POV: Why I’m Voting No on Ballot Question 4

Illustration by Larry Rains/iStock

No one should be arrested or have a criminal record for marijuana use that affects only himself. Marijuana may be safer than long-term daily heavy drinking and the use of some other drugs. And (sound bite coming…) prohibition and the War on Drugs have failed in America (true). So it sounds like we should legalize it, right? Well, maybe, but not the way Massachusetts Marijuana Legalization, Question 4, proposes in an indirect initiated state statute. It is worth reading the 25-page question. It isn’t a simple question.

Let’s first address the three main arguments in favor of the question above. Massachusetts decriminalized marijuana in 2009. To the extent that anyone is still getting caught up in the law by exceeding amounts or by selling it, we should fix that legislatively and immediately. Discrimination is illegal, so we should make efforts to avoid any disparities in the way all drug laws, including any about marijuana, affect minorities. And it is not at all clear that legalization will benefit communities of color—if alcohol and tobacco are any example, it will likely be the opposite.

Prohibition and the War on Drugs haven’t worked, and they have harmed many. But the question is how to emerge from that sensibly. And whether marijuana is safer or not is irrelevant to how to best make it legal and regulate it. There is no question its harms are not trivial despite changes in public perception.

What are the harms? There are short-term risks like impaired memory and learning, impaired judgment that can lead to risky behaviors, paranoia and psychosis, and child poisonings (serious for children, as in intensive care unit stays, and fatal for pets). These risks are more likely with marijuana with high tetrahydrocannabinol (THC) concentration. Question 4 is silent on THC concentration in what can be sold. In Colorado, where marijuana has been legalized, edibles often have very high concentrations of THC, and are even made to be attractive to kids. For those who remember smoking pot in the ’60s and ’70s, the concentration in marijuana now is much higher than it was before.

Perhaps the most concerning acute risk is impaired motor coordination. Marijuana is now the most common illegal drug found in the bodies of fatally injured drivers and this problem increases with commercialization (e.g., Colorado). Although police can do field sobriety testing (e.g., touch your nose, walk a straight line), there are no good lab tests equivalent to blood alcohol levels to enforce driving while intoxicated laws and minimize these deaths.

What about long-term risks? Marijuana is addictive. Of those who use it, 9 percent will develop a marijuana use disorder or addiction. That is a real diagnosis. And while 9 percent is less than some drugs, it is not less than others (nicotine, 65 to 70 percent, alcohol and cocaine, 21 to 23 percent). Addiction means loss of control over use and interference with what people want to do in life (relationships, family, work, school), as defined by the people who suffer from it. It is not inconsequential. Almost one in five who use it in adolescence will develop addiction, as will up to half of those who use it daily. It accounts for half of addiction treatment admissions of adolescents in the United States and one in five of those among adults. And regardless of “gateway theory” controversies (e.g., whether marijuana use is a sole cause of other drug use), the fact is that two thirds of those who use marijuana smoke cigarettes, and the risk of another substance use disorder increases threefold. Marijuana affects adolescent brain development, is associated (in prospective studies—good ones) with cognitive impairment (lower IQ scores) and school dropout (in adolescents), diminished life satisfaction and achievement, chronic bronchitis, lung cancer (in a 40-year study), and testicular cancer (when smoked), and psychosis (including schizophrenia).

So what does that have to do with legalization? Other things that cause harm are legal, right? What it has to do with the issue: legalization leads to a perception that marijuana is harmless. That perception is associated with increases in use, particularly among youth. Youth are the most vulnerable (Question 4 makes supplying those under 21 unlawful, which is good, but that is not enough, as we know from alcohol and tobacco). As perception of harm has decreased in the United States from 2002 to 2013, we have seen use increase from 4 percent to 10 percent, and predictably, addiction (marijuana use disorder) has doubled.

We already have so-called “medical” marijuana in Massachusetts (so-called because it is not handled like any other medication—it is neither well-tested nor sold in pharmacies nor evaluated as much as even over-the-counter medicines). So patients can get it and use it to treat chronic pain and other conditions. Legalization won’t change that. We already have decriminalization. So we should be able to avoid serious criminal justice system consequences for people using it for euphoria, pleasure, and relaxation. What problem does legalization then solve? It could be a faster route to avoiding any legal consequences, and it will make it easier to access for those wanting to use it, though it is not a given that it will eliminate the black market, as this depends on details of implementation and regulation. And therein lies the rub.

Question 4 does not determine details of implementation and regulation of legalization. It sets up a group of three appointed regulators who will decide everything. They need not have public health expertise, although with an annual $1 billion at stake in Massachusetts, one might guess that regulation will most likely be influenced by business concerns and not public health. They are very unlikely to address the biggest concern: unrestricted commercialization. That means advertising. Have a look at some of it. Advertising works to increase use. That is its purpose, so we know that will be the result. And the ballot question does not address the sale of high-THC products, which will almost certainly be sold as they are elsewhere. Increasing use will increase addiction to it (axiomatic) and the aforementioned consequences.

We should learn lessons from the regulation of alcohol and tobacco. But Question 4 doesn’t incorporate those lessons. We know from alcohol regulation that taxes are one of the most effective ways to limit harm; Question 4 establishes a tax of only 3.75 percent, which is just over half the 6.25 percent sales tax for goods and meals. Money from the tax goes to implementing the statute, when instead it should go to funding its consequences, for which it will be insufficient (addressing driving while intoxicated, addiction treatment, and the societal costs of the aforementioned other consequences).

In sum, marijuana is not risk-free. Even if it is a reasonable idea, legalization doesn’t solve any urgent problem. Done carelessly and without thoughtful regulation to make it available, while at the same time minimizing harms to the health of the public, it will likely do more harm than good. Massachusetts is known for being on the cutting edge of social issues and for addressing them intelligently. Question 4 doesn’t take advantage of that tradition. It defers the details for later, to be decided by the unnamed.

Too many public debates are about being for or against something. In such debates we use inflammatory language and ignore data that might oppose our predetermined views. It would be refreshing to see a public policy informed by science that recognizes data on both “sides,” and that protects the health of the public, with many on board to achieve the best result. Unfortunately, we only have a “yes” or “no” vote on Question 4. In this case, “no” is the best way to achieve that refreshing result.

Richard Saitz (CAS’87, MED’87), a School of Public Health professor and chair of community health sciences and a School of Medicine professor of medicine, is senior editor of the Journal of Addiction Medicine and a distinguished fellow of the American Society of Addiction Medicine. He can be reached at rsaitz@bu.edu.

Editor’s note: Read a POV advocating a yes vote on Question 4 here.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.