The crucial marijuana question not on the ballot: Why has Massachusetts failed to educate the public on the harmful effects of cannabis and monitor the impact of its growing use, especially among young people?

In less than three weeks, Massachusetts voters will face a binary choice when it comes to the sale of recreational marijuana. Question 8 on the ballot asks whether the state should repeal the previously voter-approved ballot question legalizing recreational cannabis sales, or keep in the place the law that was passed 10 years ago.

We are not here to answer that question, which demands consideration of many factors, including the impact marijuana laws had prior to legalization and the fact that a robust economic sector has been established following approval of the 2016 ballot question. But as health care professionals, we are sounding the alarm on what we believe has been an inexcusable failure of state officials to provide the needed regulatory oversight and public health education and monitoring of the effects of growing cannabis use, especially among young people.

Seven years into Massachusetts’ experiment with recreational cannabis commercialization has led to economic windfalls for the cannabis industry and the state government. In 2025, cannabis sales in Massachusetts reached a record $1.65 billion, with the state collecting $289 million in tax revenue.

Our state now ranks in the top five cannabis markets in the country. There is no end in sight to the cannabis bonanza: In June, Gov. Maura Healey signed cannabis reform legislation that doubles the amount of cannabis people can purchase per day or possess at any time, while increasing the number of dispensaries owned by any one entity and loosening restrictions on advertising and marketing of cannabis products. Other sales-boosters coming to the market include licensing for social consumption of cannabis in “weed cafes,” lounges, and yoga studios.  

As a group of Massachusetts clinicians and public health researchers, we are increasingly concerned about the impacts of widespread cannabis availability and associated health hazards. Since legalization, cannabis use in Massachusetts steadily increased from 15 percent of people using the drug pre-legalization in 2012, to nearly 43 percent in 2023.

Nearly half of those report using cannabis to manage mental health. However, recent research suggests that people using cannabis to treat such symptoms see no improvement in pain, anxiety, or depression, with nearly 20 percent developing an addiction – called cannabis use disorder – within the first 12 weeks of use.

Adolescents are especially at risk for the adverse mental health effects of cannabis. Among people seeking emergency psychiatric care from a Boston hospital, people testing positive for the active ingredient in cannabis – tetrahydrocannabinol (THC) – increased significantly post-legalization. The highest rate of increase was in adolescents aged 12 to 17, who also demonstrated the largest rise in cannabis-related disorder rates over any age group. Individuals with psychosis have used more cannabis since legalization and are almost twice as likely to visit the emergency room since dispensaries opened.

Children are also being inadvertently exposed to the drug. Among children 5 and under, emergency visits for cannabis exposure rose from fewer than 11 cases in 2016 to 45 in 2020. Those 19 and under had a 67 percent increase in cannabis-exposure visits to the emergency room following retail sales, moving from 18.5 to 31 incidents per 100,000 people.

Cannabis not only has negative effects on the brain, but has consequences throughout the body. Cannabis hyperemesis syndrome, a chronic disease causing nausea, vomiting, and abdominal pain, has skyrocketed in Massachusetts, leading patients to seek repeated hospitalizations and intensive care. Emergency room visits for the syndrome increased by 1,350 percent post-legalization, with young males, Hispanic, and Black individuals at highest risk.

Hospitalization costs, estimated at $20,000 per patient, more than doubled at one Boston hospital, due to patients requiring longer inpatient stays to recover.

California, Colorado, Michigan, and other high-use markets have similarly reported troubling trends post-legalization, with national reports showing that cannabis raises the risk for heart attacks, strokes, death from heart disease, asthma, and chronic obstructive pulmonary disease.

Despite such evidence that cannabis has negative health effects in Massachusetts, our state has done little to survey and confront these harmful consequences. The Cannabis Control Commission, whose mission is to safely, equitably, and effectively implement and administer the laws enabling access to cannabis in the Commonwealth, has no prominent documentation of these hazards on its website.

No statewide surveillance mechanism exists to evaluate the chronic medical disease burden associated with cannabis use. While Massachusetts collects hundreds of millions of dollars in state tax revenue from cannabis annually, not a single tax dollar supports independent research into the health effects of cannabis on the public.

We are not here to decry the legalization of cannabis. But as responsible members of the medical community, we are ringing alarms that the expanding commercialization of cannabis without protective regulation and robust public education and infrastructure is harming Massachusetts residents, especially children and minorities.

Other states have taken steps to reduce these unintended consequences. Seventeen states where legal cannabis is available have passed legislation to fund cannabis research, with six of these states directly distributing funds to independent academic institutions.

The Minnesota Department of Public Health launched a campaign to introduce conversations about cannabis risks, including impacts of the drug on memory, decision-making, and dependence. Several states apportion cannabis revenue to promote education, prevention, and early intervention.

Comprehensive advertising restrictions in other states have reduced exposure to youth and the vulnerable, with reductions in cannabis use in these groups.

Massachusetts has taken none of these approaches and, in some cases, moved in the opposite direction: advertising has expanded; restrictions have loosened; and cannabis use continues to soar.

As members of the medical community, we have long considered Massachusetts to be a beacon of public health for other states to follow. But when it comes to mitigating the harmful effects of cannabis on public health, we have unfortunately fallen to the bottom of the pack.

Sushrut Jangi is a gastroenterologist at Tufts Medical Center. Corinne Cather is chief of the Division of Public and Community Psychiatry for Mass General Brigham and is an associate professor of psychology at Harvard Medical School. Ari Cohen is the chief of pediatric emergency medicine at Mass General Hospital. A. Eden Evins is the William Cox Family Professor of Psychiatry in the field of addiction medicine at Mass General Brigham. Cheryl Y. S. Foo is an assistant professor of psychology at Harvard Medical School and a clinician-researcher at Massachusetts General Hospital’s Psychosis Clinical and Research Program. Jodi Gilman is an associate professor of psychiatry at Harvard Medical School. Nicole Nadeau is an assistant professor in emergency medicine and pediatrics at Harvard Medical School. Toby Raybould is the trauma prevention and outreach manager at Massachusetts General Hospital. The opinions expressed are of the authors, not of their institutions.

Courtesy of Commonwealth Beacon