Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations
Open accessAbstract
Background: The past decade has seen unprecedented shifts in the cannabis policy environment, and the public health impacts of these changes will hinge on how they affect patterns of cannabis use and the use and harms associated with other substances.Objectives: To review existing research on how state cannabis policy impacts substance use, emphasizing studies using methods for causal inference and highlighting gaps in our understanding of policy impacts on evolving cannabis markets.Methods: Narrative review of quasi-experimental studies for how medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) affect cannabis use and use disorders, as well as the use of or harms from alcohol, opioids, and tobacco.Results: Research suggests MCLs increase adult but not adolescent cannabis use, and provisions of the laws associated with less regulated supply may increase adult cannabis use disorders. These laws may reduce some opioid-related harms, while their impacts on alcohol and tobacco use remain uncertain. Research on RCLs is just emerging, but findings suggest little impact on the prevalence of adolescent cannabis use, potential increases in college student use, and unknown effects on other substance use.Conclusions: Research on how MCLs influence cannabis use has advanced our understanding of the importance of heterogeneity in policies, populations, and market dynamics, but studies of how MCLs relate to other substance use often ignore these factors. Understanding effects of cannabis laws requires greater attention to differences in short- versus long-term effects of the laws, nuances of policies and patterns of consumption, and careful consideration of appropriate control groups.
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Cannabis use is increasing in the US, partially due to more states legalizing recreational and medical cannabis and decriminalizing its possession and use.
“These increases are partially due to more states legalizing recreational and medical cannabis, as well as decriminalizing its possession and use (Farrelly et al., 2023, Lapham et al., 2023, Smart and Pacula, 2019).”
From Prevalence of and trends in current cannabis use among US youth and adults, 2013–2022 (2024) · cites this paper as Smart and Pacula, 2019
The Conclusions (page unavailable) say that states adopting medical cannabis laws tend to experience increased adult cannabis use. But the Methods section reports insignificant effects of recreational legalization on adult use in the early studies it reviewed, and the cited passages do not establish that decriminalization increased use. The claim therefore attributes a broader explanation for rising US use to this source than its findings support. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe increases in cannabis use among adults but not youth may be attributed to or influenced by recent surges in legalization and decriminalization of cannabis use in the US.
“These increases in adults, but not youth, use may be attributed to or influenced by recent surges in legalization and decriminalization of cannabis use in the US.”
From Prevalence of and trends in current cannabis use among US youth and adults, 2013–2022 (2024) · cites this paper as Smart and Pacula, 2019
The Abstract’s Results and the section on cannabis-use outcomes report that medical cannabis laws are associated with increased adult use but generally not adolescent use. The Introduction documents widespread US legalization and decriminalization, but the cited passages do not establish that decriminalization explains the adult–youth difference; evidence on recreational legalization was still emerging. (LLM, conf=0.84)
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- Authors
- Smart, R., & Pacula, R. L.
- Affiliations
- RAND Corporation (US)
- University of Southern California (US)
- Corresponding author
- Smart, Rosanna
- Venue
- The American Journal of Drug and Alcohol Abuse
- Publisher
- Informa UK Limited
- Published
- 2019-10-11
- Volume
- 45
- Issue
- 6
- Pages
- 644-663
- ISSN
- 0095-2990 (ISSN-L)
- 1097-9891
- PMC
- PMC6934162
- OpenAlex
- W2980236327
- Cited by
- 305
- References
- 116
- Citations by year
- 2026: 34 · 2025: 36 · 2024: 44 · 2023: 48 · 2022: 62 · 2021: 45 · 2020: 34 · 2019: 2
- FWCI
- 4.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of Drug and Alcohol Abuse (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2t32hd007545-21)
- National Institute on Alcohol Abuse and Alcoholism (R01AA026268)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32-HD007545, P2CHD041022)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- cannabis legalization, medical cannabis laws, cannabis use, cannabis use disorder, substance use, alcohol consumption, opioid use, tobacco use, adolescent cannabis use
- MeSH terms
- Marijuana Use, Adolescent, Adult, Age Factors, Alcohol Drinking, Marijuana Abuse, Humans, Legislation, Drug, Opioid-Related Disorders, Public Policy, Substance-Related Disorders, Medical Marijuana, Tobacco Use
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