The success of a ballot measure legalizing recreational marijuana in red-leaning Ohio, the 24th state to do so, illustrates the rapidly changing politics of pot as the battle to overhaul drug laws moves to conservative states and concerns grow about the public health implications.
Once the law takes effect next month, more than half of the American population will live in a state where marijuana is legal for recreational use, marking a milestone as the nation undergoes a drastic shift in its approach to the drug.
Advocates hope the 14 percentage point margin of victory in Ohio will ramp up pressure on the mostly GOP-run holdout states and, eventually, Congress. They point to the win as evidence even conservative voters are skeptical of treating marijuana as a law enforcement target and public health threat.
"To see this campaign win so comfortably in a nonpresidential year in a red state shows how far the cannabis reform movement has come," said Matthew Schweich, executive director of the Marijuana Policy Project, which advocates for legalization.
Fifteen states have legalized marijuana since 2019, including voters in two deep-red states, Missouri and Montana.
Florida could be the next major battleground if a measure slated for the 2024 ballot survives a legal challenge. Legalization bills have recently stalled in Republican-run statehouses including in Wisconsin and Texas, where public health concerns have been a barrier.
While marijuana advocates contend that the drug is safer than alcohol and tobacco, which are legal despite killing millions, experts caution that cannabis still has its downsides. Addiction is rising alongside cannabis use, and growing evidence suggests marijuana is harmful to developing brains and can exacerbate mental health conditions. Some experts who favor legalization worry about high-potency products sold on the legal market.
As marijuana moves from the streets to dispensary shelves - and as the drug becomes more easily accessible and available in new forms - a conflicting body of research has emerged about the short- and long-term public health effects. There's no clear-cut answer on whether states that have legalized are better off, leaving policymakers to wrestle with the trade-offs of leaving an unregulated illicit market without competition.
The prospects for federal marijuana legalization remain dim in Congress, leaving states as the primary battlegrounds. President Biden has not called for decriminalization or legalization, though he issued a mass pardon for people convicted of simple possession charges and his administration is considering loosening restrictions on marijuana.
National support for marijuana legalization has reached a record 70 percent, according to a Gallup poll released Wednesday. The survey found growing Republican support, with 55 percent saying it should be legal, compared with 87 percent of Democrats and 70 percent of independents.
Still, that doesn't guarantee success at the ballot box in red states. Voters in Arkansas, Oklahoma, South Dakota and North Dakota rejected legalization measures in the past year. Legalization advocates blamed factors such as underfunded campaigns and election timing for those losses, pointing to ballot measure victories in Arizona and Montana in recent years as evidence the issue has appeal among conservatives.
In Ohio, 30 percent of Republicans voted to legalize marijuana, compared with 79 percent of Democrats and 64 percent of independents, according to network exit polls.
Brad Jones Sr., a rural Ohio supporter of former president Donald Trump who usually votes for Republicans, said he backs marijuana legalization because the drug helped him kick his heroin and cocaine habit and reduced his seizures from epilepsy. He says GOP elected officials should be open-minded about marijuana.
"What they see is cartels that bring it from the border because that's what they've been screaming," said Jones, 50. "I don't think they really looked into the medical aspects of it and what it has done for people like me."
Kevin Sabet, president of Smart Approaches to Marijuana, which opposes legalization, dismissed the victory in Ohio as a likely fluke because an abortion measure that turned out left-leaning voters was also on the ballot. He said his organization will push for restrictions on advertising and THC levels in products, and Republican legislative leaders have vowed to amend the law.
"Generally, ballot initiatives are a bad way to make public health law," Sabet said.
Unlike most marijuana initiatives, Ohio's includes language to provide marijuana addiction treatment and education, acknowledging the growing and often dismissed problem of cannabis-use disorder.
Some marijuana advocates say they face challenges with including similar public health regulations in other ballot measures. In some states, initiatives must narrowly focus on one subject, a rule that has been used to challenge marijuana legalization when a ballot measure contains multiple provisions.
Experts who worry that public health takes a back seat when it comes to legalizing marijuana at the ballot box have pushed for regulations to dissuade youth use and to rein in high-potency products such as waxes and concentrates.
GOP state lawmakers and governors largely oppose legalization and, in some places, can overturn or gut voter-approved initiatives.
Florida's Republican attorney general, Ashley Moody, has challenged the legalization measure slated for the 2024 ballot. In arguments before the state Supreme Court on Wednesday, an attorney representing Moody argued that the ballot language "injected uncertainty and confusion" about whether the proposed constitutional amendment conflicts with federal law, which still outlaws marijuana.
Justices seemed skeptical of that argument, pointing to the ballot language, which notes the amendment applies only to Florida law and "does not change, or immunize violation of, federal law."
Steve Vancore, a spokesman for Trulieve, the cannabis company bankrolling the ballot initiative, said he remains "hopeful that the justices will ignore the political rhetoric, stick to the law and give Floridians the opportunity to vote on this important initiative."
