Skip to main content

Public Health Issues of Legalizing Cannabis

Considerations for Future Studies

  • Reference work entry
  • First Online:
Handbook of Substance Misuse and Addictions
  • 32 Accesses

Abstract

Cannabis has been used by humans for centuries and contains a number of cannabinoid and non-cannabinoid compounds. In the United States, cannabis has a history of and continues to follow a complicated legislative path, with many states legalizing the recreational or medicinal use of cannabis or decriminalizing its use. There have been a number of studies of the therapeutic potential of cannabis and cannabinoids over the past several decades, and there now exists several cannabinoid-based medications for the treatment of various medical conditions. There has also been emerging evidence of adverse health effects linked to cannabis use. Due to legislative changes in cannabis use and possession, individuals have increasingly looked to studies of cannabis health effects to inform decisions related to cannabis and public health. Thus, it is particularly important that future observational studies of cannabis and health effects strive to produce accurate and reliable study results. Study design considerations related to chemical constituents, exposure measurement, health outcome assessment, study design, confounding variables, and the dose-response relationship should be considered in designing future studies and when drawing conclusions related to cannabis-health outcomes in populations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,999.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 549.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

AIDS:

acquired immunodeficiency syndrome

CB1:

cannabinoid-1 receptor

CB2:

cannabinoid-2 receptor

CBD:

cannabidiol

CBN:

cannabinol

CDC:

Centers for Disease Control and Prevention

EVALI:

e-cigarette or vaping associated lung injury

FDA:

United States Food and Drug Administration

NASEM:

National Academies of Sciences, Engineering, and Medicine

THC:

Δ9-tetrahydrocannabinol

US:

United States

References

  • Andreae MH, Carter GM, Shaparin N, Suslov K, Ellis RJ, Ware MA, Abrams DI, Prasad H, Wilsey B, Indyk D, Johnson M (2015) Inhaled cannabis for chronic neuropathic pain: a meta-analysis of individual patient data. J Pain 16(12):1221–1232

    Article  Google Scholar 

  • Bonita R, Beaglehole R, Kjellstrom T (2006) Basic epidemiology. World Health Organization, Geneva, Switzerland

    Google Scholar 

  • Boomhower SR, Rasmussen EB (2014) Haloperidol and rimonabant increase delay discounting in rats fed high-fat and standard-chow diets. Behav Pharmacol 25(8):705

    Article  CAS  Google Scholar 

  • Boomhower SR, Rasmussen EB, Doherty TS (2013) Impulsive-choice patterns for food in genetically lean and obese Zucker rats. Behav Brain Res 241:214–221

    Article  Google Scholar 

  • Campbell M et al (2019) Evidence on the developmental toxicity of cannabis (marijuana) smoke and delta-9-THC. California EPA: Reproductive and cancer hazard assessment branch of the office of environmental health hazard assessment, California, USA

    Google Scholar 

  • Centers for Disease Control and Prevention (2020) Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Accessed at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html

  • Christensen R, Kristensen PK, Bartels EM, Bliddal H, Astrup A (2007) Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials. Lancet 370(9600):1706–1713

    Article  CAS  Google Scholar 

  • Freeman TP, Craft S, Wilson J, Stylianou S, ElSohly M, Di Forti M, Lynskey MT (2021) Changes in delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in cannabis over time: systematic review and meta-analysis. Addiction 116(5):1000–1010

    Article  Google Scholar 

  • Hancock S, McKim W (2017) Drugs and behavior: an introduction to behavioral pharmacology. Pearson, USA

    Google Scholar 

  • Hua T, Vemuri K, Pu M, Qu L, Han GW, Wu Y, Zhao S, Shui W, Li S, Korde A, Laprairie RB (2016) Crystal structure of the human cannabinoid receptor CB1. Cell 167(3):750–762

    Article  CAS  Google Scholar 

  • Huestis MA, Henningfield JE, Cone EJ (1992) Blood cannabinoids. I. Absorption of THC and formation of 11-OH-THC and THCCOOH during and after smoking marijuana. J Anal Toxicol 16(5):276–282

    Article  CAS  Google Scholar 

  • Johnson MW, Griffiths RR (2017) Potential therapeutic effects of psilocybin. Neurotherapeutics 14(3):734–740

    Article  CAS  Google Scholar 

  • Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME (2021) Monitoring the future national survey results on drug use 1975–2020: overview, key findings on adolescent drug use. Institute for Social Research, University of Michigan, Ann Arbor

