Legalization Of Marijuana Use Research Articles

C-31 | Impact of Marijuana Use on Prevalence and Interventions in Peripheral Artery Disease

The growing legalization of marijuana use warrants investigation of its various effects on the vasculature. We aim to determine whether marijuana users have an increased risk of peripheral artery disease (PAD) and subsequent surgical intervention. De-identified patient data from the National Inpatient Sample (NIS) from 2016-2019 were queried. Inclusion criteria included a diagnosis of marijuana use and peripheral artery disease. Patients were further stratified based on any percutaneous lower extremity vascular intervention. Data was analyzed using SPSS software in a binary logistic regression model, a p value <0.001 was considered statistically significant, and samples were standardized for comparison using predicted probabilities. Of the 30m+ patients in the NIS from 2016 to 2019, there were 623,768 patients diagnosed as marijuana users. These patients had an average age of 37.4 years, even distribution across genders, were more likely to be white and more likely to be elective admissions (p<0.001). Of these patients, 2,424 (0.38%) were concomitantly diagnosed with PAD. Marijuana users were at more than three times the risk of developing PAD (OR= 3.68, p<0.001) but had no statistically significant increased risk for mortality or requiring percutaneous intervention (p<0.001). Marijuana users are at a markedly increased risk of being diagnosed with PAD but are at no increased risk of requiring intervention nor mortality from their peripheral ischemia. Possible mechanisms for this increased risk may involve changes in coagulability and peripheral vascular tone from marijuana use. Vigilant monitoring for disease screening and progression should be initiated earlier in the outpatient setting in conjunction with cessation counseling.

Legalization of Marijuana Use for Medical in Indonesia in Relation to Law Number 35 of 2009 concerning Narcotics

Marijuana is one type of narcotics that is prohibited in Indonesia, as defined in Appendix I of Law Number 35 of 2009 concerning Narcotics. Marijuana is classified as a class I narcotic that cannot be used for medical purposes. Although it is illegal in Indonesia, some people use it as a medical substance to treat their illnesses. This research was conducted using the normative juridical method. According to the research findings, some Indonesians currently believe that marijuana is a dangerous plant that can cause temporary pleasure and addiction. On the other hand, there are also those who argue that cannabis can provide a sense of relaxation, pleasure, and happiness, as well as flow inspiration, drive away fatigue, boredom, even depression and stress. Another common misconception is that cannabis is a powerful medicine capable of alleviating various types of pain and slowing the spread of deadly diseases. Given that many other countries have legalized cannabis for medical purposes, the Appendix to Law Number 35 of 2009 must be revised by removing the cannabis plant, all plants of the cannabis genus, and all parts of the plant including seeds, fruit, straw, processed cannabis plants or parts of cannabis plants including cannabis and cannabis resin, and reclassifying them as class II narcotics so that they can be used as medical materials.&#x0D; Ganja merupakan salah satu jenis narkotika yang dilarang di Indonesia, sebagaimana didefinisikan dalam Lampran I Undang-Undang Nomor 35 Tahun 2009 tentang Narkotika. Ganja diklasifikasikan sebagai narkotika golongan I yang tidak dapat digunakan untuk tujuan medis. Meskipun ilegal di Indonesia, beberapa orang menggunakannya sebagai bahan medis untuk mengobati penyakit mereka. Penelitian ini dilakukan dengan menggunakan metode yuridis normatif. Menurut temuan penelitian, sebagian masyarakat Indonesia saat ini percaya bahwa ganja adalah tanaman berbahaya yang dapat menyebabkan kenikmatan sementara dan kecanduan. Di sisi lain, ada juga yang berpendapat bahwa ganja dapat memberikan rasa rileks, senang, dan bahagia, serta mengalirkan inspirasi, mengusir penat, bosan, bahkan depresi dan stres. Kesalahpahaman umum lainnya adalah bahwa ganja adalah obat yang ampuh yang mampu meringankan berbagai jenis rasa sakit dan memperlambat penyebaran penyakit mematikan. Mengingat banyak negara lain yang telah melegalkan ganja untuk kepentingan medis, maka Lampiran Undang-Undang Nomor 35 Tahun 2009 harus direvisi dengan menghapus tanaman ganja, semua tanaman genus ganja, dan semua bagian tanaman termasuk biji, buah, jerami, tanaman ganja yang telah diolah atau bagian tanaman ganja termasuk resin ganja dan ganja, serta mengklasifikasikannya kembali sebagai narkotika golongan II agar dapat digunakan sebagai bahan medis.

