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Oregon recriminalizes hard drugs, ending state’s drug experiment.

Most Americans want legal pot. Here's why feds are taking so long to change old rules.

Marijuana remains in an odd legal limbo in the United States , and there's one organization at the center of it: the Drug Enforcement Administration.

The DEA has for decades held that marijuana is among the most dangerous, highly addictive drugs and has no medical value, despite growing state laws, medical evidence and popular opinion to the contrary. The result: Pot is widely available in some states, heavily criminalized in others − and technically federally illegal everywhere.

The confusion could be cleared up by Congress or the courts intervening, said Carmel Shachar, Harvard School of Law professor and faculty director at the university's Health Law and Policy Clinic. But in the absence of bold congressional action on marijuana, experts and advocates are looking to the DEA to make the next move to change the nation's position on pot .

While many states and physicians have recognized marijuana's potential medical benefits, there are still health risks associated with the substance under study, including a possible increase in risk of heart failure and heart attack. The potency and lack of regulation around marijuana has also led to concerns .

Meanwhile, President Joe Biden has said he's one of the people who disagrees with the DEA's categorization of marijuana . He called for a review in 2022, kicking off a bureaucratic slog that could soon change the status quo. Here's what to know:

The DEA classifies drugs and says pot is the worst kind

The DEA says marijuana is classified as a "Schedule I" drug under the Controlled Substances Act, alongside heroin, LSD and ecstasy.

The statute classifies drugs from Schedule I to Schedule V based on their potential for abuse, addictiveness and medical use. Schedule I drugs have "high potential for abuse and the potential to create severe psychological and/or physical dependence" and "no currently accepted medical use," the DEA says.

Shachar said, "Cocaine, morphine, and methamphetamines are all Schedule II, meaning they have been determined to have some medical value. It feels very strange to have marijuana be more restricted than these substances."

Putting marijuana in Schedule I also places huge obstacles in the way of doing the kind of research that would be needed to prove there are medical uses, according to Heather Trela, director of operations and a fellow at the Rockefeller Institute of Government out of the State University of New York.

Health risks: Is marijuana more harmful to your lungs than cigarettes? A study suggests it may be.

That has created a feedback loop: It's hard to study pot to prove its medical value, because the federal government says it has no medical value.

Why is pot classified as the most dangerous? No good reason, experts say.

Marijuana has been a Schedule I drug since the statute took effect in 1971, "with very little medical or scientific evidence to demonstrate why it had to be Schedule I," Shachar said.

At the time, it had more to do with "who uses the drug than the drug itself," Trela said.

It was under President Richard Nixon that marijuana was added to the list under the most restricted category – first only provisionally until more of the science could be settled, Trela said.

Yet even when a commission formed by Nixon determined weed shouldn't be criminalized, it remained in Schedule I. Trela said Nixon knew marijuana was a "drug associated with the anti-war protesters, hippies and people of color – none of whom were fans of President Nixon and his agenda."

A top adviser to Nixon, John Ehrlichman, said as much in an interview in 1994 that was published by Harper's Magazine in 2016 : "Did we know we were lying about the drugs? Of course we did."

What could happen next? Will the DEA change its mind?

The next expected development is considered a small step, advocates say: The DEA is considering reclassifying marijuana as a lower-level controlled substance, but that wouldn't make it legal.

"It's a step in the right direction but, in terms of its practical direction, it's really more symbolic," said Morgan Fox, political director for the National Organization for the Reform of Marijuana Laws, the country's oldest cannabis legalization advocacy group.

In 2022, Biden asked the Department of Health and Human Services to review of how marijuana is classified. Last year, HHS recommended that cannabis be rescheduled as a Schedule III substance, like ketamine, testosterone, anabolic steroids or Tylenol with codeine.

If marijuana is placed on Schedule III instead, it would mean it could be legally prescribed by licensed health care providers and dispensed at licensed pharmacies. It also could help resolve a massive federal tax burden that has been placed on cannabis companies.

"It partially sends a signal that the federal government doesn't think cannabis is the worst of the worst drugs. 'Not as bad as heroin' − that's a good thing for the government to say," said Jay Wexler, a law professor at Boston University who wrote the book "Weed Rules: Blazing the Way to a Just and Joyful Marijuana Policy."

But practically, rescheduling wouldn't have much of an effect on state cannabis programs at all, Wexler said, and "everything states are doing is still a violation of federal law, and anybody who's selling, buying, processing, growing cannabis under these state programs is still in violation of federal law even if it's rescheduled."

The DEA did not give a time frame for if or when an announcement on rescheduling might come when reached by USA TODAY on Wednesday.

What would it take to make marijuana fully legal in the US?

To eliminate the stark conflict between state and federal laws, marijuana would need to be removed from the Controlled Substances Act list altogether. Experts say there's a chance that could happen eventually, but it's still a long way off.

"I think it's going to take time, but I think we will get there," Trela said.

Just as alcohol and tobacco are not considered controlled substances but are regulated by the federal government and by states, descheduling cannabis could have a similar effect, Wexler said.

A group of Democratic senators – plus Bernie Sanders, who is an independent but joins with Democrats on major issues – wrote a letter to Attorney General Merrick Garland and DEA Administrator Anne Milgram last month urging the descheduling of marijuana.

What's taking so long?

Public support for the legalization of marijuana is at an all-time high, national polling has shown. A Gallup poll in the fall found 70% of Americans support legal weed. In 2022, Pew Research Center found just 10% of Americans believe it should be completely illegal. Thirty percent support medical use only, and 59% supported legalization for medical and recreational use.

That public support has been bumped by Americans seeing firsthand through loved ones and news stories that marijuana can have medical benefits for people with illnesses who can't get relief otherwise, Wexler said.

"Why doesn't that translate into clear political outcomes to deschedule cannabis? I don’t know," Wexler said.

Experts said a combination of factors may be at play, including a desire to move toward full legalization incrementally. Legalization is also up against a number of top-line priorities, and support from the public and lawmakers is not uniform, Trela said.

"There is still a perception by many and belief that this is not where we should be going; the government should not be encouraging drug use, in their minds," Trela said. "We're not that far removed from the stigma of marijuana."

Advocates hope weed will be removed from the Controlled Substances Act altogether someday, but it doesn't look as if marijuana will be legalized on the federal level anytime soon.

Said Wexler, "Rescheduling is a step forward, but it is not nearly enough. And there's no reason to keep cannabis in the Controlled Substances Act."

Biden, at risk with young voters, is racing to shift marijuana policy

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Vice President Kamala Harris looked up from prepared remarks in the White House’s ornate Roosevelt Room this month to make sure the reporters there could hear her clearly: “Nobody should have to go to jail for smoking weed.”

Harris’ “marijuana reform roundtable” was a striking reminder of how the politics have shifted for a onetime prosecutor raised in the “Just Say No” era of zero-tolerance drug enforcement. As President Biden seeks badly needed support from young people, his administration is banking on cannabis policy as a potential draw.

Biden made similar comments to Harris’ in this month’s State of the Union address — though the 81-year-old president used the term “marijuana” instead of “weed.” The administration is highlighting its decision to grant clemency for pot possession as it races to have cannabis reclassified under the Controlled Substances Act before Biden faces voters in November.

“What’s good about this issue is it’s clean and it’s clear and it cuts through,” said Celinda Lake, one of Biden’s 2020 pollsters who works for the Coalition for Cannabis Scheduling Reform , an industry group, along with Democratic organizations supporting Biden’s reelection. “And it’s hard to get voters’ attention in this cynical environment.”

The challenge is significant. Biden is viewed favorably by only 31% of people ages 18 through 29, much worse than he fares with other age groups, according to a recent Economist/YouGov poll. Though he leads former President Trump by 21 percentage points in that age group, he needs a high turnout to repeat his 2020 formula. Biden’s age probably has played a role in alienating a group that is both essential for Democrats and historically harder to galvanize than older voters, who more consistently show up at the polls.

World & Nation

U.S. regulators might change how they classify marijuana. Here’s what that would mean

When it emerged this week that U.S. health regulators are suggesting that the federal government loosen restrictions on marijuana, the news lit up the world of weed.

Sept. 1, 2023

What’s more, the biggest step Biden is taking is incremental and not in his full control. The president wants regulators to move marijuana from a Schedule I classification under the Controlled Substances Act — the most restrictive category of drugs that also includes heroin — to Schedule III, a still highly regulated group of drugs that includes anabolic steroids.

That decision is now under review by the Drug Enforcement Administration, which has historically resisted looser drug laws and usually taken many years to review such rule changes within the law, which was signed in 1970.

Even if the DEA agrees, it will not mean marijuana is legal at the national level, something that frustrates some cannabis advocates.

MedMen’s fall shows the difficulties of the legal weed business

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“In the year 2024, it’s fair to expect more from a Democratic president,” said Matthew Schweich, executive director of the Marijuana Policy Project, a nonprofit trying to loosen laws at the local, state and federal levels.

Schweich said he worries about Trump returning to office but believes Biden has done the “absolute bare minimum,” missing a political opportunity to push for legalization in Congress and to advocate for the complete removal of marijuana from the controlled substances list, which Sen. Alex Padilla (D-Calif.) and 11 other Democratic senators urged in a January letter to the DEA.

Trump, whose administration threatened federal enforcement against localities and states that had legalized marijuana, is unlikely to attract support from legalization advocates.

Polling that Lake has done for the industry shows even the incremental step Biden is seeking could boost his approval by as much as 9 percentage points with younger voters in battleground states. But it’s hardly certain how that would play out.

A campaign aide, who would speak only on condition of anonymity, said marijuana policy is one of a number of issues the campaign believes will motivate young people — important but not as prominent as top-tier concerns including college affordability, reproductive rights, the economy, climate and healthcare.

The campaign cautions against treating young people as a monolith, noting that they care about a variety of issues and tend to see connections among them. Democrats, through a variety of methods including social media influencers and a newly launched campus outreach program, are trying to make the broader case to young people that Biden is fighting for equity and change while Trump is looking backward.

They note that young voters proved critical not only in Biden’s 2020 election but also in the 2022 midterm elections, when concerns over democracy and abortion rights helped Democrats perform better than expected.

Overall support for legalization is now at 70%, the highest recorded by Gallup, which began polling the question in 1969, when just 12% of Americans favored legalizing marijuana. The substance is legal in 24 states and Washington, D.C., for adults, and a total of 38 have made it legal for medical use, according to the National Organization for the Reform of Marijuana Laws, a legalization advocacy group.

The administration has pitched its marijuana agenda as part of its broader efforts to change other criminal sentencing laws and to improve job and business opportunities for people who have spent time in jail or prison.

Lake argues the two efforts combined could help Biden with Black men, another group with which he has lost support since winning election in 2020.

Padilla said he still gets asked about marijuana regulations regularly, even though California was the first state to pass a medical-use law in 1996. “It resonates with a lot of people,” he said.

In practical terms, reclassifying marijuana changes little. Federal penalties would remain the same, though the Justice Department has for decades treated most marijuana crimes as low-priority prosecutions. It would remain illegal to transport pot across state lines, meaning access to banks and financial markets will remain a hurdle, even for companies operating in states that have legalized pot.

The biggest difference is that scientists and doctors could more easily study the drug for medical uses, something that is now practically banned. Such a change could open the door for greater acceptance. It also would lower tax burdens for the industry in states where it is legal, by allowing deductions for ordinary business expenses that are currently prohibited by the Internal Revenue Service.

Other potential changes are less certain. Banks and credit card issuers, for instance, would not immediately lift restrictions on marijuana transactions, though that could come if regulators in the Treasury Department decide to take up the issue, according to Shane Pennington, an attorney specializing in the Controlled Substances Act who has industry clients.

Science & Medicine

Senators hail federal recommendation to ease restrictions on marijuana

The U.S. Department of Health and Human Services has delivered a recommendation to the Drug Enforcement Administration on marijuana policy, a first step toward easing federal restrictions on the drug.

Aug. 30, 2023

Biden proposed reviewing marijuana’s status in October 2022, a process that usually takes an average of more than nine years, Pennington said. The Department of Health and Human Services recommended Schedule III in August, the first step toward a change. A DEA spokesperson, in an email, said the agency would not discuss the issue while it is under review.

“It often takes a very long time, but we’re in unprecedented territory here” because the order came directly from the president, Pennington said.

Harris, in her roundtable discussion on marijuana reform, showed her impatience.

“I cannot emphasize enough that they need to get to it as quickly as possible, and we need to have a resolution based on their findings and their assessment,” she said.

The rushed nature of the process could expose the administration’s actions — which are almost certain to draw lawsuits — to further scrutiny.

