State-level marijuana liberalization policies have been evolving for the past five decades, and yet the overall scientific evidence of the impact of these policies is widely believed to be inconclusive. In this review we summarize some of the key limitations of the studies evaluating the effects of decriminalization and medical marijuana laws on marijuana use, highlighting their inconsistencies in terms of the heterogeneity of policies, the timing of the evaluations, and the measures of use being considered. We suggest that the heterogeneity in the responsiveness of different populations to particular laws is important for interpreting the mixed findings from the literature, and we highlight the limitations of the existing literature in providing clear insights into the probable effects of marijuana legalization.


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Literature Cited

  1. Anderson DM, Hansen B, Rees DI. 2012. Medical marijuana laws and teen marijuana use Disc. Pap. 6592, IZA, Bonn, Ger.
  2. Anderson DM, Hansen B, Rees DI. 2013. Medical marijuana laws, traffic fatalities, and alcohol consumption. J. Law Econ. 56:333–69 [Google Scholar]
  3. Anderson DM, Hansen B, Rees DI. 2015. Medical marijuana laws and teen marijuana use. Am. Law Econ. Rev. 17:2495–528 [Google Scholar]
  4. Anderson DM, Rees DI. 2014. The role of dispensaries: The devil is in the details. J. Policy Anal. Manag. 33:1235–40 [Google Scholar]
  5. Armbrister M. 2016. Colorado pot potency ballot initiative is withdrawn. Denver Bus. J. Jul. 8
  6. Asbridge M, Duff C, Marsh DC, Erickson PG. 2014. Problems with the identification of “problematic” cannabis use: examining the issues of frequency, quantity, and drug use environment. Eur. Addict. Res. 20:254–67 [Google Scholar]
  7. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. 2014. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern. Med. 174:101668–73 [Google Scholar]
  8. Baker D. 2007. N.M.: Won't oversee marijuana production. Assoc. Press Aug. 16
  9. Borodovsky JT, Crosier BS, Lee DC, Sargent JD, Budney AJ. 2016. Smoking, vaping, eating: Is legalization impacting the way people use cannabis?. Int. J. Drug Policy 36:141–47 [Google Scholar]
  10. Boyd CJ, Veliz PT, McCabe SE. 2015. Adolescents’ use of medical marijuana: a secondary analysis of Monitoring the Future data. J. Adolesc. Health 57:2241–44 [Google Scholar]
  11. Burns RM, Caulkins JP, Everingham SS, Kilmer B. 2013. Statistics on cannabis users skew perceptions of cannabis use. Front. Psychiatry 4:1381–10 [Google Scholar]
  12. Caulkins JP, Hawken A, Kilmer B, Kleiman M. 2012. Marijuana Legalization: What Everyone Needs to Know New York: Oxford Univ. Press
  13. Caulkins JP, Kilmer B. 2016. Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont. Addiction 111:122082–89 [Google Scholar]
  14. Caulkins JP, Kilmer B, Kleiman MAR, MacCoun RJ, Midgette G. et al. 2015. Considering Marijuana Legalization: Insights for Vermont and Other Jurisdictions. Santa Monica, CA: RAND Corp.
  15. Cerdá M, Wall M, Keyes KM, Galea S, Hasin DS. 2012. Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alcohol Depend 120:22–27 [Google Scholar]
  16. Choi A. 2014. The impact of medical marijuana laws on marijuana use and other risky health behaviors Presented at ASHE Conf., 5th, Los Angeles
  17. Choo EK, Benz M, Zaller N, Warren O, Rising KL, McConnell KJ. 2014. The impact of state medical marijuana legislation on adolescent marijuana use. J. Adolesc. Health 55:2160–66 [Google Scholar]
  18. Chu YWL. 2014. The effects of medical marijuana laws on illegal marijuana use. J. Health Econ. 38:43–61 [Google Scholar]
  19. Collett SC, Gariffo T, Hernandez-Morgan M. 2013. Evaluation of the Medical Marijuana Program in Washington, D.C Los Angeles: UCLA
  20. Compton WM, Baler R. 2016. The epidemiology of DSM-5 cannabis use disorders among U.S. adults: science to inform clinicians working in a shifting social landscape. Am. J. Psychiatry 173:6551–53 [Google Scholar]
  21. D'Amico EJ, Miles JNV, Tucker JS. 2015. Gateway to curiosity: medical marijuana ads and intention and use during middle school. Psychol. Addict. Behav. 29:3613–19 [Google Scholar]
  22. Davenport SS, Caulkins JP. 2016. Evolution of the United States: marijuana market in the decade of liberalization before full legalization. J. Drug Issues 46:4411–27 [Google Scholar]
  23. DeSimone J, Farrelly MC. 2003. Price and enforcement effects on cocaine and marijuana demand. Econ. Inquiry 41:98–115 [Google Scholar]
  24. Dinardo J, Lemieux T. 2001. Alcohol, marijuana, and American youth: the unintended consequences of government regulation. J. Health Econ. 20:6991–1010 [Google Scholar]
