1 

Statement from ONDCP Director R. Gil Kerlikowske

Why Marijuana Legalization Would Compromise Public Health and 

Public Safety 

Annotated Remarks 

Delivered at the California Police Chiefs Association Conference 

March 4th, 2010

San Jose, CA 

Thank you for inviting me here today to address your conference. I 

especially want to thank Chief Rob Davis for that introduction. 

Furthermore, I’d like to congratulate and thank your new 

President, Susan Manheimer. 

I also want to acknowledge my friend, Barney Malekian, and 

congratulate him on his appointment as the COPS Director. I 

believe our appointments speak very clearly about the level of 

support and respect this Administration has for local law 

enforcement. 

You have been at the forefront of some very controversial issues, 

and I appreciate your leadership. Other states look to California 
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for guidance, and your thoughtful and timely efforts on drug issues 

ranging from medical marijuana to pseudoephedrine are important 

for the health and safety of all Americans. 

When President Obama asked me to serve as Director of National 

Drug Control Policy, he explained that one of my first duties 

would be drafting his Administration’s first National Drug Control 

Strategy, laying out the policies and programs best suited to curb

drug use and its consequences. 

But the President didn’t want a traditional policy paper, with a few 

people from Washington putting their ideas down and then 

submitting to Congress a plan that would be forgotten or 

disregarded by the field. Instead, he asked me to travel the country 

and sit down with people on every side of this issue. 

Since my confirmation, I’ve visited 37 cities in 19 states, as well as 

8 foreign countries, holding roundtable discussions and meeting 

with hundreds of drug prevention and treatment experts, local 

officials, law enforcement, parents, teachers, community groups, 

academics, and young people. 

We also convened a working group made up of the 35 Federal 

agencies with a role in the anti-drug effort. The group’s task was 

to develop a coordinated approach at the Federal level. 

These months of consultations across the country helped highlight 

an important truth – that public safety and public health are 

threatened by drug use and its consequences. Addressing these 
3 

challenges requires a balanced, comprehensive, and evidencebased approach. 

The Administration’s Drug Control Strategy, which will be 

released soon, will build on the hard-won knowledge we already 

have, but it will also incorporate new information and new tools 

that experience in the trenches and our best research have provided 

us. 

The scope of our country’s drug problem is disturbingly clear: drug 

overdoses outnumber gunshot deaths in America and are fast 

approaching motor vehicle crashes as the leading cause of 

accidental death. It’s hard to believe since we seem to hear much 

more about H1N1, the Toyota recall, and texting while driving. 

We are also deeply concerned about two relatively recent threats to 

public safety and public health: prescription drug abuse and 

drugged driving. 

Prescription drug abuse harms the people who take these pills and 

those close to them. While we must ensure access to medications 

that alleviate suffering, it is also vital that we do all we can to 

curtail diversion and abuse of pharmaceuticals. 

Past-year initiation of non-medical prescription drug use has 

surpassed the rate for marijuana.1

 Moreover, between 1997 and 

2007, treatment admissions for prescription painkillers increased 

more than 400 percent. The latest data from the Monitoring the 

 

1 Results from the 2008 National Survey on Drug Use and Health: National Findings, Substance Abuse and Mental 

Health Services Administration (SAMHSA), 2009 
4 

Future study show that seven out of the top ten drugs used by teens 

are prescription drugs.2

And between 2004 and 2008, the number of visits to hospital 

emergency departments involving the non-medical use of narcotic 

painkillers increased 111 percent.3

Because prescription drugs are legal, they are easily accessible, 

often from a home medicine cabinet. Further, some individuals 

who misuse prescription drugs, particularly teens, believe these 

substances are safer than illicit drugs because they are prescribed 

by a healthcare professional and sold behind the counter. This is 

not the drug that people buy behind a gas station wrapped in tin 

foil, and so people think it is somehow safer. 

We know from the latest National Survey on Drug Use and Health 

that most people who abuse these drugs are getting them from 

friends and family or from a doctor.4

As law enforcement professionals and community leaders, you can 

help spread an important message to parents and other adults: If 

you have unused prescription drugs in your home, dispose of them 

properly. I also know that many of you have initiated take-backs 

with the community to help this problem, and I applaud you for 

that. 

 

2

 Treatment Episode Data Set (TEDS) Highlights - 2007, SAMHSA: National Admissions to Substance Abuse 

Treatment Services.

3 Drug Abuse Warning Network (DAWN), SAMHSA, 2010. Found at https://dawninfo.samhsa.gov/

4

 See Supra note 1.
5 

Another priority for us this year is drugged driving. 

