Is America Switching From Booze to Weed?

On a recent Monday morning, we found ourselves up in the Berkshire Mountains, in the town of Sheffield, Massachusetts. There’s a dark gray building with a big front porch, right on Route 7. It is home to a retail shop called The Pass.

It was pretty busy — especially for a Monday morning! — and the customers were happy to tell us why they were buying what they were buying.

WOMAN: It helps me with pretty much everything. Get through the day, wake up, eat, my anxiety. 

MAN: This is pretty much the only way to get my brain to shut off, to actually fall asleep. 

WOMAN: There’s so many different ways you can use it. 

MAN: This is my relaxation.

WOMAN: It just takes the edge off.

MAN: For me, it just makes everything a little bit better. 

WOMAN: Everyone could benefit off of it in their own way. 

WOMAN: It’s, you know, medicine without medicine.

What is this alleged elixir, this medicine-without-medicine?

MAN: Weed.

WOMAN: Weed. 

WOMAN: I got some weed.

MAN: Weed. 

WOMAN: Weed. 

MAN: It’s all cannabis. I absolutely love it.

WOMAN: It’s just nice to know that it’s legal now. 

You may know it as weed or marijuana or hemp or pot or, if you’re old enough, maybe you know it as grass or reefer or herb. It has gone by many names in many places and many times. Mary jane, sticky icky, chronic, devil’s lettuce, gas, ganja, 420, dope, green goddess, flower, zaza, blaze, bud, shake, skunk, greenery, kush! We’re just going to call it cannabis. That’s the name of the actual plant. The most famous component of the plant is THC, or tetrahydrocannabinol. That’s the one that gets you high. The second-best-known component is CBD, or cannabidiol, which is not intoxicating, and tends to be used for things like pain relief. But there are more than 140 cannabinoids found in different strains of the plant. You probably already know that cannabis is now legal in many states, even though it remains illegal federally. And you may know that it comes in many forms — flower, which is just the dried plant, for people who smoke, but also edibles, tinctures, beverages, chewing gum, chocolate, nasal spray, quite a few more. But here’s something I bet you don’t know: in the U.S. today, there are more D.N.D. users of cannabis — that stands for daily or near-daily — than there are daily or near-daily users of alcohol. Let that sink in for a minute. Here’s what we heard up at the Pass:

MAN: It’s better if you’re going to use it every day. You know, you can’t drink every day and be okay. 

WOMAN: If I’m in a social situation, I’m not going to grab a drink. I’m going to grab some weed. 

MAN: I was a teenage alcoholic, but now I’ve been smoking weed for 60 years, and I’m still alive. 

Alcohol is still, overall, much more popular in the U.S., but for a significant group of people, cannabis has become the drug of choice. In a recent Gallup survey, 17 percent of Americans reported using cannabis; that’s up from 7 percent just 10 years earlier. How did this happen? And what does it mean? That’s what we want to find out — in this special, four-part series on cannabis.

Michael SIEGEL: I think if everyone who was using alcohol was instead using cannabis, it would be a much safer, healthier world.

In today’s episode, Part 1: the harms of alcohol are well-established; how about cannabis?

Yasmin HURD: You’re talking about needing a whole army to study the effects of cannabis from these new products that we still do not know anything about. 

In Part 2, we’ll get into the bizarre economics of this industry, which haven’t worked out the way anyone predicted.

Nik PATEL: It’s hard to articulate the regulatory complexity of every single thing you have to do. 

In Part 3, we will visit the farm.

Chris WELD: Smells good, doesn’t it? 

And in Part 4, we will try to sort out the future.

Adam GOERS: Americans — Democrat, Republican, independent — are all supportive of seeing major cannabis change.

Along the way, we’ll hear from cannabis industry insiders, medical doctors and legal scholars, regulators and politicians — and a few happy customers:

A.C.: It tastes good. 

Z.L: I’m really energized. I thought I would be asleep.

D.A: Oh, I’m enthralled. I’m so excited.

I’m excited too.

*      *      *

So, let me tell you how this series began. It did not begin as a series about cannabis. We thought we were going to make a series about the economics of the alcohol industry.

Tom STANDAGE: When we say “cheers,” or we raise our glasses we’re doing something extremely ancient.

Our first interview was with Tom Standage. He’s an editor at The Economist, in London.

STANDAGE: And I’m also the author of a book called A History of the World in Six Glasses. 

