Skip to main content
SpringerLink
Log in

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

  • Cannabis (D D'Souza and P Skosnik, Section Editors)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

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.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

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

  1. Conboy JR. Smoke screen: America’s drug policy and medical marijuana. Food Drug Law J. 2000;55:601–17.

    CAS  PubMed  Google Scholar 

  2. Controlled Substances Act, 21 U.S.C. § 801 (1970).

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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. 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. 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. 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. 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. 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. Pardo B. Cannabis policy reforms in the Americas: a comparative analysis of Colorado, Washington, and Uruguay. Int J Drug Policy. 2014;25:727–35.

    Article  PubMed  Google Scholar 

  13. Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction. 2016;111:1764–73.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  18. Anderson DM, Hansen B, Rees DI. Medical marijuana laws and teen marijuana use. Am Law Econ Rev. 2015;17:495–528.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Harper S, Strumpf EC, Kaufman JS. Do medical marijuana laws increase marijuana use? Replication study and extension. Ann Epidemiol. 2012;22:207–12.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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. Chu Y-WL. The effects of medical marijuana laws on illegal marijuana use. J Health Econ. 2014;38:43–61.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Cowan R. A war against ourselves: how the narcs created crack. Natl Rev. 1986;5:26–31.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  46. Hall W, Degenhardt L. High potency cannabis. BMJ. 2015;350:h1205.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Couper FJ, Peterson BL. The prevalence of marijuana in suspected impaired driving cases in Washington state. J Anal Toxicol. 2014;38:569–74.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Miech RA, Johnston L, O'Malley PM. Prevalence and attitudes regarding marijuana use among adolescents over the past decade. Pediatrics. 2017;140:e20170982.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Pacula RL, Smart R. Medical marijuana and marijuana legalization. Annu Rev Clin Psychol. 2017;13:397–419.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Webster P. Debate over recreational cannabis use legalisation in Canada. Lancet. 2018;391:725–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Centre for Youth Substance Abuse Research, The University of Queensland, 31 Upland Road, St. Lucia, QLD, 4067, Australia

    Janni Leung, Chui Ying Vivian Chiu, Daniel Stjepanović & Wayne Hall

  2. The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia

    Janni Leung & Chui Ying Vivian Chiu

  3. National Addiction Centre, Kings College London, London, UK

    Wayne Hall

Authors
  1. Janni Leung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chui Ying Vivian Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Stjepanović
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wayne Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janni Leung.

Ethics declarations

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.

Additional information

This article is part of the Topical Collection on Cannabis

Appendix. Flowchart of search results for literature on how legalisation of medical and recreational cannabis use affected the prevalence of cannabis use and cannabis use disorders

Appendix. Flowchart of search results for literature on how legalisation of medical and recreational cannabis use affected the prevalence of cannabis use and cannabis use disorders

figure a

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leung, J., Chiu, C.Y.V., Stjepanović, D. et al. Has the Legalisation of Medical and Recreational Cannabis Use in the USA Affected the Prevalence of Cannabis Use and Cannabis Use Disorders?. Curr Addict Rep 5, 403–417 (2018). https://doi.org/10.1007/s40429-018-0224-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-018-0224-9

Keywords

Search

Navigation