Kevin A. Sabet, a former marijuana policy advisor in the Obama administration who heads an anti-legalization group, noted that Biden’s Health and Human Services Department released its preliminary recommendation at 4:20 p.m., slang for weed smoking time, underscoring the political nature of a normally button-down regulatory process. He argued that the decision was poorly crafted and could run afoul of U.S. treaty obligations.

But Sabet also agrees with advocates that Biden could have gone further.

“I think what the president wants to do is reap some of the benefits of the guy who’s embracing all this stuff without actually becoming in favor of legalization,” said Sabet, who heads the group Smart Approaches to Marijuana.

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Noah Bierman is an enterprise reporter focusing on clashes between red and blue states in the Washington bureau for the Los Angeles Times. He previously covered the White House and wrote for the paper’s national desk.

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No, a judge didn’t void all of New York’s legalized marijuana laws. He struck down some

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New York’s cannabis industry was unsettled Thursday by a judge’s ruling that appeared to strike down all regulations governing recreational marijuana in the state. But a key portion of the order turned out to be a mistake.

The Wednesday ruling was amended Thursday to reflect a much narrower decision after cannabis growers, sellers and other supporters voiced concerns about the implications.

The decision came in a lawsuit brought by Leafly, a cannabis sales website, which challenged the state’s rules barring marijuana dispensaries from advertising on third-party platforms.

State Supreme Court Justice Kevin Bryant, in a strongly worded decision, sided with Leafly in declaring the state’s rules were arbitrary, capricious and therefore unconstitutional.

His ruling initially appeared to void not just the marketing and advertising rules in question but the state’s entire regulatory regime for being “unconstitutionally vague.”

The decision was later amended to show that the judge voided the state rules dealing only with so-called third-party platforms such as Leafly that help marijuana companies market and promote their products.

By then, multiple news articles had appeared saying New York’s entire system for regulating marijuana had been thrown out, and an uproar had begun. State Sen. Jeremy Cooney, who chairs the Senate’s cannabis subcommittee, was among those who quickly denounced the decision.

“Today’s State Supreme Court decision was another setback in a series of blows New York’s adult-use cannabis market has faced since legalization, three years ago,” he wrote in a statement. “While some changes to marketing regulations are needed, the decision by the Court to throw out all agency regulations will ultimately slow progress at a time when we need to more aggressively combat illicit shops to grow a stronger, more-equitable legal market.”

A message was left with a spokesperson for the state court system seeking more information about the initial, mistaken ruling. The state Office of Cannabis Management said it is reviewing the corrected decision.

New York’s rollout of legalized marijuana has been defined by a slow licensing process, legal challenges, a proliferation of thousands of illicit shops and a lack of substantial regulatory enforcement.

The relatively paltry number of licensed shops has also led to complaints from marijuana farmers that there aren’t enough legal sellers to handle their crops. At the same time, authorities have been working to shut down illegal marijuana shops that have popped up all over the state, particularly in New York City, as unlicensed sellers fill the legal vacuum.

Meanwhile Leafly, the California company whose suit sparked the uproar, said it looks forward to supporting New York’s marijuana consumers and businesses following the ruling.

“It’s impossible to overstate the importance of providing consumers with choices, and educational information when making purchasing decisions,” the company said in a statement. “It is critically important that licensed-retailers have equal access to important advertising and marketing tools to help them succeed in a competitive landscape.”

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Journal of Cannabis Research

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The Journal of Cannabis Research  is an international, fully open access, peer-reviewed journal covering all topics pertaining to cannabis , including original research, perspectives, commentaries and protocols. Our goal is to provide an accessible outlet for expert interdisciplinary discourse on cannabis research.

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Journal of Cannabis Research is recruiting Associate Editors. As the growth of the journal continues, we are looking to expand our editorial team. If you have experience in any form of cannabis research, we would like to hear from you. Please follow the link below to find out more about the role and apply.

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The ICR is the first US multi-disciplinary cannabis research center at a regional, comprehensive institution. The primary goal of the ICR is to conduct or fund research related to cannabis and publicly disseminate the results of the research, which it does so in partnership with the Journal. It also advises other Colorado-based higher education institutions on the development of a cannabis-related curriculum and supports the translation of discoveries into innovative applications that improve lives. 

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March 1, 2024

Is Marijuana Bad for Health? Here’s What We Know So Far

Marijuana’s health impacts—good and bad—are coming into focus

By Jesse Greenspan

Cappi Thompson/Getty Images

With decades of legal and social opprobrium fading fast, marijuana has become an extremely popular commercial product with more than 48 million users across the U.S. Health concerns, once exaggerated, now often seem to be downplayed or overlooked. For example, pregnant patients “often tell me they had no idea there's any risk,” says University of Utah obstetrician Torri Metz, lead author of a recent paper in the Journal of the American Medical Association on cannabis and adverse pregnancy outcomes.

Fortunately, legal reforms are also gradually making it easier to study marijuana's health effects by giving U.S. scientists more access to the drug and a wider population of users to study. Although much research remains in “early stages,” the number of studies has finally been increasing, says Tiffany Sanchez, an environmental health scientist at Columbia University. As new results accumulate, they offer a long-overdue update on what science really knows about the drug.

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In addition to minor side effects that many users joke about—such as short-term memory loss—recent studies have linked marijuana to adverse health outcomes involving the lungs, heart, brain and gonads. For example, heavy marijuana consumption seems to increase the risk of clogged arteries and heart failure , and it may impact male fertility . Smoking weed likewise can lead to chronic bronchitis and other respiratory ailments (although, unlike tobacco, it hasn't been definitively tied to lung cancer). And cannabis plants hyperaccumulate metal pollutants, such as lead, which Sanchez found can enter users' bloodstreams .

Developing adolescent brains, particularly those predisposed to mental illness, may be most at risk from overconsumption. Although psychiatric effects are hotly debated , studies suggest that heavy weed use exacerbates—or may trigger— schizophrenia , psychosis and depression in youths and that it affects behavior and academic performance. “From a safety viewpoint, young people should definitely stay away from it,” says University of Ottawa psychiatrist Marco Solmi, lead author of a recent review of cannabis and health in the British Medical Journal .

24 states have legalized recreational marijuana, with 38 allowing medical use

Moreover, the drug can cross over to fetuses during pregnancy. Several studies have linked it to low birth weights , and researchers suspect it raises the likelihood of neonatal intensive care unit admissions and stillbirths . Some cannabis dispensaries have advertised their products as a cure for morning sickness, but Metz emphasizes that safer alternatives exist.

Of course, many adults use marijuana responsibly for pleasure and relaxation. Unlike with, say, opioids, there's effectively zero risk of life-threatening overdose. Plus, “people get addicted with tobacco way faster,” says Columbia University epidemiologist Silvia Martins, who studies substance use and related laws.

Cannabis, and its derivatives, also may help alleviate pain—although some researchers contend that it performs little better than a placebo . It may also decrease chemotherapy-induced nausea, calm epileptic seizures , ease the symptoms of multiple sclerosis and serve as a sleep aid .

Recent studies have hinted that the drug might slightly reduce opioid dependency rates, although this, too, is disputed . There's some evidence that weed users tend to be more empathetic , and researchers found that elderly mice get a mental boost from the drug. Still, experts caution against self-medicating: “You should ask your doctor,” Solmi says.

Some of the recent research into marijuana is more lighthearted. One study, for instance, found that, just like people, nematode worms dosed with cannabis get the munchies .

Marijuana use as little as once per month linked to higher risk of heart attack and stroke

Using marijuana as little as once per month is associated with a higher risk of both heart attack and stroke, according to a large study published Wednesday by researchers from Massachusetts General Hospital. The risks rose sharply the more frequently marijuana was used. 

The paper, which was published in the Journal of the American Heart Association, adds to the growing body of evidence suggesting marijuana may be harmful to the cardiovascular system. 

Scientists analyzed data on nearly 435,000 patients, ages 18 to 74, to see whether there was a link between marijuana use and a higher risk of heart disease, stroke or heart attack. The data came from a behavioral risk factor survey collected from 2016 to 2020 by the Centers for Disease Control and Prevention. 

Compared with people who had never used marijuana, daily cannabis users had 25% higher likelihood of heart attacks and 42% higher risk of strokes. People who used marijuana just once a week had a 3% increased likelihood of a heart attacks and 5% higher risk of strokes during the study time frame.

The study is among the largest to show a connection between marijuana use and cardiovascular health in people who don’t also smoke tobacco, said lead researcher Abra Jeffers, a data scientist at Massachusetts General Hospital. 

Nearly 75% of people in the study reported smoking as the most common way they got high. They also consumed edibles and vaped. The study did not specifically look at the risks of smoking marijuana compared to edibles.  

It’s unclear from the paper whether marijuana directly causes heart attacks and strokes or whether people who are already at risk are more likely to use it. 

Historically, some have dismissed studies looking at marijuana and heart problems because participants often use both tobacco and marijuana products, making it hard to determine which substance is really to blame, Jeffers said.

Robert Page, a clinical pharmacist who specializes in heart disease at the University of Colorado Skaggs School of Pharmacy, is worried about the emerging connections between marijuana consumption and the heart. Page was the lead author of a comprehensive statement on cannabis released by the American Heart Association in 2020.

“I think we’re beginning to see the same things we saw with smoking cigarettes back in the ’50s and ’60s — that this is a signal,” Page said. “I feel like we’re repeating history.”

Ultimately, it will take more rigorous studies to draw any firm conclusion, he said, which would involve following people for years and monitoring their marijuana use. That type of research is difficult to conduct because marijuana is still a Schedule 1 substance under the Controlled Substances Act. 

What if I just use marijuana occasionally? 

The new research found that the risks of heart attacks and strokes became higher the more days per month people used marijuana, which is called a “dose-response relationship.”

“If something is really bad or a toxin, you’d expect more of it to be worse,” said Dr. Deepak Bhatt, the director of Mount Sinai Fuster Heart Hospital in New York, who was not involved with the research. “The fact that there’s a dose response makes it seem like it probably is, in fact, the cannabis that is causing the bad outcome.”

The president of the American Heart Association, Dr. Joseph Wu, the director of the Stanford Cardiovascular Institute, drew a comparison to other common substances. 

“It’s the same dose response as somebody who smoked tobacco or as somebody who drinks alcohol,” he said. “The more you drink, the more problems you are going to have, because these are toxins.”

Ultimately, the researchers concluded that the people who really should be avoiding marijuana smoking altogether are those with pre-existing heart disease, estimated at 1 in 20 Americans. 

That marijuana is associated with heart problems is a very urgent message for Americans to be aware of, Wu said, as 1 in 5 people over age 12 now report having used marijuana in the last year, according to the National Survey on Drug Use and Health . 

“Just because something’s been legalized doesn’t mean it’s safe,” he said.

Are edibles safer?

Smoking was the most common way cannabis was consumed in the new paper, although edibles are not necessarily safe, either.

“If you force me to answer I would say not smoking is a better way of consuming it,” Bhatt said. “When you smoke things, that makes them more toxic, but that doesn’t mean that we can say it’s definitely safe to consume it as an edible.”

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Laboratory studies have shown that THC, the psychoactive ingredient in marijuana, can cause an increase in inflammation in the blood vessels, so edibles aren’t necessarily risk-free, Wu said.

“If you’re smoking marijuana it’s probably doing double the damage compared to just using edibles,” Wu said. “When you eat the edible, the THC goes into your body and can cause vascular inflammation. Whereas when you smoke, there is damage from the particulate matter and then the THC gets absorbed into your body, as well.” 

It’s not yet known why smoking marijuana affects the cardiovascular system, but there are a few possibilities, Bhatt said.  

A phenomenon called oxidative stress, an imbalance between free radicals and antioxidants in the body, can cause inflammation and damage to blood vessels. Other reasons could include marijuana’s triggering abnormal heart rhythms or even activating platelets, cells in the body that can make blood more likely to clot, leading to a heart attack or stroke. 

Should young healthy people be concerned?

The paper found that among younger adults, defined as men younger than 55 and women younger than 65, cannabis use was significantly associated with 36% higher combined odds of coronary heart disease, heart attack and stroke, regardless of whether or not they also used traditional tobacco products. 

“I’ve seen it through the years with clinical practice many times where sometimes we bang our heads thinking, ‘Why [is] this person in their 20s, or 30s or 40s [coming] in with a heart attack?” Bhatt said. While it can often be attributed to things like extremely high cholesterol or cocaine use, he said, sometimes there’s only one factor they have in common. 

“The only thing I can find after asking and asking again and again in terms of potential risk factors is marijuana,” he said. “So the smart thing to do would be not to smoke marijuana, but I realize it’s extremely popular and that’s advice that may not be well received by all.”

Akshay Syal, M.D., is a medical fellow with the NBC News Health and Medical Unit. 