A History of the World in Six Glasses is a very good book. And the interview with Standage was interesting, for sure. He told us that beer is probably the oldest alcoholic beverage, and that it was discovered accidentally.

STANDAGE: People would have made a sort of barley or wheat-rich soup, and then they might have left it out, and it would have naturally fermented with wild yeasts. There are these pictures of people drinking beer in Mesopotamia from 5,000 years ago, and they’re all drinking through straws from the same vessel.

Standage told us that beer was central to ancient economies:

STANDAGE: We know that the workers who built the pyramids — it was long thought that they were enslaved; actually they weren’t, they were paid, and they were paid partly in beer.

And he told us about the “beer theory of civilization” — that’s the idea that the human embrace of alcohol predated the age of agriculture.

STANDAGE: The beer theory of civilization is that people settled down close to wild stands of things like barley in order to be sure that they would have a reliable supply, and therefore reliable supply of beer.   

But growing barley and wheat, on purpose — cultivating them, as crops — that would produce even more raw material for more beer. As well as food for eating, of course. Man does not live on booze alone. (Although I have known a few people who tried.) But the reality is that many people have really liked alcohol for a really long time.

STANDAGE: You have to look at alcohol as a source of intellectual stimulation, as a source of joy, a source of calories to keep people alive. 

DUBNER: How important historically was alcohol just to plain human survival, in terms of delivering water that didn’t make people sick, and delivering calories that were substantial and affordable and portable? 

STANDAGE: Yes, alcohol does both of those things. If you’re worried about the safe water supply, it does work as a purification technology. For example, the Greeks mixed water and wine. They thought that this was to make the wine safe, that if you drank undiluted wine, you’d go nuts. But actually the wine was making the water safe because the tannins were antibacterial.  

So alcohol has played a key role in human civilization since the early days, and in many places it still does. We drink to celebrate, we drink to sanctify, we drink to mourn, we drink with old friends, and with people we’re just getting to know. We drink when we want to shift a mental gear. Tom Standage, for instance, plays drums in a band.

STANDAGE: I play the drums better after a pint of Guinness. I’m more relaxed, but also I’m not overthinking things too much. I’m probably prepared to take a few more risks and try a few more creative things. I do think there is a sort of useful blurriness that can come from drinking the right amount of alcohol. 

The pursuit of that useful blurriness is, in some places, a national pastime. In the U.S., more than 60 percent of us drink at least sometimes, and that has been true for over 150 years. And Covid produced a 5.5 percent rise in per-capita alcohol consumption. But how much you drink has a lot to do with how old you are, and not in the way you might expect.

STANDAGE: The main thing that we’ve observed on both sides of the Atlantic is that younger people are drinking less, or not at all in many cases, and certainly my generation — so I’m in my 50s — we seem to be drinking a lot more. 

Indeed, 85 percent Americans aged 35 to 50 now drink, a much higher number than in the past, and binge-drinking among this group — defined as four drinks within two hours for a woman and five drinks for a man — that is now at 30 percent, the highest ever recorded. So, yeah, we’re talking to Tom Standage about alcohol, and it’s super-interesting. I’m thinking about that Mesopotamian history. I’m thinking about alcohol as a social lubricant. I’m thinking about its antibacterial benefits. But then I start digging into the data about the harms of alcohol — and I am just blown away.

According to the C.D.C., the Centers for Disease Control, roughly 180,000 Americans die every year from excessive alcohol use. And that number has been rising lately, driven by an increase in women dying from alcohol use. Around 15,000 of these alcohol-related deaths come in motor-vehicle crashes, and N.H.T.S.A. — the National Highway Traffic Safety Administration — reports that alcohol use is up in their data, too. But let’s put aside death: the C.D.C. estimates that alcohol use costs the U.S. about a quarter of a trillion dollars annually — most of that in lost workplace productivity, but there’s $28 billion in healthcare costs, $25 billion in criminal-justice costs, on and on. And so I got to thinking: I know that alcohol has been around for a long time and I know it serves many purposes for many people — and I personally like it — but if you take all the advantages of alcohol and weigh them against the harms, alcohol does not come out looking very good. Now, you may be thinking, what about the health benefits of alcohol? You’ve seen all those TV news pieces about red wine preventing cancer, that kind of thing. I started wondering about that, too. So, I called up Michael Siegel, a public-health researcher at Tufts. He said you have to follow the funding.

