big tobacco, corporations

The Irony of Trump’s Tea Party Following

Oh the irony! In a May 5, 2016 article featured in Politico, the corporate elite declared that they will not open their checkbooks for Trump, and for good reason. Koch Brothers, among other mega donors, are turned off by Trump’s aggressive campaign strategy which includes mudslinging and personally attacking his opponents on social media.

The irony of the situation is that the Koch Brothers worked with the tobacco industry to create an anti-government movement, which now is largely the support base of the Trump presidential campaign. You may have heard of it, it’s the Tea Party (see Amanda Fallin-Bennett paper To quarterback behind the scenes, third-party efforts’: the tobacco industry and the Tea Party, and the book Poison Tea by Jeff Nesbit for further information). The billionaires and their political puppets (Rubio and Cruz) that helped manifest the Tea Party through third party efforts and corporate-funded front groups, no longer have control over how party loyalists vote or who they support.

Many of Trump’s supporters identify as Tea Party loyalists because of his xenophobic speeches and campaign promises that he will force other nations to pay their fair share of tariffs to the US.

Not that this should come to anyone’s surprise as Trump is not trained in international political economy or political theory, but he has no idea what he is talking about when he makes claims on balancing the terms of trade through protectionist economic policies and high tariffs. One has to question: what countries is he actually talking about anyway? It cannot be the former colonies.

High tariffs will not solve the US’s problem of widespread inequality. In Raul Prebisch’s theory on declining terms of trade, he divides the world into two, the North, consisting of colonial powers and the imperialist USA, and the Global South, which includes former colonies and Latin America (note: I prefer other terms than these but they are the ones used in international political economy).

Prebisch’s argument states that although independent, in the international economic system, the former colonies entered into an agreement with their colonizers and the imperialist power, the United States, with a distinct disadvantage given that the declining terms of trade, which increases over time and leads to higher rates of poverty. Former colonies produce raw materials or primary goods, which has a value in the global market far less than manufactured goods and international financial services (United States’ primary export, which increasingly has replaced the production of manufactured goods and the working-class jobs that manufacturing industries supplied, and is arguably a cause, among many, of growing inequality). This situation prevents the former colonies from developing economically in a way that would be competitive in the international system, both economically and politically speaking. International institutions such as the International Monetary Fund and the World Bank are controlled by the US and European countries because they are able to pay more into them, thus granting them more decision-making power.

Although Latin America has been “free” from colonial rule since the early 19th century, the region was not truly granted independence   As Saccarelli and Varadarajan state in their book Imperialism: Past, Present and Future:

“[Latin American countries] had become intimately acquainted with the notion that the end of colonial rule did not necessarily spell genuine independence.”  

Interventions to redistribute wealth through protectionist policies is another subject of debate and outside the realm of this blog post. For more information, read Prebisch’s thesis on import-substitution industrialization as a solution, and how ISI policies failed because of political corruption which redistributed wealth to the national bourgeoisie rather than advance economic development.

 Another ironic point, which I alluded to in previous paragraphs, is that the anti-BIG government “Tea Party” movement has been framed in a way that blamed the federal government for economic inequality, rather than the corporate elite, who let’s face it, has a goal to increase their wealth through policies and tax structures that ultimately concentrate wealth in the hands of the few. Economic insecurity and job loss is a result of globalization and so-called “ultra market fundamentalism”, in which corporations have been offshoring what was left of the few blue collar jobs in the US for decades. To reduce labors costs, MNCs export jobs to low income countries with the overall goal to increase profits and satisfy shareholders.

It will be interesting to see if the Koch Brothers support Hillary Clinton so as to avoid Trump in the Oval Office.

Voters, including those that support the so-called anti-government candidates, who use such rhetoric to advance an agenda for corporate welfare policies to benefit the rich off of the backs of the middle class, need to understand the role that the Koch Brothers played in creating and funding the Tea Party movement. Their goal was to deflect attraction away from a larger business strategy to become two of the most wealthiest people in the world through privatization of social programs, corporate tax cuts, and deregulation (aka the Washington Consensus) and to spread economic inequality both domestically and worldwide.



Marijuana legalization initiative in California receives a leg up from venture capitalists


In 1970 the federal government passed the Control Substances Act, which made Cannabis (marijuana) a Schedule I substance with zero medical use and high potential for abuse. Over the next 40 years a grassroots effort to legalize marijuana for medical use, and then retail sale in 2014, has developed. By 2016, however, the grassroots campaign led by medical patients, small-scale marijuana dispensary owners, and social justice advocates had quickly turned into a big money campaign, with entrepreneurs and venture capitalists partnering with social justice groups and private philanthropy foundations to support the effort to legalize retail marijuana in California.

