Medical Marijuana and Marijuana Legalization

State-level pot advancement approaches have been developing for as far back as fifty years, but the by and large logical proof of the effect of these strategies is broadly accepted to be uncertain. In this survey we sum up a portion of the vital limits of the examinations assessing the impacts of decriminalization and clinical maryjane laws on weed use, featuring their irregularities as far as the heterogeneity of approaches, the circumstance of the assessments, and the proportions of utilization being thought of. We propose that the heterogeneity in the responsiveness of various populaces to specific laws is significant for deciphering the blended discoveries from the writing, and we feature the limits of the current writing in giving clear bits of knowledge into the likely impacts of pot legalization.Keywords: marijuana progression, cannabis items, strategy elements, strategy heterogeneityGo to:

INTRODUCTION

Although the government law has disallowed the utilization and circulation of maryjane in the United States since 1937, for as far back as fifty years states have been exploring different avenues regarding pot progression polices. State decriminalization strategies were first passed during the 1970s, patient clinical access laws started to get received during the 1990s, and all the more as of late states have been trying different things with legitimization of sporting business sectors. This has brought about a range of maryjane advancement strategies across the United States that is regularly not completely perceived or thought about when leading assessments of late arrangement changes.

Consider for instance the condition of weed arrangements in the United States at a solitary place of time. As displayed in Figure 1, as of January 1, 2016, 21 states1 have decriminalized certain weed ownership offenses (NCSL 2016a), 26 states have legitimized clinical pot use, and another 16 states have received cannabidiol (CBD)- just laws (NCSL 2016b) that secure just certain strains of pot to be utilized for restorative purposes. Notwithstanding, there is enormous cover since certain states have carried out mixes of every one of these strategies, as displayed by the way that the five states as of now authorizing sporting weed use (Alaska, Colorado, Oregon, Washington, and the District of Columbia) all at first decriminalized weed and afterward passed clinical cannabis remittances prior to passing their sanctioning approaches. Accordingly, by far most of US states have moved away from a severe preclusion position toward maryjane a long time before they began considering altogether legalization.

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Figure 1

State maryjane approaches as of January 1, 2016. Information from the RAND Marijuana Policy Database (Pacula et al. 2015) and NCSL (2016a,b) with consent. Truncation: CBD, cannabidiol.

A number of elements have driven the approach changes saw in the course of recent many years, including rising state budgetary expenses related with capturing and imprisoning peaceful medication guilty parties (Raphael & Stoll 2013Reuter et al. 2001), developing logical proof of the helpful advantages of cannabinoids found in the maryjane plant (Hill 2015Koppel et al. 2014), and stressed state spending plans that have made lawmaking bodies search for new wellsprings of assessment income (Caulkins et al. 2015Kilmer et al. 2010).

The huge strategy variety over the long haul and across states would seem to offer scientists adequate chances to quantitatively survey the impact of cannabis progression strategies on an assortment of wellbeing and social results. Nonetheless, the logical writing has been delayed to create, and what exists in the writing offers commonly blended and to a great extent immaterial discoveries. This has driven numerous to presume that the past progression approaches should be innocuous and that continuous authorization would correspondingly create next to no mischief to society. In reality, ongoing reviews of individuals’ mentalities about cannabis show a reasonable change for sanctioning (Caulkins et al. 2015).

As we will contend all through this article, nonetheless, somewhere around three reasons recommend that we use alert in reaching inferences from the blended exact proof or, all the more critically, in accepting that a change to legitimately secured business markets would bring about results like those of the past tests. To start with, the writing has generally treated both decriminalization and clinical cannabis approaches as though they were straightforward dichotomous decisions, carried out correspondingly across states. Such a treatment overlooks the huge heterogeneity in these strategies that can differentially impact damages and benefits and furthermore adds to what in particular give off an impression of being blended outcomes from assessments.

Second, by far most of strategy assessments directed hitherto inspect the impact of the arrangement as far as changes in commonness rates in everybody, which expects that the extent of relaxed and weighty clients, who are pooled together in these straightforward pervasiveness rates, stays stable even as the approach changes. At long last, research has been delayed to consider the degree to which these progressions in approaches impact the technique by which the regular client burns-through weed. The potential intense mischief related with smoking a joint is not the same as that related with devouring a consumable or touching wax, especially given that the normal strength of the item ordinarily contrasts and the body’s pace of assimilation of THC fluctuates by technique (Huestis 2007).

In this article, we survey the current writing on the impacts of decriminalization and clinical weed laws on maryjane use and pot use problems considering these constraints. In contrast to different surveys, our objective isn’t to sum up all the current writing on the impacts of decriminalization and medicalization. Maybe, the motivation behind this audit is to give a superior comprehension of what can be gathered from the writing when more thought is given to the intricacies of these arrangements, the populaces inspected, and the proportions of utilization considered. Doing so permits us to pass on the requirement for more exploration, as far as estimation and examination, before we can genuinely comprehend the effects of maryjane advancement policies.Go to:

WHAT IS MEANT BY HETEROGENEOUS MARIJUANA POLICIES

Defining the Policies

It is significant for any conversation of the writing to start by characterizing the strategies being thought of. For the motivations behind this audit, we characterize four explicit pot arrangements (denial, decriminalization, clinical maryjane, and sanctioning) as far as their legitimate definitions as opposed to their execution in neighborhood networks, as the last is frequently a component of the degree of requirement, which is hard to gauge in a methodical and scientific manner. Preclusion, accordingly, can be characterized as a law that keeps up with the criminal status of any activity identified with pot ownership, use, development, deal, or appropriation. The degree of wrongdoing might be legally characterized as either an offense (causing somewhat lower criminal punishments that could possibly incorporate prison time) or a crime (involving significantly more genuine allegations, harder authorizations, and certain jail time), and the charge might be a component of the measure of cannabis included or basically of the idea of the action (e.g., deal to minors).

Notwithstanding, the accentuation is on the criminal status of the connected offenses, not how much neighborhood law requirement decides to implement it. The US government, for instance, holds its forbiddance on all pot exercises (ownership, use, development, dissemination, preparing, and deal) as do urban communities like San Francisco, despite the fact that San Francisco has embraced an arrangement of low-need implementation (Ross & Walker 2017).

Decriminalization is a strategy that was first characterized by the 1972 Shaffer Commission (otherwise called the National Commission on Marihuana and Drug Abuse), and it portrays strategies that don’t characterize ownership for individual use or easygoing (nonmonetary) appropriation as a criminal offense. The Shaffer Commission unmistakably expressed that strategies that basically brought down the punishments without eliminating the criminal status of the offense were not actually decriminalized, on the grounds that they kept up with the considerable social damage of the related criminal feelings (Natl. Comm. Marihuana Drug Abus. 1972).

