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The first person who taught me something about death and defiance was the mother of a family friend, an older woman who had moved from Punjab to the United States to be closer to her son. I remember her as delicate and draped always in pastel salwar kameezes. After she was diagnosed with breast cancer, which moved quickly to claim her bones and her brain, her desire to return to Punjab intensified. When my parents told me about the end of her life, it was with a mixture of disbelief and conviction: She survived the days-long journey to the village where she’d been born—laboring to breathe for nearly the entire flight, grimacing through prayers when she ran out of pain medication—and died two days after she arrived.

I thought of her story this week as I read about former President Jimmy Carter’s intention to live long enough to vote for Kamala Harris. Carter, who has been on hospice for well over a year, turned 100 on Tuesday and has survived far longer than many expected he would. The notion that he has rallied in order to contribute in one final way to American democracy raises a familiar question that arises in my own work with patients and families: Do we have some control, conscious or not, over when we die? Can a person stretch the days of their life to include a last meaningful act or moment?

As a palliative-care physician, I have encountered the phenomenon of people dying only after specific circumstances materialize. There was the gentleman whose family held vigil in the intensive-care unit while he continued on, improbably, even without the support of the ventilator, dying only after his estranged son had arrived. There was the woman whose fragility precluded any further chemotherapy, but who survived long enough without it to witness the birth of her first grandchild. There was the woman who was deeply protective of her daughter, and died from cirrhosis only after she’d left for the night, possibly to spare her the agony of witnessing her death. The unexpected happens frequently enough that I tell patients and families that two timelines shape the moment of death: the timeline of the body, governed by the more predictable laws of physiology, and that of the soul, which may determine the moment of death in a way that defies medical understanding and human expectations. When people wonder about the circumstance of the last heartbeat, of the final breath, I can see how they never stop searching for their loved ones’ personhood or intention, a last gesture that reveals or solidifies who that person is.

Despite the prevalence of stories suggesting that people may have the ability to time their death, no scientific evidence supports this observation. Decades ago, several studies documented a dip in deaths just before Jewish holidays, with a corresponding rise immediately afterward, suggesting that perhaps people could choose to die after one final holiday celebration. A larger study later found that certain holidays (Christmas and Thanksgiving, in this case) and personally meaningful days (birthdays) had no significant effect on patterns of dying. But this phenomenon doesn’t lend itself easily to statistical analysis, either: The importance of holidays, for instance, can’t quite stand in for the very individual motivations that define the anecdotes shared in hospital break rooms or around a dinner table. And the human truth that many recognize in these stories raises the question of whether we believe them any less fully in the absence of proof.

Palliative care often involves helping people confront and develop a relationship to uncertainty, which governs so much of the experience of illness. And when my patients tell me about themselves and about who they are now that they are sick, willpower often makes an appearance. Many say that if they focus on the positive, or visualize the disappearance of their cancer, or fight hard enough, they will win the battle for more time. I hear in their words echoes of what Nietzsche wrote, what the psychiatrist Viktor Frankl used to make sense of his years in German concentration camps: “He who has a why to live for can bear almost any how.”

And we want to believe that love or desire or commitment or heroism is still possible right up until the very end. As my patients grow sicker, and as death approaches, I talk with them and their families about what they can hope for even if a cure isn’t possible. That, in fact, death can still contain something generative. A time that may have seemed beyond further meaning becomes instead an opportunity, or an extension of the dying person’s commitments to their country, their family, their dreams. Soon, President Carter will be able to cast that vote: Next week, Georgia registrars will start mailing out absentee ballots; early voting begins the week after that. His promise to himself is a reminder that dying cannot fully dampen purpose, even as a person’s life narrows.