Michael SIEGEL: Most of the research which has been funded by alcohol companies has reported that there is a benefit to drinking moderate amounts of alcohol. On the other hand, most of the research that has not been funded by the industry has found that there actually is not a benefit, and that overall mortality is higher. 

Maybe we shouldn’t be surprised by this news. The same thing happened with cigarettes, and sugar: an industry will commission researchers from a top university to produce a study that winds up miraculously highlighting only the benefits of their product. Some public-health experts still say that moderate alcohol use isn’t a big deal; but others say that alcohol is, essentially, toxic. We’re not going to be able to settle that argument today. We’re making a different argument. Here’s what we’re saying: given that the societal costs of alcohol are so large; and that any health benefits are probably overhyped; and given that cannabis use is soaring — is it possible that we’ve entered the Era of Cannabis Replacement? And if so, what will be the effects of that? Those seem like interesting questions to me; I hope they seem interesting to you too. Because that’s the series we wound up making. Next step: now we need a little cannabis history.

*      *      *

Okay, for some history on cannabis, we’re going to rely on two people. The first is Ryan Stoa.

Ryan STOA: I’m an associate professor of law at the Louisiana State University Law Center.

Stoa has written a book called Craft Weed: Family Farming and the Future of the Marijuana Industry. He also published a fascinating article in the MIT Press Reader called “A Brief Global History of the War on Cannabis.” So you can see where he’s coming from.

STOA: We’ve had a lot of attention in the last several decades on the legalization question, should we legalize? And that feels like it’s been answered. The next question is, how should we regulate it — and maybe the bigger-picture question is, what do we want the cannabis industry to be?  

The second person we’ll hear from is Jon Caulkins.

CAULKINS: I’m a professor of operations research and public policy at Carnegie Mellon University’s Heinz College.

And what does “operations research” mean?

CAULKINS: Operations research these days may be better known as analytics. The name comes from World War II, when it was analyzing military operations. Best way to think about it is “engineering and applied mathematics applied to solving practical-decision problems.” 

And what does that have to do with cannabis, or other drugs?

CAULKINS: When I was in grad school, I wanted to study something that would help make the world a better place. I assumed that was going to be energy, environment, telecommunications. But I recognized that at that time, if you surveyed the American public, they said the number-one problem facing the nation was illegal drugs. And so I decided I would focus on that.

DUBNER: Can I just ask, what’s your personal view of drugs? And let’s use drugs to include, you know: nicotine, caffeine, marijuana, etc., etc., etc. What do you like and not like? 

CAULKINS: You can ask, I won’t answer. I’m highly committed to the idea that science should be observer-independent, dispassionate, and objective.

Okay, let’s go with dispassionate and objective. By the way, Caulkins is the researcher who put together the data I cited earlier — about the massive rise in daily or near-daily use of cannabis, and how it has eclipsed alcohol. He pulled that data from the U.S. National Survey on Drug Use and Health.

CAULKINS: For 15 years I’ve been drawing this graph, and every single year, I’ve watched it increase. Back in 1992, there were 10 times as many Americans who self-reported daily or near-daily drinking as self-reported daily or near-daily cannabis use. But cannabis use has grown enormously since that nadir in 1992. And finally, after the 2022 survey data became available, that was the first year in which the cannabis line crossed the alcohol line.  

Okay, so how did we get here? Let’s start the cannabis story at the beginning.

CAULKINS: Cannabis has a long, long history going back thousands of years.

And Ryan Stoa again:

STOA: There are some people that believe cannabis may have been one of the original crops that brought about the Neolithic revolution, when humans transitioned from being hunter-gatherers to being a more fixed agricultural species. The plant is so versatile and can be used for food, it can be used for fiber, it can be used for religious or spiritual or just recreational purposes.

DUBNER: Did it tend to be more popular among elites, or no? 

STOA: It was probably consumed by all classes of people. But when we saw prohibition measures take place around the world, it was generally aimed at the lower classes. Drug prohibition historically has been used as a tool of oppression. So it’s not necessarily the drug itself that ruling classes are concerned about, but rather using drug prohibition as a tool to make sure that there isn’t a religious or economic changing of the guard, so to speak. The Catholic Church hasn’t been terribly fond of cannabis over the years. Pope Innocent VIII issued a papal ban on cannabis in the first year of his papacy. This was in 1484. So clearly, a huge priority for him. Really wanted to promote this idea that fulfillment comes in the afterlife, and we want to reject these momentary pleasures that we feel in this body that we have now.