Cannabis and the heart: unchartered territory.

Cannabis is one of the most commonly used illicit drugs. It is a psychoactive drug with tetrahydrocannabinolbeing the main active ingredient. With increasing decriminalization and legalization of marijuana use in the USA, it is essential to study its long-term effects on cardiovascular diseases, a leading cause of death in the USA. Cannabis can trigger acute myocardial infarction in otherwise healthy young individuals, affect atherogenesis, arrhythmia, develop Takotsubo cardiomyopathy and cannabis arteritis. The only definitive treatment for these pathologies is complete abstinence. In this review we focus on discussing the long-term effects of tetrahydrocannabinol on cardiovascular pathologies, its pathophysiology and a brief discussion on its clinical features and definitive management.

What is the likelihood that underage youth can obtain marijuana from licensed recreational marijuana outlets in California, a state where recreational marijuana is legal?

Objective: Since 2012, 19 states and the District of Columbia have legalized the recreational use of marijuana for adults ages 21 and older. Marijuana use at any level can impair driving performance. Prior research on enforcement of the minimum legal marijuana use age of 21 (MLMU-21) laws is limited. The objective of the current study was to assess the ease of access to marijuana by underage patrons at recreational marijuana outlets in California, where recreational marijuana was legalized in 2016. Method: Pseudo-underage patrons were sent to 50 randomly selected licensed recreational marijuana outlets in the state to see if they could enter the outlet without showing a valid identification of their age. Results: Pseudo-underage patrons were required to show age identification to enter in 100% of the licensed recreational marijuana outlets visited. Conclusions: It appears that licensed California recreational marijuana outlets avoid selling marijuana to underage customers. One reason could be a strong incentive for recreational marijuana outlet owners and managers to avoid being shut down for an illegal activity. Practical Application: Underage youth are not obtaining marijuana at licensed recreational outlets. Future studies and cannabis enforcement agencies should investigate whether underage patrons attempt to use fake IDs at licensed marijuana outlets and whether youth are obtaining marijuana from illicit dispensaries or from social sources.

Admissions to substance use treatment facilities for cannabis use disorder, 2000-2017: Does legalization matter?

A growing number of US states have legalized marijuana use in the past decade. We examined if marijuana legalization is associated with increased marijuana-related admissions to substance use treatment facilities between 2000 and 2017. Data from the Treatment Episode Data Set-Admissions were used to examine the relationship between marijuana-related admissions among adults aged ≥18 by year and legalization status (i.e., fully legalized, medical use only [partially legalized], and illegal) (N = 35,457,854). Using interaction analyses, we further examined whether certain patient characteristics were associated with residence in states that legalized marijuana use as compared to those in which marijuana remained illegal. Overall, the proportion of marijuana-related admissions in states with legalization decreased by 2.3% from 31.7% in 2000-2005 to 29.4% in 2012-2017 (odds ratio [OR], 0.90; 95% confidence intervals [CI], 0.89-0.90) with little difference from states where marijuana use remained illegal, in which marijuana use as any reason for admissions decreased by 0.3% from 39.8% in 2000-2005 to 39.5% in 2012-2017 (OR, 0.99; 95% CI, 0.98-0.99). We did not find any striking patient characteristics (e.g., referral by the police) associated with admissions in states that legalized compared to those that had not. While earlier studies suggested that marijuana legalization is associated with increased levels of use, emergency department visits, and traffic fatalities, our findings suggest that marijuana legalization did not increase marijuana-related treatment use in the United States. This is the first study to examine the association of marijuana legalization with marijuana-related treatment use.