The idea that willpower can be an ally against death is appealing too, because it offers the possibility of transcendence, of defying the limits that the body, or illness, may impose. But, having also seen the many ways that the body does not bend to the mind, I do find myself regarding willpower with caution: What if you as a person are a fighter, but your body simply cannot fight the cancer any longer? I wonder, with my patients, if they can strive for more time without shouldering personal responsibility for the limits of biology. Similarly, two people on ventilators may love their families equally. One may die only after the final beloved family member arrives, whereas the other may die before the person rushing across the ocean makes it home. We don’t always know why. If Carter casts his vote and dies shortly thereafter, that might affirm the notion that others, too, can write the final sentence in their story. But what would it mean if Carter died before casting his vote? If he lived another year, or if he lived to see Donald Trump take office again, or watch the election be violently contested? Living with loss requires remembering that we can locate the person we have loved or admired in any given set of events that comprised their life, not just the last one.

I try to imagine my family friend’s long flight from Los Angeles to Delhi, and her ride in the taxi back to Punjab. I think about how she found a way to endure what she was told she couldn’t, all to feel beneath her feet the soil she knew best, to die in the one place that she felt belonged to her. What if her doctors had been right and she had died on the plane? My family might have mourned her single-mindedness, or we might have admired her defiance nonetheless. What makes these stories so compelling is that they remind us that death, however ravenous, cannot devour hope or possibility, even if what transpires is not the ending we imagined.

Of the first three elements to appear after the Big Bang, only one is available to buy as a bath soak. The Sads Smashing Anti-Stress Bath Treatment, which comes in shiny silver packaging, lists lithium as an ingredient and promises to take users “from weighed down to mellowed out.” It’s one of dozens of over-the-counter lithium supplements that claim to support a healthy mood. The metal is also an ingredient in Novos Core, a supplement marketed to “target the 12 root causes of aging,” plus in Life Extension, XtendLife, LifeLink, Youngevity, and AgeImmune. The anti-aging entrepreneur Bryan Johnson’s “Essential” multivitamin includes lithium too. “I am on a 1mg daily dose,” Johnson told me in an email.

Lithium, in other words, has become firmly entrenched in the wellness industry’s extensive library of supplements. But in crucial ways, it is unlike the other trendy products that dance across your Instagram stories. At higher doses, lithium is a powerful treatment for severe mood disorders—and preliminary evidence suggests that lower doses might improve well-being for people without mood disorders too. The problem is, American companies have little business interest in finding out how effective it really is.

If you put pure lithium into water, it will explode into crimson flames, but mixed with acids, lithium forms stable salts. Lithium compounds also dissolve uric acid, which doctors in the mid-1800s believed to be the cause of many illnesses. Physicians began using lithium to treat “a wide range of ailments, including headaches, diabetes, asthma, indigestion, obesity, skin disorders, rheumatism,” Walter Brown wrote in his book Lithium: A Doctor, a Drug, and a Breakthrough. By the end of the century, lithia water (water with a trace amount of lithium) was marketed as a patent medicine. (In that era, patent medicines—trademarked, proprietary cure-alls, many of which contained alcohol or opium—were a popular alternative to going to the doctor.) 7 Up was originally named Bib-Label Lithiated Lemon-Lime Soda, contained lithium citrate, and was marketed as a health tonic and hangover cure. Sears sold Schieffelin’s Effervescent Lithia Tablets, which were marketed for a variety of health concerns, including gout.

In 1949, lithium chloride, a table-salt alternative marketed to people with heart conditions, caused an outbreak of lithium poisoning in which at least two people died. The FDA, which had already started cracking down on patent medicines, quickly banned lithium in food products; later, researchers found that high doses of lithium can cause kidney failure, thyroid damage, tremors, and nausea. In 1970, the agency approved lithium carbonate for bipolar disorder; today, it’s also used off-label mostly for major depressive disorder. Then, in 1994, the FDA created the category of “dietary supplements,” which it does not evaluate, ushering lithium—mostly in the form of lithium orotate—back into a patent-medicine-like gray zone.

