Buffalo Law Review VOLUME 66 APRIL 2018 NUMBER 2 Marijuana Edibles and “Gummy Bears” PAUL J. LARKIN, JR.† For most of the last eighty years, state and federal law,1 along with international agreements to which the United States is a signatory,2 have outlawed the cultivation, distribution, and possession of marijuana, occasionally punishing such conduct quite severely.3 Over the last two † Senior Legal Research Fellow, The Heritage Foundation; M.P.P. George Washington University, 2010; J.D., Stanford Law School, 1980; B.A., Washington & Lee University, 1977. The views expressed in this Article are my own and should not be construed as representing any official position of The Heritage Foundation. I thank Lawrence A. Brett, Dr. Robert L. DuPont, David Evans, Calvin Fay, Ed Haislmaier, Mark A.R. Kleiman, Bertha K. Madras, John Malcolm, Kevin Sabet, Charles Stimson, and Amy Swearer for excellent comments on an earlier version of this Article. I also thank Lawrence A. Brett and Claudia Rychlik for outstanding research assistance. Any errors are mine. 1. See, e.g., RICHARD J. BONNIE & CHARLES H. WHITEBREAD II, THE MARIJUANA CONVICTION: A HISTORY OF MARIJUANA PROHIBITION IN THE UNITED STATES (Lindesmith Ctr. 1999) (1974). 2. See Single Convention on Narcotic Drugs, Mar. 30, 1961, 18 U.S.T. 1407, amended by 1972 Protocol, Mar. 25, 1972, 26 U.S.T. 1439; Convention on Psychotropic Substances, Feb. 21, 1971, 32 U.S.T. 543; United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, Dec. 20, 1988, 1582 U.N.T.S. 164; ROBIN ROOM ET AL., CANNABIS POLICY: MOVING BEYOND STALEMATE 3, 7–8, 75–76 (2010). 3. See Hutto v. Davis, 454 U.S. 370, 371, 375 (1982) (rejecting the claim that a forty-year sentence for possessing nine ounces of marijuana with the intent to 313 314 BUFFALO LAW REVIEW [Vol. 66 decades, however, numerous states have revised their state constitutions or criminal codes to permit marijuana use by adults for medical or recreational purposes.4 Those developments have led to a variety of novel issues that could not have arisen when marijuana was deemed contraband and was grown and sold in a sub-rosa manner.5 The ongoing distribute it was an unconstitutional cruel and unusual punishment). 4. Since 1996, twenty-nine states and the District of Columbia revised their laws to permit medicinal use of cannabis. State Medical Marijuana Laws, NAT’L CONF. ST. LEGISLATURES (Feb. 15, 2018), http://www.ncsl.org/research/health/ state-medical-marijuana-laws.aspx. There is considerable regulatory variation among those states. See, e.g., Rosalie L. Pacula et al., Words Can Be Deceiving: A Review of Variation Among Legally Effective Medical Marijuana Laws in the United States, 7 J. DRUG POL’Y ANALYSIS 1 (2014). The California law is so open- ended and has been so broadly applied that it was tantamount to a recreational- use law. See CAL. HEALTH & SAFETY CODE § 11362.5 (West 2014) (authorizing marijuana to be used for treatment of “cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief”) (emphasis added); Paul J. Larkin, Jr., Medical or Recreational Marijuana and Drugged Driving, 52 AM. CRIM. L. REV. 453, 510–12 (2015) [hereinafter Larkin, Drugged Driving]; cf. Deepak Cyril D’Souza & Mohini Ranganathan, Editorial, Medical Marijuana: Is the Cart Before the Horse?, 313 JAMA 2431, 2431 (2015) (questioning why states authorize medical marijuana for diseases such as psoriasis). Beginning in 2012, eight of those states and the District of Columbia have gone further by legalizing the possession and recreational use of small amounts of marijuana. For example, in the fall of 2016 California voters passed Proposition 64, which legalized the sale, possession, and use of marijuana for recreational purposes and empowered the state to regulate that business. Vermont