Advertisement

Current Addiction Reports

, Volume 5, Issue 4, pp 403–417 | Cite as

Has the Legalisation of Medical and Recreational Cannabis Use in the USA Affected the Prevalence of Cannabis Use and Cannabis Use Disorders?

  • Janni Leung
  • Chui Ying Vivian Chiu
  • Daniel Stjepanović
  • Wayne Hall
Cannabis (D D'Souza and P Skosnik, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Cannabis

Abstract

Purpose of Review

Since California legalised medical use of cannabis in 1996, 29 other US states have done so. Eight US states have legalised the retail sale of cannabis to adults over the age of 21 years since 2012. Critics of these policy changes have suggested that they will increase the prevalence of cannabis use and cannabis use disorders. This paper (1) briefly describes the types of regulatory regimes for medical and recreational cannabis use in the USA, (2) describes possible effects of these policies on cannabis use and (3) assesses the impacts to date of the legalisation of medical and recreational cannabis use on the prevalence of cannabis use and cannabis use disorders in the US population. We (1) describe the regulatory regimes for medical and recreational cannabis use in the USA, (2) make predictions about their possible effects on the price and availability of cannabis, (3) conduct a review to summarise studies of the effects of legalising medical cannabis use in the USA on rates of cannabis use and cannabis use disorders and (4) assess early indications of the effects of legalising recreational cannabis use on cannabis use and cannabis use disorders.

Recent Findings

Liberal forms of medical cannabis regulation have probably reduced prices and increased the availability of cannabis. Analyses of survey data suggest that these changes have increased the prevalence and frequency of cannabis use among adults over the age of 21 years, but they have not to date increased rates of cannabis use among adolescents. Two series of epidemiological studies over a decade following the introduction of medical cannabis laws have produced inconsistent results on the effects of policy changes on the prevalence of cannabis use disorders in adults. One study found that the prevalence had increased; the other did not find an increase. An analysis of data on treatment seeking for cannabis use disorders showed an increase in states with medical cannabis laws in the number of adults seeking treatment who were not under legal coercion. There are major limitations with these studies, many of which have mistakenly assumed that all states with medical cannabis laws have similarly liberal policies.

Summary

It may be a decade or more before we can fully assess the effects of liberalisation of cannabis policies on cannabis use and cannabis use disorders in the USA. It is critical that the effects of these policy changes are evaluated to ensure that cannabis is regulated in ways that minimise the harmful effects of its regular use, especially among young people.

