PDF INSTITUTE FOR HEALTH POLICY AND LEADERSHIP September 2019 ...

[Pages:4]INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

September 2019

Issue At A Glance:

The Status of Marijuana in the United States

Legalization of recreational and medical marijuana has become increasingly common throughout the states. While some studies indicate potential health benefits, others indicate adverse health outcomes and there is still much research to be conducted on the effects of marijuana policy and overall public health outcomes. This brief

provides an overview of the recent trends in marijuana usage and its health effects.

Introduction

The Federal Controlled Substances Act of 1970 classified cannabis (commonly known as marijuana) as a Schedule 1 substance. This means that it is regarded as a drug that has no accepted medical use and is considered a substance that is very likely to be abused.1 Upon the passage of the 2018 Farm Bill, a form of cannabis known as hemp was legalized at the federal level.2 Some cannabis-derived prescription drugs have also received federal approval from the Food and Drug Administration (FDA).3 Marijuana use is still illegal according to federal law.

In recent years, however, there has been a push to legalize both medical marijuana and recreational marijuana and to decriminalize its use at the state level. As of September 2019, medical marijuana is legal in 33 states and the District of Columbia (D.C.).4 Recreational marijuana use is legal in 11 states and D.C. This brief covers the recent trends and the health effects of marijuana.

Public Opinion Poll5

12%

of the US population believed that

marijuana should be legal in 1969

62%

of the US population believed that

marijuana should be legal in 2018

Bringing wholeness to individuals and communities, the Institute for Health Policy and Leadership (IHPL) strives to integrate health policy research and education with

leadership development. Our goal is to improve the health of our communities by building on our strong heritage of health promotion and disease prevention. To learn more, visit us at IHPL.llu.edu

INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

September 2019

Trends in Marijuana Usage

The 2018 National Survey on Drug Use and Health report estimates that 26 million Americans above the age of 11 had used marijuana some time in the past month of the 2017 survey. Marijuana usage among the general population steadily increased from 2002 to 2017. Roughly 7 percent of adolescents between the ages of 12 and 17 (1.6 million) and 22.1 percent of young adults between the ages of 18 and 25 (7.6 million) were reported to have used marijuana in the last month. More than 45 percent of Americans above the age of 11 have used marijuana at least once in their lifetime. Marijuana is the most commonly used illicit (illegal) drug in the nation.6

General Health Effects of Marijuana Usage

According to the Centers for Disease Control and Prevention, marijuana use may have adverse, longterm health impacts on young users whose brains are still developing. Some studies have found that marijuana use has the potential to decrease brain volume and alter brain connectivity, leading to issues with memory, learning, impulse control, decision-making, attention, and reaction time.7 Depending on the dosage consumed and the metabolism of the user, marijuana can have opposite effects. For instance, low doses of marijuana may help decrease anxiety, increase blood flow, and treat nausea. Alternatively, high doses of marijuana can cause psychosis and paranoia, constrict blood flow, and cause severe nausea and vomiting (a condition known as hyperemesis syndrome).8 A study in the Annals of Internal Medicine found that 18 percent of inhaled cannabis-related cases at an emergency room (ER) were attributed to hyperemesis syndrome.9

Marijuana use can also lead to dependency. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines marijuana addiction as Cannabis Use Disorder (CUD). CUD is characterized by comorbid physical, behavioral, and mental health issues. Quitting may be difficult and is associated with prolonged withdrawal symptoms in half of those who are treated for CUD.10 Roughly 10 percent of marijuana users become addicted. Marijuana use is also frequently associated with abuse of other substances, which is why it has historically been considered a gateway drug.7

Cannabis Terminology11

Tetrahydrocannabinol (THC) Cannabidiol (CBD)

Hemp

Marijuana

A psychoactive chemical derived from Cannabis (a flowering plant) that can cause feelings of euphoria and hallucinations.

A compound derived from Cannabis that has been known to treat seizures without psychoactive effects.

A variety of Cannabis that has less than 0.3 percent of THC by dry weight. It is often used for industrial purposes like creating paper and textiles, among other things.