This qualification between arrangements that essentially lower punishments and those that really change the lawful status of the offense is significant, but it’s anything but generally comprehended by numerous analysts assessing even the early approaches. Somewhere around 2 of the 11 broadly perceived decriminalized states from the 1970s and 1980s, California and North Carolina, didn’t eliminate the criminal status of the offense (Pacula et al. 2003Reuter & MacCoun 1995). All things considered, these states only decreased the punishments related with ownership and additionally utilization of weed, a strategy for the most part known as depenalization (MacCoun & Reuter 2001Pacula et al. 2005). However, people in depenalization purviews can in any case confront critical obstructions to get to work, understudy loans, and public help whenever trapped possessing weed, regardless of whether they are just accused of a little fine, since they can in any case get a criminal allegation on their record.

Medical weed laws (MMLs) eliminate state punishments for the utilization of cannabis for restorative purposes under indicated conditions. Albeit the government keeps on holding the 1970 grouping of cannabis as a Schedule I substance with high potential for misuse and no acknowledged clinical worth (Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, P.L. 91–513, October 27, 1970, 84 Stat. 1242, 21 U.S.C. 801, et seq.), states have utilized various administrative methodologies pointed toward expanding admittance to pot for restorative purposes since the 1970s.

Early drives through the 1980s meant to support investigation of the restorative worth of weed, yet they had minimal pragmatic importance because of their weighty dependence on government collaboration and the inability to build up an authentic stockpile channel for patients (Pacula et al. 2002). Drives passed since the 1990s have been undeniably more exhaustive, setting up remittances for the utilization, ownership, and supply of high (>3%) Δ9-tetrahydrocannabinol (THC) items for qualifying patients and their guardians or suppliers. These cutting edge MMLs have become the most ordinarily assessed strategies in similar liquor and medications strategy examination (Ritter et al. 2016), yet deficient thought of far reaching variety in how these laws have been planned and carried out has brought about uncertain and frequently conflicting discoveries (Hunt & Miles 2015Pacula et al. 2014a2015).

Legalization eliminates criminal and financial punishments for the belonging, use, and supply of pot for sporting purposes. While decriminalized nations, for example, the Netherlands have narratives of accepted authorization, and clinical pot programs are frequently viewed as not so subtle sporting sanctioning (Fischer et al. 2015Haney & Evins 2016), by law authorization is a somewhat new marvel. The November 2012 polling form drives passed by citizens in Colorado and Washington denoted the first occasion when that any locale worldwide has lawfully directed cannabis. Much consideration has been given to the as of late made retail advertises for legitimate pot in these two states, yet the business model is nevertheless one administrative choice for lawful creation, and various elective systems are accessible (Caulkins et al. 2015). Examination has not yet surveyed the outcomes of legitimization, however the consequences for the commonness of maryjane use and use issues will rely to a great extent upon the particular state-level guidelines received just as the reaction of the bureaucratic government.

Establishing clear definitions for decriminalized, medicalized, and sanctioned states isn’t only a semantic exercise; rather, it features the various components through which arrangements may impact use, remembering changes for impression of hazard or social dissatisfaction, changes in item accessibility and assortment, and changes underway strategies or costs that decrease costs. In spite of the fact that it is enticing to utilize assessments of decriminalization and clinical cannabis approaches to reveal insight into the conceivable outcomes of sanctioning, the encounters of these states may not completely mirror the progressions in cost, intensity, and item assortment that will probably result from expanded commercialization and advancement under legitimization (Caulkins et al. 2012). Also, earlier examination on decriminalization and MMLs has experienced genuine impediments because of an overreliance on rough markers that don’t represent the mind boggling and changed manners by which states have planned and carried out their arrangements (Pacula & Sevigny 2014a,bPacula et al. 2005). Albeit the current writing might be restricted in noting what legitimization will mean for cannabis use and related results, it offers huge experiences into how we ought to assess the impacts of weed strategy changes in a quickly advancing and diverse arrangement environment.

Decriminalization and Definitional Problems

As expressed already, a significant part of the logical examination assessing the effects of decriminalization in the United States has overlooked the legitimate definition given by the Shaffer Commission. In an assessment of the first 11 rules passed soon after the Shaffer Commission, Pacula and associates (2003) discovered that 2 of the 11 generally perceived decriminalized states (California and North Carolina) held the criminal status of weed ownership offenses. Also, the diminished punishments in 4 of the first 11 states (Minnesota, Mississippi, Nebraska, and North Carolina) simply applied to first-time guilty parties, a differentiation not predictable with the soul of the Shaffer Commission definition. An examination of state legal punishments in supposed nondecriminalized states and in decriminalized states uncovers that it’s anything but conceivable to particularly recognize the two gatherings (Pacula et al. 20032005). As right on time as 2001, there were 7 alleged nondecriminalized states that had taken out the criminal status of all cannabis ownership offenses and another 13 expresses that took into account the diminished punishments and expungement of the criminal offense for first-time guilty parties (Pacula et al. 2005). However, research kept on utilizing the decriminalization variable to recognize contrasts in state pot strategies that were not genuinely founded on the criminal status or level of penalties.

Given that most US considers have utilized a solitary dichotomous measure that can’t extraordinarily separate states with lower punishments and diminished criminal status, it’s anything but astounding that they had blended outcomes. Indeed, even early examinations analyzing quick changes parents in law utilizing information from the 1970s and 1980s didn’t produce predictable discoveries. Albeit a few examinations utilizing populace overview information discovered no genuinely critical effect of decriminalization on broad predominance paces of pot use (Johnston et al. 1981Maloff 1981Single 1989), one examination seeing trauma center scenes found that urban communities in states that had decriminalized had higher pot included scenes than urban communities in nondecriminalized states (Model 1993). Later investigations that scientifically depended on cross-sectional variety in decriminalization status in the last part of the 1980s and 1990s likewise created blended discoveries. For instance, considers inspecting self-revealed use among youth and youthful grown-ups that lone incorporated the single dichotomous measure for pot decriminalization tracked down no factual relationship with proportions of past-year or past-month use (DiNardo & Lemieux 2001Pacula 1998Thies & Register 1993).