Legalization of marijuana use in comparative criminal legislation

In light of the rapidly shifting legislation regarding the legalization of marijuana use, the popular notion seems to be that marijuana is a harmless pleasure, access to which should not be regulated or considered illegal. World Health Organization recommended to delete cannabis and cannabis resin from Schedule IV of the UN Single Convention on Narcotic Drugs (1961), but to maintain it in Schedule I of the 1961 Convention. The UN Commission on Narcotic Drugs decided by 27 votes to 25 and with one abstention to follow this recommendation. Тhere is the issue of how much this decision will affect the legalization of marijuana in the world. In the paper are analyzed two legislation of the Anglo-Saxon legal system, which supported this initiative (Canada and USA) and legislation of Euro-Continental legal area (Russia) that did not accept the reclassifying of cannabis from the 1961 Convention. Author has compared the Canadian code with Uruguayan, and the U. S. bill with the Mexican legislation, because Mexican bill does not provide the full legalization of marijuana use. In the Russian Federation, all deeds related to narcotic drugs, which were committed on a significant, large, and an especially large scale, and also all acts coherent to traffic of narcotic drugs, regardless of its scale, are regulated by Criminal Code of the Russian Federation. Otherwise, there will be applied an administrative law.

Abstract 14284: "Weeding" Out Wellens' Syndrome

Introduction: Wellens’ syndrome, most often associated with proximal left anterior descending coronary artery stenosis, is considered highly specific for impending myocardial infarction (MI). Its diagnosis relies on symmetric biphasic or deeply inverted T waves in leads V1-V4, normal precordial R wave progression and normal to slightly elevated cardiac markers. Pseudo-Wellens’ syndrome presents similarly, but in the absence of coronary artery disease (CAD). We present a challenging case of a patient with history of excessive recreational cannabis use and incidental electrocardiogram (ECG) findings concerning for Wellens’ syndrome who ultimately was diagnosed with Pseudo-Wellens’ syndrome. With familiarity of cannabis associated Pseudo-Wellens’ syndrome, unnecessary invasive diagnostic and therapeutic procedures were avoided. Case: A 20 year old male without significant past medical history presented for evaluation of vomiting and abdominal pain of 2 days duration. In view of his daily cannabis use, he was diagnosed with cannabis hyperemesis syndrome. An ECG to measure QTc prior to administration of ondansetron demonstrated ST elevation in lead V2. A repeat ECG showed T-wave inversions in leads V2-4. Troponin levels were negative. The patient denied chest pain or shortness of breath. An echocardiogram showed normal cardiac wall motion and an estimated ejection fraction of 55-60%. The diagnosis of Pseudo-Wellens’ syndrome secondary to cannabis use was made and the patient was subsequently discharged home following extensive cannabis cessation counseling. Discussion: The definitive treatment of Wellens’ Syndrome relies on cardiac catheterization even in patients without cardiac history or risk factors for CAD. This immediate intervention is required to halt the evolution of MI and is crucial for a positive outcome. In contrast, Pseudo-Wellens’ syndrome occurs in the absence of CAD and has been reported in younger, healthy patients in association with illicit drug use. In the era of increased legalized marijuana use, it is imperative that health care providers are familiar with cannabis induced Pseudo-Wellens’ syndrome as to avoid the potential for inappropriate invasive diagnostic modalities in otherwise healthy individuals.

High Times for U.S. Employees: Human Resource Management Considerations in Addressing Marijuana Legalization in U.S. Organizations

Recent changes in state laws have legalized marijuana use for their state citizens. Originally by 2016, twenty-six states, the District of Columbia, and Puerto Rico had legalized marijuana for medical use (State Medical Marijuana Laws, 2016). In the 2020 elections eighteen states, two U.S. territories, and the District of Columbia legalized recreational use of cannabis. We now have thirty-six states, four U.S. territories, and D.C. who have legalized medical use of the drug use (State Medical Marijuana Laws, 2021). This however creates some major issues for Human Resource professionals due to the fact that federal law still considers marijuana use illegal. This creates a confusing situation for organizations and especially Human Resource professionals who must create and enforce policies on the use of prescription and non-prescription drugs within the work environment. The purpose of this research is to determine if medical marijuana should be protected in the workplace and under what conditions. Based on the literature three research questions were posed and three hypotheses were tested based on analyzing data from a survey questionnaire that was completed by 57 working adults. Results indicate that they support the use of medical marijuana as a viable medical treatment and companies should recognize and support this medical remedy. Results indicate employees should be protected in their use of marijuana under the FMLA. Results also indicate marijuana should also be considered for long-term and permanent illnesses under the ADA. Implications are employees see marijuana in a positive light, as a viable medical treatment, and expect human resource management to support policies that allow for use of marijuana.