The Control, Regulate and Tax Adult Use of Marijuana Act (the AUMA initiative) filed on November 3, 2015, is financially backed by Sean Parker, co-founder of Napster and former president of Facebook. Lt. Governor Gavin Newsom has publicly endorsed the AUMA initiative, calling it a “thoughtful measure” that aligned with the July 2015 recommendations of Newsom’s Blue Ribbon Commission on Marijuana Policy. Other groups that endorsed the AUMA initiative include drug reform groups, Drug Policy Alliance and Marijuana Policy Project.

As of May 2016, entrepreneur Nicholas Pritzker and private firm,  WeedMaps, had contributed large sums of money to fund the ballot initiative proponents’ efforts. Table I lists the political contributions that, so far, have been made to the AUMA initiative campaign, along with a description of the political action committees and donors.

A February 2016 article printed in SF Weekly questions why Sean Parker et. al would invest so heavily in marijuana. As of May 2016, Parker has yet to respond but one could predict that he is seeing green…$$ signs. He is after all a self-proclaimed entrepreneur and venture capitalist who made billions off of the tech industry in Silicon Valley. Adding Pritzker to the cast of characters investing in the legalization campaign in California is no surprise. In 2016, financial analysts at ArcView predicted that marijuana would be the fastest growing US industry, with retail sales rapidly growing from $374 million in 2014 to $12 billion in 2020.

In February 2016, I along with Stanton Glantz at UCSF, conducted a public health analysis  of the AUMA initiative to determine whether or not it would prevent corporate capture of the marijuana market in California. The short answer is no it will not.

The additional financial backing from wealthy entrepreneurs and marijuana companies to ensure that the initiative receives the necessary 365,880 signatures by July 5, 2016, already having received 25% of the signatures by February 2016, to qualify for the statewide ballot in November 2016 only provides further evidence to support our thesis. In order to prevent a public health disaster with marijuana, it is important to launch a demand reduction program modeled on evidence-based tobacco control programs concurrently with legalization. Without such model, we will likely see the growth of another large industry, with the financial incentive to manipulate consumer consent and regulatory frameworks, and that will quickly expand into new markets in the US and worldwide.

If the initiative proponents are serious about preventing the next Big Marijuana, it is important that they rewrite the initiative using a public health rather than business framework (in our detailed analysis we provide recommendations to strengthen the AUMA initiative beginning on page 38). Otherwise California voters that support public health should vote against any legalization initiative that does not prioritize public health over profits at the November 2016 statewide election.

Political Contributions to the AUMA Initiative Campaign Between January 1-April 18, 2016
Contributor Amount Description
Sean Parker and Affiliated Entities $1,001,000 Political Action Committee funding the AUMA initiative
Nicholas Pritzker $250,000 Heir to Hyatt Hotels and private investor in technology and alternative energy companies
New Approach PAC $750,000 Political Action Committee funding the AUMA initiative. Between 2014-2016 received funding (source 1; source 2) from private philanthropy foundations: Good Ventures ($2,000,000), Van Ameringen Foundation ($517,000), DKT Liberty Project ($350,000), Riverstyx Foundation  ($50,000) and venture capitalists: Jonathan Lewis and Associates, son of the late pro-marijuana advocate Peter Lewis of Progressive Insurance ($100,000) and Privateer Holdings ($50,000), a private investment firm for marijuana. By 2016, the firm had acquired Leafly, Tilray, and Marley Natural.
Californians for Sensible Reform (WeedMaps) $750,000 A front group created in 2013 by Ghost Management Group, a venture capital firm that specializes in the emerging marijuana industry. Californians for Sensible Reform receives funding from WeedMaps, a start-up company that specializes in assisting consumers in finding deals and nearby marijuana dispensaries through a mobile app.
Drug Policy Action $500,000 A 501(c)(4) organization and political arm of Drug Policy Alliance, lead drug reform group working to legalize marijuana in California and nationwide.
California Democratic Party $1,500 In 2016 announced its support for the AUMA initiative and “the legalization, regulation and taxation of marijuana, in a manner similar to that of tobacco or alcohol.”
Total $3,252,500
Source: California Secretary of State

Lt. Governor Gavin Newsom’s Vague Response to UCSF Public Health Analysis of Marijuana Legalization Initiatives

The Sacramento Bee posted a video of its February 11, 2016 meeting with Lt. Governor Gavin Newsom on his support for the Adult Use of Marijuana Act marijuana legalization initiative.

In that interview Newsom dismissed the public health analysis of the two leading marijuana legalization initiatives I released  with Dr. Stanton Glantz the week before, on February 2, 2016. Here is a link to the UCSF press release that provides an excellent summary of the key points of the analysis.

Below I have responded to the Gavin Newsom interview in the following blog post.

In the interview Newsom states:

“Regulation is not a one day event on an election day in November. It is a dynamic process that unfolds over many years”

In response to that comment, the Bee’s Editorial board inquired:

“If you know that they [corporate players] are coming, why not put the kybosh on it now?”

