Colorado and Washington are the first states to legalize recreational marijuana.  In my state of Colorado, Amendment 64 was passed by 55 percent of voters by ballot referendum last year and took effect on January 1 of this year.  State government officials are giddy with the prospects of increased revenue from marijuana sales.  Marijuana tourism is booming in Colorado, giving new meaning to “Rocky Mountain High.”  Now, four months into this new experiment, it may be worth looking at some of the unintended consequences.

Tax revenue may not be as much as anticipated, according to Governor John Hickenlooper.  No surprise there; government officials salivating over this supposed cash cow may get a chicken rather than a cow.  With legal weed costing three times as much as black-market weed, savvy consumers may go with the cheaper product in the same way they did before legalization.  Remember the luxury tax on yachts about 15 years ago that actually reduced government revenue by decimating the U.S. boatbuilding industry?

Within two weeks of marijuana legalization in Colorado, a stoned motorist plowed into two State Police vehicles in metro Denver.  And a 69-year-old driver was pulled over in Idaho, detained, and his vehicle searched.  He was profiled over his Colorado license plate and Washington driver's license.

Tragically, a 19-year-old Wyoming college student jumped to his death from a Denver hotel balcony after eating a marijuana cookie.  Forgoing the usual spring break beaches of Florida or Texas, the student and a group of his friends visited Denver over their spring break to “sample marijuana.”  Turns out he sampled a bit more than one cookie, as most cookie-eaters would be prone to do.  But he missed the recommendation of the store clerk to cut the cookie into six pieces and eat one at a time.  Who cuts a cookie into six pieces and eats one at a time?  Does Mrs. Fields cut her cookies into six pieces like a pizza pie?  Maybe obvious for this student in hindsight, but he won’t be the last person to eat an entire cookie, as everyone normally does.  What about a hungry child who comes across one of his parent’s marijuana cookies and wants a snack?  What could go wrong?

A week later, a Denver man shot his wife to death after smoking and eating marijuana.  He ate marijuana-infused orange ginger candy, purchased legally, earlier that evening.  According to the store, “a single bite is enough."  Like the cookie, who eats a “single bite” of candy?  The man’s legal defense will revolve around the “we didn’t know this would happen” argument.  “The defense will argue strongly that this is an involuntary intoxication in the sense that he didn’t know it would produce this kind of effect on his mental state.”  Gee, wouldn’t this kind of thing be important to know about marijuana before making it legal?

The FDA certainly doesn’t take this approach – if anything, it's the opposite.  A life-saving meningitis vaccine called Bexsero is slowly moving through the approval process despite approval in Europe, Canada, and Australia, and despite lives lost waiting.  The FDA has also dithered over a drug for Duchenne muscular dystrophy, a crippling and ultimately fatal children’s disease.  While it is important to be sure that approved drugs are safe and effective, even limited safety and efficacy is a better option than doing nothing for these otherwise fatal diseases.  Yet for a recreational drug like marijuana, also potentially fatal, public safety relies on a store clerk advising customers to cut their cookies into sixths or eat only one bit of a piece of candy.

Researchers at Northwestern and Harvard found potentially serious brain alterations in young adult casual marijuana users.  The Wyoming college student certainly falls into this category.  What if a pharmaceutical company brought such a drug to market?  Especially in a form appealing to children, like a cookie or piece of candy?  Would the FDA approve it for market?  In the unlikely event they did, imagine the public outcry and litigation over such a drug.  Ten years ago, Merck paid out billions of dollars to settle multiple lawsuits over Vioxx for numerous drug-related deaths.

Who is at fault over marijuana-related fatalities?  One of the numerous Denver dispensaries?  The state legislators charged with regulating marijuana sales and use?  The governor, who signs the legislation into law?  Or the voters who approved the use of recreational marijuana use in Colorado?

Marijuana is here to stay in Colorado.  The news of Easter Sunday was not a celebration of the resurrection of Christ or Easter egg hunts, but instead the 4/20 rally in Denver.  To each his own, but is anyone thinking about the unintended consequences of laissez-faire weed and the mounting causalities left in its wake?

Brian C Joondeph, M.D., MPS, a Denver-based physician, is an advocate of smaller, more efficient government.  Twitter @retinaldoctor.