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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  • Rick Day

    Honey, it is called Big Cannabis not Big Marijuana.

    Say it with me…”Big” “Cannabis”

    see how much easier it rolllllls off the tongue?

    Big Cannabis™ coming to a store near you! :D

  • chrispatsox

    and as typical the prohibitionists completely ignore the destruction and death caused by their drug war……these “Doctors” disgust me by completey ignoring their war……All supporters of prohibition are war mongers advocating death and destruction of innocent people to further their blood lust to destroy……

    Dr. Sharon Levy, you are a baby killer….

  • Argle_Bargle

    Great comments here, pointing out just how lost is the reporter and, I would add, NPR generally on this topic. Liberals discussing cannabis are like bible-thumpers confronting stem cell science.

    But the money shot is Michael Elliott from Colorado’s Marijuana Industry Group, who briefly serves up greedhead influence: waffling on the tobacco industry (despising “some” aspects of a product that purposely kills hundreds of thousands a year?), slighting activists who put this issue on the political map, and happy to resort to the state to ensure his clients’ profitability.

    Vulture capital actively seeking regulation, especially in the current political environment, should give anyone pause. And we’re now seeing Colorado vendors claiming proprietary rights on cannabis products for which there is no peer-reviewed support – a new version of 19th century patent medicines. Along this path of willful mystification by the state and shrewd gamesmanship by business interests, cannabis in the US may become another corporate-government abomination. Non-corporate cannabis advocates should start making lawyerly comparisons to homebrewing, which was legalized in 1978.

  • mamram

    “‘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.’”

    So, you’ve embraced regulation that would eliminate any cottage industry, ensuring that large profit-driven organizations (the only kind that can navigate the regulations you’re embracing) have the whole market to themselves. And this is supposed to be reassuring?

    • Argle_Bargle


  • Eric_Jaffa

    Beer is more popular than hard liquor.

    The idea that pot growers would want to exclusively sell pot with as much THC as possible is at odds with that.

  • DeeperDish

    “’9 Percent of Those Who Use Cannabis Become Dependent’ Is Based on Drug War Diagnostics and Bad Science”
    “The problem is that these criteria are chock-full of bias that ignore the reality of non-problematic or beneficial cannabis use. In the early ’90s in the U.S., all cannabis use was seen as illegal, even for medicinal purposes. Cannabis use could be causing problems for a subject more because of its illegality than anything else, and this is not accounted for in the measuring tool.”


    • Rick Day

      We have a term for it in the reform community: “Narco Science”.

  • mydnytmover

    “the harmful effects of marijuana may not be seen for years” Marijuana has been used for 100s of years and you are still waiting to see harmful effects? You will be waiting many many more years.

  • downthelaw

    I see medical marijuana as a good thing because it is a good drug for lots of things. And I see legalization as a good thing for the jobs creation and tax revenue opportunity. But I see the end of the marijuana prohibition as a great, amazing thing for it will end the worst and most unsafe thing about marijuana, and that is the prohibition against it. The end of empowering street gangs and cartels. The end of throwing good, hard working, tax paying Americans in jail for no real crime. And using taxes and resources paid for by taxes to do so. And all the wasted resources that are used to fight something that is no real crime and something that the majority of people actually even want. Prohibition is ludicrous and it must stop.

  • teatoker

    addiction is only a problem if the addictive activity is harmful. the few people who feel paranoid or psychotic on marijuana only try it once or twice and then decide its not for them. those who smoke every day, get used to the feeling to the point that they can walk through public places, talking to people, without anyone knowing they are high.

    making a profitable market out of marijuana is not at odds with protecting the public health, because there does not need to be any shady tactics or hidden chemical additives to sell marijuana, it basically sells itself. you really don’t even need to advertise it, people will find it through Google maps and recommendations from friends.

  • Steven_Epstein

    Slaves think like slaves.

    Free people ask :
    why the plant became prohibited in the first place and why after repeal of that prohibition government need be intimately involved, as advocated by the slave masters, in the growing and selling of flowers.

    • pennyroyal

      I heard it was outlawed because it was something Blacks used. I’ll have to look up the history of its use. I never used it but am wholly in favor of medical marijuana. (I worked in healthcare and know its benefits for pain control and especially debilitating nausea)
      I think in the general public, it will be integrated into society without all the scare tactics being true. Control, legalists and authoritarian leaders want to control everyone/everything. People won’t stand for that for much longer.