Marijuana Legalization in the U.S.

Abstract

As more U.S. states move to legalize medical and recreational cannabis, an ongoing policy debate continues around whether marijuana should be legalized at the federal level. This annotated bibliography examines recent evidence from public health and policy sources to assess considerations around nationwide legalization. Findings reveal potential health benefits like access to less harmful consumption methods and risks like increased youth access. While data shows limited adverse health effects from state legalization policies, more study is required on continuing population health outcomes. Sources advocate a cautious approach, prioritizing regulation, education, and continued monitoring if federal law reforms occur. Critical public health policy lessons include starting restrictive initially with periodic review, coordinating with public health agencies, imposing product testing standards, funding further research, and targeting education on risks like poly-substance use. A balanced framework emerges, emphasizing the need to weigh potential gains in social equity and tax revenue against possible population harms. Legalization at the federal scale should learn from state experiences and start by emphasizing public health protections that can be modified over time as more evidence develops. While more research is still needed, current data can guide policy that maximizes benefits and minimizes risks.

Keywords: cannabis legalization, marijuana policy, public health, United States, and regulation.

Caulkins, J. P., Kilmer, B., Kleiman, M. A., MacCoun, R. J., Midgette, G., Oglesby, P., Pacula, R. L., & Reuter, P. H. (2015). Options and issues regarding marijuana legalization. Rand Corporation. https://marroninstitute.nyu.edu/uploads/content/Caulkins_et_al_(2015)_RAND_PE149_Options_and_Issues_Regarding_Marijuana_Legalization.pdf (Book)

This comprehensive report from RAND analyzes different complex policy options for legalizing marijuana at the state level. It outlines the pros and cons of various approaches to regulating and taxing cannabis. The authors discuss critical considerations like treating marijuana more like alcohol or tobacco, different taxation schemes, marketing and advertising restrictions, and more. I will use this source extensively to explain important nuances in crafting effective legalization policies. It provides practical frameworks for thinking through different alternatives. For example, the report suggests taxation could help limit increased use while providing government revenue, but taxes set too high could sustain black market sales (Caulkins et al., 2015, pp. 15-16). This source provides an in-depth analysis of regulatory options considering public health impacts.

Chiu, V., Leung, J., Hall, W., Stjepanović, D., & Degenhardt, L. (2021). Public health impacts to date of the legalization of medical and recreational cannabis use in the USA. Neuropharmacology, 193(108610), 108610. (Peer-reviewed journal)

A 2021 study by Chiu and colleagues comprehensively examined the early health impacts of recreational and medical marijuana authorization policies applied in the United States. The study analyzed data on outcomes like youth and adults, problematic use, crime, traffic fatalities, cannabis use, hospitalizations, and more. The authors find limited evidence of significant adverse public health effects from the policy changes. I will cite this timely study to counter claims that cannabis legalization inherently harms public health based on current data. The article’s authors determine that the effects of legalizing recreational and medical cannabis on public health appear to be small.

Goodwin, R. D., Kim, J. H., Cheslack‐Postava, K., Weinberger, A. H., Wu, M., Wyka, K., & Kattan, M. (2021). Trends in cannabis use among adults with children in the home in the United States, 2004–2017: impact of state‐level legalization for recreational and medical use. Addiction, 116(10), 2770–2778. https://doi.org/10.1111/add.15472 (Peer-reviewed journal)

Goodwin and colleagues (2021) used national survey data to thoroughly examine trends and patterns of bhang use by parents before and after states legalized medical and recreational cannabis. It found no significant increase in parental cannabis use related to the passage of therapeutic marijuana laws but a slight rise in reported use after implementing recreational policies. However, rates of frequent and problematic use did not increase. I will use this nuanced data to argue legalization should be paired with public education initiatives focused on risks and responsible use, especially for parents. The study concludes its findings underscore the importance of including messages about cannabis risks to parents of minor children in any public education campaigns associated with cannabis legalization efforts.

Hall, W., & Lynskey, M. (2020). Assessing the Public Health Impacts of Legalizing Recreational Cannabis Use: the U.S. Experience. World Psychiatry, 19(2), 179–186. https://doi.org/10.1002/wps.20735 (Peer-reviewed journal)

This article reviews the existing data on health impacts since some individual U.S. states started legally allowing recreational marijuana use by adults. The authors find limited effects detected but argue it is too early to draw definitive conclusions. Confounding factors like simultaneous tobacco control measures make cannabis-specific outcomes difficult to isolate. I will cite this study to highlight the complexities and uncertainties in determining the public health outcomes that are definitively attributable to marijuana legalization. The article states the population-level impact of recreational cannabis laws remains unclear and calls for continued systematic analysis as more robust data emerges over time.

Jameson, L. E., Conrow, K. D., Pinkhasova, D. V., Boulanger, H. L., Ha, H., Jourabchian, N., Johnson, S. A., Simeone, M. P., Afia, I. A., Cahill, T. M., Orser, C. S., & Leung, M. C. K. (2022). Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. Environmental Health Perspectives, 130(9). https://doi.org/10.1289/ehp11206 (Peer-reviewed journal)

This study closely analyzes current state policies around standards and testing for contaminants in legally sold marijuana products. It finds excellent inconsistencies between states, with many needing more robust regulations comparable to guidelines for food safety. These gaps pose potential public health risks to consumers. I will cite this timely analysis to argue that federal oversight and standardization are imperative if nationwide recreational cannabis legalization occurs to ensure product purity and safety. The article concludes that national standards for cannabis testing and labeling are needed to improve product safety and protect public health (Jameson et al., 2022, p. 9). States so far have taken varied approaches to health protection.

