Abstract
The legality, recreational and medical use of cannabis varies widely by country and region but remains largely prohibited internationally. In October 2018, Canada legalized the recreational use of cannabis—a move many viewed as controversial. Proponents of legalization have emphasized the potential to eradicate the marijuana black market, improve quality and safety control, increase tax revenues, improve the availability of medical cannabis, and lower gang-related drug violence. Conversely, opponents of legalization have stressed concerns about cannabis’ addictive potential, second-hand cannabis exposure, potential exacerbation of underlying and established mental illnesses, as well as alterations in perception that affect safety, particularly driving. This systematic review synthesizes recent international literature on the clinical and public health implications of cannabis legalization.
Highlights
Cannabis is the most widely used illicit drug [1], and cannabis use and dependence are estimated to have increased over the past two decades [2]
Only a few studies measured the prevalence of cannabis use following legalization, most found that the prevalence increased
Overall marijuana consumption increased in Washington [24], while rates of marijuana use by undergraduate students increased substantially following legalization of recreational cannabis in Colorado [25,26,27]
Summary
Cannabis is the most widely used illicit drug [1], and cannabis use and dependence are estimated to have increased over the past two decades [2]. In 2016, the United Nations Office on Drugs and Crime estimated 192 million people aged 15–64 years used cannabis [3]. The United States and Canada are estimated to have among the highest age-standardized rates of cannabis use disorders (CUDs) in the world [2]. In Canada, the prevalence of cannabis use and CUDs have increased over the past decade, paralleling changes in the legal and political climate favoring legalization [4,5]. In 2017, 4.5 million Canadians aged 15 years or older reported past-year cannabis use, 1.5 million reported daily or near-daily use, and 6.8% met criteria for CUD [6,7]
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