Advocates for Evidence-Based Health Policy Speakers
Policies that Dive into the Weed
Presently, 33 states and Washington, D.C. have legalized marijuana for medical use while 11 states and D.C. have legalized marijuana for recreation. During the “War on Drugs,” President Nixon signed the Controlled Substances Act of 1970 into law, making marijuana a Schedule I drug – the same classification as heroin. A lot has changed in the past 40 years, including the complex fabric of marijuana legalization, which continues to be a source of much controversy in the US.
An article published in JAMA Psychiatry examined the impact of recreational marijuana across multiple age groups following enactment of legalization from 2012 to 2015. This study found a 25% increase in cannabis use disorder (CUD) among adolescents aged 12-17 in states with recreational marijuana laws (RML) compared to states without. It also found increases in frequent use and CUD among adults 26 or older after RML. However, there was no statistically significant difference found in young adults 18-25. Until marijuana ceases to be on the fringes of both medical research and society, we will remain in the dark about both the short and long term benefits and potential harms of marijuana products.
These findings are relevant to several recent policies proposed at the federal level: the Marijuana Opportunity Reinvestment and Expungement (MORE) Act and the Medical Marijuana Research Act. The MORE Act would decriminalize marijuana at the federal level, expunge prior cannabis convictions and provide treatment support programs. Opponents of RML argue that passage of these laws could lead to increased problematic use of marijuana due to decreased barriers of legal access, as proposed by the study. Proponents argue that conducting rigorous studies on the effects of marijuana while it remains under Schedule I is very challenging, as the scheduling limits the ability to secure federal funding for drug studies. There are important social benefits to legalizing marijuana, particularly in addressing racial disparities in criminal justice. There have been decades of racially biased and unjust enforcement of marijuana prohibition. Latino and Black Americans are still more likely to be arrested for marijuana charges than their White peers.
For now, we are stuck with the patchwork system we have. We cannot eliminate the negative side effects of marijuana use, but with further study, we can understand and mitigate them.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Cecilia Hiu Sze Kwong. She is a medical student at Morehouse School of Medicine.
Abstract
Importance: Little is known about changes in marijuana use and cannabis use disorder (CUD) after recreational marijuana legalization (RML).
Objectives: To examine the associations between RML enactment and changes in marijuana use, frequent use, and CUD in the United States from 2008 to 2016.
Design, setting, and participants: This survey study used repeated cross-sectional survey data from the National Survey on Drug Use and Health (2008-2016) conducted in the United States among participants in the age groups of 12 to 17, 18 to 25, and 26 years or older.
Interventions: Multilevel logistic regression models were fit to obtain estimates of before-vs-after changes in marijuana use among respondents in states enacting RML compared to changes in other states.
Main outcomes and measures: Self-reported past-month marijuana use, past-month frequent marijuana use, past-month frequent use among past-month users, past-year CUD, and past-year CUD among past-year users.
Results: The study included 505 796 respondents consisting of 51.51% females and 77.24% participants 26 years or older. Among the total, 65.43% were white, 11.90% black, 15.36% Hispanic, and 7.31% of other race/ethnicity. Among respondents aged 12 to 17 years, past-year CUD increased from 2.18% to 2.72% after RML enactment, a 25% higher increase than that for the same age group in states that did not enact RML (odds ratio [OR], 1.25; 95% CI, 1.01-1.55). Among past-year marijuana users in this age group, CUD increased from 22.80% to 27.20% (OR, 1.27; 95% CI, 1.01-1.59). Unmeasured confounders would need to be more prevalent in RML states and increase the risk of cannabis use by 1.08 to 1.11 times to explain observed results, indicating results that are sensitive to omitted variables. No associations were found among the respondents aged 18 to 25 years. Among respondents 26 years or older, past-month marijuana use after RML enactment increased from 5.65% to 7.10% (OR, 1.28; 95% CI, 1.16-1.40), past-month frequent use from 2.13% to 2.62% (OR, 1.24; 95% CI, 1.08-1.41), and past-year CUD from 0.90% to 1.23% (OR, 1.36; 95% CI, 1.08-1.71); these results were more robust to unmeasured confounding. Among marijuana users in this age group, past-month frequent marijuana use and past-year CUD did not increase after RML enactment.
Conclusions and relevance: This study’s findings suggest that although marijuana legalization advanced social justice goals, the small post-RML increase in risk for CUD among respondents aged 12 to 17 years and increased frequent use and CUD among adults 26 years or older in this study are a potential public health concern. To undertake prevention efforts, further studies are warranted to assess how these increases occur and to identify subpopulations that may be especially vulnerable.
PMID: 31722000
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