At the OxyContin launch party in the mid-1990s, Richard Sackler, a member of the family that owns Purdue Pharma, stepped up to the podium to address the audience. Sackler, then senior vice president for sales, proclaimed that the launch party would be “followed by a blizzard of prescriptions that will bury the competition. The prescription blizzard will be so deep, dense, and white.”
A quarter of a century later, deaths caused by the opioid epidemic have reached an all-time high in the United States—with opioids responsible for over 72,000 deaths in 2017 alone. The Sackler family and Purdue Pharma face multiple lawsuits from the state of Massachusetts and county governments. In the lawsuit brought forward by Massachusetts, the attorney general claims that “the Sacklers made Richard’s boast come true…. They created a manmade disaster. Their blizzard of dangerous prescriptions buried children and parents and grandparents across Massachusetts, and the burials continue.” Although both the Sackler family and Purdue Pharma deny these allegations, the company halted its OxyContin marketing campaign to doctors.
A quarter century has brought other changes as well to the world of legal drugs in the United States. Colorado, one of the first of many states to legalize the recreational sale and use of marijuana, is also experiencing an opioid overdose epidemic. Scientific research indicates, however, that states that have legalized marijuana have decreased rates of opioid overdoses.
This thesis answers the question: Does marijuana legalization in Colorado save lives? Beginning with a close examination of the studies claiming that states that have legalized marijuana suffer fewer opioid overdoses than those that still prohibit the drug, this thesis conducts a thorough analysis of the medical effects of marijuana on both youth and adults. Medical research indicates few to no lasting effects to adults, but youth-onset users have a noticeable cognitive decline in their adult years. Public health does not simply compare overdoses to recreational drug use; other factors come into play as well, to include traffic safety. In that regard, research is mixed on the impact of marijuana use and driver impairment, undecided on what actually to test for in suspected marijuana-impaired traffic incidents, and operationally inconsistent in how both law enforcement officers and coroners test for marijuana use. The result? Any conclusions that can be drawn from data surrounding marijuana use and traffic fatalities in Colorado since legalization six years ago should be met with skepticism.
Drug trafficking organizations have not been static since marijuana legalization in Colorado and other states. Using a business model, this thesis examines key markers to determine if Mexican cartels have adapted to legalized marijuana. Based upon such indicators as the price of heroin, the market dominance of Mexican groups, recent cultivation increases, and the number of heroin-related arrests, it appears that Mexican groups have adapted to the new world of legal marijuana—and are pushing a cheap, highly addictive product more and more to Americans as they are transitioning off other opioid products.
The repeal of Prohibition in the United States is also examined within the context of current marijuana legalization, and many positive benefits of this type of repeal are again manifesting, almost 100 years later, as the same action is taken toward marijuana. Fewer youths use, there is more quality control over the product, and less crime is reported in Colorado. In addition, with law enforcement agencies freed up from dealing with marijuana-related crimes, other cases are being worked—and solved—at higher rates.
From a public health perspective, mental health in Colorado in the age of legal marijuana remains relatively unchanged, with minor caveats. Although Coloradans are committing suicide at record amounts year after year, research indicates that marijuana use is not tied to increased rates of suicide. Once victims’ confounding variables are accounted for, such as psychological problems, there is no direct link between suicide and marijuana use.
American pharmaceutical companies and their marketing campaigns are also examined in this thesis, along with the marijuana industry’s lobbying efforts. The results indicate a more malleable public that accepts legalized marijuana and increasingly buys into the idea of marijuana use promoting a healthy lifestyle. In terms of licit opioids, however, almost all positive impacts (from an industry perspective) have been played out. In recent years, the amount of opioids prescribed has consistently decreased and, as the Purdue Pharma example indicates, government and public dissatisfaction with the role that Big Pharma has had in the opioid epidemic is growing.
Although Uruguay legalized marijuana for a variety of reasons other than popular support, its experiences can be used to help strengthen Colorado’s policies. Specifically, the use of a database adopted solely for the purpose of limiting purchases to the legal limit may help minimize youth and intra-state commerce access. In addition, legal limits on tetrahydrocannabinol (THC), the psychoactive compound in cannabis, may decrease medical issues associated with high-dose use of retail products.
Marijuana legalization has largely had no impact on public health in Colorado. Each year, more and more people are committing suicide, dying on the roads, and overdosing on opioids. Marijuana has done little to stem these tragedies, with the exception of overdoses being mitigated somewhat by legal cannabis. More research needs to be conducted in Colorado and other states that have legalized marijuana, with accurate and consistent data on drug impairment and polydrug (alcohol/marijuana) incidents. This thesis concludes by recommending a variety of policy changes in Colorado, explaining how many state agencies can be used to effect positive change.