Kim, J. H., Weinberger, A. H., Zhu, J., Barrington-Trimis, J., Wyka, K., & Goodwin, R. D. (2021). Impact of state-level cannabis legalization on poly use of alcohol and cannabis in the United States, 2004–2017. Drug and Alcohol Dependence, 218, 108364. (Peer-reviewed journal)

Kim et al. (2021) utilize national survey data to analyze trends and patterns in the simultaneous use of alcohol and marijuana before and after state-level cannabis legalization policies were enacted. It finds concerning increases in dual alcohol and marijuana use following recreational marijuana legalization, primarily among young adults aged 18-25. However, gains were not uniform across states. I will cite this evidence to advocate that federal legalization measures must be accompanied by thorough public education initiatives warning about the risks of poly-substance use and providing guidelines for safer use. The study states its data shows that the importance of targeted prevention messaging and behavioral interventions addressing simultaneous alcohol and cannabis use, especially among younger adults.

Leung, J., Chiu, V., Chan, G. C. K., Stjepanović, D., & Hall, W. D. (2019). What Have Been the Public Health Impacts of Cannabis Legalisation in the USA? A Review of Evidence on Adverse and Beneficial Effects. Current Addiction Reports, 6(4), 418–428. https://doi.org/10.1007/s40429-019-00291-x (Peer-reviewed journal)

This peer-reviewed article, published shortly after initial recreational marijuana legalization, summarizes the evidence on the positive and negative health-related impacts of cannabis legalization policies implemented in the U.S. The authors find the data remains relatively limited at this stage, with mixed evidence of both harms and benefits attributable to the policy changes. I will use this review to emphasize the need to continue reviewing research and systematically monitoring data if recreational marijuana is legalized federally to clarify public health effects over time as they emerge. The article concludes by advocating policymakers must prioritize systematically monitoring and researching the impacts on public health” as cannabis law reforms continue to evolve.

Schauer, G. L. (2021). Cannabis Policy in the United States: Implications for Public Health. JNCI Monographs, 2021(58), 39–52. https://doi.org/10.1093/jncimonographs/lgab016 (Peer-reviewed journal)

The author explores essential factors related to current marijuana policies in the U.S. from a public health point of view. It argues that legalization initiatives should involve coordination with public health agencies and be paired thoughtfully with regulations on product testing, marketing, and retail density. It also advocates for comprehensive public education campaigns and continued investment in research on effects. I will cite this source to argue for a cautious approach to federal cannabis law reforms that makes public health considerations like those raised in this analysis a primary focus. The author states that prudent policies can maximize the benefits and minimize the harms of cannabis use through evidence-based measures like age restrictions, potency caps, and more.

References

Caulkins, J. P., Kilmer, B., Kleiman, M. A., MacCoun, R. J., Midgette, G., Oglesby, P., Pacula, R. L., & Reuter, P. H. (2015). Options and issues regarding marijuana legalization. Rand Corporation. https://marroninstitute.nyu.edu/uploads/content/Caulkins_et_al_(2015)_RAND_PE149_Options_and_Issues_Regarding_Marijuana_Legalization.pdf

Chiu, V., Leung, J., Hall, W., Stjepanović, D., & Degenhardt, L. (2021). Public health impacts to date of the legalization of medical and recreational cannabis use in the USA. Neuropharmacology, 193(108610), 108610. https://doi.org/10.1016/j.neuropharm.2021.108610

Goodwin, R. D., Kim, J. H., Cheslack‐Postava, K., Weinberger, A. H., Wu, M., Wyka, K., & Kattan, M. (2021). Trends in cannabis use among adults with children in the home in the United States, 2004–2017: impact of state‐level legalization for recreational and medical use. Addiction, 116(10), 2770–2778. https://doi.org/10.1111/add.15472

Hall, W., & Lynskey, M. (2020). Assessing the Public Health Impacts of Legalizing Recreational Cannabis Use: the U.S. Experience. World Psychiatry, 19(2), 179–186. https://doi.org/10.1002/wps.20735

Jameson, L. E., Conrow, K. D., Pinkhasova, D. V., Boulanger, H. L., Ha, H., Jourabchian, N., Johnson, S. A., Simeone, M. P., Afia, I. A., Cahill, T. M., Orser, C. S., & Leung, M. C. K. (2022). Comparison of State-Level Regulations for Cannabis Contaminants and Implications for Public Health. Environmental Health Perspectives, 130(9). https://doi.org/10.1289/ehp11206

Kim, J. H., Weinberger, A. H., Zhu, J., Barrington-Trimis, J., Wyka, K., & Goodwin, R. D. (2021). Impact of state-level cannabis legalization on poly use of alcohol and cannabis in the United States, 2004–2017. Drug and Alcohol Dependence, 218, 108364. https://doi.org/10.1016/j.drugalcdep.2020.108364

Leung, J., Chiu, V., Chan, G. C. K., Stjepanović, D., & Hall, W. D. (2019). What Have Been the Public Health Impacts of Cannabis Legalisation in the USA? A Review of Evidence on Adverse and Beneficial Effects. Current Addiction Reports, 6(4), 418–428. https://doi.org/10.1007/s40429-019-00291-x

Schauer, G. L. (2021). Cannabis Policy in the United States: Implications for Public Health. JNCI Monographs, 2021(58), 39–52. https://doi.org/10.1093/jncimonographs/lgab016