  25. Fairman BJ. 2015. Trends in registered medical marijuana participation rates across 13 US states and District of Columbia. Drug Alcohol Depend 159:72–79 [Google Scholar]
  26. Fischer B, Kuganesan S, Room R. 2015. Medical marijuana programs: implications for cannabis control policy—observations from Canada. Int. J. Drug Policy 26:115–19 [Google Scholar]
  27. Fox CR, Tannenbaum D. 2011. The elusive search for stable risk preferences. Front. Psychol. 2:298 [Google Scholar]
  28. Galenianos M, Pacula RL, Persico N. 2012. A search-theoretic model of the retail market for illicit drugs. Rev. Econ. Studies 79:1239–69 [Google Scholar]
  29. Gettman J. 2015a. Marijuana Arrests in Colorado After the Passage of Amendment 64 New York: Drug Policy Alliance
  30. Gettman J. 2015b. Status Report: Marijuana Legalization in Washington After 1 Year of Retail Sales and 2.5 Years of Legal Possession New York: Drug Policy Alliance
  31. Gordon AJ, Conley JW, Gordon JM. 2013. Medical consequences of marijuana use: a review of the current literature. Curr. Psychiatry Rep. 15:12419 [Google Scholar]
  32. Gorman DM, Huber J. 2007. Do medical cannabis laws encourage cannabis use?. Int. J. Drug Policy 18:3160–67 [Google Scholar]
  33. Haardörfer R, Berg CJ, Lewis M, Payne J, Pillai D. et al. 2016. Polytobacco, marijuana, and alcohol use patterns in college students: a latent class analysis. Addict. Behav. 59:58–64 [Google Scholar]
  34. Hall W. 2009. The adverse health effects of cannabis use: What are they, and what are their implications for policy?. Int. J. Drug Policy 20:6458–66 [Google Scholar]
  35. Hall W. 2015. What has research over the past two decades revealed about the adverse effects of cannabis use?. Addiction 110:119–35 [Google Scholar]
  36. Hall W, Lynskey M. 2016. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction 111:101764–73 [Google Scholar]
  37. Haney M, Evins AE. 2016. Does cannabis cause, exacerbate, or ameliorate psychiatric disorders? An oversimplified debate discussed. Neuropsychopharmacology 41:2393–401 [Google Scholar]
  38. Harper S, Strumpf EC, Kaufman JS. 2012. Do medical marijuana laws increase marijuana use? Replication study and extension. Ann. Epidemiol. 22:3207–12 [Google Scholar]
  39. Hasin DS, O'Brien CP, Auriacombe M, Borges G, Bucholz K. et al. 2013. DSM-5 criteria for substance use disorders: recommendations and rationale. Am. J. Psychiatry 170:834–51 [Google Scholar]
  40. Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP. et al. 2015a. Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry 72:121235–42 [Google Scholar]
  41. Hasin DS, Wall M, Keyes KM, Cerdá M, Schulenberg J. et al. 2015b. Medical marijuana laws and adolescent marijuana use in the USA from 1991–2014: results from annual, repeated cross-sectional surveys. Lancet Psychiatry 2:7601–8 [Google Scholar]
  42. Hill KP. 2015. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 313:242474–83 [Google Scholar]
  43. Huestis MA. 2007. Human cannabinoid pharmacokinetics. Chem. Biodivers. 4:81770–804 [Google Scholar]
  44. Hughes JR, Fingar JR, Budney AJ, Naud S, Helzer JE. 2014. Marijuana use and intoxication among daily users: an intensive longitudinal study. Addict. Behav. 39:101464–70 [Google Scholar]
  45. Humphreys K. 2016. So, something interesting happens to weed after it's legal. The Washington Post Wonkblog May 4. https://www.washingtonpost.com/news/wonk/wp/2016/05/04/the-price-of-legal-pot-is-collapsing/
  46. Hunt PE, Miles J. 2015. The impact of legalizing and regulating weed: issues with study design and emerging findings in the USA. Curr. Topics Behav. Neurosci. https://doi.org/10.1007/7854_2015_423
  47. Johnston D, Lewis NA. 2009. Ending raids of dispensers of marijuana for patients. New York Times March 18, p. A20
  48. Johnston LD, O'Malley PM, Bachman JG. 1981. Marijuana decriminalization: the impact on youth 1975–1980 Monitoring the Future Occas. Pap. 13, Inst. Soc. Res., Univ. Mich., Ann Arbor
  49. Keyes KM, Wall M, Cerdá M, Schulenberg J, O'Malley PM. et al. 2016. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991–2014. Addiction 111:2187–95 https://doi.org/10.1111/add.13523 [Google Scholar]
  50. Khatapoush S, Hallfors D. 2004. “Sending the wrong message”: Did medical marijuana legalization in California change attitudes about and use of marijuana?. J. Drug Issues 34:741–70 [Google Scholar]
  51. Kilmer B, Caulkins JP, Pacula RL, MacCoun RJ, Reuter P. 2010. Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets Santa Monica, CA: RAND Corp.