Exploring Impact of Marijuana (Cannabis) Abuse on Adults Using Machine Learning.

Marijuana is the most common illicit substance globally. The rate of marijuana use is increasing in young adults in the US. The current environment of legalizing marijuana use is further contributing to an increase of users. The purpose of this study was to explore the characteristics of adults who abuse marijuana (20–49 years old) and analyze behavior and social relation variables related to depression and suicide risk using machine-learning algorithms. A total of 698 participants were identified from the 2019 National Survey on Drug Use and Health survey as marijuana dependent in the previous year. Principal Component Analysis and Chi-square were used to select features (variables) and mean imputation method was applied for missing data. Logistic regression, Random Forest, and K-Nearest Neighbor machine-learning algorithms were used to build depression and suicide risk prediction models. The results showed unique characteristics of the group and well-performing prediction models with influential risk variables. Identified risk variables were aligned with previous studies and suggested the development of marijuana abuse prevention programs targeting 20–29 year olds with a regular depression and suicide screening. Further study is suggested for identifying specific barriers to receiving timely treatment for depression and suicide risk.

Post-Legalization Drug Communication: Examining a Colorado Cannabis Campaign

Colorado legalized marijuana use for recreational purposes by adults over 21 in 2012. Our goal is to examine the first major communication campaign (called Good-To-Know) mounted by the state government with the objective of informing the public regarding regulatory and safety precautions surrounding newly legal use. Methods: We assess the content of campaign’s central messaging qualitatively by comparing its major themes in terms of criteria developed from the literature and the campaign’s own goals. Results: With minor exceptions (lack of audience segmentation; limiting the focus to generating knowledge) Colorado’s Good-To-Know campaign rates well when assessed against specific criteria for effective drug communication campaigns as well as its own goals. Conclusions: We conclude that although there were minor limitations to this campaign, policy makers and activists should think proactively about messaging content in states where legalization is imminent. And that more research on legal drug use messaging needs to occur.

State variation in marijuana use among U.S. adults with cancer.

e24064 Background: The number of cancer survivors in the United States (U.S.) is projected to exceed 20 million by 2024. More and more U.S. states are legalizing marijuana use for both recreational and medicinal purposes. This study estimated the prevalence of marijuana use by state among adult cancer survivors. Methods: U.S nationally representative, cross-sectional data from the 2018-2019 Behavioral Risk Factor Surveillance System Survey (BRFSS) Marijuana Use module were used. A total of 13,174 cancer survivors in 17 states was included. Analyses were weighted to account for BRFSS’s complex survey design with results generalizable to 5.7 million cancer survivors. The outcome variable was marijuana use in the past 30 days. Weighted prevalence estimates were computed. Weighted, multivariable logistic regression model estimated the association between state and marijuana use, adjusting for sociodemographic, health, and healthcare factors. Analyses were performed in January 2021. Results: The prevalence of past-month marijuana use among adult cancer survivors in these states was 9.2%. States varied widely in terms of the prevalence of marijuana use. Marijuana use was higher among those who resided in Guam (15.9%), followed by New Hampshire (13.1%), and lowest for those in Puerto Rico (3.3%) ( p&lt; 0.0001). In the adjusted models, compared with the adult cancer survivors residing in California, those living in Maryland, Minnesota, North Dakota, Ohio, South Carolina, Tennessee, Utah, West Virginia, and Wyoming were significantly less likely to use marijuana. Conclusions: Nearly 9% of adult cancer survivors used marijuana, and those who resided in Guam, New Hampshire, Florida, and California are at higher risk for marijuana use. Given the increasing number of cancer survivors and the proliferation of marijuana legalization, identifying high-risk cancer survivors for marijuana use and informing physicians and patients about safe uses and doses and the potential adverse effects of marijuana use is critical.

