Now that recreational marijuana will be legal in Massachusetts, what will the impact be?

One of the main arguments that opponents of Question 4—the ballot question to legalize marijuana in Massachusetts—raised is that it could lead to pot shops on every corner and heavy use among state residents, including those who under the legal age for consumption. Given your own research on marijuana liberalization laws, do you share that concern?

Believe it or not, pot shops on every corner is way back on my list of concerns about legalization. If you think about it, we enacted medical marijuana policy in 2012, which allowed for 35 dispensaries. The first dispensary (of seven) didn’t open until 2015, two-plus years after the law was enacted. This is a byproduct of both the bureaucratic approval process along with towns and cities fighting back on dispensaries and their location. I already see towns, including my own, proactively working to ensure recreational shops and advertising are “not in our backyard” or even close. They are very concerned for their teens.

Question 4 was written with little regard to the public health or safety sectors, very similarly to Colorado’s, where the marijuana industry also took the lead. However, the local level has shown to be powerful in Colorado and can be in Massachusetts as well. It’s been very interesting watching Colorado figure out legalization—and the unintended consequences they’re facing, including the location of marijuana dispensaries and businesses. I think it’s very important for us to take note and be wary of slipping into the loopholes written into our policy, which as written allows the “green rush” for-profit marijuana industry into our health and safety zones, and possibly our backyards.

In a recent blog post, you wrote that, "marijuana policy is a gray area" for which "we don't have the answers yet." So how would you advise Massachusetts regulators as the state wades into this uncharted area?

Marijuana laws are passed at the state level, leaving states to pass often very different policies even under the same umbrella terms of “medical marijuana” or “legalization.” This phenomenon combined with the newness of enactment and implementation of marijuana laws makes it difficult for research to adequately understand the results of these changes. Thus far, most studies compare varying states with either medical marijuana and/or legalization to varying states without, which is problematic (why we don’t compare candy apples to THC-infused gummy bears). There are differences in if OR how much people are allowed to: possess, grow, and distribute marijuana, as well as logistics surrounding nonprofit vs. for-profit dispensary and business options, legal protections for consumers, taxation, the list goes on. To me, what is most worrisome in some state laws, including here in Massachusetts, is the allowance for commercialism, for-profit business selling marijuana and marijuana products, which we’ve seen take off in Colorado leaving wakes of unintended social costs and consequences. The taxes are small compared to the possible costs. As the tobacco and alcohol industries know well, you need heavy and lifelong users to be profitable—and I fear the beginning of that occurring with the commercialism of marijuana. Most people in Massachusetts want legalization for adult use, but remain very concerned about increased use in children and teens, whose brains are in a critical state of maturation and who already use marijuana at high rates. Colorado passed legalization in 2012 and now has the highest rate of adolescent use in the country (NSDUH 2013-2014).

We can have legalization without commercialism—that is one of our options. I think this divide is where we need to think comprehensively and compassionately to amend our current law so adults can still use small amounts of marijuana safely while limiting the provisions that may lead to abuse and diversion to our teens. Let’s start at the local level: local government, communities, schools, police departments, and most importantly, our homes. Until we close these loopholes, we’re playing defense in uncharted, potentially dangerous and costly territory.

You recently published a paper that analyzes the impact of medical marijuana laws on youth in 45 states. As we've seen a huge spike both in Massachusetts and nationally in opioid addiction following their medical use, what did you find when it comes to the continuation and scale of use among those who used medical marijuana?

Good question, unfortunately the answer is located right in the middle of that “gray area” and well beyond the scope of my research. Simply put, we don’t know yet. There are many factors floating around that need to be better examined. I will say that I am a full believer in any medical marijuana policy that would enable patients with specified medical conditions to use marijuana as an alternative mode of treatment, such as: reduce spasticity in neurological conditions or intraocular pressure in glaucoma, and especially ease symptoms in HIV/AIDS and cancer with adequate controls to prevent diversion and abuse. We know marijuana cannabinoids are effective and possibly less harmful in treating a variety of symptoms relating to varying illnesses, which is so important for those suffering to get treatments that help. However, if these policies aren’t well written, controlled, and regulated, states may experience unintended consequences that go beyond the medicinal use for patients who truly need it, similarly to the current opioid epidemic.

It very difficult to compare marijuana to opioids or any prescription drug, though. For one, medical marijuana is outside the regulatory process of the Food and Drug Administration (FDA) and strains sometimes take the name “Deadhead Og” or “Maui Wowie” vs. opioid’s oxycodone or hydrocodone that are taken under a doctor’s supervision and dispensed with prescription warning labels and descriptions of exact drug chemical compounds and side effects. However, marijuana and opioids both pose risk of addiction if abused. Just like the opioid epidemic, greater availability of any medicinal drug can lead to increased use, abuse, and dependence. The big differences are the risk of addiction potential between marijuana and opioids—and the differing abilities for society sectors to control the quantities. Marijuana is a more benign drug in comparison, but is more widely socially accepted and prevalent.

Is there anything else you'd like add about your own study or the recently passed recreational marijuana law in Massachusetts?

Like the tsunami of change that we may be headed for after November’s election, marijuana policy may too be swept along for the ride backwards or possibly just take a hiatus until 2020. With a very different Congress and what is looking like an alt-right administration in Washington, we do not know how these changes will affect more liberally designed state marijuana policies yet. Marijuana is still illegal to possess, grow, sell, or prescribe under federal law (Controlled Substance Act of 1970) and the FDA has not approved the medicinal use of marijuana for any disease, symptom or condition. Although President-elect, Donald Trump stated that marijuana will still be a state issue similarly to Obama’s “hands-off” approach, he later selected Alabama Senator Jeff Sessions to Attorney General. Sessions has always been a very vocal opponent to marijuana use and more recently liberalization policy. In the position of U.S. attorney General, Sessions will be head of enforcing law and defending against public safety threats, and from his history, he clearly sees marijuana liberalization policies as a threat—which could affect how these recent state policies play out in Massachusetts and across the nation. Industry may regret their recent very large investments to get policies passed in 2016. In the meantime, it may have bought Massachusetts time to close important loopholes and re-think the effects of commercialism in our state.