will join that club on July 1, 2018, when a new state law goes into effect permitting recreational marijuana use, albeit without large-scale commercialization. Magdalena Cerdá et al., Association of State Recreational Marijuana Laws with Adolescent Marijuana Use, 171 JAMA PEDIATRICS 142, 143 (2017); Michael R. Blood & Julie Watson, California Issues 1st Licenses for Legal Pot Market, U.S. NEWS & WORLD REP. (Dec. 15, 2017, 8:34 AM), https://www.usnews.com/news/best-states/california/articles/2017-12-15/californ ia-issues-1st-licenses-for-legal-pot-market; Chantal Da Silva, Vermont Becomes Ninth State to Legalize Marijuana, But Getting Pot Might Be Tricky, NEWSWEEK (Jan. 23, 2018), http://www.newsweek.com/vermont-becomes-ninth-state- legalize-marijuana-heres-where-buy-it-787792. 5. For a sample of recently published scientific, professional, and popular books and papers discussing those issues (in addition to the literature cited elsewhere in this Article), see NAT’L HIGHWAY SAFETY ADMIN., U.S. DEP’T OF TRANSP., DOT HS 812 440, MARIJUANA-IMPAIRED DRIVING: A REPORT TO CONGRESS (2017); NAT’L ACAD. SCI., ENG’G, & MED., THE HEALTH EFFECTS OF CANNABIS AND CANNABINOIDS: THE CURRENT STATE OF EVIDENCE AND RECOMMENDATIONS FOR RESEARCH (2017) [hereinafter NAT’L ACAD. REP.]; OFF. OF NAT’L DRUG CONTROL 2018] MARIJUANA EDIBLES 315 debate over marijuana policy has generated considerable disagreement over a host of issues,6 particularly over the treatment of marijuana under the state liberalization initiatives as a legitimate article of trade or medicine, even though it remains contraband under federal law.7 One point on which everyone has agreed is that marijuana should not be peddled to children.8 Perhaps that POLICY, MARIJUANA MYTHS AND FACTS: THE TRUTH BEHIND 10 POPULAR MISCONCEPTIONS (2014), http://www.nationaldec.org/goopages/pages_download gallery/download.php?filename=19411.pdf&orig_name=418.pdf; WILLIAM J. BENNETT & ROBERT A. WHITE, GOING TO POT: WHY THE RUSH TO LEGALIZE MARIJUANA IS HARMING AMERICA (2015); JONATHAN P. CAULKINS ET AL., MARIJUANA LEGALIZATION: WHAT EVERYONE NEEDS TO KNOW (2d ed. 2016) [hereinafter CAULKINS ET AL., MARIJUANA LEGALIZATION]; KEVIN A. SABET, REEFER SANITY: SEVEN GREAT MYTHS ABOUT MARIJUANA (2d ed. 2018); Laura Amato et al., Systematic Review of Safeness and Therapeutic Efficacy of Cannabis in Patients with Multiple Sclerosis, Neuropathic Pain, and in Oncological Patients Treated with Chemotherapy, 41 EPIDEMIOLOGY PREV. 279 (2017); Marcus A. Bachhuber et al., Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010, 174 JAMA INTERNAL MED. 1668 (2014); Alain Braillon, Low-Risk Cannabis Use Is an Oxymoron, 107 AM. J. PUB. HEALTH e26 (2017); June H. Kim et al., State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers, 106 AM. J. PUB. HEALTH 2032 (2016); Melvin D. Livingston et al., Recreational Cannabis Legalization and Opioid- Related Deaths in Colorado, 2000–2015, 107 AM. J. PUB. HEALTH 1827 (2017); Andrew A. Monte et al., The Implications of Marijuana Legalization in Colorado, 313 JAMA 241 (2015); David L. Nathan et al., The Physicians’ Case for Marijuana Legalization, 107 AM. J. PUB. HEALTH 1746 (2017). 6. See, e.g., W. Hall & M. Weier, Assessing the Public Health Impacts of Legalizing Recreational Cannabis Use in the USA, 97 CLINICAL PHARMACOLOGY 607 (2015); Angela Hawken et al., Editorial, Quasi-Legal Cannabis in Colorado and Washington: Local and National Implications, 108 ADDICTION 837 (2013); Todd Subritzky et al., Issues in the Implementation and Evolution of the Commercial Recreational Cannabis Market in Colorado, 27 INT’L J. DRUG POL’Y 1 (2016); see generally Paul J. Larkin, Jr., Introduction to a Debate: “Marijuana: Legalize, Decriminalize, or Leave the Status Quo in Place?,” 23 BERKELEY J. CRIM. L. (forthcoming 2018) (summarizing the arguments on each side) [hereinafter Larkin, Marijuana Debate]. 