Marijuana IS NOT “Harmless”
Only the Cannabis Industry, and those deceived by their decades-long tobacco-like campaign of normalization, are saying marijuana is harmless. Those who are studying the effects of regular marijuana use are warning the drug is in fact clearly harmful — not only to those most vulnerable (youth and young adults with still-developing brains) but to regular adult heavy users as well.
Even as those appointed to regulate the marijuana industry in Massachusetts are being bombarded by the self-serving narrative of this next addiction-for-profit industry, doctors and scientists are amassing volumes of evidence that regular marijuana use IS harmful.
Here is the testimony of a neuroscientist submitted to the Massachusetts’ Cannabis Control Commission. Lawmakers, voters, regulators, mothers and fathers, as well as would-be and current users, should read the following and its embedded links:
Dear Members of the Cannabis Control Commission,
I am a PhD level neuroscientist, trained analyst in mental health and substance use disorder pathophysiology and therapeutic areas, and parent of three young children; I have been a leader in youth substance abuse prevention efforts in the MetroWest region for the past 7 years.
A growing body of scientific evidence suggests that no amount of marijuana use is safe for children and youth; chronic use during adolescence is associated with long-lasting effects on the brain resulting in increased risk of addiction and negative impacts on mental health (including suicide and psychosis 1,2) and achievement metrics. Marijuana/cannabis is not “harmless”. Commercialization and use of high potency marijuana products, including concentrates and edibles, are of particular concern with respect to increased risk of negative consequences for public health and safety. Legalization of marijuana reduces youth perception of harm and increases access to marijuana by youth. Because marijuana legalization is associated with public health and safety consequences resulting from increased use by both youth and adults, tax revenue gained from legal marijuana is quickly offset by the social costs. Rational policy includes no criminal punishment for possessing a small amount of marijuana but does include assessment, intervention and treatment as-needed for problem use.
Any marijuana policy must include: significant local controls; limits on THC concentration; no marijuana advertising; strong provisions, and funding, for the prevention of youth marijuana use; safeguards for public health and safety to include drugged driving; and a mechanism for short- and long-term data collection to track marijuana use rates and related public health and safety metrics.
Minimizing negative impacts on public health and safety must remain the primary focus of any marijuana policy; oversight measures must ensure this focus.
Marijuana Legalization Does Impact Youth Use
From prevention science, we know that increased access and availability and increased normalization of marijuana use are associated with increased youth use. Further there is a vast body of literature regarding the impact of adult substance use on youth use; increased marijuana use by parents, older siblings, and other respected adults in the lives of children does contribute to the normalization of marijuana use, reduced perception of harm, and reduced perception of parental disapproval. Taken together with marijuana advertising and other commercialization pressures, these factors increase youth use.
A regional analysis of the 2015 Healthy Kids Colorado survey data by Dr. Christian Thurstone3, an Associate Professor of Addiction Psychiatry and the Director of Medical Training of the Addiction Psychiatry Fellowship program at the University of Colorado, gives an example of this. Dr. Thurstone says:
“A common theme among these regions [with higher youth marijuana use] is a high level of marijuana commercialization in the forms of retail and medical stores. Other commonalities should be investigated to determine the most appropriate interventions.”
Indeed, an overlay of commercial marijuana shops with regional marijuana youth use data, shows that the regions with the highest youth marijuana use rates in CO (and the nation) are also those that have the highest degree of commercial pot shops or a high degree of marijuana/THC outlet density.
– Dr. Thurstone also says:
“I’m interested in this subject because 95 percent of the teenagers treated for substance abuse and addiction in my adolescent substance-abuse treatment clinic at Denver Health are there because of their marijuana use, and because nationwide, 67 percent of teens are referred to substance treatment because of their marijuana use. Marijuana is the No. 1 reason why adolescents seek substance-abuse treatment in the United States.”
Limits on THC Concentration are Necessary
Commercialization and use of products with a high concentration of THC, including edibles and concentrates (some with THC near 100%), are of particular concern with respect to increased risk of negative consequences for public health and safety, particularly for youth. In Uruguay, legal marijuana is capped at 15% THC. The Netherlands government4>; has said: they “plan to place cannabis with a THC concentration of 15% or higher on the Opium Act’s Schedule I, making high-potency cannabis a hard drug. The government sees high-potency cannabis as carrying an unacceptably high risk. It is a contributory factor in increasing damage to health, especially when used at a young age. That is why the consumption and production of this type of cannabis needs to be discouraged.”