Florida governor and Republican presidential candidate Ron DeSantis has opposed marijuana legalization, but some analysts say the measure still has a good chance of passing the 60 percent threshold to become law, even in a conservative-leaning state.
The Ohio win "creates a tailwind" for Florida's legalization effort, said former congressman Carlos Curbelo, a Miami Republican.
"Florida Republicans, especially younger conservatives, have a strong libertarian streak to them," he said. "Certainly, this will give organizers of this effort a sense of momentum going into next year."
But proponents of marijuana legalization face tougher challenges in statehouses.
"Getting this work done legislatively is a much more difficult lift," said Paul Armentano, deputy director of the marijuana advocacy group NORML. "Many legislators still treat this issue as if it's a fringe issue rather than a bipartisan mainstream cause."
After Pennsylvania legislators held a hearing last week to consider marijuana legalization, state Rep. Kathy L. Rapp (R) said she is concerned about cannabis-use disorder, impaired driving and the ease of youth access to vaping devices.
"Advocates keep telling me that legalizing cannabis will give the state the opportunity to regulate where it can be sold and at what age people can purchase it," Rapp said in a Nov. 2 statement. "Unfortunately, our rules and regulations won't be enough to keep cannabis out of the hands of kids."
Steven M. Schain, a Pennsylvania attorney who teaches cannabis law at Stockton University in New Jersey, said Pennsylvania is losing out on tax revenue, industry jobs and a safe supply for adults because people there simply buy marijuana in adjacent states, including New Jersey, Maryland - and, soon, Ohio.
"The legalization of adult-use cannabis in Ohio is a deafening wake-up call" for Pennsylvania legislators," Schain said.
In Republican-controlled Texas, where political opposition to recreational marijuana remains strong and law enforcement in some parts of the state targets cannabis crimes more aggressively, lawmakers have approved a limited medical marijuana program that critics deride as weak and little used.
A Democratic-sponsored bill to legalize cannabis for adult use received a rare committee hearing in the last legislative session, but the measure went nowhere. Other bills to reduce penalties for marijuana possession and expand the medical marijuana program to include chronic pain passed the House but did not advance in the Senate.
Texans and residents in other states where marijuana remains illegal have instead turned to stores selling high-inducing hemp products such as THCA hemp flower and delta-8, the latter of which is the subject of court battles over its legality.
Congress legalized hemp in 2018, but some unregulated intoxicating products derived from the plant have prompted consumer safety concerns because they are untested, underscoring how the continuing criminalization of marijuana also presents public health concerns. Health authorities have warned manufacturers may use unsafe chemicals in development and improper labeling could fool consumers about their effects.
Proponents of legalization say marijuana sold through dispensaries, instead of dealers, can undergo testing for contaminants and to verify potency levels and be subject to packaging and labeling requirements.
"I'm not saying there is no harm with cannabis, but I think there is more harm with no regulation and oversight by our government," said Wisconsin Senate Minority Leader Melissa Agard (D), who has unsuccessfully sponsored marijuana legalization bills every legislative session for the past decade.
Agard has also argued that Wisconsin is losing potential tax revenue to neighboring Illinois, Michigan and Minnesota, which have legalized marijuana. The opportunity to tax marijuana to supports schools and other public services was a major selling point when legalization was first presented to voters in Colorado and Washington state a decade ago.
States that have legalized cannabis generated $3.8 billion in tax revenue in 2022, according to the Marijuana Policy Project, a slight decrease from the prior year.
"If a state does not allow legal and taxable cannabis, they are leaving money on the table," said Richard Auxier, an analyst for the Tax Policy Center who studies marijuana taxation.
He cautioned that those revenues are not large enough to replace income or property taxes or to be the primary funding source for education and health-care budgets. But future recessions and deficits could prompt politicians to give marijuana legalization a second look as a way to avoid tax hikes or save programs, he said.
In addition to cannabis sales taxes, the growing marijuana industry has been embraced as an engine for jobs and economic activity, though it also faces challenges from falling prices and regulatory chaos. The U.S. cannabis market was valued at $13 billion in 2022 and is projected to grow 14 percent yearly, according to Grand View Research, a market forecaster.
The financial upsides have not swayed Republican lawmakers so far, forcing advocates to rely on ballot measures such as Ohio's to legalize cannabis in red and red-leaning states. But citizen initiatives are not allowed in 17 of the states where marijuana remains illegal, including Wisconsin, Texas and Pennsylvania, while others have onerous restrictions for ballot measures to qualify.
Marijuana advocates are also closely watching New Hampshire, where Republican Gov. Chris Sununu said he would support a state-run monopoly model for legalization, and Hawaii, the only state with a Democratic governor and Democratic majorities in both chambers of the legislature that hasn't legalized marijuana, as statehouses where they could prevail next year.
"Knowing that a majority of our residents support legalization, it is reasonable to assume change is inevitable. To ignore this reality would be shortsighted and harmful," Sununu said in a May statement. "By regulating the sale of marijuana in New Hampshire, the state will ensure our citizens are in a safer place."
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Emily Guskin and Andrew Ba Tran contributed to this report.