For decades, scientists have debated whether the lithia-water craze had any truth to it—if low doses of lithium might benefit a larger population than people with mental-health conditions, maybe even everyone. Some researchers think it’s worth investigating whether lithium is an essential micronutrient, like calcium or magnesium, with a recommended daily minimum of some yet-to-be-determined amount. Lithium carbonate is typically given at 600 to 900 milligrams a day for mood disorders. We get minuscule amounts of lithium from foods such as grains, potatoes, tomatoes, and cabbage. Depending on where you live and what mineral deposits are nearby, your tap water may also contain lithium. A 2024 review paper led by Allan Young, a psychiatrist at King’s College London, determined that most lithium orotate supplements on the market today contain a “micro” dose of 5 to 20 milligrams, and many have a “trace” dose of just 1 milligram. (The Sads Smashing Anti-Stress Bath Treatment contains 127 milligrams of lithium orotate, but it’s meant to be absorbed through the skin, not ingested.)

[From the May 1928 issue: The secret of longevity]

The effects of such low doses remain a mystery. Although a 2020 meta-analysis of studies from nine countries (including the United States) found that higher amounts of naturally occurring lithium in tap water are indeed associated with lower suicide rates, studies from places such as Switzerland and the East of England have found no association. In a 2021 study of rural Argentina, places with more lithium in their tap water had more suicides. Martin Plöderl, a co-author of the recent Switzerland study, told me that his team has found a publication bias in studies of lithium in tap water: Those with positive findings are more likely to end up in journals. Research into lithium’s effects on dementia, Alzheimer’s, and longevity has also been promising but inconclusive. A 2011 study of tap-water data from Japan found that the more lithium in the water, the longer people lived. Lithium consumption has been linked to longer life spans in flies, roundworms, and yeast, perhaps because it regulates molecules involved in metabolism and resistance to stress, Michael Ristow, a medical researcher at Charité University Medicine Berlin and co-author of the Japan study, said. A 2019 study found that bipolar-disorder patients who take lithium have longer telomeres—a proxy for lower biological age—than patients with other psychiatric disorders. And a more recent study from Japan found that people who took lithium for mood disorders had lower rates of dementia than similar patients who did not take lithium.

These data are compelling enough for Ristow, who told me he takes a low dose of lithium every day. Nassir Ghaemi, a psychiatrist at Tufts University School of Medicine, did not comment on his personal use, but told me, “I think it’s beneficial in people who are middle-aged and older, who have any risk factors for dementia.” To really be sure, randomized trials in humans are needed. Because lithium is an ancient element, however, it can’t be patented—only novel inventions are available for intellectual-property protection. In order to obtain a patent, a company would have to come up with some different delivery method or other improvement. Pharmaceutical companies, which are regulated by the FDA, therefore have little reason to fund an expensive clinical trial, especially when cheap versions are already sold over the counter. But supplement companies have incentive to sell lithium OTC without conducting rigorous research on its effects. Zero clinical trials for lithium orotate are currently registered in the U.S., despite its widening market availability.

Scientists don’t yet know whether lithium-orotate supplementation would yield different results than lithium in tap water. Only two studies on such supplementation have ever been conducted in humans—one from 1973 and one from 1986—and they have small sample sizes and no placebo groups. “Given lithium does work at least for preventing bipolar disorder, it’s a scandal that we don’t know how it works,” Young told me. If low-dose lithium remains akin to a patent medicine, Americans could miss out on understanding how and how well it works, and if taking it comes with any risks. In at least one case report from 2007, a woman took 18 tablets of a lithium supplement called Find Serenity Now at once and went to the hospital after vomiting. She was discharged with no other serious issues, but the risks of long-term use simply haven’t been assessed.

