Dozens of doctors, scientists warn Mass. marijuana is ripe for ‘regulatory failure’

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Dozens of local doctors and scientists criticized the state’s marijuana regulatory system Thursday, saying the current rules don’t adequately protect public health from high-potency cannabis products now sold legally at 19 stores around Massachusetts.

Consumers of THC, marijuana’s main psychoactive compound, are at risk of becoming addicted, and face increased risk of “serious mental health problems including acute psychosis paranoia, schizophrenia, depression, anxiety, and suicide,” the statement said.

“When public health is not prioritized in the regulation of addictive substances, the public and our young people are put at risk,” the group said, comparing the burgeoning marijuana industry to the tobacco and opioid crises.

The 16-page “statement of concern,” sent to state lawmakers last week, was organized by the Massachusetts Prevention Alliance, which opposed marijuana legalization. It was signed by more than 40 clinicians and researchers with institutions such as Harvard Medical School, Massachusetts General Hospital, and Boston Children’s Hospital.

The statement called for the Cannabis Control Commission to halt all new business licensing to conduct a public health assessment of its social equity program, remove industry representatives from advisory boards, and “indefinitely delay” cannabis cafes and home delivery.

The group also said the state should adopt a “public health framework,” selling marijuana only in government-run stores, having health officials regulate cannabis, and banning flavored products that appeal to youths.

In a state with a large medical community, the statement marked one of the most prominent public messages by physicians since cannabis stores started opening in November.

Marijuana advocates questioned why the group had waited to speak up until now.

One of the signatories, Dr. Sharon Levy, director of Boston Children’s Hospital’s adolescent substance use program and a cannabis advisory board member, said the hospital has seen “a lot more psychosis” related to marijuana use since pot was legalized, as well as long-term mental issues associated with newer high-potency cannabis products such as vape cartridges, edibles, dabs, and oils.

She worries that the government will repeat past mistakes by being slow to rein in potentially addictive products until long-term studies have confirmed their harms. With cannabis, that could take even longer, she said, because it largely causes mental health effects that can be difficult to study.

“Unlike lung cancer, which is a very objective diagnosis, a lot of the harms that we’re seeing are in the mental health realm, which are a little bit harder to objectify,” Levy said. “In the not-too-distant future, people will be looking at this and saying, ‘How did anyone think that this would be OK?’ ”

The public-health regulatory framework has been proven to work with tobacco, so the state wouldn’t have to reinvent a system for pot, said another signatory, Dr. Eden Evins, director of Massachusetts General Hospital’s Center for Addiction Medicine and a psychiatry professor at Harvard Medical School.

“Permitting cannabis use is one thing we’re all in favor of, but promoting it is another thing,” Evins said. “We’d like the regulators to protect public health rather than see their role as promoting cannabis use and cannabis markets.”

Dr. Jordan Tishler, who teaches at Harvard Medical School and treats medical cannabis patients at his private practice, InhaleMD, said the statement makes some good points but ignores the potential benefits of cannabis for the common afflictions of chronic pain, anxiety, depression, and insomnia. Many doctors are interested in these benefits, he said, but the statement was largely signed by addiction specialists, who make up a fraction of physicians and are only focused on harms.

“What we’re looking at here is a very strongly worded PR piece that looks like it’s got a lot of buy-in, but frankly is only a very small group of people,” Tishler said. “I’m not saying there aren’t harms, but the harms are a minor facet of a vast world of benefits, like the tip of the iceberg.”

The group’s relatively minor engagement in the regulatory public-comment process since last year has angered at least one marijuana regulator and some advocates who worked to mold regulations to balance public health, safety, and consumer access.

“If any of the clinicians or scientists asking for ‘indefinite delays’ would like to move from their goal of reversing the will of voters, legislators, and regulators to actually influencing the policy that is being made as we speak, they are welcome to,” cannabis Commissioner Shaleen Title said.

The group behind the statement said it wanted to bring together clinicians’ voices for policy makers to hear arguments that oppose those of the well-financed industry.

“We’re up against a giant lobby that wants to advance sales and promotion of a dangerous, potentially addictive drug that’s incredibly harmful to people under the age of 25,” said Heidi Heilman, president of the Massachusetts Prevention Alliance.

The group accused the state’s social equity program of unfairly targeting minority neighborhoods for more pot shops. But cities and towns determine where stores are allowed to open — not the state. The social equity program aims to redress the harms of the war on drugs by helping people from areas with high rates of marijuana arrests start their own pot businesses.

The statement “is based on flawed assumptions and a fundamental misunderstanding of the commission’s social equity program,” said Title. She said the commission has recommended that municipalities not concentrate retail outlets in any area, particularly low-income ones.

Commissioner Jennifer Flanagan, the public health appointee, said she agreed with the group’s concerns about potency levels and serving sizes. The statement, she said, seemed to validate the state’s work, as many actions it called for are already in place, such as tracking public health outcomes, launching awareness campaigns, and not allowing cannabis companies to use cartoon character images or sponsor sports events.

“This industry and the way we came about was a ballot question, so we have to work with that,” Flanagan said. “Simply opening dispensaries doesn’t coincide with public health initiatives, but we’re mandated to do that, so it’s a balancing act.”

The group also called for combining the medical and recreational marijuana programs unless medical marijuana is “regulated like medicine,” though it doesn’t specify what that means.

Eliminating the medical program would greatly hurt patients, said Nichole Snow, executive director of the Massachusetts Patient Advocacy Alliance.

“This is not only too little, too late,” Snow said, “it puts on full display that the Massachusetts medical community does not understand the wider policy decisions that were made by the Legislature and the commission in their absence ... in the past three years.”

Jane Allen, a local public health researcher at RTI International, said the group’s call for a public campaign about marijuana’s links to mental illness may be misguided, as governments first need to establish credibility with cannabis consumers through a neutral tone. She said she advised the state last year to first educate people about the law and safe practices related to locking up products and starting low and slow with edibles.

“Governments, historically being anti-marijuana, don’t have much credibility in this space with consumers,” Allen said. “You need to build your authority first through a non-biased, non-judgemental campaign that telegraphs to people that we’re in a different space now. I suggested they wait to tackle other, more complex issues until after they built that credibility.”