Health Policy Brief
Issue Summary:
The State of Colorado is committed to the promotion of safety, the protection of the public, and the prevention of exposures that result in injury. In contradiction to these commitments, the current warning labels on recreational use of marijuana are vague, in particular as applicable to women planning to be pregnant, pregnant or breast-feeding. Recreational use of marijuana poses serious health risks to pregnant women and fetal development. These health risks make it necessary to modify the current warning label. The purpose of a warning label is to remind and inform the public about health risks associated with the use of the product provided that health risk is known to exist with its use. The state of Colorado recently adopted Article XVII, Section 16 of the Constitution of Colorado (Amendment 64) that legalized recreational marijuana. Consequently, the Marijuana Enforcement Division of Colorado enacted rules and mandated that warning labels should be attached to all recreational marijuana retail products, which promote general public safety. The current label states (see Figure 1), “There may be additional health risk associated with the consequences of this product for women who are pregnant, breastfeeding, or planning on becoming pregnant.” Recreational marijuana had been illegal up to this legislation; therefore the time to act is now, since the public is unaware of the research available on marijuana.
Background Information:
- Unhealthy activities, such as tobacco use during pregnancy, were brought to the attention of the general public by the Surgeon General in 1969 with the Public Health Cigarette Smoking Act which required appropriate warning labels. Tobacco and alcohol warning labels are in active use through updated research.
- The active ingredient in marijuana, delta-9-tetrahydrocannabinol (THC), is highly potent and acts in the brain in a manner that triggers mind-altering responses.
- Marijuana can easily cross the placenta of pregnant women and subject the fetus to its harmful effects. Consumption during the 16 to 22 day period following conception can lead to significant likelihood of the fetus developing anencephaly, decreased fetal movements in the developing fetus, and a 2-3 fold increase in the incidence rate of stillbirth.
- Marijuana use during pregnancy results in defective development of nerve cells in the fetal brain resulting in life-long brain function deficits.
- Marijuana use during pregnancy has led to long-term neurobehavioral abnormalities and neuropsychiatric illnesses in children.
Figure 1: The Current warning label on marijuana products
Alternatives:
Women should be made aware of the serious risks to the fetus associated with using marijuana. As a consequence, women will refrain from consuming marijuana when they are planning to be pregnant, pregnant or breast feeding.
Alternative #1
Modification of the label to create a clear and meaningful statement: “Should not be used by women who are pregnant, breastfeeding, or planning on becoming pregnant.” Recent legislation in Colorado allowing recreational marijuana to be sold to the public without effective warning labels could have dterimental effects on developing fetuses. Bold, effective warning labels capture attention, easily understood, and more likely to increase compliance.
- Strengths: Uses minimal text necessary to clearly convey the message. Conveys an expicit and clear message on what not to do.
- Weaknesses: Warning label must be large enough to be easily read by the intended public.
- Supporters: The State of Colorado wants to protect and ensure public safety. Additionally, pregnant women and child activists want the public to be informed.
- Opposers: People who are not aware of the research on health risks to the fetus may think it as not necessary.
Alternative #2
The pulic service announcement billboards in all establishments that sell recreational marijuana, similar to alcohol and tobacco product announcements. Such billboards would remind and inform the public about health risks.
- Strengths: Exposure to the announcements would draw attention and the warnings could get established in mind to ultimately change behavior.
- Weaknesses: Difficult to enforce and costly to implement. Additionally, there may be activities and distractions that compete for the attention of the public.
- Supporters: Business establishments interested in the protection of women who are pregnant, breastfeeding, or planning to become pregnant.
- Opposers: Business establishments that view compliance as a burden.
Alternative #3
Use of a signal word like “Warning” to convey singular but greater effectiveness of the label. Guidelines of effective warning were developed from research and standards in America. The word “Warning” indicates a potentially hazardous situation that may result in death or serious injury if not avoided.
- Srengths: The signal word appears at the top to attract attention to the hazard.
- Weaknesses: Warning may have multiple interpretations.
- Supporters: Stakeholders that have an interest in standardizing the warning labeling in recreational marijuana.
- Opposers: Stakeholders that assume marijuana use in pregnancy is harmless.
Policy Recommendation:
A combination of Alternative #1 and #3, change in language and the signal word in bold lettering are my recommendation for the warning label. Since the rate of marijuana usage has been on the rise in Colorado, urgent action is needed to mitigate potential health risks to fetuses. The core issue is an effective warning label to protect developing fetuses and pregnant women. Many women in the state are not aware of the serious implications of marijuana use on the health of the developing fetus. Therefore, warning labels must be modified immediately for all retail products of marijuana: The label should read “Warning: Should not be used by women that are pregnant, breastfeeding, or planning on becoming pregnant.”
Conclusion:
I earnestly urge the legislature to support and adopt this modification immediately into the “Article XVII, Section 16 of the Constitution of Colorado (Amendment 64).” Furthermore, I request that the legislature take interest to oversee its implementation by the Colorado State Marijuana Enforcement Division. The time immediately following the legalization of marijuana is a very critical to shaping the views, behaviour and thinking of people. It is undeniable that marijuana has detrimental effects on the developing fetus. It is understandable that the state wants to protect its citizens and promote public safety. The State also has the responsibility to protect the rights of the vulnerable and defenseless, such as the unborn. At a minimum, a clear and direct warning label will make the mother aware of the risks to which she is exposing the fetus. On a more broader sense, these changes represent a huge stride forward in protecting the public by the state. It is the state’s obligation to provide this education in the form of clear and direct warning labels.
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