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In the late 19th century, people such as Mark Twain and President Theodore Roosevelt traveled to Lithia Springs, Georgia, to drink lithium-rich water. The springs’ appeal endures: You can order water from its website, which states, “Locals have always believed Lithia Spring Water flows from the fountain of youth.” Lithium predates human life, is extracted from stone, and can have a profound impact on a person’s emotional life. No wonder it tempts our never-ending desire for some primordial cure-all, whether it be found in a groundwater spring or in our very own bathtubs.

Presidents always seem to have a crisis to deal with. George W. Bush had 9/11. Barack Obama had the Great Recession. Donald Trump had the coronavirus pandemic. Joe Biden had the war in the Middle East. For America’s next president, the crisis might be bird flu.

The United States is in the middle of an unprecedented bout of bird flu, also known as H5N1. Since 2022, the virus has killed millions of birds and spread to mammals, including cows. Dairy farms are struggling to contain outbreaks. A few humans have fallen sick, too—mostly farmworkers who spend a lot of time near chickens or cows—but Americans have largely remained nonplussed by bird flu. No one in the U.S. has died or gotten seriously sick, and the risk to us is considered low, because humans rarely spread the virus to others.

On Friday, the fear of human-to-human spread grew ever so slightly: The CDC confirmed that four health-care workers in Missouri had fallen sick after caring for a patient who was infected with bird flu. A few weeks earlier, three other Missourians showed symptoms of bird flu after coming in contact with the same person. It’s still unclear if the workers were infected with H5N1 or some other respiratory bug; only one has been given an H5N1 test, which came back negative.

The CDC says the risk to humans has not changed, but the incident in Missouri underscores that the virus is only likely to generate more scares about human-to-human transmission. The virus is showing no signs of slowing down. In the absolute worst-case scenario—where Friday’s news is the first sign of the virus freely spreading from person to person—we are hurtling toward another pandemic. But the outbreak doesn’t have to get that dire to create headaches for the American public, and liabilities for the next president.

Either Trump or Kamala Harris will inherit an H5N1 response that has been nightmarishly complex, controversial, and at times slow. Three government agencies—the FDA, the CDC, and the U.S. Department of Agriculture—share responsibility for the bird-flu response, and it’s unclear which agency is truly in charge. The USDA, for example, primarily protects farmers, while the CDC is focused on public health, and the FDA monitors the safety of milk.

Adding to the complexity is that a lot of power also rests with the states, many of which have been loath to involve the feds in their response. States must typically invite federal investigators to assess potential bird-flu cases in person, and some have bristled at the prospect of letting federal officials onto farms. The agriculture commissioner for Texas, which has emerged as one of the bird-flu hot spots, recently said the federal government needs to “back off.” Meanwhile, wastewater samples—a common way to track the spread of a virus—indicate that bird flu is circulating through 10 of the state’s cities.

Government alone can only do so much. Though only 14 Americans have knowingly come down with bird flu, we have a woefully incomplete picture of how widely it is spreading in humans. Since March, about 230 people nationwide have been tested for the virus. Although the federal government has attempted to compel farmworkers to get tested—even offering them $75 to give blood and nasal swabs—it has struggled to make inroads. That could be because of a range of factors, such as distrust of the federal government because of farmworkers’ immigration status, and lack of awareness about the growing threat of bird flu. A USDA spokesperson told me the agency expects testing to increase as it “continues outreach to farmers.”

You should be experiencing some serious déjà vu by now. In 2020, the U.S. was operating in the dark regarding COVID because tests were scarce, many states were not publicly reporting their COVID numbers, and the federal government and states were fighting over lockdowns. The systematic problems that dogged the pandemic response are still impediments today, and it’s unclear whether either candidate has a plan to fix them. Trump and Harris both seem more intent on pretending that the worrying signs of bird flu simply don’t exist. Neither has outlined a plan for containing the virus, or said much of anything publicly about it. (The Trump and Harris campaigns did not respond to requests for comment.) If America is going to avoid repeating our COVID mistakes, things need to change fast. Angela Rasmussen, a virologist at the University of Saskatchewan, highlighted the need for more widespread testing, and vaccinations for those at high risk of catching the virus. (The federal government has a stockpile of bird-flu vaccines, but has not deployed them.)