DUBNER: What is the typical prohibitionist’s playbook?

STOA: Associate the plant with violence. Associate cannabis with depravity. Associate it with other dangerous drugs. Portray cannabis users as religious extremists or dangerous minorities, and help turn the tide against that population and towards prohibition. Those are all tried-and-true strategies that we’ve seen over the years.

Okay, and how about a brief history of cannabis in the U.S.?

STOA: John Adams writes this two page to-do list on his way to the Continental Congress. On page one of the to do-list is, quote, “Hemp to be encouraged,” unquote. On page two was the Declaration of Independence. So higher up on his priority list, perhaps. I mean, American farmers were growing hemp for quite a long time, even into the 20th century, and were a dominant force.  

CAULKINS: It’s absolutely true that in, say, the 19th century, Americans were growing the cannabis plant, but they were growing it to make rope and shirts and so on. The use of cannabis as an intoxicant really did not become a major issue until the 20th century and, honestly, even in the first half of the 20th century, it was pretty darn uncommon. 

STOA: Early 20th century, we saw psychoactive marijuana strains coming up from Mexico or Latin America. Popularized in the U.S. South, and of course went northward. Embraced by proponents and fans and musicians of the jazz era. And so as jazz spread around the United States, so too did marijuana use. 

CAULKINS: Our original federal law, the Harrison Narcotics Act of 1914, was passed primarily because do-gooder Americans wanted to push back against the British opium trade in China, and didn’t want to be over there without a U.S. law, saying that the opioids are problematic.

But the Harrison Narcotics Act of 1914 didn’t say anything about cannabis, which was still technically legal. That was about to change.

CAULKINS: So, it was first prohibited by states. The federal government came to the party late.

In 1915, California became the first state to criminalize cannabis. By 1931, a majority of states had done the same, and in 1937, Congress completed the ban by passing the Marihuana Tax Act, “marihuana” being the term used in Mexico. The regulators were hoping to give the drug a dangerous, south-of-the-border vibe.

CAULKINS: Throughout the 20th century, the United States passed a variety of drug-specific federal laws. In 1970, that somewhat incoherent assemblage of laws were brought together into an integrated framework called the Controlled Substances Act. It’s a myth that that was the beginning of the “war on drugs.” The laws had been passed long before. It was just a reorganization. 

It was President Nixon who signed the Controlled Substances Act. He called drug use “public enemy No. 1.” And what did Nixon think about cannabis? Here’s what he told some White House aides, as captured by his secret tape-recording system: “I know that it’s not particularly dangerous … I know most of the kids are for legalizing it … But on the other hand, it’s the wrong signal at this time.”

Over the next few decades, the signals began to change. Many millions of people were using cannabis, which propped up a massive black market. Millions of people were arrested for selling and using cannabis, and that struck many people as absurd, especially for a drug that even Nixon didn’t think was particularly dangerous. Public sentiment shifted, and in 1996, California approved cannabis for medicinal use — physicians prescribed it for chronic pain, multiple sclerosis, bowel disease, glaucoma, epilepsy, and other conditions. Several states followed California’s lead, and then in 2012, Colorado and Washington became the first states to fully legalize cannabis for recreational use. Back in the Nixon era, only 15 percent of Americans said they supported legalization for everybody over 21; today, that number is 70 percent. Cannabis is fully legal in 24 states, as well as Washington, D.C., and it’s approved for medical use in another 14 states. And as we’ve been hearing, consumption is way up. So who’s doing the consuming?

CAULKINS: If we do a pie chart of who’s using cannabis, it’s absolutely dominated by daily and near-daily users. The people who only use once or twice a week are an unimportant footnote from the perspective of industry. At one time, people thought marijuana was a young person’s drug. It is not. That 1960s association, cannabis and college, that stopped being true long ago. The median age of the user of the median day of use is 35. It’s not a young person’s substance anymore. Of those daily and near-daily users, about half report some evidence of having a substance-use disorder. So, an important segment of the market is consumption by people who are providing evidence that they don’t have full control over their substance, and it’s harming them. But are they going to commit violent acts? No. Are they going to die of an overdose? No. It’s just a very different, and far less-scary profile of problems.