A Department of Transportation study released in December 

showed that 16 percent of nighttime weekend drivers tested 

positive for a licit or illicit drug.5

This study highlighted the alarming prevalence of drugged driving, 

and I’ve made anti-drugged driving efforts a top priority. 

We will be assessing how we can help states deal with this issue, 

and I will be meeting with leaders – from trainers of Drug 

Recognition Experts (DRE), to police chiefs, researchers, and 

policy makers –to see how the Administration can engage with 

them to reduce this threat. 

This evening I’ll be in Sacramento, meeting with 30 officers 

currently undergoing DRE training. I will encourage them in their 

efforts and sit down with them to better understand the issues they 

face in this area. 

I know it is impossible to talk about drug policy issues ranging 

from prevention to policing, from drugged driving to treatment, 

without mentioning the role of the most commonly used illicit drug 

today – marijuana. 

You all know the impacts of marijuana in this state– from the 

proliferation of marijuana being grown on public lands and indoor 

grows, to the negative effects of marijuana use among youth, the 

 

5

2007 National Roadside Survey of Alcohol and Drug Use by Drivers: Drug Results, U.S. Department of 

Transportation, National Highway Traffic Safety Administration, December 2009. Accessible at 

http://www.ondcp.gov/publications/pdf/07roadsidesurvey.pdf 
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increasing influence of violent gangs on the marijuana trade, and 

the problems associated with medical marijuana dispensaries. 

As I’ve said from the day I was sworn in, marijuana legalization –

for any purpose – is a non-starter in the Obama Administration. 

I’d like to explain why we take this position.

First, on the medical marijuana issue, I believe that the science 

should determine what a medicine is, not popular vote. 

We’ve seen the problems of medical marijuana here in this state 

but also in places like Colorado, too, where kids are given the 

message that since marijuana is a medicine, it must be safe.6

But we’ve also seen how localities are dealing with this, with 

success, through zoning, planning regulations, nuisance laws, and 

other mechanisms. 

I recently met with officials from the Netherlands, they are closing 

down marijuana outlets – or “coffee shops” – because of the 

nuisance and crime risks associated with them. What used to be 

thousands of shops have now been reduced to a few hundred, and 

some cities are shutting them down completely.7

 

6

“Doctor says medical marijuana laws hurt teens,” NPR. Talk of the Nation, Feb, 10, 2010. Accessible at 

http://www.npr.org/templates/rundowns/rundown.php?prgId=5&prgDate=02-10-2010

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“Government to scale down coffee shops,” Ministry of Health, Welfare, and Sport, Sept. 11, 2009. Accessible at 

http://www.minvws.nl/en/nieuwsberichten/vgp/2009/government-to-scale-down-coffee-shops.asp. Also see “Dutch 

border towns to close coffee-shops,” Expatica, October 24, 2008, 

http://www.expatica.com/fr/news/local_news/Dutch-border-towns-close-coffee_shops.html. It is also worth noting 

that research from MacCoun, R. and Reuter, P. (2001; Drug War Heresies, Cambridge University Press) shows that, 

despite traditionally higher rates of marijuana use in the U.S., there was a tripling in lifetime marijuana use and a 

more than doubling of past-month use among 18- to 20-year-olds in the Netherlands from 1984 to 1996 – a time 

when the commercialization of Dutch coffee shops was rapidly expanding. 
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This brings me to the issue of outright legalization. 

The concern with marijuana is not born out of any culture-war 

mentality, but out of what the science tells us about the drug’s 

effects. 

And the science, though still evolving, is clear: marijuana use is 

harmful. It is associated with dependence, respiratory and mental 

illness, poor motor performance, and cognitive impairment, among 

other negative effects.8

We know that over 110,000 people who showed up voluntarily at 

treatment facilities in 2007 reported marijuana as their primary 

substance of abuse.9

 Additionally, in 2008 marijuana was involved 

in 375,000 emergency visits nationwide.10 

 

8

 Moore and colleagues (2005) summed up the literature on respiratory illnesses and marijuana in the Journal of 

General Internal Medicine by stating that “the current literature of case reports and clinical samples suggests that 

marijuana-related respiratory problems may constitute a significant public health burden.” See Moore, B.A., et al, 

Respiratory effects of marijuana and tobacco use in a U.S. sample, Journal of General Internal Medicine 20(1):33-

37, 2005. Also see Tashkin, D.P., Smoked marijuana as a cause of lung injury, Monaldi Archives for Chest Disease

63(2):93-100, 2005. Other evidence on the effect of marijuana on lung function and the respiratory system, and the 

link with mental illness, can be found in expert reviews offered by Hall W.D, and Pacula R.L. (2003), Cannabis use 

and dependence: Public health and public policy. Cambridge, UK: Cambridge University Press., and Room, R., 

Fischer, B., Hall, W., Lenton, S., and Reuter, P. (2009), Cannabis Policy: Moving beyond stalemate, The Global 

Cannabis Commission Report, the Beckley Foundation. Room et al. write, “Cannabis use and psychotic symptoms 

are associated in general population surveys and the relationship persists after adjusting for confounders. The best 

evidence that these associations may be causal comes from longitudinal studies of large representative cohorts.” 

