Treating marijuana the same as alcohol is impossible for several reasons. There are no measurements for marijuana impairment that relate across the board to how we understand alcohol impairment.

What Are the Costs Associated with Marijuana Legalization?

An employer who takes the view that Friday night use of marijuana is none of his concern will begin to see ramifications when impairment on Monday morning endangers workplace safety.

As marijuana legalization surges across our nation, many of us view it as an inevitable tidal wave of unquestioning change that we must consider the new cultural norm. The prevailing mindset seems to be that "everyone wants it." However, the simple fact that the marijuana lobby has a brilliant marketing strategy of social norming does not mean that everyone wants marijuana legalization, nor does it indicate that our responses to this issue are coming from an informed point of view.

Common sense has employers concerned about the impacts of impairment in the workplace, but the pressures and threats that using marijuana is the constitutional right of the employee causes entire corporations to consider backing down from drug-free workplace policies that help ensure public health and safety. Common sense would also have parents and school personnel recognizing the harm to young people, but the constant thrum that marijuana is harmless (and even . . . good medicine) has many authority figures looking the other way when it comes to teen marijuana use because we are prone to believe everyone is doing it.

In the same vein of thought that draws these conclusions, we also hear that marijuana should be viewed the same way as alcohol, which is socially acceptable for adults, yet we would never consider it appropriate to use alcohol in a way that negatively impacts the workplace or allow kids to use alcohol with abandon.

According to The Economic Costs of Alcohol Abuse report, alcoholism costs U.S. employers 500 million lost work days per year (NIDA, 2000). The cost of alcohol abuse in the United States is at least $185 billion annually. In other words, for every dollar we bring in, we spend ten. Why are we holding this up as a revenue model?

It has been said that by regulating marijuana like alcohol, teen use will decrease; but taking into account that in 2009 more than 70 percent of teens 18 years and under had experienced drinking alcohol, it does not seem possible that treating marijuana as alcohol will result in less use by teens (NIH, 2009). When adolescents use marijuana regularly, they can experience a lasting 6-8 point I.Q. reduction that, for most people, drops them significantly for potentially completing their education and gaining substantial future employment (Meier, et al., 2012).

Treating marijuana the same as alcohol is impossible for several reasons. The potency and serving suggestions for marijuana cannot be standardized in the same way regulatory authorities have measured alcohol, due to lack of uniform measurement techniques. Additionally, there are no measurements for marijuana impairment that relate across the board to how we understand alcohol impairment. A simple breath alcohol test allows us to know the immediate blood-alcohol ratio impacting the subject’s brain, where no such standard exists for marijuana. To be exact, no such measurement will be ready for years to come.

Current options allow for employers, law enforcement officers, or medical personnel to simply find marijuana present in the subject's system. Metabolized rates of THC (the psychoactive component of marijuana) vary widely based on each individual's body type. However, impairment cannot be measured by a simple screening test.

Where alcohol impairment rates are fairly standard, marijuana impairment rates are wildly unpredictable. As commercialized marijuana products continue to be refined and enhanced, allowing for soaring levels of THC that are commonly 10-20 times more potent than in previous decades, some users report effects of acute impairment lasting for days after use. Therefore, an employer who takes the view that Friday night use of marijuana is none of his concern will begin to see ramifications when impairment on Monday morning endangers workplace safety.

Zero Tolerance Supports Public Safety
These are just a few of the reasons it remains imperative for employers to maintain thorough and consistent screening practices in order to strengthen Safe and Drug-Free Workplace stances. As screening becomes more advanced through techniques such as oral swabbing, which allows for shorter detection time with THC, sending strong messages that impairment in the workplace will not be tolerated is both public safety and fiscally responsible.

While the marijuana industry does project billions of dollars streaming into the economy through tax revenues, pols and pundits alike fail to attempt to calculate cost load (Fairchild, 2013). Here are some important things we must consider:

A federal report on workplace drug testing by SAMHSA states that employees using marijuana cause 55 percent more accidents than those who do not, and positive drug tests showing THC in the employee's system verifies 85 percent more on-the-job injuries by marijuana users (Autry, 1998). This same report lists increased absenteeism and loss of work productivity as additional costs to the U.S. employer. While the National Drug Intelligence Center reports that substance abuse costs this country upwards of $193 billion each year, these costs are limited in scope and do not include the costs of associated destructive behaviors, such as child abuse or domestic violence (National Drug Intelligence Center, 2011).

Regardless of what the commercialization proponents say in paid advertising campaigns, marijuana does produce a dependence that requires addiction recovery and treatment. Data sets from the National Survey on Drug Use and Health from 2012 show admissions to addiction treatment facilities document marijuana as the second-highest reason for treatment--directly behind alcohol (NSDUH, 2014). The Partnership for Drug-Free Kids states that 23.5 million Americans are addicted to alcohol and drugs, which amounts to one in every 10 people over the age of 12 (Join Together, 2010). The financial burden of addiction and recovery treatment has yet to be fully addressed in efforts for national health care reform, but one thing we do know is that costs are staggeringly out of control.

