Most U.S. states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use, and Cannabis Use Disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical MML programs.
Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized v. non-medical). Multilevel linear regression models adjusted for state-level random effects and covariates as well as historical trends in use.
Nationwide cross-sectional survey data from the U.S. National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level.
2004-2013 NSDUH respondents (N ~ 67,500/year); age groups 12-17, 18-25, and 26+ years. States had implemented 8 medicalized and 15 non-medical MML programs.
Primary outcome measures included 1) Active (past-month) marijuana use; 2) Heavy use (>300 days/year); and 3) Cannabis Use Disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group, and state-level characteristics across the study period.
Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13% to 6.59%, p=0.01) skewing toward greater heavy marijuana by 2.36% (from 14.94 to 17.30, p=0.09) after MMLs were enacted. However, no associated increase in the prevalence of Cannabis Use Disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type.
Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults 26+ years.
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