However examinations of the grown-up family populace (Saffer & Chaloupka 1999) and considers looking at youth yet joining different proportions of lawful danger (DeSimone & Farrelly 2003Pacula et al. 2003) discovered proof of a positive relationship between decriminalization status and pervasiveness of use. MacCoun et al. (2009) note that the way that the state decriminalization pointer stays positive and critical in examinations that likewise incorporate extra controls for the legal punishments for these offenses recommends that this action is getting some different option from a sign identified with a decrease in the legitimate danger. Theories offered incorporate an intermediary of more extensive social acknowledgment of pot use and a publicizing impact of the diminished policies.

Even past the issue of strategy estimation, results from US examines assessing the effect of pot decriminalization should be deciphered with alert for a few reasons. In the first place, in numerous examinations, pot ownership punishments don’t change considerably after some time, which systematically puzzles the impacts of unnoticed state attributes (e.g., intense on-wrongdoing administrators) with contrasts saw in the degree of punishments. Second, on the grounds that there is no exhaustive information source announcing the genuine punishments caused by wrongdoers, these investigations have all depended on intermediaries, like most extreme or middle fines as demonstrated by legal laws. These legal punishments could conceivably precisely mirror the genuine seriousness of the punishments forced in a ward. Last, proof has shown that residents have generally restricted information with regards to the legal punishments and approaches for pot ownership in their states (MacCoun et al. 2009), which makes it hard to decipher proof appearance that evacuation of such punishments has a critical causal impact on maryjane consumption.

Medical Marijuana Laws in a Complex and Dynamic Policy Environment

In 1996, California turned into the primary state to pass what is currently usually perceived as a MML. As of January 2016, 25 extra states have passed comparative enactment. Exact proof reliably shows a solid relationship among’s MMLs and the pervasiveness of pot use and cannabis use issues (Cerdá et al. 2012Wall et al. 2011), however examines have not reliably upheld a causal translation (Anderson et al. 2015Hasin et al. 2015bLynne-Landsman et al. 2013Wen et al. 2015).

One clarification for the conflicting discoveries from causal investigations is that the particular arrangements of state MMLs have fluctuated broadly both among states and inside some random state over the long run (Pacula et al. 2014a,b). The utilization of a solitary dichotomous marker for the underlying entry of a MML in strategy assessment clouds the two kinds of variety. Since the impacts of any strategy will rely upon the particular legal arrangements and their execution, contemplates looking at result information covering distinctive time periods are truth be told assessing the impacts of totally different approaches. Further puzzling correlation of earlier gauges is the way that the government implementation position has changed over the long run, and state MML arrangements have adjusted close by changes in the administrative stance.

When one investigates how MMLs have advanced since the entry of California’s law in 1996, it turns out to be straightforward how a solitary dichotomous measure misses the mark regarding portraying these approaches inside a state and across states after some time. We comprehensively classify state strategies into three waves, each started by a significant political change: the polling form period (1996–2000), the early administrative time (2000–2009), and the late authoritative time (2009–present).

The polling form time states are the initial seven expresses that established arrangements through voting form drives (if consequently challenged by state courts). These early laws planned to secure the privileges of patients who utilized clinical maryjane and their guardians who aided that utilization. Government resistance to these approaches was express, and one month after Proposition 215 passed in California, then, at that point drug despot Barry McCaffrey took steps to capture any doctor who prescribed cannabis to a patient (Pertwee 2014). The danger of government implementation made a significant hindrance to setting up plainly characterized legitimate admittance to clinical maryjane.

Early MMLs during the voting form time were frequently unclear, characterizing clinical use extensively to incorporate utilization, home development, creation, transportation, and procurement. The majority of the laws were uncertain with respect to the legitimateness of gathering developing or retail facade dispensaries, bringing about disarray among law authorization, patients, and guardians regarding what comprised lawful support in the clinical cannabis market. Moreover, the vulnerability of the government reaction to these state tests implied that polling form period strategies once in a while commanded patients to enlist with a state authority, making it significantly more hard for law requirement to separate genuine clinical clients from sporting clients. It is consequently obvious that examination looking at the impacts of the early state polling form laws on weed use has discovered immaterial impacts (Gorman & Huber 2007Khatapoush & Hallfors 2004).

With the section of S.B. 862 of every 2000, Hawaii turned into the initial state to go a MML through the state council instead of by voting form drive. Gaining from the baffling encounters of patients and law requirement under the previous state approaches, expresses that passed laws during this early authoritative period (2000–2009) offered more unequivocal lenient gestures with respect to the production network. Most laws passed during this period included patient library arrangements, remittances for home development, and cutoff points on the measure of cannabis that patients or guardians could have and develop. Likewise, numerous states that had at first gone laws through voting form drives (e.g., California and Oregon) made further arrangement changes through their state councils during this period trying to explain issues and address strains that had emerged.

Although MMLs during this early authoritative time set up more clear meanings of what established legitimate inventory, vulnerability about the government reaction to these strategies hindered a conventional state guideline of makers. For example, Colorado’s 2001 law didn’t unequivocally endorse agreeable developing, yet the uncertainty of the law considered its accepted activity. Through S.B. 420, California altered its underlying MML to expressly take into consideration agreeable development, yet administrative tact was left to nearby governments. New Mexico was the lone state in the early authoritative time to build up lawful arrangements for state-authorized dispensaries in its underlying enactment in July 2007, however dangers of government indictment prompted inconclusive postponements in permitting (Baker 2007).

Protracted legitimate debates about the authenticity of retail outlets under state law joined with colossal vulnerability about the government reaction prompted the lethargic advancement of clinical cannabis markets all through numerous states during the early authoritative time, which clarifies why numerous investigations assessing MMLs from this period discover immaterial impacts on commonness of maryjane use (Anderson et al. 20122015Harper et al. 2012Lynne-Landsman et al. 2013Pacula et al. 2015). While standards may have been changing because of these laws, direct access through business sectors was not really expanding (Smart 2016). However, two investigations utilizing information from just this time span track down a critical constructive outcome of MML sanctioning on use among explicit high-hazard populaces (Chu 2014Pacula et al. 2010).

Utilizing quarterly information from the 2000–2003 Arrestee Drug Abuse Monitoring (ADAM), Pacula et al. (2010) find a positive relationship among MML and self-detailed pot use (affirmed through pee tests) among grown-up male arrestees. Chu (2014) similarly discovered huge beneficial outcomes of MML arrangements on cannabis ownership captures and weed related treatment affirmations, however the outcomes are touchy to demonstrate particular. These examinations may demonstrate that expanded clinical pot supply in a questionable strategy climate basically influenced cannabis utilization among an in danger populace of hefty clients. Be that as it may, the outcomes are additionally reliable with endogenous reactions by police authorization or treatment offices and may not reflect real changes in use.

