With state after state either medically or recreationally legalizing marijuana, critics opposed to these liberalization efforts claimed there would be negative consequences, namely an increase in both cannabis usage and an escalation in cannabis abuse disorders. Defenders of legalization make the counterclaim that any increase is negligible, and other factors, such as social justice issues related to the war on drugs, outweigh any concerns of usage increase. So what does science say? Where does research lead us?
Legalization: What’s Behind the Data?
It’s a sticky, complex question because there are multiple studies, some with surprisingly nuanced findings. (One unfortunate pattern I noticed during my research is that writers tend to overgeneralize results or underreport certain aspects of data. I’ve made every effort to not do that in this article.)
In 2012 researchers from Columbia University investigated the question of whether decriminalization or legalization in all 50 U.S. states would lead to a rise in the diagnosis of cannabis use disorder (CUD–the combined term for cannabis abuse and cannabis addiction). The researchers, who published their results in the journal Drug and Alcohol Dependence, utilized the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to gather information about the habits of marijuana users.
To corroborate this data from NESARC, the researchers then “. . checked their findings against recent figures gathered from another nationwide project, called the National Survey on Drug Use and Health, which explores drug use trends in all American adults and teenagers” according to sciencedirect.com. Pardon the pun, but the results were a mixed bag at best.
Legalization of marijuana, commerce, and social justice are intimately linked.
Source: finance.dailyherald.comWhile the researchers concluded that “people in pro-medical marijuana states use marijuana more often than people living in other states” and that “the overall percentage of people affected by cannabis abuse and addiction is higher in medical marijuana states than in non-medical marijuana states,” they simultaneously cautioned that the “number of affected individuals apparently goes up because the increase in total users leads to a larger pool of individuals at-risk for developing problems.” In other words, you would expect that as more people use marijuana, a certain percentage will develop addiction issues, but the percentage as a whole is debatable.
Then in late 2019, another study echoed the findings of the NESARC study, with a focus on Recreational Marijuana Legalization (RML). The study, structured as a survey and published in the Journal of the American Medical Association (JAMA) found the “proportion of respondents aged 12 to 17 years reporting cannabis use disorder increased from 2.18% to 2.72%, while the proportion of respondents 26 years or older reporting frequent marijuana use increased from 2.13% to 2.62% and those with cannabis use disorder, from 0.90% to 1.23%.” While these are noticeable increases, they are hardly huge jumps.
Legalization: Limitations of Studies
However, there were several limitations to the study. As the authors state, “First, the study relied on self-reported marijuana use, and the social desirability to report use may change after legalization.” This is a potentially major confounding variable. Boston University Public School of Health defines a confounding variable as “a distortion (inaccuracy) in the estimated measure of association that occurs when the primary exposure of interest is mixed up with some other factor that is associated with the outcome.”
In other words, there is another unaccounted-for factor potentially at play that is affecting the outcome of the data. In this case, the very fact that people live in a state where they don’t have to fear recriminations for admitting marijuana usage will likely encourage them to share more frequently and deeply their associated behaviors.
The researchers also concluded that the “frequency of use and CUD are only 2 of the important dimensions of marijuana use” and that “future studies should examine additional measures,” measures that might indicate deeper issues associated with CUD. This was particularly concerning because the researchers did not use the revised DSM-5 criteria which are broader, and therefore more inclusive.
Additionally, the study was also limited to the short-term effects of RML, so follow-up studies would be needed to establish larger trends. And finally, the study excluded “people who are homeless or residing in institutions, potentially underestimating the prevalence of marijuana use and related disorders.” Inclusion of this demographic may change the data.
Then, in August of 2021, a study was released from Columbia University’s Mailman School of Public Health which examined the effects of medical marijuana legalization on overall usage by teenagers. According to the university’s website, “The researchers analyzed the results of eleven separate studies dating back to 1991 using data from four large-scale U.S. surveys: Monitoring the Future, National Longitudinal Survey of Youth, National Survey on Drug Use and Health, and the Youth Risk Behavior Survey.” The researchers concluded that there were “ No significant changes, increases, or decreases occurred in adolescent recreational use following enactment of medical marijuana laws.”
Legalization: A Complex Issue
Deborah Hasin, PhD, professor of Epidemiology at Columbia’s Mailman School and senior author of the study stated, “For now, there appears to be no basis for the argument that legalizing medical marijuana has increased teens’ use of the drug,” but cautionied, “However, we may find that the situation changes as commercialized markets for medical marijuana develop and expand, and as [more] states legalize recreational marijuana use.”
Hasin further warned that “Far fewer studies have examined the effects of medical marijuana laws among adults,” adding “Although we found no significant effect on adolescent marijuana use, existing evidence suggests that adult recreational use may increase after medical marijuana laws are passed.” It is not an unreasonable assumption to think that as adult marijuana usage increases, adolescent usage will increase in a parallel fashion. However, there is no current data to bolster that assumption.
