apply the same standard to many other aspects of athletic competition. There seems to be no reasonable justification for drawing a line in the sand that places drug use on one side and the above-mentioned performance enhancers on the other.

Given that drugs are significantly cheaper than psychologists, permitting their use might actually level out the playing field for poorer athletes. Finally, if fairness is our major concern we can easily solve the problem by lifting the prohibition – thus making drugs available to all athletes.

Performance-enhancing drugs and harm

The second objection is that drug use, unlike coaches and massage therapists, causes harm. Removing the prohibition might make things fairer but it would come at a heavy price.

In response to this objection, ethicist Julian Savulescu has argued that performance-enhancing drugs are not particularly dangerous, and if their use was no longer clandestine they would be safer still. It is difficult to know whether allowing drug use would lead to greater harm to athletes, but for the sake of argument let’s assume Savulescu is wrong and accept that drug use is risky.

Is harm prevention a reasonable justification for limiting drug use in sport? One thing to bear in mind is that the very act of participating in many sporting activities is dangerous. Climbing, boxing, mixed martial arts, rugby, AFL, NFL, cricket, horse riding and many other sports can cause significant physical harms and sometimes result in death. There is no rush to ban people from climbing Mount Everest even though it is far more dangerous than taking EPO.

The NFL in America recently agreed to pay US$750 million to compensate for head injuries sustained by former players. Still, NFL athletes are allowed to collide with great force every week. It is certainly not obvious that performance-enhancing drugs cause more damage than high-impact sports.

I have not suggested that drug use should be permissible in sport because there might be persuasive arguments for proscription I have not addressed. For example, one might argue that using drugs is an attempt to win in the “wrong way”. If so, we need to know why using other performance enhancers like caddies in golf or high-tech equipment is winning in the “right way”.

But, the two claims most often used for prohibiting performance-enhancing drugs do not seem to provide sufficient grounds for a ban unless one is willing also to prohibit many other aspects of sport in the name of fairness and harm prevention.

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Human Rights and Duterte’s War on Drugs

Philippine President Rodrigo Duterte’s war on drugs has led to thousands of extrajudicial killings, raising human rights concerns, says expert John Gershman in this interview.

Interview by Michelle Xu , Interviewer John Gershman , Interviewee

December 16, 2016 3:56 pm (EST)

Since becoming president of the Philippines in June 2016, Rodrigo Duterte has launched a war on drugs that has resulted in the extrajudicial deaths of thousands of alleged drug dealers and users across the country. The Philippine president sees drug dealing and addiction as “major obstacles to the Philippines’ economic and social progress,” says John Gershman, an expert on Philippine politics. The drug war is a cornerstone of Duterte’s domestic policy and represents the extension of policies he’d implemented earlier in his political career as the mayor of the city of Davao. In December 2016, the United States withheld poverty aid to the Philippines after declaring concern over Duterte’s war on drugs.

How did the Philippines’ war on drugs start?  

When Rodrigo Duterte campaigned for president, he claimed that drug dealing and drug addiction were major obstacles to the Philippines’ economic and social progress. He promised a large-scale crackdown on dealers and addicts, similar to the crackdown that he engaged in when he was mayor of Davao, one of the Philippines’ largest cities on the southern island of Mindanao. When Duterte became president in June, he encouraged the public to “go ahead and kill” drug addicts. His rhetoric has been widely understood as an endorsement of extrajudicial killings, as it has created conditions for people to feel that it’s appropriate to kill drug users and dealers. What have followed seem to be vigilante attacks against alleged or suspected drug dealers and drug addicts. The police are engaged in large-scale sweeps. The Philippine National Police also revealed a list of high-level political officials and other influential people who were allegedly involved in the drug trade.

“When Rodrigo Duterte campaigned for president, he claimed that drug dealing and drug addiction were major obstacles to the Philippines’ economic and social progress.”

Philippines

Rodrigo Duterte

Drug Policy

The dominant drug in the Philippines is a variant of methamphetamine called shabu. According to a 2012 United Nations report , among all the countries in East Asia, the Philippines had the highest rate of methamphetamine abuse. Estimates showed that about 2.2 percent of Filipinos between the ages of sixteen and sixty-four were using methamphetamines, and that methamphetamines and marijuana were the primary drugs of choice. In 2015, the national drug enforcement agency reported that one fifth of the barangays, the smallest administrative division in the Philippines, had evidence of drug use, drug trafficking, or drug manufacturing; in Manila, the capital, 92 percent of the barangays had yielded such evidence.

How would you describe Duterte’s leadership as the mayor of Davao?

After the collapse of the Ferdinand Marcos dictatorship, there were high levels of crime in Davao and Duterte cracked down on crime associated with drugs and criminality more generally. There was early criticism of his time as mayor by Philippine and international human rights groups because of his de facto endorsement of extrajudicial killings, under the auspices of the “Davao Death Squad.”

Duterte was also successful at negotiating with the Philippine Communist Party. He was seen broadly as sympathetic to their concerns about poverty, inequality, and housing, and pursued a reasonably robust anti-poverty agenda while he was mayor. He was also interested in public health issues, launching the first legislation against public smoking in the Philippines, which he has claimed he will launch nationally.

What have been the outcomes of the drug war?

By early December , nearly 6,000 people had been killed: about 2,100 have died in police operations and the remainder in what are called “deaths under investigation,” which is shorthand for vigilante killings. There are also claims that half a million to seven hundred thousand people have surrendered themselves to the police. More than 40,000 people have been arrested.