In 2009, the vulnerability about the government’s reaction was apparently settled. Presently following the introduction of President Barack Obama, Attorney General Eric Holder gave an explanation that government specialists would stop meddling with clinical cannabis dispensaries working in consistence with state law (Johnston & Lewis 2009). On October 19, 2009, Deputy Attorney General David Ogden formalized this arrangement of government nonenforcement with a reminder expressing that bureaucratic examiners “ought not zero in administrative assets … on people who are in clear and unambiguous consistence with existing state laws accommodating the clinical utilization of pot” (Ogden 2009, pp. 1–2).

The explanation of the government position drastically changed the administrative construction of state clinical cannabis supply channels. State MMLs passed during the late authoritative time (2009–present) set up undeniably more thorough and unequivocal guidelines in regards to clinical pot circulation, regularly requiring elaborate frameworks that would require a very long time to completely carry out. A few early-establishing states (e.g., Oregon and Maine) altered their laws to officially permit and direct state-authorized dispensaries. State administrative specialists turned out to be all the more conspicuously associated with the creation and dispersion of weed by supervising the apportioning, assembling, and marking of cannabis-determined products.

Following the Ogden Memo, necessities for the enlistment of patients and guardians got undeniably more norm in state strategies, and the interest of both expanded significantly in state clinical weed programs (Fairman 2015Sevigny 2014). States that had deferred the execution of formal inventory channels (e.g., New Mexico) moved rapidly to permit dispensaries, and different states started to determine authoritative debates about what comprised legitimately secured causes of supply. Close by this extension of clinical cannabis markets during this period, media consideration toward the issue of legitimate maryjane additionally expanded notably (Schuermeyer et al. 2014Stringer & Maggard 2016).

Compared to prior time spans, in the late administrative period cannabis use may react all the more altogether to changes in arrangement as the accessibility and strength of the medication developed with the changing construction and size of clinical weed markets (Sevigny et al. 2014). Surely, the one investigation to assess the impacts of MML entry utilizing just approaches ordered in the early and late administrative times (Wen et al. 2015) tracked down a critical constructive outcome of MML authorization on the likelihood of late pot use (14%), day by day maryjane use (15%), and pot use problems (10%). More investigations zeroed in on these later laws are expected to evaluate if these discoveries are robust.

Perhaps on account of the government authorization for states to control clinical cannabis all the more straightforwardly, clinical maryjane arrangements embraced by states interestingly during this postlegislative time (e.g., by New York, Massachusetts, Illinois) contain an assortment of highlights that contrast significantly from those of the laws of early receiving states. For instance, all MMLs passed after 2009 have set up a state-authorized dispensary framework and don’t permit individual development by patients or their parental figures, besides under barely characterized conditions. In addition, since 2010, states have received clinical maryjane approaches that are more predictable with conventional clinical consideration and drug guideline (Williams et al. 2016). For instance, all require testing and naming of maryjane cannabinoid profiles notwithstanding a genuine clinical specialist patient relationship requiring the continuous administration of the condition.

Evidence that MML rules are proceeding to move in a more medicalized bearing is obvious by the developing number of high CBD-just laws since 2014. CBD is a normally happening nonpsychoactive compound in cannabis that has been exhibited in an assortment of clinical investigations not exclusively to have helpful impacts yet in addition to counter the inebriating impacts of THC (Koppel et al. 2014Russo et al. 2007Whiting et al. 2015). These new laws permit qualifying patients to utilize CBD extricate, for the most part in oil structure, with negligible THC substance, and its utilization is by and large just took into account a thin scope of ailments. Sixteen states have passed CBD laws since 2014, however these approaches have been to a great extent overlooked by support gatherings, and no exploration is examining their effects (NCSL 2016b). For certain special cases, there is as yet restricted guideline on power (THC fixation) and other cannabinoids, clinical item testing, and strategies for consumption.

Considering Heterogeneous Implementation of Legalization

As of July 2016, five states have approaches legitimizing the ownership of determined amounts of pot by grown-ups matured 21 and more established for sporting purposes.2 Voters in Colorado and Washington supported legitimization drives in November 2012, and extra arrangements were passed in Alaska, Oregon, and the District of Columbia in November 2014. The current administrative climate is intricate and dynamic, as state and neighborhood governments are ceaselessly adjusting enactment to develop alongside the business (Subritzky et al. 2016). The impacts of these strategies on pot use and use problems will be dictated by how the plan and execution of the lawful administrative system impact market construction, cost and accessibility, and view of hazard and social endorsement. As examination pushes ahead in assessing the impacts of sporting legitimization, thought should be given to contrasts and similitudes in the administrative structures set up by each state.

The District of Columbia is the lone legitimized ward in the United States that doesn’t permit the offer of cannabis for sporting use. Under DC’s law, grown-ups can lawfully grow up to six plants (of which close to three can be developed) in their main living place and move up to 1 ounce of pot to another grown-up matured 21 and more seasoned if there is no compensation. Offer of any measure of pot stays a criminal offense, deserving of as long as a half year in prison and a fine of $1,000 (Marijuana Work. Gathering 2016). Conversely, strategies in Colorado, Washington, Oregon, and Alaska build up popularized models of weed guideline. Retail deals in Colorado and Washington started separately in January and July 2014, and Oregon started permitting deals for sporting use from clinical weed dispensaries in October 2015. The Frozen North started authorizing retail and item makers in September 2016 (Hall & Lynskey 2016). Comparative with the home development model of the District of Columbia, commercialization is required to significantly diminish creation costs and produce motivations for lawful providers to advance weighty utilization (Caulkins & Kilmer 2016).

However, the business model of authorization likewise offers expanded degree for guideline, and each state has created its own assortment of administrative rules and legitimate arrangements that could have significant ramifications for the business sectors that create inside them. For instance, though all states require separate licenses for cultivators, producers or processors, and retailers, just as permitting or confirmation for testing offices, Washington alone has embraced guidelines limiting the quantity of licenses a solitary firm can claim. Besides, Washington restricts permit holders from being engaged with both creation and retail, with an end goal to deny vertical mix and the efficiencies underway and dissemination that can accompany it. Washington has additionally restricted the quantity of retail location licenses accessible to stay away from issues identified with overproduction; different states have not. Be that as it may, all states aside from Alaska limit the size of development offices, and Washington has an extra cap on absolute statewide creation. Notwithstanding this approach heterogeneity at the state level, neighborhood regions have some caution in deciding the quantity of foundations allowed, the severity of drafting necessities, and the time and way wherein organizations are permitted to work. These distinctions in the construction of the market ought to hypothetically impact the accessibility and cost of cannabis in each state, for reasons portrayed in more prominent detail below.

