Public Health Experts Have Mixed Feelings About Legal Marijuana in Massachusetts

It may affect everything from mass incarceration to the opioid crisis.
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With post-election discussion focused squarely on president-elect Donald Trump, you may have forgotten that something kind of big happened here in Massachusetts: We passed Question 4, legalizing marijuana for those 21 and older.

The initiative saw both passionate support and opposition, with high-profile politicians taking both sides. But where do public health experts fall on the issue? Turns out, there’s division there, too.

We spoke with Vaughan Rees, director of the Harvard T.H. Chan School of Public Health’s Center for Global Tobacco Control; Leo Beletsky, a professor of law and health sciences at Northeastern University; and Margie Skeer, an assistant professor of public health and community medicine at Tufts University School of Medicine. Each has mixed feelings about the new law—because marijuana legalization isn’t only about getting high.

Here, their thoughts on some of the major public health issues associated with legalized marijuana.

Criminal Justice

All three agree that, if one good thing comes from marijuana legalization, it’s cutting down on drug-related mass incarceration, and the racial disparities associated with marijuana arrests.

“I’m delighted that we’re going to see an end to young people being criminalized and facing jail sentences or prison sentences, and having a criminal record which will impact them, perhaps for life,” Rees says.

Skeer agrees, adding that the new law will hopefully ease the disproportionately high rate at which racial minorities are stopped and penalized for drug crimes. “Social justice is an incredibly important aspect of public health,” she says.

Child and Teen Use

It’s not hard to see why adolescents should be barred from using marijuana. Youth use has been linked with cognitive impairments, including poor memory and educational problems, and early-onset drug use is associated with substance abuse later on. Whether Question 4 will affect these issues, however, is up for debate.

Rees fears that, without airtight regulation, the marijuana industry will proliferate like the tobacco industry before it, pedaling products to children and teenagers. “[They may] target the youth of Massachusetts with their products to get them hooked, so they will become good customers and use their products, potentially to the detriment of their own health,” he says.

Edibles are likely to be among the most problematic products, Skeer says. They’re relatively inconspicuous, she notes, can be taken anywhere, and aren’t heavily regulated. Plus, Skeer says, edibles—and legalized marijuana in general—create a decreased perception of risk, potentially leading children and teenagers to believe the substance is less harmful than it may be.

“The transition of not using to using would be a lot easier for young, early, preteens to say, ‘Oh, I can get high if I eat a gummy candy or a brownie or a cookie, rather than, ‘I have to smoke something,'” she says.

But as Beletsky sees it, youth marijuana use in Massachusetts is already “pervasive,” and this law is unlikely to exacerbate that. “Look at the data from Colorado and Washington, which does not suggest that there is any increase in teen use of marijuana,” he says.

Drugged Driving

How will legal weed affect driving under the influence? That’s hard to say.

Looking to data from states where the drug is already permitted, Beletsky says, suggests that “more people are driving under the influence of marijuana, but that doesn’t necessarily lead to more accidents or more crashes.” (A study from AAA showed that, post-legalization, Washington saw an uptick in crash victims with marijuana in their systems, but that doesn’t necessarily prove the drug is to blame for those accidents.)

Skeer isn’t so sure. “I’ve heard so much, anecdotally, that it’s not as harmful as alcohol, and that’s not necessarily true,” she says.

Indeed, the biggest problem may be that it’s hard to tell how much marijuana is dangerous while driving. There’s not a breathalyzer-esque test for marijuana, or an agreed-upon threshold for how much is too much.

“We have some clear lines for alcohol, but we don’t have those [for marijuana,]” Beletsky says. “Where you draw the line is very unclear still.”

Health Risks

Pot may not have the dirty reputation of cigarettes, but smoking marijuana is still smoking. “There’s some pretty good evidence that smoking marijuana, just like smoking anything else, is not good for you,” Beletsky says. Specifically, it may be linked with respiratory disease, asthma, some cancers, and, in some users, worsened psychosis.

There’s also a lot we don’t know about how marijuana works. While it’s fairly accepted that marijuana can negatively affect young brains, it’s unclear whether the same is true of adults.

All in all, Rees says, many people seem to have conveniently forgotten that marijuana is a drug, and one with potential health consequences. “I don’t think we’ve done a good job of thinking through the consequences of making a drug that is dependence-forming legal,” he says.

Opioid Use

Some recent studies suggest that legalizing medical marijuana may help reduce opioid overdoses, perhaps because patients turn to pot instead of opioid painkillers. Whether the same is true of recreational marijuana is unknown, but Beletsky say it’s worth exploration since Massachusetts is “getting pummeled with overdose deaths.”

Still, the research is new, and not fully understood. “It’s a little bit of a leap for me to see how the legalization might help with the opioid epidemic,” Skeer says.

Rees echoes Skeer, though both say that the topic warrants further study. “I’m not sure that it justifies legalization,” Rees says. “There might be other ways to reduce the opioid epidemic.”

The Bottom Line

Legal marijuana is a complicated issue. But does the good outweigh the bad?

For Beletsky, it does. “I do believe that the positive ramifications will outweigh the negative ramifications,” he says.

Rees, too, thinks there’s good to be found, but emphasizes that the state needs strict age regulations and proper risk communication. “It’s a good thing on the whole, but we need to try to protect kids,” he says.

Skeer takes the opposite position. While she’s in favor of Question 4’s social justice implications, she says it’s likely to have unintended consequences. “I think there will be more harm than there is benefit, at least at first,” she says. “The way that the law was written I don’t think was focused on public health—it was more focused on industry.”

This story has been updated to clarify the findings of a cited study on drugged driving.


Jamie Ducharme Jamie Ducharme, Contributor jducharme@bostonmagazine.com