Marijuana | Let Florida voters decide if recreational…

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Marijuana | Let Florida voters decide if recreational marijuana should be legal, state Supreme Court rules

Florida could become yet another state to legalize recreational marijuana after the state Supreme Court determined Monday that the question should go before the voters in November.

If approved with 60% of the vote, the constitutional amendment would allow adults 21 or older to “possess, purchase, or use” up to 3 ounces of marijuana products, as well as legalize marijuana accessories.

It would also allow medical marijuana treatment centers and other state-licensed businesses to “acquire, cultivate, process, manufacture, sell, and distribute such products and accessories.”

The approval comes two years after the court ruled a similar marijuana measure was misleading and struck it from the 2022 ballot.

This time, the Court ruled 5-2 that the amendment had a singular purpose and clear language.

Read the Florida Supreme Court’s decision to allow voters to decide on marijuana legalization

Republican Attorney General Ashley Moody had opposed the measure, arguing it shouldn’t be put on the ballot because it would be misleading to voters as it doesn’t make clear marijuana is illegal under federal law.

Justices rejected that argument, along with the idea that voters would think the amendment would allow companies to “immediately enter the cannabis market” without a license.

The two dissenters, Justices Renatha Francis and Meredith Sasso, were Gov. Ron DeSantis’ two most recent appointees to the bench. Three other DeSantis appointees voted to allow the ballot measure.

The amendment was backed by Trulieve, the state’s largest medical marijuana producer, which put about $40 million into the campaign to get it on the ballot.

“We look forward to supporting this campaign as it heads to the ballot this fall,” Trulieve CEO Kim Rivers said in a statement, adding the company will also be a strong backer of “the next important phase to educate Floridians on the amendment and secure a yes vote on Amendment 3 this November.”

DeSantis has said he opposes legalization, adding that he doesn’t like the “pungent odor” of marijuana in public spaces. He warned the ballot initiative’s language is too broad to control the smell, but supporters say it allows the Florida Legislature to put limits on outdoor consumption.

Following the ruling, Republican Florida House Speaker Paul Renner also said Monday he didn’t see a “critical need” for legalizing recreational marijuana.

“It looks innocuous,” he said. “But then you start asking yourself, ‘Can you smoke on a child’s playground? Can you smoke in an elevator?’ … The marijuana amendment is overly broad to serve the self interest of those that are going to grow it and make billions and billions of dollars off of it.”

The justices wrote, however, that the amendment “leaves untouched the Department of Health’s existing authority to ‘issue reasonable regulations …'”

The effect the amendment will have on turnout for the general election is unclear.

“This would be coming up in the context of a presidential election,” said Gregory Koger, a professor of political science. “We were already expecting voter turnout to be high, above 60%. That being said, this initiative could bring additional voters to the polls who are more interested in increasing access to marijuana than voting for either one of the two candidates.”

Recreational pot is fully legal in 24 of the 50 states, with 13 others, including Florida, having legalized medicinal marijuana. Five states have decriminalized pot.

A Gallup poll from November showed 68% of Americans thought marijuana should be legal.

In Florida, where medicinal pot was legalized in 2016 with 71% of the vote, a University of North Florida poll from November found that 67% said they would vote for the recreational marijuana amendment.

A Florida Chamber of Commerce poll, meanwhile, found only 57% of Florida voters supported the amendment, which would not be enough to meet the 60% threshold for passage.

“The national Gallup poll has got 52% of conservatives supporting legal marijuana,” Koger said. “It’s splitting them in half. … It sort of puts the Republican Party in an interesting position. I imagine there would be some degree of tension on this issue. So I’m intrigued to see how they manage that conflict.”

For Democrats, the impact on turnout could be less than in a lower-turnout midterm year but still noticeable, said Daniel A. Smith, political science chair at the University of Florida

“Democrats should benefit,” Smith said. “Democratic positions are aligned … and voters should be able to make an easy connection between the candidates with a D next to their name and their support for these measures.”

The state justices on Monday also ruled on a proposed amendment to allow abortion access , saying voters in November would be able to determine its future in Florida. At the same time, the court upheld the 15-week ban on abortions, thus enabling a six-week ban to go into effect 30 days after this ruling.

Future Florida Leaders, a progressive young-voter organization, wasted no time in announcing Monday it would immediately start distributing “College Democrats-branded condoms and rolling papers” on college campuses. The goal would be to raise awareness of the marijuana and abortion rights amendment.

But the pot referendum might allow Republicans “to have their cake and eat it too,” Smith said.

“There are certainly a lot of folks in this state who have their medical marijuana card but are also MAGA supporters,” Smith said. “Those hard-core Trump supporters are not going to be thinking about this issue as aligning their position with the Democratic Party. That’s just not going to happen.”

Matt Isbell, a Democratic elections analyst who runs the MCIMaps site, said the effect on turnout for Democrats “really depends on the campaign.”

“I don’t think that by itself, it’s automatically going to have a super-notably statistical change,” Isbell said. “… The only way it’s going to have a real effect is if there’s a heavy campaign about it.”

He cited the 2014 medical marijuana initiative, which largely was detached from the governor’s race that year and did not boost turnout among Democrats. That measure failed, while a better-organized measure passed two years later.

David Jolly, a former Republican Congress member from St. Petersburg and co-founder of the Forward Party, said that much of the public has started to tune out marijuana opponents after their worst-case scenario predictions for medicinal marijuana haven’t panned out.

“We haven’t seen those negative consequences of it as a society,” Jolly said. “And I think that’s one of the reasons you see such broad support for [recreational use] now.”

John Morgan, head of the Orlando law firm Morgan & Morgan, who spearheaded the 2016 medicinal pot amendment, also said he believed the recreational measure would get widespread support.

“It’s bipartisan now,” Morgan said. “Only a few very old white men are still against it, and they don’t know why.”

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Recreational weed will be on Florida’s 2024 ballot, Supreme Court rules

• Kirby Wilson Times staff
• Romy Ellenbogen Times staff

Floridians will vote on recreational marijuana in November after the Florida Supreme Court signed off Monday on ballot language for a proposed constitutional amendment.

The amendment would permit nonmedical marijuana use and would remove criminal or civil penalties for adults over 21 who possess and use up to 3 ounces of pot for personal use. At least 60% of Floridians must approve it to become law. Florida voters passed the state’s medical marijuana statute with 71% of the vote in 2016.

Florida Attorney General Ashley Moody had challenged the proposed amendment, arguing the ballot summary would mislead voters because it states that marijuana would be legal when it is illegal federally.

But in a 5-2 decision, the conservative Supreme Court ruled that the language wasn’t misleading.

The ballot initiative’s summary “clearly states that the amendment legalizes adult personal possession and use of marijuana as a matter of Florida law,” wrote the court’s majority, which included justices Charles Canady, Jorge Labarga and John Couriel.

Joining the majority were Carlos Muñiz and Jamie Grosshans, who filed their own opinions.

Justices telegraphed part of the ruling during arguments over the amendment in November . Canady said then he was “baffled” by the state’s argument about the language being misleading, and other justices were similarly skeptical of the state’s push against the amendment.

However, Justices Renatha Francis and Meredith Sasso wrote in separate dissenting opinions published Monday that they agreed the language would be misleading.

Gov. Ron DeSantis appointed five justices — Couriel, Francis, Grosshans, Muñiz and Sasso — now on the court.

More than 1 million Florida voters have signed petitions in support of the recreational marijuana initiative led by the group Smart & Safe Florida. The Marijuana company Trulieve is almost solely responsible for the nearly $40 million the group had raised as of the end of December.

“We are thankful that the Court has correctly ruled the ballot initiative and summary language meets the standards for single subject and clarity. We look forward to supporting this campaign as it heads to the ballot this Fall,” Trulieve CEO Kim Rivers said in a statement Monday.

Moody criticized Trulieve in an August brief, writing, “In its pursuit of a larger customer base and greater profits, Trulieve has invited millions of Floridians to join it in reckless violation of federal criminal law.”

DeSantis has also opposed the amendment. In March, he said that the amendment was “incredibly broad” and said that people being able to smoke pot anywhere could pose a quality of life issue.

“If you’re saying you can’t regulate it or you can’t limit it, which that’s how I read that, that could be a big problem,” he said.

John Bash, an attorney for the group sponsoring the amendment, said the amendment has language that would allow the Legislature to limit public consumption just like Florida does for tobacco.

Twenty-four states allow the use of recreational marijuana, including Ohio, whose voters approved it with 57% in favor last year.

If voters support the Florida amendment, it will go into effect six months after the election. At that point, Floridians who are 21 and older would be able to purchase marijuana products at already existing and licensed medical marijuana distributors. Florida currently has 25 qualified treatment centers that operate more than 600 dispensaries statewide.

The amendment would also open the door for the Florida Legislature to license other entities that aren’t medical marijuana treatment centers to cultivate, process, sell and distribute marijuana products.

Kirby Wilson is a politics reporter, covering the leaders of Florida and explaining the political landscape. Reach him at [email protected].

Romy Ellenbogen is a Tallahassee correspondent, covering state government with a focus on criminal justice and health. Reach her at [email protected].

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Medical Marijuana and Marijuana Legalization

Rosalie liccardo pacula.

1 RAND Corporation, Santa Monica, California 90407; gro.dnar@alucap , gro.dnar@tramsr

2 National Bureau of Economic Research, Cambridge, Massachusetts 02138

Rosanna Smart

State-level marijuana liberalization policies have been evolving for the past five decades, and yet the overall scientific evidence of the impact of these policies is widely believed to be inconclusive. In this review we summarize some of the key limitations of the studies evaluating the effects of decriminalization and medical marijuana laws on marijuana use, highlighting their inconsistencies in terms of the heterogeneity of policies, the timing of the evaluations, and the measures of use being considered. We suggest that the heterogeneity in the responsiveness of different populations to particular laws is important for interpreting the mixed findings from the literature, and we highlight the limitations of the existing literature in providing clear insights into the probable effects of marijuana legalization.

INTRODUCTION

Although the federal law has prohibited the use and distribution of marijuana in the United States since 1937, for the past five decades states have been experimenting with marijuana liberalization polices. State decriminalization policies were first passed in the 1970s, patient medical access laws began to get adopted in the 1990s, and more recently states have been experimenting with legalization of recreational markets. This has resulted in a spectrum of marijuana liberalization policies across the United States that is often not fully recognized or considered when conducting evaluations of recent policy changes. Consider for example the state of marijuana policies in the United States at a single point of time. As shown in Figure 1 , as of January 1, 2016, 21 states 1 have decriminalized certain marijuana possession offenses ( NCSL 2016a ), 26 states have legalized medical marijuana use, and another 16 states have adopted cannabidiol (CBD)-only laws ( NCSL 2016b ) that protect only certain strains of marijuana to be used for medicinal purposes. However, there is tremendous overlap because some states have implemented combinations of each of these policies, as shown by the fact that the five states currently legalizing recreational marijuana use (Alaska, Colorado, Oregon, Washington, and the District of Columbia) all initially decriminalized marijuana and then passed medical marijuana allowances before passing their legalization policies. Thus, the vast majority of US states have moved away from a strict prohibition position toward marijuana well before they started considering outright legalization.

State marijuana policies as of January 1, 2016. Data from the RAND Marijuana Policy Database ( Pacula et al. 2015 ) and NCSL (2016a , b) with permission. Abbreviation: CBD, cannabidiol.

A number of factors have driven the policy changes observed over the past several decades, including rising state budgetary costs associated with arresting and incarcerating nonviolent drug offenders ( Raphael & Stoll 2013 , Reuter et al. 2001 ), growing scientific evidence of the therapeutic benefits of cannabinoids found in the marijuana plant ( Hill 2015 , Koppel et al. 2014 ), and strained state budgets that have caused legislatures to look for new sources of tax revenue ( Caulkins et al. 2015 , Kilmer et al. 2010 ).

The tremendous policy variation over time and across states would appear to give researchers ample opportunities to quantitatively assess the effect of marijuana liberalization policies on a variety of health and social outcomes. However, the scientific literature has been slow to develop, and what exists in the literature offers generally mixed and largely insignificant findings. This has led many to conclude that the previous liberalization policies must be harmless and that ongoing legalization would similarly generate very little harm to society. Indeed, recent surveys of people’s attitudes about marijuana show a clear shift in favor of legalization ( Caulkins et al. 2015 ).

