Partnership to End Addiction is focused on the effects of substances on youth and, as such, does not weigh in on the legality of adult nonmedical use of marijuana (commonly referred to as “recreational marijuana use”). However, the legalization of adult nonmedical use in states across the U.S. has led to widespread commercialization and normalization of marijuana use, which has adversely affected our target population of interest: young people.
The risks of marijuana use to young people have been demonstrated through clinical and epidemiological research, and the concerns about these health risks and the adverse consequences of legalization have been consistently voiced by national medical societies (e.g., American Medical Association, American Society of Addiction Medicine, American Psychiatric Association, and American Academy of Pediatrics).
Marijuana use often begins in adolescence, and marijuana is one of the most commonly used substances among adolescents. Marijuana can interfere with healthy brain development, precipitate or exacerbate mental health conditions, and increase the likelihood of other substance use among young people.
When used regularly during adolescence and early adulthood, marijuana can alter the structure and function of the brain, including the parts responsible for decision making, reward seeking, and impulse control, and can impair learning and memory. Teens who use marijuana are at higher risk for other substance use and a range of cognitive and mental health problems. Early initiation and regular use are also associated with greater likelihood of developing a marijuana use disorder, which occurs in roughly one in six adolescent users – a rate that is nearly double that found among adult-onset users. Young people are also at greater risk of negative health effects due to the increasing strength/potency of marijuana products, including risk of psychosis, especially among those predisposed to mental health problems. In addition to the health risks, adolescent marijuana use is associated with increased likelihood of poor academic performance. Unfortunately, regular or heavy use is common among young people who use marijuana, a pattern unlikely to be improved by legalization.
The very act of legalizing marijuana sends a message that the drug is safe and acceptable to use. This shift in cultural norms especially puts adolescents at risk. Legalizing marijuana for adult nonmedical use is associated with reduced perceptions of the harms of marijuana among adults and youth. Data from three decades of survey research indicate that decreased perceptions of harm are strongly associated with increased rates of adolescent use. Legalization also is associated with increased access to marijuana and with higher rates of risky use among young people. Minimum age laws are not sufficient to prevent underage use because teens’ primary sources of marijuana are their friends and family. The substances that are legal for adults to use – alcohol, tobacco/nicotine, and (in some states) marijuana – are the substances most commonly used by minors.
In the U.S., legalization takes the form of commercialization. The tobacco and alcohol industries provide an illustrative example of how businesses that profit from addictive substances put the public’s health at risk. Through innovations in product development, marketing and lobbying, the tobacco industry made its product more addictive and dramatically increased its consumer base in a relatively short period of time. The marijuana industry has already begun implementing the tobacco industry’s successful strategies. The alcohol industry garners a significant portion of its profits from underage and excessive drinking, both of which are injurious to public health. The growing marijuana industry is similarly incentivized to promote underage and heavy use, as people who begin using marijuana as teens are much more likely to use the drug frequently and intensely, which drives profits.
If marijuana is legalized for adult nonmedical use, public health measures can help to reduce underage use. Research on alcohol, tobacco/nicotine, and marijuana shows that there are effective policies that can help reduce use of legal addictive substances among youth. This includes, for example, restricting flavored products; limiting potency; prohibiting products, packaging/labeling, and advertising/marketing that appeal to young people; requiring child-resistant packaging; prohibiting online sales and delivery; and enforcing minimum purchase age laws.
However, discussions about legalizing marijuana fail to account for the substantial investment needed to adequately regulate the drug and prevent adolescent use and related public health harms.
It is incumbent on states that have or are considering legalizing marijuana to implement policies that help protect youth and to commit resources to offer effective prevention and treatment services for those who are at risk of or develop a marijuana use disorder.