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Of course, no one should blame the Boomers. They just happened to be the largest group to challenge the political and medical communities’ view that marijuana (aka cannabis) was a dangerous drug and its use should continue to be a crime. The establishment ignores the facts. In many countries around the world, marijuana is considered a medicine and routinely used both for inhaling and as an infusion for drinking. But what they do in other countries should have no bearing on what happens in the US. Libertarian arguments that all drug-taking is victimless has also never really taken off. The cost of lost production forces us to pay higher prices for goods and services. The cost of hospital treatment for drug abuse means every taxpayer is a victim. So the Republican “tough on crime” policies have always favored the use of the criminal law to penalize those who abuse drugs.

Yet, looking around the US today sees a different landscape. Fourteen states have passed laws allowing the use of marijuana for medicinal purposes. Leading the way, as always, California has a proposition in the November midterms to legalize marijuana outright. What has happened to produce such a revolution? There are two answers. The first has been a general toning down of the rhetoric in favor of scientific debate. When marijuana was first criminalized back in the 1930s, the medical profession stood together and denounced the drug as a tool of the Devil, tempting people into sin and depravity. Today sees a significant number of doctors singing a different tune. First, a gesture to the traditional group: there is no doubt that smoking marijuana can and does cause lung cancer and, over time, there is evidence suggesting loss of memory and some brain damage. But there is also an impressive body of international evidence proving marijuana highly effective in giving pain relief. The use has to build up over at least six months. Once a stable concentration is achieved in the blood stream, it relieves chronic pain from arthritis, fibromyalgia, multiple sclerosis and cancers.

The second justification is fiscal. The sale of medical marijuana already makes a significant contribution to state funds through the tax system. In a recession, all contributions are gratefully received. If the outright legalization goes through in California, it is estimated the annual tax take will rise from about $200 million to $1.5 billion. It will also lead to a better system of regulation so that, like alcohol, its distribution can be controlled. None of this changes the need for “conventional” drugs to relieve pain. Tramadol in its different forms will remain the first response to moderate to severe pain. But in chronic cases, the continuing use of any drug can lead to dependence and the debate shifts. Which of the drugs is better when use may be indicated for years? In the fourteen states with Illinois perhaps about to join them, the option of marijuana rather than tramadol is there to be freely made. Legalization has undermined the criminal gangs and reduced prices. The quality of the product is also guaranteed whereas, on the street, marijuana can be cut with many strange and sometimes dangerous substances. This is the practical reality on the ground and there is no point in trying to turn the clock back. Pain management in these states now includes marijuana. For those who disapprove, tramadol and the other traditional drugs remain available.

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