As we will argue throughout this article, however, at least three reasons suggest that we use caution in drawing conclusions from the mixed empirical evidence or, more importantly, in assuming that a change to legally protected commercial markets would result in outcomes similar to those of the previous experiments. First, the literature has largely treated both decriminalization and medical marijuana policies as if they were simple dichotomous choices, implemented similarly across states. Such a treatment ignores the significant heterogeneity in these policies that can differentially influence harms and benefits and also contributes to what appear to be mixed results from evaluations. Second, the vast majority of policy evaluations conducted thus far examine the effect of the policy in terms of changes in prevalence rates in the general population, which assumes that the proportion of casual and heavy users, who are pooled together in these simple prevalence rates, remains stable even as the policy changes. Finally, research has been slow to consider the extent to which these changes in policies influence the method by which the typical user consumes marijuana. The potential acute harm associated with smoking a joint is different from that associated with consuming an edible or dabbing wax, particularly given that the average potency of the product typically differs and the body’s rate of absorption of THC varies by method ( Huestis 2007 ).

In this article, we review the existing literature on the effects of decriminalization and medical marijuana laws on marijuana use and marijuana use disorders in light of these limitations. Unlike other reviews, our goal is not to summarize all the existing literature on the effects of decriminalization and medicalization. Rather, the purpose of this review is to provide a better understanding of what can be gleaned from the literature when more consideration is given to the complexities of these policies, the populations examined, and the measures of use considered. Doing so allows us to convey the need for more research, in terms of measurement and analysis, before we can truly understand the impacts of marijuana liberalization policies.

WHAT IS MEANT BY HETEROGENEOUS MARIJUANA POLICIES

Defining the policies.

It is important for any discussion of the literature to begin by defining the policies being considered. For the purposes of this review, we define four specific marijuana policies (prohibition, decriminalization, medical marijuana, and legalization) in terms of their legal definitions rather than their implementation in local communities, as the latter is often a function of the level of enforcement, which is difficult to measure in a systematic and analytic way. Prohibition, therefore, can be defined as a law that maintains the criminal status of any action related to marijuana possession, use, cultivation, sale, or distribution. The level of crime may be statutorily defined as either a misdemeanor (incurring relatively lower criminal penalties that may or may not include jail time) or a felony (entailing much more serious charges, tougher sanctions, and certain prison time), and the charge may be a function of the amount of marijuana involved or simply of the nature of the activity (e.g., sale to minors). Regardless, the emphasis is on the criminal status of the related offenses, not the degree to which local law enforcement chooses to enforce it. The US federal government, for example, retains its prohibition on all marijuana activities (possession, use, cultivation, distribution, processing, and sale) as do cities like San Francisco, although San Francisco has adopted a policy of low-priority enforcement ( Ross & Walker 2017 ).

Decriminalization is a policy that was first defined by the 1972 Shaffer Commission (also known as the National Commission on Marihuana and Drug Abuse), and it describes policies that do not define possession for personal use or casual (nonmonetary) distribution as a criminal offense. The Shaffer Commission clearly stated that policies that simply lowered the penalties without removing the criminal status of the offense were not technically decriminalized, because they maintained the substantial social harm of the associated criminal convictions ( Natl. Comm. Marihuana Drug Abus. 1972 ). This distinction between policies that simply lower penalties and those that actually change the legal status of the offense is important, and yet it is not widely understood by many researchers evaluating even the early policies. At least 2 of the 11 widely recognized decriminalized states from the 1970s and 1980s, California and North Carolina, did not remove the criminal status of the offense ( Pacula et al. 2003 , Reuter & MacCoun 1995 ). Instead, these states merely reduced the penalties associated with possession and/or use of marijuana, a policy generally known as depenalization ( MacCoun & Reuter 2001 , Pacula et al. 2005 ). Yet, individuals in depenalization jurisdictions can still face significant barriers to access work, student loans, and public assistance if caught in possession of marijuana, even if they are only charged with a small fine, because they can still get a criminal charge on their record.

Medical marijuana laws (MMLs) remove state penalties for the use of marijuana for medicinal purposes under specified conditions. Although the federal government continues to retain the 1970 classification of marijuana as a Schedule I substance with high potential for abuse and no accepted medical value (Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, P.L. 91–513, October 27, 1970, 84 Stat. 1242, 21 U.S.C. 801, et seq.), states have employed a number of regulatory approaches aimed at increasing access to marijuana for medicinal purposes since the 1970s. Early initiatives through the 1980s aimed to encourage study of the therapeutic value of marijuana, but they had little practical significance due to their heavy reliance on federal cooperation and the failure to establish a legitimate supply channel for patients ( Pacula et al. 2002 ). Initiatives passed since the 1990s have been far more comprehensive, establishing allowances for the use, possession, and supply of high (>3%) Δ 9 -tetrahydrocannabinol (THC) products for qualifying patients and their caregivers or providers. These modern MMLs have become the most commonly evaluated policies in comparative alcohol and drugs policy analysis ( Ritter et al. 2016 ), but incomplete consideration of widespread variation in how these laws have been designed and implemented has resulted in inconclusive and often contradictory findings ( Hunt & Miles 2015 ; Pacula et al. 2014a , 2015 ).

Legalization removes criminal and monetary penalties for the possession, use, and supply of marijuana for recreational purposes. Whereas decriminalized countries such as the Netherlands have histories of de facto legalization, and medical marijuana programs are often regarded as thinly veiled recreational legalization ( Fischer et al. 2015 , Haney & Evins 2016 ), de jure legalization is a relatively new phenomenon. The November 2012 ballot initiatives passed by voters in Colorado and Washington marked the first time that any jurisdiction worldwide has legally regulated marijuana. Much attention has been given to the recently created retail markets for legal marijuana in these two states, but the commercial model is but one regulatory option for legal production, and a number of alternative strategies are available ( Caulkins et al. 2015 ). Research has not yet assessed the consequences of legalization, but the effects on the prevalence of marijuana use and use disorders will depend largely on the specific state-level regulations adopted as well as the response of the federal government.

Establishing clear definitions for decriminalized, medicalized, and legalized states is not merely a semantic exercise; rather, it highlights the different mechanisms through which policies may influence use, including changes in perceptions of risk or social disapproval, changes in product availability and variety, and changes in production methods or costs that reduce prices. Although it is tempting to use evaluations of decriminalization and medical marijuana policies to shed light on the likely consequences of legalization, the experiences of these states may not fully reflect the changes in price, potency, and product variety that will likely result from increased commercialization and promotion under legalization ( Caulkins et al. 2012 ). Additionally, prior research on decriminalization and MMLs has suffered from serious limitations due to an overreliance on crude indicators that do not account for the complex and varied ways in which states have designed and implemented their policies ( Pacula & Sevigny 2014a , b ; Pacula et al. 2005 ). Although the existing literature may be limited in answering how legalization will affect marijuana use and associated outcomes, it offers significant insights into how we should evaluate the effects of marijuana policy changes in a rapidly evolving and multilayered policy environment.

Decriminalization and Definitional Problems

As stated previously, much of the scientific research evaluating the impacts of decriminalization in the United States has ignored the legal definition provided by the Shaffer Commission. In an examination of the original 11 statutes passed shortly after the Shaffer Commission, Pacula and colleagues (2003) discovered that 2 of the 11 widely recognized decriminalized states (California and North Carolina) retained the criminal status of marijuana possession offenses. Moreover, the reduced penalties in 4 of the original 11 states (Minnesota, Mississippi, Nebraska, and North Carolina) only applied to first-time offenders, a distinction not consistent with the spirit of the Shaffer Commission definition. A comparison of state statutory penalties in so-called nondecriminalized states and in decriminalized states reveals that it is not possible to uniquely distinguish the two groups ( Pacula et al. 2003 , 2005 ). As early as 2001, there were 7 so-called nondecriminalized states that had removed the criminal status of all marijuana possession offenses and another 13 states that allowed for the reduced penalties and expungement of the criminal offense for first-time offenders ( Pacula et al. 2005 ). Yet, research continued to use the decriminalization variable to identify differences in state marijuana policies that were not truly based on the criminal status or level of penalties.

Given that most US studies have made use of a single dichotomous measure that cannot uniquely differentiate states with lower penalties and reduced criminal status, it is not surprising that they had mixed results. Even early studies examining immediate changes in laws using data from the 1970s and 1980s did not generate consistent findings. Although several studies making use of population survey data found no statistically significant impact of decriminalization on general prevalence rates of marijuana use ( Johnston et al. 1981 , Maloff 1981 , Single 1989 ), one study looking at emergency room episodes found that cities in states that had decriminalized had higher marijuana-involved episodes than cities in nondecriminalized states ( Model 1993 ). More recent studies that analytically relied on cross-sectional variation in decriminalization status in the late 1980s and 1990s also produced mixed findings. For example, studies examining self-reported use among youth and young adults that only included the single dichotomous measure for marijuana decriminalization found no statistical association with measures of past-year or past-month use ( DiNardo & Lemieux 2001 , Pacula 1998 , Thies & Register 1993 ). Yet analyses of the adult household population ( Saffer & Chaloupka 1999 ) and studies examining youth but incorporating other measures of legal risk ( DeSimone & Farrelly 2003 , Pacula et al. 2003 ) did find evidence of a positive association between decriminalization status and prevalence of use. MacCoun et al. (2009) note that the fact that the state decriminalization indicator remains positive and significant in analyses that also include additional controls for the statutory penalties for these offenses suggests that this measure is picking up something other than a signal related to a reduction in the legal risk. Hypotheses offered include a proxy of broader social acceptance of marijuana use and an advertising effect of the reduced policies.

Even beyond the problem of policy measurement, results from US studies evaluating the impact of marijuana decriminalization need to be interpreted with caution for several reasons. First, in many studies, marijuana possession penalties do not vary substantially over time, which analytically confounds the effects of unobserved state characteristics (e.g., tough-on-crime lawmakers) with differences observed in the level of penalties. Second, because there is no comprehensive data source reporting the actual penalties incurred by offenders, these studies have all relied on proxies, such as maximum or median fines as indicated by statutory laws. These statutory penalties may or may not accurately reflect the true severity of the penalties imposed in a jurisdiction. Last, evidence has shown that citizens have relatively limited knowledge as to the statutory penalties and policies for marijuana possession in their states ( MacCoun et al. 2009 ), which makes it difficult to interpret evidence showing that removal of such penalties has a significant causal effect on marijuana consumption.

Medical Marijuana Laws in a Complex and Dynamic Policy Environment

In 1996, California became the first state to pass what is now commonly recognized as an MML. As of January 2016, 25 additional states have passed similar legislation. Empirical evidence consistently shows a strong correlation between MMLs and the prevalence of marijuana use and marijuana use disorders ( Cerdá et al. 2012 , Wall et al. 2011 ), but studies have not consistently supported a causal interpretation ( Anderson et al. 2015 , Hasin et al. 2015b , Lynne-Landsman et al. 2013 , Wen et al. 2015 ).

One explanation for the inconsistent findings from causal studies is that the specific provisions of state MMLs have varied widely both among states and within any given state over time ( Pacula et al. 2014a , b ). The use of a single dichotomous indicator for the initial passage of an MML in policy evaluation obscures both types of variation. Because the effects of any policy will depend on the specific statutory provisions and their implementation, studies examining outcome data covering different time frames are in fact evaluating the effects of very different policies. Further confounding comparison of prior estimates is the fact that the federal enforcement position has changed over time, and state MML provisions have adapted alongside changes in the federal stance.

When one takes a historical look at how MMLs have evolved since the passage of California’s law in 1996, it becomes easy to understand how a single dichotomous measure falls short of describing these policies within a state and across states over time. We broadly categorize state policies into three waves, each initiated by an important political change: the ballot era (1996–2000), the early legislative era (2000–2009), and the late legislative era (2009–present).

The ballot era states are the first seven states that enacted policies through ballot initiatives (whether subsequently contested by state courts or not). These early laws aimed to protect the rights of patients who used medical marijuana and their caregivers who assisted in that use. Federal opposition to these policies was explicit, and one month after Proposition 215 passed in California, then-drug czar Barry McCaffrey threatened to arrest any physician who recommended cannabis to a patient ( Pertwee 2014 ). The threat of federal enforcement created an important barrier to establishing clearly defined legal access to medical marijuana. Early MMLs during the ballot era were often vague, defining medical use broadly to include consumption, home cultivation, production, transportation, and acquisition. Most of the laws were ambiguous as to the legality of group growing or storefront dispensaries, resulting in confusion among law enforcement, patients, and caregivers as to what constituted legal participation in the medical marijuana market. Furthermore, the uncertainty of the federal response to these state experiments meant that ballot era policies rarely mandated patients to register with a state authority, making it even more difficult for law enforcement to differentiate legitimate medical users from recreational users. It is thus unsurprising that research examining the effects of the early state ballot laws on marijuana use has found insignificant effects ( Gorman & Huber 2007 , Khatapoush & Hallfors 2004 ).