Marijuana use among US adults with cancer: Findings from the 2018-2019 Behavioral Risk Factor Surveillance System.

12088 Background: Cancer survivors experiencing adverse effects from their cancer and treatment report decreased symptom burden with marijuana use. An increasing number of U.S. states have legalized marijuana use for both medical and recreational purposes. This study aimed to assess the prevalence of current marijuana use and to identify the factors associated with its use among US adults with cancer living in 17 U.S. states and territories. Methods: Data from the 2018-2019 Behavioral Risk Factor Surveillance System Marijuana Use module were analyzed. In 2018, 13 states (California, Florida, Idaho, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Ohio, South Carolina, Tennessee, West Virginia, and Wyoming) and 2 territories (Guam and Puerto Rico) participated in the optional marijuana use module. In 2019, 12 states (California, Idaho, Illinois, Maryland, Minnesota, New Hampshire, North Dakota, South Carolina, Tennessee, Utah, West Virginia, and Wyoming) and 1 territory (Guam) participated in the optional marijuana use module. The analytic sample included 13,174 adults with cancer. The analysis was weighted to account for BRFSS’s complex survey design. The primary outcome was current marijuana use (in the past 30-days). Multivariable logistic regression was used to identify demographic, socioeconomic, clinical, and behavioral factors associated with marijuana use among US adults with cancer. Results: Overall, 9.2% of adult cancer survivors (n = 13,174; weighted 5.7 million; 37.9% men) reported marijuana recently current use, 51.3% of whom used it for medical reasons only, with 65.2% reporting smoking as the main method of administration. Adult cancer survivors were significantly more like to use marijuana if they were younger (odds ratio [OR] for 55-64 versus 18-44 years old: 0.60; 95% CI: 0.38-0.93; P &lt; 0.01); male (OR for female versus male: 0.65; 95% CI: 0.48-0.87; P &lt; 0.01); non-Hispanic Black race/ethnicity (OR: 2.00; 95% CI: 1.21-3.33; P &lt; 0.01); having depression (OR: 1.58; 95% CI: 1.17-2.14; P &lt; 0.01) and current (OR: 3.23; 95% CI: 2.20-4.74; P &lt; 0.01) or former tobacco smoker (OR: 2.40; 95% CI: 1.70-3.38; P &lt; 0.01) and binge drinker (OR: 2.25; 95% CI: 1.53-3.29; P &lt; 0.01). Conclusions: Among a large cohort of US adults with cancer, marijuana use was commonly reported and certain subgroups were at higher risk for marijuana use. Health professionals should identify the risk factors for elevated marijuana use, especially as more states legalize medical and recreational marijuana use despite uncertain health risks.

Endosomal CB1 stimulates neuronal differentiation of Neuro‐2A cells

In recent years many states have legalized marijuana use for medical and recreational purposes, which emphasizes the need to better understand the actions of this chemical on the human cells. The main psycho-active component of marijuana, Δ9-tetrahydrocannabinol (THC), exerts its biological effects through two receptors named cannabinoid type-1 receptor (CB1R) and cannabinoid type-2 receptor (CB2R). Both receptors belong to one of the largest families of proteins from human genome, named G protein-coupled receptors (GPCR), which has over 700 members and represents the target for about 30% of the therapeutic agents available today. CB1R is the main receptor in the central nervous system and this receptor stimulation is responsible for the behavioral responses observed after marijuana use. In contrast to the majority of GPCRs which are localized exclusively at the plasma membrane (cell surface), CB1 is present not only at the plasma membrane but also in the endosomes. The subcellular localization of this receptor is under the control of Rab5 GTP-ase, which stimulates its traffic from the plasma membrane to the endosomes and Rab4 GTP-ase, which has an opposite effect. Noteworthy, cannabinoid-like molecules as THC, due to their high lipophilicity may activate both plasma membrane and endosomal CB1R. CB1R stimulation has been shown to stimulate neuronal differentiation of different neuroblastoma cell lines, but the pool of receptors involved in this effect remains unknown. To answer this question, in the present work we manipulate Rab5 GTP-ase cellular levels by transfection in Neuro-2A cells. We found that in control Neuro-2A cells, CP55,940 (100 nM, a CB1R agonist) increased the number of differentiated cells to 259.18 ± 17.62 % compared to control . Rab5 GTP-ase transfection alone enhanced the number of differentiated cells to 171.42 ± 10.28 %, and these effects were further augmented by treatment with CP55,940 to 455.10 ± 27.82 % (p<0.05 from three independent transfections. Our preliminary data that CB1 receptors with endosomal localization are more important in stimulation of neuronal differentiation.

