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Journal of Cannabis Research

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• Published: 04 February 2020

Marijuana legalization and historical trends in marijuana use among US residents aged 12–25: results from the 1979–2016 National Survey on drug use and health

• Xinguang Chen 1 ,
• Xiangfan Chen 2 &
• Hong Yan 2  

BMC Public Health volume  20 , Article number:  156 ( 2020 ) Cite this article

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Marijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization.

Data ( n  = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model.

After controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003.

The model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

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Introduction

Marijuana use and laws in the united states.

Marijuana is one of the most commonly used drugs in the United States (US) [ 1 ]. In 2015, 8.3% of the US population aged 12 years and older used marijuana in the past month; 16.4% of adolescents aged 12–17 years used in lifetime and 7.0% used in the past month [ 2 ]. The effects of marijuana on a person’s health are mixed. Despite potential benefits (e.g., relieve pain) [ 3 ], using marijuana is associated with a number of adverse effects, particularly among adolescents. Typical adverse effects include impaired short-term memory, cognitive impairment, diminished life satisfaction, and increased risk of using other substances [ 4 ].

Since 1937 when the Marijuana Tax Act was issued, a series of federal laws have been subsequently enacted to regulate marijuana use, including the Boggs Act (1952), Narcotics Control Act (1956), Controlled Substance Act (1970), and Anti-Drug Abuse Act (1986) [ 5 , 6 ]. These laws regulated the sale, possession, use, and cultivation of marijuana [ 6 ]. For example, the Boggs Act increased the punishment of marijuana possession, and the Controlled Substance Act categorized the marijuana into the Schedule I Drugs which have a high potential for abuse, no medical use, and not safe to use without medical supervision [ 5 , 6 ]. These federal laws may have contributed to changes in the historical trend of marijuana use among youth.

Movements to decriminalize and legalize marijuana use

Starting in the late 1960s, marijuana decriminalization became a movement, advocating reformation of federal laws regulating marijuana [ 7 ]. As a result, 11 US states had taken measures to decriminalize marijuana use by reducing the penalty of possession of small amount of marijuana [ 7 ].

The legalization of marijuana started in 1993 when Surgeon General Elder proposed to study marijuana legalization [ 8 ]. California was the first state that passed Medical Marijuana Laws (MML) in 1996 [ 9 ]. After California, more and more states established laws permitting marijuana use for medical and/or recreational purposes. To date, 33 states and the District of Columbia have established MML, including 11 states with recreational marijuana laws (RML) [ 9 ]. Compared with the legalization of marijuana use in the European countries which were more divided that many of them have medical marijuana registered as a treatment option with few having legalized recreational use [ 10 , 11 , 12 , 13 ], the legalization of marijuana in the US were more mixed with 11 states legalized medical and recreational use consecutively, such as California, Nevada, Washington, etc. These state laws may alter people’s attitudes and behaviors, finally may lead to the increased risk of marijuana use, particularly among young people [ 13 ]. Reported studies indicate that state marijuana laws were associated with increases in acceptance of and accessibility to marijuana, declines in perceived harm, and formation of new norms supporting marijuana use [ 14 ].

Marijuana harm to adolescents and young adults

Adolescents and young adults constitute a large proportion of the US population. Data from the US Census Bureau indicate that approximately 60 million of the US population are in the 12–25 years age range [ 15 ]. These people are vulnerable to drugs, including marijuana [ 16 ]. Marijuana is more prevalent among people in this age range than in other ages [ 17 ]. One well-known factor for explaining the marijuana use among people in this age range is the theory of imbalanced cognitive and physical development [ 4 ]. The delayed brain development of youth reduces their capability to cognitively process social, emotional and incentive events against risk behaviors, such as marijuana use [ 18 ]. Understanding the impact of marijuana laws on marijuana use among this population with a historical perspective is of great legal, social and public health significance.

Inconsistent results regarding the impact of marijuana laws on marijuana use

A number of studies have examined the impact of marijuana laws on marijuana use across the world, but reported inconsistent results [ 13 ]. Some studies reported no association between marijuana laws and marijuana use [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], some reported a protective effect of the laws against marijuana use [ 24 , 26 ], some reported mixed effects [ 27 , 28 ], while some others reported a risk effect that marijuana laws increased marijuana use [ 29 , 30 ]. Despite much information, our review of these reported studies revealed several limitations. First of all, these studies often targeted a short time span, ignoring the long period trend before marijuana legalization. Despite the fact that marijuana laws enact in a specific year, the process of legalization often lasts for several years. Individuals may have already changed their attitudes and behaviors before the year when the law is enacted. Therefore, it may not be valid when comparing marijuana use before and after the year at a single time point when the law is enacted and ignoring the secular historical trend [ 19 , 30 , 31 ]. Second, many studies adapted the difference-in-difference analytical approach designated for analyzing randomized controlled trials. No US state is randomized to legalize the marijuana laws, and no state can be established as controls. Thus, the impact of laws cannot be efficiently detected using this approach. Third, since marijuana legalization is a public process, and the information of marijuana legalization in one state can be easily spread to states without the marijuana laws. The information diffusion cannot be ruled out, reducing the validity of the non-marijuana law states as the controls to compare the between-state differences [ 31 ].

Alternatively, evidence derived based on a historical perspective may provide new information regarding the impact of laws and regulations on marijuana use, including state marijuana laws in the past two decades. Marijuana users may stop using to comply with the laws/regulations, while non-marijuana users may start to use if marijuana is legal. Data from several studies with national data since 1996 demonstrate that attitudes, beliefs, perceptions, and use of marijuana among people in the US were associated with state marijuana laws [ 29 , 32 ].

Age-period-cohort modeling: looking into the past with recent data

To investigate historical trends over a long period, including the time period with no data, we can use the classic age-period-cohort modeling (APC) approach. The APC model can successfully discompose the rate or prevalence of marijuana use into independent age, period and cohort effects [ 33 , 34 ]. Age effect refers to the risk associated with the aging process, including the biological and social accumulation process. Period effect is risk associated with the external environmental events in specific years that exert effect on all age groups, representing the unbiased historical trend of marijuana use which controlling for the influences from age and birth cohort. Cohort effect refers to the risk associated with the specific year of birth. A typical example is that people born in 2011 in Fukushima, Japan may have greater risk of cancer due to the nuclear disaster [ 35 ], so a person aged 80 in 2091 contains the information of cancer risk in 2011 when he/she was born. Similarly, a participant aged 25 in 1979 contains information on the risk of marijuana use 25 years ago in 1954 when that person was born. With this method, we can describe historical trends of marijuana use using information stored by participants in older ages [ 33 ]. The estimated period and cohort effects can be used to present the unbiased historical trend of specific topics, including marijuana use [ 34 , 36 , 37 , 38 ]. Furthermore, the newly established hierarchical APC (HAPC) modeling is capable of analyzing individual-level data to provide more precise measures of historical trends [ 33 ]. The HAPC model has been used in various fields, including social and behavioral science, and public health [ 39 , 40 ].

Several studies have investigated marijuana use with APC modeling method [ 17 , 41 , 42 ]. However, these studies covered only a small portion of the decades with state marijuana legalization [ 17 , 42 ]. For example, the study conducted by Miech and colleagues only covered periods from 1985 to 2009 [ 17 ]. Among these studies, one focused on a longer state marijuana legalization period, but did not provide detailed information regarding the impact of marijuana laws because the survey was every 5 years and researchers used a large 5-year age group which leads to a wide 10-year birth cohort. The averaging of the cohort effects in 10 years could reduce the capability of detecting sensitive changes of marijuana use corresponding to the historical events [ 41 ].

Purpose of the study

In this study, we examined the historical trends in marijuana use among youth using HAPC modeling to obtain the period and cohort effects. These two effects provide unbiased and independent information to characterize historical trends in marijuana use after controlling for age and other covariates. We conceptually linked the model-derived time trends to both federal and state laws/regulations regarding marijuana and other drug use in 1954–2016. The ultimate goal is to provide evidence informing federal and state legislation and public health decision-making to promote responsible marijuana use and to protect young people from marijuana use-related adverse consequences.

Materials and methods

Data sources and study population.

Data were derived from 31 waves of National Survey on Drug Use and Health (NSDUH), 1979–2016. NSDUH is a multi-year cross-sectional survey program sponsored by the Substance Abuse and Mental Health Services Administration. The survey was conducted every 3 years before 1990, and annually thereafter. The aim is to provide data on the use of tobacco, alcohol, illicit drug and mental health among the US population.

Survey participants were noninstitutionalized US civilians 12 years of age and older. Participants were recruited by NSDUH using a multi-stage clustered random sampling method. Several changes were made to the NSDUH after its establishment [ 43 ]. First, the name of the survey was changed from the National Household Survey on Drug Abuse (NHSDA) to NSDUH in 2002. Second, starting in 2002, adolescent participants receive $30 as incentives to improve the response rate. Third, survey mode was changed from personal interviews with self-enumerated answer sheets (before 1999) to the computer-assisted person interviews (CAPI) and audio computer-assisted self-interviews (ACASI) (since 1999). These changes may confound the historical trends [ 43 ], thus we used two dummy variables as covariates, one for the survey mode change in 1999 and another for the survey method change in 2002 to control for potential confounding effect.

Data acquisition

Data were downloaded from the designated website ( https://nsduhweb.rti.org/respweb/homepage.cfm ). A database was used to store and merge the data by year for analysis. Among all participants, data for those aged 12–25 years ( n  = 749,152) were included. We excluded participants aged 26 and older because the public data did not provide information on single or two-year age that was needed for HAPC modeling (details see statistical analysis section). We obtained approval from the Institutional Review Board at the University of Florida to conduct this study.

Variables and measurements

Current marijuana use: the dependent variable. Participants were defined as current marijuana users if they reported marijuana use within the past 30 days. We used the variable harmonization method to create a comparable measure across 31-wave NSDUH data [ 44 ]. Slightly different questions were used in NSDUH. In 1979–1993, participants were asked: “When was the most recent time that you used marijuana or hash?” Starting in 1994, the question was changed to “How long has it been since you last used marijuana or hashish?” To harmonize the marijuana use variable, participants were coded as current marijuana users if their response to the question indicated the last time to use marijuana was within past 30 days.

Chronological age, time period and birth cohort were the predictors. (1) Chronological age in years was measured with participants’ age at the survey. APC modeling requires the same age measure for all participants [ 33 ]. Since no data by single-year age were available for participants older than 21, we grouped all participants into two-year age groups. A total of 7 age groups, 12–13, ..., 24–25 were used. (2) Time period was measured with the year when the survey was conducted, including 1979, 1982, 1985, 1988, 1990, 1991... 2016. (3). Birth cohort was the year of birth, and it was measured by subtracting age from the survey year.

The proportion of people covered by MML: This variable was created by dividing the population in all states with MML over the total US population. The proportion was computed by year from 1996 when California first passed the MML to 2016 when a total of 29 states legalized medical marijuana use. The estimated proportion ranged from 12% in 1996 to 61% in 2016. The proportion of people covered by RML: This variable was derived by dividing the population in all states with RML with the total US population. The estimated proportion ranged from 4% in 2012 to 21% in 2016. These two variables were used to quantitatively assess the relationships between marijuana laws and changes in the risk of marijuana use.

Covariates: Demographic variables gender (male/female) and race/ethnicity (White, Black, Hispanic and others) were used to describe the study sample.

Statistical analysis

We estimated the prevalence of current marijuana use by year using the survey estimation method, considering the complex multi-stage cluster random sampling design and unequal probability. A prevalence rate is not a simple indicator, but consisting of the impact of chronological age, time period and birth cohort, named as age, period and cohort effects, respectively. Thus, it is biased if a prevalence rate is directly used to depict the historical trend. HAPC modeling is an epidemiological method capable of decomposing prevalence rate into mutually independent age, period and cohort effects with individual-level data, while the estimated period and cohort effects provide an unbiased measure of historical trend controlling for the effects of age and other covariates. In this study, we analyzed the data using the two-level HAPC cross-classified random-effects model (CCREM) [ 36 ]:

Where M ijk represents the rate of marijuana use for participants in age group i (12–13, 14,15...), period j (1979, 1982,...) and birth cohort k (1954–55, 1956–57...); parameter α i (age effect) was modeled as the fixed effect; and parameters β j (period effect) and γ k (cohort effect) were modeled as random effects; and β m was used to control m covariates, including the two dummy variables assessing changes made to the NSDUH in 1999 and 2002, respectively.

The HAPC modeling analysis was executed using the PROC GLIMMIX. Sample weights were included to obtain results representing the total US population aged 12–25. A ridge-stabilized Newton-Raphson algorithm was used for parameter estimation. Modeling analysis was conducted for the overall sample, stratified by gender. The estimated age effect α i , period β j and cohort γ k (i.e., the log-linear regression coefficients) were directly plotted to visualize the pattern of change.

To gain insight into the relationship between legal events and regulations at the national level, we listed these events/regulations along with the estimated time trends in the risk of marijuana from HAPC modeling. To provide a quantitative measure, we associated the estimated period effect with the proportions of US population living with MML and RML using Pearson correlation. All statistical analyses for this study were conducted using the software SAS, version 9.4 (SAS Institute Inc., Cary, NC).

Sample characteristics

Data for a total of 749,152 participants (12–25 years old) from all 31-wave NSDUH covering a 38-year period were analyzed. Among the total sample (Table  1 ), 48.96% were male and 58.78% were White, 14.84% Black, and 18.40% Hispanic.

Prevalence rate of current marijuana use

As shown in Fig.  1 , the estimated prevalence rates of current marijuana use from 1979 to 2016 show a “V” shaped pattern. The rate was 27.57% in 1979, it declined to 8.02% in 1992, followed by a gradual increase to 14.70% by 2016. The pattern was the same for both male and female with males more likely to use than females during the whole period.

Prevalence rate (%) of current marijuana use among US residents 12 to 25 years of age during 1979–2016, overall and stratified by gender. Derived from data from the 1979–2016 National Survey on Drug Use and Health (NSDUH)

HAPC modeling and results

Estimated age effects α i from the CCREM [ 1 ] for current marijuana use are presented in Fig.  2 . The risk by age shows a 2-phase pattern –a rapid increase phase from ages 12 to 19, followed by a gradually declining phase. The pattern was persistent for the overall sample and for both male and female subsamples.