    Google Scholar 

  • Krishnasamy VP, Hallowell BD, Ko JY, Board A, Hartnett KP, Salvatore PP, Danielson M, Kite-Powell A, Twentyman E, Kim L, Cyrus A (2020) Update: characteristics of a nationwide outbreak of e-cigarette, or vaping, product use–associated lung injury—United States, August 2019–January 2020. Morb Mortal Wkly Rep 69(3):90

    Article  Google Scholar 

  • Leung L (2011) Cannabis and its derivatives: review of medical use. J Am Board Family Med 24(4):452–462

    Article  Google Scholar 

  • Li X, Hua T, Vemuri K, Ho JH, Wu Y, Wu L, Popov P, Benchama O, Zvonok N, Qu L, Han GW (2019) Crystal structure of the human cannabinoid receptor CB2. Cell 176(3):459–467

    Article  CAS  Google Scholar 

  • Mead A (2019) Legal and regulatory issues governing cannabis and cannabis-derived products in the United States. Front Plant Sci 10:697

    Article  Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine (2017) The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research

    Google Scholar 

  • Paneth N, Susser E, Susser M (2002) Origins and early development of the case-control study: Part 1, Early evolution. Sozial-und Präventivmedizin 47(5):282–288

    Article  Google Scholar 

  • Rabiee R, Lundin A, Agardh E, Forsell Y, Allebeck P, Danielsson AK (2020) Cannabis use, subsequent other illicit drug use and drug use disorders: a 16-year follow-up study among Swedish adults. Addict Behav 106:106390

    Article  Google Scholar 

  • Rasmussen EB, Reilly W, Buckley J, Boomhower SR (2012) Rimonabant reduces the essential value of food in the genetically obese Zucker rat: an exponential demand analysis. Physiol Behav 105(3):734–741

    Article  CAS  Google Scholar 

  • Richards JR, Smith NE, Moulin AK (2017) Unintentional cannabis ingestion in children: a systematic review. J Pediatr 190:142–152

    Article  Google Scholar 

  • Rogeberg O, Elvik R (2016) The effects of cannabis intoxication on motor vehicle collision revisited and revised. Addiction 111(8):1348–1359

    Article  Google Scholar 

  • Rothman KJ, Greenland S (2008) Modern epidemiology. Lippincott Williams & Wilkins

    Google Scholar 

  • Spindle TR, Cone EJ, Herrmann ES, Mitchell JM, Flegel R, LoDico C, Bigelow GE, Vandrey R (2020) Pharmacokinetics of cannabis brownies: a controlled examination of Δ9-tetrahydrocannabinol and metabolites in blood and oral fluid of healthy adult males and females. J Anal Toxicol 44(7):661–671

    Article  CAS  Google Scholar 

  • Temple EC, Brown RF, Hine DW (2010) The ‘grass ceiling’: limitations in the literature hinder our understanding of cannabis use and its consequences. Addiction 106(2):238–244

    Google Scholar 

  • Thomas BF, Pollard GT (2016) Preparation and distribution of cannabis and cannabis-derived dosage formulations for investigational and therapeutic use in the United States. Front Pharmacol 7:285

    Article  Google Scholar 

  • Tomar RS, Beaumont J, Hsieh JCY (2009) Evidence on the carcinogenicity of marijuana smoke. California EPA: Reproductive and Cancer Hazard Assessment Branch of the Office of Environmental Health Hazard Assessment, California, USA

    Google Scholar 

  • van der Pol P, Liebregts N, de Graaf R, Korf DJ, van den Brink W, van Laar M (2013) Validation of self-reported cannabis dose and potency: an ecological study. Addiction 108(10):1801–1808

    Article  Google Scholar 

  • Vandrey R, Raber JC, Raber ME, Douglass B, Miller C, Bonn-Miller MO (2015) Cannabinoid dose and label accuracy in edible medical cannabis products. JAMA 313(24):2491–2493

    Article  CAS  Google Scholar 

  • Walsh Z, Callaway R, Belle-Isle L, Capler R, Kay R, Lucas P, Holtzman S (2013) Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy 24(6):511–516

    Article  Google Scholar 

  • Webster TF (2007) Bias magnification in ecologic studies: a methodological investigation. Environ Health 6(1):1–17

    Article  Google Scholar 

  • Zuardi AW, Rodrigues NP, Silva AL, Bernardo SA, Hallak JE, Guimarães FS, Crippa JA (2017) Inverted U-shaped dose-response curve of the anxiolytic effect of cannabidiol during public speaking in real life. Front Pharmacol 8:259

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven R. Boomhower .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Boomhower, S.R. (2022). Public Health Issues of Legalizing Cannabis. In: Patel, V.B., Preedy, V.R. (eds) Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-92392-1_74

Download citation

Publish with us

Policies and ethics