Vol. 155 October 1, 2016 Legalizing Recreational Marijuana?

Hub thumbnail 2015Massachusetts voters and 7 other states will be voting November 8 on proposed laws “legalizing, regulating, and taxing Marijuana”. All of these “binding” Questions have been placed on the ballots by “Initiative Petition” (grassroots’ signature campaigns … no pun intended).The proposed Massachusetts law will legalize for anyone 21 or older the possession of 1 ounce of marijuana outside a residence or up to 10 ounces inside a residence, of up to 6 marijuana plants, and of GIVING without payment 1 ounce or less to another person 21 or older. The actual bill fills 11 full pages which reflects not only the controversial issues surrounding the bill, but also the complexities of proposed regulations and taxation.  

Colorado legalized recreational marijuana four years ago, and its experiences (both positive and negative) are currently feeding both sides of the debate of the economic, social, and political consequences.

I will only summarize some of the medical issues (“the News”) with scant remarks about some other issues (”the Editorial”).

Marijuana is a gateway drug: Not really
Physician researchers studying substance abuse ( at least those pediatrician-scientists who present at conferences in Boston) consider nicotine, alcohol, and marijuana as almost equivalent “initial drugs of choice” in adolescents and young adults who become addicted to heroin or opiates. They speak of marijuana “heavy-users” ( more than one joint daily), not marijuana “addicts”, and they represent a small percentage of adolescent MJ users.

Marijuana is addictive: Maybe a little
About 9-10% of users become “dependent”, “need to have daily MJ to feel normal”. Those who start using MJ under the age of 21 are more likely to become dependent. The withdrawal symptoms when heavy users stop after many years are much less than those who stop use of opiates, heroin, alcohol, or even nicotine. No medications are necessary, and any troublesome symptoms usually respond to cognitive behavioral therapy (talking to a therapist). “Addictive behavior” such as crimes to obtain money and violent acts are not usually associated with MJ dependency.

Marijuana is safe: Yes
Lester Grinspoon, MD in his landmark books, “Marijuana Reconsidered” (1971) and “Marihuana (sic): The Forbidden Medicine ” (1991), stated that no one has ever died of a  marijuana overdose, and that statement still stands true.

Marijuana changes your brain: Yes, if under 21 yo.
This reason and the dangers of small children eating large amounts of edible MJ are the reasons the American Academy of Pediatrics opposes the legalization of MJ but NOT its decriminalization.

The Academy also recommends that marijuana be decriminalized, so that penalties for marijuana-related offenses are reduced to lesser criminal charges or civil penalties. Efforts to decriminalize marijuana should take place in conjunction with efforts to prevent marijuana use and promote early treatment of adolescents with marijuana use problems.”

Heavy use  of MJ before the age of 21 can change how the brain functions as revealed by functional MRIs (fMRI).  Heavy MJ use can actually change brain structure in areas associated with impulse control and “executive functions”. Some studies show a lowering of IQ by 8-9 points in heavy users. The long term effects of these structural changes in adolescents are being studied, but everyone seems to agree that MJ use should not be legalized for those under 21 years of age.

Marijuana can impair your driving: Perhaps
Studies do show that MJ can prolong your reaction time and reduce attention span (less so than alcohol – check out this YouTube video), so the opponents of legalization believe that the law will lead to more car accidents. The data on actual accidents, whether fatal or not, is not so clear. There is no standard method to measure “MJ intoxication”. Blood and urine tests measure MJ metabolites which can be present for up to 45-50 days after smoking a single joint (depending on age, weight, and belt size). These tests, since they depend on measuring metabolites, may not even turn positive until 24-48 AFTER a new user smokes a joint. Such tests can identify regular users, but there is no correlation between blood and urine test levels and the actual degree of impairment.  Remember, even the “gold standard” in drunk driving cases, Breathalyzer results, are not permitted to be entered as evidence in court because of variations in calibration and field administration.


The Massachusetts Medical Society opposes  the legalization of recreational marijuana because of 1) “the addictive nature of marijuana”, 2) “the adverse effects on developing brains”, and 3) “the appeal of edibles to youngsters”.

The effect of legalization on youth access to marijuana is a controversial subject that is dismissed by pediatric researchers.

“Adolescents and pre-adolescents already have open access to MJ. Legalizing it won’t change that.”
It is worth remembering that Dr. Grinspoon got interested in the medical effects of marijuana when his son was undergoing chemotherapy, and MJ reduced his nausea greatly. Lester’s wife easily bought that MJ in a Newton schoolyard in the 60s.

That reality that MJ distribution and sales will become a big business is why proponents are pushing its tax revenue upside. Opponents are concerned that “Big Tobacco” or other nefarious organizations will take over the MJ market.

My vote:
I will vote “NO” on Question 4 in Massachusetts proposing the  “Legalization, Regulation, and Taxation of Marijuana” primarily because of its unknown consequences that should become clearer in time (even just a year or two would help). Also, our state’s less than stellar track record in satisfactorily implementing the much smaller program of legalizing medical marijuana ( 59 pages of regulations in 2013 and several public missteps) gives me real pause about how it could all play out.

I think that the recreational use of marijuana will eventually be legalized in Massachusetts, and that there can be some real benefits of such a change.  But, I also think that there is too much that is vague and/or capable of manipulation in this proposed law, even at 11 pages long.

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