Where There’s Smoke – As Marijuana Law Gets Tweaked, Doctors Remain Vigilant

When Massachusetts voters approved a ballot question in November legalizing marijuana for recreational purposes, a brave new world of open pot use didn’t suddenly begin.

What did commence was a long, sticky, and still-ongoing legislative process to craft, at the legislative level, exactly what the law will look like.

That effort should include educating the public that, while marijuana might now be legal, it can still be damaging, said Dr. Henry Dorkin, who was recently sworn in as president of the Mass. Medical Society (MMS) for 2017-18.

“The packaging issue, and signage in places where marijuana will be purchased, are important,” he said. “We’re already working on some materials, which we want to make available to physicians in their offices — similar to things we already do with with narcotics. I think people need to understand all the ramifications of anything they ingest, and part of the medical society’s mission is to see to it that the public, as well as our legislators and physicians, are fully informed.”

However, he concedes that the ship has sailed on legalization itself — voters saw to that by a 53{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 47{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} margin — and lawmakers have moved on to the law’s details, such as a tax structure on legal pot, state governance of marijuana-related matters, local control by communities over pot-related businesses, and other matters.

For example, the Legislature’s Joint Committee on Marijuana Policy has discussed changing the suggested tax rate on pot sales. The law as approved by voters sets a 3.75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} tax on retail sales, plus a 2{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} local option tax, all on top of the state’s 6.25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} sales tax, for a total of 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

That’s well under the rates set by most other states that allow marijuana sales and use. Still, the Department of Revenue estimates that even those figures would generate about $65 million in revenue in the first year and about $130 million by the second.

“Higher tax rates are likely to generate greater revenue for the Commonwealth, dissuade youth from consuming since they tend to be price-sensitive, and generally reduce market demand,” a recent state Senate report said. “However, they may limit the development of a regulated industry and drive consumers to purchase marijuana illegally in the black market.”

Lawmakers aren’t afraid of making changes to the law; they’ve already delayed the expected start date for commercial marijuana sales from January 2018 to July 2018. They’ve also discussed whether the law’s creation of a three-person Cannabis Control Commission appointed by the state treasurer should be altered to give the Legislature more authority on marijuana issues.

Senate President Stanley Rosenberg said the joint committee could recommend leaving oversight with the treasurer, creating a wholly independent panel, or something in between, the State House News Service reported. “There are more right ways of doing it than wrong ways … it’s a whole new venture for government, and we just want to get it right.”

On the issue of local control, residents of some communities where a majority of voters rejected the measure argue that municipal officials should be able to keep pot sales out of their town. But others have been more circumspect.

 “I believe there’s already sufficient local control in the question that was passed,” Holyoke Mayor Alex Morse said at a recent public hearing on legalized-marijuana issues in West Springfield. “I think it’s important that local councils, Select Board members, and even mayors don’t have the authority to ban it from their communities, and even those communities that have voted against it by a majority of residents should have the choice as to whether they would like to go to a dispensary for medication or recreational [marijuana].”

Many of the Mass. Medical Society’s issues boil down to public health and public safety, particularly when it comes to young people and the health effects of marijuana on developing brains.

 “The ballot initiative [legalizes pot for] age 21 and older, but we have data that the brain is still developing through adolescence, even through age 25. We have some concerns about the impact on the developing brain,” Dorkin told HCN.

“We also want to see that whatever legislation is crafted includes some provisions for funding research into the untoward effects of marijuana, and data suggesting that adolescents are somewhat more likely to become addicted to marijuana if they start using it early enough. These are just a few of the issues we’re looking at; we’re interested in how this legislation is crafted to protect the public as marijuana becomes available recreationally in the Commonwealth.”

Dorkin said the MMS has a “good working relationship” with state lawmakers, and that the society testifies on many issues of public health and is confident that its concerns are taken into account.

In April, former MMS President Dr. James Gessner testified before the joint committee, supporting legislation that would increase the public-health protections in the state’s marijuana laws. He backed several bills that would:

• Promote public-health education, with a particular emphasis on education and marketing policies aimed to prevent marijuana use among youth;

• Fund, conduct, and publish research on the clinical and public-health effects of recreational marijuana; and

• Amend the oversight structure to provide a strong medical and public-health voice in the Cannabis Control Commission.

“The medical society remains concerned about the omission of detail throughout the ballot initiative,” Gessner noted. “While many provisions of the ballot measure require regulations to be promulgated on certain issues, such as safe packaging of edible products and the safe cultivation practices, the lack of detail provided in the statutory charges and lack of reference to national standards leaves the content of the regulations entirely to the discretion of the Cannabis Control Commission.

“The medical society urges modification of the statutory language to provide further detail on the direction and content of the regulations,” he went on. “This would help ensure the regulations on edibles are genuinely effective in limiting accidental ingestion by children, for example, and would reduce likelihoods of contaminated products.”

The issue of edibles is one that physician groups — and other opponents of legalized pot — raised multiple times during discussions about the ballot question last year. In an opinion piece in the Boston Globe several months before Election Day, 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.”

Around the same time, 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.

The issue of marijuana edibles is a particularly vexing one for opponents, as they are often indistinguishable, on first glance, from common candy. A group of 120 state legislators who publicly opposed the ballot question last year noted 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.

“That’s still very important concern — the edibles are being made in the most attractive form possible,” Dorkin told HCN. “We’re concerned that adolescents will find this appealing, and younger people, children, will get into it. There are always concerns about infants getting into things they shouldn’t — the whole issue of laundry-detergent pods has been discussed at length. Certainly, we want to make sure marijuana edibles are not ingested by people below the age of the law.”

Other matters the Legislature is dealing with range from home growing (the law currently allows 12 plants per household) to whether field sobriety tests for marijuana can be used in court cases. But for many physicians, helping the public understand the health risks of marijuana is the most critical component of the law’s implementation.

“There are all kinds of concerns in daily life,” Dorkin said. “The physician’s goal, in addition to treating the sick, is preservation of good health. We feel the more people understand the issues, the better they will be at staying out of trouble.”

Gessner agreed. “Data is critical to developing good policy, and to protecting the health of the public,” he told the joint committee. “Our public-health experience with tobacco should be a clarion call to government as we work to set marijuana policy. We cannot allow marijuana to replace tobacco as the next public-health threat. Evidence-based research and data are the only way we can ensure history does not repeat itself. Too many lives are at stake.”