Newsom’s response was vague.

“We can only do so much and what we want is flexibility.”

Newsom continued to denounce our work and challenged our credibility as public health authorities in tobacco control, arguing that our analysis contained several “profound mistakes.” Newsom recommended that the media and the public read the seven page response to the analysis that we were sent on the Saturday before the analysis was to be released to the public.

These criticisms were based on a draft copy of the report that I sent for feedback to authors of the Adult Use of Marijuana Act initiative on January 6, three weeks prior to publication of the final report.

Stanton Glantz and I spent the weekend reviewing the critique and, to be sure that we carefully addressed every detail, prepared a comprehensive response to the law firm of Olson, Hagel, and Fishburn, which represents the advocates for the Adult Use of Marijuana Act initiative.  As part of this effort, we asked several lawyers who are experts in tobacco and alcohol legalese to review our responses and ensure that we were not misunderstanding the initiative or its provisions. Ultimately, we changed a few words and minor technicalities in the final report, but the overall conclusions of the analysis remained the same.

Bottom line is that these initiatives prioritize creating a new market and new industry, that could easily and rapidly resemble the tobacco industry, over protecting public health.

In the interview Newsom stated that California does not want to be overly prescriptive to avoid the problems that Colorado, Washington, and Oregon (which has not implemented its regulations or opened its market yet) are facing without describing what those problems are or what the AUMA initiative would do to avoid these problems. After saying that, he went on to state:

“We have some very prescriptive provisions at least for the first five years. And the idea behind that is to get smaller players a head start so that they have the ability to develop their businesses…at least we would have five years. The critique I think that it should have been 20 years, which is equally arbitrary, 20, 5, 10 years and whatever. But we feel five years would give us time to develop even stronger parameters.”

Note the words “develop their businesses” while the words “protecting public health” are absent.

The five year provision that Newsom is referring to is one that would prevent the Department of Consumer Affairs from issuing large-scale cultivation licenses for the first five years of the legal marijuana market. In our analysis, we do not include a specific recommendation on how many years this provision should have been, but rather state that this provision will likely do little to prevent corporate capture of the market.

Rather, we stress the importance of creating simultaneously with legalization a comprehensive marijuana prevention and control program modeled on the California Tobacco Control Program as an important safeguard to protect the public from the predatory marketing and lobbying practices of the forthcoming marijuana industry.

Newsom also argued that the initiative contained very prescriptive provisions regarding marketing, packaging, and “youth” prevention and family education programs for which the authors of AUMA did not get credit.

We considered that these provisions were included in the initiative.

In fact, our analysis of these provisions was far more nuanced than Newsom credited. Using evidence-based research from tobacco and alcohol control, we concluded that these provisions will likely have little to no effect on preventing youth initiation, protecting the general public, and containing the lobbying and economic power of the emerging marijuana industry.

One of the most ironic comments Newsom made at the end of the interview was:

“[Marijuana] is a vice but it’s also medicinal, and that’s what distinguishes it from tobacco…That said this is a terrible drug for our kids.”

Why is protecting the general public not an important priority?

Legalization advocates, politicians, and California voters need to consider why Newsom and the authors of the AUMA initiative are so quick to legalize marijuana, given that in its current form this initiative fails to include several lessons from tobacco and alcohol control to proactively create a legal and social environment that would protect, rather than harm, public health. In particular, the initiative:

  • Fails to include a marijuana prevention and control program modeled on the California Tobacco Control Program;
  • Several marijuana industry representatives will sit on marijuana advisory boards and guide regulations and implementation of the new laws;
  • Funding for marijuana research will end ten years after marijuana is legalized and marijuana-related disease research is not a priority; and
  • Marketing and advertising restrictions are weak and based on ineffective alcohol regulations that have not prevented alcohol initiation in youth and overconsumption in the general population.

California voters should consider that there are likely underlying political and economic motives behind the move to quickly legalize marijuana in California in November 2016.

The more appropriate thing to do would be for the authors of the AUMA initiative, among others involved in legalizing retail marijuana, to withdraw and resubmit new initiatives that would truly prioritize public health over creating a new business. If this faction refuses to do this, then California voters should vote against any legalization initiative that does not contain the recommendations in our public health analysis (starting on page 38) as a clear message that California voters want marijuana legalization done right, through a pro-public health framework.


Public Health Analysis of Marijuana Legalization Initiatives

On February 2, 2016 I along with Stanton Glantz published a report entitled: “A Public Health Analysis of Two Proposed Marijuana Legalization Initiatives for the 2016 California Ballot: Creating the New Tobacco Industry.” In our analysis, we considered the public health impacts of two recent ballot proposals to legalize marijuana in the State of California, the Adult Use of Marijuana Act and the Marijuana Legalization Initiative Statute. This analysis evaluated whether or not these initiatives would create a new industry akin to the tobacco or alcohol industries. Rather than arguing for or against marijuana legalization, our analysis considered that if we accept marijuana legalization as forthcoming, how can we use the history and invaluable lessons from overcoming powerful industries, like the tobacco or alcohol industries, to proactively create a legal and social environment that would protect, rather than harm, public health?

