Massachusetts Medical Society: Comments on Massachusetts Cannabis Control Commission Draft Regulations

Comments on Massachusetts Cannabis Control Commission Draft Regulations

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.

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