Age effect for the risk of current marijuana use, overall and stratified by male and female, estimated with hierarchical age-period-cohort modeling method with 31 waves of NSDUH data during 1979–2016. Age effect α i were log-linear regression coefficients estimated using CCREM (1), see text for more details

The estimated period effects β j from the CCREM [ 1 ] are presented in Fig.  3 . The period effect reflects the risk of current marijuana use due to significant events occurring over the period, particularly federal and state laws and regulations. After controlling for the impacts of age, cohort and other covariates, the estimated period effect indicates that the risk of current marijuana use had two declining trends (1979–1992 and 2001–2006), and two increasing trends (1992–2001 and 2006–2016). Epidemiologically, the time trends characterized by the estimated period effects in Fig. 3 are more valid than the prevalence rates presented in Fig. 1 because the former was adjusted for confounders while the later was not.

Period effect for the risk of marijuana use for US adolescents and young adults, overall and by male/female estimated with hierarchical age-period-cohort modeling method and its correlation with the proportion of US population covered by Medical Marijuana Laws and Recreational Marijuana Laws. Period effect β j were log-linear regression coefficients estimated using CCREM (1), see text for more details

Correlation of the period effect with proportions of the population covered by marijuana laws: The Pearson correlation coefficient of the period effect with the proportions of US population covered by MML during 1996–2016 was 0.89 for the total sample, 0.81 for male and 0.93 for female, respectively ( p  < 0.01 for all). The correlation between period effect and proportion of US population covered by RML was 0.64 for the total sample, 0.59 for male and 0.49 for female ( p  > 0.05 for all).

Likewise, the estimated cohort effects γ k from the CCREM [ 1 ] are presented in Fig.  4 . The cohort effect reflects changes in the risk of current marijuana use over the period indicated by the year of birth of the survey participants after the impacts of age, period and other covariates are adjusted. Results in the figure show three distinctive cohorts with different risk patterns of current marijuana use during 1954–2003: (1) the Historical Declining Cohort (HDC): those born in 1954–1972, and characterized by a gradual and linear declining trend with some fluctuations; (2) the Sudden Increase Cohort (SIC): those born from 1972 to 1984, characterized with a rapid almost linear increasing trend; and (3) the Contemporary Declining Cohort (CDC): those born during 1984 and 2003, and characterized with a progressive declining over time. The detailed results of HAPC modeling analysis were also shown in Additional file 1 : Table S1.

Cohort effect for the risk of marijuana use among US adolescents and young adults born during 1954–2003, overall and by male/female, estimated with hierarchical age-period-cohort modeling method. Cohort effect γ k were log-linear regression coefficients estimated using CCREM (1), see text for more details

This study provides new data regarding the risk of marijuana use in youth in the US during 1954–2016. This is a period in the US history with substantial increases and declines in drug use, including marijuana; accompanied with many ups and downs in legal actions against drug use since the 1970s and progressive marijuana legalization at the state level from the later 1990s till today (see Additional file 1 : Table S2). Findings of the study indicate four-phase period effect and three-phase cohort effect, corresponding to various historical events of marijuana laws, regulations and social movements.

Coincident relationship between the period effect and legal drug control

The period effect derived from the HAPC model provides a net effect of the impact of time on marijuana use after the impact of age and birth cohort were adjusted. Findings in this study indicate that there was a progressive decline in the period effect during 1979 and 1992. This trend was corresponding to a period with the strongest legal actions at the national level, the War on Drugs by President Nixon (1969–1974) President Reagan (1981–1989) [ 45 ], and President Bush (1989) [ 45 ],and the Anti-Drug Abuse Act (1986) [ 5 ].

The estimated period effect shows an increasing trend in 1992–2001. During this period, President Clinton advocated for the use of treatment to replace incarceration (1992) [ 45 ], Surgeon General Elders proposed to study marijuana legalization (1993–1994) [ 8 ], President Clinton’s position of the need to re-examine the entire policy against people who use drugs, and decriminalization of marijuana (2000) [ 45 ] and the passage of MML in eight US states.

The estimated period effect shows a declining trend in 2001–2006. Important laws/regulations include the Student Drug Testing Program promoted by President Bush, and the broadened the public schools’ authority to test illegal drugs among students given by the US Supreme Court (2002) [ 46 ].

The estimated period effect increases in 2006–2016. This is the period when the proportion of the population covered by MML progressively increased. This relation was further proved by a positive correlation between the estimated period effect and the proportion of the population covered by MML. In addition, several other events occurred. For example, over 500 economists wrote an open letter to President Bush, Congress and Governors of the US and called for marijuana legalization (2005) [ 47 ], and President Obama ended the federal interference with the state MML, treated marijuana as public health issues, and avoided using the term of “War on Drugs” [ 45 ]. The study also indicates that the proportion of population covered by RML was positively associated with the period effect although not significant which may be due to the limited number of data points of RML. Future studies may follow up to investigate the relationship between RML and rate of marijuana use.

Coincident relationship between the cohort effect and legal drug control

Cohort effect is the risk of marijuana use associated with the specific year of birth. People born in different years are exposed to different laws, regulations in the past, therefore, the risk of marijuana use for people may differ when they enter adolescence and adulthood. Findings in this study indicate three distinctive cohorts: HDC (1954–1972), SIC (1972–1984) and CDC (1984–2003). During HDC, the overall level of marijuana use was declining. Various laws/regulations of drug use in general and marijuana in particular may explain the declining trend. First, multiple laws passed to regulate the marijuana and other substance use before and during this period remained in effect, for example, the Marijuana Tax Act (1937), the Boggs Act (1952), the Narcotics Control Act (1956) and the Controlled Substance Act (1970). Secondly, the formation of government departments focusing on drug use prevention and control may contribute to the cohort effect, such as the Bureau of Narcotics and Dangerous Drugs (1968) [ 48 ]. People born during this period may be exposed to the macro environment with laws and regulations against marijuana, thus, they may be less likely to use marijuana.

Compared to people born before 1972, the cohort effect for participants born during 1972 and 1984 was in coincidence with the increased risk of using marijuana shown as SIC. This trend was accompanied by the state and federal movements for marijuana use, which may alter the social environment and public attitudes and beliefs from prohibitive to acceptive. For example, seven states passed laws to decriminalize the marijuana use and reduced the penalty for personal possession of small amount of marijuana in 1976 [ 7 ]. Four more states joined the movement in two subsequent years [ 7 ]. People born during this period may have experienced tolerated environment of marijuana, and they may become more acceptable of marijuana use, increasing their likelihood of using marijuana.

A declining cohort CDC appeared immediately after 1984 and extended to 2003. This declining cohort effect was corresponding to a number of laws, regulations and movements prohibiting drug use. Typical examples included the War on Drugs initiated by President Nixon (1980s), the expansion of the drug war by President Reagan (1980s), the highly-publicized anti-drug campaign “Just Say No” by First Lady Nancy Reagan (early 1980s) [ 45 ], and the Zero Tolerance Policies in mid-to-late 1980s [ 45 ], the Anti-Drug Abuse Act (1986) [ 5 ], the nationally televised speech of War on Drugs declared by President Bush in 1989 and the escalated War on Drugs by President Clinton (1993–2001) [ 45 ]. Meanwhile many activities of the federal government and social groups may also influence the social environment of using marijuana. For example, the Federal government opposed to legalize the cultivation of industrial hemp, and Federal agents shut down marijuana sales club in San Francisco in 1998 [ 48 ]. Individuals born in these years grew up in an environment against marijuana use which may decrease their likelihood of using marijuana when they enter adolescence and young adulthood.

This study applied the age-period-cohort model to investigate the independent age, period and cohort effects, and indicated that the model derived trends in marijuana use among adolescents and young adults were coincident with the laws and regulations on marijuana use in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Limitations

This study has limitations. First, study data were collected through a household survey, which is subject to underreporting. Second, no causal relationship can be warranted using cross-sectional data, and further studies are needed to verify the association between the specific laws/regulation and the risk of marijuana use. Third, data were available to measure single-year age up to age 21 and two-year age group up to 25, preventing researchers from examining the risk of marijuana use for participants in other ages. Lastly, data derived from NSDUH were nation-wide, and future studies are needed to analyze state-level data and investigate the between-state differences. Although a systematic review of all laws and regulations related to marijuana and other drugs is beyond the scope of this study, findings from our study provide new data from a historical perspective much needed for the current trend in marijuana legalization across the nation to get the benefit from marijuana while to protect vulnerable children and youth in the US. It provides an opportunity for stack-holders to make public decisions by reviewing the findings of this analysis together with the laws and regulations at the federal and state levels over a long period since the 1950s.

Availability of data and materials

The data of the study are available from the designated repository ( https://nsduhweb.rti.org/respweb/homepage.cfm ).

Abbreviations

Audio computer-assisted self-interviews

Age-period-cohort modeling

Computer-assisted person interviews

Cross-classified random-effects model

Contemporary Declining Cohort

Hierarchical age-period-cohort

Historical Declining Cohort

Medical Marijuana Laws

National Household Survey on Drug Abuse

National Survey on Drug Use and Health

Recreational Marijuana Laws

Sudden Increase Cohort

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Additional file 1: table s1..

Estimated Age, Period, Cohort Effects for the Trend of Marijuana Use in Past Month among Adolescents and Emerging Adults Aged 12 to 25 Years, NSDUH, 1979-2016. Table S2. Laws at the federal and state levels related to marijuana use.

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Yu, B., Chen, X., Chen, X. et al. Marijuana legalization and historical trends in marijuana use among US residents aged 12–25: results from the 1979–2016 National Survey on drug use and health. BMC Public Health 20 , 156 (2020). https://doi.org/10.1186/s12889-020-8253-4

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9 facts about Americans and marijuana

The use and possession of marijuana is illegal under U.S. federal law, but about three-quarters of states have legalized the drug for medical or recreational purposes. The changing legal landscape has coincided with a decades-long rise in public support for legalization, which a majority of Americans now favor.

Here are nine facts about Americans’ views of and experiences with marijuana, based on Pew Research Center surveys and other sources.

As more states legalize marijuana, Pew Research Center looked at Americans’ opinions on legalization and how these views have changed over time.

Data comes from surveys by the Center,  Gallup , and the  2022 National Survey on Drug Use and Health  from the U.S. Substance Abuse and Mental Health Services Administration. Information about the jurisdictions where marijuana is legal at the state level comes from the  National Organization for the Reform of Marijuana Laws .

More information about the Center surveys cited in the analysis, including the questions asked and their methodologies, can be found at the links in the text.

Around nine-in-ten Americans say marijuana should be legal for medical or recreational use,  according to a January 2024 Pew Research Center survey . An overwhelming majority of U.S. adults (88%) say either that marijuana should be legal for medical use only (32%) or that it should be legal for medical  and  recreational use (57%). Just 11% say the drug should not be legal in any form. These views have held relatively steady over the past five years.

Views on marijuana legalization differ widely by age, political party, and race and ethnicity, the January survey shows.

While small shares across demographic groups say marijuana should not be legal at all, those least likely to favor it for both medical and recreational use include:

• Older adults: 31% of adults ages 75 and older support marijuana legalization for medical and recreational purposes, compared with half of those ages 65 to 74, the next youngest age category. By contrast, 71% of adults under 30 support legalization for both uses.
• Republicans and GOP-leaning independents: 42% of Republicans favor legalizing marijuana for both uses, compared with 72% of Democrats and Democratic leaners. Ideological differences exist as well: Within both parties, those who are more conservative are less likely to support legalization.
• Hispanic and Asian Americans: 45% in each group support legalizing the drug for medical and recreational use. Larger shares of Black (65%) and White (59%) adults hold this view.

Support for marijuana legalization has increased dramatically over the last two decades. In addition to asking specifically about medical and recreational use of the drug, both the Center and Gallup have asked Americans about legalizing marijuana use in a general way. Gallup asked this question most recently, in 2023. That year, 70% of adults expressed support for legalization, more than double the share who said they favored it in 2000.

Half of U.S. adults (50.3%) say they have ever used marijuana, according to the 2022 National Survey on Drug Use and Health . That is a smaller share than the 84.1% who say they have ever consumed alcohol and the 64.8% who have ever used tobacco products or vaped nicotine.

While many Americans say they have used marijuana in their lifetime, far fewer are current users, according to the same survey. In 2022, 23.0% of adults said they had used the drug in the past year, while 15.9% said they had used it in the past month.

While many Americans say legalizing recreational marijuana has economic and criminal justice benefits, views on these and other impacts vary, the Center’s January survey shows.

• Economic benefits: About half of adults (52%) say that legalizing recreational marijuana is good for local economies, while 17% say it is bad. Another 29% say it has no impact.

• Criminal justice system fairness: 42% of Americans say legalizing marijuana for recreational use makes the criminal justice system fairer, compared with 18% who say it makes the system less fair. About four-in-ten (38%) say it has no impact.
• Use of other drugs: 27% say this policy decreases the use of other drugs like heroin, fentanyl and cocaine, and 29% say it increases it. But the largest share (42%) say it has no effect on other drug use.
• Community safety: 21% say recreational legalization makes communities safer and 34% say it makes them less safe. Another 44% say it doesn’t impact safety.

Democrats and adults under 50 are more likely than Republicans and those in older age groups to say legalizing marijuana has positive impacts in each of these areas.

Most Americans support easing penalties for people with marijuana convictions, an October 2021 Center survey found . Two-thirds of adults say they favor releasing people from prison who are being held for marijuana-related offenses only, including 41% who strongly favor this. And 61% support removing or expunging marijuana-related offenses from people’s criminal records.

Younger adults, Democrats and Black Americans are especially likely to support these changes. For instance, 74% of Black adults  favor releasing people from prison  who are being held only for marijuana-related offenses, and just as many favor removing or expunging marijuana-related offenses from criminal records.

Twenty-four states and the District of Columbia have legalized small amounts of marijuana for both medical and recreational use as of March 2024,  according to the  National Organization for the Reform of Marijuana Laws  (NORML), an advocacy group that tracks state-level legislation on the issue. Another 14 states have legalized the drug for medical use only.

Of the remaining 12 states, all allow limited access to products such as CBD oil that contain little to no THC – the main psychoactive substance in cannabis. And 26 states overall have at least partially  decriminalized recreational marijuana use , as has the District of Columbia.

In addition to 24 states and D.C.,  the U.S. Virgin Islands ,  Guam  and  the Northern Mariana Islands  have legalized marijuana for medical and recreational use.

More than half of Americans (54%) live in a state where both recreational and medical marijuana are legal, and 74% live in a state where it’s legal either for both purposes or medical use only, according to a February Center analysis of data from the Census Bureau and other outside sources. This analysis looked at state-level legislation in all 50 states and the District of Columbia.

In 2012, Colorado and Washington became the first states to pass legislation legalizing recreational marijuana.

About eight-in-ten Americans (79%) live in a county with at least one cannabis dispensary, according to the February analysis. There are nearly 15,000 marijuana dispensaries nationwide, and 76% are in states (including D.C.) where recreational use is legal. Another 23% are in medical marijuana-only states, and 1% are in states that have made legal allowances for low-percentage THC or CBD-only products.