  52. Kilmer JR, Hunt SB, Lee CM, Neighbors C. 2007. Marijuana use, risk perception, and consequences: Is perceived risk congruent with reality?. Addict. Behav. 32:3026–33 [Google Scholar]
  53. King E, Behrman J. 2009. Timing and duration of exposure in evaluations of social programs. World Bank Econ. Rev. 22:539–66 [Google Scholar]
  54. Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S. et al. 2014. Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders. Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 82:171556–63 [Google Scholar]
  55. Kosterman R, Bailey JA, Guttmannova K, Jones TM, Eisenberg N. et al. 2016. Marijuana legalization and parents’ attitudes, use, and parenting in Washington State. J. Adolesc. Health 59:4450–56 [Google Scholar]
  56. Loflin M, Earleywine M. 2014. A new method of cannabis ingestion: the dangers of dabs. Addict. Behav. 39:101430–33 [Google Scholar]
  57. Lynne-Landsman SD, Livingston MD, Wagenaar AC. 2013. Effects of state medical marijuana laws on adolescent marijuana use. Am. J. Public Health 103:81500–6 [Google Scholar]
  58. MacCoun R, Pacula RL, Chriqui JF, Harris K, Reuter P. 2009. Do citizens know whether their state has decriminalized marijuana? Assessing the perceptual component of deterrence theory. Rev. Law Econ. 5:347–71 [Google Scholar]
  59. MacCoun R, Reuter P. 2001. Evaluating alternative cannabis regimes. Br. J. Psychiatry 178:123–28 [Google Scholar]
  60. Maloff D. 1981. A review of the effects of the decriminalization of marijuana. Contemp. Drug Probl. 10:307–22 [Google Scholar]
  61. Marijuana Work. Group. 2016. Initiative 71: Marijuana Working Group Status Report. Washington, DC: Gov. D.C. [Google Scholar]
  62. Markowitz S, Tauras J. 2009. Substance use among adolescent students with consideration of budget constraints. Rev. Econ. Househ. 7:423–46 [Google Scholar]
  63. Miech RA, Johnston L, O'Malley PM, Bachman JG, Schulenberg J, Patrick ME. 2015. Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007–2013. Int. J. Drug Policy 26:336–44 [Google Scholar]
  64. Model K. 1993. The effect of marijuana decriminalization on hospital emergency room episodes: 1975–1978. J. Am. Stat. Assoc. 88:423737–47 [Google Scholar]
  65. Natl. Comm. Marihuana Drug Abus. 1972. Marihuana: a signal of misunderstanding. First Rep. Natl. Comm. Marihuana Drug Abus., US Gov. Print. Off Washington, DC: [Google Scholar]
  66. NCSL (Natl. Conf. State Legis.). 2016a. Marijuana overview Aug. 2. http://www.ncsl.org/research/civil-and-criminal-justice/marijuana-overview.aspx
  67. NCSL (Natl. Conf. State Legis.). 2016b. State medical marijuana laws Jul. 20. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx
  68. Nussbaum AM, Thurstone C, McGarry L, Walker B, Sabel AL. 2015. Use and diversion of medical marijuana among adults admitted to inpatient psychiatry. Am. J. Drug Alcohol Abus. 41:2166–72 [Google Scholar]
  69. Ogden DW. 2009. Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana: Memorandum for Selected United States Attorneys Washington, DC: US Dep. Justice, Off. Deputy Atty.