Broadly the analysis was based on five overarching themes:

“Marijuana legalization through a pro-public health framework is an appropriate response to the social inequities and large public costs of a failed War on Drugs.

There is an opportunity to legalize marijuana in a way that would address and prevent the emerging and future public health problems associated with marijuana use (e.g., youth initiation, indoor use, social normalization, and health disparities) by implementing a strong public health-focused regulatory system.

Left unchecked, a wealthy and politically powerful marijuana industry, which is even larger than the existing medical marijuana industry, will rapidly appear and eventually resemble (and may become a subsidiary of) the tobacco industry.

Legalization will make it easier for this new industry to exercise political power to block effective regulation, and marijuana prevention and control.

The California Tobacco Control Program should be used as an operative model because it has effectively countered the tobacco industry and substantially reduced use and associated health costs of tobacco without making it illegal.”

Up until this analysis was published, the debate surrounding marijuana legalization was centered on two primary opposing views. On one side there were those that oppose legalizing marijuana because it would lead to commercialization of another substance that could adversely impact public health. Those that fall into this camp argue rather for decriminalization of marijuana possession laws and that the state should concentrate criminalization penalties on drug traffickers rather than individual users.

The other side argues that marijuana prohibition has been a huge public policy failure, and that marijuana legalization in a regulated commercial market will have a positive social and economic impact on the public. Those that fall into this broad category of legalizing marijuana and regulating it like alcohol, argue that marijuana legalization will address social justice and public safety issues, while at the same time create new opportunities for economic growth and increased revenue for the state general fund.

Neither of these two camps consider that regulating marijuana through a pro-public health framework, rather than a pro-business framework modeled on alcohol regulations, can address social justice issues while at the same time prevent the growth of another large industry. Without such controls, for example, a comprehensive marijuana prevention and control program and dedicated funds for continuous marijuana-related disease research, another industry will likely develop that would take advantage of the public through marketing and lobbying tactics aimed at undermining regulations designed to protect the public health.

Because the legal market is in its early stages of development, there may be an opportunity for other states to shape regulations that favor public health over profits. This analysis provides a pathway to achieve that goal.

That is if the public, including marijuana legalization advocates, government officials, and health advocacy organizations, choose to read and consider their recommendations which can be found on pages 38-43 of the analysis.










California’s Proposed Marijuana Legalization Initiatives for 2016

Retail marijuana is a topic of significant interest in the United States given that four states have legalized its sale and several ballot initiatives will likely be proposed for the presidential election in November 2016. There are myriad factors that influence voting patterns such as the type of election years. According to the National Census Bureau:

“Voting rates are historically higher in years with presidential elections than in congressional election years. For example the national voting rate in 2012 -a Presidential election- was 61.8 percent while the national voting rate in 2010 -a Congressional election- was 45.5 percent”

In 2012, 42% of Californian 18-24 year olds voted compared to 2010 where only 25% of Californian’s young adults participated in the election. And 2014 was even worse with 15.9 percent of 18-to 24-year olds having voted, a percentage rate that was not statistically different from the national average. Young people also care about social issues more than economic issues (which tend to appeal to the interests of older voters). Remember 2008 when the United States was voting to elect its first African American president and California was also voting to legalize same sex marriage? A record 51% of 18-24 year olds voted in that election, which was the highest percentage of voter turnout among young adults between years 1996 and 2014. Social issues matter to young people and so will marijuana legalization, especially if it is framed as a social justice issue.

Ok enough numbers, let’s talk campaigns and initiatives.

There are seven different campaign committees that have submitted official language to the California Office of the Attorney General. Of these seven campaigns, there are a total of twelve initiatives to regulate and tax retail sales of marijuana, one is five different versions coming from the same campaign group.

Marijuana Legalization Proposed Initiatives for 2016 in California
Name Organizers Initiative Number
Marijuana Control, Legalization and Revenue Act Version 1 Americans for Policy Reform 15-0020
Marijuana Control, Legalization and Revenue Act Version 2 Americans for Policy Reform 15-0039
Marijuana Control, Legalization and Revenue Act Version 3 Americans for Policy Reform 15-0085
Marijuana Control, Legalization and Revenue Act Version 4 Americans for Policy Reform 15-0086
Marijuana Control, Legalization and Revenue Act Version 5 Americans for Policy Reform 15-0087
Cannabis Legalization Act of 2016 CA Cannabis Unity Campaign 15-0058
California Craft Cannabis Initiative Omar Figueroa and Heather L. Burke 15-0017
Community Restoration Act of 2016 to Regulate, Control, and Tax Cannabis Alice Hoffman of the CA NAACP 15-0038
The Control, Regulate and Tax Cannabis Act of 2016 Coalition for Cannabis Policy Reform (ReformCA) 15-0075
Cannabis Hemp and Marijuana Legalization California Cannabis Hemp Initiative 15-0050
The Safe Communities, Parks, and Schools Act of 2016 (Formerly the Responsible Use Act of 2016 15-0024) Californian’s for Safer Communities 15-0052

Who are the groups?

