The most efficient way to minimize marijuana use would be to use funds from taxes on marijuana sales to implement a marijuana prevention and control program, modeled on the successful California Tobacco Control Program , under the administration of the California Department of Public Health. The key to the success of the CTCP has been that it is a broad-based campaign focused on reinforcing the nonsmoking norm aimed at the population as a whole – not just smokers or youth, for each element of the program, including the statewide hard hitting, evidence-based media campaign. Indeed, by focusing on adults through its comprehensive tobacco control program, California has achieved one of the lowest youth smoking rates in the country. Similar to the CTCP, an effective marijuana prevention and control program would implement social norm change strategies including: 1) Countering pro-marijuana influences in the community; 2) Reducing exposure to secondhand marijuana smoke and aerosol, marijuana smoke and aerosol residue, marijuana waste, and other marijuana products ; 3) Reducing availability of marijuana and marijuana products; and 4) Promoting and supporting services that help marijuana users quit. There would be a state-level administrative office housed in the Department of Public Health with separate funding, dedicated to the primary purpose of preventing and reducing marijuana use and protecting the public from secondhand smoke exposure. Funding would be earmarked in the initiative and be protected from diversion by the Legislature or Governor. Chapter 10 If modeled on the CTCP, a marijuana prevention and control program would allocate funding to local health departments and, cannabis grow racks on a competitive basis, to community-based organizations to create marijuana prevention and control coalitions, and to coordinate efforts with schools.

The marijuana prevention and control program would mount an ongoing statewide media campaign, and would provide continuous training and technical assistance to local marijuana prevention and control programs, in large part through the competitive statewide grantees. The marijuana tax would provide an ongoing annual revenue stream to support implementation of a statewide media campaign that would consist of paid radio, television, billboard, internet and social media, and print adverThising. The media campaign would include public relations campaigns for general market and population-specific communities, including various ethnic populations, young adult, and Lesbian Gay Bisexual Transgender communities. The media campaign would frame the messages and inform the public on the harms of marijuana use and secondhand exposure, expose and publicize predatory marketing by the marijuana industry, and encourage quitting through a cessation helpline. The CTCP statewide campaign aimed at the general population has reduced smoking and provided billions of dollars in healthcare savings for Californians, both as individuals and as taxpayers. It is reasonable to hypothesize that a marijuana prevention and control program based on the CTCP would have similar effectiveness and financial benefits. The CTCP was most effective in its early years when it was larger, Chapter 10 and before inflation eroded its purchasing power. Based on the experience of the CTCP, an annual budget of $340 million would be adequate and would allow for mounting an effective campaign to counter the adverse public health impact of the new marijuana industry.The AUMA initiative imposes a cultivation and retail sales tax on marijuana and marijuana products. The cultivation tax will be for marijuana flower: $9.25 per dry weight ounce and for marijuana leaves: $2.75 per dry weight ounce. The retail sales tax will be an ad valorem tax of 15% of the total sale. The Board of Equalization will have the authority to adjust the tax rate for marijuana leaves annually to reflect changes in the price of marijuana flowers and will have the authority to adjust the cultivation and retail sales tax for inflation .

After money is dispersed to the regulatory agencies to cover administrative costs, the marijuana tax will be used to support youth substance abuse and prevention programs, economic development, medical marijuana research, and to research the implementation and effect of AUMA. Marijuana tax will also be dedicated to the California Highway Patrol for enforcement and to develop standards and programs, including field sobriety testing protocols, and to environmental restoration and protection . The AUMA initiative states that retail marijuana sales will “generate hundreds of millions of dollars annually”7 to cover the costs of administrating the new law and will provide funds for programs designed to educate and treat substance use disorders in youth. Most of the first money, however, is allocated to programs that prioritize marijuana businesses rather than to programs that would prevent marijuana use and reduce consumption, likely increasing the external costs associated with marijuana legalization, such as increased healthcare spending . The program that receives the most funding is the Governor’s Office of Business and Economic Development that will reach $50 million in 2023 to invest in economic development and job placement for communities affected by “past federal and state drug policies.” The initiative provides $2 million annually to the University of California, San Diego Center for Medicinal Cannabis Research to conduct research on the benefits and adverse effects of marijuana as a pharmacological agent. Other research priorities that will be conducted by universities in California are discussed below and do not prioritize funding marijuana-related disease research as a basis for future policy. The AUMA initiative provides $3 million for five years to the California Highway Patrol and law enforcement to develop standards and programs, including field sobriety testing protocols. Given the lack of accurate and reliable chemical tests to determine marijuana impairment, five years might not be sufficient to develop methods to determine marijuana impairment while driving. In Colorado, in which retail sale of marijuana became legal in 2014, regulators are still trying to determine the best way to detect marijuana impairment while driving.