Keywords

Medical marijuana laws Marijuana abuse Cannabis use disorder Health surveys USA 

Notes

Acknowledgements

We acknowledge Research librarian Sarah Yeates for assisting with literature searching, proofreading and editing, as well as bibliography management for this manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Conboy JR. Smoke screen: America’s drug policy and medical marijuana. Food Drug Law J. 2000;55:601–17.PubMedGoogle Scholar
  2. 2.
    Controlled Substances Act, 21 U.S.C. § 801 (1970).Google Scholar
  3. 3.
    Cambron C, Guttmannova K, Fleming CB. State and national contexts in evaluating cannabis laws: a case study of Washington State. J Drug Issues. 2017;47:74–90.CrossRefPubMedGoogle Scholar
  4. 4.
    Chapman SA, Spetz J, Lin J, Chan K, Schmidt LA. Capturing heterogeneity in medical marijuana policies: a taxonomy of regulatory regimes across the United States. Subst Use Misuse. 2016;51:1174–84.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Klieger SB, Gutman A, Allen L, Pacula R, Ibrahim JK, Burris S. Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017. Addiction. 2017;112:2206–16.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Garvey T, Yeh BT. State legalization of recreational marijuana: selected legal issues. Washington, DC: Congressional Research Office. 2014. Available from: https://fas.org/sgp/crs/misc/R43034.pdf. Accessed 17 Nov 2014.
  7. 7.
    Hudak J. Colorado’s rollout of legal marijuana is succeeding: a report on the state’s implementation of legalization. Washington, DC: Brookings Institution and the Washington Office on Latin America (WOLA). 2014. Available from: http://www.brookings.edu/~/media/research/files/papers/2014/07/colorado-marijuana-legalization-succeeding/cepmmjcov2.pdf. Accessed 11 Nov 2015.
  8. 8.
    Colorado Department of Public Health and Environment. Retail marijuana. Denver: State of Colorado. 2013. Available from: https://www.colorado.gov/pacific/cdphe/retail-marijuana. Accessed 21 Feb 2016.
  9. 9.
    Washington State Liquor Control Board. FAQs on marijuana. 2015. Available from: http://www.liq.wa.gov/mj2015/faqs_i-502. Accessed 19 May 2018.
  10. 10.
    Wallach PA. Washington’s marijuana legalization grows knowledge, not just pot. Washington, DC: Brookings Institution and the Washington Office on Latin America (WOLA). 2014. Available from: http://www.brookings.edu/research/reports/2014/08/25-washington-marijuana-legalization-knowledge-experiment-wallach. Accessed 11 Nov 2015.
  11. 11.
    Washington State Department of Revenue. Taxes due on marijuana. Olympia: State of Washington. 2014. Available from: http://dor.wa.gov/Content/FindTaxesAndRates/marijuana/Default.aspx. Accessed 19 May 2018.
  12. 12.
    Pardo B. Cannabis policy reforms in the Americas: a comparative analysis of Colorado, Washington, and Uruguay. Int J Drug Policy. 2014;25:727–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction. 2016;111:1764–73.CrossRefPubMedGoogle Scholar
  14. 14.
    D'Amico EJ, Tucker JS, Pedersen ER, Shih RA. Understanding rates of marijuana use and consequences among adolescents in a changing legal landscape. Curr Addict Rep. 2017;4:343–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen H-U. The World Health Organization Composite International Diagnostic Interview short-form (CIDI-SF). Int J Methods Psychiatr Res. 1998;7:171–85.CrossRefGoogle Scholar
  16. 16.
    Lynne-Landsman SD, Livingston MD, Wagenaar AC. Effects of state medical marijuana laws on adolescent marijuana use. Am J Public Health. 2013;103:1500–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Choo EK, Benz M, Zaller N, Warren O, Rising KL, McConnell KJ. The impact of state medical marijuana legislation on adolescent marijuana use. J Adolesc Health. 2014;55:160–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson DM, Hansen B, Rees DI. Medical marijuana laws and teen marijuana use. Am Law Econ Rev. 2015;17:495–528.CrossRefGoogle Scholar
  19. 19.
    Johnson J, Hodgkin D, Harris SK. The design of medical marijuana laws and adolescent use and heavy use of marijuana: analysis of 45 states from 1991 to 2011. Drug Alcohol Depend. 2017;170:1–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Hasin DS, Wall M, Keyes KM, Cerdá M, Schulenberg J, O'Malley PM, et al. Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys. Lancet Psychiatry. 2015;2:601–8.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Wen H, Hockenberry JM, Cummings JR. The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances. J Health Econ. 2015;42:64–80.CrossRefPubMedGoogle Scholar