The states with the largest number of dispensaries include California, Oklahoma, Florida, Colorado and Michigan.

Note: This is an update of a post originally published April 26, 2021, and updated April 13, 2023.  

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Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain

Affiliations.

• 1 National Drug and Alcohol Research Centre (NDARC), Faculty of Medicine, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia. [email protected].
• 2 National Drug and Alcohol Research Centre (NDARC), Faculty of Medicine, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
• 3 Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia.
• PMID: 30635715
• DOI: 10.1007/s00406-018-0960-9

The use of medical cannabis and cannabis-based medicines has received increasing interest in recent years; with a corresponding surge in the number of studies and reviews conducted in the field. Despite this growth in evidence, the findings and conclusions of these studies have been inconsistent. In this paper, we outline the current evidence for medical cannabis and cannabis-based medicines in the treatment and management of chronic non-cancer pain. We discuss limitations of the current evidence, including limitations of randomised control trials in the field, limits on generalisability of previous findings and common issues such as problems with measurements of dose and type of cannabinoids. We discuss future directions for medicinal cannabinoid research, including addressing limitations in trial design; developing frameworks to monitor for use disorder and other unintended outcomes; and considering endpoints other than 30% or 50% reductions in pain severity.

Keywords: Cannabis; Cannabis-based medicines; Chronic pain; Medical cannabis.

Publication types

• Cannabinoid Receptor Modulators / pharmacology*
• Cannabinoids / pharmacology*
• Chronic Pain / drug therapy*
• Medical Marijuana / pharmacology*
• Cannabinoid Receptor Modulators
• Cannabinoids
• Medical Marijuana

Grants and funding

• 1119992/National Health and Medical Research Council
• 1104600/National Health and Medical Research Council
• 113243/National Health and Medical Research Council

Marijuana and Cannabinoids: Health, Research and Regulatory Considerations (Position Paper)

Executive summary.

Marijuana and related substance misuse are complex issues impacting family medicine, patient health, and public health. The American Academy of Family Physicians (AAFP) believes family physicians are essential in addressing all forms of inappropriate substance use. The AAFP urges its members to be involved in the diagnosis, treatment, and prevention of substance use, as well as secondary diseases impacted or caused by use. The World Health Organization (WHO) reports approximately 2.5% of the global population uses cannabis annually, making it the most commonly used drug worldwide. 1  Simultaneously, the AAFP acknowledges preliminary evidence indicates marijuana and cannabinoids may have potential therapeutic benefits, while also recognizing subsequent negative public health and health outcomes associated with cannabis use. 2

During the 20 th  century, law enforcement and public policy activities have undermined opportunities for scientific exploration. Barriers to facilitating both clinical and public health research regarding marijuana is detrimental to treating patients and the health of the public. The lack of regulation poses a danger to public health and impedes meaningful, patient-centered research to exploring both therapeutic and negative impacts of marijuana and cannabinoids.

Relevant AAFP Policy

Marijuana Possession for Personal Use The American Academy of Family Physicians (AAFP) opposes the recreational use of marijuana. However, the AAFP supports decriminalization of possession of marijuana for personal use. The AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration, for all individuals, including youth. 3

The AAFP also recognizes that several states have passed laws approving limited recreational use and/or possession of marijuana. Therefore, the AAFP advocates for further research into the overall safety and health effects of recreational use, as well as the effects of those laws on patient and societal health. 4

It should be noted that cannabis and marijuana are not interchangeable terms. In this position paper, cannabis is an overarching term used to refer to the plant  Cannabis sativa . Substances derived from the cannabis   plant include marijuana, hemp, and cannabinoids.

Call to Action Family physicians have a vested interest in policies that advance and protect the health of their patients and the public. The regulatory environment surrounding cannabis, medical and recreational marijuana, and cannabidiol (CBD) is rapidly changing, along with the retail environment. This shift has not been accompanied by robust scientific research regarding the health effects of cannabis, both therapeutic or detrimental. The AAFP recognizes the need for substantial clinical, public health, and policy evidence and research regarding cannabis, marijuana, cannabinoids, and CBD to inform evidence-based practice and the impact on public health.

• The AAFP promotes a society which is free of substance misuse, including alcohol and drugs. 3
• The AAFP recognizes there is support for the medical use of marijuana and cannabinoids, but advocates that usage be based on high-quality, evidence-based public health, policy, and patient-centered research, including the impact on vulnerable populations. 3
• The AAFP advocates for further studies into the use of medical marijuana and related compounds. This process should also ensure appropriate funding allocated for this research.
• The AAFP calls for decreased regulatory barriers to facilitate clinical and public health cannabis research, including reclassifying cannabis from a Schedule I controlled substance. 3
• The AAFP advocates for further research into the overall safety and health effects of recreational use, as well as the impact of legal recreational marijuana use laws on patient and societal health. 4
• The AAFP advocates for robust regulation regarding labeling and child-proof packaging of all marijuana and cannabinoid products.
• The AAFP opposes the recreational use and legalization of marijuana, but supports decriminalization of marijuana for personal use. The AAFP recognizes the benefits associated with intervention and treatment, in lieu of incarceration. 4
• The AAFP advocates for regulation regarding marketing claims, labeling, and advertising of all marijuana and cannabinoid products.
• The AAFP supports requirements testing current marijuana and cannabinoid products for safety, dosing, and product consistency.

In the Exam Room

• The AAFP urges its members to be involved in the diagnosis, treatment, and prevention of substance use, as well as the secondary diseases impacted by use.
• The AAFP calls for family physicians to discuss the health consequences of marijuana and cannabis use, as well as prevention strategies to prevent use and unintended consequences of marijuana exposure in at-risk populations.

Cannabis use, both medically and recreationally, is prevalent throughout history. Extensive evidence indicates cannabis was used by ancient civilizations, dating back more than 5,000 years ago. 1  In the U.S. in the 19th and early 20th centuries, cannabis was frequently used for medicinal purposes, often prescribed by clinicians. 1,5  Cannabis was first listed in the  United States Pharmacopoeia  in 1851, indicating use as an analgesic, hypnotic, and anticonvulsant agent. 5  After the 1937  Marihuana Tax Act , in 1942, cannabis was removed from the  United States Pharmacopoeia . 5

Attitudes and perceived risk of marijuana use have changed with the varying levels of legalization in the U.S. Surveying marijuana use is essential to gauge public health implications of increased access to marijuana, cannabinoid, and cannabis products. According to the 2018 National Institute on Drug Abuse (NIDA) Monitoring the Future Survey (MTF), daily, past month, past year, and lifetime marijuana use among 8 th  graders has declined, and remained unchanged in 10 th  and 12 th  graders, when compared to the 2013 MTF survey. 6  Despite the changing landscape of marijuana regulations nationwide, past year use of marijuana reached and maintained its lowest levels in more than two decades in 2016 among 8 th  and 10 th  graders. 6  However, marijuana vaping did significantly increase between 2017 and 2018, mirroring trends in youth tobacco use. 6  The NIDA 2017 National Survey on Drug Use and Health indicates nearly 53% of adults between the ages of 18-25 have tried marijuana at some point in their lifetime, 35% have used marijuana within the past year, and 22% within the past month. 7  While the lifetime use remains relatively stable for this cohort, from 2015-2017, past year and past month use increased 2.7% and 2.3%, respectively. 7  Nearly half of adults 26 or older reported using marijuana at some point in their lifetime. 7  Although adults ages 26 and up report the highest percentage of lifetime use, this age group has a significantly lower past year use (12%) and past month use (8%). 7

Forms and Use of Cannabis The cannabis plant,  Cannabis sativa , is comprised of both non-psychoactive and psychoactive chemicals called cannabinoids. 5  The cannabinoid commonly known for its psychoactive properties is delta-9-tetrahydrocannabinol (THC). 5  CBD is the most abundant cannabinoid in cannabis, and is considered to be largely non-psychoactive. 5  The biological system responsible for the synthesis and degradation of cannabinoids in mammals is referred to as the endocannabinoid system, which is largely comprised of two g-coupled protein receptors (GPCRs). 8  The GPCRs—CB1 and CB2—are found throughout many bodily tissues. However, CB1 is most concentrated in the neural tissues. 5,8  CB2 receptors are found in the brain, but are mostly found in immune cells, like macrophages, microglia, osteoclasts, and osteoblasts. 5,8

There are many forms of, and products derived from, the  Cannabis sativa  plant, including hemp, CBD, and marijuana.  Cannabis sativa  with less than 0.3% THC is considered industrial hemp, and can be used for industrial agriculture cultivation. 9,10  Industrial hemp can be harvested and used for many things, including fibers for textiles, food products, and building materials. 11,12  CBD, the non-psychoactive cannabinoid, is extracted from the flower of industrial hemp. 13  Marijuana and hemp, technically speaking, are the same plant. 13  However, the hemp variety of cannabis contains no more than 0.3% THC, while the marijuana variety contains 5-20% THC. 13

Marijuana and CBD are most commonly used via inhalation, ingestion, and topical absorption. 5  Inhalation can be through combustible mechanisms using dried flowers, including the use of a pipe, rolled joints, blunts, and water pipes (also called bongs). 14  Vaping marijuana and CBD concentrates are an increasingly popular inhalation method. 5,6  Concentrates, the concentrated form of marijuana and CBD, come in various forms, including oil, butter, or a dark sticky substance often referred to as shatter. 15  Concentrates can be both smoked or vaporized, and may also be used as additives or cooking agents for ingestion. 5,15  There are many different ways to ingest cannabinoids. Food products—called edibles—like brownies, gummies, cookies, and candies are common forms of cannabis ingestion, as well as liquid forms like juices, soda, and tea. 5,16  Tinctures are liquid, ultra-concentrated alcohol-based cannabis extracts commonly applied in and absorbed through the mouth. 17  Topical cannabis is applied to, and absorbed through, the skin in a cream or salve form. 18

Routes or methods of administration affect cannabis delivery. When cannabis is smoked or vaporized, onset of effect is within 5-10 minutes with a duration of 2-4 hours. 19  When ingested, effect is within 60-180 minutes with a duration of 6-8 hours. 19  The oromucosal route has an onset of 15-45 minutes and a duration of 6-8 hours. 19  Topical administration of cannabis or cannabinoids has variable onset and duration. 19  The smoked or vaporized method offers the more rapid activity for acute symptoms with the topical preparations offering less systemic effects. 19

Health Effects of Cannabis

Although there is preliminary evidence indicating cannabinoids may have some therapeutic benefit, a large portion of the evidence is very limited for many reasons. These include small sample sizes, lack of control groups, poor study design, and the use of unregulated cannabis products. There are also clear negative health and public health consequences that must be considered, as well as the need for a significant increase in evidence. More research is needed to create a robust evidence base to weigh the potential therapeutic benefits against potential negative impacts on health and public health. Currently, there are three medical formulations of cannabis approved for use in the U.S.; dronabinol, nabilone, and epidiolex. 20  Nabiximols is approved for use in the United Kingdom. 21  Dronabinol is delta-9 THC and ingested as either an oral solution or an oral capsule. 22  Nabilone is an oral capsule containing synthetic THC. 23  Epidiolex is a CBD oral solution. 24  Nabiximols is an oral mucosa spray containing the cannabinoids THC and CBD. 25

In 2015, Whiting, et al, performed a meta-analysis and systematic review of research on the medical use of cannabis. 25  This systematic review served as the basis for many recommendations in 2017 by the National Academy of Science, Engineering, and Health Report on medical marijuana. 5  Dronabinol, nabilone, and nabiximols were included in the studies. However, other cannabis formulations were found in research trials, including CBD, marijuana, and other cannabinoids. 26  Evidence is most substantial for nausea and vomiting associated with chemotherapy, chronic pain treatment, multiple sclerosis spasticity, and intractable seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. 27  There is moderate evidence for the use of cannabinoids for sleep and limited evidence for use in psychiatric conditions, such as post-traumatic stress disorder, depression, anxiety, and psychosis; appetite stimulation and weight gain; and no evidence for cancer treatment. 5

Dronabinol and nabilone were both approved in 1985 for use in treating refractory chemotherapy-induced nausea and vomiting. 5,23  Dronabinol is approved by the Food and Drug Administration (FDA) for appetite stimulation and weight gain, despite limited and often inconclusive evidence that it or other cannabinoids are effective. 22  This drug has traditionally been used in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients to mitigate weight loss and to treat anorexia-cachexia syndrome associated with cancer and anorexia nervosa. 5,22

Cannabinoids have been assessed for chronic pain management. Many forms of chronic pain management were studied, including cancer and chemotherapy-induced pain, fibromyalgia, neuropathic pain, rheumatoid arthritis, non-cancer pain, and musculoskeletal pain. Several studies indicate smoked THC and nabiximols were both associated with pain reduction. 5,25,26  There is limited, mixed evidence regarding the viability of cannabinoids for some forms of chronic pain management. 5  However, limitations exist with these studies, including the variable doses of THC and CBD; unregulated, non-FDA approved products; and conflicting evidence. Studies assessing cannabinoids in treating the spasticity due to multiple sclerosis or paraplegia have mixed results. The cannabinoids nabiximols, dronabinol, and TCH/CBD have all been associated with decreased spasticity. Nabilone and nabiximols were the only drugs with statically-significant decreases. 2,25

In 2018, the FDA approved a cannabidiol oral solution called epidiolex for the treatment of refractory seizures associated with Dravet syndrome and Lennox-Gastaut syndrome. 28  Epidiolex was associated with significant seizure reduction when compared to placebo. 29–31  Dravet syndrome and Lennox-Gastaut syndrome are disorders associated with severe seizures, impaired cognitive skills and development, and uncontrollable muscle contractions. 29–31

Moderate evidence exists for the use of cannabis for sleep. Nabilone and nabiximols have been associated with improvement in sleep from a baseline and sleep restfulness. 2,5,25  Improved sleep was also considered a secondary outcome when evaluating other conditions (chronic pain, multiple sclerosis) with various cannabinoids. 2,5,25

There is limited evidence for the use of cannabis or cannabinoids for the treatment of post-traumatic stress disorder (PTSD), anxiety, depression, or psychosis. Of the limited evidence, nabilone was associated with a decrease in PTSD related nightmares. 5,25  One small study indicated CBD improved public speaking anxiety. 5  There are no studies directly evaluating the effectiveness of cannabis in the treatment of depression. However, some studies measured depression as a secondary outcome, but indicated no difference in depression when compared to placebo. 25  Limited evidence (two studies) have shown no difference in treating psychosis with CBD, amisulpride, or placebo. 25  Evidence indicates individuals who use marijuana are more likely to experience temporary psychosis and chronic mental illness, including schizophrenia. 5,32