A variety of Cannabis that has more than 0.3 percent of THC by dry weight. It is often used for recreational or medici2nal purposes.

INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

September 2019

Health Effects of Active Cannabis Components

Cannabidiol (CBD) CBD can be ingested, topically applied, or inhaled.12 The FDA approved the CBD drug Epidiolex as treatment for two epilepsy disorders for patients over the age of two.2 Preliminary studies show that CBD may also be beneficial in alleviating symptoms such as pain, psychosis, anxiety, and nausea. According to the World Health Organization, there is no evidence that CBD poses a threat to public health through addiction or misuse.13 However, states are beginning to ban the sale of CBD-infused foods and beverages due to concerns over the safety and efficacy of CBD-infused edible products and lack of FDA approval.14

Tetrahydrocannabinol (THC)

The FDA approved dronabinol, a synthetic THC used to stimulate appetite for patients with HIV and treat nausea and vomiting for patients undergoing chemotherapy.15 THC is associated with the common side effects attributed to marijuana use: increased heart rate, memory loss, red eyes, dry mouth, feelings of "high," and issues with memory and coordination.16 The city of Milwaukee placed a health alert against using THC oil in e-cigarettes after more than 15 people were hospitalized with lung inflammation.17

Effects of Legalization

To date, 11 states and Washington D.C. have legalized both medical and recreational marijuana while 33 states have legalized only medical marijuana use with 13 of those states allowing only CBD oil with limited THC content. Marijuana use of any kind is still prohibited in three states.18

Two separate analyses determined that THC content in marijuana increased by eight percentage points between 1995 and 2014 and eight percentage points between 2008 and 2017.19,20 The Colorado Division of Justice Office of Research and Statistics reported that since becoming the first state to legalize recreational marijuana in 2014, the state experienced increases in felony marijuana court cases, a 15 percent decline in the number of driving under the influence cases, decline of four percent in the number of people who tested positive for THC in a fatal car accident, decline in drop-out rates, no changes in marijuana use among students, and threefold increase in emergency room visits for marijuanarelated issues.21 Nationally, prenatal exposure to marijuana has been increasing.22 In late August 2019, the Surgeon General Jerome Adams issued an advisory against marijuana use during pregnancy or in adolescence.23 Given that many of these laws are recent, a significant amount of data is lacking and there is still much research to be conducted to better understand the health impacts of the various forms of legalization.

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

September 2019

Next Steps

More recently, some studies are beginning to indicate that access to marijuana may decrease the likelihood of opioid overdoses if marijuana is the prescribed alternative for pain. At the same time, concerns for negative health effects at higher doses and the role marijuana may play as a gateway drug still exist. Given that marijuana is illegal under federal law, medical marijuana is not covered under insurance. This poses a barrier for accessing it for people with low incomes.24 As research on marijuana and its policies continue to develop, we must ensure that any identified benefits are accessible to all equally and that any negative effects of marijuana policies that are identified be addressed appropriately.

References

1. 2.

explainer/ 3.

comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms 4. 5.

legalization/ 6. 7. 8.

swept-the-market-raising-concerns-about-health-risks 9.

route-exposure-observational-study 10.

substancerelated-disorders-2155-6105-S11-013.php?aid=84734 11. 12.

boomers-should-know-about/#476f49401646 13. 14. 15.

oral/details 16. 17.

immediately/23803335/ 18. 19. 20. 21.

publishes-report-impacts-marijuana-legalization-colorado 22. 23.

misuse/advisory-on-marijuana-use-and-developing-brain/index.html 24. 25.

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Did You Know?

People who come to the ER for issues related to edible cannabis are more likely to have psychiatric symptoms, cardiovascular syndromes, and intoxication than those

who come to the ER for problems related to inhaled

cannabis.9

Did You Know?

California was the first state to legalize medical marijuana in

1996, followed by Alaska, Oregon, and Washington in

1998.25

11209 Anderson Street Loma Linda, CA 92354

Phone: 909-558-7022 Fax: 909-558-5638 IHPL.llu.edu

Questions? Please contact Priya Vedula, MPH Health Policy Analyst at the Institute for Health Policy & Leadership (pvedula@llu.edu)

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