  22. 22.
    • Sarvet AL, Wall MM, Fink DS, Greene E, Le A, Boustead AE, et al. Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta-analysis. Addiction. 2018;113:1003–16.  https://doi.org/10.1111/add.14136. This study conducted a systematic review and meta-analysis comparing cannabis use among adolescents by medical marijuana laws in the USA. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Harper S, Strumpf EC, Kaufman JS. Do medical marijuana laws increase marijuana use? Replication study and extension. Ann Epidemiol. 2012;22:207–12.CrossRefPubMedGoogle Scholar
  24. 24.
    Williams AR, Santaella-Tenorio J, Mauro CM, Levin FR, Martins SS. Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder. Addiction. 2017;112:1985–91.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Martins SS, Mauro CM, Santaella-Tenorio J, Kim JH, Cerdá M, Keyes KM, et al. State-level medical marijuana laws, marijuana use and perceived availability of marijuana among the general U.S. population. Drug Alcohol Depend. 2016;169:26–32.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mauro CM, Newswanger P, Santaella-Tenorio J, Mauro PM, Carliner H, Martins SS. Impact of medical marijuana laws on state-level marijuana use by age and gender, 2004-2013. Prev Sci. 2017.  https://doi.org/10.1007/s11121-017-0848-3.
  27. 27.
    Chu Y-WL. The effects of medical marijuana laws on illegal marijuana use. J Health Econ. 2014;38:43–61.CrossRefPubMedGoogle Scholar
  28. 28.
    • Pacula RL, Powell D, Heaton P, Sevigny EL. Assessing the effects of medical marijuana laws on marijuana use: the devil is in the details. J Policy Anal Manage. 2015;34:7–31 This study summarizes limitations of research methods used to examine the effects of medical marijuana laws on cannabis use, explains the implications of policy heterogeneity on the interpretation of findings and provides suggestions for how future work can incorporate different policy baselines in their evaluations. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ogden DW. Investigations and prosecutions in states authorizing the medical use of marijuana. Washington, D.C.: U.S. Department of Justice. 2009. Available from: http://www.justice.gov/opa/documents/medical-marijuana.pdf. Accessed 3 May 2018.
  30. 30.
    Pacek LR, Mauro PM, Martins SS. Perceived risk of regular cannabis use in the United States from 2002 to 2012: differences by sex, age, and race/ethnicity. Drug Alcohol Depend. 2015;149:232–44.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Nussbaum AM, Thurstone C, McGarry L, Walker B, Sabel AL. Use and diversion of medical marijuana among adults admitted to inpatient psychiatry. Am J Drug Alcohol Abuse. 2015;41:166–72.CrossRefPubMedGoogle Scholar
  32. 32.
    Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72:1235–42.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hasin DS, Sarvet AL, Cerdá M, Keyes KM, Stohl M, Galea S, et al. US adult illicit cannabis use, cannabis use disorder, and medical marijuana laws: 1991-1992 to 2012-2013. JAMA Psychiatry. 2017;74:579–88.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Compton WM, Grant BF, Colliver JD, Glantz MD, Stinson FS. Prevalence of marijuana use disorders in the United States: 1991-1992 and 2001-2002. JAMA. 2004;291:2114–21.CrossRefPubMedGoogle Scholar
  35. 35.
    • Hasin DS. US epidemiology of cannabis use and associated problems. Neuropsychopharmacology. 2018;43:195–212 This study summarised health and psychosocial consequenses of cannabis exposure and changes over time in medical and recreational marijuana laws, cannabis perceived harms, potency and prevalence of cannabis use, cannabis use disorders and cannabis-related problems. CrossRefPubMedGoogle Scholar
  36. 36.
    Compton WM, Han B, Jones CM, Blanco C, Hughes A. Marijuana use and use disorders in adults in the USA, 2002-14: analysis of annual cross-sectional surveys. Lancet Psychiatry. 2016;3:954–64.CrossRefPubMedGoogle Scholar
  37. 37.
    Freeman TP, Winstock AR. Examining the profile of high-potency cannabis and its association with severity of cannabis dependence. Psychol Med. 2015;45:3181–9.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Mehmedic Z, Chandra S, Slade D, Denham H, Foster S, Patel AS, et al. Potency trends of Δ9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. J Forensic Sci. 2010;55:1209–17.CrossRefPubMedGoogle Scholar
  39. 39.