There was no evidence or insufficient evidence for the use of cannabis or cannabinoids in the treatment of cancer; neurodegenerative disorders like Huntington’s chorea, Parkinson’s disease, or amyotrophic lateral sclerosis; irritable bowel syndrome; or addiction. 5

Cannabis overdose is rare in adults and adolescents. 33  Children who experience acute intoxication from cannabis generally ingest marijuana or other cannabinoids through experimentation. 33  When compared to adults and adolescents, children are more likely to experience life-threatening symptoms of acute cannabis intoxication, which may include depressed respiration rates, hyperkinesis, or coma. 33  Management consists of supportive care dependent on the manifestation of symptoms. 33  Adults and adolescents may experience increased blood pressure and respiratory rates, red eyes, dry mouth, increased appetite, and slurred speech. 33

Negative health effects are also associated with marijuana and cannabinoid use. Frequent marijuana use has been associated with disorientation. In teens, it has been linked with depression, anxiety, and suicide. 5,32  However, this is not a proven causal relationship. Lung health can also be negatively impacted depending on the delivery mechanism. 34  Smoking marijuana can cause lung tissue scarring and damage blood vessels, further leading to an increased risk of bronchitis, cough, and phlegm production. 34  This generally decreases when users quit. 34

Secondhand smoke is a serious issue associated with marijuana use. However, there is limited evidence on how it impacts heart and lung health. 34  Detectable THC has been found in children who live in the home or have a caretaker who use marijuana, subjecting children to developmental risks of THC exposure. 35  Fetal, youth, and adolescent exposure to THC is associated with negative health effects, including impacting brain development. 34  There is inconsistent, insufficient evidence to determine the long-term effects of marijuana and cannabinoid use while breastfeeding. 36  However, THC has been detected in breast milk for up to six days post-cannabinoid use, and exposure to cannabinoids is known to impact development in children. 37  Evidence also suggests cannabis use during pregnancy may be linked with preterm birth. 38  Cardiovascular health may be impacted by smoked marijuana use. However, the negative health effects are associated with the harmful chemicals in smoke similar to tobacco smoke. 34

Approximately 9% of all individuals who use marijuana develop an addiction, which is variable by age of first use and frequency of use. 34  That number for addiction jumps to 17% for individuals who begin using marijuana as teenagers and 25-50% of those who smoke marijuana daily. 34  Marijuana use does not typically lead to harder drug use, like cocaine and heroin, in most individuals. 39  Further research is needed to evaluate any potential gateway effect. 39

Mental health outcomes associated with marijuana use include an increased risk of anxiety and depression. Marijuana has been linked to schizophrenia, psychoses, and advancing the trajectory of the disease, particularly in individuals with pre-existing genetic indicators. 5,34  Global research also suggests daily use of high-potency marijuana increases risk for psychotic episodes among individuals with no underlying mental health condition. 40  While it is widely accepted that marijuana acutely impairs cognitive function, studies suggest differential outcomes regarding short- versus long-term cognitive impairment. 34

Research Considerations

The regulatory environment surrounding cannabis, marijuana, and cannabinoid research creates barriers detrimental to facilitating meaningful medical, public health, policy, and public safety research. Approval for research expands beyond institutional review boards. Due to the Schedule I classification by the Drug Enforcement Agency (DEA), researchers seeking to investigate health effects associated with cannabis must follow a regimented application process. 41  Applicants must submit an Investigational New Drug (IND) application to the FDA, which will then be reviewed to determine scientific validity and research subjects’ rights and safety. 42  Researchers must also follow the NIDA regulatory procedures for obtaining cannabis for research purposes. 41  Researchers may only use cannabis supplied by the University of Mississippi, the single NIDA-approved source for cannabis research. 41  Requiring research to rely on one source of cannabis limits availability and the variety of products. While the University of Mississippi cultivates different strains of cannabis, it is unable to supply the vast array of strains of cannabis found in the evolving retail environment with varying levels of THC, CBD, and cannabinoid content. 5  Substantial funding and capacity is required for researchers to obtain all regulatory approval and remain in compliance while conducting cannabis-related research. The required processes and procedures present a serious burden, dissuading researchers from pursuing cannabis-related projects. This has led to a lack of empirical evidence regarding a myriad of health-related issues, including potential therapeutic benefits of cannabis, public health impact, health economics, and the short- and long-term health effects from cannabis use.

In order to address the research gaps associated with both beneficial and harmful effects of cannabinoids used in both medical and recreational capacities, the AAFP calls for a comprehensive review of processes and procedures required to obtain approval for cannabis research.  

The AAFP encourages the appropriate regulatory bodies, such as the DEA, NIDA, FDA, Department of Health and Human Services (DHHS), National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC), to collaborate with non-governmental stakeholders to determine procedures to decrease the burden of cannabis-related research while maintaining appropriate regulatory safety guards. This should include a reclassification of marijuana from Schedule I to facilitate clinical research. The AAFP calls for increased funding from both public and private sectors to support rigorous scientific research to address gaps in evidence regarding cannabis to protect the health of the public and inform evidence-based practices. 3  Future research should address the impact of cannabis use on vulnerable and at-risk populations.

Regulatory Considerations

While cannabis was federally regulated in 1906 for consumer and safety standards and labeling requirements, the  Marihuana Tax Act  of 1937 was the first federal regulation to impose a fine or imprisonment for non-medical use and distribution of cannabis. 5  The tax act also regulated production, distribution, and use of cannabis, further requiring anyone dealing with cannabis to register with the federal government. 5  In 1970, the DEA classified marijuana as a Schedule I drug, which is defined as a drug with no current acceptable medical use and a high potential for abuse. 43  Other Schedule 1 drugs include heroin, lysergic acid diethylamide (LSD), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote. 43  Since this class of substances is determined as having no medical usage, they cannot be legally prescribed and thus, there is no medical coverage for them.

Marijuana is illegal under federal law. Penalties cover possession, sale, cultivation, and paraphernalia. However, the Agriculture Improvement Act of 2018 included a U.S. Department of Agriculture (USDA) Hemp Production Program, removing hemp from the Controlled Substances Act. 10,44  As a result, CBD  sourced from hemp plants containing no more than 0.3% THC is legal to produce. 10,44  The FDA has approved three medications containing cannabinoids: epidiolex (CBD), dronabinol, and nabilone (synthetic cannabinoids). 5  No other forms of cannabis are currently regulated by the FDA. The AAFP calls upon the FDA to take swift action to regulate CBD and cannabinoid products now legal in order to protect the health of the public.

States have separate marijuana, cannabinoid, and cannabis laws, some of which mirror federal laws, while others may be more harsh, or have decriminalized and even legalized marijuana and cannabis. 45  In 1996, California was the first state to legalize the medical use of marijuana. 46  States have subsequently decriminalized and/or legalized cannabinoids, medical marijuana, and recreational marijuana. 46  As of August 2019, 30 states, along with the District of Columbia, Guam, and Puerto Rico have legalized marijuana in varying forms. 46  Decriminalization laws may include reduction of fines for possession of small amounts of marijuana, reclassification of criminal to civil infractions, excluding the infraction from criminal records and expunging prior offenses and convictions related to marijuana. 47  Thirty-three states, along with the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands have a comprehensive, publicly-available medical marijuana/cannabis program, and 13 of these states have also removed jail time for possessing small amounts of non-medical marijuana. 47  Adult recreational marijuana use is legal in 13 states and the District of Columbia. 47  Vermont and the District of Columbia, however, do not allow the sale of marijuana for recreational purposes. This means it is not a crime to use and possess marijuana recreationally, but commercial sales are not allowed. 47  States have also authorized the sale of products that have low levels of THC, but high levels of CBD. These products are widely available in retail locations, but are highly unregulated. 47  The benefits of CBD touted by the public and retailers are largely anecdotal. The vast majority of these claims are not substantiated by valid research.

Decriminalizing and legalizing marijuana can decrease the number of individuals arrested and subsequently prosecuted for possession and/or use. 48  However, evidence suggests that these practices are not applied equitably. People of color are more likely to be arrested and prosecuted for marijuana possession despite overall decreased arrest rates. 48  Incarceration impacts health. People who are incarcerated have significantly higher rates of disease than those who are not, and are less likely to have access to adequate medical care. 49

The AAFP “opposes the recreational use of marijuana. However, the AAFP supports decriminalization of possession of marijuana for personal use. The AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration, for all individuals, including youth.” 4  The AAFP calls for family physicians to advocate to prevent unnecessary incarceration by diverting eligible people from the justice system to substance abuse and/or mental health treatment. 49

There are many public health considerations when regulating cannabis products. Serious public health concerns include impaired driving, youth exposure to advertisements, and accidental poisoning in children. Second to alcohol, marijuana is the most common illicit drug associated with impaired driving and accidents. 34  Marijuana slows reaction time and decision making, substantially increasing risk for traffic accidents. 50  Some states have a zero-tolerance policy, where there is no allowable detectable level of THC while driving, while other states have set five nanograms per milliliter or higher limits of THC, or minimally-detectable amounts of THC. 51

Evidence indicates adolescents who are exposed to medical marijuana advertising are more likely to have positive views of and subsequently use marijuana. 52  Those exposed to medical marijuana advertising were more likely to report past use and expectant future use. 52  These adolescents also reported agreeing with statements like, marijuana helps people relax and get away from their problems. 52  Adolescent exposure to medical marijuana advertising was also associated with self-reporting negative consequences associated with marijuana use, including missing school and concentration issues. 52  The AAFP calls for immediate regulation of advertising of all marijuana and cannabinoid products to decrease youth exposure to aid in preventing initiation and subsequent use of marijuana.

Children are most susceptible to severe effects associated with marijuana poisoning, including decreased coordination, lethargy, sedation, difficulty concentrating, and slurred speech. 53  Exposure may also include serious, potentially life-threatening symptoms like respiratory distress and coma. 33  Unintentional exposures to marijuana in children have increased each year since 2012, likely due to legalization policies across the U.S. and popularity of edibles. 53  Edibles often look exactly like their non-THC counterparts, and come in brightly colored packaging appealing to children, often mimicking candy products. 53  Effective legislation requiring childproof packaging for edible products can help mitigate and prevent unintentional exposure in children. 54  Family physicians should discuss safe storage of all cannabis products with their patients who live with children. 54  Under the Child Abuse Prevention and Treatment Act (CAPTA), physicians are mandated reporters of suspected child abuse and neglect. 55  The 2010 law requires states to enact laws for reporting substance use-exposed infants to child protective services. 55

Family physicians play a key role in addressing marijuana, cannabinoid, and cannabis product use; reducing barriers to research; and advocating for appropriate policy to protect the health of patients and the public.

Family physicians can address the inappropriate use of marijuana, cannabinoid, and cannabis products. Family physicians should discuss safe storage of all cannabis products with patients who live with or serve as primary caregivers for children to prevent unintended exposure. 56  It is important to discuss the developmental and negative impacts of marijuana and cannabis products with individuals who are or can become pregnant, children, and adolescents. Family physicians should also emphasize the serious consequences of impaired driving and marijuana intoxication.

It is essential to decrease barriers to research all forms of marijuana, cannabis, and cannabinoids, including a reclassification of cannabis as a Schedule I drug. High-quality research regarding the impact on patients, public health, society, and health policy are essential to providing patient-centered care and promoting evidence-based public health practices. Immediate regulations for marijuana and cannabinoid products, including CBD, like product safety and consistency safeguards, child-proof packaging, labeling, marketing claims and advertising, and impairment standards are vital for consumer safety and injury prevention. Regulatory measures focused on preventing youth initiation of marijuana and cannabinoid product use must be prioritized to prevent a public health epidemic.

The health benefits associated with intervention and treatment of recreational marijuana and cannabinoid use, in lieu of incarceration, is an important policy consideration.

Utilizing an interdisciplinary, evidence-based approach to addressing both medical and recreational marijuana and cannabis use is essential to promote public health, inform policy, and provide patient-centered care. Family physicians, in partnership with public health and policy professionals, can play an imperative role in addressing the changing landscape of marijuana and cannabis products.

• Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the acute care setting.  P T . 2017;42(3):180-188. Accessed August 20, 2019.
• Abrams DI. The therapeutic effects of cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report.  Eur J Intern Med . 2018;49:7-11.
• American Academy of Family Physicians. Substance abuse and addiction . Accessed August 20, 2019.
• American Academy of Family Physicians. Marijuana possession for personal use . Accessed August 20, 2019.
• The National Academies of Science, Engineering, and Medicine.  The Health Effects of Cannabis and Cannabinoids . Washington, D.C.: National Academies Press; 2017.
• National Institute on Drug Abuse. DrugFacts: Monitoring the Future Survey: high school and youth trends. www.drugabuse.gov/publications/drugfacts/monitoring-future-survey-high-school-youth-trends. Accessed August 20, 2019.
• National Institute on Drug Abuse. National Survey of Drug Use and Health . Accessed August 20, 2019.
• Mackie K. Cannabinoid receptors: where they are and what they do.  J Neuroendocrinol . 2008;20(s1):10-14.
• Hilderbrand RL. Hemp & cannabidiol: what is a medicine?  Mo Med . 2018;115(4):306-309. Accessed August 20, 2019.
• U.S. Department of Agriculture. Hemp production program . Accessed August 20, 2019.
• Heidi H. Oregon State University launches largest, most comprehensive hemp research center in the nation. Oregon State University. www.today.oregonstate.edu/news/oregon-state-university-launches-largest-most-comprehensive-hemp-research-center-nation. Accessed August 20, 2019.
• Lee MJ. The legalization of hemp. Accessed August 20, 2019.
• Shipman M. Is hemp the same thing as marijuana? NC State University. Accessed August 20, 2019.
• National Institute on Drug Abuse. What is marijuana?  Accessed August 20, 2019.
• Drug Policy Alliance. Marijuana concentrates.  Accessed August 20, 2019.
• MacCoun RJ, Mello MM. Half-baked — the retail promotion of marijuana edibles.  N Engl J Med . 2015;372(11):989-991.
• Peschel W, Peschel, Wieland. Quality control of traditional cannabis tinctures: pattern, markers, and stability.  Sci Pharm . 2016;84(3):567-584.
• Rosenblatt S, Tucker J, DeAngelo S. Methods and compositions of cannabis extracts. Accessed August 20, 2019.
• MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing.  Eur J Intern Med . 2018;49:12-19.
• U.S. Food and Drug Administration. FDA regulation of cannabis and cannabis-derived products: questions and answers . Accessed August 20, 2019.
• National Cancer Institute. NCI Drug Dictionary. Nabiximols.  Accessed August 20, 2019.
• U.S. Food and Drug Administration. Syndros (dronabinol) oral solution . Accessed August 20, 2019.
• U.S. Food and Drug Administration. CESAMETTM (nabilone) capsules.  Accessed August 20, 2019.
• Greenwich Biosciences. Epidiolex® (cannabidiol). www.epidiolex.com/. Accessed August 20, 2019.
• Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use. A systematic review and meta-analysis.  JAMA . 2015;313(24):2456-2473.
• Abuhasira R, Shbiro L, Landschaft Y. Medical use of cannabis and cannabinoids containing products – Regulations in Europe and North America.  Eur J Intern Med . 2018;49:2-6.
• Devinsky O, Cilio MR, Cross H, et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders.  Epilepsia . 2014;55(6):791-802.
• U.S. Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy.  Accessed August 20, 2019.
• Devinsky O, Patel AD, Cross JH, et al. Effect of cannabidiol on drop seizures in the Lennox–Gastaut syndrome.  N Engl J Med . 2018;378(20):1888-1897.
• Devinsky O, Cross JH, Laux L, et al. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome.  N Engl J Med . 2017;376(21):2011-2020.
• Perucca E. Cannabinoids in the treatment of epilepsy: hard evidence at last?  J Epilepsy Res . 2017;7(2):61-76.
• Volkow ND, Swanson JM, Evins AE, et al. Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review.  JAMA Psychiatry . 2016;73(3):292-297.
• Wang GS. Cannabis (marijuana): acute intoxication. UpToDate. Accessed August 20, 2019.
• Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use.  N Engl J Med . 2014;370(23):2219-2227.
• Wilson KM, Torok MR, Wei B, et al. Detecting biomarkers of secondhand marijuana smoke in young children.  Pediatr Res . 2017;81(4):589-592.
• Reece-Stremtan S, Marinelli KA. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015.  Breastfeed Med . 2015;10(3):135-141.
• Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk.  Pediatrics . 2018;142(3):e20181076.
• Corsi DJ, Walsh L, Weiss D, et al. Association between self-reported prenatal cannabis use and maternal, perinatal, and neonatal outcomes.  JAMA . 2019;322(2):145-152.
• Centers for Disease Control and Prevention. Does marijuana use lead to other drug use?  Accessed August 20, 2019.
• Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study.  The Lancet Psychiatry . 2019;6(5):427-436.
• U.S. Food and Drug Administration. Marijuana research with human subjects . Accessed August 20, 2019.
• National Institute on Drug Abuse (NIDA). NIDA’s role in providing marijuana for research. www.drugabuse.gov/drugs-abuse/marijuana/nidas-role-in-providing-marijuana-research. Accessed August 20, 2019.
• U.S. Drug Enforcement Administration. Drug scheduling . Accessed August 20, 2019.
• U.S. Food and Drug Administration. Statement from FDA Commissioner Scott Gottlieb, M.D., on signing of the Agriculture Improvement Act and the agency's regulation of products containing cannabis and cannabis-derived compounds. Accessed August 20, 2019.
• American Bar Assocation. Conflicting state and federal marijuana laws create ethical complications for lawyers. Accessed August 20, 2019.
• National Conference of State Legislatures. Marijuana laws. www.ncsl.org/bookstore/state-legislatures-magazine/marijuana-deep-dive.aspx. Accessed August 20, 2019.
• National Conference of State Legislatures. Marijuana laws. Accessed August 20, 2019.
• Drug Policy Alliance. From prohibition to progress: a status report on marijuana legalization. Accessed August 20, 2019.
• American Academy of Family Physicians. Incarceration and health: a family medicine perspective (position paper) . Accessed August 20, 2019.
• Centers for Disease Control and Prevention. What you need to know about marijuana use and driving . Accessed August 20, 2019.
•  National Conference of State Legislatures. Drugged driving | Marijuana-impaired driving . Accessed August 20, 2019.
• RAND Corporation. Adolescents who view more medical marijuana advertising are more likely to use marijuana, have positive views about the drug . Accessed August 20, 2019.
• Center on Addiction. Childhood poisoning: safeguarding young children from addictive substances. Accessed August 20, 2019.
• Center on Addiction. Toddlers and THC: the number of young children exposed to marijuana is on the rise. Accessed August 20, 2019.
• Child Welfare Information Gateway. Mandatory reporters of child abuse and neglect.  Accessed August 20, 2019.
• Children’s Hospital Colorado. Marijuana safety in the home . Accessed August 20, 2019.

(July 2019 BOD)

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

Cannabis (Marijuana) Research Report What is marijuana?

Marijuana—also called  weed, herb, pot, grass, bud, ganja, Mary Jane , and a vast number of other slang terms—is a greenish-gray mixture of the dried flowers of  Cannabis sativa . Some people smoke marijuana in hand-rolled cigarettes called joints ; in pipes, water pipes (sometimes called  bongs ), or in  blunts (marijuana rolled in cigar wraps). 1 Marijuana can also be used to brew tea and, particularly when it is sold or consumed for medicinal purposes, is frequently mixed into foods ( edibles ) such as brownies, cookies, or candies. Vaporizers are also increasingly used to consume marijuana. Stronger forms of marijuana include sinsemilla (from specially tended female plants) and concentrated resins containing high doses of marijuana’s active ingredients, including honeylike hash oil , waxy budder , and hard amberlike shatter . These resins are increasingly popular among those who use them both recreationally and medically.

The main psychoactive (mind-altering) chemical in marijuana, responsible for most of the intoxicating effects that people seek, is delta-9-tetrahydrocannabinol (THC). The chemical is found in resin produced by the leaves and buds primarily of the female cannabis plant. The plant also contains more than 500 other chemicals, including more than 100 compounds that are chemically related to THC, called cannabinoids . 2

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National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017 Jan 12.

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

• Hardcopy Version at National Academies Press

15 Challenges and Barriers in Conducting Cannabis Research

Several states have legalized cannabis for medical or recreational use since the release of the 1999 Institute of Medicine (IOM) 1 report Marijuana and Medicine: Assessing the Science Base ( IOM, 1999 ). As of October 2016, 25 states and the District of Columbia had legalized the medical use of cannabis, while 4 states and the District of Columbia had also legalized recreational cannabis use ( NCSL, 2016 ; NORML, 2016a ). 2 In November 2016, voters in California, Maine, Massachusetts, and Nevada approved ballot initiatives to legalize recreational cannabis, while voters in Arkansas, Florida, Montana, and North Dakota approved ballot initiatives to permit or expand the use of cannabis for medical purposes ( NORML, 2016b ).

Policy changes are associated with marked changes in patterns of cannabis use. In recent years, the number of U.S. adolescents and adults ages 12 and older who reported using cannabis increased by 35.0 percent and 20.0 percent for use in the past month and in the past year, respectively ( Azofeifa et al., 2016 ). Revenue from the sale and taxation of cannabis can serve as a proxy measure for cannabis use and suggests that the scope of cannabis use in the United States is considerable. For example, the total estimated value of legal cannabis sales in the United States was $5.7 billion in 2015 and $7.1 billion in 2016 ( Arcview Market Research and New Frontier Data, 2016 ). At the state level, the Colorado Department of Revenue reported that sales and excise taxes on recreational and medical cannabis sales totaled $88,239,323 in fiscal year 2015 ( CDOR, 2016a, p. 29 ), 3 and in Washington, state and local sales taxes and state business and occupation taxes on recreational and medical cannabis totaled $53,410,661 in fiscal year 2016 ( WDOR, 2016a , b ). 4

Despite these changes in state policy and the increasing prevalence of cannabis use and its implications for population health, the federal government has not legalized cannabis and continues to enforce restrictive policies and regulations on research into the health harms or benefits of cannabis products that are available to consumers in a majority of states. As a result, research on the health effects of cannabis and cannabinoids has been limited in the United States, leaving patients, health care professionals, and policy makers without the evidence they need to make sound decisions regarding the use of cannabis and cannabinoids. This lack of evidence-based information on the health effects of cannabis and cannabinoids poses a public health risk.

In order to promote research on cannabis and cannabinoids, the barriers to such research must first be identified and addressed. The committee identified several barriers to conducting basic, clinical, and population health research on cannabis and cannabinoids, including regulations and policies that restrict access to the cannabis products that are used by an increasing number of consumers and patients in state-regulated markets, funding limitations, and numerous methodological challenges. The following sections discuss these barriers in detail.

• REGULATORY AND SUPPLY BARRIERS

Regulatory Barriers

Investigators seeking to conduct research on cannabis or cannabinoids must navigate a series of review processes that may involve the National Institute on Drug Abuse (NIDA), the U.S. Food and Drug Administration (FDA), the U.S. Drug Enforcement Administration (DEA), institutional review boards, offices or departments in state government, state boards of medical examiners, the researcher's home institution, and potential funders. A brief overview of some of these review processes is discussed.

Researchers conducting clinical research on biological products such as cannabis must submit an investigational new drug (IND) application to the FDA. As a next step, the investigator may contact NIDA, an important source of research-grade cannabis, to obtain an administrative letter of authorization (LOA). An LOA describes the manufacturer's facilities, as well as the availability and pertinent characteristics of the desired cannabis product (e.g., strains, quality, strength, pharmacology, toxicology). To safeguard against the acquisition of cannabis or cannabinoids for non-research purposes, investigators must also apply for a DEA registration and site licensure before conducting studies involving cannabis or any of its cannabinoid constituents, irrespective of their pharmacologic activity. 5 The investigator must submit the IND and LOA to the FDA and the DEA for review ( FDA, 2015 ).

After submitting an IND application, researchers must wait at least 30 days before initiating research, during which period the FDA reviews the application to ensure that research participants will not be exposed to unreasonable risk ( FDA, 2016a ). If the FDA determines that the proposed research would expose study participants to unreasonable risk or that the IND application is in some other way deficient, a clinical hold postponing the research may be imposed. This hold is not lifted until and unless the sponsoring researchers have resolved the deficiencies ( FDA, 2016b ).

It is important to note that the Controlled Substances Act of 1970 classified cannabis as a Schedule I substance, the highest level of drug restriction. 6 As defined by the Act, Schedule I substances are those that (1) have a high potential for abuse; (2) have no currently accepted medical use in treatment in the United States; and (3) have a lack of accepted safety for their use under medical supervision. 7 Other substances classified in Schedule I include heroin, LSD, mescaline, hallucinogenic amphetamine derivatives, fentanyl derivatives (synthetic opioid analgesics), and gammahydroxybutyrate (GHB). 8 By contrast, Schedule II substances—though they also have a high potential for abuse and may lead to severe psychological or physical dependence—are defined as having a currently accepted medical use and can be prescribed with a controlled substance prescription ( DEA, 2006 ). 9

In some states, researchers conducting clinical research on cannabis or cannabinoid products must also apply for and receive a controlled substance certificate from a state board of medical examiners or a controlled substance registration from a department of the state government in order to conduct clinical trials or any other activity involving Schedule I substances ( Alabama Board of Medical Examiners, 2013 ; MDHSS, n.d .). Some state governments require additional approvals. For example, California requires that all trials involving Schedule I or II controlled substances be registered with and approved by the Research Advisory Panel of California ( CADOJ/OAG, 2016 ). When the necessary approvals are secured, only then can the investigator apply for a DEA registration and site licensure to conduct research on a Schedule I controlled substance (see Box 15-1 for examples of research barriers).

Illustrative Examples of the Current Research Barriers to Colorado Researchers.

Researchers conducting trials of Schedule I substances must additionally submit a research protocol to the DEA that includes details regarding the security provisions for storing and dispensing the substance. 10 Previously, nonfederally funded studies on cannabis were also required to undergo an additional review process conducted by the Public Health Service. This review process was determined to unnecessarily duplicate the FDA's IND application process in several ways and, as of June 2015, is no longer required. 11

To ensure that controlled substances obtained for research purposes will be stored and accessed in accordance with DEA security requirements, local DEA officials may perform a preregistration inspection of the facility where the proposed research will take place ( University of Colorado, 2016 ). DEA security requirements include storing cannabis in a safe, a steel cabinet, or a vault, and limiting access to the storage facility to “an absolute minimum number of specifically authorized employees. 12 The extent of the security measures required by DEA varies with the amount of cannabis being stored, 13 and among local DEA jurisdictions ( Woodworth, 2011 ). Funders must bear the costs of meeting the necessary security requirements.

Additionally, as with any human clinical trial, approval from an institutional review board must be sought. 14 Obtaining this approval confirms that an appropriate plan to protect the rights and welfare of human research subjects has been outlined in the proposed research efforts. If a study is being conducted in a clinical research center, a separate review may be required by this entity's medical or research advisory committee.

In summary, basic and clinical researchers seeking to obtain cannabis or cannabinoids from NIDA for research purposes—including efforts to determine the value of cannabis or cannabinoids for treating a medical condition or achieving a therapeutic end need—must obtain a number of approvals from a range of federal, state, or local agencies, institutions, or organizations. This process can be a daunting experience for researchers. The substantial layers of bureaucracy that emerge from cannabis's Schedule I categorization is reported to have discouraged a number of cannabis researchers from applying for grant funding or pursuing additional research efforts ( Nutt et al., 2013 ). Given the many gaps in the research of the health effects of cannabis and cannabinoids, there is a need to address these regulatory barriers so that researchers will be better able to address key public health questions about the therapeutic and adverse effects of cannabis and cannabinoid use.

CONCLUSION 15-1 There are specific regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research. 15

Barriers to Cannabis Supply

In the United States, cannabis for research purposes is available only through the NIDA Drug Supply Program ( NIDA, 2016a ). The mission of NIDA is to “advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health,” rather than to pursue or support research into the potential therapeutic uses of cannabis or any other drugs ( NIDA, 2016b ). As a result of this emphasis, less than one-fifth of cannabinoid research funded by NIDA in fiscal year 2015 concerns the therapeutic properties of cannabinoids ( NIDA, 2016c ). 16 Because NIDA funded the majority of all the National Institutes of Health (NIH)-sponsored cannabinoid research in fiscal year 2015 ( NIDA, 2016c ), 17 its focus on the consequences of drug use and addiction constitutes an impediment to research on the potential beneficial health effects of cannabis and cannabinoids.