Demand curve analysis of marijuana use among persons living with HIV

BackgroundDespite medicalization and legalization of marijuana use, factors influencing demand for marijuana among persons living with HIV (PLWH) are incompletely understood. This knowledge gap undermines effective clinical management and policies. This study used demand curve simulation methods to address these issues. MethodsMarijuana-using PLWH (N = 119) completed experimental tasks to simulate amount of marijuana purchasing/use across different costs (money or time), and likelihood of reselling marijuana or marijuana therapeutic-use registration card in relation to profits. Additional simulations assessed purchasing of marijuana relative to other drug and non-drug goods. ResultsSimulated marijuana use decreased as money and time costs increased. Consumption was greater for participants with more severe Cannabis Use Disorder (CUD) and anxiety, intermediate pain levels, and past 90-day opioid use. Whereas few participants chose to sell their registration card, marijuana resale (diversion) steeply increased with profit. Likelihood of seeking marijuana therapeutic-use certification decreased in relation to registration card money cost, having to visit more physicians to get a signature, and delay to receiving the card, and increased with duration of certification. Participants who reported recent opioid use were more likely to seek certification. Consumption of several commodities assessed was independent of marijuana. ConclusionsSimulated marijuana use was related to participants’ clinical profile (CUD, anxiety and pain symptoms, recent opioid use), and unrelated to purchasing other goods. Likelihood of seeking marijuana therapeutic-use registration was affected by several types of costs and recent opioid use. Participants were unlikely to divert registration cards. We discuss clinical and policy implications of these findings.

Marijuana: A systems-based primer of adverse effects associated with use and an overview of its therapeutic utility.

Marijuana use is on the rise in the United States. By the end of 2019, 33 states have legalized marijuana use and marijuana byproduct use for medical purposes. However, marijuana use does not come without side effects. This manuscript reviews the increasing usage of marijuana and the different forms (natural and synthetic) that patients may use when presenting to clinicians. It also addresses the biochemical and behavioral changes observed with marijuana use, including the location and changes associated with cannabinoid receptors (abbreviated CB1 and CB2). These two topics lead into an extensive review of the side effects of marijuana use. This manuscript discusses gastrointestinal side-effects, such as Cannabinoid Hyperemesis Syndrome, pancreatitis, and hepatotoxicity. It also briefly reviews cardiovascular, neurologic, and pulmonary side effects. This article provides an overview of therapeutic effects of marijuana including the antiemetic effect, its medical utility as an appetite stimulant, and usefulness in cancer patients post-chemotherapy. A thorough social history pertaining to marijuana use is an important consideration for clinicians in patients presenting with a variety of symptoms, including those effecting the gastrointestinal, cardiovascular, pulmonary, or neurologic systems.

Marijuana use among cancer survivors: Quantifying prevalence and identifying predictors

IntroductionMore and more U.S. states are legalizing marijuana use for both recreational and medical purposes. This study estimated the prevalence of current marijuana use and identified its individual-level predictors among adult cancer survivors (CS) living in 15 U.S. states and territories. MethodsU.S. nationally representative, cross-sectional data from the 2018 Behavioral Risk Factor Surveillance System Survey (BRFSS) Marijuana Use module were used. A total of 9325 CS was included. Analyses were weighted to account for BRFSS’s complex survey design with results generalizable to 4.02 million CS. The outcome was current (past 30-day) marijuana use. Weighted prevalence estimates were computed. Multivariable logistic regression examined individual-level demographic, socio-economic, clinical, and behavioral predictors associated with marijuana use. ResultsWeighted analysis indicated that 9.2% reported current marijuana use, 50.5% of which used it for medical reasons with smoking being the main method of administration, 71.3%. Among racial/ethnic groups, non-Hispanic blacks had the highest prevalence of marijuana use (18.6%). The prevalence of current marijuana use decreased with age (P < .001). CS were more likely to use marijuana if they were male, non-Hispanic black (versus non-Hispanic whites), not married, uninsured, current and former tobacco smoker, binge drinker, ever having depressive disorder, and those who had fair/poor health. ConclusionsMarijuana use is prevalent among CS and certain subgroups are at higher risk for marijuana use. With the proliferation of marijuana legalization, identifying high-risk CS for marijuana use and informing them about its risks and safety is critical.

