For some, the debate over whether to legalize recreational marijuana in Maine hangs on concerns related to criminal justice or economics. But for others, the central issue is public health.
Some members of the medical community are concerned about the consequences of making pot more available. We continue our weeklong series of reports, “High Stakes,” with this report by Patty Wight.
At the Northern New England Poison Center in Portland, phones ring around the clock. The calls run the gamut from toddlers who accidentally swallowed medications or house cleaners to teens and adults who’ve overdosed on various substances.
In the past few years, poison center Director Dr. Karen Simone has noticed an increase in calls involving one substance in particular.
“The problems that we’ve had in our local area, and they’re similar around the country, are related to children not being able to tell the difference between candy that includes marijuana, and candy that does not,” she says.
After medical marijuana became more accessible in Maine through a 2009 ballot initiative, edibles have been an increasingly popular way to consume cannabis: they’re foods such as cookies, brownies or candy infused with THC, the primary psychoactive ingredient in marijuana.
But an edible can contain multiple doses of THC. So if an unsuspecting consumer ingests an entire marijuana-infused chocolate bar, for example, they could get a dose of THC that’s double or triple the intended amount.
“If, as an adult I take that kind of dose, it can make me sick, I can vomit, I could get dizzy, I could have a very unpleasant trip that scares me,” Simone says. “For a child, they can become psychotic, they can be frightened, they can see things, their heart rates increase.”
According to Poison Control Center data, these kinds of poisonings in Maine have ebbed and flowed. In the years when Maine’s medical marijuana system launched — from 2010 to 2012 — the poison center got 73 calls. During the next two years after the system was in place, the calls more than doubled to 162.
Simone expects poisonings to increase further if Maine legalizes recreational marijuana.
“I think if Colorado is any lesson for us, the emergency department every day will have to deal with this. So I think to say it’s not a big deal and it’s insignificant is wrong,” she says. “I wouldn’t panic, but I do think in a time where we already have opioid issues, where we already have marijuana and alcohol issues, this is just going to be one more thing that’s going to be making the lives of the people of Maine a little bit more challenging.”
Colorado has seen a spike in marijuana-related hospitalizations since recreational pot became available in 2014.
A report from the Colorado Department of Public Safety in March found that before commercialization, there were 800 marijuana-related exposures per 100,000 hospitalizations. In the year and a half after commercialization, that rate tripled to 2400.
But that uptick, says Colorado Director of Public Health Dr. Larry Wolk, may simply be the result of better reporting.
“People are more willing to be honest about whether or not they’ve used marijuana since it’s legal,” he says. “Whereas in the past, if they came in and were vomiting or dizzy or anxious, they might have just disclosed the symptoms, but not necessarily that they consumed an edible three hours before, two hours before, whatever it is.”
And Wolk points out that it was out-of-state visitors that had the highest increase in marijuana-related hospitalizations in Colorado: 109 percent, compared with a 44 percent increase for Coloradoans.
As for overall use, rates for kids ages 12-17 in Colorado have remained relatively flat, with a 2 percent increase. Among young adults, use has increased by 10 percent. For those 26 and up, it has gone up 5 percent.
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“It’s actually been, at best I think, a nonevent. And at worst, maybe a little too soon to tell,” Wolk says.
He notes one positive outcome: legalization has generated tax revenue to fund public health programs about marijuana.
“Arguably, you have some more opportunities, I think, to educate and do surveillance and even research the potential negative or positive or potential medical impact,” he says.
But in Maine, the idea of legalizing marijuana doesn’t sit well with the Maine Medical Association.
“Our concern would be that this sends the message that marijuana is harmless,” says Dr. Brian Pierce, the immediate past president of the MMA.
Pierce expects they’ll take an official stance against legalization in October.
“We all agree that it’s harmful for teenage users, it’s harmful in folks who are addicted, and it’s harmful in heavy use, it tends to last in your system quite awhile,” he says.
Part of the challenge with marijuana is that research has been limited due to its federal status as an illegal drug. But according to the National Institute on Drug Abuse, heavy use is linked to brain development and behavior issues in kids and teens. It’s also connected to breathing illnesses and mental health problems, including heightened symptoms of schizophrenia and temporary psychosis.
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Even with these health risks, some Maine physicians support legalization.
Dr. Michael Parker, a urologist in Lewiston who makes it clear that he is not a marijuana user, says even though he shares the health concerns of marijuana’s effect on teens and young adults, that’s associated with heavy use. And he thinks alcohol is much worse.
“Why don’t we go back to prohibition and stop the use of alcohol? Essentially, humanity has its vices, and this is a minor vice that’s been made into a major vice,” he says.
The way Parker sees it, Maine has essentially legalized marijuana already through the medical program. The state, he says, might as well take control of recreational pot as well.
“And tax it and regulate it,” he says.
But regulation needs to be driven by appropriate priorities, according to Dr. Stanton Glantz, a professor of medicine at the University of California San Francisco and director of Center for Tobacco Control Research and Education.
“What we’re seeing happen right now is marijuana legalization is not being driven by public health priorities,” he says, but by business priorities. “And the irony is, if you look at tobacco, which is perfectly legal, by having aggressive demand reduction programs, we’ve been reducing the social acceptability of tobacco use, and use has been declining. In contrast, marijuana, which has been illegal, sees use increasing, and it’s socially sanctioned.”
Glantz thinks marijuana should be legalized. But if states are serious about public health, he says, they should simultaneously launch programs that reduce demand, modeled after the most aggressive and effective tobacco control programs.
To read the rest of the series "High Stakes: How Legalizing Pot Could Affect Maine," click here.