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Although human rights organizations and political leaders have spoken out against the crackdown, Duterte has been relatively successful at not having the legislature engaged in any serious oversight of or investigation into this war. Philippine Senator Leila de Lima, former chairperson of the Philippine Commission on Human Rights and a former secretary of justice under the previous administration, had condemned the war on drugs and held hearings on human rights violations associated with these extrajudicial killings. However, in August, Duterte alleged that he had evidence of de Lima having an affair with her driver, who had been using drugs and collecting drug protection money when de Lima was the justice secretary. De Lima was later removed from her position chairing the investigative committee in a 16-4 vote by elected members of the Senate committee.

What is the public reaction to the drug war?

The war on drugs has received a high level of popular support from across the class spectrum in the Philippines. The most recent nationwide survey on presidential performance and trust ratings conducted from September 25 to October 1 by Pulse Asia Research showed that Duterte’s approval rating was around 86 percent. Even through some people are concerned about these deaths, they support him as a president for his position on other issues. For example, he has a relatively progressive economic agenda, with a focus on economic inequality.

Duterte is also supporting a range of anti-poverty programs and policies. The most recent World Bank quarterly report speaks positively about Duterte’s economic plans. The fact that he wants to work on issues of social inequality and economic inequality makes people not perceive the drug war as a war on the poor.

How is Duterte succeeding in carrying out this war on drugs?

The Philippine judicial system is very slow and perceived as corrupt, enabling Duterte to act proactively and address the issue of drugs in a non-constructive way with widespread violations of human rights. Moreover, in the face of a corrupt, elite-dominated political system and a slow, ineffective, and equally corrupt judicial system, people are willing to tolerate this politician who promised something and is now delivering.

“Drug dealers and drug addicts are a stigmatized group, and stigmatized groups always have difficulty gaining political support for the defense of their rights.”

There are no trials, so there is no evidence that the people being killed are in fact drug dealers or drug addicts. [This situation] shows the weakness of human rights institutions and discourse in the face of a popular and skilled populist leader. It is different from college students being arrested under the Marcos regime or activists being targeted under the first Aquino administration, when popular outcry was aroused. Drug dealers and drug addicts are a stigmatized group, and stigmatized groups always have difficulty gaining political support for the defense of their rights.

How has the United States reacted to the drug war and why is Duterte challenging U.S.-Philippines relations?

It’s never been a genuine partnership. It’s always been a relationship dominated by U.S. interests. Growing up in the 1960s, Duterte lived through a period when the United States firmly supported a regime that was even more brutal than this particular regime and was willing to not criticize that particular government. He noticed that the United States was willing to overlook human rights violations when these violations served their geopolitical interests. He was unhappy about the double standards. [Editor’s Note: The Obama administration has expressed concern over reports of extrajudicial killings and encouraged Manila to abide by its international human rights obligations.] For the first time, the United States is facing someone who is willing to challenge this historically imbalanced relationship. It is unclear what might happen to the relationship under the administration of Donald J. Trump, but initial indications are that it may not focus on human rights in the Philippines. President-Elect Trump has reportedly endorsed the Philippine president’s effort, allegedly saying that the country is going about the drug war "the right way," according to Duterte .

The interview has been edited and condensed.

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The Evidence—and Lack Thereof—About Cannabis

Research is still needed on cannabis’s risks and benefits. 

Lindsay Smith Rogers

Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread.

Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. 

In this Q&A, adapted from the August 25 episode of Public Health On Call , Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS , associate professor of Mental Health , about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. 

Do you think medicinal cannabis paved the way for legalization of recreational use?

The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use.

But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders.

Does cannabis have viable medicinal uses?

The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer.

There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. 

And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication.

What do we know about the risks of marijuana use?  

Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. 

It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. 

What benefits do you see to legalization?

When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. 

And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations.

What big questions about cannabis would you most like to see answered?

We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted.

Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence.

Are there studies looking into the risks you mentioned?

Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder.

If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about?

I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.

Lindsay Smith Rogers, MA, is the producer of the Public Health On Call podcast , an editor for Expert Insights , and the director of content strategy for the Johns Hopkins Bloomberg School of Public Health.

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• Publications
• IZA Discussion Papers
• Persuasive Agenda-Setting: Rodrigo Duterte's Inauguration Speech and Drugs in th...

IZA DP No. 13027: Persuasive Agenda-Setting: Rodrigo Duterte's Inauguration Speech and Drugs in the Philippines

published in: Journal of Development Economics, 2022, 156 ,102843

Can democratically elected politicians persuade their constituents to alter policy priorities? With little empirical support for this hypothesis to date, we propose that Rodrigo Duterte's inauguration speech on June 30, 2016 systematically shifted the Filipinos' policy agenda toward prioritizing illegal drugs. We first study day-to-day variation in national and sub-national Google searches over six months, identifying a strong and persistent increase in drug-related searches right after the speech. Placebo tests rule out potentially confounding topics, such as pharmaceutical drugs, Duterte's 'War on Drugs', or common time trends with neighboring countries. Next, to better identify causality, we exploit the exogenous timing of traditional local festivals, which we argue resulted in some of the Philippines' 81 provinces being less exposed to Duterte's speech. The corresponding results are consistent with our hypothesis: less exposed provinces had smaller increases in drug-related Google searches. Finally, we examine individual-level survey responses that more directly capture policy priorities and uncover similar results: crime has moved to the top of the Filipinos' policy agenda. Results that exploit the same identication strategy based on local festivals hint at a causal effect of the speech on these policy priorities.

• policy priorities
• agenda setting

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