H5N1 is already showing its potential to spoil both candidates’ promises to lower grocery prices. Poultry flocks have been hit hard by bird flu, and the price of eggs has spiked by 28 percent compared with a year ago. (Inflation also played a role in increased prices, but bird flu is mostly to blame.) The next president will have to spar with America’s dairy industry if they want to get useful data on how widely the virus is spreading. Dairy farmers have been reluctant to test workers or animals for fear of financial losses. But none of this will compare with the disruption that a new president will have to deal with should this virus spread more freely to humans. For Americans, that will likely mean a return to masks, another vaccine to get, and isolation. Some experts are warning that schools could be affected if the virus begins spreading to humans more readily.

Bird flu doesn’t seem like a winning message for either candidate. Talk of preparing for any type of infectious disease triggers the fears of uncertainty, isolation, and inconvenience that Americans are still trying to shake after the pandemic. It’s hard to imagine either Trump or Harris starting their presidency by instituting the prevention measures that so many people have grown to hate. Unfortunately, the next commander in chief may not have a choice.

On a recent Sunday morning, I sat on a cushioned mat across from Sister True Vow, a Buddhist nun at Blue Cliff Monastery. I had traveled two hours north from Brooklyn to Pine Bush, New York, to seek her perspective on the human tendency to want. “Desire and craving mean forever running and grasping after something we don’t yet have,” Sister True Vow told me, making gentle but unwavering eye contact. There was something else I wanted to know about desire, though. So I asked what she thought of Ozempic.

Before my visit to Blue Cliff, I had been thinking about how so many people taking GLP-1 medications find that, without even trying, they’ve suddenly released their desires for food, alcohol, tobacco, shopping, and more—and how Buddhists have been contemplating this exact transition for centuries. In his first sermon after reaching enlightenment, the Buddha taught that humans suffer because of our desires, and we must unshackle ourselves from them in order to become enlightened. And to some people who take Ozempic or other GLP-1 medications, the lack of cravings feels like freedom. For others, life becomes a little empty. If renunciation of desire is the key to enlightenment, why does the medication version of Nirvana seem relatively lackluster?

Roughly one in eight Americans has tried a GLP-1 drug, a number that could increase as pressure is put on companies to lower prices and generics enter the market. This means that millions of Americans could soon confront a changed relationship with their general sense of desire. It’s a rare chance to peer inside a mindset that’s usually reserved for the spiritually awakened, and discover what it’s like to stop wanting, and what achieving that state in a matter of weeks reveals about the nature of human desire.

GLP-1 drugs such as Ozempic, Wegovy, and Mounjaro mimic a hormone that not only stimulates insulin production but also interacts with the brain’s reward circuitry. Scientists are still working out exactly how people respond psychologically. Despite some anecdotal reports of depression and anxiety, a recent study didn’t find an uptick in neuropsychiatric issues with semaglutide, the active ingredient in Ozempic and Wegovy, compared with three other antidiabetic medications; another found that the drugs are not significantly associated with increased suicidal thoughts. The question of desire is more subtle. Davide Arillotta, a psychiatrist at the University of Florence, recently led a study that analyzed tens of thousands of English-language posts about GLP-1 drugs on YouTube, Reddit, and TikTok and found that, unsurprisingly, many express enthusiasm about weight loss. But other people “reported a lack of interest in activities they once enjoyed, as well as feelings of emotional dullness,” he told me.

[Read: Did scientists accidentally invent an anti-addiction drug?]

