Editor’s note: Today Gov. Phil Scott said he will decide next week what action he will take on S54, the commercial cannabis bill approved by the Legislature last month. His options are to veto, sign, or to do neither and allow it to pass into law unsigned. The following op-ed is signed by well-known Vermont pediatrician Dr. Lewis First and many other pediatricians and other Vermont physicians.
September 30, 2020
Dear Governor Scott:
With our signatures we join with Vermont Medical Society in asking you to Veto S.54. You have drawn on evidence-based policy following the advice of Vermont Health Commissioner Mark Levine to successfully respond to COVID-19, an unparalleled policy decision in the US which has saved countless lives and resulted in Vermont leading the nation in COVID response and being a model for other states.
It is following this same evidence-based medicine and best practice, that the medical community of Vermont recommends a S54 Veto. Such a veto decision would be in line with the policy position dictated by close review of the science and research that the Vermont Department of Mental Health prepared (below). We agree with their statement as quoted here:
“It is our position, based on the review of the scientific evidence, that the net effect of commercial cannabis sales on overall mental health will be negative. We further note that this additional negative impact on mental health will come at a very vulnerable time for the state, given the already strained resources for mental health and substance abuse treatment services. The major costs that will likely be incurred as a consequence of increased cannabis use and increased cannabis use related problems could likely consume a significant portion of any revenue gained by taxation.
EVIDENCE : DMH is concerned that the risks associated with cannabis use have been significantly downplayed by advocates of commercial cannabis, with attempts being made to portray the science as being less conclusive and less settled than it actually is. Many of these health concerns have been delineated in recent reports from the Governor’s Marijuana Advisory groups. Further updates include the following:
Emergency Department Visits: A recent study of a large urban hospital in Colorado has found that cannabis-related emergency department visits more than tripled from 2012 to 2016 with approximately 25% of these visits being primarily due to psychiatric causes (Monte et al., 2019).
Psychosis: Perhaps the strongest evidence for severe mental health problems related to cannabis use is related to psychosis were multiple studies have linked regular cannabis use to an estimated doubling of the risk of a psychotic illness as well a more refractory course among people with existing psychotic illness.
Violent behavior as a result of cannabis induced paranoia and other psychotic symptoms is also an increasing concern. A 2019 study from Lancet Psychiatry found that their data indicated that “if high-potency cannabis were no longer available, 12.2% of cases of first-episode psychosis could be prevented” across the sites they studied (Di Forti et al.., 2019). Brain Development: There is strong evidence that cannabis use is linked to negative alterations in both brain structure and function. A major study called the Adolescent Brain Cognitive Development study (the ABCD study) is now underway that is poised to answer these questions more definitely but results will not be available for several years.
Suicide: An emerging concern is the increased association between cannabis and suicide. A 2019 paper reviewing multiple studies found that adolescent cannabis was associated with increased depression in young adulthood and a tripling of the risk of a suicide attempt (Gobbi et al., JAMA Psychiatry 2019).
Cognitive Problems and IQ: There is abundant evidence from animal and human studies that cannabis use is associated with reduced functioning in many specific areas of cognition and, with heavier use, intelligence. Use in Pregnancy: Cannabis use is not recommended in pregnancy and has been associated with low birth weight (Crume et al., 20181 ) and future cognitive and emotional problems in children (Goldschmidt et al., 2014). Despite these known risks, a recent investigation into regulated cannabis dispensaries in Colorado found that employees, when asked, recommended cannabis for pregnancy associated morning sickness 69% of the time and usually did not recommend speaking to the woman’s physician first (Dickson et al., 20182 ).
Substance Abuse: There is little evidence that cannabis will be helpful in solving the opiate crisis with the bulk of scientific data in both adults and animals indicating the opposite, namely that cannabis use increases the risk of other types of drug use. An important study conducted with rats showed that cannabis exposure in pregnancy was associated with increased heroinseeking behavior in the offpsring (Szutorisz et al., 2014).
While we recognize that there are many sides to this important debate, we feel that it is extremely important the lawmakers base their opinion and votes understanding the true health and monetary costs that could accompany commercial sales of cannabis in Vermont.”
We appreciate the opportunity to communicate this information to you and are certainly open to further dialogue on the topic.
https://www.jpeds.com/article/S0022-3476(18)30181-1/fulltext2https://journals.lww.com/greenjournal/Fulltext/2018/06000/Recommendations_From_Cannabis_Dispensaries_About.13. aspx “ (Memo VDMH April 2019)
Good public health policy does not include marijuana commercialization with advertising which leads to more addiction, more health care costs and more physical and mental harms. Promises by lobbyists of racial justice, product purity, protecting kids or a removal of the illicit market have proven false. More addicted Vermonters are required to produce profit in this unique addiction-for-profit industry, benefiting largely out of state investors and their lobbyists.
Please put Vermonters’ health and welfare first and Veto this bill. This bill allows advertising, the sole purpose of which is to create more users, more dependence and more addiction. Policies which create more addiction with the ensuing morbidity and mortality, like policies which lead to more morbidity and mortality from out of control COVID 19, in the end harm Vermont’s economy more than the cost of a judicious stay at home order.
John Hughes, MD
Lewis First, MD
David Rettew, MD
Kimberly Blake, MD
Catherine Antley, MD
Craig Nachbauer, MD
John Reuwer, MD
Debra Henley, MD
Janet Kirwan, MD
Lesley Brodie, MD
Steven S Levine, MD
Linda Angier, MD.
and dozens more Vermont Medical Doctors.The list continues to grow even as we send this.
Photo: Pediatrician Dr. Lewis First, from Twitter.