On November 6th, Massachusetts voters will consider a state-wide ballot initiative to legalize the medicinal use of marijuana. Under the proposed law, residents with qualifying medical conditions and a doctor's prescription would be able to purchase marijuana legally, and approved providers would be able to grow and distribute marijuana legally. If Question 3 passes, Massachusetts will become the 18th state to "medicalize" marijuana.
Passions run high on this issue, with both supporters and opponents guilty of arguments that are misleading, or worse. But case for Question 3, despite its imperfections, is the more persuasive.
The crucial problem with Question 3 is that it addresses a half-measure, medicalization, rather than the real issue, legalization.
Marijuana prohibition makes no sense. Governments should not interfere with individual behavior except when this generates substantial "externalities," meaning adverse impacts on others. Marijuana can produce externalities (e.g., traffic accidents), but this is not the whole story.
Many goods and activities generate external costs. Driving on the highway creates congestion and air pollution; smoking causes increased use of publicly funded health care and second-hand smoke; alcohol use contributes to traffic accidents and diminished workplace productivity. High-calorie foods and lack of exercise promote obesity and therefore elevated health-care costs.
Yet most societies do not outlaw any of these things, despite their significant externalities. Why? Because we recognize that the external costs of prohibition are even worse. Prohibition drives markets underground, generating violence, corruption, diminished quality control, infringements on civil liberties, and more. And it impedes the use of prohibited goods or activities by those who would use them responsibly, legal or not.
For most goods and activities, therefore, policy attempts to strike a balance; it punishes irresponsible use, as with DUI laws, but keeps other uses legal and above ground. That is the right policy for marijuana. Legalization would not eliminate all marijuana-related harms, but it avoids the harms from prohibition.
If marijuana is legal, then medicalization is moot. And a debate about legalization avoids the pretense that society can have it both ways: allow medical use without concern about non-medical use.
An honest debate about full legalization, however, is not currently in the cards. If legalization is off the table, medicalization better than nothing.
The argument for medicalization is that marijuana has valuable medicinal uses. Question 3, for example, suggests that marijuana is useful in treating cancer, glaucoma, HIV/AIDS, hepatitis C, Crohn's disease, Parkinson's disease, ALS, multiple sclerosis, and other conditions.
Opponents argue, however, that smoked marijuana has not been proven more effective in treating these illnesses than other medications, in particular those derived from marijuana components (e.g., Marinol, which is synthetic THC). Double-blind, placebo-controlled trials that compare smoked marijuana to other medications are indeed rare.
But even if no scientific evidence shows that smoked marijuana is better than the alternatives, millions of people believe that using marijuana improves their health. Why, then, should anyone interfere? A free society lets people judge for themselves what is in their own interest, assuming no harm to others.
The problem, according to opponents, is that medicalization will increase recreational use. The evidence, however, suggests that medicalization has no measurable impact on overall use. Presumably recreational users who purchase medical marijuana are mainly substituting these for black market purchases.
Medical marijuana opponents also claim that advocates are hiding their true objective, legalization. This charge is accurate in many cases, but relevant only if full legalization is the wrong policy. Many medical marijuana critics, moreover, are guilty of their own hypocrisy; they fail to mention that the absence of scientific evidence on smoked marijuana is due, in large part, to federal obstructionism.
If Question 3 passes, many recreational users will avail themselves of the medical market, and the mockery this makes of the medical system is unfortunate. Likewise, some medicalization advocates pretend they are only trying to help sick people — when they know that medicalization is back-door legalization — and this hypocrisy is distasteful.
Yet medicalization allows legitimate patients, with ailments severe and minor, the chance to improve their lives without fear of legal punishment or the hassle of dealing with the black market. At the end of the day, that is more important than the disingenuous way this outcome might come about. The case for Question 3 may not be perfect, but it strong.