Cannabis advocates insist that it is not addictive. Jon Caulkins’s data suggests that, at the very least, it is habit-forming. So I wanted to hear from someone who knows more about addiction.

Yasmin HURD: I’m Yasmin Hurd. I’m the director of the Addiction Institute at the Icahn School of Medicine at Mount Sinai in New York. I am a neuroscientist who studies the neurobiology of substance-use disorders. 

Hurd is one of the few researchers who studies the addictive potential of cannabis.

HURD: People were like, “Yasmin, why are you studying cannabis? This is not an addictive drug. You should be studying cocaine.” However, the number of investigators has increased as the problem of cannabis has risen, and as the legalization has risen. 

She thinks the U.S. rushed into legalization.

HURD: There was this dramatic switch where cannabis was considered the evil devil. And then it was switched, like, “Oh, okay, let’s start making money. Let’s put a dispensary on every block.” 

I asked Hurd how she got started as an addiction researcher.

HURD: When I told my really close friends that I was going to focus on studying addiction, they all laughed or didn’t believe me, because they were like, “Yasmin, you don’t use drugs. How can you go into a field that you actually have not done anything?” They’re like, “Yasmin, you’re from Jamaica, and you still don’t use cannabis.” But with all the stress that occurs in my life, I may actually start using CBD though. But, no, I have not imbibed in terms of smoking cannabis. I think I’m just a chicken. Because I would need to know every single component of the product. But really my path down to this science of addiction really came with looking at neurodegenerative disorders like Parkinson’s disease. Parkinson’s disease is the lesion of these dopamine cells in the brain, but these dopamine cells are also critical for reward, motivation, goal-directed behavior. And when you study these Parkinson’s animal models, you can pharmacologically tease that system with dopamine drugs like cocaine and amphetamine. And I was fascinated by how these drugs completely change behavior. That was how I got started.

DUBNER: So, how much variance is there among the human species in the way that they will process a given drug, or the way that the dopamine response will happen? If you were to take 100 people, observationally equivalent in terms of weight and makeup and so on, and give them the same amount of a drug — let’s say it’s cannabis, just for the sake of this conversation — how much variance is there in both the short and long-term effects? 

HURD: There’s a lot of variance when individuals take drugs, even if you give them, like you said, the same amount, and their same body weight, and so on. Part of that is driven by genetics. Environment — early-life events, for example, can modulate the amount of particular transmitters that you have, and even your stress response can then cause downstream effects in terms of how the drug may have a bigger effect than it would in another person. So the variability between individuals is enormous. 

DUBNER: What’s the difference between how cannabis and alcohol act on the brain?

HURD: When we talk about cannabis, we’re talking about THC, the main psychoactive component of cannabis. That binds to cannabinoid receptors in our brain and body, and these cannabinoid receptors are on cells that indirectly regulate dopamine. Alcohol is a little bit more complex. 

DUBNER: I thought you were going to say, “sloppy.” 

HURD: Actually, yes, that’s a good word. It’s a little bit more sloppy. 

DUBNER: Tell me what you can about the addictive qualities, or magnitude, of using cannabis. Just give me a kind of overview, and then we’ll figure out how to drill down into that. 

HURD: Okay, that may take a couple hours.  

DUBNER: That’s fine. I’ve got time.  

HURD: So, THC, that’s associated with reward, the reinforcement. THC binds to the cannabinoid receptors in the brain. The cannabinoid receptors are there not for THC. They’re there for our endogenous cannabinoid ligands.

DUBNER: Okay, did you say that we have endogenous cannabinoid ligands? 

HURD: Correct. We have endogenous cannabinoid ligands. 

DUBNER: Okay, I don’t know what really any of those words mean. So if you would, tell me more about that.

HURD: So these endogenous cannabinoid ligands are there mediating the actions of multiple biological processes. In fact, cannabinoid receptors are expressed throughout practically every organ in the body. And they modulate aspects of cell development, homeostasis in the brain, they are important for regulating every single aspect from mood, motor function, every single thing. 

DUBNER: It sounds like there’s nothing they’re not potentially connected to. 

HURD: Exactly. They’re there from very early in utero because our endogenous cannabinoid systems are critical for hardwiring of the brain in the sense of laying down the blueprint on which the cells are formed, and the pathways that they make. So when people consume cannabis, THC will bind to the receptor, the endogenous cannabinoid receptors. It’s binding at a much higher concentration than the endogenous ligands. So you already have THC binding at supraphysiological levels. The original plant on the planet, that was like two to four percent THC. Today, you have concentrations of THC, depending on the product, that can go from 10 to 90 percent THC. So that becomes a huge issue. We know that, for every addictive substance, the higher the concentration of that particular chemical, the greater the addiction risk.