  1. Americans for Policy Reform is a campaign committee that proposed the “Marijuana Control, Legalization and Revenue Act of 2016” an open source document that allows California’s citizens to provide recommendations on how marijuana should be regulated and taxed.


2. California Cannabis Unity Campaign is “dedicated to legalizing cannabis in 2016 for adult, medical, and industrial use” with the message that marijuana prohibition is a “Human Rights Issue”.  A link on their website for more information on marijuana prohibition sends the viewer to NORML’s website.


3. California Craft Cannabis Initiative is “a proposed initiative to re-legalize and regulate adult-use cannabis in California in 2016. ​ Purposed to re-establish California as a world leader in the cannabis movement.” This initiative is being led by Omar Figueroa and Heather L. Burke, two constitutional and criminal defense attorneys whose goal is to place a strong initiative (not competing initiatives) on the ballot to increase the likelihood of passage. In April 2015, Figueroa and Burke stated that they were collaborating with Americans for Policy reform, authors of the Marijuana Control, Legalization and Revenue Act of 2016, which is likely why they are not seeking contributions on their website at this time and only ask for voters to contribute to the policy discussion.

4. California National Association for the Advancement of Colored People (NAACP) does not need an introduction. NAACP’s initiative was filed by CA Board Member Alice Huffman on the basis that the war on drugs has failed to penalize organized crime and rather has targeted communities of color, resulting in criminal records, mass incarceration and financial penalties not imposed on affluent white communities.

5. California Cannabis Hemp Initiative of 2016 is ran by Buddy Duzy, the campaign coordinator, who wants to end hemp prohibition. This initiative aims to “decriminalize cannabis hemp and create and fund new cannabis hemp based industries”. The CCHI had received funding from the California Cannabis Coalition but the primary donor stopped funding the initiative in February 2015 after the CCHI failed to follow through with agreed upon commitments.


6.  Californians for Safer Communities is a “grassroots effort to effectively reform California’s marijuana laws by promoting a level playing field for consumers and small businesses, while also emphasizing the importance of public safety within our communities.” This campaign originally started off as the Grow Up California campaign, led by Marinda and Chad Hanes, to pass an initiative known as the “Responsible Use Act of 2016”. Californians for Safer Communities now is leading the effort for its initiative “The Safe Communities, Parks, and Schools Act of 2016.”


7. Coalition for Cannabis Policy Reform (ReformCA) is the organization that led the failed California Proposition 19 campaign in 2010. This Coalition is led by Dale Sky Jones based in Oakland, California. Of all the marijuana policy reform groups that have placed initiatives on the ballot, Coalition for Cannabis Policy Reform is expected to be the largest, best-funded organization. If all other reform groups can have their needs met in the Coalition for Cannabis Policy Reform initiative, it is likely that these other factions will not continue campaigning their individual ballot initiatives. Oh and guess what? ReformCA hired law firm Manatt, Phelps and Phillips to run their campaign and draft the initiative language. This law firm also represents cigarette company Philip Morris.


The Californians for Safer Communities created an initiative comparison table that provides the highlights, positives, and negatives of each proposed initiative.

Below I provide a comparison of the various initiatives to what was recommended by TEROC in July 2015 to the Lt. Governor’s Blue Ribbon Commission. These twelve initiatives fail to even meet half of what TEROC recommended, not surprising as these groups represent commercial interests rather than public health.

Comparison of Statewide Ballot Initiatives for Retail Marijuana in California to TEROC Recommendations

Comparison of Statewide Ballot Initiatives for Retail Marijuana in California to TEROC Recommendations

So far the American Civil Liberties Union, Drug Policy Alliance, and the Marijuana Policy Project have not submitted language to the Office of the Attorney General for a proposed ballot initiative. Part of the reason could be that their champion, Lt. Governor Gavin Newsom, has shifted focus to gun reform rather than marijuana legalization. The gun control initiative will keep:

Newsom “so busy he will have little time to get deeply involved with the [marijuana] initiative.”

