When voters enter the booth on Tuesday in South Portland and Lewiston, marijuana will be on the ballot alongside the governor’s race and other political choices. Voters in those two cities will decide whether to adopt ordinances to allow those age 21 and older to possess and use marijuana recreationally.

This follows a successful bid in Portland in 2013 and statewide initiatives the previous year in both Colorado and Washington to legalize recreational use of marijuana. A similar effort to put an ordinance on the ballot in York was rejected by selectmen. While the South Portland and Lewiston ordinances would legalize use and possession within municipal borders, neither local ordinance will legalize the sale of marijuana.

David Boyer, political director of the Maine Marijuana Policy Project, sees passing ordinances on the local level as a means for building momentum for a statewide ballot initiative as early as 2016.

But as a laissez faire attitude toward marijuana increasingly takes hold, health care workers have raised concerns about increasing access to another potentially addictive substance in the marketplace.

‘Get the record straight’

Since the 1970s, Americans’ attitude toward marijuana has undergone a seismic shift, with more Americans today supporting legalizing recreational marijuana than not, according to the Pew Research Center. Consequently, the perceived harm of marijuana has plummeted while its use has risen.

The U.S. Office of Substance Abuse in its 2012 National Survey on Drug Use and Health found that 18.9 million Americans age 12 and older use marijuana, up from 14.5 million in 2002. Meanwhile, The Washington Post reported in August that Maine ranks 13th in the nation for marijuana use with about 8.4 percent of Mainers reportedly using in the past month.

To capitalize on the rising acceptance of marijuana use and following defeats in the state Legislature, Boyer and the Marijuana Policy Project hope to nudge the state toward a change in its drug policy by first finding success on the municipal level.

“One objective of these local ordinances is to promote public education,” Boyer said, as well as to “get the record straight about marijuana.”

Legal and taxed marijuana — which is beyond the scope of the Lewiston and South Portland ordinances — could contribute to state coffers, like alcohol and tobacco, Boyer said. Already, Maine’s medical marijuana industry generates $5 million in revenue. The industry’s sales are subject to the state’s 5.5 percent sales tax.

Boyer defends legal recreational marijuana as far more benign than both alcohol and tobacco, which are legal. The choice ought to be left to the individual, he says.

According to the national drug survey, there were 135.5 million alcohol users in 2012; about 18 million suffered from alcohol dependence. Many chronic alcohol users face serious health consequences, such as cirrhosis, Korsakoff syndrome (an alcohol-induced dementia) and death. Alcohol use is often a precursor to violent crime, while no such connection has yet been found for marijuana.

But health care workers point out that there’s a deficit of research into the negative effects of marijuana compared with what is available for alcohol and tobacco.

“It’s difficult to answer [questions about the harm of cannabis] because we don’t have the years of research into [its] negative effects,” said Dr. Vijay Amarendran, medical director of outpatient services at Acadia Hospital in Bangor.

Still, Amarendran asserts that certain truths are evident: “It is an addictive substance.”

As many as 4.2 million Americans have a marijuana dependence, a figure that has been largely steady since 2002, according to the national drug survey. There also is a recognized marijuana withdrawal syndrome that the New England Journal of Medicine described in a June 2014 article as having symptoms that include depression, craving, dysphoria and insomnia.

One group that research has shown to be uniquely susceptible to addiction and the negative effects of marijuana use is adolescents, Amarendran said.

‘Disease of adolescence’

Marijuana use by adolescents declined during the 1980s into the early 1990s after a high point in the in the mid-1970s, according to the national drug survey. But the last 20 years have seen an uptick of marijuana use with at least 7.2 percent of adolescents reporting use in 2012. According to a Hazelden Foundation survey, 71 percent of young adults who have used marijuana reported first using between the ages of 14 and 19, while 15 percent reported first using it before age 14.

This presents a startling picture because “addiction is a disease of adolescence” with long-term consequences, according to Leslie Adair, director of Mental Health and Family Services at Hazelden, a substance abuse treatment nonprofit based in Center City, Minnesota.

Any substance use in adolescence increases the likelihood of addiction or dependence developing later in life. The national drug survey found 13.2 percent of marijuana users who first tried the substance at the age of 14 or younger had a dependence disorder compared with 2.2 percent of users who first tried it at the age of 18 or older.

Why? Substantive use during adolescence compromises a critical period of cognitive development.

“It causes changes to normal developmental processes,” Adair said. “Development stops when chemical use begins.”

During adolescence, the brain’s prefrontal cortex — the brain’s brake pedal — undergoes major development that lasts until age 24, Amarendran explained. This region is key for carrying out executive functions, such as abstract thought, long-term planning, working memory, and emotional and impulse control. When a substance such as marijuana interacts with the prefrontal cortex during adolescence, it stalls the development of impulse control, which can lead to risky behavior down the road because of a difficulty managing addictive impulses.

Adolescence also is a time of anxiety and social awkwardness when many are self-conscious and uncomfortable with themselves, Adair said. As a result, adolescents may turn to alcohol or marijuana as a “ready-made fix” — though that fix ultimately diminishes the ability to cope.

While there is risk for adolescent use, the outlook is not wholly apocalyptic. According to the New England Journal of Medicine, changes to the development and functioning of the brain from marijuana are not always permanent and can be reversed through cessation.

Boyer also pointed out that in Colorado, adolescent use has not risen as opponents predicted, although health care workers there are urging caution and calling for increased prevention through education as the first year of legal marijuana sales draws to a close.

But Adair would not have anyone underestimate the parental influence.

“The effect parents have on behavior, beliefs and values is communicated in subtle ways,” she said. Often this may be by omission and not taking a stance.

Boyer agreed that education would be an important part of legalization and that tax revenue may foot the bill for it. He also said it’s important to “not demonize [children] if they use it.” Being open is the only way to deal with someone struggling with substance use, he said.

Christopher Burns is a digital desk editor at the Bangor Daily News