Joint Concerns – Medical Professionals Worry About Prospect of Legalized Marijuana

Vermont Gov. Peter Shumlin makes no secret of his stance on marijuana. He’s long promoted legalization of the drug for recreational purposes, as Colorado, Washington, Oregon, and Alaska have done and other states, including Massachusetts, are considering, and he’s spoken and written at length about why pot possession shouldn’t be a crime, but an open, regulated activity.
In short, he’s as pro-marijuana as a governor can be.
Yet, he thinks Massachusetts has a terrible ballot question on its hands.
The marijuana-legalization bill up for referendum on Question 4 of Massachusetts’ Election Day ballot, Shumlin argues on his blog, “would allow edibles that have caused huge problems in other states, smoking lounges, home-delivery service, and possession of up to 10 ounces of marijuana. Vermont’s bill allows none of that. If Massachusetts moves forward with their legalization bill while Vermont delays, the entire southern part of our state could end up with all the negatives of a bad pot bill and none of the positives of doing the right thing.”
If a pro-pot governor has such harsh words for the Massachusetts bill, it’s not hard to imagine what medical professionals think.
“We’re concerned for a number of reasons — about recreational marijuana in general and this particular ballot question,” Dr. James Gessner, president of the Mass. Medical Society (MMS), told HCN. He noted that the human brain is still developing throughout one’s 20s, and among the late-developing areas of the brain are those governing judgment issues.
“Marijuana is the single most commonly used drug among adolescents and has significant effects on the developing brain, impairs memory and judgment, and, with early, prolonged use, can have a distinct, negative effect on intellectual development,” he went on. “My concern is really with the unexpected consequences on youth and adolescents. At a time of risk taking in their lives, this drug really blunts judgment.”
If that’s true, then what the Massachusetts bill does, opponents argue, is make it far easier for adults — and children — to get their hands on a harmful substance they might have avoided before simply due to fear of legal consequences. The bill would also lend a veneer of respectability to marijuana, said Dr. Robert Roose, chief medical officer, Addiction Services, for the Sisters of Providence Health System.
“The main concern is providing access to psychoactive substances that have negative consequences for some individuals, and sending a message that marijuana products are safe and beneficial, when there’s really not strong evidence to suggest either of those things may be true,” Roose told HCN.
Some of the state’s top leaders echo this view. In an opinion piece in the Boston Globe earlier this year, Gov. Charlie Baker, Attorney General Maura Healey, and Boston Mayor Martin Walsh argued that marijuana is not safe — citing risks like impaired brain development, disinterest in school, and motor-vehicle accidents — and increasing access to it makes little sense at a time when the state is already grappling with a well-documented opioid-addiction epidemic.
“There are serious and immediate implications for public safety,” they wrote. “In the year after the drug was legalized in Colorado, marijuana-related emergency-room visits increased nearly 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, as did traffic deaths involving marijuana. Edible marijuana products — often in the form of brownies, candy, or soda — pose a particular threat for children, who may mistake them for regular treats.”
They cited a report from the Rocky Mountain High Intensity Drug Trafficking Area, which found that marijuana use has decreased among minors nationwide in recent years, but Colorado youths are 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} more likely to have used the drug regularly since it became legal for adults two years ago. “Many believe that, since the drug is legal for adults, it must be safe to use.”
That trickle-down impact on young people is one key driver — though far from the only one — in a growing movement in the medical community to convince voters to defeat the marijuana-legalization measure in November. Time will tell whether those efforts will bear fruit.