Effects of Recreational Marijuana Legalization on College Students: A Longitudinal Study of Attitudes, Intentions, and Use Behaviors

PurposeAs legal recreational marijuana use expands rapidly across the U.S., there is growing concern that this will lead to higher rates of use among college-aged young adults. Given the limited research addressing this issue, a longitudinal study was conducted to evaluate the effects of legalizing recreational use on the attitudes, intentions, and marijuana use behaviors of college students in two different legalization contexts, Washington State and Wisconsin. MethodsSurvey data assessing marijuana attitudes, intentions, and use behavior were collected from 2011 to 2016 on a longitudinal cohort of 338 students at two large public universities in Washington and Wisconsin. Time series analyses were conducted to evaluate postlegalization changes in ever use, 28-day use, and mean attitude and intention-to-use scores in Washington state, using Wisconsin participants as the control group. ResultsEver use, attitude, and intention-to-use scores did not change significantly more in Washington after legalization than in Wisconsin. However, among prior users, the proportion using in the last 28 days rose faster in Washington after legalization that it did in Wisconsin (p < .001). ConclusionsThe findings suggest that legalization had the greatest effects on current marijuana users, who are surrounded by a climate that is increasingly supportive of its use.

Marijuana legalization and historical trends in marijuana use among US residents aged 12\u201325: results from the 1979\u20132016 National Survey on drug use and health

BackgroundMarijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization.MethodData (n = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model.ResultsAfter controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003.ConclusionThe model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Present Conditions of Marijuana Regulation in USA: Medical and Recreational Use

In most countries marijuana is regulated by the Single Convention on Narcotic Drugs. In Japan marijuana use is illegal under the Marijuana Control Law. In USA, marijuana is also classified as a schedule I drug, which is the most stringent regulation category under federal law. On the other hand, California became the first state to legalize marijuana for medical uses in 1996. Since then, several other US states have approved marijuana for medical or recreational use. However, marijuana remains completely illegal in most states, while some allow only cannabidiol (CBD) extracted from marijuana for medical use. In June 2018, the US Food and Drug Administration approved Epidiolex, the first marijuana-derived drug, containing purified CBD, to treat certain rare childhood seizure syndromes. Therefore the situation surrounding control of marijuana in USA is complex. Recently, a definite trend toward reconsidering marijuana regulation has been seen around the world, which could have a major impact on marijuana policy in Japan. In this review, we investigated existing medical and recreational marijuana laws in various US states, with a focus on California, which approved recreational use in 2018. Here, we describe the current state of marijuana regulation in terms of both medical and recreational use. In addition, we discuss public safety issues associated with marijuana, including crime, traffic accidents, and emergency department visits from possible marijuana exposure, as well as generated tax revenues, from official marijuana-related reports in Colorado, which legalized marijuana use in 2012.

An Ethical Framework to Manage Patient Requests for Medical Marijuana.

An increasing number of states are legalizing marijuana use for medicinal purposes despite marijuana use remaining criminalized at the federal level and continued Schedule I status by the US Food and Drug Administration. Many of those states in which medical marijuana is legal require physician involvement to facilitate patient access. In addition, physicians may have ethical objections to medical marijuana use or may not believe there is adequate scientific evidence to support its use. The constellation of these factors creates an ethical quandary for physicians when approached by patients for assistance in accessing medical marijuana. This article provides an ethical framework that provides guidance to physicians in managing these patient requests taking into consideration the above ethically relevant factors.