According to an article in Annals of Emergency Medicine, those states that began allowing marijuana for medical use before 2005 saw calls to poison control centers for children accidentally exposed to marijuana triple. In states that have not permitted marijuana for medical use, there were no incidents (Wang, 2014). In Colorado, where recreational marijuana has been permitted, cases of child poisonings have risen significantly with at least two cases of small children requiring intubation to continue breathing. Cannabis-related emergency hospital admission rates overall have been rising sharply in the United States, according to the Drug Abuse Warning Network (DAWN), which shows emergency department admissions increasing from 16,251 in 1991 to over 461,028 in 2012 (SAMHSA, 2013). Marijuana-related admissions to hospital emergency rooms account for more than all other drugs combined. While we hear repeatedly that marijuana is "safe," we desperately need a definition of what entails "safety" when emergency rooms are burdened with marijuana-related health issues.

Where marijuana for medical use has been touted as a revenue stream, an audit of the Colorado system (touted as the world’s finest regulatory implementation) showed heavy financial losses to the point of operating at a deficit with violations of the regulatory system rampant (Ray, 2013). This has not seemed to be a large-scale consideration as we look through the lenses of dollar signs with recreational marijuana.

Colorado law enforcement is continually strapped to cover costs associated with road-side drug testing when alcohol is not the culprit of an impaired driver. To date, the framework for marijuana regulation does not include reimbursement to local or statewide jurisdictions for expenditures on trained Drug Recognition Experts, blood tests, or court costs associated with traffic offenses. These are losses suffered at the taxpayers' expense.

Problems Associated with Legalization
In a compiled report by Dr. Bertha Madras of the Harvard Medical School's Department of Psychiatry, marijuana use disorder is associated with higher mortality. It has lasting adverse effects on the future of young adults through increases of anxiety, panic, depression, psychotic symptoms, cognitive losses, and neuropsychological decline and causes various adverse health effects, such as psychosis (Madras, 2012). Our nation’s Mental Health Parity Act has not been fully implemented to address the scope of mental health issues that are exacerbated by marijuana use, rather than clinical treatment.

Questions still left unanswered would be the impact of second-hand marijuana smoke to children and family members and costs related to associated illnesses. Much less the fact that smoking marijuana puts the user at similar, if not greater, risks associated with tobacco. The California Office of Environmental Health Hazards’ assessment on the carcinogenicity of marijuana smoke states, "[s]tudies reporting results for direct marijuana smoking have observed statistically significant associations with cancers of the lung, head and neck, bladder, brain, and testis. The strongest evidence of a causal association was for head and neck cancer, with two of four studies reporting statistically significant associations. The evidence was less strong but suggestive for lung cancer, with one of three studies conducted in populations that did not mix marijuana and tobacco reporting a significant association. Suggestive evidence also was seen for bladder cancer, with one of two studies reporting a significant association. For brain and testicular cancers, the single studies conducted of each of these endpoints reported significant associations" (Tomar PhD, Beaumont PhD, & Ysieh PhD, 2009).

There are far more questions and problems associated with the legalization of marijuana (with no compelling medical evidence to remove it as a Federally Controlled Schedule 1 Substance) than there are good solutions at this point. While it is clear that thoughtful dialogue should take place in order to learn more and formulate positive strategies, fast-tracking a recreational drug to legal status through a ruse of impossible regulatory ideologies will prove irresponsible and costly. Exact figures of societal costs will not be known for many years to come, if they are ever able to be truly calculated, but we must keep the whole spectrum of issues pertaining to marijuana at the forefront of our decision and policy-making efforts.

1. Autry, J. H. (1998). Testimony on Federal Workplace Drug Testing. Washington D.C.: SAMHSA.
2. Fairchild, C. (2013, April 20). Legalizing Marijuana Would Generate Billions in Additional Tax Revenue Annually. Retrieved July 15, 2014, from Huffington Post:
3. Join Together. (2010, September 28). New Data Show Millions of Americans with Alcohol and Drug Addiction Could Benefit from Health Care. Retrieved July 15, 2014, from Drug Free America:
4. Madras, B. P. (2012). What the Latest Top Cannabis Research Tells Us. Retrieved July 15, 2014, from
5. Meier, M., Caspi, A., Ambler, A., Keefe, R., McDonald, K., Ward, A., et al. (2012). Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife. Durham: PNAIS.
6. National Drug Intelligence Center. (2011). The Economic Impact of Illicit Drug Use on American Society. Washington D.C.: U.S. Department of Justice.
7. NIDA. (2000). The Economic Costs of Alcohol Abuse. Washington D.C.: National Institute of Health.
8. NIH. (2009). National Institute of Abuse of Alcohol and Alcoholism. Retrieved July 15, 2014, from Understanding the Impact of Alcohol on Human Health and Well-Being:
9. NSDUH. (2014). National Admissions to Substance Abuse Treatment Services. BHSIS Series S-71, HHS Publication No. (SMA)14-4850. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
10. Ray, D. E. (2013). Medical Marijuana Regulatory System Performance Audit. Denver, CO: State of Colorado, Office of the Auditor.
11. SAMHSA. (2013). Drug Abuse Warning Network: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: SAMHSA.
12. Tomar PhD, R., Beaumont PhD, J., & Ysieh PhD, J. (2009). Evidence on the Carcinogenicity of Marijuana Smoke. Sacramento: CA Office of Environmental Health Hazards.
13. Wang, S. (2014). Association of Unintentional Pediatric Exposures with Decriminalization of Marijuana in the United States. Annals of Emergency Medicine.

This article originally appeared in the September 2014 issue of Occupational Health & Safety.

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