Marijuana's place in society is evolving. Shatterproof will continue to examine the evidence with a critical lens in order to understand both the impact of these changes, and the areas where individuals, families, and communities could benefit from support.

The political landscape surrounding marijuana has been changing rapidly in recent years. States across the U.S. are decriminalizing the drug, while others are legalizing its medical and recreational use.

Research shows the benefits of medical marijuana use. Research also demonstrates that reducing the criminal penalties for possessing or using marijuana has the potential to reduce costs and criminal justice impacts. Still, more research is needed to understand marijuana’s place in medicine and in society, and how legislation and regulation should approach the substance moving forward.

Marijuana as Medicine

Marijuana can be been used for medicinal purposes in many healthcare settings to treat a number of conditions. Smoking marijuana has been shown to reduce nausea and vomiting among those receiving chemotherapy for cancer. For patients with complex pain, smoking marijuana can lessen both the physical and emotional effects of pain —though it may have the side effect of causing a decline in mental abilities. This same pain relief can also be achieved by taking medication containing cannabinoids (the active ingredient in marijuana), but with fewer negative side effects than using marijuana itself.

Cannabinoids have also been shown to improve short-term sleep outcomes, patient-reported multiple sclerosis symptoms, and other conditions. There is currently one FDA-approved medication derived from CBD, used in severe seizure conditions, and two FDA-approved medications which contain synthetic cannabinoids, used to treat nausea and increase appetite. Current medical marijuana research focuses on individual cannabinoids, or marijuana leaves ingested by a means other than smoking, in order to avoid the potential harmful effects of smoking marijuana.

Research around the medical benefits of smoking marijuana is not standardized due to lack of standard potency and dose. Additionally, the marijuana plant itself is classified as a controlled substance, which creates challenges and barriers to using it for research purposes.

Despite these limitations, smoking marijuana for medicinal purposes is allowed in 31 states, DC, Guam, and Puerto Rico. In these states or regions, medical marijuana is accessible through home cultivation, dispensaries or others similar systems. In practice, this often means that a patient seeking to obtain medical marijuana must first register for a medical card, then can purchase medical marijuana from a regulated, state-licensed dispensary.

Negative Health Effects of Marijuana Use

Marijuana, like any drug, including FDA-approved medications, also has several adverse physical and mental effects.

Individuals who currently smoke marijuana are two times more likely to have episodes of chronic bronchitis than individuals who do not smoke at all, an effect seen in multiple studies . However, unlike cigarettes, marijuana use has not been linked to increased risk of lung and upper respiratory tract cancers. Similarly, occasional marijuana use does not increase risk of chronic obstructive pulmonary disease, but it is important to monitor cumulative and long-term use.

The risk of being involved in a car accident increases approximately two-fold after smoking marijuana. The proportion of fatally injured drivers who test positive for marijuana has increased significantly over the past decade – from 4% in 1999 to 12% in 2010. Consuming marijuana has been shown to increase the risk of fatal car accident 1.6 times.

Marijuana use has also been associated with negative mental health impacts. Daily marijuana use is associated with earlier onset of psychosis compared to no use, particularly among individuals with schizophrenia.

Like other substances, marijuana can be addictive—but marijuana has less tendency to lead to dependence than other substances. However, given that marijuana is the most widely used illicit drug, marijuana use disorder accounts for the highest proportion of individuals 12 or older receiving addiction treatment (besides alcohol) – 20% in 2016. The prevalence of marijuana use disorder has doubled over the past decade.

Importantly, marijuana use is particularly harmful for teens. Starting marijuana use during adolescence is associated with lifetime decline in IQ and general neuropsychological functioning , even with sustained abstinence in adulthood. Similarly, teens appear to be more negatively affected by heavy marijuana use than adults, particularly in regard to learning and memory.