All of the cannabis that NIDA provides to investigators is sourced from the University of Mississippi, which is currently the sole cultivator of the plant material and has been since 1968 ( NIDA, 1998 , 2016a ). 18 In the past, the varieties of cannabis that were available to investigators through NIDA were limited in scope and were not of comparable potency to what patients could obtain at their dispensaries ( Stith and Vigil, 2016 ). Because of restrictions on production and vicissitudes in supply and demand, federally produced cannabis may have been harvested years earlier, is stored in a freezer (a process that may affect the quality of the product) ( Taschwer and Schmid, 2015 ; Thomas and Pollard, 2016 ), and often has a lower potency than cannabis sold in state-regulated markets ( Reardon, 2015 ; Stith and Vigil, 2016 ). In addition, many products available in state-regulated markets (e.g., edibles, concentrates, oils, wax, topicals) are not commonly available through federal sources ( NIDA, 2016d ). Since the products available through the federal system do not sufficiently reflect the variety of products used by consumers, research conducted using cannabis provided by NIDA may lack external validity. In July 2016, NIDA posted a formal request for information on the varieties of cannabis and cannabis products of interest to researchers ( NIDA, 2016e ). Reflecting the perceived shortcomings of cannabis and cannabis products currently provided by NIDA, a summary of the comments received in response to this request states that “the most consistent recommendation was to provide marijuana strains and products that reflect the diversity of products available in state dispensaries” ( NIDA, 2016e ).

Naturally, it is difficult for a single facility at the University of Mississippi to replicate the array and potency of products available in dispensaries across the country. It is worth noting, however, that NIDA has been increasingly responsive to the needs of clinical investigators. For example, NIDA has contracted with the University of Mississippi to produce cannabis strains with varying concentrations of Δ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD) ( NIDA, 2016d ), and NIDA has previously authorized development of cannabis extracts, tinctures, and other dosage formulations for research purposes ( Thomas and Pollard, 2016 ). As mentioned above, NIDA has sought public comment on the needs of cannabis researchers in order to inform efforts to “expand access to diverse marijuana strains and products for research purposes” ( NIDA, 2016e ). In addition, cannabis is made available to research investigators funded by NIH at no cost. 19 Finally, the DEA has adopted a new policy that increases the number of entities that may be registered under the Controlled Substances Act (CSA) to grow (manufacture) marijuana to supply legitimate researchers in the United States. 20 Under this new policy, the DEA will facilitate cannabis research by increasing the number of private entities allowed to cultivate and distribute research-grade cannabis. As of December 2016, the University of Mississippi remains the sole cultivator of cannabis provided to researchers by NIDA ( NIDA, 2016a ).

Although new plans are being made to provide a wider array of more clinically relevant cannabis products for research, at present this issue is still a significant barrier for conducting comprehensive research on the health effects of cannabis use. How the proposed changes will affect cannabis research in the future remains to be seen.

CONCLUSION 15-2 It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects of cannabis use.

Funding Limitations

Funding for research is another key barrier; without adequate financial support, cannabis research will be unable to inform health care or public health practice or to keep pace with changes in cannabis policy and patterns of cannabis use. NIH is responsible for funding research across a number of health domains. In 2015, NIH spending on all cannabinoid research totaled $111,275,219 ( NIDA, 2016c ). NIDA, a member institute of NIH, has as its mission to study factors related to substance abuse and dependence and conducts research on the negative health effects and behavioral consequences associated with the abuse of cannabis and other drugs ( NIDA, 2016b ). Because cannabis was historically perceived to have only negative effects, the majority of cannabis research has been conducted under the auspices of NIDA.

In fiscal year 2015, studies supported by NIDA accounted for 59.3 percent ($66,078,314) of all NIH spending on cannabinoid research; however, only 16.5 percent ($10,923,472) of NIDA's spending on cannabinoid research supported studies investigating therapeutic properties of cannabinoids ( NIDA, 2016c ). 21 , 22 As demonstrated in Chapter 4 of this report, a growing body of evidence suggests that cannabis and cannabinoids also have therapeutic health effects. In light of these findings, a comprehensive research agenda that investigates both the potential adverse and the potential therapeutic health effects of cannabis use is needed.

However, it may be unrealistic to expect NIDA to have the resources or interest to fund this broader research agenda, which could involve investigating the health effects of cannabis use on a diverse range of conditions (e.g., metabolic syndrome, cardiovascular disease, cancer, obesity and sedentary behavior, Alzheimer's disease) that are targeted by other institutes and centers of NIH. While it is not clear how these studies might be funded, almost assuredly the changing norms and the changing legal status of cannabis will have an impact on conditions that are targeted by institutes other than NIDA, and it will become increasingly important to have a funding mechanism to better understand the comprehensive health effects of cannabis so that consumers and policy makers can respond to changing trends accordingly.

CONCLUSION 15-3 A diverse network of funders is needed to support cannabis and cannabinoid research that explores the harmful and beneficial health effects of cannabis use.

• METHODOLOGICAL CHALLENGES

Drug Delivery Challenges

Another challenge in investigating the potential health effects of cannabis and cannabinoids is the identification of a method of administering the drug that is accepted by study participants, that can be performed at most research sites, and that ensures standardized dosing. Smoking as a route of administration is particularly challenging, as some study participants may not view it as an acceptable method of drug administration, and academic medical centers or other locations where cannabis or cannabinoid research takes place may lack facilities where study participants can smoke under controlled conditions. Furthermore, variations among individuals in terms of their cannabis smoking techniques make it difficult to ensure that study participants reliably receive the targeted dose of the drug. Devices for providing a metered dose of cannabis via inhalation exist ( Eisenberg et al., 2014 ), but the FDA has not approved such devices for use. Standardized smoking techniques have also been developed ( Foltin et al., 1988 ) but can be difficult to perform correctly. These difficulties are due, in part, to differences among individuals in their tolerance of the potential psychoactive effects of the drug ( D'Souza et al., 2008 ; Ramaekers et al., 2009 ), which may prevent the receipt of equal doses by all study participants.

Researchers have also explored vaporization as a method for administering cannabis ( Abrams et al., 2007 ). Cannabinoids vaporize at lower temperatures than the temperature at which pyrolytic toxic compounds are created through combustion; as a result, levels of some carcinogenic compounds are lower in cannabis vapor than in cannabis smoke ( Eisenberg et al., 2014 ). However, there is a paucity of research on the effectiveness of these devices as a mode of drug administration. For example, data on the plasma concentrations of cannabinoids achieved through use of vaporizers exists, but they are limited ( Abrams et al., 2007 ; Zuurman et al., 2008 ). In addition, even less is known about the long-term pulmonary effects of inhaling a vaporized liquid than about the effect of inhaling plant material. As vaporizing devices proliferate and evolve, researchers may benefit from advances in their portability and usability, but they will also have to account for clinically relevant differences in the functioning and the effectiveness of an increasingly wide range of models.

To circumvent the practical and methodological challenges involved in administration of cannabis through smoking or vaporization, investigators may choose to study the health effects of orally administered dronabinol or nabilone, which offer a more controlled method of drug delivery. However, the effects generated by these isolated cannabinoids might, at least in part, be different from those produced by the use of the whole cannabis plant, which also contains CBD and other cannabinoids, as well as terpenoids and flavonoids. As a result, extrapolating from the observed health effects associated with use of an isolated cannabinoid such as dronabinol or nabilone in order to predict the health effects associated with the use of cannabis may lead to erroneous conclusions.

The Placebo Issue

The gold standard of drug development is the prospective, randomized, double-blind, placebo-controlled clinical trial. Placebo cannabis produced by solvent extraction is available from NIDA and has a potency of 0.002 percent THC by weight and 0.001 percent CBD by weight ( NIDA, 2016d ). 23 The extraction process seems to retain the terpenoids and flavonoids so that the combusted placebo material smells similar to the true cannabis, thus helping to preserve the blinding to some extent. However, the psychoactive and vasoactive effects of cannabis pose a considerable challenge for effective blinding, since study participants who feel such effects will surmise that they are receiving cannabis or cannabinoids, and not a placebo.

Strategies to promote the effectiveness of blinding exist. For example, if the cannabis being studied has a very low THC content, study participants—especially those who, through regular use of more potent cannabis strains, are inured to the psychoactive effects of cannabis with low THC content—may not notice the psychoactive effects of the cannabis and therefore be unable to reliably determine whether they are using cannabis or a placebo. There is also a possibility that cannabis products with a lower ratio of the concentration of THC to the concentration of CBD may have less psychoactivity than products with a comparatively higher ratio of the concentration of THC to the concentration of CBD ( Hindocha et al., 2015 ; Jacobs et al., 2016 ). Using these strains with diminished psychoactive effects could promote more effective blinding. Researchers may also try treating both study arms in a placebo-controlled cannabis trial with a mildly psychoactive or sedating drug, the effects of which may help to ensure that study participants are unable to determine whether they are receiving a placebo or cannabis. However, by introducing another active agent, the investigators risk obfuscating the results of their study.

A potential method for assessing the effectiveness of blinding in a cannabis trial is to ask study participants to guess whether they are receiving true cannabis or a placebo. If most or all of the participants correctly guess their assignment, it can be inferred that the blinding was ineffective. Whether or not such methods are employed, investigators risk undermining their study results. On the one hand, conducting the test carries the risk of discovering that attempts at blinding were ineffective, thereby rendering the study results invalid. On the other hand, not conducting the test may lead journal reviewers aware of the challenges of blinding in cannabis trials to assume that blinding was ineffective and to discount the study results accordingly. Thus, research to address the challenge of achieving reliably effective blinding in a cannabis trial is of marked importance.

Exposure Assessment

In order to arrive at valid and meaningful results, population studies on the health effects of cannabis require as detailed an ascertainment of exposure to cannabis as possible. However, obtaining such a detailed exposure history can be difficult. This is especially true for recreational cannabis use due to the lack of a standardized dose and the existence of diverse routes of administration, including multiple modes of inhalation ( Schauer et al., 2016 ). In addition, known pharmacological biomarkers of cannabis use may be unreliable in some circumstances, while population studies to identify novel pharmacological biomarkers of cannabis exposure are limited ( Hartman et al., 2016 ; Schwope et al., 2011 ). Furthermore, the wide variety of different cannabis strains developed through a long and ongoing process of cultivation and the associated variation in the concentration of active substances in cannabis further complicate the characterization of cannabis exposure ( ElSohly and Gul, 2014 ; Elsohly et al., 2016 ; Mehmedic et al., 2010 ). Finally, recreational cannabis may contain chemical contaminants or adulterants ( Busse et al., 2008 ). Cannabis users may be unaware of the presence of these chemicals, making it unlikely that such chemicals would be identified through toxicological evaluation unless the user became involved in a forensic investigation.

Most observational studies, particularly case-control and cohort studies, depend on self-report in order to assess cannabis exposure. These reports may be incomplete, inaccurate, or imprecise due to failure on the part of investigators to ask cannabis users detailed questions about their cannabis exposure history, including the source of their cannabis exposure (e.g., smoking, edibles, vaping), or because users themselves may have limited knowledge of some aspects of their exposure or may be resistant to reporting some information. Personal recall of substance use may also be affected by other factors. For example, memory problems have been identified as a cause of inaccuracies in reporting drug use ( Johnson and Fendrich, 2005 ; Pedersen, 1990 ). In other cases, study participants may not report illicit substance use in an attempt to conform to perceived social norms ( Johnson and Fendrich, 2005 ). Similarly, individuals with substance dependency syndromes may have psychiatric comorbidity that affects the accuracy of reporting.

Finally, important information often missing from cannabis exposure histories is the extent of other substance use. As noted in Chapter 14 , there is limited evidence that cannabis use is associated with the use of other licit or illicit substances. Despite this association and the confounding effect of polysubstance use on evaluations of the health effects of cannabis use, surveys used to characterize cannabis exposure histories do not always assess for the presence of other substance use. Since secondhand exposure to cannabis smoke can have minor health effects, there may also be value in assessing for such exposure as part of larger assessments of cannabis exposure ( Herrmann et al., 2015 ).

Cannabis-Related Study Designs

In researching the health outcomes of cannabis use, the committee identified a number of studies, particularly cohort studies, of general health outcomes such as all-cause mortality or important chronic illnesses such as cancers or cardiovascular diseases. For both cohort and case-control studies, a better assessment of cannabis use would offer more valuable information, such as years of use and age at first use. Particularly for cohort studies, this would offer better ascertainment of the duration and net burden of use as well as more insight into period and age effects. As discussed in the proceeding health outcomes chapters of the report, in many of the existing cohort studies cannabis use was often queried only at baseline, and thus there was little information on interval use over time or on the variation or cessation in that use. There was also very limited information on interval health events as the cohorts progressed, impeding a summarization of long-term use and the consequent health effects. Attention to these issues will likely improve the precision of study findings.

CONCLUSION 15-4 To develop conclusive evidence for the effects of cannabis use on short- and long-term health outcomes, improvements and standardization in research methodology (including those used in controlled trials and observational studies) are needed.

The methodological challenges and the regulatory, financial, and access barriers described above markedly affect the ability to conduct comprehensive basic, clinical, and public health research on the health effects of cannabis use, with further consequences for the many potential beneficiaries of such research. In the absence of an appropriately funded and supported cannabis research agenda, patients may be unaware of viable treatment options, providers may be unable to prescribe effective treatments, policy makers may be hindered from developing evidence-based policies, and health care organizations and insurance providers lack a basis on which to revise their care and coverage policies. In short, such barriers represent a public health problem. See Box 15-2 for a summary of the chapter conclusions.

Summary of Chapter Conclusions .

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As of March 2016, the Health and Medicine Division continues the task of producing consensus studies and convening activities previously undertaken by the Institute of Medicine (IOM).

The count of states where cannabis is legalized for medical use includes Ohio and Pennsylvania, where medical cannabis laws were not operational as of October 2016 ( NCSL, 2016 ).

$22,225,750 (Marijuana Sales Tax [2.9%]) + $42,017,798 (Retail Marijuana Sales Tax [10%]) + $23,995,775 (Retail Marijuana Excise Tax [15%]) = $88,239,323.

Medical Cannabis: $5,236,536 (State Retail Sales Tax) + $792,906 (State Business and Occupation Tax) + $ 2,084,323 (Local Retail Sales Tax) = $8,113,765. Recreational Cannabis: $30,017,823 (State Retail Sales Tax) + $4,050,212 (State Business & Occupation Tax) + $11,228,861 (Local Retail Sales Tax) = $45,296,896. $8,113,765 (Total Medical Cannabis Taxes) + $45,296,896 (Total Recreational Cannabis Taxes) = $53,410,661.

Code of Federal Regulations, Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances, Title 21, § 1301.11 and Code of Federal Regulations, Schedules of Controlled Substances, Title 21, § 1308.11.

Code of Federal Regulations, Schedules of Controlled Substances, Title 21, § 1308.11; United States Code, Schedules of Controlled Substances, Title 21, § 812.

United States Code, Schedules of Controlled Substances, Title 21, § 812(b)(1).

Code of Federal Regulations, Schedules of Controlled Substances, Title 21, § 1308.11.

United States Code, Schedules of Controlled Substances, Title 21, § 812(b)(2).

Code of Federal Regulations, Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances, Title 21, § 1301.18.