Also see Degenhardt, L. & Hall, W. (2006), Is cannabis a contributory cause of psychosis? Canadian Journal of 

Psychiatry, 51: 556-565. A major study examining young people and, importantly, a subset of sibling pairs was 

released in February 2010 and concluded that marijuana use at a young age significantly increased the risk of 

psychosis in young adulthood. See McGrath, J., et al. (2010), Association between cannabis use and psychosisrelated outcomes using sibling pair analysis in a cohort of young adults, Archives of General Psychiatry. 

9

 See Supra note 1. 

10 See Supra note 3. 
8 

Several studies have shown that marijuana dependence is real and 

causes harm. We know that more than 30 percent of past-year 

marijuana users age 18 and older are classified as dependent on the 

drug,11 and that the lifetime prevalence of marijuana dependence in 

the US population is higher than that for any other illicit drug. 

Those dependent on marijuana often show signs of withdrawal and 

compulsive behavior.12

 

Traveling the country, I’ve often heard from local treatment 

specialists that marijuana dependence is as a major problem at callin centers offering help for people using drugs. 

Marijuana negatively affects users in other ways, too. For 

example, prolonged use is associated with lower test scores and 

lower educational attainment because during periods of 

intoxication the drug affects the ability to learn and process 

information, thus influencing attention, concentration, and shortterm memory.13

 

11 Compton, W., Grant, B., Colliver, J., Glantz; M., Stinson, F. (2004), Prevalence of Marijuana Use Disorders in the 

United States: 1991-1992 and 2001-2002, Journal of the American Medical Association, 291:2114-2121. 

12 Budney, A.J. & Hughes, J.R. (2006), The cannabis withdrawal syndrome, Current Opinion in Psychiatry, 19: 233-

238.; Budney, A.J., Hughes, J.R., Moore, B.A. & Vandrey, R. (2004), Review of the validity and significance of 

cannabis withdrawal syndrome. American Journal of Psychiatry, 161: 1967-1977.; Budney, A.J.,Vandrey, R.G., 

Hughes, J.R., Moore, B.A. & Bahrenburg, B. (2007), Oral delta-9-tetrahydrocannabinol suppresses cannabis 

withdrawal symptoms, Drug and Alcohol Dependence, 86: 22-29.; Kouri, E.M. & Pope, H.G. (2000), Abstinence 

symptoms during withdrawal from chronic marijuana use, Experimental and Clinical Psychopharmacology, 8: 483-

492.; Jones, R.T., Benowitz, N. & Herning, R.I. (1976), The 30-day trip: clinical studies of cannabis use, tolerance 

and dependence. In Braude, M. & Szara, S. (eds.), The Pharmacology of Marijuana. New York: Academic Press, 

Vol. 2, pp. 627-642.

13 For a review of the evidence on marijuana and educational attainment, see: Lynskey, M.T. & Hall, W.D. (2000),

The effects of adolescent cannabis use on educational attainment: a review, Addiction, 96: 433-443.
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Advocates of legalization say the costs of prohibition – mainly 

through the criminal justice system – place a great burden on 

taxpayers and governments. 

While there are certainly costs to current prohibitions, legalizing 

drugs would not cut the costs of the criminal justice system. 

Arrests for alcohol-related crimes such as violations of liquor laws 

and driving under the influence totaled nearly 2.7 million in 2008. 

Marijuana-related arrests totaled around 750,000 in 2008. 14

 

Our current experience with legal, regulated prescription drugs like 

Oxycontin shows that legalizing drugs is not a panacea. In fact, its 

legalization widens its availability and misuse, no matter what 

controls are in place. In 2006, drug-induced deaths reached a high 

of over 38,000, according to the Centers for Disease Control – an 

increase driven primarily by the non-medical use of 

pharmaceutical drugs.15

 

Controls and prohibitions help to keep prices higher, and higher 

prices help keep use rates relatively low, since drug use, especially 

among young people, is known to be sensitive to price.16 

The relationship between pricing and rates of youth substance use 

is well-established with respect to alcohol and cigarette taxes. 