Nevertheless, the ACLU and DPA are still deeply committed to marijuana policy reform and may still pursue marijuana legalization in California, especially given that there may be other wealthy donors that want to see the right initiative pass. Kaufman and Olson Hagel & Fishburn have been hired by Sean Parker, former Facebook president, to run a legalization campaign. The Drug Policy Alliance was originally involved in that campaign but there was a falling out after some disagreement on the draft initiative’s language. But DPA does have a national agenda to reform marijuana laws and may negotiate with the Parker campaign in order to make that happen. I will update this blog as soon as the Parker initiative has been filed, stay tuned.

As always, there is still time to influence the language of the draft initiative that may come from the Parker campaign.


The Difference Between Advocacy and Proactively Shaping the Outcome of Policy…it’s HUGE

The legalization and commercialization of marijuana is increasingly becoming a significant topic of public discourse in the United States, Latin America, and Europe. Senator Bernie Sanders in his bid for the Democratic nomination for president pledges to remove marijuana from the list of Schedule I drugs. According to the 1970 Controlled Substances Act, marijuana is listed as a Schedule I drug with zero medical use and high potential for abuse. It has even become part of internal policy discussions within programs of the United Nations. In October 2015, a draft document from the United Nations Office on Drugs and Crime, the UNODC called for the decriminalization of drug use and possession of personal consumption. The document was leaked by none other than Richard Bronson, CEO of LinkedIn and one of five prominent business leaders that support legalizing marijuana in the United States.

There are several different motivations behind the move to legalize marijuana including combating drug trafficking particularly in Latin America, addressing the social injustice of the ‘war on drugs’, normalizing a substance that is perceived as less harmful than other legal drugs (i.e. tobacco and alcohol), and of course profit.

With several (Example 1, Example 2, Example 3, Example 4, Example 5, Example 6, Example 7) ballot initiatives already submitted to the California Attorney General’s Office, marijuana legalization is at the forefront of several internal debates among public health officials, school boards, the marijuana industry, venture capitalists, and policymakers, all of which have competing interests. This past week I attended and presented at the Tobacco Control, Research and Education Joining Forces to Address New Challenges Joint Conference (no pun intended) hosted by the California Tobacco Control Program, the Tobacco Related Disease Research Program, and the Tobacco Use Prevention Education Program. Every keynote speech, plenary talk, and breakout session, even my own entitled “Building it Better: Marijuana Policy and Lessons from Big Tobacco”, addressed in some way or another the issue of marijuana legalization and its impact on tobacco control. Other challenges included e-cigarettes and of course how menthol cigarette sales and predatory marketing tactics of the cigarette companies disproportionately impact the health of African Americans. I will address the implications of marijuana legalization on menthol sales and the cigarette companies in my next blog post…stay tuned.

California already has a well established marijuana industry that has been developing over the last forty years. The industry has largely worked underground and in the shadows due to the federal illegality of marijuana production, distribution, and sale. Without a statewide or national tracking system, it is difficult to know precisely how much marijuana is produced in California annually. Nevertheless, the High Intensity Drug Trafficking Area Central Valley program, a local agency that receives funding from the Federal Drug Enforcement Agency to address drug trafficking and production in critical regions, estimates that California may produce 75%-85% of the world’s marijuana, which is transported to states on the East Coast, Canada, and even Europe.

We may not be a tobacco growing state, but we are a marijuana producing state. Medical marijuana is now recognized as a legitimate business in California after the governor signed the medical marijuana package in September 2015, where the Board of Equalization will license, collect fees, and oversee tax administration of the medical side of production. In July 2015, BOE District 2 representative, Fiona Ma, called for a state chartered banking institution to deal with the issue that the industry conducts its business in large amounts of cash. Industry representative, Nate Bradley of the California Cannabis Industry Association, captures the implication of these new regulations and Ma’s banking proposal in the following:

“Gov. Brown and his colleagues in the Legislature have just given the green light to let California’s cannabis industry become the thriving, taxpaying, job-creating industry it was always destined to become”

We can and should expect the mom and pop, fragmented market to transform into a more professionalized and sophisticated operation, especially if marijuana is legalized for retail sales in 2016.

As I said in an earlier post, the public health community can shape how large the nascent marijuana industry becomes but needs to engage NOW rather than wait until this problem is too big to proactively address. We are always on the defense, let’s play some offense for once.

Also in an earlier post I discussed briefly my experience in policy discussions on regulating retail marijuana in California as:

“Those that are concerned are lumped into an unfair category of prohibitionist because we are aware that without appropriate controls, marijuana will likely become the next Big Tobacco.”

Ironically, when this issue was brought to the public health community to request their involvement in shaping marijuana regulations for California, there was an underlying sentiment that their involvement would mean more than shaping policy, it would mean that they were actually supporting legalization.

