Clearing the Haze? Context and Consequences of Cannabis Legalization in Europe and North America

Earlier this month, recreational cannabis use was legalized in Germany. A minor sensation, as this makes traditionally conservative Germany the first country in the European Union to do so. Even the Netherlands, often regarded as having the most liberal drug policy in Europe, only tolerates cannabis, but has never actually legalized it for recreational use.

Cannabis legalization in Europe began mainly on a medical basis. Countries such as Germany, the United Kingdom, and the Netherlands have passed laws legalizing the use of medical cannabis under certain conditions.¹ However, countries such as the Netherlands and Portugal have also long taken a more tolerant stance toward the personal use of cannabis. More recently, countries such as Spain and Luxembourg have enacted laws or are considering legalizing cannabis for recreational use.¹

Over the past two decades, however, North America in particular has seen a remarkable shift in the legality of cannabis. What was once considered an illegal drug is now increasingly seen as a potential tool for medical treatment and even recreational purposes. This development has had an impact not only on usage patterns, but also on the social and political landscape of North America.

As in Europe, the legalization of cannabis in North America began primarily on a medical basis. California led the way in 1996 when it became the first U.S. state to legalize the use of medical cannabis. Since then, many other states and Canadian provinces have followed suit.²

The legalization of recreational cannabis use followed the medical trend. In 2012, Colorado and Washington were the first U.S. states to legalize the use of cannabis for recreational purposes. This decision was backed by growing popular support and was also intended to reduce illegal drug-related crime and create new sources of revenue for state coffers. Since then, other states have taken similar steps, with cannabis becoming a legal and regulated product that can be purchased in specialty stores.² Since 2018, the recreational use of cannabis has been legal in Canada.

The legalization of cannabis has led to a significant change in usage patterns. Both medical and recreational use of cannabis have increased, with the latter increasing more in some cases. Studies show that legalization has not necessarily led to an increase in overall cannabis use, but rather a shift from illicit to legal sources.

The legalization of cannabis has both social and political implications. On the one hand, it has led to a decriminalization of cannabis use and reduced the burden on the criminal justice system. On the other hand, there are still concerns about the impact of cannabis use on health and the potential increase in drug use overall. In addition, there is a debate about the regulation of the cannabis market and the taxation of cannabis products.³

Overall, the legalization of cannabis in North America has undergone a complex and multilayered evolution, with both positive and negative effects. Although legalization remains controversial, experience to date shows that it has had a significant impact on North American society and politics.

The history of cannabis use spans thousands of years and is rich in cultural, medicinal, and social influences. As early as ancient civilizations such as ancient China, cannabis was valued for its medicinal properties. Traditional Chinese Medicine used cannabis to treat pain, inflammation, and other ailments. Similarly, cannabis was also used in Indian Ayurvedic Medicine, where it was known as “bhang” and was used as a painkiller, anti-inflammatory, and sleep aid.⁴

Cannabis was also used in ancient Egypt in medical and religious contexts. Here, papyrus scrolls were found that indicate the use of cannabis to treat eye inflammation and other complaints. Cannabis also played a role in religious rituals.

Although the medicinal use of cannabis has a long history, it has also been used for recreational purposes. In some Middle Eastern and Central Asian cultures in particular, the use of cannabis in social gatherings and ritual celebrations was widespread. In India, for example, traditional festivals such as Holi and Diwali were often accompanied by the consumption of cannabis products.⁵

Over time, the use of cannabis spread to different parts of the world and found its way into various forms of art, literature, and music. In the 1960s and 1970s, cannabis experienced a renaissance in the Western world, particularly in the wake of the hippie movement and the rise of the counterculture.

However, the history of cannabis use is also characterized by legal restrictions and prohibitions, especially in the 20th century. Laws were passed in many countries restricting or prohibiting the cultivation, possession, and use of cannabis, often due to moral or political concerns. Despite these obstacles, the history of cannabis remains rich with cultural traditions, medicinal applications, and social controversies that persist to this day.⁶

Cannabis has attracted increasing interest as a potential therapeutic agent in recent years. Numerous scientific studies have investigated the potential of cannabis and its derivatives in the treatment of a variety of diseases and symptoms.

A JAMA meta-analysis by Whiting et al. found that cannabis can significantly contribute to the relief of chronic pain, particularly neuropathic pain.⁷ These findings were supported by another meta-analysis, which showed that cannabinoids are effective in the treatment of pain, spasticity, and nausea.⁸

In addition, research has shown that cannabis can also play a promising role in neurology. The meta-analysis by Stockings et al. found that cannabinoids can significantly contribute to the reduction of seizure frequency in patients with epilepsy.⁹ Beyond pain and epilepsy, cannabis has also shown positive effects on the symptoms of mental illness. A meta-analysis published in Lancet Psychiatry found that cannabinoids can potentially help reduce anxiety, depression, and post-traumatic stress disorder.¹⁰

Despite these promising results, further studies are needed to evaluate the long-term effects and safety of cannabis as a therapeutic agent. In particular, randomized controlled trials are needed to better understand optimal dosing, best methods of administration, and potential adverse effects. Nevertheless, research to date suggests that cannabis can be a promising therapeutic tool, especially for patients who do not respond to conventional treatments.

Besides the potential benefits of cannabis, its uncontrolled use also poses risks to health and society. Studies show that excessive or inappropriate cannabis use can have negative effects. Long-term and intensive cannabis use has been linked to problems such as cognitive impairment, mental disorders, and addiction.¹¹

In adolescents and young adults in particular, regular use of cannabis can increase the risk of developmental disorders and impair cognitive functioning. This can have an impact on academic performance, working life, and general quality of life. In addition, there are concerns about the link between cannabis use and mental health conditions such as anxiety disorders, depression, and psychosis.¹² Consequently, cannabis use remains illegal for adolescents in North America and Europe.

To minimize these risks, adequate education on the responsible use of cannabis is crucial. The implementation of effective prevention and intervention strategies and education about the potential risks are necessary to reduce the negative effects of cannabis use and protect public health.

In a nutshell, the increasing legalization of cannabis in Europe and North America marks a significant turning point in the history of the use of this plant. Society is facing new challenges and opportunities as it slowly breaks away from old taboos and explores new ways of using and regulating it. It is crucial to learn from the experience and knowledge gained to make responsible decisions that take into account both the needs of the population and public health.