With the passage of S.B. 862 in 2000, Hawaii became the first state to pass an MML through the state legislature rather than by ballot initiative. Learning from the frustrating experiences of patients and law enforcement under the earlier state policies, states that passed laws during this early legislative era (2000–2009) made more explicit allowances regarding the supply chain. Most laws passed during this period included patient registry provisions, allowances for home cultivation, and limits on the amount of marijuana that patients or caregivers could possess and grow. In addition, many states that had initially passed laws through ballot initiatives (e.g., California and Oregon) made further policy changes through their state legislatures during this period in an attempt to clarify issues and address tensions that had emerged.

Although MMLs during this early legislative era established clearer definitions of what constituted legal supply, uncertainty about the federal response to these policies inhibited a formal state regulation of producers. For instance, Colorado’s 2001 law did not explicitly sanction cooperative growing, but the ambiguity of the law allowed for its de facto operation. Through S.B. 420, California amended its initial MML to explicitly allow for cooperative cultivation, but regulatory discretion was left to local governments. New Mexico was the only state in the early legislative era to establish legal provisions for state-licensed dispensaries in its initial legislation in July 2007, but threats of federal prosecution led to indefinite delays in licensing ( Baker 2007 ).

Protracted legal disputes about the legitimacy of retail outlets under state law combined with tremendous uncertainty about the federal response led to the slow development of medical marijuana markets throughout many states during the early legislative era, which helps explain why many studies evaluating MMLs from this period find insignificant effects on prevalence of marijuana use ( Anderson et al. 2012 , 2015 ; Harper et al. 2012 ; Lynne-Landsman et al. 2013 ; Pacula et al. 2015 ). Whereas norms may have been changing in response to these laws, direct access through markets was not necessarily increasing ( Smart 2016 ). Yet, two studies making use of data from only this time period find a significant positive effect of MML enactment on use among specific high-risk populations ( Chu 2014 , Pacula et al. 2010 ). Making use of quarterly data from the 2000–2003 Arrestee Drug Abuse Monitoring (ADAM), Pacula et al. (2010) find a positive association between MML and self-reported marijuana use (confirmed through urine samples) among adult male arrestees. Chu (2014) similarly found significant positive effects of MML policies on marijuana possession arrests and marijuana-related treatment admissions, though the results are sensitive to model specification. These studies may indicate that increased medical marijuana supply in an uncertain policy environment primarily affected marijuana consumption among an at-risk population of heavy users. However, the results are also consistent with endogenous responses by police enforcement or treatment facilities and may not reflect actual changes in use.

In 2009, the uncertainty about the federal government’s response was seemingly resolved. Shortly following the inauguration of President Barack Obama, Attorney General Eric Holder issued a statement that federal authorities would cease interfering with medical marijuana dispensaries operating in compliance with state law ( Johnston & Lewis 2009 ). On October 19, 2009, Deputy Attorney General David Ogden formalized this policy of federal nonenforcement with a memorandum stating that federal prosecutors “should not focus federal resources … on individuals who are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana” ( Ogden 2009 , pp. 1–2).

The clarification of the federal position dramatically changed the regulatory structure of state medical marijuana supply channels. State MMLs passed during the late legislative era (2009–present) established far more comprehensive and explicit regulations regarding medical marijuana distribution, often requiring elaborate systems that would take years to fully implement. Several early-enacting states (e.g., Oregon and Maine) amended their laws to formally allow and regulate state-licensed dispensaries. State regulatory authorities became more prominently involved in the production and distribution of marijuana by overseeing the dispensing, manufacturing, and labeling of cannabis-derived products.

Following the Ogden Memo, requirements for the registration of patients and caregivers became far more standard in state policies, and the participation of both increased dramatically in state medical marijuana programs ( Fairman 2015 , Sevigny 2014 ). States that had delayed the implementation of formal supply channels (e.g., New Mexico) moved quickly to license dispensaries, and other states began to resolve legislative disputes about what constituted legally protected sources of supply. Alongside this expansion of medical marijuana markets during this period, media attention toward the issue of legal marijuana also increased markedly ( Schuermeyer et al. 2014 , Stringer & Maggard 2016 ).

Compared to earlier time periods, in the late legislative era marijuana use might respond more significantly to changes in policy as the availability and potency of the drug evolved with the changing structure and size of medical marijuana markets ( Sevigny et al. 2014 ). Indeed, the one study to evaluate the effects of MML passage using only policies enacted in the early and late legislative eras ( Wen et al. 2015 ) found a significant positive effect of MML enactment on the probability of recent marijuana use (14%), daily marijuana use (15%), and marijuana use disorders (10%). More studies focused on these later laws are needed to assess if these findings are robust.

Perhaps because of the federal permission for states to regulate medical marijuana more directly, medical marijuana policies adopted by states for the first time during this postlegislative era (e.g., by New York, Massachusetts, Illinois) contain a variety of features that differ considerably from those of the laws of early adopting states. For example, all MMLs passed after 2009 have established a state-licensed dispensary system and do not allow personal cultivation by patients or their caregivers, except under narrowly defined circumstances. Moreover, since 2010, states have adopted medical marijuana policies that are more consistent with traditional medical care and pharmaceutical regulation ( Williams et al. 2016 ). For example, all require testing and labeling of marijuana cannabinoid profiles in addition to a bona-fide clinical doctor-patient relationship requiring the ongoing management of the condition.

Evidence that MML statutes are continuing to move in a more medicalized direction is evident by the growing number of high CBD-only laws since 2014. CBD is a naturally occurring nonpsychoactive compound in cannabis that has been demonstrated in a variety of clinical studies not only to have therapeutic effects but also to counter the intoxicating effects of THC ( Koppel et al. 2014 , Russo et al. 2007 , Whiting et al. 2015 ). These new laws allow qualifying patients to use CBD extract, mostly in oil form, with minimal THC content, and its use is generally only allowed for a narrow range of medical conditions. Sixteen states have passed CBD laws since 2014, but these policies have been largely ignored by advocacy groups, and no research is studying their impacts ( NCSL 2016b ). With some exceptions, there is still limited regulation on potency (THC concentration) and other cannabinoids, medical product testing, and methods of consumption.

Considering Heterogeneous Implementation of Legalization

As of July 2016, five states have policies legalizing the possession of specified quantities of marijuana by adults aged 21 and older for recreational purposes. 2 Voters in Colorado and Washington approved legalization initiatives in November 2012, and additional policies were passed in Alaska, Oregon, and the District of Columbia in November 2014. The current regulatory environment is complex and dynamic, as state and local governments are continually adapting legislation to evolve along with the industry ( Subritzky et al. 2016 ). The effects of these policies on marijuana use and use disorders will be determined by how the design and implementation of the legal regulatory framework influence market structure, price and availability, and perceptions of risk and social approval. As research moves forward in evaluating the effects of recreational legalization, consideration needs to be given to differences and similarities in the regulatory frameworks established by each state.

The District of Columbia is the only legalized jurisdiction in the United States that does not allow the sale of marijuana for recreational use. Under DC’s law, adults can legally grow up to six plants (of which no more than three can be mature) in their primary residence and transfer up to 1 ounce of marijuana to another adult aged 21 and older if there is no remuneration. Sale of any amount of marijuana remains a criminal offense, punishable by up to six months in jail and a fine of $1,000 ( Marijuana Work. Group 2016 ). In contrast, policies in Colorado, Washington, Oregon, and Alaska establish commercialized models of marijuana regulation. Retail sales in Colorado and Washington began respectively in January and July 2014, and Oregon began allowing sales for recreational use from medical marijuana dispensaries in October 2015. Alaska began licensing retail and product manufacturers in September 2016 ( Hall & Lynskey 2016 ). Relative to the home cultivation model of the District of Columbia, commercialization is expected to substantially reduce production costs and generate incentives for legal suppliers to promote heavy consumption ( Caulkins & Kilmer 2016 ).

However, the commercial model of legalization also offers increased scope for regulation, and each state has crafted its own collection of regulatory guidelines and legal provisions that could have important implications for the markets that develop within them. For example, whereas all states require separate licenses for cultivators, manufacturers or processors, and retailers, as well as licensing or certification for testing facilities, Washington alone has adopted regulations restricting the number of licenses a single firm can own. Moreover, Washington prohibits license holders from being involved in both production and retail, in an effort to forbid vertical integration and the efficiencies in production and distribution that can come with it. Washington has further limited the number of retail store licenses available to avoid issues related to overproduction; the other states have not. However, all states except Alaska restrict the size of cultivation facilities, and Washington has an additional cap on total statewide production. In addition to this policy heterogeneity at the state level, local municipalities have some discretion in determining the number of establishments permitted, the strictness of zoning requirements, and the time and manner in which businesses are allowed to operate. These differences in the structure of the market should theoretically influence the availability and cost of marijuana in each state, for reasons described in greater detail below.

Other important legal differences exist across states in terms of the allowance for a nonretail market. Washington is the only state that requires all marijuana for recreational use to be purchased through state-licensed retailers; no home cultivation is allowed. The other three states permit home cultivation by adults subject to specified plant limits (as in the District of Columbia). There are also different approaches to taxation. Currently, the three states with operating retail markets (Colorado, Washington, and Oregon) have instituted ad valorem taxes specific to marijuana, ranging from 17% in Oregon to 37% in Washington. In contrast, Alaska’s policy establishes a tax on cultivation, imposing a $50 per ounce tax on marijuana bud (i.e., flowers) and a $15 per ounce tax on other parts of the plant (stems and leaves).

Differences in how state and local governments regulate the commercial market will generate heterogeneous effects on the retail price of marijuana, which will have important consequences for both the extensive and intensive margins of use and abuse ( Pacula & Lundberg 2014 , Pacula et al. 2014b ). Moreover, because marijuana is involved in a variety of forms and potencies, choices about the tax level, base, and point of collection can also influence the products and potencies available to consumers and the prices they face ( Caulkins et al. 2015 ). Currently, retail stores are allowed to offer marijuana flowers, concentrates, and infused products in solid and liquid form. The original legalization measures in Colorado and Washington did not explicitly distinguish between product types when establishing consumer purchase limits. As marijuana concentrates and infused products have captured an increasing share of legal retail sales, regulations have had to expand. Effective October 2016, adult residents in Colorado are limited to purchasing 1 ounce of marijuana flower, 8 g of concentrates, or 80 10-mg servings of THC in infused product form. In Washington and Alaska, consumers can purchase 1 ounce of marijuana flower, 7 g of marijuana concentrates, 16 ounces of infused product in solid form, or 72 ounces in beverage form. Oregon’s regulations are similar, except for a stricter limit of 5 g for marijuana concentrates. Alaska’s rules also limit buyers to 5,600 mg of THC in a single purchase.

Due to concerns regarding accidental ingestion of edibles by children, states have further regulated marijuana-infused products by implementing stricter packaging and labeling requirements and designating potency limits for individual serving sizes. Washington and Colorado designate individual serving sizes of 10 mg of THC and 100 mg total for an individually wrapped package. In Colorado, products that cannot be stamped, such as drinks or granola, must contain no more than a designated individual serving, effectively banning many of the high-potency marijuana-infused beverages currently sold. Oregon and Alaska have more conservative requirements, designating individual serving sizes of 5 mg of THC and 50 mg total for an individually wrapped package. Still, no state has capped the potency of marijuana products. A measure to limit the THC content of all marijuana products sold at retail stores in Colorado to 16% (Initiative 139) was withdrawn by the Healthy Colorado Coalition in 2016 due to the emergence of a well-funded opposition campaign ( Armbrister 2016 ). In Alaska, a proposal to cap marijuana product potency at 76% THC was also voted down. The lack of restrictions on potency enables the marketing of products with very high (and often uncertain) levels of THC.

Increased marketing has been an important concern under the commercial model, because advertising can be used to promote harmful use and has been shown to influence adolescent marijuana use and intention to use ( D’Amico et al. 2015 ). Colorado’s regulations prohibit Internet pop-up advertisements and advertisements that target children. Washington allows retailers to have only two signs (not to exceed 1,600 square inches) at their place of business, but the signs cannot contain marijuana-themed imagery nor can marijuana-related imagery be featured in window displays. Alaska and Oregon continue to revise rules for marijuana marketing. The strictness of state regulations for advertising and the way they are enforced can partly mediate the extent to which legalization influences perceptions and consumption behaviors among legal consumers as well as adolescents. However, these potential benefits of advertising restrictions must be balanced against potential efficiency costs resulting from information asymmetries between suppliers and consumers.

