As of early 2014, 20 states plus the District of Columbia have passed measures permitting the use of marijuana for medical purposes, and two states—Washington and Colorado—have legalized the use, cultivation and distribution of small amounts of marijuana for all adult users. While the federal prohibition of marijuana remains in effect, a growing number of states are considering and implementing other regulatory models for marijuana. This article discusses these trends and looks to the future of federal-state relations in this area.

Voters in three Western states – Colorado, Oregon, and Washington – will decide today whether to legalize the recreational use of marijuana by adults 21 and over, while also establishing a state regulatory and taxation framework similar to those used for tobacco and alcohol.  Passage of these measures would set up a showdown with the federal government, because the drug would still be illegal under federal law.

Prescription drug abuse continues to be recognized as the nation’s fastest-growing drug problem.  The latest “Monitoring the Future” study from the University of Michigan indicated that prescription drugs are second only to marijuana in their frequency of abuse. In Kentucky, the rate of overdoses from prescription drugs doubled among men and tripled among women between 2000 and 2009. In Florida, estimates suggest as many as seven people are dying daily from accidental overdoses. Deaths from prescription drug overdoses are the leading cause of accidental death in 17 states.

A recent National Survey on Drug Use and Health found prescription medication abuse is a significant societal health issue, with more Americans abusing prescription drugs than cocaine, heroin, hallucinogens and inhalants combined. It also found that one in five teens will abuse a prescription medication at least once in their lifetime.  Preventing prescription drug abuse and misuse, an epidemic in our country, is one of the key strategic priorities of the Cardinal Health Foundation.

Idaho Supreme Court Chief Justice Daniel T. Eismann can attest to the success of the drug courts in his state. As a former drug court judge, he knows full well why the legislature continues to support the problem-solving courts even in tough fiscal times.

This week, both the Washington Post and the New York Times have reported on the growing popularity of "spice," the generic term for a legal synthetic substitute for the active ingredient in marijuana.  Sold in many locations as packages of incense, the herbal mixture is coated with a chemical that causes some of the same effects of marijuana. 

As the costs of prosecuting and incarcerating marijuana users continues to escalate, several states have decriminalized possession of small amounts of the drug. while some consider legalization.  Supporters argue that the money saved could be better used to investigate more serious crimes and to provide drug treatment options.  Opponents argue that such efforts would lead to increased drug use.

On May 11, President Obama announced a new approach to "confronting the complex challenge of drug abuse and its consequences."   The new National Drug Control Strategy calls for reducing the rate of youth drug use by 15 percent over the next five years and for similar reductions in chronic drug use, drug abuse deaths and drugged driving.

State prescription drug monitoring programs are used to control drug misuse that cause the epidemic of accidental deaths. CSG's interstate compact will enable efficient data sharing between states for public health and law enforcement purposes.

The cost of substance abuse and addiction is staggering— hitting state budgets hard.  Alternative methods of managing substance abuse can pay off for states.  States’ fiscal crises have simultaneously provided opportunities to develop new strategies for substance abuse programs and forced funding decreases for successful programs.

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