Interviews BLOG

J. Wesley “Wes” Boyd, MD, Ph.D., is on the faculty in psychiatry at Harvard Medical School and is a staff psychiatrist at Boston Children’s Hospital (BCH) and at Cambridge Health Alliance (CHA). He is the co-founder and co-director of the Human Rights and Asylum Clinic at CHA and works in the Adolescent Substance Abuse Program at BCH. Dr. Boyd teaches medical ethics and the humanities at Harvard and is a graduate of both Yale and the University of North Carolina at Chapel Hill. In the middle of his many commitments, Dr. Boyd penned the book “Almost Addicted: Is my (or my loved ones) drug use a problem?” We earlier spoke with Dr. Boyd and asked him a few questions regarding drug abuse, specifically in terms of the rising trend of prescription drug abuse.

For this interview, we followed up Dr. Boyd regarding the ethics surrounding the legalization of marijuana.

TestCountry: Dr. Boyd, thanks for taking the time to speak with us again. The last time we spoke, we talked primarily about the rising problem of prescription drug abuse. This time, I would like to know your opinion about the recent legalization of recreational marijuana use in Colorado and Washington. First off, in your opinion, what do you think about the use of marijuana as a medicine?

Dr. Boyd: I am a psychiatrist, and as far as I know there are no psychiatric conditions for which marijuana might be useful. Many people do find it useful in helping with nausea from chemotherapy, for example, and with certain pain conditions. If it is helpful in those situations I would be hard pressed to decry its usefulness as a medication in those circumstances.

TestCountry: For example, are there any benefits from using marijuana over other medicines?

Dr. Boyd: I have heard secondhand that for some individuals marijuana has helped in ways that no other medication has, so for some individuals I believe the answer to this question is yes, but I don’t have any direct experience in seeing marijuana used medicinally.

TestCountry: How do you feel about the fact that currently, in most U.S. states, we tell our kids that marijuana is not ok to use recreationally, but it is ok to use as a medicine?

Dr. Boyd: I have heard my share of adolescents make exactly this argument, but the fact that cannabis can be used medicinally and abused recreationally is not so different from the fact that opiate painkillers can be life-saving for individuals experiencing chronic pain but they are also exceedingly dangerously drugs of abuse.

TestCountry: Do we confuse the issue by saying that it can be used both recreationally and as a medicine, especially in light of teens and prescription drug abuse?

Dr. Boyd: I imagine it is confusing for adolescents—and others, for that matter—to hear that teens should not use marijuana at all and then to know that it is also used, in certain circumstances, medicinally.

TestCountry: How do you feel about marijuana’s reputation as a gateway drug?

Dr. Boyd: I don’t really think of marijuana as a gateway drug. There are no doubt some folks who do move from marijuana to “harder” drugs—although I don’t really like that term— many individuals who use marijuana never progress to other drugs.

Because of this, the objections I have against marijuana use among young people are not because I worry that it is a gateway drug but instead because marijuana itself can wreak havoc on lives here and now in terms of worsening school performance, decreasing motivation, harming memory, and straining family relationships. It can also lead to future psychiatric problems such as anxiety, depression, and psychosis even after someone has used.

TestCountry: Do you see any big benefits to a nationwide decriminalization of marijuana use?

Dr. Boyd: Yes. In fact, part of me would like to see all drugs decriminalized. I favor decriminalization of drugs for several reasons. One, we could tax drug sales and use the money for intensive educational efforts about the harmful effects of drugs. Two, because they are illegal, the way most drugs are currently distributed and sold is dramatically dangerous to everyone in a multitude of ways. Three, imprisoning folks for drug sales and possession costs our nation hundreds of millions of dollars that could be better spent elsewhere. And finally, although we might win a few battles in the “drug war,” it is a war that ultimately will never be won.

TestCountry: What about any negative consequences?

Dr. Boyd: The negative consequences of legalizing marijuana—or any drug that is currently illegal—is that some might take that to mean that using the drug is non-problematic. I hear this already from teens I treat who say, “Massachusetts has decriminalized the possession of a small amount of weed, so it obviously isn’t actually bad for you.”

Of course, the only adolescents who have said this to me are already using cannabis. Because I worry about this aspect of legalizing marijuana—and possibly other drugs—I do believe that tax revenue that is generated through the legal sale of drug ought to be used, in part, to educate everyone about drugs.

TestCountry: In your opinion, could lifting federal regulations regarding marijuana use have a big impact on the school, the workplace, and other areas of our communities?

Dr. Boyd: Yes, in various ways. At a minimum, if marijuana is legalized then individuals can’t be punished for having it turn up on a drug test for work or otherwise. Also, given that marijuana’s effects can linger long after it is used, on the job or at school performance might suffer.

TestCountry: Alcohol can only be purchased by people ages 21 and up. In your opinion, would similar rules need to put in place for marijuana use in order to establish clear guidelines for its use?

Dr. Boyd: There would almost definitely have to be similar age restrictions on who could use marijuana legally. Given that marijuana use during adolescence affects brain development and can adversely impact the architecture of the brain—which is probably why it can cause the psychiatric effects I mentioned earlier—I would favor making the age as high as a society would allow.

TestCountry: The use of marijuana comes down to a health behavior decision, much in the same way that participation in other risky behavior does. How do you feel about the legislation of health behaviors?

Dr. Boyd: I have mixed feelings about legislating health behaviors, although if there is a cost to the public for certain kinds of behaviors then a case can be made for legislating them.

But this question is excellent because it implicitly points out the randomness of our current drug laws. I understand the historical reasons why our laws have evolved as they have, but from a rational perspective, why should alcohol consumption be legal and marijuana not? And for that matter, why should the single largest killer in the history of humankind—namely, tobacco—be legal whereas cannabis and other drugs are not?

TestCountry: Is there a difference in making recreational marijuana use illegal and other current health legislation, such as not allowing smoking in bars and the recent super-sized soda ban in New York City?

Dr. Boyd: If one’s behavior—such as smoking in a public place—affects the wellbeing of others (either because of secondhand smoke places people at risk for disease themselves or because it is simply nauseating to smell), I don’t have much of a problem legislating it. Also, a case could be made to support the idea that if you are or will be a recipient of publically subsidized healthcare (whether via Medicaid, Medicare, VA benefits, or you are a government employee—at any level-- with health insurance benefits), then everyone around you has a stake in your level of health. I’d wager that most individuals wouldn’t accept such an argument, but one certainly could be made.