Anna, a 51-year-old in California who works in marketing—and who requested to withhold her last name to discuss details of her medical history—told me that several months after she started taking Mounjaro, she began to feel listless. Anna was diagnosed with depression 20 years ago, and treated her symptoms successfully. This was different. She still enjoyed aspects of her life: playing with her dog, spending time with her kids. “I still get joy out of them, but I have to force myself to do them,” she told me. In subreddits about GLP-1 drugs, others express similar concerns. “Does anyone feel depressed or feel lack of enjoyment of life while on ozempic ?” one person asked. From another: “Does the apathy fade?” “I just haven’t been finding much interest, joy, or motivation to do things. I haven’t been able to pinpoint why, exactly,” someone else wrote.

Desire, or wanting, is a discrete mental phenomenon that is driven by the neurotransmitter dopamine. In the 1980s, Kent Berridge, a neuroscientist at the University of Michigan, led a study demonstrating that the neurobiology of wanting was separate from liking. Wanting is the motivation to pursue a reward, whereas liking is the enjoyment we get from that reward. This wanting is different from a cognitive plan, like wanting to stop by the library later; it’s an urge to act. Berridge and others have shown that wanting involves different chemicals and areas of the brain than liking does. This means we can want what we don’t like, and enjoy what we don’t crave; for example, Berridge has argued that addiction stems from the triumph of desire over enjoyment. Anhedonia, the loss of pleasure in activities that used to be meaningful, is commonly understood to be a symptom of psychological conditions such as depression. A better term for what’s happening to some GLP-1 users, Berridge said, would be avolition—a loss of motivation and wanting.

The circuitry of desire can be surprisingly easy to manipulate. Berridge has shown that increasing dopamine can make rats seek out painful electric shocks. Some people who take dopamine-increasing Parkinson’s drugs develop compulsive gambling or shopping habits—an issue of too much wanting. Certain Tourette’s drugs, such as Haldol, lower dopamine levels, and can make life feel dull to some people. In his 1985 book, The Man Who Mistook His Wife for a Hat and Other Clinical Tales, the neurologist Oliver Sacks wrote about a man with Tourette’s named Ray, who said that when he took Haldol, he was “average, competent, but lacking energy, enthusiasm, extravagance and joy.” Ray’s solution was to take the drug during the week, then get his fix of exuberance on the weekends.

GLP-1 drugs affect dopamine pathways in the brain in ways that scientists are still working to understand. Kyle Simmons, who’s leading a clinical trial of GLP-1 drugs for alcohol-use disorder, told me that his team plans to pay special attention to participants’ potential loss in pleasure and their loss in wanting—and the difference between the two. Researchers still don’t know whether taking a GLP-1 drug reduces all cravings or just the strongest ones, Berridge said. But the evidence from other desire-disrupting drugs and experiments can help illuminate why certain people on GLP-1 drugs end up feeling a bit blah. Some might have previously relied on food to regulate their emotions, and can’t eat at the same volume anymore. Others may feel lethargic simply because they’re eating less. And for a person who is used to strong feelings of wanting, “all of a sudden, that goes away, and you have to reestablish what your behavioral drivers should be,” Karolina Skibicka, a neuroscientist at Penn State who did some of the first studies on GLP-1 and dopamine in rats, told me.

[Read: The science behind Ozempic was wrong]

This explanation mirrored what Sister True Vow said as she reflected on my questions about anecdotal reports of apathy and GLP-1 drugs. Buddhism recommends contemplating your cravings over a period of years in order to gradually loosen your grip on them in a deliberate way. Ozempic and its peers, by contrast, “do it in a chemical way, without the psychology of us coming along with it,” Sister True Vow said. When people strongly identify with their cravings, feeling them disappear over a matter of weeks can be jarring. But it can also be an opportunity to uncover the roots of our desire in order to eventually let them go in a more deliberate way, Sister True Vow said. This doesn’t mean people have to forgo enjoyment of the present moment—in fact, Buddhism encourages such pleasures.

