Public Health Effects of Medical and Recreational Marijuana

• In Event: Implementation is Politics: Effects of Variation in State Cannabis Policy

Abstract

Medical and recreational marijuana has become increasingly popular across the United States. This paper explores the truth regarding how much of a health threat allowing medical and recreational marijuana is to the general public. Once an issue that only ballot initiatives and progressives would touch, support for legalization of marijuana in some form or another has grown dramatically since the 1990s. Since 1996, many states legalized medical marijuana and decriminalized possession of small amounts of marijuana, with several states going beyond that to allow recreational marijuana for adults over 21.

While many well-known doctors have changed their position, other medical experts and the federal government continue to raise concerns about the potential for addiction and mental health conditions to worsen or develop with the use of marijuana for any purpose. Much of the social science literature suggests that marijuana legalization is associated with greater problems in crime and health outcomes, particularly mental health. However, recent literature suggests that marijuana legalization has helped health outcomes, even substance abuse, when considering its effects on specific genetic and chronic conditions, as well as mediation of addiction to opioids. This paper explores the role of medical and recreational marijuana legalization on public health by considering several aspects of health in a state to determine the true impact of allowing marijuana in some form, medical or recreational, within a state.

This study analyzes the impact of medical and recreational marijuana on health concerns. To date, the literature focuses on ecological or small-n studies that focus on mental health incidence; yet, this is not the only, or even best, indicator of health of a population. It can also be myopic. The ecological studies that suggest a direct causal link suffer from ecological fallacies. Further, the small n-studies are potentially misleading owing to biased samples. This study analyzes the effects of legalization of medical and recreational marijuana from 1996-2019 from across all states to better address this issue. It explores the impact on mental health and the opioid epidemic, along with overall mortality and select morbidity rates.

I find that there are differences between states that ban marijuana, allow medical marijuana and allow recreational marijuana. However, the biggest discrepancies are seen between states that ban marijuana versus those that allow at least medical marijuana. Most measures of health indicate that the quality of health is higher for states that allow medical marijuana, including states that expanded to include recreational marijuana. Most of the health indicators show that health outcomes are equivalent or higher than states that do not allow medical marijuana. Two mental health conditions, psychosis and depression, are higher in states with medical and/or recreational marijuana, but as this is a population-based study, this does not mean causality or even a link among individuals that have medical marijuana cards. There are differences between states that restrict marijuana and allow at least medical marijuana, but we should be careful to draw conclusions at this stage of the legalization process with few states legalizing medical or recreational medical until the 2000s or 2010s.

This is part of a book project that explores legalization of marijuana’s effect on society. Other chapter show that crime and arrest rates do not increase with legalization of medical and recreational marijuana. More commonly states noted a decline. In this chapter, it finds a similar pattern in public health; though, with some caveats. This suggests that the early efforts to legalize marijuana are not leading to the apocalyptic consequences that public health experts and social scientists predicted. Indeed, some conditions improve or remain at their standard rate. While there are elevated risks for some that use marijuana, many of these outcomes develop as a result of individual variation and genetic susceptibility to developing mental health conditions. Overall, there are higher indicators of health within the population and less severe problems with the opioid epidemic within states that allow medical marijuana. Further research should consider this question and specific conditions at greater length when we continue to discuss the social and health effects of legalization of marijuana.

Author

• Mitchell Dylan Sellers, Tulane University