The President’s Podium: The Real Issue of Question 4
by James S. Gessner, M.D., President, Massachusetts Medical Society
Citizens thinking about how to vote on Ballot Question 4 – whether or not to legalize recreational marijuana – should ask some important questions before casting their ballot.
How would our health and safety, and especially that of our children, be affected should recreational marijuana become legal? What affect will it have on our highway and occupational safety? Should Massachusetts allow ready access to a substance with a potential for addiction when we are fighting an epidemic of opioid abuse that is already disrupting and destroying too many lives?
These are critical questions, because this referendum, more than anything else, is really about public health and safety.
Marijuana is not harmless. Its main ingredient – tetrahydro-cannabinol (THC) – is a mind-altering substance, and the amount of THC has been increasing steadily over the years. The THC content in marijuana today is four times stronger than it was in the 1980s.
We know that a risk of addiction exists with marijuana. According to the National Institute of Drug Abuse (NIDA), approximately 9 percent of those who use marijuana will become addicted. The rate jumps to 17 percent, or about 1 in 6, for those starting to use it in their teens and rises to 25–50 percent among daily users.
We also know its use contributes to cognitive impairment, presents a risk during pregnancy, poses a threat to highway and occupational safety, and can damage the developing brains of adolescents – the last being one of marijuana’s most troubling effects.
A 2014 article in the New England Journal of Medicine by NIDA Director Dr. Nora D. Volkow and her colleagues reviewed the current state of the science on the adverse health effects of recreational marijuana. Here is part of what they concluded:
Marijuana use has been associated with substantial adverse effects, some of which have been determined with a high level of confidence…. As policy shifts toward legalization of marijuana, it is reasonable and probably prudent to hypothesize that its use will increase and that, by extension, so will the number of persons for whom there will be negative health consequences.
In summary: the legalization of marijuana will lead to more marijuana use and more use will lead to more people with poorer health.
Physicians are especially concerned about the impact of this law on children and adolescents, despite a proposed ban on sales to anyone under 21. An age restriction doesn’t work with tobacco and alcohol; it won’t work with marijuana. In Colorado, where legalization occurred in 2012, the state has seen an increase in marijuana use by youth 12-17 that is now 56 percent higher than the national average.
Adding to the concern is that teen perception of the risks of marijuana has decreased over the past decade, largely due to efforts to legalize medical and recreational marijuana. The American Academy of Pediatrics has warned that increasing the availability of marijuana for adults, regardless of restrictions, expands access for youth and persuades them that it’s not dangerous – and that’s a wrong message to send to our young people.
Legalization will also likely to lead to greater danger on our highways, because the skills needed for driving – alertness, concentration, coordination, reaction time – are impaired with marijuana use. In Washington state, where voters approved recreational marijuana in 2012, the number of fatal crashes involving drivers who recently used marijuana doubled in one year, according to a study by the AAA Foundation for Traffic Safety. Colorado has likewise seen a jump – 48 percent – in marijuana-related traffic deaths.
Those are compelling reasons against legalization. But the ballot question itself gives us more reasons to vote no on Question 4.
First, the referendum permits the sale of marijuana edibles, such as cookies, candies, snack foods, and drinks, which are especially appealing to children.
Second, it lacks any provision for public health oversight or authority in the development of regulations that would guide implementation of the law. And third, it has no allowance for any revenue from the sale of the drug to be earmarked for health education, prevention, or treatment programs. These are serious failings.
A careful read of this ballot question reveals that this was created by and for the marijuana industry, without regard for public health in the Commonwealth.
The Massachusetts Medical Society and 10 physician specialty groups, representing a wide variety of medical specialties, including pediatrics, primary care, emergency medicine, obstetrics, and psychiatry, have stated their opposition to Question 4 for the reasons listed above.
We think preventing possible addiction, guarding our public health and safety, and protecting children and adolescents are far more important and valuable than the commercialization of marijuana and the “recreational” use of a substance capable of causing harm. We hope our patients think so, too.
The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine. Versions of the above have been distributed to newspapers across the Commonwealth for publication as commentary.