7. See, e.g., Gonzales v. Raich, 545 U.S. 1, 32–33 (2005) (upholding Congress’s Commerce Clause authority to prohibit the local cultivation and use of marijuana in compliance with state law); United States v. Oakland Cannabis Buyers’ Coop., 532 U.S. 483, 494–95 (2001) (holding that medical necessity is not a defense under federal law to a charge of unlawfully distributing marijuana). 8. See THOMAS BABOR ET AL., DRUG POLICY AND THE PUBLIC GOOD 105 (2010) (“Preventing people from becoming illicit drug users is a broadly shared goal 316 BUFFALO LAW REVIEW [Vol. 66 is because the supporters of marijuana liberalization believe that arguing for marijuana to be treated in the same manner as alcohol—viz., lawfully sold but regulated—is an easier political sell than complete legalization. Perhaps that is because proponents of liberalization know that the political blowback from any proposal that would allow minors free access to marijuana would sink their efforts to legalize adult marijuana use. Or perhaps it is because of something else entirely. Regardless, despite the well-known adage that advocates for any principle tend to push it to the extreme limit of its logic,9 no one argues today that minors should be free to use marijuana in the same manner as adults. Even states that allow marijuana to be sold to adults for recreational purposes deny minors that privilege.10 The problem arises of how to police that judgment with respect to a variety of different commercial food products, colloquially known as “edibles.” They are designed to be eaten and often resemble food products that anyone, including minors, would consume. Edibles allow individuals to obtain the psychoactive benefits of using marijuana among policymakers. When focused on young people, prevention programmes enjoy broad popular support as well.”); e.g., COLO. CONST. art. XVIII, § 16(1)(a), (2)(b), (3), (4) (creating a state constitutional right for only adults to use marijuana for recreational purposes); COLO. REV. STAT. § 18-18-406 (2017); 1 COLO. CODE REGS. § 212-2.402(A) (2017) (“Licensees are prohibited from transferring, giving, or distributing Retail Marijuana, Retail Marijuana Concentrate, or Retail Marijuana Product to persons under 21 years of age.”); WASH. REV. CODE § 69.50.360(3) (2017); WASH ADMIN. CODE § 314-55-095(1) (2017). Medical and recreational uses of marijuana raise distinct concerns. See, e.g., COLO. CONST. art. XVIII, § 16(7) (stating that recreational marijuana amendment does not limit the rights of a medical marijuana patient); id. art. XVIII, § 14(6) (creating special rules for medical marijuana use by minors). No state that has permitted marijuana to be used recreationally—Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Vermont, and Washington (along with the District of Columbia)—permits cannabis to be distributed to minors for recreational use. See Robert J. MacCoun & Michelle M. Mello, Half- Baked—The Retail Promotion of Marijuana Edibles, 372 N. ENG. J. MED. 989, 989–90 (2015). 9. See Hein v. Freedom from Religion Found., 551 U.S. 587, 615 (2007) (lead opinion). 10. Cerdá et al., supra note 4, at 143. 