A recent statistic indicates that ~20% of marijuana users who are daily/near daily users account for approximately 80% of sales. Industry representatives themselves have said that these daily/near daily users require products that are of high quality and high THC concentration (likely because of biological tolerance resulting from chronic use). Many of these individuals would likely meet criteria for a cannabis use disorder (CUD). In fact, in a 2017 Country Drug Report for the Netherlands5, 47% of drug abuse treatment entrants were there for a primary addiction to cannabis.
Emerging scientific data indicate that use of cannabis products containing high concentrations of THC are of particular concern with respect to the potential for harm to children, increased risk of addiction and mental health issues. As a neuroscientist with a focus on psychiatric pathophysiology, this is alarming. The conversations with parents, clinical care givers/counselors, law enforcement, the perceptions of many young people, and the impact of marijuana on their lives is troubling. Here is a recent quote from a MA Police Chief:
“The trend is growing quickly with this stuff. We just had another kid (actually late 20s) vape oils all day, then eat edibles causing major suicidal ideation and psychosis. This kid was OUT OF IT.”
We’ve seen the THC ziti, chocolate pretzels, chocolate chip cookies, and lollipops – and four kids requiring ER visit…”
There is no question that marijuana use is increasing among 18-25 year olds, across the country and in Colorado; this age range coincides with the typical age of onset of schizophrenia. The average age of onset is approximately 18 in men and 25 in women and the National Alliance on Mental Illness (NAMI) lists Substance Use (and marijuana use in particular6) as a possible cause. Neuroscience research now shows that the brain does not fully develop until at least the age of 25. This quote from an Addiction Recovery Coach in Massachusetts sums this concern up well, “Can we do a study on the amount of kids we are working with who have developed schizophrenia or have lost all desire for life because of heavy pot use with an un[der]developed brain? It’s really terrifying. Exploitation by those who only care about making a dollar continues to become more evident.” This concern cannot be overstated. We cannot afford to wait for decades to pass before we acknowledge this negative impact on mental health, like our nation did with tobacco and physical health.
New scientific research findings regarding the negative impact of marijuana use on public health are emerging every day. Some recent examples of this include:
- Emergency Visits Related to Marijuana Use at Colorado Hospital Quadruple (American Academy of Pediatrics News, May 2017)7
- Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans (Journal of Psychiatric Research, June 2017)8
- The Impact of Cannabis Use Disorder on Suicidal and Non-suicidal Self-Injury in Iraq/Afghanistan-Era Veterans with and without Mental Health Disorders (Suicide Life Threat Behav., March 2017)9
- Marijuana and acute health care contacts in Colorado (Preventative Medicine, March 2017)10
Key Elements of Cannabis Regulations to Minimize Public Health and Safety Harms
An important guide for developing cannabis regulations that strive to reduce the negative impact on public health and safety was authored in 2016 by Dr. Stanton Glantz, a key opinion leader in nicotine addiction and tobacco prevention.11, 12 The document is titled: “A Public Health Analysis of Two Proposed Marijuana Legalization Initiatives for the 2016 California Ballot: Creating the New Tobacco Industry”. I ask that you please take the time to carefully read this analysis. It provides important background for understanding how the recommendations for best practices, below, for marijuana policy have been derived.
Demand a strong per se standard for driving while high.
As Colorado and Washington have demonstrated, states with legalization should expect a surge in fatalities related to driving while high. A strong per se standard for driving while high is critical to deter as many marijuana users as possible from driving while impaired to keep the roads as safe as possible.
Establish an independent oversight office, staffed solely by public health experts, to track data related to marijuana use.
Following the adage of “you can’t manage what you can’t measure,” an independent office staffed solely by public health professionals needs to gather and track data related to the health impacts of marijuana use. An independent body is needed, staffed with research experts with deep expertise in addictive substances and social cost measures. Otherwise, while the pot lobby drives for-profit consumption through marketing and sales, there will be no robust data collection to track the industry’s impact.
Dedicate funds to marijuana prevention education and marijuana-related disease research and education.
Adolescents are particularly vulnerable to serious, negative consequences from marijuana use. 21 years of age should be set as the minimum age of purchase and access to marijuana. Funding must be dedicated to fully educate youth and the general public about the risks associated with marijuana use. Broad based media campaigns aimed at the general public, as well as youth, should be implemented to minimize drug use and addiction.
Set up a statewide law enforcement office to measure black market and cartel activity, and coordinate with neighboring states.
Colorado has seen an unprecedented rise in black market activity since legalization. The state had one organized crime filing in 2007, and 40 in 2015. In 2016, reports of Mexican cartel activity began to filter in, indicating that underground networks are taking advantage of the changing laws to hide in plain sight. Gathering data on this black market activity will be critical, and the industry will not shoulder that burden.