DUBNER: I’ve seen you and others argue that the legalization of cannabis in the U.S. has really outpaced the research and the science. If I had to guess, I would say that it’s simply not known how cannabis at that potency will react or will affect people, short-term and especially long-term. Is that about right? 

HURD: That’s completely correct. No one has studied the majority of products that are out there today. You have hundreds of products. So scientists, we’re still studying these low concentrations of THC on so many different biological processes, because it is complex. There are so many things that we need to know about cannabis’s effects on health. What’s cannabis’s effects on cognition? What’s cannabis’s effects on reward, addiction? What’s cannabis’s effects on motor function? So you’re talking about needing, like, a whole army to study the effects of cannabis from a scientific perspective on these new products that we still do not know anything about. Cannabis was considered a Schedule 1 drug by the D.E.A., meaning that it was highly addictive with no medicinal purpose. And that drove a lot of challenges for researchers, because — I don’t think people realize, in order to do this research with a Schedule 1 drug, there are a lot of regulatory hurdles that you have to jump through. Even being able to give a small dose of THC to a rat, it’s like 1,000-page things.

So, millions of people are using a drug whose risks, according to Yasmin Hurd, are not fully understood. We’ll hear more, later in this series, about how cannabis may soon be removed from that Schedule 1 drug listing. Coming up: how do the risks of cannabis compare to the risks of alcohol?

*      *      *

In the past, we have made not one but two series about the ongoing opioid crisis in the U.S. That crisis had its roots in legal drugs that were prescribed by physicians. As we move ahead with widespread cannabis legalization, some people — like Mount Sinai addiction researcher Yasmin Hurd — may see the opioid crisis as a warning: Be careful when you introduce new drugs into the national bloodstream! But there’s another public-health crisis that is so widespread, so baked into our culture, that we rarely think about it. Here again is Michael Siegel, the public-health researcher at Tufts we heard from earlier.

SIEGEL: The effects of alcohol on our society are overwhelming. At least 100,000 deaths a year are attributable to alcohol. Tremendous amount of violence is related to alcohol, sexual abuse, sexual assault.  

DUBNER: Have there been studies between populations that drink and don’t drink for non-health reasons? You know, certain religious groups that just don’t consume alcohol — I would think that’s a pretty nice study cohort. 

SIEGEL: There’s no question that when you look at populations that don’t drink alcohol, that there’s a massive decline in morbidity and mortality. The classic studies were done with a group called Seventh Day Adventists who, for religious reasons, do not drink.

DUBNER: One could say there are different characteristics among that population that may not relate to alcohol consumption at all that may be accounting for the different outcomes, yes? 

SIEGEL: Yeah, absolutely. But if you look at these studies, they’ve done a lot of work to control for those variables. They’re really well done studies and even controlling for some of those other lifestyle factors, they’re still finding an effect. I want to make it clear that in no way am I arguing that we should be prohibiting alcohol use. You know, we tried that. Didn’t work. 

DUBNER: How pervasive would you say has been the problem of the alcohol industry influencing academic research into alcohol? 

SIEGEL: It’s been a huge problem, and it continues to be a huge problem. The biggest problem is not necessarily that there is research being done that is funded by alcohol companies. The real problem is that researchers who are conflicted because of accepting that funding have either accepted or put themselves into positions where they are making policy recommendations. There are some very specific things that trouble me about what we’re not doing about alcohol that I think need to be changed. One is the whole issue of regulation of advertising. I think that we are just completely letting the alcohol companies get away with murder, essentially. They can do anything they want. They can target youth, they can have very attractive images of alcohol use that appeal to youth. We don’t allow that with tobacco. I don’t see any reason why we should allow it with alcohol. There are very few organizations that are talking about alcohol as a carcinogen. It is a carcinogen, and everyone should know that. 

DUBNER: When we were talking earlier about industry funding of research for alcohol — or tobacco or sugar, etc. — I’m curious what you can tell us about cannabis. Is that an issue yet? 