2018] MARIJUANA EDIBLES 317 without inhaling carcinogens.11 Edibles have two other attractive features as well: they can contain a heavy dose of sugar, making them enticing for people with a sweet tooth, and they avoid the tell-tale aroma of smoked marijuana, making them attractive for minors trying to avoid detection by their parents. Selling edibles poses the risk that children will find and mistakenly consume a product that injures them and that adolescents will find and intentionally consume the same product. How do we prevent those results? Who should make that decision—the local, state, or federal governments? Will the method selected to prevent those harms infringe on the ability of adults to purchase the same delivery mechanism? If so, does that matter? This Article will discuss one of those issues: namely, whether the Food and Drug Administration (FDA) should intervene and regulate the sale of edible forms of marijuana to prevent the risk that children who happen upon their parents’ “stash” will unwittingly consume it, believing that it is a traditional form of candy, or that adolescents will knowingly consume it, hoping for its psychoactive effects. Part I will discuss the retail distribution of marijuana in edible forms. Part II will identify the potential harms that minors can suffer from the consumption of marijuana, regardless of its form. It also explains the particular harms that can result from distributing food containing cannabinoids, the psychoactive ingredients in marijuana, 11. See, e.g., ROBERT L. DUPONT, THE SELFISH BRAIN: LEARNING FROM ADDICTION 156 (1997) (“Marijuana smoke contains more tar and cancer-causing chemicals than even cigarette smoke. One marijuana cigarette has as much cancer-causing tar as 17 tobacco cigarettes. Marijuana smoke, like tobacco smoke, causes bronchitis, inflammation of the airways in the lings, and chronic respiratory illnesses.”); GEORGE F. KOOB ET AL., DRUGS, ADDICTION, AND THE BRAIN 306 (2014) (“Marijuana smoke may also have the same potential toxicity as cigarette smoke with regard to lung function.”); Daniel G. Barrus et al., Tasty THC: Promises and Challenges of Cannabis Edibles, RTI PRESS 2, 4 (Nov. 2016) (stating that anecdotal consumer reports attribute interest in edibles to the ability to use them discretely, their more relaxing state of intoxication they provide, and the ability to avoid toxins and health risks). 318 BUFFALO LAW REVIEW [Vol. 66 principally one known by the acronym THC.12 Part III then discusses the options available to the local, state, and federal governments, particularly to the U.S. Food and Drug Administration, to prevent minors from suffering those harms by prohibiting the distribution of marijuana edibles that could be mistaken for candy or some other treat that a minor could eat. I. THE DISTRIBUTION OF MARIJUANA IN EDIBLE FORM Legalization initiatives have led to the sale of marijuana by private parties from brick-and-mortar buildings called “dispensaries” when marijuana is sold for medical use.13 Those businesses sell marijuana in the traditional dried plant form of leaves and flowers that can be smoked in cigarettes, cigars, pipes, water pipes, and “blunts” (marijuana wrapped in tobacco leaves), or, using today’s new technology, vaporized and inhaled (or, to use the vernacular, “vaped”). The psychoactive component of marijuana, THC, also comes in the form of oil or concentrates. Another popular medium is commercial food products, known as “edibles.” Food is rarely used as the delivery system for drugs, 12. DUPONT, supra note 11, at 154–55; LESLIE L. IVERSEN, THE SCIENCE OF MARIJUANA 35 (2d ed. 2008); Harold Kalant, Effects of Cannabis and Cannabinoids in the Human Nervous System, in THE EFFECTS OF DRUG ABUSE ON THE HUMAN NERVOUS SYSTEM 387, 387 (Bertha Madras & Michael Kuhar eds., 2014). The technical name for THC is Δ9-tetrahydrocannabinol. The chemical structure of THC closely resembles that of anandamide, an endogenously produced cannabinoid, named after the Sanskrit term “ananda,” which means “bliss.” See Bertha Madras, Drug Use and Its Consequences, in THE EFFECTS OF DRUG ABUSE ON THE HUMAN NERVOUS SYSTEM, supra, at 11; Maximilian Peters & Raphael Mechoulam, The Endocannabinoid System, in 2 PROFESSIONAL PERSPECTIVES ON ADDICTION MEDICINE 31, 34–36 (Mark Sanford & Donald Avoy eds., 2009). 