  70. Pacula RL. 1998. Does increasing the beer tax reduce marijuana consumption?. J. Health Econ. 17:5557–86 [Google Scholar]
  71. Pacula RL, Boustead A, Hunt P. 2014a. Words can be deceiving: a review of variation among legally effective medical marijuana laws in the United States. J. Drug Policy Anal. 7:11–19 [Google Scholar]
  72. Pacula RL, Chriqui JF, King J. 2003. Decriminalization in the United States: What does it mean? Work. Pap. 9690, NBER Cambridge, MA:
  73. Pacula RL, Chriqui JF, Reichmann DA, Terry-McElrath YM. 2002. State medical marijuana laws: understanding the laws and their limitations. J. Public Health Policy 23:4413–39 [Google Scholar]
  74. Pacula RL, Heaton P, Powell D, Sevigny EL. 2015. Assessing the effects of medical marijuana laws on marijuana use: The devil is in the details. J. Policy Anal. Manag. 34:17–31 [Google Scholar]
  75. Pacula RL, Jacobson M, Maksabedian EJ. 2016. In the weeds: a baseline view of cannabis use among legalizing states and their neighbors. Addiction 111:973–80 [Google Scholar]
  76. Pacula RL, Kilmer B, Grossman M, Chaloupka FJ. 2010. Risks and prices: the role of user sanctions in marijuana markets. B. E. J. Econ. Anal. Policy 10:11–36 [Google Scholar]
  77. Pacula RL, Kilmer B, Wagenaar AC, Chaloupka FJ, Caulkins JP. 2014b. Developing public health regulations for marijuana: lessons from alcohol and tobacco. Am. J. Public Health 104:61021–28 [Google Scholar]
  78. Pacula RL, Lundberg R. 2014. Why changes in price matter when thinking about marijuana policy: a review of the literature on the elasticity of demand. Public Health Rev 35:21–18 [Google Scholar]
  79. Pacula RL, MacCoun R, Reuter P, Chriqui J, Kilmer B. et al. 2005. What does it mean to decriminalize marijuana? A cross-national empirical examination. Substance Abuse: Individual Behaviour, Social Interactions, Markets and Politics 16 M Grossman, B Lindgren 347–70 Amsterdam: Elsevier [Google Scholar]
  80. Pacula RL, Powell D, Heaton P, Sevigny E. 2015. Assessing the effects of medical marijuana laws on marijuana: The devil is in the details. J. Public Policy Anal. Manag. 34:7–31 [Google Scholar]
  81. Pacula RL, Sevigny EL. 2014a. Marijuana liberalization policies: why we can't learn much from policy still in motion. J. Policy Anal. Manag. 33:1212–21 [Google Scholar]
  82. Pacula RL, Sevigny EL. 2014b. Natural experiments in a complex and dynamic environment: the need for measured assessment of the evidence. J. Policy Anal. Manag. 33:1232–35 [Google Scholar]
  83. Pertwee R. 2014. Handbook of Cannabis Oxford, UK: Oxford Univ. Press
  84. Raphael S, Stoll MA. 2013. Why Are So Many Americans in Prison? New York: Russell Sage Found.
  85. Rendon J. 2013. Super-Charged: How Outlaws, Hippies, and Scientists Reinvented Marijuana Portland, OR: Timber Press
  86. Reuter P, Hirschfield P, Davies C. 2001. Assessing the Crackdown on Marijuana in Maryland. Baltimore, MD: Abell Found.