Other significant lawful contrasts exist across states as far as the stipend for a nonretail market. Washington is the lone express that requires all cannabis for sporting use to be bought through state-authorized retailers; no home development is permitted. The other three states license home development by grown-ups subject to determined plant limits (as in the District of Columbia). There are likewise various ways to deal with tax assessment. Right now, the three states with working retail showcases (Colorado, Washington, and Oregon) have organized advertisement valorem charges explicit to pot, going from 17% in Oregon to 37% in Washington. Conversely, Alaska’s strategy builds up an assessment on development, forcing a $50 per ounce charge on cannabis bud (i.e., blossoms) and a $15 per ounce charge on different pieces of the plant (stems and leaves).

Differences in how state and neighborhood governments manage the business market will produce heterogeneous impacts on the retail cost of maryjane, which will have significant ramifications for both the broad and serious edges of utilization and misuse (Pacula & Lundberg 2014Pacula et al. 2014b). Additionally, in light of the fact that cannabis is engaged with an assortment of structures and potencies, decisions about the duty level, base, and point of assortment can likewise impact the items and potencies accessible to purchasers and the costs they face (Caulkins et al. 2015). At present, retail locations are permitted to offer maryjane blossoms, thinks, and injected items in strong and fluid structure. The first authorization measures in Colorado and Washington didn’t expressly recognize item types while building up buyer buy limits. As pot focuses and imbued items have caught an expanding portion of lawful retail deals, guidelines have needed to grow. Successful October 2016, grown-up inhabitants in Colorado are restricted to buying 1 ounce of maryjane bloom, 8 g of concentrates, or 80 10-mg servings of THC in imbued item structure. In Washington and Alaska, shoppers can buy 1 ounce of weed bloom, 7 g of maryjane concentrates, 16 ounces of mixed item in strong structure, or 72 ounces in drink structure. Oregon’s guidelines are comparable, with the exception of a stricter constraint of 5 g for pot concentrates. The Frozen North’s principles additionally limit purchasers to 5,600 mg of THC in a solitary purchase.

Due to concerns in regards to incidental ingestion of edibles by youngsters, states have additionally managed maryjane implanted items by executing stricter bundling and marking prerequisites and assigning power limits for singular serving sizes. Washington and Colorado assign singular serving sizes of 10 mg of THC and 100 mg absolute for an independently wrapped bundle. In Colorado, items that can’t be stepped, like beverages or granola, should contain close to an assigned individual serving, adequately restricting large numbers of the great intensity cannabis mixed refreshments presently sold. Oregon and Alaska have more moderate prerequisites, assigning singular serving sizes of 5 mg of THC and 50 mg complete for an exclusively wrapped bundle. All things considered, no state has covered the power of maryjane items. An action to restrict the THC substance of all cannabis items sold at retail locations in Colorado to 16% (Initiative 139) was removed by the Healthy Colorado Coalition in 2016 because of the rise of an all around supported resistance crusade (Armbrister 2016). In Alaska, a proposition to cover weed item strength at 76% THC was additionally opposed. The absence of limitations on intensity empowers the promoting of items with high (and frequently questionable) levels of THC.

Increased showcasing has been a significant worry under the business model, since publicizing can be utilized to advance destructive use and has been displayed to impact young adult pot use and goal to utilize (D’Amico et al. 2015). Colorado’s guidelines restrict Internet spring up ads and commercials that target kids. Washington permits retailers to have just two signs (not to surpass 1,600 square inches) at their business environment, however the signs can’t contain pot themed symbolism nor can pot related symbolism be highlighted in window shows. The Frozen North and Oregon keep on overhauling rules for pot showcasing. The severity of state guidelines for publicizing and the manner in which they are implemented can incompletely intercede the degree to which authorization impacts insights and utilization practices among lawful purchasers just as young people. Be that as it may, these likely advantages of promoting limitations should be adjusted against potential proficiency costs coming about because of data deviations among providers and consumers.

As was the situation with decriminalization and MMLs, sanctioning is certifiably not a paired arrangement variable. The home development model of the District of Columbia will have totally different ramifications for supply than the marketed models of Colorado, Washington, Oregon, and Alaska. Inside popularized states, heterogeneity in how creation and cost are directed will prompt various ramifications for utilization by legitimate grown-up clients and overflows to juvenile business sectors. Limitations put on publicizing could restrict youth openness to informing that could energize experimentation, yet just if the guidelines are upheld. The manner by which item accessibility and intensity are managed will effectsly affect the all out amount of cannabis devoured by clients and their degree of inebriation, which will thusly impact the commonness of weed use issues. Legitimized states have picked various methods of controlling, and this strategy heterogeneity should be considered in future work while evaluating the impacts of sanctioning on use.Go to:

WHAT IS MEANT BY HETEROGENEOUS POPULATIONS

The previous section focused on the heterogeneity of the policies being implemented. However, the effects of these diverse policies may well vary depending on the population group studied. Heterogeneous effects across population subgroups may be driven by differences in budget constraints (Markowitz & Taurus 2009), price elasticities (Pacula & Lundberg 2014), preferences for risk (Fox & Tannenbaum 2011), or search costs (Galenianos et al. 2012Pacula et al. 2010), to name a few. Mixed findings in the current literature with respect to the impact of prior liberalization policies may thus reflect legitimate differences in the populations being studied.

Past research has generally attempted to accommodate this potential heterogeneity by stratifying analyses by age (e.g., adolescents, young adults, older adults) and, to a lesser extent, frequency of use (number of times used in the past month/year or near-daily use). The potential effects on youth consumption have been of particular concern in the literature, because evidence suggests that use of marijuana during early adolescence predicts increased risk of dependence, lower educational attainment, and cognitive impairment (Hall 20092015). Limiting the analysis to adolescents, research shows that MML enactment has largely insignificant or even negative effects on youth marijuana use measures (Anderson et al. 2015Choo et al. 2014Gorman & Huber 2007Harper et al. 2012Hasin et al. 2015bLynne-Landsman et al. 2013), with only Wen et al. (2015) finding a significant increase in the probability of past-year initiation among youths aged 12–20. The results of the few studies that have focused on changes in marijuana consumption among adults have been more mixed, with some showing no effect of MML passage on measures of use (Gorman & Huber 2007Harper et al. 2012) and others finding significant positive effects (Chu 2014Wen et al. 2015).

