The Massachusetts Medical Society appreciates the work the
Cannabis Control Commission (CCC) has undertaken in drafting regulations
outlining the adult use of marijuana in Massachusetts.
For various medical and safety reasons, the Medical Society opposed the
legalization of recreational marijuana. However, following the ballot
initiative legalizing recreational marijuana, the Medical Society membership
urged that the Society remain engaged in the ensuing legislative and regulatory
processes. This was in order to provide the critical voice of the medical
community as policy makers grapple with so many issues that will affect the
health of the public. To that end, the Medical Society has reviewed the draft
regulations with an eye toward protecting and promoting the health of the
residents of our Commonwealth, with particular attention to vulnerable
populations including children, adolescents, young adults and pregnant women.
We offer the following comment:
Section 500.105(D) – Marketing and Advertising
Requirements
Enumerated
Warning Statements – 500.105(D)(1)(d)
The Medical Society was pleased that the CCC has outlined
the requirements of the mandated warning label. We believe, however, that the
underlying scientific and clinical data indicate the need to strengthen the
statements on the levels of risk.
For example, we request amendment to the warning, currently
listed as an optional warning in 500.105(D)(1)(d)(iii) “There may be health
risks associated with consumption of this product” and that the warning be
changed to, “There are health
risks associated with consumption of this product.” There is sound evidence
that there are risks associated with marijuana use. Importantly, the term
“risk” already makes clear that not all persons who consume marijuana products
will experience adverse health consequences. Therefore, the phrasing used in
these draft regulations does not sufficiently convey the health risks of
recreationally consuming marijuana.
Further, we recommend that this warning statement, “There are health risks associated with
consumption of this product” be the required statement, in place of “Please
Consume Responsibly” (500.105.(D)(1)(d) “Please Consume Responsibly’ mirrors
messaging by the alcohol industry; these have been shown to promote the product
rather than promote caution or awareness.
In addition, because of the particular risk of marijuana use
to the developing brain, which continues to develop beyond childhood through a
person’s early to mid-20s, an additional warning statement to this effect
should be included.
In addition, the Medical Society urges amendment to these
regulations to provide a mechanism for additional warnings to be added to this
list, or for warnings to be amended, as additional research emerges on this
topic.
Standardized
Warning – 500.105(D)(1)(e)
The standardized warning includes a superfluous quotation mark in the warning
label, following the word “CHILDREN”: “…KEEP THIS PRODUCT AWAY FROM CHILDREN.” There may be health risks associated…” The Medical Society is unclear if this was
accidental, or if the first quotation includes the statement for marijuana not
sold as a marijuana product. Either way, the current text could lead to confusion
for those producing marketing content for marijuana establishments to know
exactly where the standardized warning label ends.
We again note that the warning label as drafted fails to
fully convey the risks of marijuana and marijuana products. As in the
enumerated warnings, we urge amendment to, “There may be health risks
associated with consumption of this product” so that it be changed to, “There are
health risks associated with consumption of this product,” for the reasons
detailed in our comments on Section 500.105(D)(1)(d)(iii), above.
Studies show marijuana increases the risk of stillbirth and
adversely affects brain development in the infant and fetus. Therefore,
we recommend the line in the standardized warning on page 45 of the regulations
regarding the risk of marijuana use for pregnant women, be strengthened to read
“Marijuana use during pregnancy and breast-feeding may cause harm to the baby.”
Marijuana use while the brain is developing, has been shown
to have adverse and long term effects. Because, as described above, the young adult
brain continues to develop into the early to mid 20s, we believe that
information should also be included in the standardized warning about the
developing brain of young adults who are allowed to consume marijuana under
these regulations. Young adult consumers should be warned about the potential long
term impacts of marijuana on the developing brain.
The Medical Society also recommends that additional detail
be added to the line in the standardized warning on the delay of the effects of
edible marijuana products, which currently reads, “The intoxicating effects of
edible products may be delayed by 2 hours or more.” The Medical Society
suggests adding a more explicit statement of the risks of over-consumption of
marijuana products. We suggest adding a sentence to explain explicitly about
how this delay may encourage consumers to consume more than intended, and warn
of the acute risks associated with over-consumption.
Section 500.105(E)(1)(g) – Labeling of
Marijuana and Marijuana Products
Labeling Marijuana Not Sold as a Marijuana Product –
Section 500.105(E)(1)(g) and Section 500.105(E)(1)(p)
The
Medical Society strongly supports this standardized warning label for all
marijuana sold in Massachusetts. We urge that this warning label be expanded to
present the entire warning contained in the section 500.105(D)(1)(e), including
the latter section which appears to be intended for marijuana products. The
additional information (contained in the full warning statement in 500.105(D)(1)(e),
but which is omitted in this section) addresses important issues about the
potential delay of intoxicating effects, potential for overconsumption, and the
impairment of concentration, coordination and judgement- all of which appear to
still apply to marijuana not sold as a marijuana product. We again recommend
the less ambiguous language related to health risks and pregnancy: “There are
associated health risks.” And “Marijuana use during pregnancy and breastfeeding
may harm the baby.”
Section 500.140 – Additional
Operational Requirements for Storefront and Delivery Retail Sale
Consumer Education -
500.140(I)(1)
The
Medical Society urges significant strengthening of the requirements for
consumer education materials to include more robust information about health
risks, such as explicitly including warnings about risks for pregnant women and
women who are breastfeeding. Information should be added to inform consumers of
the risks of marijuana use to a developing brain—which affects children as well
as young adults into their mid-20s.
Consumers should have access to information and resources about the
specific risks for the developing brain, and be aware of the acute, short term
and long term health effects associated with these products.
The
Medical Society believes that these consumer education materials are critical
to assuring that all consumers are aware of the health risks inherent in
marijuana use. We believe that additional safeguards should be provided to
ensure that the intent of these materials are not diluted with marketing
information or other messaging. We urge the Commission to consider either
creating the educational materials, or amending the approval process of this
section to require approval of materials, rather than simply requiring they be
made available upon inspection.
We urge
the CCC to ensure mechanisms for updating these regulations as more research
related to the health effects of marijuana emerges from Massachusetts and from
other states. The Medical Society appreciates the opportunity to provide
comment on these select provisions of the regulations which will directly
impact the public health effects of legalization of marijuana for adult use. We
urge that all portions of the regulations be continuously evaluated through the
lens of public health. We offer the diverse expertise of the Medical Society as
a resource as you work toward promulgation of final regulations.
Lastly,
we urge the CCC to work in good faith toward implementing the additional
programming authorized by the Legislature in Chapter 55 of the Acts of 2017,
such as collaborations with the Department of Public Health on prevention and
research initiatives.