13. As of September 2015, there were 385 licensed retail stores, 496 licensed marijuana cultivators, and 141 licensed infused product manufacturers in Colorado. Subritzky et al., supra note 6, at 1. One Arizona business has a drive- thru. Marcella Baietto, Arizona’s First Medical Marijuana Drive-Thru Now Open, AZ CENTRAL (Oct. 28, 2017), https://www.azcentral.com/story/news/nation- now/2017/10/28/arizonas-first-medical-marijuana-drive-thru-now-open/8096110 01/. 2018] MARIJUANA EDIBLES 319 including controlled substances.14 Edibles, however, serve in that role. Those foods come in different forms, such as cookies, candies, cakes, popcorn products, lozenges, chocolates, butter, popsicles, and liquids,15 as well as the Alice B. Toklas brownies made popular in the 1960s.16 As one observer noted, “[e]ssentially, a cannabis culinary professional can infuse just about anything you want to eat with THC . . . .”17 Edibles, it seems, are quite popular among marijuana’s consumers.18 One estimate is that between eleven and twenty-six percent of people who have used marijuana 14. Buprenorphine (a drug that avoids the psychoactive effects of opiates and the discomfort of withdrawal) and naloxone (an opiate antagonist) are delivered in sublingual strips, nicotine and aspirin are delivered in gum, and a few other drugs come in a similar form. George S. Wang et al., Association of Unintentional Pediatric Exposures with Decriminalization of Marijuana in the United States, 63 ANNALS OF EMERGENCY MED. 684, 688 (2014) [hereinafter Wang et al., Multistate Study 2005–2011]. No FDA-approved medication is smoked. Herbert D. Kleber & Robert L. DuPont, Physicians and Medical Marijuana, 169 AM. J. PSYCHIATRY 564, 564 (2012). 15. See, e.g., 1 COLO. CODE REGS. § 212-2.103 (2017) (“‘Edible Retail Marijuana Product’ means any Retail Marijuana Product for which the intended use is oral consumption, including but not limited to, any type of food, drink, or pill.”); JOHN HUDAK, MARIJUANA: A SHORT HISTORY 17–18 (2016) (noting that edibles come in “countless forms including cookies, brownies, candies, granola, salad dressing, and even pasta sauce.”); Katherine M. Kosa et al., Consumer Use and Understanding of Labeling of Information on Edible Marijuana Products Sold for Recreational Use in the States of Colorado and Washington, 43 INT’L J. DRUG POL’Y 57, 57 (2017); MacCoun & Mello, supra note 8, at 989–90; George Sam Wang et al., Unintentional Pediatric Exposures to Marijuana in Colorado, 2009– 2015, 170 JAMA PEDIATRICS 1, 2 (2016) [hereinafter Wang et al., Colorado Study 2009–2015]; Jennifer Maloney & David-George-Cosh, Big Brewer Makes a Play for Marijuana Beverages, WALL ST. J. (Oct. 27, 2017), https://www.wsj.com/ articles/big-brewer-makes-a-play-for-marijuana-beverages-1509300002?mod=m ktw&mg=prod/accounts-wsj. 16. Inspired by I LOVE YOU, ALICE B. TOKLAS (Warner Bros.-Seven Arts 1968). Toklas was a real-life writer whose cookbook had a recipe for marijuana brownies. 17. HUDAK, supra note 15, at 20; id. at 18 (“The variety now available is a real testament to American entrepreneurship and innovation.”). 18. A 2015 estimate was that sixteen to twenty-six percent of patients using medical cannabis consume edible products. Ryan Vandrey, et al., Cannabinoid Dose and Label Accuracy in Edible Medical Cannabis Products, 313 JAMA 2491, 2491 (2015). 