As medical professionals who have worked closely with medical cannabis patients, we have seen time and time again the therapeutic benefits that cannabis can provide. We believe the legalization and regulation of cannabis in Hawaii is in the best interest of public health.

>> First, there are far more health-related problems associated with alcohol use than with cannabis use. Adults should not be punished for using a safer substance.

The chronic health effects of alcohol result in more than 100,000 deaths a year in the United States, according to Centers for Disease Control and Prevention data. Meanwhile, cannabis has not been shown to increase all-cause mortality. While alcohol causes more than 2,300 fatal overdoses per year, suspected fatal overdoses from cannabis products are vanishingly rare.

While no drug — including cannabis — is entirely harmless, cannabis is less toxic, less harmful to the body, less addictive and less likely to contribute to violent or reckless behavior than alcohol.

There are numerous barriers to registering in the medical cannabis program — including costs, fear of being on a government list, and a prohibition on Veterans Affairs doctors recommending cannabis.

Unsurprisingly, many “recreational” (adult-use) customers use cannabis as an over-the-counter medication. A survey of adult-use consumers found most use cannabis for sleep, pain relief or both. Most who had taken opioids or other pain medicines were able to reduce or eliminate their use.

The dangers of opioids are well known, and the long-term use of large amounts of over-the-counter painkillers also carries serious risks, from stomach bleeding to organ damage. For many, cannabis use offers the same or better relief than other medications without the toxicity.

>> Second, only in a legal, regulated market can measures be taken to protect consumers and the environment. Rules can be implemented to keep dangerous additives and pesticides out of cannabis products, to require lab testing, and to protect the environment. Legalization also allows regulators to mandate warnings about the health risks of cannabis.

>> Third, legalizing and regulating cannabis creates barriers to teens accessing the drug. Prohibition has failed miserably at keeping cannabis out of the hands of youth. And while prohibitionists try to stoke fears that legalizing cannabis will increase youth access to and consumption of cannabis, the data speaks otherwise.

In July 2021, the Journal of the American Medical Association published a report analyzing federal data from more than 1.4 million high school students. The researchers found the enactment of adult-use legalization laws was not associated with an increase in the use or frequency of cannabis in high school students. And a sting operation in Colorado found that 98.5% of buyers ages 18-20 were unable to buy cannabis in a legal dispensary.

Seventy percent of Americans support making cannabis legal, and they care just as much about protecting young people as those who wish to keep cannabis illegal. They simply understand that regulation would be a more effective way of doing it.

>> Fourth, taxes received from the sale of legal adult-use cannabis — tens of millions annually once the market matures — can be used for the betterment of public health, including drug prevention education, treatment and reinvestment in disproportionately impacted communities.

>> Finally, criminalizing cannabis hurts people in many ways, while sensible regulation protects them. Criminalization has torn families apart and marked tens of thousands of Hawaii residents, disproportionately Native Hawaiians, with criminal records that stand in the way of jobs, housing and other opportunities.

We urge the Legislature to legalize and regulate cannabis, and to do so with a foundational commitment equity and justice. Legalization should include robust expungement of past records and resentencing of prisoners, ample opportunities for equity in the industry and Native Hawaiian ownership. And it must avoid recriminalizing innocuous conduct such as by including unscientific per se laws that criminalize sober drivers.

Cannabis is widely available and commonly used, and it’s not going anywhere. Half of the U.S. population has access to legalized adult-use cannabis and none of these states are looking back. Cannabis production and distribution should be regulated and controlled, and the industry should be equitable and just. Let’s make 2024 the year Hawaii stops being islands of prohibition.

Dr. Bryon Adinoff is with Doctors for Drug Policy Reform; Wendy Gibson-Viviani is a nurse who was a member of the state’s Dual Use of Cannabis Task Force.