This sentiment is false. The differences between advocacy and proactively shaping policy are quite different. For example:

Differences between Pro-Legalization and Proactively Shaping Policy
Advocating for Legal Market Proactively Shaping Policy
Local Control State preemption to create a standardized regulatory system Local government may impose stricter regulations on sales, smokefree, taxation, and marketing
Minor sales Sales to 18 and older Sales to 21 and older
Licensing Requirements No licensing fees or enforcement mechanisms Local and state retail licenses with annual fees
Smokefree Laws Exemptions for restaurants, bars, clubs to prevent youth exposure at home No public usage to protect bystanders and to prevent normalization of behavior
Marketing/ Advertising Prohibited in venues where 30% of readership is under 21, protects commercial speech rights No advertising or marketing
Taxation Low taxes to prevent black market sales High enough to deter initiation and problematic use
Dedicated Funds Taxes dedicated to school programs, budget deficit, and general fund Taxes earmarked for health education and prevention, and media campaigns
Health Education & Prevention School-based intervention programs

Cessation programs not necessary

Aimed at general public, culturally tailored messaging, free cessation services
Media Campaign Informs public on responsible adult use and on preventing youth initiation Year round media campaigns aimed at the general public on health risks and industry manipulation, promotes cessation
Industry Involvement Appointed members from industry to sit on oversight committees or working groups Industry may not sit on any regulatory or advisory committee. Any industry interaction with government officials or public health must be made publicly available.

The key difference between advocating for and proactively shaping legislation is that the latter does not have a stake in whether the law passes or not. The latter is a pragmatic strategy taking into account that if marijuana is legalized and the public health community is not at the table, the resulting regulations will favor the interests of the industry. And we know that the industry does not care about the public’s health, they do care however, about profit. Profit means:

Recruiting new and young smokers through widespread marketing including use of cartoon characters…


candy flavors…candy_16

school-based interventions that don’t work…

Youth smoking increased after one year (1999-2000) implementation of Life Skills according to Philip Morris

Youth smoking increased after one year (1999-2000) implementation of Life Skills according to Philip Morris

exemptions in smokefree laws, placing tax revenues in the general fund, and prohibiting sales to minors but not requiring enforcement or licensing of retailers and…

denying the science on health risks associated with use and secondhand exposure…

Regulating Marijuana in California_071

As we did with e-cigarettes at the local level, we can take a proactive approach in shaping marijuana regulations. We should not be debating whether marijuana legalization is inevitable or not, instead we should be using our hard won lessons learned from regulating tobacco in California and apply these lessons to marijuana policy. Even some that may seem impossible for tobacco, like age 21 sales or prohibit marketing, we can have at the beginning of a legalized market. We should be expecting marijuana legalization to pass in 2016 in California, and even if it doesn’t, at least we can say we were at the table proactively shaping policy rather than sitting on the sidelines.


The Pro-E-Cigarette Advocacy Network

In May 2015, University of Illinois at Chicago MidAmerica Center for Public Health Practice, an institution dedicated to healthy living through social environment change, held its annual conference, Change Institute, in Chicago, IL. The Insitute´s general focus is on three key areas of public health: reduce tobacco use, increase physical activity, and healthy eating. This year´s theme was on how to create and adopt innovative approaches to control tobacco. I along with Dr. Randy Uang from the University of California, San Francisco presented on emerging products related to tobacco that may undermine achievements made by the tobacco control movement over the last 40 years in a presentation entitled: “Defending Public Health from Tobacco: Health Far We’ve Come and Where we Can Go.”  These new products include e-cigarettes, hookah, and marijuana, all of which facilitate poly-product use among youth and young adults. For example, marijuana users may use e-cigarettes to vape hash oil or marijuana users may smoke a mentholated cigarette following marijuana use to sustain the high, a phenomenon known as “blunt chasing”. The cigarette companies have known about “blunt chasing” since the 1980s.

This presentation began with a discussion on how far states, in particular Illinois, have come in terms of controlling tobacco and the power of the tobacco industry. It ended with a discussion on products, e-cigarettes for example, that may make or break tobacco control. Without strong regulations on e-cigarettes at the state or local level in the United States, the rate of use among youth has escalated between 2011 and 2014. Adding to the chaos is that the cigarette companies entered the market in 2013 and have been influencing e-cigarette policy debates ever since, using their historic tactics and immense resources to pass pro-industry legislation and prevent strong state laws regulating their sale and use.

Electronic cigarettes (e-cigarettes), also known as electronic nicotine delivery systems (ENDS), are battery operated devices that deliver an aerosol of nicotine (in most cases), flavors, and other chemicals to the user. E-cigarettes exist in a wide variety of forms including “cigalikes”, which resemble conventional cigarettes, and “open system” devices (including “vape pens” and “tanks”) with a greater heating capacity that can be refilled with a liquid solution of nicotine, marijuana hash oil, or other drugs. Most brands offer a wide variety of flavors, including conventional cigarette flavors (tobacco and menthol) and candy flavors (gummy bears, bubble gum, cotton candy) that appeal to youth.