The Buddha’s first sermon also described the Middle Way: a balance between the extremes of asceticism and indulgence. Enlightenment is approached not by breaking completely free from desire, but by gaining awareness of how and why you want things. After many months on the drugs, some GLP-1 users appear to be finding their own Middle Way. “I have had to learn more about what desire is, how it works,” Anna told me. When she meditated on what exactly she liked about her favorite hobby—collecting perfume—she realized that she is drawn to the infinite variety of scents, how they produce memories and smell different depending on where on the body they’re applied. I told her she sounded a bit like a Buddhist.

Modern American life is often accused of overloading our dopamine system with TikTok swipes and Amazon Prime deliveries, to the point that influencers and psychologists alike have endorsed “dopamine fasting” to help people break their instant-gratification habits. Desire, in other words, is a monster to be tamed if happiness is to be achieved. Yet people’s emotional responses to GLP-1 drugs reveal that our relationship with wanting is more complex. If an overattachment to every craving can bring suffering, a total renunciation of them can be unsatisfying too.

One Sunday earlier this month, Dave Portnoy ordered a pizza, plopped down on his couch to watch football, and lit a blunt. He was angry. The Barstool Sports founder, who is beloved by many right-leaning young men, was in his mansion in Massachusetts, where he could legally smoke weed “like a human,” as he said in a video posted on X. But he can’t do that at his home in Miami. “Freedom. It’s about freedom,” Portnoy said, encouraging viewers to vote yes on an amendment that would legalize recreational cannabis in Florida, before blowing smoke into the camera.

If Florida passes the amendment, the state would become something of an aberration. Although 24 other states already have legal pot on the books, just four of them voted for Donald Trump in 2020: Alaska, Missouri, Ohio, and Montana. Many top Republicans remain vehemently against legal weed, warning that the drug brings disorder and health risks, especially as marijuana has become more potent. Earlier this year, Virginia Governor Glenn Youngkin vetoed a bill allowing the sale of weed, making a claim that recreational marijuana is linked to “increased gang activity and violent crime”—a link that researchers are still divided over. Senator J. D. Vance, the Republican vice-presidential candidate, has also repeatedly expressed that he is against legalization.

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But the measure in Florida has the support of the state’s most famous Republican. Trump posted on Truth Social earlier this month that he will be voting for the initiative. “I believe it is time to end needless arrests and incarcerations of adults for small amounts of marijuana for personal use,” he wrote. Polls suggest that the referendum is hovering just a tick above the 60 percent threshold it needs to pass and therefore enshrine in Florida’s constitution the right to possess, purchase, and use marijuana. It’s not a sure thing, but if it does indeed go through, the decision would be “an incredibly important concession for American conservatism,” Allan Lichtman, a historian at American University, told me. Florida could end up becoming a tipping point for the rest of the Republican Party.

When Florida acts, other conservative states listen. Under Republican Governor Ron DeSantis, Florida has positioned itself as an antidote to blue America. One week after New York announced its COVID “vaccine passport” in 2021, DeSantis issued an order banning local businesses from requiring proof of immunization. Other red states, including Texas, Georgia, and Alabama, followed suit. And after Florida enacted its “Don’t Say Gay” law in March 2022, more than a dozen states introduced similar bills governing the teaching of sexual orientation in schools. “Florida has been right at the epicenter of the culture war that’s been so important for Republicans in recent years,” Lichtman said.

With legal weed, Florida has not escaped the culture wars. DeSantis has remained vehemently against the measure, even after Trump’s endorsement, as has the state Republican Party, which has said that legalization would “INSTANTLY make Florida more blue.” The state approved medical marijuana in 2016, and Florida’s largest medical-marijuana dispensary has spent tens of millions of dollars to wrangle the nearly 900,000 signatures required to get the referendum on the ballot in November. The DeSantis administration appealed to the state’s supreme court in an unsuccessful attempt to get the initiative struck from the ballot.

