The physician’s code of ethics states, “First, do no harm,” placing patient safety and public health as the central goals.

Thus, one must balance the benefits and the harms of a policy such as cannabis legalization and assure that the potential benefit/harm ratio is greater in a regulated, legal cannabis marketplace than in environment where the cultivation, distribution, sale, possession, and use of cannabis is criminalized.

Foremost, cannabis regulation must optimize public health and promote social justice, with two key priorities:

• reduce the harmful consequences associated with cannabis misuse
• reduce the illegal cannabis market with minimal reliance upon the criminal justice system, which has contributed to social injustice and individual harms

These two priorities lie in tension. Eliminating the illegal cannabis market is straightforward. Removing all penalties and restrictions regarding the production, distribution, and possession of cannabis would eliminate the illicit market because, by definition, all such activity would be legal. However, that approach does not address the harms associated with cannabis misuse. Conversely, a prohibitive or highly restrictive regulatory environment may slightly reduce problematic use, but it increases the viability and profitability of the illegal market. So, the optimal approach to cannabis regulation is a moderate one, balancing the needs of social justice and public health.

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Thus, the issue is not whether cannabis can be harmful.  The issue is whether cannabis prohibition is effective in protecting public health (it is not); whether the known harms of cannabis prohibition, particularly upon persons of color who bear the brunt of the drug prohibition, outweigh the potential harms of cannabis regulation (they do not), and whether the public benefits from science-based regulation of cannabis for adult use (it does).