Between 2010 and 2014, e-cigarette use among middle and high school students exponentially grew. According to data from the Centers for Disease Control and Prevention, e-cigarette use among youth tripled between 2013 and 2014 and nicotine is now the leading form of recreational drug use among teenagers. CDC ecigsWhy the rapid increase in such a short period of time? Well, e-cigarettes are largely unregulated in terms of marketing and advertising, minimum purchase age, retail licensing, public use, and taxation. The major e-cigarette and cigarette companies that own e-cigarette brands took advantage of the lack in regulation and launched mass marketing campaigns on television, print, and the Internet and increased e-cigarette availability by moving their sale beyond specialty “vape shops.”

ECIGs youth

The federal Food and Drug Administration has not exerted its authority to regulate e-cigarettes as tobacco products, and so these products do not face the same advertising and marketing restrictions that other tobacco products are subject to. In 1971, President Nixon signed into law the Public Health Cigarette Smoking Act, which bans all tobacco advertising on radio and television. In 1998, the Master Settlement Agreement addressed public concern that cigarette company targeting of youth was increasing youth smoking, by prohibiting sports and event sponsorship, billboards, giveaways, and cartoon characters. However, cigarette companies are masters of reinvention and so used their close relationships with tobacco retailers and focused their marketing expenditures at the retail sales environment to circumvent laws that prohibit or significantly restrict their promotional activities.

Without FDA regulation, the cigarette companies are re-using historic advertising and marketing tactics to sell nicotine products in the 21st century. (Note: e-cigarette companies are also using these tactics). Stanford has a collection of e-cigarette and cigarette advertisements on its “Research into the Impact of Tobacco Advertising project” website. Here are two from Blu (owned by Lorillard) and Fin (an independent company).

ecig ban FIn

Fairly similar arguments and messaging…Freedom

By October 2015, only eight states had included e-cigarettes in their smokefree laws (Connecticut, Maine, North Dakota, New Jersey, Utah in effect and Delaware, Hawaii, and Oregon enacted but not yet in effect). As indicated earlier, the federal government had not defined e-cigarettes as tobacco products or regulated marketing and product standards.

Why are e-cigarettes escaping federal and state regulation? Well, since 2009, legislation has been opposed by an evolving pro-e-cigarette advocacy network of groups whose members’ interests differ but who have common goals of minimizing e-cigarette regulation and preserving consumer access. The initial pro-e-cigarette advocacy network began as several loose-knit bottom-up efforts led by users and retailers but rapidly evolved into a top-down anti-policy campaign after cigarette companies entered into policy debates.

Defending Public Health 5142015_233

The cigarette companies have a shared interest in opposing restrictions on e-cigarettes but also promote policies that will protect both their cigarette and e-cigarette markets by eliminating competition from small and medium sized independent companies. For instance, cigarette companies, through industry-funded think tanks pushed for regulations on e-cigarettes that would exempt bars and nightclubs from smokefree legislation, a common cigarette company strategy dating back to the 1990s. Industry-funded think tanks involved in the pro-e-cigarette advocacy network, like American Council on Science and Health (ACSH), Heartland Institute, National Center for Public Policy Research (NCPPR), American Enterprise Institute (AEI), American Legislative Council (ALEC), and State Policy Network (SPN), all have received money from the cigarette companies since at least the 1990s and were still receiving funding during e-cigarette policy debates (2010-2014).

Cigarette and E-Cigarette Company Funding to Think Tanks (2010-2014)
Cigarette $355,000 $360,000 Undisclosed amount1 Undisclosed amount $536,000 $105,000
E-Cigarette $41,000 N/A2 N/A N/A N/A N/A
1Think tank stated received cigarette company funding but did not publicly disclose amount

2No publicly available data for 2012 or 2013 for actual amount

Cigarette companies also pushed for product restrictions that would eliminate competition from small companies and vape shop retailers. For example, in 2013, RJ Reynolds was pushing product regulations for the proposed FDA deeming rule to ban the production and sale of open system e-cigarette products, which were predominately sold by small e-cigarette companies and e-cigarette retail stores. E-cigarette users and vape shops retailers, through online social forums, protested RJ Reynolds’ move to push out small retailers but did not file public comment to protest RJ Reynolds’ recommendations to the FDA.

PM was pushing for health warning labels on its e-cigarette products that ironically (or not) were stricter and larger than what was required for conventional cigarettes.

E-cigarettes remain a serious public health issue for local and state governments. Because the FDA is moving at a glacial pace and state governments are more likely to listen to the concerns of their corporate donors rather than their constituents, it is important that local governments continue to pass legislation that restricts e-cigarette sales and indoor use. State health departments, in the absence of strong laws controlling e-cigarette sale, use, and taxation, should run mass media campaigns aimed at the general public on the harms of e-cigarette use, dual use, and cigarette company involvement in the e-cigarette market and associated policy debates.