As was the case with decriminalization and MMLs, legalization is not a binary policy variable. The home cultivation model of the District of Columbia will have very different implications for supply than the commercialized models of Colorado, Washington, Oregon, and Alaska. Within commercialized states, heterogeneity in how production and price are regulated will lead to different consequences for consumption by legal adult users and spillovers to adolescent markets. Restrictions placed on advertising could limit youth exposure to messaging that could encourage experimentation, but only if the regulations are enforced. The way in which product availability and potency are regulated will have important effects on the total quantity of marijuana consumed by users and their level of intoxication, which will in turn influence the prevalence of marijuana use disorders. Legalized states have chosen different ways of regulating, and this policy heterogeneity will need to be considered in future work when assessing the effects of legalization on use.

WHAT IS MEANT BY HETEROGENEOUS POPULATIONS

The previous section focused on the heterogeneity of the policies being implemented. However, the effects of these diverse policies may well vary depending on the population group studied. Heterogeneous effects across population subgroups may be driven by differences in budget constraints ( Markowitz & Taurus 2009 ), price elasticities ( Pacula & Lundberg 2014 ), preferences for risk ( Fox & Tannenbaum 2011 ), or search costs ( Galenianos et al. 2012 , Pacula et al. 2010 ), to name a few. Mixed findings in the current literature with respect to the impact of prior liberalization policies may thus reflect legitimate differences in the populations being studied.

Past research has generally attempted to accommodate this potential heterogeneity by stratifying analyses by age (e.g., adolescents, young adults, older adults) and, to a lesser extent, frequency of use (number of times used in the past month/year or near-daily use). The potential effects on youth consumption have been of particular concern in the literature, because evidence suggests that use of marijuana during early adolescence predicts increased risk of dependence, lower educational attainment, and cognitive impairment ( Hall 2009 , 2015 ). Limiting the analysis to adolescents, research shows that MML enactment has largely insignificant or even negative effects on youth marijuana use measures ( Anderson et al. 2015 , Choo et al. 2014 , Gorman & Huber 2007 , Harper et al. 2012 , Hasin et al. 2015b , Lynne-Landsman et al. 2013 ), with only Wen et al. (2015) finding a significant increase in the probability of past-year initiation among youths aged 12–20. The results of the few studies that have focused on changes in marijuana consumption among adults have been more mixed, with some showing no effect of MML passage on measures of use ( Gorman & Huber 2007 , Harper et al. 2012 ) and others finding significant positive effects ( Chu 2014 , Wen et al. 2015 ).

Yet, as noted above, the use of a dichotomous MML variable misses important variations in the specific implementation of supply channels, which may be particularly important in determining the extent to which medical marijuana is diverted to adolescent markets ( Boyd et al. 2015 , Nussbaum et al. 2015 , Salomonsen-Sautel et al. 2012 ). When studies focus on the effects of dispensary legalization, there is some evidence of a significant increase in youth consumption ( Pacula et al. 2015 , Wen et al. 2015 ), though other studies find no effect ( Hasin et al. 2015b ). Even within the same study, estimated effects switch sign depending on whether consumption is measured by past-month use, frequency of use, or dependence ( Pacula et al. 2015 , Wen et al. 2015 ). Similar inconsistencies exist in studies of the effects of specific dimensions of MML policy on measures of marijuana use in the general population ( Anderson & Rees 2014 , Choi 2014 , Pacula et al. 2015 ). Thus, age alone is clearly not an adequate way of capturing population heterogeneity.

Perhaps a more relevant dimension of population heterogeneity pertains to differentiating casual or light users from high-risk consumers, often identified in this literature as arrestees ( Chu 2014 , Pacula et al. 2010 ), polysubstance users ( Wen et al. 2015 , Williams & Mahmoudi 2004 ), or those admitted to treatment ( Pacula et al. 2015 ). Only a few studies have focused on high-risk users, but those that have tend to find more consistent evidence that marijuana liberalization significantly increases use ( Chu 2014 ; Model 1993 ; Pacula et al. 2010 , 2015 ; Wen et al. 2015 ). The response of high-risk users to marijuana policy changes will likely differ from that of casual users or nonusers due to differences in price sensitivity ( Pacula & Lundberg 2014 , Sumnall et al. 2004 ), knowledge of the policy environment ( MacCoun et al. 2009 ), engagement with drug markets ( Pacula et al. 2010 ), and perceived social or physical harms from use ( Haardörfer et al. 2016 , Kilmer et al. 2007 ). By examining how marijuana liberalization policy affects the prevalence of marijuana use, many past evaluations have conflated changes in the consumption of casual users with changes in the consumption of regular or heavy users. Because casual users represent a larger proportion of the total number of users, such analyses will discount the behaviors of heavy users, who account for a larger proportion of the total quantity of marijuana consumed ( Burns et al. 2013 , Davenport & Caulkins 2016 ).

The overreliance on using prevalence measures as the outcome of interest in past work is largely a consequence of limited data availability, but as legal markets for marijuana develop, there is an urgent need to assess the alternative measures of use that are more relevant for understanding potential harms. Nationally representative data show that the number of daily or near-daily (DND) users has increased approximately sevenfold since 1992 ( Burns et al. 2013 ), and the prevalence of marijuana use disorders has almost doubled since 2001 ( Hasin et al. 2015a ). Simultaneous use of marijuana with other substances (e.g., tobacco and alcohol) is common and has been shown to be associated with increased risk of adverse consequences ( Subbaraman & Kerr 2015 , Terry-McElrath et al. 2014 ). Currently, we have little evidence to indicate how marijuana liberalization policies will affect these outcomes ( Wen et al. 2015 ). Moving forward, it will be important to develop more comprehensive data collection and sampling designs to assess how marijuana liberalization policies affect populations at risk for problematic use as well as the use of particularly dangerous products or methods of consumption.

WHAT IS MEANT BY HETEROGENEOUS PRODUCTS

Past research has generally focused on how liberalization affects the prevalence of marijuana use and has paid less attention to how liberalization affects the type of marijuana used or the way in which it is consumed. But marijuana is not a uniform product. The cannabis plant itself can develop in a number of different ways, depending on the genetic variety, temperature, culture condition, and lighting it receives. The potency of the consumable product, typically measured by concentration or level of THC, will vary by strain, cultivation technique, and method of processing. There are also a variety of ways to consume marijuana, with the most common methods including smoking, vaporization, and ingestion of edible products ( Schauer et al. 2016 ).

Both potency and methods of consumption have evolved over time. Decriminalization occurred during a time when marijuana was largely smoked, which facilitated comparisons of marijuana use rates between decriminalized and nondecriminalized states. Medical marijuana brought with it new products (e.g., oils and edibles), new methods for consuming it (e.g., dabbing, vaping), and new techniques for controlling potency ( Pacula et al. 2016 , Rendon 2013 ). Legalization only extends these new products to even more users. It is difficult to predict the extent to which legalization will increase product innovation, as growth in the industry will promote the development of new methods for extracting and synthesizing the hundreds of chemicals in the cannabis plant, of which relatively little is known ( Caulkins et al. 2015 ).

Systematic data collection on methods of use and potency is limited, but available evidence indicates that marijuana users in states with medical or recreational legalization consume a different product mix than users in other states. Individuals living in MML states, particularly in states with greater access to dispensaries, have significantly higher likelihood of vaporizing or ingesting marijuana products compared to individuals in states without MMLs ( Borodovsky et al. 2016 ). Evidence also suggests that states that legally permit medical marijuana dispensaries experience significant increases in average marijuana potency ( Sevigny et al. 2014 ). Within states with legalized dispensaries, adults who use marijuana for medicinal purposes are significantly more likely to vaporize it or consume edibles than individuals who use it for recreational purposes ( Pacula et al. 2016 ).

It is complicated to assess the impact of policy on use if the product being consumed or the method of consumption changes in line with the policy. Outcomes such as level of intoxication or dependency may well vary according to the type and method of marijuana consumption, and simply comparing use in legalized states to use in nonlegalized states will not reflect these differences. Changes in product variety will not threaten the identification of changes on the extensive margin of use (meaning any use or prevalence), because existing survey measures can provide information on the number of people who transition from nonusers to users and those who continue using rather than quitting. However, most of the adverse physical and behavioral consequences associated with marijuana use come from heavy users ( Gordon et al. 2013 , Hall 2015 , Volkow et al. 2014 ). Proper evaluation of the public health consequences of legalization relies on the ability of research to estimate the effects of marijuana policy changes on the intensive margin of use.

Data on quantity of marijuana used are surprisingly limited, and researchers have yet to construct a standardized measure for the unit of marijuana consumption (as exists with alcohol). Prior research has examined changes on the intensive margin through self-reported data on frequency of use, measured by days of use in the past month or past year. The implicit assumption has been that more days of use accurately proxies for higher intensity of use ( Temple et al. 2011 ). Yet, marijuana consumption among DND users can vary from smoking a single low-THC joint each day to using high-THC products multiple times per day via multiple delivery methods ( Hughes et al. 2014 , Zeisser et al. 2012 ). Given the variety of delivery devices, strains, and cannabinoid concentrations that become available as the legal industry expands, measuring changes in days of use will fail to capture a number of individuals who transition from occasional to heavy users.

Heterogeneity of marijuana products presents further problems for understanding how medical and recreational legalization affect marijuana use disorders. Previous research examining patterns of use and the development of dependence may not generalize to a legal environment in which there is greater social acceptance, fewer perceived risks and harms, and a wider variety of product types and potencies ( Asbridge et al. 2014 ). Although the definition of marijuana use disorder is evolving ( Compton & Baler 2016 , Hasin et al. 2013 ), there has been little clinical assessment of whether the use of different marijuana products carries different risks of dependence or harms. Some evidence suggests that vaporizing hash oil or dabbing is more positively associated with tolerance and withdrawal among adults compared to smoking marijuana ( Loflin & Earleywine 2014 ), but there may be differential effects for adolescents. As marijuana product diversity expands, there is a need for a more comprehensive understanding and analysis of consumption to accurately evaluate changes in use prevalence, intensity of use, and risk for marijuana use disorder.

AN ALTERNATIVE PERSPECTIVE FOR EVALUATING THE EFFECTS OF MEDICAL MARIJUANA LAWS AND LEGALIZATION

In light of the substantial variation underlying the policies being evaluated, the populations considered, and the products consumed, it is not surprising that the scientific literature evaluating the impact of these policies is inconclusive. The decisions made by researchers to focus on specific time periods, states, populations, and/or outcome measures have often been driven by what data were available and not by a careful consideration of the mechanisms by which these policies are expected to influence marijuana use or use disorders among various populations. As this article has established, these decisions can influence the likelihood of finding—or not finding—specific effects because of the heterogeneity of these policies and of the markets that are emerging in light of them.

The program evaluation literature has widely recognized the time it takes between the passing of new policies and their full implementation as a problematic issue ( Hunt & Miles 2015 , King & Behrman 2009 ). A common empirical strategy for accommodating delays in implementation is the inclusion of lagged policy variables, and this approach has been explored in a few articles from the medical marijuana literature ( Anderson et al. 2013 , Bachhuber et al. 2014 , Chu 2014 ). However, assuming a constant allowance for lagged effects obscures the fact that these delays are not random but are correlated with the specific provisions established by state law, the broader federal policy environment, and the setting in which the policy change occurs.

The relationship between state policy heterogeneity and variation in how long it takes for markets to emerge is something that is just beginning to receive the attention it deserves in the literature ( Collett et al. 2013 , Smart 2016 ). As explained by Smart (2016) , patient registration rates do a better job than simple dichotomous policy variables at capturing the extent to which medical marijuana markets are operating throughout a state. Smart notes that despite the adoption of early policies by many states, the relative size of the associated markets, as measured by registered patients, remained small in most states until federal enforcement policy was clarified in 2009, at which time markets in all states grew substantially faster. In an analysis that explicitly accounts for changes in the size of medical marijuana markets, Smart (2016) finds statistically more robust and consistent evidence of the impacts of these markets on various measures of consumption across users from all age groups.

The consideration of the relative size of these markets across states highlights the necessity to consider the issue of dynamics. Whereas some aspects of medical marijuana and legalization policies can have immediate impacts (e.g., on the criminalization of marijuana use or the ability to grow it at home), other effects of these policies take time to occur or disseminate. In the case of markets, for example, it takes time for regulations to develop regarding how many businesses are allowed, who is allowed to operate a business, and where those businesses are allowed to operate. It takes even longer once those rules are passed for businesses to obtain permits and begin distribution. Thus, it should not be surprising that after the passing of marijuana legalization measures in Colorado and Washington in November 2012, it took at least 18–20 months for retail stores to open. Data on the consequences of the opening of these stores beyond sales and tax revenues are just beginning to become available, which is why rigorous scientific evaluations of the impact of these policies have been slow to develop.