SIEGEL: I think cannabis a little bit different in that the health effects are very different. The issue with cannabis is much more behaviors — for example, driving under the influence of cannabis — than long-term effects of cannabis use on chronic disease. There is some evidence that cannabis, when smoked, does have lung irritants. But for the most part, we’re not dealing with the same magnitude of chronic disease as when we’re talking about something like tobacco or alcohol.   

DUBNER: And what if I say, well, that may be the case now, based on the known science about alcohol versus cannabis, but there’s less known science about cannabis. And until quite recently, there’s been much, much, much less use of cannabis than alcohol. So maybe we just don’t know yet. Alcohol is the devil you know, at least. What would you say to that argument? 

SIEGEL: I think that there’s enough that we do know about cannabis that we can definitively say that it’s not going to create the kind of health effects that we see with alcohol. What we don’t know is really if there are long-term risks of long-term use of cannabis. The concerns are more in terms of the way that cannabis use might interfere with someone’s life, especially youth, than necessarily that we’re going to see hundreds of thousands of people dying from it. I think that’s unlikely. I think it’s really important for us to understand — for policymakers especially to understand — that a regulated market where a product is legal is very often much safer than an unregulated product. Potentially, if it’s not well-regulated, contaminants or toxins getting into these products — I mean, we saw that with THC vaping products where we had this outbreak of lung disease, where I think at least 50 or 60 people died.

DUBNER: What’s known so far about the addictive nature of cannabis? Because I’ve read reports all over the map on that.

SIEGEL: There’s no question that cannabis qualifies as an addictive drug. But the major concern with cannabis use is not simply addiction to cannabis, but that cannabis use seems to be associated with experimentation with other drugs as well. And so when somebody is using cannabis, it’s not just that they’re using cannabis, it’s that there’s a risk that they may become addicted to other products. 

DUBNER: That’s an argument I remember hearing when I was a teenager, the “gateway drug” argument. How true does that argument turn out to be? Do we know that habitual users of cannabis are more likely to, quote, move on to other, harder drugs? 

SIEGEL: That is where there is a lot of strong evidence. You know, a lot of people have been saying that vaping is a gateway to smoking, and what they’re doing is basically taking the cannabis model and applying it to vaping without there actually being research. There really is not research showing that vaping is a gateway to smoking. 

DUBNER: In other words, vaping may be a substitute for smoking instead of —

SIEGEL: Exactly. There’s a lot more evidence that vaping is actually a substitute for smoking. With cannabis, there is evidence that cannabis use can be a gateway to the use of other drugs. 

DUBNER: What are the other drugs, and how likely is the gateway effect? 

SIEGEL: I think the biggest concern is alcohol use.

DUBNER: The concern about cannabis use is that it leads to more alcohol use? That’s the big concern? 

SIEGEL: Yeah. I mean, there’s very strong evidence that youth who use cannabis are also more likely to drink more alcohol. Now, what’s not clear is: is this a direct, causal relationship? In other words, is it the cannabis use that somehow is having effects on the brain that make it more susceptible to addiction? Or is it simply that people who are  more risk-taking, if they’re experimenting with one substance, they’re also more likely to experiment with another substance. 

DUBNER: So if I were to ask you what seems like a simple question, I’m curious to know how you’d answer it. Is cannabis a substitute or a complement for alcohol in general? 

SIEGEL: All of the evidence that I’ve seen shows that cannabis is a complement to other drugs. It doesn’t appear that people are switching from one form of drug use and then going to cannabis use as a form of harm reduction. So it’s very different than vaping, where there’s strong evidence that vaping is literally an alternative, competing product with tobacco. 

DUBNER: What about cannabis as a potential replacement for pharmaceutical drugs? Are there examples you can point to where cannabis might be a much better option for some conditions, some people, some situations? 

SIEGEL: It’s interesting because there hasn’t been a tremendous amount of research in this area by researchers, but there’s been a lot of research by the general public, in terms of just trying it. A lot of what we know about the usefulness of cannabis for different diseases or ailments or pain comes from people trying it, and reporting. “Hey, this is really working for me, and I can avoid taking opiates or worse things.” There are medical uses for cannabis. And there are many situations in which you can reduce harm by allowing people to use cannabis for medical reasons.