Effective treatments for marijuana use disorder and the mental impacts of this disease are still being researched. There is currently no pharmaceutical treatment specifically for marijuana use disorder as there is for other substance use disorders (specifically alcohol and opioids). But, other forms of treatment, such as cognitive rehabilitation exercises, have been shown to be somewhat effective in reducing potential mental impairment associated with heavy marijuana use.

Still, it's important to note that the belief that marijuana is a gateway drug – that using it will lead individuals to start using other, more dangerous substances — is not supported by evidence. While marijuana use has been linked to nicotine addiction in adolescents, and to future use of LSD, amphetamines, and heroin, this does not mean marijuana use causes an individual to use other drugs. Instead, research shows that a significant portion of this connection between early marijuana use and future substance use or addiction to other drugs is actually due to other common genetic and environmental factors

Marijuana Legislation

Legislation of marijuana varies widely between the federal and state level, and among states. Laws regulating or controlling marijuana use can be divided into three main types: medical marijuana laws, decriminalization laws, and legalization laws.

Medical marijuana laws differ from state to state, but generally all such laws:

1. Protect people from criminal penalties for using marijuana for an approved medical purpose.
2. Allow in-state access to marijuana through home cultivation, dispensaries, or other systems for approved persons.
3. Allow for the sale of a variety of strains with different potencies by specific entities.
4. Allow for smoking or vaporization of marijuana by approved persons.

Marijuana decriminalization laws generally make consuming small, personal amounts of marijuana a civil or local infraction, rather than a state crime; Or, they allow the infraction to be prosecuted as a misdemeanor with no possibility of jail time, rather than as a more serious crime with stringent penalties. Similarly, some states have reduced the criminal penalties for marijuana use or possession or have expunged certain marijuana convictions from individuals’ criminal records.

Marijuana legalization laws generally legalize recreational use of small amounts of marijuana by adults (individuals 21 years of age and older), coupled with strict regulation and taxation .

Federally, the sale, distribution, and use of marijuana remains illegal under the Controlled Substances Act of 1970, and therefore the federal government can choose to override state laws and prosecute those using marijuana, despite differing state legislation.

Currently 17 states have some form of law in place legalizing CBD for medical use, 32 states have some form of broad medical marijuana law in place (for medical marijuana leaf use or medical use of CBD), 14 states have decriminalized use of marijuana, and 8 states have legalized recreational marijuana use. In 3 states, marijuana use remains completely illegal.

Benefits and Consequences of Marijuana Legislation

Medical marijuana laws have been associated with a decrease in opioid overdoses , but acceptance for medical marijuana is mixed among doctors and healthcare providers. Decriminalization of marijuana has the potential for substantial cost savings , because it reduces the costs associated with prosecution and punishment of these crimes. Research has shown that marijuana decriminalization can also result in a moderate decrease in crime (including homicide and assault). It also decreases stigma related to marijuana use and addiction more broadly, which can encourage individuals to seek treatment when needed. Marijuana legalization, however, has been shown to be associated with a 2-fold increase in marijuana-associated fatal car crashes.

As marijuana legislation evolves, regulation will be key to reducing the harmful effects of increased accessibility, such as drugged driving and unintentional ingestion. Furthermore, legislation policies should focus on restricting access for adolescents who are particularly susceptible to marijuana addiction and negative consequences.

Current Rates of Marijuana Use

Marijuana use in the US has increased slightly, particularly among young adults. In 2017, 45% of people age 12 or older reported having used marijuana at least once, and 10% reported using in the past 30 days, representing an 8% increase from 2016 (prevalence 9%). Separated by age, people who are 20-25 years old have the highest reported frequency of use – over half have used at least once, and one in five report using in the past month.

Rates of marijuana use and dependence can increase following implementation of medical marijuana laws or other laws concerning marijuana legalization; However, given mixed evidence, more research is needed in this area.

Looking Forward

Ultimately, marijuana’s benefits, consequences, and place in our society are evolving. As both use and legislation change, Shatterproof will continue to examine the evidence with a critical lens in order to understand both the impact of these changes, and the areas where individuals, families, and communities could benefit from support.