Yet, as noted above, the use of a dichotomous MML variable misses important variations in the specific implementation of supply channels, which may be particularly important in determining the extent to which medical marijuana is diverted to adolescent markets (Boyd et al. 2015Nussbaum et al. 2015Salomonsen-Sautel et al. 2012). When studies focus on the effects of dispensary legalization, there is some evidence of a significant increase in youth consumption (Pacula et al 2015Wen et al 2015), though other studies find no effect (Hasin et al 2015b). Even within the same study, estimated effects switch sign depending on whether consumption is measured by past-month use, frequency of use, or dependence (Pacula et al 2015Wen et al 2015). Similar inconsistencies exist in studies of the effects of specific dimensions of MML policy on measures of marijuana use in the general population (Anderson & Rees 2014Choi 2014Pacula et al. 2015). Thus, age alone is clearly not an adequate way of capturing population heterogeneity.

Perhaps a more relevant dimension of population heterogeneity pertains to differentiating casual or light users from high-risk consumers, often identified in this literature as arrestees (Chu 2014Pacula et al. 2010), polysubstance users (Wen et al. 2015Williams & Mahmoudi 2004), or those admitted to treatment (Pacula et al. 2015). Only a few studies have focused on high-risk users, but those that have tend to find more consistent evidence that marijuana liberalization significantly increases use (Chu 2014Model 1993Pacula et al. 20102015Wen et al. 2015).

The response of high-risk users to marijuana policy changes will likely differ from that of casual users or nonusers due to differences in price sensitivity (Pacula & Lundberg 2014Sumnall et al. 2004), knowledge of the policy environment (MacCoun et al. 2009), engagement with drug markets (Pacula et al. 2010), and perceived social or physical harms from use (Haardörfer et al. 2016Kilmer et al. 2007). By examining how marijuana liberalization policy affects the prevalence of marijuana use, many past evaluations have conflated changes in the consumption of casual users with changes in the consumption of regular or heavy users. Because casual users represent a larger proportion of the total number of users, such analyses will discount the behaviors of heavy users, who account for a larger proportion of the total quantity of marijuana consumed (Burns et al. 2013Davenport & Caulkins 2016).

The overreliance on using prevalence measures as the outcome of interest in past work is largely a consequence of limited data availability, but as legal markets for marijuana develop, there is an urgent need to assess the alternative measures of use that are more relevant for understanding potential harms. Nationally representative data show that the number of daily or near-daily (DND) users has increased approximately sevenfold since 1992 (Burns et al. 2013), and the prevalence of marijuana use disorders has almost doubled since 2001 (Hasin et al. 2015a). Simultaneous use of marijuana with other substances (e.g., tobacco and alcohol) is common and has been shown to be associated with increased risk of adverse consequences (Subbaraman & Kerr 2015Terry-McElrath et al. 2014). Currently, we have little evidence to indicate how marijuana liberalization policies will affect these outcomes (Wen et al. 2015). Moving forward, it will be important to develop more comprehensive data collection and sampling designs to assess how marijuana liberalization policies affect populations at risk for problematic use as well as the use of particularly dangerous products or methods of consumption.Go to:

WHAT IS MEANT BY HETEROGENEOUS PRODUCTS

Past research has generally focused on how liberalization affects the prevalence of marijuana use and has paid less attention to how liberalization affects the type of marijuana used or the way in which it is consumed. But marijuana is not a uniform product. The cannabis plant itself can develop in a number of different ways, depending on the genetic variety, temperature, culture condition, and lighting it receives. The potency of the consumable product, typically measured by concentration or level of THC, will vary by strain, cultivation technique, and method of processing. There are also a variety of ways to consume marijuana, with the most common methods including smoking, vaporization, and ingestion of edible products (Schauer et al. 2016).

Both potency and methods of consumption have evolved over time. Decriminalization occurred during a time when marijuana was largely smoked, which facilitated comparisons of marijuana use rates between decriminalized and nondecriminalized states. Medical marijuana brought with it new products (e.g., oils and edibles), new methods for consuming it (e.g., dabbing, vaping), and new techniques for controlling potency (Pacula et al. 2016Rendon 2013). Legalization only extends these new products to even more users. It is difficult to predict the extent to which legalization will increase product innovation, as growth in the industry will promote the development of new methods for extracting and synthesizing the hundreds of chemicals in the cannabis plant, of which relatively little is known (Caulkins et al. 2015).

Systematic data collection on methods of use and potency is limited, but available evidence indicates that marijuana users in states with medical or recreational legalization consume a different product mix than users in other states. Individuals living in MML states, particularly in states with greater access to dispensaries, have significantly higher likelihood of vaporizing or ingesting marijuana products compared to individuals in states without MMLs (Borodovsky et al. 2016). Evidence also suggests that states that legally permit medical marijuana dispensaries experience significant increases in average marijuana potency (Sevigny et al. 2014). Within states with legalized dispensaries, adults who use marijuana for medicinal purposes are significantly more likely to vaporize it or consume edibles than individuals who use it for recreational purposes (Pacula et al. 2016).

It is complicated to assess the impact of policy on use if the product being consumed or the method of consumption changes in line with the policy. Outcomes such as level of intoxication or dependency may well vary according to the type and method of marijuana consumption, and simply comparing use in legalized states to use in nonlegalized states will not reflect these differences. Changes in product variety will not threaten the identification of changes on the extensive margin of use (meaning any use or prevalence), because existing survey measures can provide information on the number of people who transition from nonusers to users and those who continue using rather than quitting. However, most of the adverse physical and behavioral consequences associated with marijuana use come from heavy users (Gordon et al. 2013Hall 2015Volkow et al. 2014). Proper evaluation of the public health consequences of legalization relies on the ability of research to estimate the effects of marijuana policy changes on the intensive margin of use.

Data on quantity of marijuana used are surprisingly limited, and researchers have yet to construct a standardized measure for the unit of marijuana consumption (as exists with alcohol). Prior research has examined changes on the intensive margin through self-reported data on frequency of use, measured by days of use in the past month or past year. The implicit assumption has been that more days of use accurately proxies for higher intensity of use (Temple et al. 2011). Yet, marijuana consumption among DND users can vary from smoking a single low-THC joint each day to using high-THC products multiple times per day via multiple delivery methods (Hughes et al. 2014Zeisser et al. 2012). Given the variety of delivery devices, strains, and cannabinoid concentrations that become available as the legal industry expands, measuring changes in days of use will fail to capture a number of individuals who transition from occasional to heavy users.