What that means is that researchers working in this space need to pay far greater attention to the specific mechanisms that different types of policies are likely to influence and to consider them within the proper timeframe when assessing impacts on specific populations. We show in Figure 2 some of the primary mechanisms discussed in the literature through which these changes in policies might impact use (i.e., perceived harm, disapproval of regular use, legal risk of use, ease of access and price) as well as the hypothesized effects of various types of policies on each. For simplicity, we consider each mechanism separately, though it is important to note that these are likely not independently determined (e.g., changes in legal risk may influence perceived harms, or changes in ease of access may influence disapproval). A small, medium, or large arrow (pointing up or down) in each cell indicates the relative magnitude and direction of the hypothesized effect. Shading represents the availability of empirical evidence to support the theoretical prediction, with white indicating an absence of existing studies and darker shades representing greater and more consistent support for the hypothesized effect. We provide three simplified versions of a medical marijuana policy and a legal recreational market to illustrate a wider range of policies that would to varying degrees influence the general size of the associated markets (in terms of both users and sellers).

Mechanisms through which marijuana policies might affect marijuana use and use disorders. This simple illustration shows that even within a single policy area (e.g., medical marijuana), the different variations of the policy can differentially influence each of the mechanisms related to use. For example, we hypothesize that medical marijuana policies will ceteris paribus have a larger impact on people’s perceptions about the drug (perceived harm and disapproval of regular use) than they will have on the legal risk and ease of access to marijuana regardless of policy, assuming that only medical users are provided access and legal protections. Relatedly, because these markets serve a relatively smaller group of users, the overall impacts on price are presumed to be small, although they might increase with the third type of MML, which could allow for competitive forces among suppliers to start influencing price ( Anderson et al. 2013 , Humphreys 2016 , Pacula et al. 2010 ) and potency ( Sevigny et al. 2014 ) in these markets. The existing evidence generally suggests that the passage of any type of MML significantly lowers perceived harms among adults ( Choi 2014 , Khatapoush & Hallfors 2004 ) but not among adolescents ( Choi 2014 , Keyes et al. 2016 ). However, the expansion of commercial medical marijuana markets and increased exposure to medical marijuana after 2009 have been associated with significant reductions in adolescent perceptions of harm or disapproval associated with marijuana use ( Miech et al. 2015 , Schuermeyer et al. 2014 , Sobesky & Gorgens 2016 , Thurstone et al. 2011 ).

Of course, under a policy of legalization, the hypothesized effects on some of the mechanisms (perceptions and legal risk) are larger and more immediate. Preliminary evidence from Colorado and Washington shows that commercial legalization has significantly reduced perceived harms and disapproval of marijuana use ( Kosterman et al. 2016 , Sobesky & Gorgens 2016 ), and marijuana-related arrests have plummeted ( Gettman 2015a , b ). Access and prices, however, will likely still be differentially influenced by the regulations that shape the market structure and the level of competition in the market ( Caulkins et al. 2015 , Smart 2016 ). The overall impact on consumption, then, would depend on ( a ) the relative importance of perceptions and legal risk vis-à-vis access and price for the specific population being evaluated, and ( b ) whether one is evaluating an immediate (short-run) response to the policy or a long-run effect that is inclusive of market mechanisms.

Another important consideration for interpreting findings when evaluating legalization effects is the baseline policy in place prior to legalization. Because most careful evaluations are done based on marginal changes over time, the baseline policy in the states that subsequently legalize will determine the extent to which a particular mechanism is impacted by the change in formal policy. States like Washington and Colorado, for example, which moved to legalization from a medical marijuana policy that already provided broad access and loose regulation of dispensaries, will likely experience far less of an impact on perceptions and access than states starting from a more restrictive medical marijuana policy or no law at all. Generalization of findings from these two state experiences, therefore, would not necessarily apply to states that may be considering a move to legalization without first allowing medical marijuana markets.

Thus far we have discussed heterogeneous policies, populations, and products as limitations that complicate the evaluation of how marijuana liberalization policies affect marijuana use and marijuana use disorders. However, Figure 2 suggests that this rich variation also offers unique opportunities for future research. By carefully considering the specific aspects of legalization statutes in the context of existing state policies, researchers have increased the scope for determining the mechanisms that are most important for influencing marijuana use among different populations. As more comprehensive data on marijuana prices and products become available, future work can examine not only whether liberalization affects marijuana use, but also whether it affects who uses marijuana, what products are used, and how these products are consumed. The literature has shown that not all marijuana liberalization policies are created equal, but by exploiting this variation we will be able to better evaluate which policy designs will maximize the potential benefits of legalization while minimizing potential harms.

The variety of marijuana liberalization policies across the US states is often ignored or inadequately considered when assessing the impacts of further policy reform. Despite the widespread state experimentation with alternative marijuana policies since the 1970s, our knowledge of the impact of these liberalization policies on the consumption of marijuana, and its benefits and harms, is far less developed than one would expect. There are a number of reasons for this, including, particularly, lack of attention to the heterogeneity of existing policies, the specificity of the populations examined, and modes of consumption.

Although findings tend to be mixed when we look at the literature as a whole, some consistent themes seem to emerge when we consider the literature with an eye toward differences between policies and populations. For example, studies that are attentive to the development of medical marijuana markets (e.g., through measures of the presence of active dispensaries or the size of the market) seem to consistently show a positive correlation of liberalization policies with use among high-risk users (arrestees, people in need of treatment, and polysubstance users). Similarly, many studies have shown a positive association with adult use of marijuana, whereas most have found no association with youth prevalence or frequency of use in general school populations. The extent to which these findings can be drawn on to make inferences about the potential impact of legalization on these same populations is not clear. Just as it took time for researchers to pay more careful attention to the differential effects of policy elements over time ( Hasin et al. 2015b , Pacula et al. 2015 , Smart 2016 , Wen et al. 2015 ), as well as possible heterogeneous responses by different types of users ( Pacula et al. 2015 , Wen et al. 2015 ), it will take time for research to emerge that fully reconsiders these associations in light of the full policy dynamics (i.e., changes in a policy within a single state over time and duration of exposure of a population to a given policy type). As more studies account for and consider these heterogeneous effects and dynamics, we may get better clarity regarding the margins on which particular types of policies do or do not influence behavior, and for whom.

Because legal markets will continue to evolve before these questions are fully answered, the real work that lies ahead relies on obtaining more accurate information on the amount and type of products that various people are consuming. Imagine trying to communicate to the public health field the health benefits or harms of alcohol consumption without being able to indicate specific levels or amounts that translate into impairment in well-understood dose-response relationships. Or imagine trying to assess the harmful effects of smoking without being able to differentiate an experimental or occasional smoker from someone who smokes a pack a day. Yet, that is exactly where the science is today in terms of our measurement of marijuana consumption. Precise data on things such as a standardized dose, regular versus experimental use, heavy use, episodic impairment, or even simultaneous use of marijuana and alcohol are not yet captured in most of the data tracking systems used to evaluate the impact of these policies, and they are desperately needed. If marijuana is anything like alcohol, little harm will come from casual, occasional use by mature adults, and indeed such use might generate considerable benefits. Moreover, it is also possible that marijuana, like alcohol, generates positive benefits for one population (mature adults) while also causing negative harms for another population (youth and young adults). Scientific research needs to be mindful of this heterogeneity.

SUMMARY POINTS

• State policies legalizing marijuana are part of the evolution of state liberalization policies that has taken place since the 1970s.
• Existing studies evaluating the impacts of prior state experimentation have generated inconclusive findings, and only recently has research attempted to understand the reasons for these mixed results.
• One should be cautious when interpreting the evidence from all studies pooled together, because studies are not equivalent in their attention to policy heterogeneity, policy dynamics, and population heterogeneity.
• The literature has largely treated both decriminalization and medical marijuana policies as if they were simple dichotomous choices, when in fact there can be substantial variation in the implementation of these policies that influences how adults or youth respond.
• Relatively few studies evaluating the impact of MMLs give adequate consideration to the fact that some aspects of liberalizations policies are realized immediately (e.g., ability to grow one’s own), whereas other aspects may take time to evolve (e.g., opening of a market) or change in response to future state and federal policies.
• Studies that focus on how marijuana liberalization policies influence past-month or past-year prevalence conflate changes in consumption among light and casual users with changes in consumption among regular and heavy users.
• Although relatively few in number, studies that focus on high-risk users (arrestees, poly-substance users, heavy users) tend to find more consistent evidence that medical marijuana policies increase use, suggesting that this segment of the population is particularly sensitive to policy changes.

FUTURE ISSUES

• As legal markets for marijuana develop, there is an urgent need to assess the consequences of liberalization on alternative measures of use that are relevant for understanding potential harms; this requires developing better measures of standardized dose, heavy use, episodic impairment, and simultaneous use.
• Research needs to pay more attention to the influence of these policies on the types of products consumed, the amount of THC being consumed in different products, and product development.
• Future work also needs to give stronger consideration of the baseline from which new state policies are being evaluated. For example, legalization is likely to generate smaller population changes in medical marijuana states that already have active dispensaries than in states with no prior medical marijuana stores.
• Researchers need to pay far greater attention to the specific mechanisms different types of policies are likely to influence and to consider them within the proper timeframe when assessing impacts on specific populations because not all users will respond in the same ways.

ACKNOWLEDGMENTS

This article was supported by a grant from the National Institute on Drug Abuse to the RAND Corporation (R01DA032693). The article benefited from research assistance provided by Anne Boustead, Ervant Maksabedian, and Gabriel Weinberger. We should also give credit to several of our DPRC colleagues whom we have been fortunate enough to conduct research with and who have influenced our thinking on this literature, including Jonathan Caulkins, Beau Kilmer, Mark Kleiman, Mireille Jacobson, Priscillia Hunt, David Powell, Paul Heaton, Eric Sevigny, Peter Reuter, and Rob MacCoun. All errors in the article are our own.

DISCLOSURE STATEMENT

The authors are not aware of any affiliations, memberships, funding, or financial holdings that might be perceived as affecting the objectivity of this review.

1 For simplicity, this article refers to the District of Columbia (DC) as a state.

2 Uruguay also legalized recreational marijuana in 2013, and Canada’s prime minister is working on a formal proposal expected to be delivered to the Canadian Parliament in April 2017. We are focusing on the US experience here because no formal stores are open in either Uruguay or Canada at this time.

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Virginia Politics | Gov. Youngkin vetoes bills that would legalize…

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Virginia politics | gov. youngkin vetoes bills that would legalize retail marijuana sales, increase minimum wage.

Gov. Glenn Youngkin on Thursday vetoed seven bills, including those with the potential to reshape life in Virginia.

HB 698 and SB 448 aimed to establish a retail market for marijuana starting in May 2025. HB 1 and SB 1 would have increased the state’s minimum wage from $12 per hour to $13.50 at the start of the new year and $15 per hour starting in 2026. Both passed the House and Senate by tight margins.

The marijuana bill would have “endanger[ed] Virginians’ health and safety,” Youngkin said in a release.

“States following this path have seen adverse effects on children’s and adolescent’s health and safety, increased gang activity and violent crime, significant deterioration in mental health, decreased road safety, and significant costs associated with retail marijuana that far exceed tax revenue,” he said, adding that a retail market wouldn’t end illegal sales or ensure product safety.

“Addressing the inconsistencies in enforcement and regulation in Virginia’s current laws does not justify expanding access to cannabis, following the failed paths of other states and endangering Virginians’ health and safety.”

The governor cited a 400% increase in calls since 2016 to U.S. Poison Control regarding children who have consumed high amounts of edible cannabis, and an 85% increase in such calls to the Blue Ridge Poison Control Center since possession of cannabis became legal in the state.

In 2021, Virginia became the first Southern state to legalize marijuana use, possession and cultivation in small amounts, but buying it continues to be illegal for those without a medical marijuana card.

State Sen. Aaron Rouse, a Virginia Beach Democrat and the chief patron of the Senate’s version of HB 698, wrote Thursday in a post on X, formerly known as Twitter, that Youngkin’s “dismissive” treatment of the issue of marijuana sales is “unacceptable.”

“Public servants are obligated to tackle pressing issues,” Rouse wrote. “This legislation would have combated the illegal market and ensured access to safe, tested and taxed cannabis products.”

In striking down HB 1, Youngkin explained he prefers to let the free market decide salaries and wages “dynamically.” He called the proposed increases “arbitrary” and argued it will increase operational costs for small businesses outside of Northern Virginia, forcing them to increase prices which will drive up inflation, “ultimately hurting the workers the proposal seeks to assist.”

“This wage mandate imperils market freedom and economic competitiveness,” reads Youngkin’s statement.

Youngkin also vetoed three other bills:

• SB696 – would allow those convicted of felony offenses relating to marijuana distribution prior to July 2021 who are still in prison or on probation to have an automatic hearing to consider modifying their sentences.
• HB157 – would eliminate the exemption from minimum wage requirements for farm workers and temporary foreign workers
• HB974 – would allow employees to satisfy the burden of proof in workers’ compensation claims based on circumstantial evidence and the testimony of others.