DeSantis’s position is aligned with the GOP’s overall message on marijuana, which has stayed fairly consistent even as the party has flipped on many other issues. After all, Richard Nixon led the War on Drugs, Ronald Reagan declared marijuana “probably the most dangerous drug in the United States,” and both Presidents Bush conducted massive enforcement sweeps to signal that the federal government would not loosen its prohibitionist stance. For his part, Trump said in 2015 that recreational marijuana is “bad, and I feel strongly about that.” He has bragged that he’s never touched the stuff. As president, he also claimed to have donated one of his paychecks to fund a public-health campaign against the drug. At times, however, he has also said that states should decide whether or not to legalize.

But Republican voters are gradually breaking away from the party’s hard-line stance. A slim majority are now in favor of legalization, according to Gallup, which has tracked Americans’ views on marijuana every year since 1969. Republicans’ newfound support is as much a matter of age as of politics. Unlike the main state party, the Florida Young Republicans group called legalization “the obvious choice.”

If Florida ends up becoming a weed trendsetter for Republicans, it wouldn’t be the first time. Something similar happened with medical marijuana: By the time legalization came to Florida, many blue states had already green-lit their own medical-marijuana programs. But Florida was the first state in the South to dispense medical marijuana. In the next few years, Arkansas, Oklahoma, and Louisiana followed. If Florida passes the new measure, it would present “a notable marker in this pattern that we have seen,” Joanne Spetz, the director of the Institute for Health Policy Studies at UC San Francisco, told me.

Part of that diffusion of medical marijuana was influenced by more conservative states learning from the experience of more liberal ones, and designing their programs to be more palatable to a population that doesn’t want to see beachfront pot docs selling medical cards to every tourist with a headache. In red states, medical-marijuana programs “tend to be more restrictive” than in blue states, Daniel Mallinson, a public-policy professor at Penn State Harrisburg, told me. The same may hold for recreational marijuana. Whether states follow Florida’s lead might come down to whether the state can implement legalization in a way that simultaneously fulfills the will of the electorate and doesn’t make retirees in the Villages lament that they’ve suddenly been transported to Denver. Put simply: It might come down to the smell.

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“I don’t want every hotel to really smell,” DeSantis warned at a press conference in early March. It’s a concern shared by Trump himself, who last month posted that Florida must ensure that “we do not smell marijuana everywhere we go, like we do in many of the Democrat run Cities.” New York Republicans have introduced legislation to ban marijuana smoking in public in response to New Yorkers being “regularly assailed with the pungent odor of marijuana on public sidewalks, in parking lots and other public spaces”—which even Democratic Mayor Eric Adams acknowledged is pervasive. And Vance opposed his own state’s legalization efforts, because “I want to be able to do normal things without being slammed in the face with the smell of weed.”

Of course, most states with legal marijuana also restrict public consumption of the drug, but enforcement is often spotty. Florida is not exactly known for effectively preventing public disorder. It is the state that has made headlines for Disney World patrons attempting to steal a golf cart, annual spring-break riots, and men who risk danger with alligators (whether it’s throwing a gator through a drive-thru window or stealing one from a mini-golf course).

Even if Florida enters a new era of reefer madness and manages to somehow keep the Disney World tourists, spring breakers, and “Florida men” calm, not every red state will quickly follow suit; voters in Oklahoma and Arkansas voted against legalization in recent years. Still, Florida’s measure could be a win for conservatives—even the ones who are anti-weed. They are right: Marijuana can be addictive, and pot smoke stinks. But the status quo—one in which marijuana is banned on the federal level—keeps the drug in a gray area that prevents it from being studied on university campuses and regulated by the FDA. Yes, legalization might mean Republicans smell weed on street corners, but it could also allow for more research into the effects of marijuana, and more regulation of where and when the drug can be used.

Until a critical mass of red states embraces recreational weed, it’s hard to see anything changing. Florida cannot bring the entire Republican Party along overnight, but perhaps sometime soon, Dave Portnoy and his “stoolies” in Florida can legally order pizza, watch football, and smoke a joint on the couch.