Heterogeneity of marijuana products presents further problems for understanding how medical and recreational legalization affect marijuana use disorders. Previous research examining patterns of use and the development of dependence may not generalize to a legal environment in which there is greater social acceptance, fewer perceived risks and harms, and a wider variety of product types and potencies (Asbridge et al. 2014).

Although the definition of marijuana use disorder is evolving (Compton & Baler 2016Hasin et al. 2013), there has been little clinical assessment of whether the use of different marijuana products carries different risks of dependence or harms. Some evidence suggests that vaporizing hash oil or dabbing is more positively associated with tolerance and withdrawal among adults compared to smoking marijuana (Loflin & Earleywine 2014), but there may be differential effects for adolescents. As marijuana product diversity expands, there is a need for a more comprehensive understanding and analysis of consumption to accurately evaluate changes in use prevalence, intensity of use, and risk for marijuana use disorder.Go to:

AN ALTERNATIVE PERSPECTIVE FOR EVALUATING THE EFFECTS OF MEDICAL MARIJUANA LAWS AND LEGALIZATION

In light of the substantial variation underlying the policies being evaluated, the populations considered, and the products consumed, it is not surprising that the scientific literature evaluating the impact of these policies is inconclusive. The decisions made by researchers to focus on specific time periods, states, populations, and/or outcome measures have often been driven by what data were available and not by a careful consideration of the mechanisms by which these policies are expected to influence marijuana use or use disorders among various populations. As this article has established, these decisions can influence the likelihood of finding—or not finding—specific effects because of the heterogeneity of these policies and of the markets that are emerging in light of them.

The program evaluation literature has widely recognized the time it takes between the passing of new policies and their full implementation as a problematic issue (Hunt & Miles 2015King & Behrman 2009). A common empirical strategy for accommodating delays in implementation is the inclusion of lagged policy variables, and this approach has been explored in a few articles from the medical marijuana literature (Anderson et al. 2013Bachhuber et al. 2014Chu 2014). However, assuming a constant allowance for lagged effects obscures the fact that these delays are not random but are correlated with the specific provisions established by state law, the broader federal policy environment, and the setting in which the policy change occurs.

The relationship between state policy heterogeneity and variation in how long it takes for markets to emerge is something that is just beginning to receive the attention it deserves in the literature (Collett et al. 2013Smart 2016). As explained by Smart (2016), patient registration rates do a better job than simple dichotomous policy variables at capturing the extent to which medical marijuana markets are operating throughout a state. Smart notes that despite the adoption of early policies by many states, the relative size of the associated markets, as measured by registered patients, remained small in most states until federal enforcement policy was clarified in 2009, at which time markets in all states grew substantially faster. In an analysis that explicitly accounts for changes in the size of medical marijuana markets, Smart (2016) finds statistically more robust and consistent evidence of the impacts of these markets on various measures of consumption across users from all age groups.

The consideration of the relative size of these markets across states highlights the necessity to consider the issue of dynamics. Whereas some aspects of medical marijuana and legalization policies can have immediate impacts (e.g., on the criminalization of marijuana use or the ability to grow it at home), other effects of these policies take time to occur or disseminate. In the case of markets, for example, it takes time for regulations to develop regarding how many businesses are allowed, who is allowed to operate a business, and where those businesses are allowed to operate. It takes even longer once those rules are passed for businesses to obtain permits and begin distribution. Thus, it should not be surprising that after the passing of marijuana legalization measures in Colorado and Washington in November 2012, it took at least 18–20 months for retail stores to open. Data on the consequences of the opening of these stores beyond sales and tax revenues are just beginning to become available, which is why rigorous scientific evaluations of the impact of these policies have been slow to develop.

What that means is that researchers working in this space need to pay far greater attention to the specific mechanisms that different types of policies are likely to influence and to consider them within the proper timeframe when assessing impacts on specific populations. We show in Figure 2 some of the primary mechanisms discussed in the literature through which these changes in policies might impact use (i.e., perceived harm, disapproval of regular use, legal risk of use, ease of access and price) as well as the hypothesized effects of various types of policies on each. For simplicity, we consider each mechanism separately, though it is important to note that these are likely not independently determined (e.g., changes in legal risk may influence perceived harms, or changes in ease of access may influence disapproval).

A small, medium, or large arrow (pointing up or down) in each cell indicates the relative magnitude and direction of the hypothesized effect. Shading represents the availability of empirical evidence to support the theoretical prediction, with white indicating an absence of existing studies and darker shades representing greater and more consistent support for the hypothesized effect. We provide three simplified versions of a medical marijuana policy and a legal recreational market to illustrate a wider range of policies that would to varying degrees influence the general size of the associated markets (in terms of both users and sellers).

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Figure 2

Mechanisms through which marijuana policies might affect marijuana use and use disorders. This simple illustration shows that even within a single policy area (e.g., medical marijuana), the different variations of the policy can differentially influence each of the mechanisms related to use. For example, we hypothesize that medical marijuana policies will ceteris paribus have a larger impact on people’s perceptions about the drug (perceived harm and disapproval of regular use) than they will have on the legal risk and ease of access to marijuana regardless of policy, assuming that only medical users are provided access and legal protections.

Relatedly, because these markets serve a relatively smaller group of users, the overall impacts on price are presumed to be small. Although they might increase with the third type of MML, which could allow for competitive forces among suppliers to start influencing price. (Anderson et al. 2013Humphreys 2016Pacula et al. 2010) and potency (Sevigny et al. 2014) in these markets. The existing evidence generally suggests that the passage of any type of MML significantly lowers perceived harms among adults (Choi 2014Khatapoush & Hallfors 2004). Thus, but not among adolescents (Choi 2014Keyes et al. 2016). However, the expansion of commercial medical marijuana markets and increased exposure to medical marijuana after 2009 have been associated with significant reductions in adolescent perceptions of harm. Also disapproval associated with marijuana use (Miech et al. 2015Schuermeyer et al. 2014Sobesky & Gorgens 2016Thurstone et al. 2011).

Of course, under a policy of legalization, the hypothesized effects on some of the mechanisms (perceptions and legal risk) are larger and more immediate. Preliminary evidence from Colorado and Washington shows that commercial legalization has significantly reduced perceived harms and disapproval of marijuana use. (Kosterman et al. 2016Sobesky & Gorgens 2016), and marijuana-related arrests have plummeted (Gettman 2015a,b). Access and prices, however, will likely still be differentially influenced by the regulations. That Is that shape the market structure and the level of competition in the market (Caulkins et al. 2015Smart 2016). The overall impact on consumption, then, would depend on (a) the relative importance of perceptions and legal risk vis-à-vis access and price for the specific population being evaluated. Also (b) whether one is evaluating an immediate (short-run) response to the policy or a long-run effect that is inclusive of market mechanisms.