    Grucza RA, Agrawal A, Krauss MJ, Bongu J, Plunk AD, Cavazos-Rehg PA, et al. Declining prevalence of marijuana use disorders among adolescents in the United States, 2002 to 2013. J Am Acad Child Adolesc Psychiatry. 2016;55:487–94.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kaskie B, Ayyagari P, Milavetz G, Shane D, Arora K. The increasing use of cannabis among older Americans: a public health crisis or viable policy alternative? Gerontologist. 2017;57:1166–72.PubMedGoogle Scholar
  41. 41.
    Mair C, Freisthler B, Ponicki WR, Gaidus A. The impacts of marijuana dispensary density and neighborhood ecology on marijuana abuse and dependence. Drug Alcohol Depend. 2015;154:111–6.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Davis JM, Mendelson B, Berkes JJ, Suleta K, Corsi KF, Booth RE. Public health effects of medical marijuana legalization in Colorado. Am J Prev Med. 2016;50:373–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Smart R, Caulkins JP, Kilmer B, Davenport S, Midgette G. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Addiction. 2017;112:2167–77.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Cowan R. A war against ourselves: how the narcs created crack. Natl Rev. 1986;5:26–31.Google Scholar
  45. 45.
    Ramaekers JG, Kauert G, van Ruitenbeek P, Theunissen EL, Schneider E, Moeller MR. High-potency marijuana impairs executive function and inhibitory motor control. Neuropsychopharmacology. 2006;31:2296.PubMedGoogle Scholar
  46. 46.
    Hall W, Degenhardt L. High potency cannabis. BMJ. 2015;350:h1205.CrossRefPubMedGoogle Scholar
  47. 47.
    Di Forti M, Marconi A, Carra E, Fraietta S, Trotta A, Bonomo M, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry. 2015;2:233–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Hunt P, Pacula RL. Early impacts of marijuana legalization: an evaluation of prices in Colorado and Washington. J Prim Prev. 2017;38:221–48.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Cerdá M, Wall M, Feng T, Keyes KM, Sarvet A, Schulenberg J, et al. Association of state recreational marijuana laws with adolescent marijuana use. JAMA Pediatr. 2017;171:142–9.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Couper FJ, Peterson BL. The prevalence of marijuana in suspected impaired driving cases in Washington state. J Anal Toxicol. 2014;38:569–74.CrossRefPubMedGoogle Scholar
  51. 51.
    Urfer S, Morton J, Beall V, Feldmann J, Gunesch J. Analysis of Δ9-tetrahydrocannabinol driving under the influence of drugs cases in Colorado from January 2011 to February 2014. J Anal Toxicol. 2014;38:575–81.CrossRefPubMedGoogle Scholar
  52. 52.
    Keyes KM, Wall M, Cerda M, Schulenberg J, O'Malley PM, Galea S, et al. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014. Addiction. 2016;111:2187–95.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Miech RA, Johnston L, O'Malley PM. Prevalence and attitudes regarding marijuana use among adolescents over the past decade. Pediatrics. 2017;140:e20170982.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Fleming CB, Guttmannova K, Cambron C, Rhew IC, Oesterle S. Examination of the divergence in trends for adolescent marijuana use and marijuana-specific risk factors in Washington State. J Adolesc Health. 2016;59:269–75.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Miech RA, Johnston L, O'Malley PM, Bachman JG, Schulenberg J, Patrick ME. Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013. Int J Drug Policy. 2015;26:336–44.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Schuermeyer J, Salomonsen-Sautel S, Price RK, Balan S, Thurstone C, Min S-J, et al. Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003-11. Drug Alcohol Depend. 2014;140:145–55.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Pacula RL, Smart R. Medical marijuana and marijuana legalization. Annu Rev Clin Psychol. 2017;13:397–419.CrossRefPubMedGoogle Scholar
  58. 58.
    Webster P. Debate over recreational cannabis use legalisation in Canada. Lancet. 2018;391:725–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Janni Leung
    • 1
    • 2
  • Chui Ying Vivian Chiu
    • 1
    • 2
  • Daniel Stjepanović
    • 1
  • Wayne Hall
    • 1
    • 3
  1. 1.Centre for Youth Substance Abuse ResearchThe University of QueenslandSt. LuciaAustralia
  2. 2.The National Drug and Alcohol Research CentreUniversity of New South WalesRandwickAustralia
  3. 3.National Addiction CentreKings College LondonLondonUK

Personalised recommendations