Medical Marijuana 101: Doctors, Regulators Brace For 'Big Marijuana'

The argument that marijuana is poised to become Big — as in Big Tobacco — begins more than a hundred years ago, argues Dr. Sharon Levy, a pediatrician at Boston Children's Hospital.

Changes in curing made tobacco easier to inhale, additives made it more addictive, and machines began to churn out inexpensive, readily available cigarettes, she says. With these “innovations” and lots of market savvy ads, tobacco use and addiction rose dramatically.

"Is there anything to prevent innovative products with marijuana that will do the exact same thing?" asked Levy, who runs the adolescent substance abuse program at Children’s.

Levy described her concerns about Big Marijuana in the New England Journal of Medicine last month. She acknowledges that marijuana is nowhere near as harmful as is tobacco, and that marijuana has some health benefits. But Levy worries that marijuana addiction rates, now around 9 percent of users, could climb to those seen among tobacco users (32 percent) without strict controls on growers and manufacturers. Growers are already producing strains of marijuana with stronger and stronger concentrations of THC, the ingredient that makes people high. It’s also the ingredient that seems to trigger depression, anxiety and sometimes psychosis in Levy’s adolescent patients.

"At the heart of it," Levy said, "the drive to make a profitable market out of marijuana is at odds with protecting the public health because the way to make marijuana profitable is to sell more and more of it."

More marijuana, Levy assumes, would be bad for the public’s health, and she worries that many of the harmful effects of marijuana may not be seen for years — as was the case with tobacco.

Marijuana industry leaders bristle at the suggestion they are following in the steps of Big Tobacco.

"I despise the tobacco industry — or many aspects of them — as well and certainly don’t want to be part of something, you know — a lying industry," said Michael Elliott, director of the Marijuana Industry Group in Colorado. Elliott says his members supported taxes, product testing, licensing and many rules for marijuana that the tobacco industry fought for years.

"We ended up embracing regulation when a lot of people in the marijuana community, a lot of the activists, didn’t want regulation," Elliott said. "They wanted to be able to grow it from their home and sell to whoever and have there be little to no oversight, and we were not OK with that."

The marijuana industry is not “big” yet. It’s approved for medical purposes in Massachusetts as well as 22 other states and legal for recreational use in Washington and Colorado. But the industry to support use in these states is growing quickly.

"The opportunity is huge," said Alan Brochstein, who last year founded 420 Investor, an online group that tracks about 200 publicly traded marijuana stocks. "We are taking an industry that’s been around for a very long time, but it’s been illegal, transitioning to a real industry where people can enter it without being criminals, where we can use automation and all sorts of technology to make it a more efficient industry."

What entrepreneurs call opportunity is a major headache for some agencies charged with overseeing legal marijuana.

"The challenge with regulating this industry is that there is no road map," said Ron Kammerzell, Colorado’s deputy senior director of marijuana enforcement. "There is no best practices in other states that we can look at. We're pretty much creating it as we implement this program."

In Colorado, the first state to legalize marijuana for everyone, Kammerzell and his colleagues are pouring through tobacco, alcohol and gambling regulations to help craft the rules for marijuana.

"Our biggest objective is to protect the youth in the state and make sure that we are doing this as responsibly as possible, so we took a lot of cues from the tobacco settlement agreements," Kammerzell said.

Those agreements between Big Tobacco and states restricted ads, promotions and sponsorships aimed at children and teenagers. Colorado, like Massachusetts, does not allow additives in marijuana for medical purposes. Both states require testing so that consumers will know how strong different ingredients are in the marijuana they buy.

But Levy worries about the loopholes. She points out that the tobacco industry is often accused of skirting youth restrictions with candy flavored cigarettes, for example, that appeal to youth even if they are not direct marketing.

"I’m beginning to have a sense of déjà vu about this," said Richard Daynard, a law professor at Northeastern University who has focused for more than 30 years on tobacco liability cases. He says marijuana is different.

"It’s never going to be as deadly as tobacco, but that’s not saying very much," Daynard continued. "That’s the world we’re about to enter, so I think the best advice would be, stop, look and listen before we go there."

Levy says it would be helpful if key national agencies — the Food and Drug Administration, the National Institutes of Health and others — were collaborating on a strategy to address the industrialization of marijuana.

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