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In the past 20 years, the drive to legalise medical marijuana (cannabis) has gained national attention with the public and policy makers. Beginning in 1996 states started implementing MMLs (medical marijuana laws), and by the end of 2015, 23 states and the District of Columbia had adopted laws legalizing marijuana use for medical purposes. We find that measures of policy diffusion and political culture are important drivers of adoption. However, the relative effects of positive pressure from neighbouring states and negative pressure from the ideological distance between adopting and non-adopting states is such that complete diffusion is unlikely.

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Factors driving the diffusion of medical marijuana legalisation in the United States

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In the past 20 years, the drive to legalise medical marijuana (cannabis) has gained national attention with the public and policy makers. Beginning in 1996 states started implementing MMLs (medical marijuana laws), and by the end of 2015, 23 states and the District of Columbia had adopted laws legalizing marijuana use for medical purposes.

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Summary

Background

Adolescent use of marijuana is associated with adverse later effects, so the identification of factors underlying adolescent use is of substantial public health importance. The relationship between US state laws that permit marijuana for medical purposes and adolescent marijuana use has been controversial. Such laws could convey a message about marijuana acceptability that increases its use soon after passage, even if implementation is delayed or the law narrowly restricts its use. We used 24 years of national data from the USA to examine the relationship between state medical marijuana laws and adolescent use of marijuana.

Methods

Using a multistage, random-sampling design with replacement, the Monitoring the Future study conducts annual national surveys of 8th, 10th, and 12th-grade students (modal ages 13-14, 15-16, and 17-18 years, respectively), in around 400 schools per year. Students complete self-administered questionnaires that include questions on marijuana use. We analysed data from 1 098 270 adolescents surveyed between 1991 and 2014. The primary outcome of this analysis was any marijuana use in the previous 30 days. We used multilevel regression modelling with adolescents nested within states to examine two questions. The first was whether marijuana use was higher overall in states that ever passed a medical marijuana law up to 2014. The second was whether the risk of marijuana use changed after passage of medical marijuana laws. Control covariates included individual, school, and state-level characteristics.

Findings

Marijuana use was more prevalent in states that passed a medical marijuana law any time up to 2014 than in other states (adjusted prevalence 15·87% vs 13·27%; adjusted odds ratio [OR] 1·27, 95% CI 1·07-1·51; p=0·0057). However, the risk of marijuana use in states before passing medical marijuana laws did not differ significantly from the risk after medical marijuana laws were passed (adjusted prevalence 16·25% vs 15·45%; adjusted OR 0·92, 95% CI 0·82-1·04; p=0·185). Results were generally robust across sensitivity analyses, including redefining marijuana use as any use in the previous year or frequency of use, and reanalysing medical marijuana laws for delayed effects or for variation in provisions for dispensaries.

Interpretation

Our findings, consistent with previous evidence, suggest that passage of state medical marijuana laws does not increase adolescent use of marijuana. However, overall, adolescent use is higher in states that ever passed such a law than in other states. State-level risk factors other than medical marijuana laws could contribute to both marijuana use and the passage of medical marijuana laws, and such factors warrant investigation.

Funding

US National Institute on Drug Abuse, Columbia University Mailman School of Public Health, New York State Psychiatric Institute.

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Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys

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JavaScript is disabled on your browser. Please enable JavaScript to use all the features on this page. Adolescent use of marijuana is associated with adverse later effects, so the identification of factors underlying adolescent use is of substantial public health importance.

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Opponents of legalization worry that fully allowing recreational marijuana use would make pot far too accessible and, as a result, expand its use and misuse.

The major concern is that letting for-profit businesses - "Big Marijuana" - market and sell cannabis may lead them to market aggressively to heavy pot users, who may have a drug problem. This is similar to what's happened in the alcohol and tobacco industries, where companies make much of their profits from users with serious addiction issues. Among alcohol users, for instance, the top 10 percent of users consume, on average, more than 10 drinks each day.

Marijuana users exhibit similar patterns. In Colorado, one study of the state's legal pot market, conducted by the Marijuana Policy Group for the state's Department of Revenue, found the top 29.9 percent heaviest pot users in Colorado made up 87.1 percent of demand for the drug. For the marijuana industry, that makes the heaviest users the most lucrative customers.

Kevin Sabet, head of Smart Approaches to Marijuana, the nation's leading anti-legalization group, explained: "If we were a country with a history of being able to promote moderation in our consumer use of products, or promote responsible corporate advertising or no advertising, or if we had a history of being able to take taxes gained from a vice and redirect them into some positive areas, I might be less concerned about what I see happening in this country. But I think we have a horrible history of dealing with these kinds of things."

Drug policy experts say there are alternatives to commercial legalization, like putting state governments in charge of marijuana production and sales, which could tame the for-profit incentive and give states more direct control over prices and who buys pot.

But legalization opponents worry that any move toward legalization will inevitably attract powerful for-profit forces, especially since the marijuana industry has already taken off in several states. "The reality is there are myriad other forces at work here," Sabet said. "Chief among them are the very powerful forces of greed and profit. When I look at how things are set up in states like Colorado, where the marijuana industry gets a seat at the table for every state decision on marijuana policy, it troubles me."

Given these concerns, opponents favor more limited reforms than legalization. Sabet, for example, said nonviolent marijuana users shouldn't be incarcerated for the drug. Other critics of legalization support legalizing marijuana for medical purposes but not recreational use.

It's rare that opponents of legalization argue for the full continuation of the current war on pot. SAM and its members, for instance, broadly agree that the current drug and criminal justice policies are far too punitive and costly, helping contribute to the mass incarceration of Americans. So while they may support some reforms, they feel that legalization simply goes too far - and could lead to worse consequences than the alternatives.

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Opponents of legalization worry that fully allowing recreational marijuana use would make pot far too accessible and, as a result, expand its use and misuse. The major concern is that letting for-profit businesses - "Big Marijuana" - market and sell cannabis may lead them to market aggressively to heavy pot users, who may have a drug problem.

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The University of Notre Dame Australia :: EzProxy Login

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Svrakic, D. M., Lustman, P. J., Mallya, A., Lynn, T. A., Finney, R., & Svrakic, N. M. (2012). Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective. Missouri medicine, 109(2), 90–98.

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Legalization, Decriminalization & Medicinal Use of Cannabis: A Scientific and Public Health Perspective

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Empirical and clinical studies clearly demonstrate significant adverse effects of cannabis smoking on physical and mental health as well as its interference with social and occupational functioning. These negative data far outweigh a few documented benefits…

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the US

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American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA) publications

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The American Journal of Public Health (AJPH) from the American Public Health Association (APHA)

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the US

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Use of marijuana exclusively for medical purposes

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To characterize the socio-demographic characteristics, medical conditions, and psychiatric comorbidities of users of marijuana for medical and non-med...

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Abstract

Background

Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence.

Methods

We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ ( n = 34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of ∼68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence.

Results

In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% CI: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% CI: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% CI: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use.

Conclusions

States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use.

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