320 BUFFALO LAW REVIEW [Vol. 66 medicinally have consumed edibles.19 Approximately five million units of edible products were sold in Colorado in 2014, the first year of recreational marijuana sales; one company alone produced 40,000 THC-infused candy bars per month.20 All told, edibles constituted forty-five percent of the $573 million in revenue generated by legal cannabis sales in Colorado and forty percent—more than 570,000 units—of marijuana sales in Washington.21 The pharmacokinetics—the action of the body on a drug, viz., metabolism, distribution, and elimination—of inhalation and ingestion differ materially from each other. Inhaling marijuana quickly distributes THC to the brain by entering the circulatory system in the lungs, providing the user with the hoped-for psychoactive effect without delay. By contrast, ingesting marijuana through an edible takes far longer to achieve that effect because the food must be digested and pass through the liver, which metabolizes much of the THC, before it becomes available to the brain.22 As a result, someone unfamiliar with the pharmacokinetics of marijuana, such as a minor or first-time user, or someone who travels to a state with liberal marijuana laws for the purpose of trying out cannabis, a so-called “marijuana tourist,” might overconsume the amount of THC-laced food necessary to receive the effect and, instead, wind up with a very unpleasant experience and a trip to the emergency 19. Barrus et al., supra note 11, at 2. 20. Id.; Kosa et al., supra note 15, at 57; Subritzky et al., supra note 6, at 3; see also Jane A. Allen et al., New Product Trial, Use of Edibles, and Unexpected Highs Among Marijuana and Hashish Users in Colorado, 176 DRUG & ALCOHOL DEPENDENCE 44, 46 (2017) (noting that in Colorado in 2014, more than seventy percent of a sample of past-year marijuana and hashish users tried a new product and half of them consumed an edible). 21. Barrus et al., supra note 11, at 2; Kosa et al., supra note 15, at 57; Wang et al., Colorado Study 2009–2015, supra note 15, at 2. 22. IVERSEN, supra note 12, at 41–47, 129; Barrus et al., supra note 11, at 3– 5; NAT’L INST. ON DRUG ABUSE, MARIJUANA 2–3 (Aug. 2017) [hereinafter NAT’L INST., MARIJUANA]. 2018] MARIJUANA EDIBLES 321 room.23 Inhaled and edible versions of marijuana have another important difference, too. Businesses have developed edibles that resemble the traditional candies attractive to children. Some edibles resemble “Gummy Bears,” while others have been labeled as “Pot Tarts,” “Buddahfinger,” “Munchy Way,” or Keef Kat.”24 That clever—perhaps too clever—marketing strategy raises a serious medical and public policy issue because THC produces harmful effects in minors that do not occur in adults due to the materially different stages of neurological development for the two groups. This presents state and federal governments with a legal problem that did 23. MacCoun & Mello, supra note 8, at 989–90. That may be what happened to Maureen Dowd when she ate a THC-laced candy bar in Colorado. Maureen Dowd, Don’t Harsh Our Mellow, Dude, N.Y. TIMES (June 3, 2014), https://www.nytimes.com/2014/06/04/opinion/dowd-dont-harsh-our-mellow-dude .html; see also HUDAK, supra note 15, at 17 (discussing what has been called the “Maureen Dowd Effect”); Allen et al., supra note 20, at 46; Barrus et al., supra note 11, at 5 (noting that 65 percent of edible users have an adverse experience and that “[t]he lack of consistency and the delayed intoxication may cause both new and experienced users of cannabis to consume higher than intended amounts of the drug. Edible products are responsible for the majority of health care visits due to cannabis intoxication, which is likely due to the failure of users to appreciate the delayed effects.”). 