  87. Reuter P, MacCoun RJ. 1995. Assessing the legalization debate. Policies and Strategies to Combat Drugs in Europe G Estievenart 39–49 Amsterdam: Kluwer [Google Scholar]
  88. Ritter A, Livingston M, Chalmers J, Berends L, Reuter P. 2016. Comparative policy analysis for alcohol and drugs: current state of the field. Int. J. Drug Policy 31:39–50 [Google Scholar]
  89. Ross A, Walker A. 2017. The impact of low-priority laws on criminal activity: evidence from California. Contemp. Econ. Policy. In press. https://doi.org/10.1111/coep.12179
  90. Russo EB, Guy GW, Robson PJ. 2007. Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis‐based medicine. Chem. Biodivers. 4:81729–43 [Google Scholar]
  91. Saffer H, Chaloupka FJ. 1999. The demand for illicit drugs. Econ. Inq. 37:3401–11 [Google Scholar]
  92. Salomonsen-Sautel S, Sakai JT, Thurstone C, Corley R, Hopfer C. 2012. Medical marijuana use among adolescents in substance abuse treatment. J. Am. Acad. Child Adolesc. Psychiatry 51:7694–702 [Google Scholar]
  93. Schauer GL, King BA, Bunnell RE, Promoff G, McAfee TA. 2016. Toking, vaping, and eating for health or fun: marijuana use patterns in adults, U.S., 2014. Am. J. Prev. Med. 50:11–8 [Google Scholar]
  94. Schuermeyer J, Salomonsen-Sautel S, Price RK, Balan S, Thurstone C. et al. 2014. Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003–2011. Drug Alcohol Depend 140:145–55 [Google Scholar]
  95. Sevigny EL. 2014. Medical marijuana by the numbers Presented at Annu. Conf. Int. Soc. Study Drug Policy, 8th Rome:
  96. Sevigny EL, Pacula RL, Heaton P. 2014. The effects of medical marijuana laws on potency. Int. J. Drug Policy 25:308–19 [Google Scholar]
  97. Single E. 1989. The impact of marijuana decriminalization: an update. J. Public Health Policy 10:456–66 [Google Scholar]
  98. Smart R. 2016. Essays on the effects of medical marijuana laws PhD Thesis, Univ. Calif Los Angeles:
  99. Sobesky M, Gorgens K. 2016. Cannabis and adolescents: exploring the substance misuse treatment provider experience in a climate of legalization. Int. J. Drug Policy 33:66–74 [Google Scholar]
  100. Stringer RJ, Maggard SR. 2016. Reefer madness to marijuana legalization: media exposure and American attitudes toward marijuana (1975–2012). J. Drug Issues 46:4428–45 [Google Scholar]
  101. Subbaraman MS, Kerr WC. 2015. Simultaneous versus concurrent use of alcohol and cannabis in the National Alcohol Survey. Alcohol. Clin. Exp. Res. 39:5872–79 [Google Scholar]
  102. Subritzky T, Pettigrew S, Lenton S. 2016. Issues in the implementation and evolution of the commercial recreational cannabis market in Colorado. Int. J. Drug Policy 27:1–12 [Google Scholar]
  103. Sumnall HR, Tyler E, Wagstaff GF, Cole JC. 2004. A behavioural economic analysis of alcohol, amphetamine, cocaine and ecstasy purchases by polysubstance misusers. Drug Alcohol Depend 76:193–99 [Google Scholar]
  104. Temple EC, Brown RF, Hine DW. 2011. The “grass ceiling”: Limitations in the literature hinder our understanding of cannabis use and its consequences. Addiction 106:238–44 [Google Scholar]
  105. Terry-McElrath YM, O'Malley PM, Johnston LD. 2014. Alcohol and marijuana use patterns associated with unsafe driving among U.S. high school seniors: high use frequency, concurrent use, and simultaneous use. J. Stud. Alcohol Drugs 75:3378–89 [Google Scholar]
  106. Thies CF, Register CA. 1993. Decriminalization of marijuana and the demand for alcohol, marijuana and cocaine. Soc. Sci. J. 30:4385–99 [Google Scholar]
  107. Thurstone C, Lieberman SA, Schmiege SJ. 2011. Medical marijuana diversion and associated problems in adolescent substance treatment. Drug Alcohol Depend 118:2–3489–92 [Google Scholar]
  108. Volkow ND, Baler RD, Compton WM, Weiss SRB. 2014. Adverse health effects of marijuana use. N. Engl. J. Med. 370:2219–27 [Google Scholar]
  109. Wall MM, Poh E, Cerdá M, Keyes KM, Galea S, Hasin DS. 2011. Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear. Ann. Epidemiol. 21:9714–16 [Google Scholar]
  110. Wen H, Hockenberry JM, Cummings JR. 2015. The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances. J. Health Econ. 42:64–80 [Google Scholar]
  111. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S. et al. 2015. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA 313:242456–73 [Google Scholar]
  112. Williams AR, Olfson M, Kim JH, Martins SS, Kleber HD. 2016. Older, less regulated medical marijuana programs have much greater enrollment rates than newer “medicalized” programs. Health Aff 35:3480–88 [Google Scholar]
  113. Williams J, Mahmoudi P. 2004. Economic relationship between alcohol and cannabis revisited. Econ. Rec. 80:24836–48 [Google Scholar]
  114. Zeisser C, Thompson K, Stockwell T, Duff C, Chow C. et al. 2012. A “standard joint”? The role of quantity in predicting cannabis-related problems. Addict. Res. Theory 20:182–92 [Google Scholar]

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