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NAMI Mass Opposes Recreational Marijuana Ballot Initiative

This fall, Massachusetts voters will likely have the opportunity to vote on whether the sale of marijuana for recreational use should be legalized in the Commonwealth. The National Alliance on Mental Illness (NAMI) of Massachusetts states its strong opposition to this ballot question because the legalization of recreational marijuana will have detrimental effects for those with mental illness and for people predisposed to mental illness.

Although marijuana use has been legalized for medicinal purposes, the American Psychiatric Association asserts that marijuana should not be used for the treatment of any mental illness.[1] In fact, marijuana poses a danger for those with mental illness and young people predisposed to mental illness because of the neurological actions of the drug. Further, the effective treatment of mental illness is hindered by marijuana use; people using marijuana are more likely to miss appointments and tend to struggle with medication adherence compared with those who are not using.[2] A report published by the Vermont Department of Health earlier this year found that many indicators of mental health including psychosis, depression, schizophrenia, anxiety, brain function, and psychosocial functioning are all worsened by non-medical marijuana use.[3] The availability of recreational marijuana will pose a great risk to those with mental illness because of both the direct effects on the brain and the consequent effects on treatment adherence.

Dual diagnoses—the presence of both a drug use disorder and a mental illness—are frighteningly common; fifty-three percent of people suffering from a drug use disorder also have a diagnosis of at least one serious mental illness. Likewise, between one-third and one-half of people diagnosed with a mental illness are also diagnosed with a substance use disorder.[4] According to the National Institute for Drug Abuse, a division of NIH, drug use disorders, including cannabis use disorder, are highly comorbid with mental health disorders. For some individuals, drug use disorders predate mental illness. Meanwhile for others, mental illness can lead to the development of a drug use disorder; this phenomenon is often a result of attempts to self-medicate.[5] It is crucial to understand that legalizing recreational marijuana in Massachusetts will allow those with mental illness easier access to marijuana, which may in turn lead to a greater incidence of dual diagnosis.

It is essential to note the alarming relationship between marijuana use and psychotic disorders, particularly schizophrenia. For people predisposed to schizophrenia, regular marijuana use leads to an earlier age of diagnosis, an increase in hospital visits due to the illness, and a smaller chance of recovery.[6] Marijuana use for those with schizophrenia is associated with a worsening of symptoms.[7] It is highly disturbing, therefore, that one-third of people in the United States with a diagnosis of schizophrenia use marijuana regularly.[8] Recreational marijuana will increase access to marijuana for those with schizophrenia and will consequently have rippling negative health effects for this vulnerable population.

Although marijuana is often not considered an addictive substance, it is possible to become addicted to and dependent on marijuana. When this occurs, it is considered a cannabis use disorder. According to a report put forth this year by the Massachusetts Special Senate Committee on Marijuana, 1 in 9 marijuana users become addicted to the substance and require treatment in order to overcome this addiction.[9] Before the age of 18, the risk of developing a cannabis use disorder doubles for those regularly using marijuana. Unfortunately, this population makes up the largest percentage of marijuana users and is also most vulnerable to the deleterious effects of marijuana.[10]

Regular use of marijuana prior to 18 years of age also increases the risk of the illicit use of other drugs, including opioids. NAMI Massachusetts echoes the concerns raised by Mayor Walsh, Attorney General Healey, and Governor Baker in their letter to the editor in the Boston Globe: given the current opioid crisis in Massachusetts, it is unthinkable that recreational marijuana may become available and worsen the crisis we already have on our hands.[11]

Legalizing recreational marijuana use would pose a great threat to the health and wellbeing of those with mental illness as well as young people predisposed to mental illness. This fact is simply unacceptable. For the aforementioned reasons, NAMI Massachusetts strongly opposes this ballot measure.


(approved by the NAMI Mass Board at its 4/30/16 board meeting)

[1] American Psychiatric Association. “Position Statement on Marijuana as Medicine” December 2013.

[2] National Alliance on Mental Illness. “Marijuana and Mental Illness Fact Sheet” March 2013.

[3] Vermont Department of Health. “Health Impact Assessment: Marijuana Regulation in Vermont.” January 2016.

[4] National Alliance on Mental Illness. “Marijuana and Mental Illness Fact Sheet” March 2013.

[5] National Institute on Drug Abuse. “Drug Facts: Comorbidity: Addiction and Other Mental Disorders.” March 2011.

[6] National Alliance on Mental Illness. “Marijuana and Mental Illness Fact Sheet” March 2013.

[7] National Institute on Drug Abuse. “Drug Facts: Marijuana” March 2016.

[8] National Alliance on Mental Illness. “Marijuana and Mental Illness Fact Sheet” March 2013.

[9] Special Senate Committee on Marijuana. “Report of the Special Senate Committee on Marijuana.” 8 March 2016

[10] Lisdahl, Krista. “Speaking of Psychology.” Marijuana: The Brain Changer. 14 October 2014. Web. 2 February 2016.

[11] Baker, Charlie, Maura Healey, and Martin J. Walsh. “Mass Should Not Legalize Marijuana.” Boston Globe, 4 Mar. 2016. Web. 10 March 2016