DUBNER: Okay, so here’s my big question, Michael. Alcohol has been around forever. It’s widely used in many cultures, in many settings. It’s often used responsibly and often gives a lot of people a lot of pleasure, a lot of benefit. But there are, as we’ve been talking about today, really significant downsides as well, from physiological to the user him- or herself, to the downstream effects like drunk driving and violence too. So, at the moment, it seems like there’s this gigantic experiment going on in America, with many states legalizing cannabis after many years of it being illegal. And I could envision an argument that it might be a fantastic thing if more people were to switch over to cannabis from alcohol, and even, maybe, that if they were going to start using something, that it might be better to use cannabis than alcohol. What would you make of that theory? 

SIEGEL: You know, if somebody came up to me today and said, “We will make a deal with you. You can replace all alcohol use with cannabis use. Would you take it?” I would take it in a moment. I would immediately agree to that deal. I think that if everyone who was using alcohol was instead using cannabis, it would be a much safer, healthier world. Now, I’m not suggesting that we should be encouraging everyone to go out using cannabis. 

DUBNER: It sounds kind of like you are, Michael. 

SIEGEL: No, I’m saying in this hypothetical situation, where someone is offering me a deal, I would take that immediately, and then work on trying to reduce cannabis use. Because the effects of alcohol in our society are overwhelming. I mean, it just — it’s wreaking havoc on our society. 

So that’s one view of our cannabis replacement theory. We went back to the addiction researcher Yasmin Hurd to ask whether she would prefer that alcohol users were using cannabis instead.

HURD: Oh, that’s a really challenging question. I would say, if we knew then what we know now, neither alcohol or tobacco would be approved. Because they contribute to huge health impact in our society. And alcohol leads to more deaths every year. But would I want to get rid of alcohol? Even though I like my sauvignon blanc? You know, perhaps, but the fact is that we know more about alcohol. We still don’t know about cannabis. So, it’s difficult for me to truly answer that question. 

DUBNER: How long is it going to take to know what should be known about a substance that’s widely legalized and available? 

HURD: That’s an excellent question. And I’m going to be honest and say, I don’t know. Near-daily and daily use of cannabis is much higher than it is for alcohol. That’s where our society has gone. So, does frequency matter? What we need to know right now are the aspects of the high-concentrated products, because that’s what is out there in the public. Even these aspects of the pattern of cannabis use that relates to addiction and psychiatric risk, we do not know much about. 

And Michael Siegel again:

SIEGEL: One of the philosophies of public health is the theory of harm reduction. We’re not going to stop people from using substances completely. So, why don’t we focus on trying to find ways that will cause the least health harm. I think a combination of legalizing recreational marijuana use combined with strict regulation and incentives to direct people towards the lesser harm is really the best strategy to go with. 

So that’s what the public-health experts have to say. That we need to know more. That we need a well-regulated market with “incentives to direct people towards the lesser harm.” But — and I certainly mean no offense to Michael Siegel or Yasmin Hurd — but it isn’t academic public-health experts like them who make the markets. In the case of cannabis, we’re talking about free-wheeling entrepreneurs, government regulators, and professional loophole-finders. So coming up next time, in Part 2 of our series: how does this market work — or not work?

Nik PATEL: The entirety of the cannabis market is filled with amazing number of contradictions.

Nikesh PATEL: Cannabis also has the added difficulty of having a rich history that’s rooted in criminalization. 

Precious OSAGIE-ERESE: Oh, it’s been a doozy.

That’s next time. Until then, take care of yourself — and, if you can, someone else, too.

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Freakonomics Radio is produced by Stitcher and Renbud Radio. Also, big congratulations to the three winners of this year’s Nobel prize in economics: Daron Acemoglu, Simon Johnson, and James Robinson. They have each appeared on Freakonomics Radio in the past. And you can hear a full interview with Acemoglu on People I (Mostly) Admire; that’s one of the other podcasts we make, hosted by Steve Levitt. He interviewed Acemoglu not long ago, and we’re republishing that episode soon. This episode of Freakonomics Radio was produced by Dalvin Aboagye and Zack Lapinski, and we had help this week from George Hicks. Our staff also includes Alina Kulman, Augusta Chapman, Eleanor Osborne, Ellen Frankman, Elsa Hernandez, Gabriel Roth, Greg Rippin, Jasmin Klinger, Jeremy Johnston, Jon Schnaars, Lyric Bowditch, Morgan Levey, Neal Carruth, Rebecca Lee Douglas, Sarah Lilley, and Theo Jacobs. Our theme song is “Mr. Fortune,” by the Hitchhikers; our composer is Luis Guerra