Opposition Mounts
Earlier this year, the MMS joined the Campaign for a Safe and Healthy Massachusetts, a coalition of health and community leaders established to oppose the ballot question allowing commercial sale of marijuana for recreational use. Other members include the Mass. Hospital Assoc., the Assoc. for Behavioral Healthcare, the Massachusetts Assoc. of Superintendents, the Massachusetts Chiefs of Police, all Massachusetts district attorneys, and an array of state leaders including Baker, Walsh, and House Speaker Robert DeLeo.
While a vote four years ago to legalize medical marijuana hasn’t been without controversy — doctors still worry about prescribing a product that’s still illegal under federal law — recreational pot presents a completely different set of issues.
“There’s a lot of data about kids that use marijuana heavily and face school failure, failure to graduate, difficulty keeping a job,” Gessner said. “Plus, it’s smoked. We’ve spent 50 years talking about the dangers of smoking. This is simply another form of lung attack.”
Gessner also raises the potency issue, arguing that the active ingredient in marijuana — known as tetrahydrocannabinol, or THC — typically comprised about 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of marijuana in the 1970s, while the current potency can approach 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, though it varies from batch to batch. In Colorado, the average THC percentage has been around 17{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.
But even recreational-marijuana supporters, like Vermont’s governor, find the bill currently up for referendum in the Bay State to be a deeply flawed one, favoring potential pot producers and sellers but including no provision for education, counseling, or treatment for users. It also allows a wide range of marijuana products — not just the smoked variety, but waxes, resins, and ‘edibles,’ often indistinguishable from common candy. The latter concerns 120 state legislators who recently voiced their opposition to the ballot question.
They note that edibles account for 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of marijuana sales in Colorado, and the number of children under age 10 who suffered from marijuana exposure has increased by 150{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in Colorado since the state legalized commercial marijuana, including edibles.
“This a bill for producers that allows for one of the most dangerous exposures in edibles,” Gessner said. “These are manufactured products branded to look exactly like legitimate food products. If edibles are available, they will wind up in the hands of the least suspecting groups: babies, infants, children. I can see a fourth-grader eating a brownie laced with marijuana, then riding a bicycle, or an eighth-grade girl eating a candy bar, and who knows what happens?”
The Campaign for a Safe and Healthy Massachusetts recently won a victory in the state Supreme Judicial Court, which ordered the ballot question amended to make clear that edibles, not just smoked marijuana, would be legalized.
“We are pleased the SJC has recognized that this ballot question would usher in an entirely new marijuana-edibles market and that voters must be informed of that fact,” coalition spokesman Corey Welford said in a press statement. “Under this proposal, the marijuana industry would be allowed to promote and sell these highly potent products, in the form of gummy bears and other candies, that are a particular risk for accidental use by kids.”
Since becoming the first state to legalize marijuana for adults, the coalition notes, Colorado has also become the number-one state in the nation for teen marijuana use. Use by teens aged 12-17 jumped by more than 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in the two years since legalization, even as that rate declined nationally. In Washington, the group notes, the number of fatal car crashes involving marijuana doubled in the one year since legalization.
“When we think about addiction — whether to alcohol, cannabis, or opiates like heroin — it’s appropriately described as a chronic disease of the brain,” Roose noted, “and we know very well, with many years of evidence, that the more accessible a substance with a psychoactive component is, the more likely it is to be used.”
Shumlin — again, an enthusiastic supporter of recreational marijuana — laments the fact that the Massachusetts bill will allow edibles that have caused problems in other states, smoking lounges, home delivery service, and possession of up to 10 ounces of pot, while a bill he is promoting in Vermont allows none of that.
“If Massachusetts moves forward with their legalization bill while Vermont delays,” he wrote, “the entire southern part of our state could end up with all the negatives of a bad pot bill and none of the positives of doing the right thing.”

Reversal of Fortune
For doctors like Roose who have been on the front lines of the state’s battle against rampant opioid addiction, opening the doors wide to recreational marijuana would be a blow against the progress being made against drug abuse and its often-tragic effects.
“The earlier you have someone hooked or identified as a user of your product, the greater market share you can expect down the line,” he told HCN. “That’s the converse of what we’re trying to do in public health; we want to delay the start of something that can affect their brain.”
In their opinion piece, Baker, Healey, and Walsh noted that emergency departments and drug-treatment centers are beyond capacity, and first responders are stretched to their limits.
“We should not be expanding access to a drug that will further drain our health and safety resources,” they wrote, arguing that any tax revenues from marijuana sales would be vastly insufficient to cover the added public-health costs legalized pot would bring, and that almost all the financial benefits would go directly to pot producers and their investors.
Roose isn’t as concerned with the financial costs as the human ones, so he comes back repeatedly to the question, what does substance abuse of any kind do to a society in terms of illness and premature death?
“When we look at alcohol, nicotine, all drugs, we should take an approach that effectively mitigates those risks. That’s what treatment providers in the medical community should be looking at,” he said. “The brain can develop into the 30s, and when we delay the onset of someone experimenting with these substances, we’re looking at benefits to society from less recurrence of mental illness, improved educational attainment, and lowered rates of addiction — very approachable goals for the medical community.”
Conversely, he went on, the more accessible a state makes those substances, and the less the risks to young people are recognized, the more problems arise. It’s similar, he said, to the past cultural belief, long disproved, that prescription medications are somehow safer than street drugs, leading to lax oversight and the addiction problems ravaging the Commonwealth today.
Of course, the effects of legalized marijuana won’t be an issue if voters defeat Question 4. A Boston Globe survey in July found 51{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents opposed to the measure, 41{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in favor, and the remainder unsure.
Gessner worries that a burgeoning market for marijuana in all its forms would find the most purchase in socioeconomically disadvantaged neighborhoods, and wonders why provisions for addiction counseling and treatment weren’t included in the bill’s language, as they were when casino gambling was legalized in Massachusetts. “Those things are completely missing. The bill doesn’t recognize the unintended consequences, especially for youth.”
Roose stressed that he doesn’t support further criminalizing pot possession and creating new punishments for users. “That’s not shown to have a positive outcome. We would rather intervene with education and provide comprehensive treatment for those substance-use disorders.”
That job will certainly become more difficult if marijuana sales are allowed to emerge from the shadows, easily accessible to adults — and, most likely, young people, too.