 

14 Federal Bureau of Investigation (2008) Uniform crime reports, Washington, DC. Available at: 

http://www.fbi.gov/ucr/ucr.htm 

15 Heron M., Hoyert D., Murphy S., et al. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14. 

Hyattsville, MD, National Center for Health Statistics, 2009. See 

http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf 

16 For example, see: Williams, J., Pacula, R., Chaloupka, F., and Wechsler, H. (2004), “Alcohol and Marijuana Use 

Among College Students: Economic Complements or Substitutes?” Health Economics 13(9): 825-843.; Pacula R., 

Ringel, J., Suttorp, M. and Truong, K. (2008), An Examination of the Nature and Cost of Marijuana Treatment 

Episodes. RAND Working Paper presented at the American Society for Health Economics Annual Meeting, 

Durham, NC, June 2008. Jacobson, M. (2004), “Baby Booms and Drug Busts: Trends in Youth Drug Use in the 

United States, 1975-2000,” Quarterly Journal of Economics 119(4): 1481-1512. 
10 

There is literature showing that increases in the price of cigarettes 

triggers declines in use.17

 

Marijuana has also been touted as a cure-all for disease and black 

market violence – and for California’s budget woes. Once again, 

however, there are important facts that are rarely discussed in the 

public square. 

The tax revenue collected from alcohol pales in comparison to the 

costs associated with it. Federal excise taxes collected on alcohol 

in 2007 totaled around $9 billion; states collected around $5.5 

billion.18

Taken together, this is less than 10 percent of the over $185 billion 

in alcohol-related costs from health care, lost productivity, and 

criminal justice.19

Alcohol use by underage drinkers results in $3.7 billion a year in 

medical costs due to traffic crashes, violent crime, suicide 

attempts, and other related consequences.20

 

17 See, for example, Chaloupka, F., “Macro-Social Influences: Effects of Prices and Tobacco Control Policies on the 

Demand for Tobacco Products,” Nicotine & Tobacco Research, 1999, and other price studies at 

http://tigger.uic.edu/~fjc and www.uic.edu/orgs/impacteen. Orzechowski & Walker, Tax Burden on Tobacco, 2006. 

USDA Economic Research Service, www.ers.usda.gov/Briefing/tobacco. Farelly, M., et al., State Cigarette Excise 

Taxes: Implications for Revenue and Tax Evasion, RTI International, May, 2003, 

http://www.rti.org/pubs/8742_Excise_Taxes_FR_5-03.pdf. Country tax offices. CDC, Data Highlights 2006 [and 

underlying CDC data/estimates]. Miller, P., et al, “Birth and First-Year Costs for Mothers and Infants Attributable to 

Maternal Smoking,” Nicotine & Tobacco Research 3(1):25-35, February 2001. Lightwood, J. & Glantz, S., “ShortTerm Economic and Health Benefits of Smoking Cessation - Myocardial Infarction and Stroke,” Circulation 

96(4):1089-1096, August 19, 1997, http://circ.ahajournals.org/cgi/content/full/96/4/1089. Hodgson, T., “Cigarette 

Smoking and Lifetime Medical Expenditures,” The Millbank Quarterly 70(1), 1992. U.S. Census. National Center 

for Health Statistics. 

18 See http://www.taxpolicycenter.org/taxfacts/displayafact.cfm?Docid=399 

19 Harwood, H. (2000), Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, 

Update Methods and Data. Report prepared for the National Institute on Alcoholism and Alcohol Abuse. 
11 

Tobacco also does not carry its economic weight when we tax it; 

each year we spend more than $200 billion and collect only about 

$25 billion in taxes.21

Though I sympathize with the current budget predicament – and 

acknowledge that we must find innovative solutions to get us on a 

path to financial stability – it is clear that the social costs of 

legalizing marijuana would outweigh any possible tax that could 

be levied. In the United States, illegal drugs already cost $180 

billion a year in health care, lost productivity, crime, and other 

expenditures.22

 That number would only increase under 

legalization because of increased use. 

Rosy evaluations of the potential economic savings from 

legalization have been criticized by many in the economic 

community. For example, the California Board of Equalization 

estimated that $1.4 billion of potential revenue could arise from 

legalization. This assessment, according to a researcher out of the 

independent RAND Corporation is, and I quote, “based on a series 

of assumptions that are in some instances subject to tremendous 

uncertainty and in other cases not valid.”23

 

 

20 See Pacific Institute for Research and Evaluation (PIRE), 2009, Underage Drinking Costs. Accessed on March, 1, 

2010. Available at http://www.udetc.org/UnderageDrinkingCosts.asp 

21 State estimates found at supra note 27. Federal estimates found at 

https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf, Also see 

http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em and 

http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see “Smokingcaused costs” on p.2.