Office of the Secretary, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services. Notice. “Announcement of Revision to the Department of Health and Human Services Guidance on Procedures for the Provision of Marijuana for Medical Research as Published on May 21, 1999,” Federal Register , 80, no. 120 (June 23, 2015): 35960, https://www ​.gpo.gov/fdsys ​/pkg/FR-2015-06-23/pdf/2015-15479 ​.pdf (accessed November 25, 2016).

Code of Federal Regulations, Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances, Title 21, § 1301.72 (a) and (d).

Code of Federal Regulations, Registration of Manufacturers, Distributors, and Dispensers of Controlled Substances, Title 21, § 1301.71 (c).

Code of Federal Regulations, Institutional Review Boards, Title 21, § 56.103.

The committee was specifically directed in its statement of task not to comment on cannabis policy issues, such as regulatory options for legalization, taxation, or distribution. While the committee has identified the Schedule 1 classification of cannabis as posing a significant barrier to the conduct of scientific research on the health effects of cannabis, the committee is aware that any decision on the regulation of cannabis involves many factors far outside the committee's remit and expertise. Specifically, the committee did not comment on the abuse or dependency liability or accepted medical use of cannabis compared to other scheduled drugs.

In fiscal year 2015, NIDA's investment in cannabinoid research totaled $66,078,314, of which $10,923,472 was allocated for therapeutic cannabinoid research ( NIDA, 2016c ).

In fiscal year 2015, NIH's investment in cannabinoid research totaled $ $111,275,219, of which $66,078,314 was allocated to NIDA ( NIDA, 2016c ).

NIDA contracts with the University of Mississippi through an open solicitation process. Although the University of Mississippi is currently NIDA's only supplier of research-grade cannabis, other groups can compete for the contract ( NIDA, 2015 , 2016a ).

In December 2016, cannabis provided by NIDA was generally free for NIH-sponsored research. For research not funded by the federal government, the cost of non-placebo cannabis was $10.96 per cigarette and $1,133 per pound ($2,497 per kilogram) ( NIDA, 2016d ).

DEA, U.S. Department of Justice. Policy Statement. “Applications to Become Registered Under the Controlled Substances Act to Manufacture Marijuana to Supply Researchers in the United States,” Federal Register , 81, no. 156 (August 12, 2016): 53846, https://www ​.gpo.gov/fdsys ​/pkg/FR-2016-08-12/pdf/2016-17955 ​.pdf (accessed January 7, 2017).

$66,078,314 (Total NIDA spending on cannabinoid research in fiscal year 2015)/$111,275,219 (Total NIH spending on cannabinoid research in fiscal year 2015) = 0.593. $10,923,472 (Total NIDA spending on therapeutic cannabinoid research in fiscal year 2015)/$66,078,314 (Total NIDA spending on cannabinoid research in fiscal year 2015) = 0.165.

By contrast, NIH spending on tobacco research totaled $300 million in 2015, and spending on research related to the harms and benefits of alcohol use totaled $473 million in 2015 ( NIH, 2016 ).

In December 2016, placebo cannabis provided by NIDA was generally free for NIH-sponsored research. For research not funded by the federal government, the cost of placebo cannabis was $13.94 per cigarette and $1,133 per pound ($2,497 per kilogram) ( NIDA, 2016d ).

• Cite this Page National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017 Jan 12. 15, Challenges and Barriers in Conducting Cannabis Research.
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211 Marijuana Essay Topics & Examples

Should marijuana be legalized? This question is controversial and worth discussing!

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• Preventing Negative Effects of Marijuana Use The aim of the study is to ascertain specific interventions that would allow reducing cannabis use within the framework of the environment where marijuana is legal.
• Analysis of Arguments: Should Marijuana Be Legalized? Pro Arguments: The majority of Americans agree on the necessity to legalize marijuana. This initiative is accompanied by concerns regarding the actual use of marijuana.
• Risks and Benefits of Medical Marijuana The use of marijuana in the medical sphere is a highly debated and discussed topic. Patients with epilepsy claim that the use of marijuana prevents seizures and provides immense relief.
• Medical Marijuana: Issues & Ethical Considerations The use of medical marijuana in anxiety disorders and PTSD has many concerns. Prescribing medical cannabis can potentially benefit a patient but can cause additional health and legal issues.
• The Benefits of Medical Marijuana This paper aims to discuss that medical marijuana is helpful in the treatment and management of chronic pain conditions such as cancer and epilepsy.
• The Issue of Legalization of Marijuana The issue of the legalization of marijuana in the territory of the state is not unambiguous, therefore it is analyzed by a large number of specialists.
• Synthetic Marijuana: Physiological and Social Factors The report generated by Drug and Alcohol Dependence article in the year 2010 showed that the majority of the people who used synthetic marijuana were between the ages of 12 to 29.
• Cannabis or Marijuana for Medical Use In the West, for the first time, medical use became known thanks to the work of Professor O’Shaughnessy, who personally observed the process of her treatment in India.
• Marijuana Research: Personal Connection and Medical Use In the United States, military marijuana is prohibited, but initially, it was used for recreation and as a form of medicine in the twentieth century.
• Marijuana Possession in a High-School Student Case Her participation in the program will be an educational experience and put the juvenile offender in touch with professionals who can understand the motives of her behavior instead of giving Jane Doe an actual criminal […]
• Marijuana Legitimization and Medical Controversy The proponents of the legitimization of marijuana for medical use argue that it has numerous medical uses. Currently, in the US, there is a rather peculiar situation with the legalization of marijuana for medical use.
• Workplace Policy on Marijuana Use in Michigan The legalization and decriminalization of marijuana use in 23 states of the US lead to complicated issues when it comes to the consideration of workplace policies.
• Law: Legislation Regarding Marijuana Farming To evaluate the applicability of the proposed marijuana farming bill, the current marihuana production legislation needs to be reviewed, and the changes in social norms regarding criminal behavior are to be analyzed.
• Marijuana Legalization: Controversial Issue in Canada Canada became the second country in the world to legalize the cultivation and consumption of cannabis in 2018. Besides, the substance is addictive, and it is challenging to stop consuming it.
• Marijuana: Myths and Legal Justification Over the past decades, much attention has been drawn to the question of the categorization of marijuana in terms of the national systematization of drugs controlled by the US Drug Enforcement Administration.
• Marijuana Legalization and Issues to Consider If marijuana is fully legalized, there might be a rise in use among youth, which is dangerous from the physiological point of view, and there will be no legal justification to end it.
• Hip-Hop and Marijuana Use in College Students It has been estimated that over half of the college student population regularly use marijuana, while over 25% used it during past month.
• Marijuana Use among American and Bolivian Students The study is a perfect example of the use of theory in a research. As such, it is possible for college students in Bolivia to have a similar deviant behavior, which in this case is […]
• The Relationships Between Marijuana and the Legal System The most common ideas discussed within a framework of this debate are connected to the issues of permission to keep marijuana at home for personal needs such as medical needs, and a total ban on […]
• Should Marijuana Be a Medical Option? Medical marijuana is used to refer to the use of marijuana as a physician-recommended form of medication in its natural or synthetic form.