Legalization and Race
Most recently, a study titled Racial and Ethnic Differences in Cannabis Use Following Legalization in US States With Medical Cannabis Laws was conducted again by the Columbia University Mailman School of Public Health, with Deborah S. Hasin listed as one of the researchers. The authors of the study relied on “Self-reported past-year and past-month cannabis use and, among people that used cannabis, daily past-month cannabis use and past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) cannabis use disorder” [criteria].
The findings of the study were split along racial lines and age groups. Specifically, the researchers found that “living in a state after enactment of recreational cannabis laws was associated with increases in the odds of cannabis use within the past year and past month among Hispanic and non-Hispanic White individuals (as well as individuals identifying as Native American, Pacific Islander, Asian, or more than 1 race) compared with the period before the passage of recreational use laws.” However, the researchers also found that “there were no increases among non-Hispanic Black individuals” or “among individuals aged 12 to 20 years for all race and ethnicity groups.”
This study also listed similar limitations that the previous Columbia medical marijuana study mentioned. The upshot of the study, then, is that in general, while marijuana users under 20 or Black marijuana users did not see a rise in reported usage, Hispanic and non-Hispanic White users did. Such findings argue for more nuanced, detailed research.
The Gist of Legalization Studies
On the whole, study after study has found that either legalization leads to no changes in marijuana usage or increases in abuse, or that the negative consequences are typically minimal in nature. The bottom line is that attitudes about marijuana, and legalization specifically, are changing, and perhaps more importantly, how we police and adjudicate marijuana usage in our justice system, especially with regard to the role of our federal government, is increasingly being called into question.
These shifting attitudes were corroborated by a 2017 CBS News poll in which “found 71% of Americans opposed the federal government taking action to stop the sale or use of marijuana in states where it is legal—including majorities of Democrats, Independents, and Republicans.”
Legalization, Abuse, and Semantics
There are semantic issues with aspects of all of these studies, however, because of the fuzzy boundaries of marijuana addiction, or cannabis use disorder. Previously, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defined cannabis use disorder as “the continued use of cannabis despite impairment in psychological, physical, or social functioning.”
Subsequently, The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) has revised the terms of cannabis use disorder defined by multiple “pathological patterns classified under impaired control, social impairment, risky behavior, or physiological adaptation.”
Elizabeth Hartney, Director of the Centre for Health Leadership and Research at Royal Roads University, Canada, writes that the DSM-5 clarified that at least two of the following symptoms within a 12-month period indicates cannabis use disorder:
- Taking more cannabis than was intended
- Difficulty controlling or cutting down cannabis use
- Spending a lot of time on cannabis use
- Craving cannabis
- Problems at work, school, and home as a result of cannabis use
- Continuing to use cannabis despite social or relationship problems
- Giving up or reducing other activities in favor of cannabis
- Taking cannabis in high-risk situations
- Continuing to use cannabis despite physical or psychological problems
- Tolerance to cannabis
- Withdrawal when discontinuing cannabis
But even such descriptions of patterns are problematic in their own right. What does it mean to take more cannabis than was intended? What constitutes a lot of time using cannabis? What defines a high-risk situation? Of course, well-trained, experienced medical professionals can help fill in the gaps of subjectivity. Still, it’s not an exact science, though most people would likely agree that marijuana, like any drug, can be overused and create issues for people.
Legalization: The Bottom Line
The reality is that we are still learning about the effects, both good and bad, regarding the broad legalization of marijuana, because we are still in the nascent stages of this social experiment.
At the end of the day, legalization efforts will always need to be balanced with the possibility, or even the probability, that some people are going to abuse their privileges. That is human nature, and it is highly unlikely that we will create a system where everything turns out positive for all involved.
As Kevin Sabet, the president and CEO of Virginia-based Smart Approaches to Marijuana, and an opponent of widespread legalization points out:
“Also, we don’t want to see a return to an enforcement-heavy policy that throws everybody behind bars or saddles young people, especially, with criminal records that prevent them from getting a job or being able to access public benefits or being able to go to school. We want to see people given another chance. But we also want to see this treated as a health issue, and you don’t treat marijuana as a health issue by ignoring it or facilitating its use. You do brief interventions if they’re needed, treatment if it’s needed. I don’t think everyone who uses marijuana needs treatment, just like everyone who drinks or uses other drugs doesn’t need treatment.”
We ultimately must look at things holistically, taking into account multiple factors and variables to make an intelligent, informed decision that on the whole does more good than bad. This may be easier said than done, especially in a highly partisan political environment. But we owe it to ourselves and upcoming generations to get it right.
I’ll leave you with the wise words of that bastion of liberalism, Richard Nixon: “Federal and state laws (should) be changed to no longer make it a crime to possess marijuana for private use.”
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