Cannabis legalization in the USA:

Consequences and public health implications

Jasmina Burdzovic Andreas, PhD

Senior Researcher

Norwegian Institute of Public Health

www.fhi.no

Background

• Cannabis (marijuana) in USA classified as

a Schedule 1 drug under federal CSA; i.e.,

high abuse potential + no medical use

• Medical marijuana laws (MML)

1996 in CA

• Recreational marijuana laws (RML)

2012 in CO and WA

http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html

https://www.nap.edu/resource/24625/Cannabis-report-highlights.pdf

MML

• Still no FDA approval for marijuana plant

• FDA-approved 2 cannabinoid-based

medications (Dronabinol and Nabilone)

• Epidiolex clinical trials (for epilepsy)

MML

• Opioid abuse (2015 National Bureau of Economic Research white paper;

2014 JAMA Bachhuber et al., 2017 AMJPubH Livingston et al.)

MML and RML: public health implications

• Increased availability – increased use?

• Normalization

• De-stigmatization

• Perceived harms

• Changes since MML/RML?

MML and RML:

public health implications

• Trends from national surveys

• Changing nature of cannabis use; novel

products and intake modes

• Ingestion marked by delayed drug effects

• Dosages and potencies unclear, with still

uncertain health consequences

Public health implications

• Emergency Room (ER) admissions

• Cannabis use and use disorders

• Perceived harms from use and future use

plans

ER admissions (all)

ER admissions (all)

ER admissions (children)

Source:

Wang et al. (2016). Unintentional Pediatric Exposures to Marijuana in Colorado, 2009-2015; JAMA Pediatrics.

2016;170(9):e160971. doi:10.1001/jamapediatrics.2016.0971

Alaska, Colorado, Oregon, and Washington regulate/require labelling and packaging for edibles

Source:

Hasin et al. (2017). US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws.

JAMA Psychiatry. 2017;74(6):579-588. doi:10.1001/jamapsychiatry.2017.0724

Cannabis use and disorders

Source:

Hasin et al. (2017). US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws.

JAMA Psychiatry. 2017;74(6):579-588. doi:10.1001/jamapsychiatry.2017.0724

Cannabis use and disorders

Source:

Williams et al. (2017). Loose regulation of medical marijuana programs associated with higher rates of adult marijuana

use but not cannabis use disorder. Addiction. 2017 Nov;112(11):1985-1991. doi: 10.1111/add.13904.

Cannabis use and disorders

Cannabis use and disorders

Source:

Martins et al. (2016). State-level medical marijuana laws, marijuana use and perceived availability of marijuana among the

general U.S. population . Drug and Alcohol Dependence, 2016 Dec 1;169:26-32. doi: 10.1016/j.drugalcdep.2016.10.004.

Cannabis use (youth)

Cannabis use (youth)

• The Rocky Mountain HIDTA excludes such

reports from its summary on the impact of

legalization in Colorado; 3 key sources of youth

data deemed not useable

• increases in cannabis offenses/arrests/school

suspensions

• increased CO rank in national youth use

statistics (3rd vs 14th)

• increases in monthly youth use (SAMHSA)

The High Intensity Drug Trafficking Area Program (HIDTA), part of the National Drug Control Strategy

Cannabis use (youth)

Source:

Cerda et al. (2017). Association of State Recreational Marijuana Laws With Adolescent Marijuana Use.

JAMA Pediatrics. 2017;171(2):142-149. doi:10.1001/jamapediatrics.2016.3624

Source:

Cerda et al. (2017). Association of State Recreational Marijuana Laws With Adolescent Marijuana Use.

JAMA Pediatrics. 2017;171(2):142-149. doi:10.1001/jamapediatrics.2016.3624

Perceived harm

Conclusions

• Novel public health, medical, and scientific

challenges

• Varied sources of data

• Varied populations

• Varied laws

• State-to-state and within-state differences

Question

• Only prevalence rates reported and

examined (yes/no use)

• Frequency of use among users?

Conclusions

• Still no uniform, cohesive picture

• Further research needed

• Varied “legalization” options and strategies

to be considered