24. See Barrus et al., supra note 11, at 6; MacCoun & Mello, supra note 8, at 990; Jack Healy, New Scrutiny on Sweets with Ascent of Marijuana, N.Y. TIMES, Oct. 30, 2014, at A13. The same fundamental mistake—marketing marijuana products to minors—sank reform efforts in the 1970s. See EMILY DUFTON, GRASS ROOTS: THE RISE AND FALL AND RISE OF MARIJUANA IN AMERICA 75 (2017) (“the movement’s peak [in the 1970s] also brought with it the movement’s downfall. Much of the new paraphernalia for sale deliberately riffed on children’s toys, as smokers were offered everything from pot-themed Frisbees and board games to Christmas stockings. Even more troubling, children were quickly becoming the targets of paraphernalia marketing themselves. By 1978, newspapers were reporting that kids had easy access to head shops and were able to purchase pipes, papers, and bongs with no questions asked. The paraphernalia market that sprang up in the wake of decriminalization developed too quickly for government oversight and, with its interest in profits and giving the growing smoking population what it desired, it also chose not to regulate itself. In doing so, it set itself up for its own demise when a new generation of marijuana activists— parents angry at the rising rate of adolescent pot use—emerged in the wake of the paraphernalia boom. Once they made their power felt, it would be decades before decriminalization was spoken of positively in Washington again.”). 322 BUFFALO LAW REVIEW [Vol. 66 not occur before the state legalization efforts began: what to do about the open-and-obvious public commercial distribution of food containing an illegal substance that poses unique harms for minors. II. THE PROBLEM OF MARIJUANA USE BY MINORS Advocates for the liberalization of the marijuana laws argue that, because marijuana is no more harmful than alcohol, the government should treat the two drugs alike, allowing cannabis to be regulated and sold. Treating marijuana like alcohol during Prohibition not only deprives people of its benefits in the medicinal treatment of conditions like chemotherapy-induced nausea, epilepsy-induced seizures, and multiple sclerosis spasticity, but also leads to considerable social harms.25 A better approach, supporters 25. The most commonly cited therapeutic uses of cannabinoids are for the treatment of chemotherapy-induced nausea and emesis, AIDS-induced anorexia and cachexia (HIV/AIDS wasting), and the neuropathic pain and spasticity caused by multiple sclerosis. See, e.g., BRITISH MED’L ASS’N, THERAPEUTIC USES OF CANNABIS 21–49 (1997); NAT’L ACAD. REP., supra note 5, at 53–54 (listing conditions for which marijuana is a treatment for which there are varying degrees of scientific support); HUDAK, supra note 15, at 15, 22 (noting that cannabidiol, an ingredient of cannabis ingredient, has anticonvulsive and anti- inflammatory properties); JERROLD S. MEYER & LINDA F. QUENZER, PSYCHOPHARMACOLOGY: DRUGS, THE BRAIN, AND BEHAVIOR 410–11 (2d ed. 2018); Alan J. Budney et al., Cannabis, in LOWINSON AND RUIZ’S SUBSTANCE ABUSE: A COMPREHENSIVE TEXTBOOK 233 (Pedro Ruiz & Eric Strain eds., 5th ed. 2011); see also Marcus A. Bachhuber et al., Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010, 174 JAMA INTERNAL MED. 1668 (2014) (reporting that there were fewer opioid overdoses in states with medical marijuana laws); Wayne Hall & Louisa Degenhardt, Adverse Health Effects of Non-Medical Cannabis Use, 374 LANCET 1383, 1389 (2009) (“The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs.”); Gemayel Lee et al., Medical Cannabis for Neuropathic Pain, 22 CURRENT PAIN & HEADACHE REP. 8 (2018) (“Nearly 20 years of clinical data supports the short-term use of cannabis for the treatment of neuropathic pain.”); Philip McGuire et al., Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial, 175 AM. J. PSYCHIATRY 225 (2018); Madeline H. Meier et al., Associations between Cannabis Use and Physical Health Problems in Early Midlife: A Longitudinal Comparison of Persistent Cannabis versus Tobacco Users, 73 JAMA PSYCHIATRY 731 (2016); Theresa H.M. Moore et al., Cannabis Use and Risk of Psychotic or Affective Mental Health Outcomes: A Systematic Review, 370 LANCET 319 (2007);