Introduction and Legalization

Currently, there are ten states and the District of Columbia with legislation that allow recreational or medicinal use of marijuana. Several other states also have laws that legalize the use of marijuana for recreational or medicinal use. Among the states that allow recreational use of marijuana for adults 21 years and older are Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont and Washington. Other states allow for limited use of medical marijuana in the form of oils, pills and cannabis-infused products; most states have also decriminalized possession of small amounts of marijuana. Medical use of marijuana for specific conditions varies in different states; for example use in severe epileptic conditions are allowable in Alabama and Mississippi.

California was the first state to legalize medical marijuana in 1996 with Colorado and Washington being the first two states to pass legislation allowing recreational use of marijuana in 2012. Data from retail sales of marijuana in Washington indicate sales of almost 2 billion dollars with tax revenue reaching $700 million dollars from 2014-2019.1 The state of Colorado reports increasing retail marijuana sales with a slight decrease in the sale of medical marijuana (Figure 1).

Figure 1. Colorado Marijuana Sales.2

Retail sales of marijuana in Massachusetts had transactions worth over 23 million dollars in the first two months, with a tax of 17% benefiting the commonwealth.3 Legalization allows for use by the public, but also allows government regulation and monitoring of sales for tax revenue and licensing. Several advocates of legalization of marijuana feel decriminalization is the first step towards legalization. Decriminalization indicates that the activity is still illegal, but enforcement and penalties are not as severe (Figure 2).

Figure 2. Marijuana Legal Status Map.4

Surveys of the general public have indicated an increase in support and acceptance for legalization of marijuana has to 62%, when compared to just 16% in 1990 (Figure 3). This acceptance in translated by younger users as safe with minimal health consequences.5

Figure 3. Percent Supporting Marijuana Legalization.7
Figure 4. Daily Marijuana Use.13

The CDC demonstrates the percentage of past month marijuana use* among persons aged ≥18 years, by highest level of education completed — National Survey on Drug Use and Health, United States, 2002–2014, which continues as an upward trend, but still remains below 15% (Figure 5).10

Figure 5. Vaping Nicotine or Marijuana Among Teens.13

The chemical in marijuana, delta-9-tetrahydrocannabinol (THC) that targets the cannabinoid receptors has been determined to be more potent today than it was just a few decades ago in the 1980s. The THC concentrations averaged 15% in 2012, compared to 4% in the 1980s. This higher concentration may increase the risk of effects from the drug and/or the potential addiction.

The number of emergency room (ER) visits in 2008 documented in the U.S. connected to marijuana use has steadily increased to over 370,000, particularly in the 12-17 year old age group. Data from the Children’s Hospital in Denver Colorado has demonstrated an increase in ER visits from 106 in 2005 to 631 in 2014, when legalization occurred.14 Due to the impact on judgment and perception, driving can be dangerous when smoking marijuana and after alcohol, it is the second most frequent substance found in drivers implicated in fatal automobile accidents.

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