💡 Interesting Cannabis Topics to Write about

• Use of Marijuana for the Medicinal Purposes It is therefore quite evident that even though the marijuana legalization will go hand in hand with a set minimum age within which individuals will be allowed to use it, at the long run the […]
• The Medicinal Value of the Marijuana: There Are Potential Benefits to a Patient Other Than Risks This article provides an insight to the effects of chemotherapy treatment to the body of the cancer victims. It defines the drug in a lengthy way including what the drug is, the effects of taking […]
• Pros and Cons of Legalization of Medical Marijuana It is evident that medical treatment with the use of marijuana would be beneficial for both: patients and the government because of the opportunity to earn on taxation.
• Legalization of Recreational Use of Marijuana The role of the Supreme Court in the specified case boils down to stating the conditions, in which the prescription and the following use of marijuana by the patient, can be deemed as legitimate.
• The Chances of a Successful Appeal by a Marijuana Convict The Superior Court ruled that the Fourth Amendment rights of the defendant were violated; a decision that was upheld by the Court of Appeal.
• Marijuana Legalization: Chronic Seizure Treatment With that said, despite numerous states already having legalized one or both applications, the federal government remains opposed to either form of legalization, and marijuana possession and use remain federal offenses.
• Adverse Effects of Marijuana Use This paper aims to provide an analysis of the article that gives a perspective on the adverse health effects and harm related to marijuana use. Thus, the academic article on the adverse effects of marijuana […]
• “Adverse Health Effects of Marijuana Use” by Volkow et al. Based on national marijuana studies and DSM-IV, the researchers conclude that addiction to marijuana is a non-debatable statement and that starting marijuana use in adolescence doubles or even quadruples the risks of cannabis use disorder.
• Marijuana Use May Double the Risk of Accidents for Drivers According to the Department of Safety and Homeland Security, the number of Americans driving under the influence of illegal substances has risen drastically. The risk of a crash is also related to the number of […]
• Legalized Marijuana: Negative and Positive Sides The economy and finance from the very beginning were anticipating that this law will bring the largest income to the state’s budget and create plenty of job opportunities under the rule of law.
• Marijuana: Legislative History and Future The focus of the legislation in many states is to end the illegal sale of cannabis and monetize it for tax purposes and so that distribution can be controlled.
• Ethical Perspective of the Legalization of Marijuana In spite of a popular view of the medical benefits of marijuana, doctors insist that the use of marijuana provides the same dangerous effect as other drugs.
• Marijuana Legalize: Advanatages and Disadvantages The truth that marijuana is illegal and prohibited is suitably caused by the number of funds invested in the war against drugs.
• Arguments for Banning the Legalization of Marijuana Marijuana is a dangerous drug that should not be legalized even if it is in the context of it containing the medicinal value.
• Federalism and Medical Marijuana Needless to say, United States faced political and social challenges as well, and the disputes over federalism and over the legal use of marijuana in medicine are still the most burning and controversial issues in […]
• The Effects of Marijuana on the Body, Mind and Brain Cells A drug is a substance that changes the bodily function of a body when consumed, there are several definitions of the word drug but it is believed that the most important function of a drug […]
• College Students in UK and Marijuana The reasons for the punishments are very different but the result remains the same: marijuana is still used by the majority of students and is available for everyone.
• Decriminalizing Marijuana for Medicinal Use Because of inconsistent and problematical data, it is impracticable to access quantitatively to what extent that drugs encourage the incidence of crime.
• Psychological Effects of Marijuana Some people experience panic reactions, which tend to be temporary and often are triggered by a feeling of not being in control Marijuana’s psychological effects include a sense of euphoria or well-being, relaxation, altered time […]
• Logical Benefits of Legalizing Marijuana This will be a source of revenue to the government; when the revenues increase, it means that gross domestic product for the country increases. It will be a source of income not only to the […]
• Social Effects of Marijuana Research has shown that the use of marijuana affects the smoker’s day-to-day lifestyle in relation to society, the environment, and day-to-day activities.
• Federal vs. State Law: Medical Marijuana in the US The main problem is that these laws and regulations have not reduced the number of people who use marijuana for medical purposes.
• Medical Marijuana: Pros of Legalizing It must be admitted that at the time of the passage of these laws, histories from some, but not all, heroin users indicated that the use of marijuana had preceded the use of heroin.
• Marijuana: To Legalize or Not to Legalize? Marijuana, which is also known under dozens of nicknames such as weed or pot, is now the most widespread illegal drug across the US. Moreover, the vast majority of marijuana abusers claim pot to be […]
• Marijuana Legalization and Consumption Among Youth The most popular excuse among drug consumers is the instrumental use of the drug. As long as the drug influence is undermined, the number of college students willing to experience the marijuana effects will be […]
• Legalization of Medical Marijuana: Help or Harm? Nowadays, a majority of people worldwide support the legalization of marijuana, and it is possible to predict that this support will keep getting stronger in the future.
• Medical Marijuana Legalization Concerns This change raises political concerns and requires the government to review its economy to adapt to the use of MM. The representation of the legal process highlighted the history of previous legislations and reported on […]
• Medical Marijuana: Legal and Research Concerns However, while the purpose of recreational marijuana is often disconnected from its long-term effects on people’s health in scholarly discussions, the use of medical marijuana is viewed from the point of patient’s health and the […]
• Medical Marijuana in the Army: Addressing a Problematic Issue Denying the use of medicinal marijuana as one of the fastest and the most efficient ways of relieving pain in the military setting, one will inevitably infringe upon the rights of American troops.
• Should Marijuana Be Legalized? Marijuana legalization is a topic of social trends and beliefs that are based not only on health but political and economic factors as well.
• Marijuana Legalization and Its Benefits for Society The example of several states that have already introduced the appropriate law provides the ground for vigorous debates about the absence of the expected deterioration of the situation and emergence of multiple problems associated with […]
• Marijuana Legalization in 5 Policy Frameworks The legalization of marijuana is still one of the debatable issues at the federal and state levels. For instance, the use of marijuana is prohibited at the federal level while the recreational and medical use […]
• Marijuana Legalization in California The muscle relaxation effect of marijuana also appears to be a positive effect that should be used to argue for its legalization.
• Legalization of Marijuana in the United States It should not be forgotten that it is a cause of numerous tragedies. Also, some studies show that the use of marijuana is especially dangerous for young people.
• Medical Marijuana Legalization by National Football League However, it must be realized that some of these players are usually in excruciating pain to the point that some may have lost consciousness.
• Marijuana: Users, Desired Effects and Consequences The frequent users consist of youths and adults who have abused Marijuana to the extent they have become dependent on it.
• Effects of Marijuana on Memory of Long-Term Users The pivotal aim of the proposed study is to evaluate the impact of marijuana use on long-term memory of respondents. The adverse impact of marijuana after the abstinent syndrome refers to significant changes in prefrontal […]
• Trends in the Use of Marijuana The researchers claim that the legalization of marijuana in California led to the development of the acceptance of marijuana use as well as the increase in this drug consumption.
• Medical Marijuana Legalization Rebuttal The claim of fact is that A.C.A.continues to be beneficial despite the arguments of Republican politicians and current challenges. The claim of policy is the appeal to Republicans and Democrats to work together on the […]
• Marijuana Legislation and Americans’ Contribution To identify whether patients with intractable pain hold more favorable views regarding legislation of marijuana use than the general public, it is necessary to determine various inclusion and exclusion criteria that might influence the society’s […]
• Medical Marijuana Policy and Framing Approach This is a clear indication that different arguments can be presented by these actors to support the legalization and use of medical marijuana.
• Policy Analysis: Rules for Growing Medical Marijuana Overall, the main goal of the document is to address the health needs of people requiring marijuana to relieve the manifestations of their illness as well as the implications of growing marijuana for medical purposes.
• Marijuana Crime in California State and Federal Courts To compare the severity of the punishment that could be imposed by a federal court to what was announced at a state institution, it should be remembered that the investigation process would not take long […]
• Controversy Around Medical Marijuana Legalization The consideration of the problem of marijuana legalization from the perspective of public safety involves such points as crime rates and traffic accidents. The fact of economic benefits of the Cannabis legalization is also apparent: […]
• The Legalization of Marijuana: Regulation and Practice It is imperative to note that legalization of marijuana is a topic that has been quite controversial and has led to numerous discussions and disagreements.
• Marijuana History, Medical Purposes and Threats Although many people believe that marijuana is harmless and the access to it should be unlimited, it has a number of negative health effects and might lead to addiction.
• Marijuana Use and Serious Mental Illnesses 21% of the respondents of 18 years and above claimed to have used marijuana for the first time prior to their 12th birthday.
• Marijuana as an Unjustifiable Pain Reliever The debate on whether to legalize the use of marijuana has been there for the last 20 years. In addition to this, it causes panic and anxiety hence causing the user to hallucinate.
• The Safety of Using Medicinal Marijuana for Pain Relief Speaking about the introduction section of the study, it is important to note that it is rather short if compared to other parts of the article as the researchers were paying more attention to presenting […]
• Should Marijuana Be Treated Like Alcohol? Considering the benefits that would accompany the legalization of marijuana and its treatment like alcohol, I strongly agree with Buckley’s comparison; marijuana should be treated like alcohol. First, the use of marijuana affects the body […]
• Political Issues of Marijuana in America The largest demographic groups against the legalization of marijuana include the Republicans and the southerners. Most of the Democrats continue to support the legalization of marijuana in the country.
• Changes in Laws of Marijuana Regulation In addition, the study intends to uncover the impacts of the said laws and the accompanying changes. The case studies will be compared to assess the impacts of legislations on marijuana in the society.
• Concepts of Legalizing Marijuana Although in most cases, most individuals associate Marijuana with numerous health complications and social problems, for example, brain damage, and violent behavior hence, supporting its illegalization, such individuals take little consideration of its significance in […]
• Marijuana Legalization in Illinois The case for legalization of marijuana in Colorado evidences the need to alter federal laws prohibiting marijuana for its legalization law to have both statutory and federal backing in the state of Illinois.
• Public Safety and Marijuana Legalization Some of the states have failed to tax marijuana. Hence, it is difficult to get the precise figures in terms of tax values that states could collect from marijuana.
• Heroin and Marijuana Abuse and Treatment The success in the process of drug addiction treatment is only possible when the patient is willing to co-operate and has a desire to recover and defeat the habit.
• The Marijuana Usage Legislation This research paper is aimed at discussing the effects that can be produced by the changes in the legislation on the use, storage, and distribution of marihuana.
• Medical Marijuana Program in California The physicians should also do a periodic review of the treatment and how the patients respond to the medical marijuana. The medical marijuana is only restricted to patients who are qualified and recommended by a […]
• History and Effects of Legalization of Marijuana As predicted, the legalization of marijuana in several states has led to an increase of marijuana abuse among youngsters Studies have shown a pattern of the use of cannabis and risky behavior of the individuals.
• Debates Around Legalization of Medical Marijuana The supporters and opponents of the legalization of marijuana have opted to focus on either the positive or the negative aspects of the effects of the drug to support their views on policies to legalize […]
• Federal Drug Laws vs. State Medical Marijuana Acts A senate bill for the case of Los angeles is on the process of considering the use of marijuana for medical purpose.
• The Use of Marijuana and Its Benefits Criminalization of the use of marijuana and negative reviews as well as negative exposure from the media has driven marijuana use to the black markets with often negative consequences to the economy and society.
• Medical Marijuana use for Terminal Colon Cancer The author hopes to use this paper to highlight the uses of marijuana in management of colon cancer at its terminal stage.
• How New York Would Benefit From Legalized Medical Marijuana The arrests resulting from possession of marijuana in New York is quite huge compared to those in California and New Jersey states in America.
• Should Be It Legal to Sell the Marijuana in the United States? What I want to know is the reasons of why so many people use such serious psychoactive drug as marijuana of their own accord and do not want to pay special attention to their activities […]
• Supporting of Marijuana Legalization Among the Adult Population Proponents argue that legalization of marijuana will lead to increased revenues for the government amid economic challenges. Legalizing marijuana will not lead to cancer and deaths but will spark the debate for apparent effects of […]
• Marijuana: The Issues of Legalization in the USA To understand all the possible effects of the marijuana legalization, it is necessary to pay attention to the definition and classification of the drug with references to determining the most important social and legal aspects […]
• Reasons for Legalization of Marijuana The legalization of the drug would bring to an end the discrimination of the African Americans in marijuana-related arrests, reduce the sales of the drug and its use among teenagers, encourage the development of hemp […]
• Legalizing Marijuana: Arguments and Counter-Arguments On the other hand, many groups have outlined that the legalization of marijuana would lead to an increase in the rate of crime in addition to opening up of the gateway to the abuse of […]
• Drug use and misuse in western society: Effects of chronic marijuana use among young women and girls It is also based on the fears of the impacts of the drug use, concerns over the reduced productivity that’s likely to cause harm to the user and the society and so on.
• Medical Marijuana Policy in the United States The importance of legalization of medical marijuana is that, the government will be able to monitor and control marijuana in the country.
• The Arguments For and Against Marijuana Decriminalization The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it.
• The Illegal Use of Marijuana Canada is among the leading nations in the percentage use of illegal marijuana as stated in the World Drug Report of the year 2007.
• Marijuana and Its Economic Value in the USA The grim reality of the economic performance of the United States of America lies in the lengthy debate over the legalization of marijuana.
• Should We Legalize Marijuana For Medical Use? In addition to that, the use of Marijuana especially by smoking either for medical reasons or to heal ailments, is a social activity that will help bring them together and improve their social ties.
• Why Marijuana Should Be Legalized? The government should save that money it uses in prohibiting the use of marijuana as it has no proved harm to the users.
• Arguments on Why Marijuana Should Be Illegalized The greater part of the population believes that the sustained use of this product is beneficial in numerous ways. Therefore, it is clear that the negative effects of the drug outdo the constructive ones.
• A Case for Legalizing Marijuana Marijuana is one of the drugs that the government policy targets and as it currently stands, the government uses a lot of resources in prosecuting and punishing marijuana consumers through the legal system.
• The Marijuana Industry and Its Benefits Marijuana use also slows down the growth of cancerous tumors in the brain, lungs, and breasts; thus, it is valuable in the management of cancer.
• The Decriminalization of Marijuana One of the main reasons that the supporters of this argument have progressed is that by decriminalization of marijuana, the government would save huge amounts of money that it uses on enforcing laws that relate […]
• The Use of Marijuana in California The US government ensures that its use is limited to a minimum by enforcing harsh punishments to the dealers and users of marijuana.
• Federal Government Should Not Legalize the Use of Marijuana On the other hand the use of marijuana actually increased in the country. It is not only the DEA or the federal government that is reluctant in the legalization of marijuana.
• Issues with Marijuana Legalization in the United States This is the reason why the debate on the legalization of marijuana has been on the increase since the past 10 years.
• The history of marijuana According to the new set of legislation, it was considered illegal to be found in possession of 25 grams of marijuana.
• Does Legalizing Marijuana Help or Harm the United States? The latter measure is not merely being advocated by the proponents of marijuana use since the legalization of marijuana has been supported by NAACP not because it fully backs the smoking of marijuana.
• Marijuana, Heroin and Prescription Opiate Abuse and How Are They Related to the Society The core issues mentioned in the article revolves around addiction and abuse of opioid agents as well as its relation to the use of heroin and marijuana.
• Increasing Marijuana Use in High School The author’s concerns in the article are that the usage of marijuana is becoming prevalent among the American youth. It is evident that the author is against the publication and marketing of the medical marijuana […]
• The Union: The Business Behind Getting High by Brett Harvey Some other reasons advanced by the documentary include the ability of the government to control the sale of such drugs to minors and also collection of tax revenue. The documentary espouses a number of reasons […]
• The Debates on the Legal Status of Marijuana This means that the use of marijuana encourages the consumption of other drugs such as alcohol and cigarettes. Additionally, the use of marijuana is associated with increase in crime and consumption of other illicit drugs.
• Marijuana Is a Healthier Alternative to Cigarettes Cigarette smoking has also been reported to cause respiratory infections due to the damage caused in the cells that prevent entry of microorganisms into the respiratory system hence reducing the immunity of the system.
• Marijuana’s Negative Effects and Advantages Marijuana is the most commonly abused drug among the youths and adults in the United States and other countries in the world.
• Use of Marijuana and Its Consequences The plant was grown in the United States of America for agricultural purposes during the colonial period up to the beginning of the 20th century.
• Should Marijuana Drugs Be Decriminalized? The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it. Thus, decriminalization of marijuana is likely […]
• Argument About Legalizing Marijuana in America Therefore, if at all the government of the United States is to prohibit the use of marijuana in the country, it should be ready to cater for the high costs that come in hand with […]
• Marijuana’s Positive and Negative Effects The main aim of creating these institutions is to evaluate the impact and the effects of marijuana on the abusers and on the environment.
• Limited and Controlled Use of Marijuana The question of legalizing marijuana refers to the legal use of marijuana both in private and public places for medical use or otherwise.
• The Moral and Ethical Reasons Why Marijuana should be legal It is my humble opinion that the billions of dollars being spent on the war against marijuana should be diverted to more useful projects like feeding the less fortunate in the society.
• The Problem of Legalization of Marijuana and Hemp Many individuals tend to believe that the use of Marijuana is morally wrong as it alters the mental state of the user and leads to dangerous addictions and actions in the end.
• Minor and Major Arguments on Legalization of Marijuana Premises 1: If marijuana were to be legalized it would be impossible to regulate its’ sell to, and use by the minors. Making marijuana illegal is denying them a right to the use of this […]
• The Reasons Why Marijuana Should be Made Legal Among the reasons that support the legalization of marijuana include: the medical basis that marijuana has some benefits and that the state could gain revenue from the trade of marijuana as opposed to the costs […]
• Why Is Marijuana Legalized In Some States And Not Others? I consider the legalization of marijuana to be a positive step as its prohibition entails intrusion of personal freedom and just like any other substance it is only harmful when it is not taken in […]
• The Effect of Legalization of marijuana in the Economy of California It has been predicted that if the government legalizes the drug, there will be a lot of changes pertaining to the demand for the drug in the market and as a result, there will be […]
• Marijuana Must Not Be Legalized According to the national institute of drug abuse, the active chemical in marijuana, tetrahydrocannabinol, act on the region of the brain responsible for time awareness, sensory, attention, thoughts, memory and pleasure.
• Decriminalization of Marijuana The decriminalization of marijuana resulted due to public outcry over the effects of marijuana. Among the disadvantages include the saving of money and time for other businesses, promotion of the judicial justice as the centre […]
• Policy Brief: Why Marijuana Use Should Be Legalized in the Us In this perspective, it is valid to argue that marijuana users may be undergoing long incarcerations in US jails due to the misconceived fantasies that took root in the public mind in the 1930’s, and […]
• Medical Uses of Marijuana The feelings of hallucination make one to lose consciousness and feel as though in very different world that is full of bliss.
• Should Marijuana Be Legalized in Canada?
• Drug Testing and Legalization of Marijuana
• Has the Time Come to Legalize Marijuana?
• Framing the User: Social Constructions of Marijuana Users
• Drugs and Legalization Drug Marijuana Dealing
• Decriminalization and Marijuana Smoking Prevalence
• Has Marijuana Become More Accepted in Today’s Culture?
• Get Ready for Americas Fastest-Growing Industry: Marijuana
• Clearing the Smoke Between Cigarettes and Marijuana
• Key Findings and Decriminalization of Marijuana
• Facts That Most People Don’t Know About Marijuana
• Issues Hampering the Legalization of Marijuana
• Economical Argument for the Legalization of Marijuana
• Juvenile Smoking and Marijuana Use
• All the Reasons Why Marijuana Should Be Legalized for Medical Purposes
• Exploring the Effects and After Effects of Marijuana
• Factors That Influences Teenagers to Use Marijuana
• College Students Attitude Toward Marijuana Use on Campus
• Drugs Case for Legalizing Marijuana
• Logical Reasoning for the Legalization Marijuana
• Future Trends and Marijuana for Medicinal Purposes
• Countering Anti-Medical Marijuana Efforts in Massachusetts
• Abnormal Psychology Problem: Excessive Use of Marijuana and Alcohol
• Food and Drug Administration Bans Use of Marijuana in the US
• Addiction and Smoking Marijuana Plays
• Analyzing Affordable Care Act and Marijuana
• Driving Under the Influence of Marijuana is Hazardous
• America Requirements Medicinal Weed: Marijuana Legalization
• Comparing and Contrasting Marijuana and Alcohol
• Many People Believe That Marijuana Should Be Legalized
• How Media Framing Effects Marijuana Prohibition and Legalization?
• How Can Legalize Marijuana Help the United States?
• How Does Military Jurisdiction Deal with Marijuana Now Would Legalization?
• How America Will Benefit from Legal Marijuana?
• How Legalizing Marijuana Will Impact Society?
• Does Marijuana Cause Brain Damage?
• How Marijuana Will Not Work in the US?
• Does Marijuana Have Any Medicinal Uses?
• How Many Individuals Smoke Marijuana in the United States?
• Does Previous Marijuana Use Increase the Use of Other Drugs?
• How Medical Marijuana Works?
• How the Social Contract Theory Prevents the Legalization of Marijuana?
• How Marijuana Affects Hauora?
• Why Do Americans Enjoy Marijuana?
• What are the Positive and Negative Effects of Legalizing Marijuana?
• What are the Benefits and Drawbacks of Legalising Marijuana?
• Does Legalizing Marijuana Make Sense?
• What Are the Medical Causes and Effects of Marijuana Use?
• How Are Employers Coping with Medical Marijuana Legislation?
• Does Marijuana Work the Treatment of Diseases?
• Does Marijuana Have Medicinal Purposes?
• How Does Marijuana Law Work in District of Columbia Class?
• Does Increasing the Beer Tax Reduce Marijuana Consumption?
• How Legalizing Marijuana Could Help Boost the Economy?
• Does Marijuana Have More Harmful or More Beneficial Effects?
• How Will Marijuana Legalization Affect Public Health?
• Does Marijuana Use Impair Human Capital Formation?
• How Gender and Age Effects Marijuana Usage and Brain Function?
• How Marijuana Affects Our Society?
• How American Children Start to Smoke Marijuana and Why?
• Chicago (A-D)
• Chicago (N-B)

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