22 The Economic Costs of Drug Abuse in the United States, 1992-2002, Office of National Drug Control Policy, 

Executive Office of the President, Washington, DC: (Publication No. 207303), 2004.

23 Pacula, R. (2009). Legalizing Marijuana: Issues to Consider Before Reforming California State Law. Accessed at 

www.rand.org 
12 

Recent testimony from a RAND researcher concluded that “There 

is a tremendous profit motive for the existing black market 

providers to stay in the market, as they can still cover their costs of 

production and make a nice profit.”24

Canada’s experience with taxing cigarettes showed that a $2 tax 

differential per pack versus the United States created such a huge 

black market smuggling problem that Canada repealed its tax 

increases.25

 

Legalizing marijuana would also saddle government with the dual 

burden of regulating a new legal market while continuing to pay 

for the negative side effects associated with an underground 

market whose providers have little economic incentive to 

disappear.26

Now that I’ve told you what the research says, let me tell you what 

this means in practical terms. Legalization means the price comes 

down, the number of users goes up, the underground market 

adapts, and the revenue gained through a regulated market will 

never keep pace with the financial and social cost of making this 

drug more accessible. 

Now let’s talk about what will work to reduce drug use. 

 

24 Ibid. 

25 Gruber J., Sen, A. & Stabile, M. (2003), “Estimating Price Elasticities When There is Smuggling:

The Sensitivity of Smoking to Price in Canada,” Journal of Health Economics 22(5): 821-842.

26 See Supra note 23. 
13 

The Office of National Drug Control Policy is pursuing a 

combined, coordinated public health and public safety strategy. 

This strategy recognizes that the most promising drug policy is one 

that prevents drug use in the first place. 

We have many proven methods for reducing the demand for drugs. 

The demand can be decreased with comprehensive, evidence-based 

prevention programs focused on adolescence, which science 

confirms is the peak period for drug-use initiation and the potential 

for addiction. 

Our young people must be made aware of the risks of drug use – at 

home, in school, in sports leagues, in faith communities, in places 

of work, and in other settings and activities that attract youth. 

This is vital because an individual who reaches age 21 without 

smoking, using drugs or abusing alcohol is virtually certain never 

to do so. 

ONDCP’s National Youth Anti-Drug Media Campaign can 

reinforce these efforts by connecting with youth through popular 

television shows, Internet sites, magazines, and films. Community 

anti-drug coalitions can provide an environment conducive to 

remaining drug-free. Expanding early intervention services for 

drug users and treatment options for the addicted will also be 

major components of our effort to reduce demand for drugs in this 

country. 
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Surveys of prevalence show that these efforts work. Drug use 

today remains comparatively low. Annual marijuana prevalence 

peaked among 12th graders in 1979 at 51 percent. By 2009, 

annual prevalence had fallen by about one-third. Similar statistics 

can be found for other age groups. However, we are seeing some 

troubling signs that have bubbled up in the last year or two. The 

perception that drugs are dangerous is dropping, and that usually 

predicts imminent increases in use. 

At the same time, we’ve learned that trying to manage drugaddicted criminal offenders entirely through the criminal justice 

system results in a costly, destructive cycle of arrest, incarceration, 

release, and re-arrest. 

Together, we can transform this situation through new 

collaborations between the criminal justice system and the 

treatment system. Drug courts are just one example of how these 

systems can work together. 

Re-entry programs that provide addiction treatment, combined 

with intensive monitoring and swift and certain sanctions for 

violations – as evidenced by Hawaii’s HOPE program – are 

another example of the kind of scientifically supported crosssystem initiatives we seek to expand, especially in the probation 

system, which represents a highly important but often underutilized and forgotten role in drug and crime control. 

We advocate further research on pre-arrest diversion programs like 

the one piloted in High Point, North Carolina. These programs 

threaten dealers in a community with credible sanctions, but also 
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offer them other resources to change their lives. Research on these 

kinds of pre-arrest diversion programs is just emerging, but 

preliminary results have been positive. 

We are also firm believers in the law enforcement techniques you 

employ every day, based on local assessments of needs and 

available resources. 

A balanced approach based on a combination of public health and 

public safety strategies is the surest route to reducing drug use and 

its consequences. This approach employs best practices in 

prevention, treatment, and law enforcement with community 

partners. We know that working together has resulted in lowering 

crime and drug use. 

Thank you for being on the front line of these issues. I look 

forward to supporting you to reduce drug use and its consequences. 

######