Pass strong product liability and dram shop laws for marijuana.
The marijuana industry is promoting and selling a psychotropic product that will be associated with negative outcomes and addiction for some users; the marijuana industry must be held accountable for product liability and dram shop laws. Shops that sell marijuana to individuals who are clearly impaired should be strictly liable to anyone injured by that person. Manufacturers, distributors, and retailers should be liable to those who have adverse reactions from using their product.
Restrict edibles and concentrates.
The most serious danger to public health with respect to legal marijuana products are edibles and concentrate products. Their high THC concentration, resemblance to non-laced consumer products (candy, topical lotions, etc.), and ease of use create serious, costly problems. They must be heavily regulated to prohibit their advertising, sales, and use.
Ban public consumption of marijuana and enforce the public consumption ban.
Include marijuana in existing smoke-free laws to reduce exposure to secondhand smoke. These laws must be enforced. Massachusetts must send a strong message that normalizes public consumption of marijuana. Unfortunately, after marijuana legalization in Massachusetts, the smell of marijuana is frequent in public spaces; this serves to normalize marijuana use, especially for our youngest demographic in Massachusetts.
Mandate strict advertising restrictions.
Advertising should be limited to inside retail stores only, with no visibility to youth. Like alcohol and tobacco, underage users are a very profitable market for the marijuana industry, even if sales to them are illegal; 11% of alcohol sales are from those 20 years old and younger. Early-onset users are more likely to become highly profitable heavy users, and brand loyalty is generally developed and solidified when users are younger. Advertising is therefore an important component to targeting and capturing these users, as the U.S. experience with tobacco has demonstrated. To the extent possible, advertising should be heavily regulated and restricted. Moreover, simple prohibitions on ads “targeting minors” have an empirically poor track record—there is too much legal room to debate on what targets minors and what does not. Good restrictions must go farther than that and be general in nature. The “WeedMaps” advertisement billboards in Massachusetts, many in locations highly visible to youth (including two at the entrance road to “Ultimate Obstacles” in West Boylston, an adventure center and birthday party venue for youth), displaying misleading or even false information, are meant to reduce the perception of harm and perception of disapproval to “normalize” the use of marijuana in Massachusetts.
Heavy penalties for advertising or selling to minors.
Given the importance of keeping marijuana out of the hands of minors, this is a critical component of a strong regulatory policy.
Targeting investors with enforcement actions.
Strong enforcement should address those financing non-compliant marijuana operations, as well as the operators.
Proactive prosecutions of lawbreakers.
This includes proactively promising, via a formal memorandum, to refer marijuana businesses that do not comply with state law to federal law enforcement, or promising to bring state racketeering prosecutions and/or forfeiture actions against not only the operators but also their investors, no matter where they are located. (Creating potential criminal liability for investors is key to controlling the industry—those solely interested in returns are highly unlikely to risk prosecution in exchange for a slightly higher return on investment.)
The work of the CCC has tremendously important implications for public health and safety of Massachusetts youth, families, and adults. Knowing this, I can confidently say that the evidence-based policies outlined above and in the referenced document, rooted in what has worked in tobacco prevention, are critical to minimize harm. Additionally, I provide a brief summary of must-haves below:
- Tight restrictions on retail outlet density and hours/days of sale are critical to reduce problem use
- Ban all marijuana-related advertising outside of retail interior Strict limits on THC concentration (no more than 10-15% THC and consider requiring a particular range of THC/CBD ratios13), edibles, and packaging (see what Australia is doing with tobacco packaging14)
- Strict regulations for child-proof_packaging and labeling to include warning labels
- Strict regulations for product testing and labeling
- Higher tax rates and product prices, with designated funding for prevention and education
- Messaging to the public that helps to denormalize marijuana use
- Safeguards for public health and safety to include drugged driving
- A mechanism for short- and long-term data collection to track marijuana use rates and related public health and safety metrics
- Strong input and oversight by public health/prevention/public safety experts is critical to ensure a public health focus instead of a business-friendly focus.
Massachusetts is considered a leader in the Nation for public health with some of the ‘best hospitals, research centers, and academic institutions in the world. I ask that this Commission and any additional oversight bodies seek out continued guidance from prevention and public health experts on the ground, in communities across the Commonwealth, to ensure these voices are heard. It is important that Massachusetts show that we are the public health leaders that the rest of the nation thinks we are, by prioritizing public health over commercial interests.
Thank you very much for the opportunity to provide comments and for your continued time and attention to ensure a strong focus on public health and safety.
Amy Turncliff, PhD