While this is an important provision that should be addressed, a more effective approach would be to earmark marijuana tax revenue to a comprehensive marijuana prevention and control program aimed at the general population. Such program would have the effect of preventing marijuana initiation and heavy consumption that would be associated with increased marijuana-related traffic accidents and fatalities. Earmarked funds to support comprehensive prevention and control programs over time, which are not included in the initiative, will be critical to reduce marijuana prevalence, marijuana-related diseases, and costs arising from marijuana use. A public health framework for legalized marijuana would require that the marijuana tax be at least budget neutral, so as to cover the costs of legalizing marijuana, including marijuana prevention and education, marijuana related disease research and education, as well as the costs of managing the business aspects of the new marijuana market. The marijuana tax would also need to be high enough to cover health related costs as a result of increased marijuana use . Additional tax increases would be permitted if doing so was determined to be appropriate as a way of reducing marijuana initiation and promoting cessation, as a general revenue source, or both. While an ad valorem tax is simple to implement, cannabis drying racks there is no guarantee that it would cover the costs associated with legalizing marijuana in California. In particular, as market prices fall, the revenues generated from the marijuana tax will also fall. As evidenced by the Colorado experience, greater supply likely will drive down the price of marijuana and marijuana products in California. There is also a danger of price manipulation by the marijuana industry. In Colorado, price manipulation has been an issue, in which retailers are increasingly lowering prices to compete with other marijuana retail outlets. The existence of an illicit untaxed market complicates tax policy making due to concerns that if the marijuana tax is too high it would drive consumers to the illicit market. A comprehensive demand reduction program would probably reduce this problem. If marijuana-related costs follow the same trajectory as tobacco, then it is likely that the tax will not generate enough revenue to cover administrative costs and healthcare costs to California taxpayers. While the costs of treating marijuana-induced illness is unknown, in 2009, the healthcare costs of smoking in California was $18.1 billion, 156 an amount that would have been much higher without California’s comprehensive tobacco control program. For an ad valorem tax to be large enough to cover total costs, it would need to be increased as costs go up, which, if marijuana use increases, are likely to grow faster than inflation. The fiscal impact estimate reports of the California Legislative Analyst’s Office of the two initiatives do not include the economic impact of a retail marijuana market on increasing health care costs for California government or the state as a whole. The AUMA initiative is strong in that it will prohibit marijuana use wherever smoking or e-cigarette use is prohibited by state or local laws, and grants authority to local governments to adopt smoke free laws stronger than the state. Because the 1995 California statewide smoke free law contained exemptions, marijuana use will be permitted in 65% of hotel/motel guestrooms, banquet facilities and meeting rooms, small businesses , designated break rooms, private smoker lounges, warehouses, taxis, long-term health care facilities, and in multi-unit housing, unless these venues are covered under local laws stronger than the state law.

The AUMA initiative also creates a problematic loophole that will allow local governments to permit marijuana use in licensed facilities that admit only adults 21 years and older, are not visible to the public, and do not sell tobacco or alcohol. It will also permit smoking in private residences in the 1,000-foot buffer zone “only if such smoking is not detectable by others,” which is an unenforceable measure. They also have the beneficial side effect of decreasing the normalization of tobacco use, and supporting smoking cessation. To accomplish these goals for legalized marijuana, a public health framework would prohibit consumption anywhere combustible tobacco product consumption is prohibited under local and state smoke free laws. Local governments would not be preempted from adopting stronger regulations than the state, and local and state smoke free laws would not contain exemptions for indoor use in hospitality venues, marijuana retail stores, and marijuana clubs. Both initiatives grant local governments authority to permit marijuana smoking inside marijuana retail stores or marijuana clubs. This provision ignores an important lesson from tobacco control that smoke free bars are particularly effective at protecting workers from secondhand smoke exposure and at denormalizing smoking. For example, employees working in bars and nightclubs with higher ambient nicotine concentrations have higher levels of nicotine exposure regardless of own smoking status. If local governments implement laws that would permit marijuana smoking inside marijuana stores or clubs, it will likely negatively impact the working class poor, immigrants, and individuals from communities of color, and will contribute to health disparities. Lower socioeconomic status individuals are more likely to work in establishments that do not have 100% smoke free coverage or circumvent the law through exemptions . In California, for example, exemptions in the statewide smoke free law disproportionately expose low income workers, Latinos, and young adults to secondhand tobacco smoke in the workplace, thereby contributing to health disparities. In addition, women may be disproportionately impacted by permitting marijuana smoking in hospitality venues because women are over represented in the hospitality industry. This potential loophole also ignores the fact that exemptions in smoke free laws are difficult to amend once the law has been passed. For example, over the last twenty years, the State of California has failed to close important loopholes in the state smoke free law despite attempts from legislators. This situation highlights the importance of enacting effective measures initially to prevent unnecessary secondhand exposure to the public. In addition, these exemptions will likely promote consumption and other risky behavior, such as driving while under the influence of marijuana. While allowing for such on-site consumption at marijuana businesses or clubs is based on the view that it will allow for adults to use marijuana in a responsible way, such social use away from home not only creates a risk of increasing overall use but also facilitates marijuana consumption prior to driving home while still under its influence. The reality is that similar to bars failing to promote socially responsible alcohol consumption, marijuana retailers with the financial incentive to promote over consumption will replicate this behavior with marijuana.