In any society, there is tension between what members of that society want, and what is legally permissible.

Some people want to drive very fast, but that puts those drivers and others at risk, so as a society we impose speed limits. Some people like to smoke cigarettes, but as a society we recognize the harm from cigarette smoking and restrict the sale of cigarettes and tobacco products to those 21 and older. Some people like to cross roads when it is convenient to them, but to protect pedestrians and drivers, we install crosswalks and impose fines for jaywalkers.

So whether it is driving, cigarette smoking or crossing the streets, we impose laws that seek to provide a balance between personal freedom, and what is good for society and the communities in which we live.

In Hawaii, Gov. Ben Cayetano signed Act 228 into law in 2000, legalizing the use of medical cannabis. In 2019, Gov. David Ige announced he would let a bill to become law that would decriminalize small amounts of cannabis. Although possession of three grams or less of marijuana is now punishable by a $130 fine, in reality, fines are not being issued on a regular basis. Also, as a result of this law, jail time was no longer a penalty for personal marijuana use.

Marijuana use directly affects brain function, specifically the parts of the brain responsible for memory, learning, attention, decision-making, coordination, emotions and reaction time. Marijuana users and advocates may dispute how much of an impact marijuana has, but people use marijuana exactly because it does have an impact on them, just as nicotine or alcohol has an impact on the body and mind of those who consume them.

What we permit as a society, we promote. Legalizing recreational marijuana, by definition, promotes its use, which from a health care perspective creates challenges. THC, the principal psychoactive constituent of cannabis, can remain in the body for days, weeks or even months, well after the user is no longer high or stoned. So the operator of a hospital, nursing home or home health agency has no way of determining if an employee who uses marijuana is high, or has been high recently and is no longer high.

One salient question to ask is whether legalizing recreational marijuana will have a net positive or negative effect in our communities. Will it increase test scores for students, reduce homelessness, increase productivity at work, or increase health and wellness in our communities?

If we are unsure as to the net benefit to our community were we to legalize recreational marijuana, then maybe what we have — access to medical cannabis as needed, and the decriminalization of personal amounts of cannabis — is good enough.

Hilton R. Raethel, M.P.H., M.H.A., is CEO of the Healthcare Association of Hawaii.