Another important consideration for interpreting findings when evaluating legalization effects is the baseline policy in place prior to legalization. Because most careful evaluations are done based on marginal changes over time, the baseline policy in the states that subsequently legalize. This will determine the extent to which a particular mechanism is impacted by the change in formal policy. States like Washington and Colorado, for example, which moved to legalization from a medical marijuana policy that already provided broad access and loose regulation of dispensaries.

This will likely experience far less of an impact on perceptions and access than states starting from a more restrictive medical marijuana policy or no law at all. Generalization of findings from these two state experiences. Therefore, would not necessarily apply to states that may be considering a move to legalization without first allowing medical marijuana markets.

Thus far we have discussed heterogeneous policies, populations, and products as limitations that complicate the evaluation of how marijuana liberalization policies affect marijuana use and marijuana use disorders. However, Figure 2 suggests that this rich variation also offers unique opportunities for future research. By carefully considering the specific aspects of legalization statutes in the context of existing state policies, researchers have increased the scope for determining the mechanisms that are most important for influencing marijuana use among different populations. As more comprehensive data on marijuana prices and products become available, future work can examine not only whether liberalization affects marijuana use, but also whether it affects who uses marijuana, what products are used, and how these products are consumed. The literature has shown that not all marijuana liberalization policies are created equal, but by exploiting this variation we will be able to better evaluate which policy designs will maximize the potential benefits of legalization while minimizing potential harms.Go to:

CONCLUSION

The variety of marijuana liberalization policies across the US states is often ignore or inadequately considered when assessing the impacts of further policy reform. Despite the widespread state experimentation with alternative marijuana policies since the 1970s, our knowledge of the impact of these liberalization policies on the consumption of marijuana, and its benefits and harms, is far less developed than one would expect. There are a number of reasons for this, including, particularly, lack of attention to the heterogeneity of existing policies, the specificity of the populations examined, and modes of consumption.

Although findings tend to be mix when we look at the literature as a whole, some consistent themes seem to emerge when we consider the literature with an eye toward differences between policies and populations. For example, studies that are attentive to the development of medical marijuana markets (e.g., through measures of the presence of active dispensaries or the size of the market) seem to consistently show a positive correlation of liberalization policies with use among high-risk users (arrestees, people in need of treatment, and polysubstance users).

Similarly, many studies have shown a positive association with adult use of marijuana, whereas most have found no association with youth prevalence or frequency of use in general school populations. The extent to which these findings can be drawn on to make inferences about the potential impact of legalization on these same populations is not clear. Just as it took time for researchers to pay more careful attention to the differential effects of policy elements over time (Hasin et al 2015bPacula et al 2015Smart 2016Wen et al 2015).

That is as well as possible heterogeneous responses by different types of users (Pacula et al 2015Wen et al 2015), it will take time for research to emerge that fully reconsiders. Thus, these associations in light of the full policy dynamics (i.e., changes in a policy within a single state over time and duration of exposure of a population to a given policy type). As more studies account for and consider these heterogeneous effects and dynamics, we may get better clarity regarding the margins on which particular types of policies do or do not influence behavior, and for whom.

Because legal markets will continue to evolve before this questions are fully answer, the real work that lies ahead relies on obtaining more accurate information on the amount and type of products that various people are consuming. Imagine trying to communicate to the public health field the health benefits or harms of alcohol consumption without being able to indicate specific levels or amounts that translate into impairment in well-understood dose-response relationships. Or imagine trying to assess the harmful effects of smoking without being able to differentiate an experimental or occasional smoker from someone who smokes a pack a day.

Yet, that is exactly where the science is today in terms of our measurement of marijuana consumption. Precise data on things such as a standardize dose, regular versus experimental use, heavy use, episodic impairment, or even simultaneous use of marijuana and alcohol are not yet captured in most of the data tracking systems use to evaluate the impact of these policies, and they are desperately in need. If marijuana is anything like alcohol, little harm will come from casual, occasional use by mature adults, and indeed such use might generate considerable benefits. Moreover, it is also possible that marijuana, like alcohol, generates positive benefits for one population (mature adults) while also causing negative harms for another population (youth and young adults). Scientific research needs to be mindful of this heterogeneity.​

SUMMARY POINTS

  1. State policies legalizing marijuana are part of the evolution of state liberalization policies that has taken place since the 1970s.
  2. Existing studies evaluating the impacts of prior state experimentation have generated inconclusive findings, and only recently has research attempted to understand the reasons for these mixed results.
  3. Also, one should be cautious when interpreting the evidence from all studies pooled together, because studies are not equivalent in their attention to policy heterogeneity, policy dynamics, and population heterogeneity.
  4. The literature has largely treated both decriminalization and medical marijuana policies as if they were simple dichotomous choices, when in fact there can be substantial variation in the implementation of these policies that influences how adults or youth respond.
  5. Relatively few studies evaluating the impact of MMLs give adequate consideration to the fact that some aspects of liberalizations policies are realize immediately (e.g., ability to grow one’s own), whereas other aspects may take time to evolve (e.g., opening of a market) or change in response to future state and federal policies.
  6. Studies that focus on how marijuana liberalization policies influence past-month or past-year prevalence conflate changes in consumption among light and casual users with changes in consumption among regular and heavy users.
  7. Although relatively few in number, studies that focus on high-risk users (arrestees, poly-substance users, heavy users) tend to find more consistent evidence that medical marijuana policies increase use, suggesting that this segment of the population is particularly sensitive to policy changes.

FUTURE ISSUES

  1. As legal markets for marijuana develop, there is an urgent need to assess the consequences of liberalization on alternative measures of use that are relevant for understanding potential harms; this requires developing better measures of standardized dose, heavy use, episodic impairment, and simultaneous use.
  2. Research needs to pay more attention to the influence of these policies on the types of products consumed, the amount of THC being consumed in different products, and product development.
  3. Future work also needs to give stronger consideration of the baseline from which new state policies are being evaluated. For example, legalization is likely to generate smaller population changes in medical marijuana states that already have active dispensaries than in states with no prior medical marijuana stores.
  4. Lastly, Researchers need to pay far greater attention to the specific mechanisms different types of policies are likely to influence and to consider them within the proper timeframe when assessing impacts on specific populations because not all users will respond in the same ways.

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