He signed 100 other bills Thursday including “bills that strengthen law enforcement’s ability to prosecute child predators and expand Department of Corrections inmate access to quality health services.”

Gavin Stone, 757-712-4806, [email protected]

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Personal Health

Medical Marijuana Is Not Regulated as Most Medicines Are

The industry lacks randomized controlled clinical trials that can clearly establish benefits and risks.

By Jane E. Brody

Dan Shapiro was the first person I knew to use medical marijuana. As a junior at Vassar College in 1987, he was being treated for Hodgkin’s lymphoma with potent chemotherapy that caused severe nausea and vomiting. When Dan’s mother learned that smoking marijuana could relieve the distressing side effect, to help her son, this otherwise law-abiding woman planted a garden full of the illegal weed in her Connecticut back yard.

Decades later, marijuana as medicine has become a national phenomenon, widely accepted by the public. Although the chemical-rich plant botanically known as Cannabis sativa remains a federally controlled substance, its therapeutic use is now legal in 36 states and the District of Columbia.

Yet experts in the many specialties in which medical marijuana is said to be helpful have only rarely been able to demonstrate its purported benefits in well-designed scientific studies. And they caution that what is now being legally sold as medicinal marijuana in dispensaries throughout the country is anything but the safe, pure substance Americans commonly expect when they are treated with licensed medications.

For example, in Oregon, where both recreational and medicinal marijuana can be sold legally, all recreational marijuana must be tested for pesticides and solvents, but such tests are not required for most medical marijuana, an audit by the Secretary of State published in January 2019 showed. The Oregon Health Authority does not require tests for heavy metals and microbes that might sicken users.

Indeed, most of the same health concerns raised decades ago about using marijuana therapeutically are still unresolved, even as the potency of the plant’s intoxicating ingredient, tetrahydrocannabinol, best known as THC, has increased fivefold. Furthermore, exclusive medical use is uncommon ; in a Canadian study of 709 medical users, 80.6 percent also reported using marijuana recreationally.

“People are using a medical excuse for their recreational marijuana habit,” said Dr. Kenneth Finn, a pain management specialist in Colorado Springs and editor of a new, 554-page professional book on the subject, “Cannabis in Medicine: An Evidence-Based Approach.”

Proponents of medical marijuana argue that cannabis is relatively safe and less expensive than licensed pharmaceuticals and is often used for conditions for which effective therapies are lacking or inadequate. Opponents say that what is most lacking are standardized marijuana products and randomized controlled clinical trials that can clearly establish benefits and risks.

The evidence — or lack thereof — of health benefits that can be reliably attributed to smoking, vaping or ingesting marijuana, even in its purest form, is described in great detail in Dr. Finn’s book. “Components of the cannabis plant can help in various conditions, but that’s not what people are buying in stores,” he said in an interview. “Let’s do the research on purified, natural, noncontaminated cannabinoids,” as the various potentially therapeutic chemicals in marijuana are called.

Three such substances have been approved by the Food and Drug Administration. One, Epidiolex, a cannabidiol-based liquid medication, is approved to treat two forms of severe childhood epilepsy. The others, dronabinol (Marinol, Syndros) and nabilone (Cesamet), are pills used to curb nausea in cancer patients undergoing chemotherapy and to stimulate appetite in AIDS patients with wasting syndrome.

Another marijuana-based drug, nabiximols (Sativex), is available in Canada and several European countries to treat spasticity and nerve pain in patients with multiple sclerosis.

Medicinal cannabis is hardly a new therapeutic agent. It was widely used as a patent medicine in the United States during the 19th and early 20th centuries and was listed in the United States Pharmacopoeia until passage of the Marijuana Tax Act in 1937 rendered it illegal.

Then a federal law in 1970 made it a Schedule 1 controlled substance, which greatly restricted access to marijuana for legitimate research. Also complicating attempts to establish medical usefulness is that plants like marijuana contain hundreds of active chemicals, the amounts of which can vary greatly from batch to batch. Unless researchers can study purified substances in known quantities, conclusions about benefits and risks are highly unreliable.

That said, as recounted in Dr. Finn’s book, here are some conclusions reached by experts about the role of medical marijuana in their respective fields:

Pain Management

People using marijuana for pain relief do not reduce their dependence on opioids. In fact, Dr. Finn said, “patients on narcotics who also use marijuana for pain still report their pain level to be 10 on a scale of 1 to 10.” Authors of the chapter on pain, Dr. Peter R. Wilson, pain specialist at the Mayo Clinic in Rochester, Minn., and Dr. Sanjog Pangarkar of the Greater Los Angeles V.A. Healthcare Service, concluded, “Cannabis itself does not produce analgesia and paradoxically might interfere with opioid analgesia.” A 2019 study of 450 adults in the Journal of Addiction Medicine found that medical marijuana not only failed to relieve patients’ pain, it increased their risk of anxiety, depression and substance abuse.

Multiple Sclerosis

Dr. Allen C. Bowling, neurologist at the NeuroHealth Institute in Englewood, Colo., noted that while marijuana has been extensively studied as a treatment for multiple sclerosis, the results of randomized clinical trials have been inconsistent. The trials overall showed some but limited effectiveness, and in one of the largest and longest trials, the placebo performed better in treating spasticity, pain and bladder dysfunction, Dr. Bowling wrote. Most trials used pharmaceutical-grade cannabis that is not available in dispensaries.

The study suggesting marijuana could reduce the risk of glaucoma dates back to 1970. Indeed, THC does lower damaging pressure inside the eye, but as Drs. Finny T. John and Jean R. Hausheer, ophthalmologists at the University of Oklahoma Health Sciences Center, wrote, “to achieve therapeutic levels of marijuana in the bloodstream to treat glaucoma, an individual would need to smoke approximately six to eight times a day,” at which point the person “would likely be physically and mentally unable to perform tasks requiring attention and focus,” like working and driving. The major eye care medical societies have put thumbs down on marijuana to treat glaucoma.

Allison Karst, a psychiatric pharmacy specialist at the V.A. Tennessee Valley Healthcare System, who reviewed the benefits and risks of medical marijuana , concluded that marijuana can have “a negative effect on mental health and neurological function,” including worsening symptoms of PTSD and bipolar disorder.

Dr. Karst also cited one study showing that only 17 percent of edible cannabis products were accurately labeled. In an email she wrote that the lack of regulation “leads to difficulty extrapolating available evidence to various products on the consumer market given the differences in chemical composition and purity.” She cautioned the public to weigh “both potential benefits and risks,” to which I would add caveat emptor — buyer beware.

Jane Brody is the Personal Health columnist, a position she has held since 1976. She has written more than a dozen books including the best sellers “Jane Brody’s Nutrition Book” and “Jane Brody’s Good Food Book.” More about Jane E. Brody

Jane Brody’s Personal Health Advice

After joining the new york times in 1965, she was its personal health columnist from 1976 to 2022. revisit some of her most memorable writing:.

Brody’s first column, on jogging , ran on Nov. 10, 1976. Her last, on Feb. 21. In it, she highlighted the evolution of health advice  throughout her career.

Personal Health has often offered useful advice and a refreshing perspective. Declutter? This is why you must . Cup of coffee? Yes, please.

As a columnist, she has never been afraid to try out, and write about, new things — from intermittent fasting  to knitting groups .

How do you put into words the pain of losing a spouse of 43 years? It is “nothing like losing a parent,” she wrote of her own experience with grieving .

Need advice on aging? She has explored how to do it gracefully ,  building muscle strength  and knee replacements .

Retail marijuana bill advances in House; New Hampshire's role in sales hotly debated

CONCORD — Should recreational cannabis shops in New Hampshire look and operate as franchises like McDonald's or as heavily regulated stand-alone retailers?

A model for how recreational marijuana would be sold if it is legalized in New Hampshire was approved in the House Finance Committee Tuesday but the conflict over it is far from resolved. The committee voted in favor of an agency model, where the state would have influence over marijuana businesses, but not full control. It would also allow stores to have unique interior features.

But the legislation faces an uncertain future in the state Senate, which appears to prefer a franchise model, giving the state full control over the industry. Under this model, stores would be identical, like a fast food chain, but owned by individual franchisees who would be responsible for running the actual businesses. The franchisor, in this model, would be the New Hampshire Liquor Commission.

House Bill 1633 , sponsored by Rep. Erica Layon, R-Derry, would allow anyone 21 and older to possess and consume marijuana in New Hampshire. The bill sets up guidelines for the regulation and sale of the drug.

Under this bill, consumers could buy cannabis legally at 15 retail locations authorized by the New Hampshire Liquor Commission. The stores would be run under an agency model in which the state would hold significant power over businesses without it being a state-run industry.

However, New Hampshire Gov. Chris Sununu as well as members of the Senate have voiced their preference for the state-run franchise model.

Layon’s model ultimately won out in the House when the Finance Committee voted 19-6 on Tuesday to approve HB 1633 with her amendment that made clear the use of the agency model. The committee had earlier rejected an amendment from Rep. Dan McGuire, R-Epsom, which was influenced by language from Sen. Daryl Abbas, R-Salem, and other senators, that would've replaced Layon's bill with the franchise model.

The agency model's victory in the House committee is likely to set up a fight with the Senate and governor if it passes the full House on April 11.

The bill also passed with other changes included in Layon’s amendment and another from Rep. Peter Leishman, D-Peterborough.

Agency vs. franchise model

Under the agency model, Layon said the state would not be "going into business" with the retailers that would own individual stores, meaning the state would not be setting things like wages or prices.

Layon said the agency model is better because with the franchise model, promoted by Sen. Abbas, the state's Liquor Commission would set the prices at all levels, from the grower to the manufacturer and up. She says this wouldn’t allow for a “functional market” and could lead to predatory pricing.

Abbas  told WMUR  the agency model is too similar to the retail model that he said has failed in other states.

The franchise model, he said, “Offers the market protection so a larger company or a larger operation can’t oversaturate the market and manipulate the sale price, causing the smaller places to go under.”

Layon said that her model is more restrictive than anything that's passed in other states. She thinks the franchise model would be too risky.

“I don't want to substitute a state cartel for the illegal cartel, and I'm worried that if they're setting all the prices, that's what's going to happen,” she said. 

Layon also said under an agency model, marijuana stores could each have a unique look and feel. She said there would be certain guidelines to make sure New Hampshire has "classy cannabis:" all 15 of the stores under her bill would have the same exterior, and there would be no neon lights, no cartoony faces, no decorations that would be glorifying misuse of marijuana allowed. But outside of those regulations, retailers could do what they want to the inside.

She said that making stores somewhere people want to shop is an important factor in marketing and attracting customers. Otherwise, she said, "there's no point in doing any of this."

“The question is do people want to go to sort of a big box McDonald's for their cannabis, or do they want to go to something that's a little bit more unique? We don't have the same range in the Northeast as you would have in California, but there's one place that literally looks like a Bath and Body Works,” Layon said. A franchise model, she continued, “would totally prohibit any innovation that way and how somebody would run a store.”

How will cannabis bill fare in the NH Senate?

In the Senate, many members have repeatedly voted against cannabis legalization in the past. 

“I’m not a big proponent of marijuana, even though I personally supported medical marijuana and decriminalization,” said Senate President Jeb Bradley, R-Wolfeboro, at a press conference in January. However, he said, he sees an “opportunity” for legalization.

The agency vs. franchise models will likely be a point of contention in the Senate. Abbas is not the only senator who opposes the agency model. Sen. Cindy Rosenwald, D-Nashua, has also voiced her preference for the franchise model that she said would allow for more state control.

Layon, however, thinks there is a path for the bill to pass the Senate.

Will NH Gov. Chris Sununu support the legalization of marijuana?

In May 2023, Sununu flipped his stance on marijuana to being open to legalization – if done the “right way.” 

HB 1633 was modeled in large part based on his stipulations.

“My model has been set to meet everything that he has set out publicly,” Layon said. Indeed, some of the language of her bill mirrors  his May statement , including a prohibition on “marijuana miles,” where stores are densely concentrated.

However, Sununu supports a franchise model over the agency model outlined in Layon's bill. She said he changed to the word franchise at the “11th hour,” but she thinks agency stores are an acceptable path because they still include significant state influence.

Her bill also doesn’t include a Sununu-supported ban on lobbying by franchises, something she thinks would be a legal liability.

Layon said she is talking to Sununu's office now to see if there are any remaining gaps in her bill that he would like to see filled.

“I think that there's the potential of a path to passing my bill even without the governor if necessary, but I'd much rather have everybody realize that this is something that is important,” said Layon. 

Echoing Sununu’s stipulations, she continued, “And we need to do it in a way that’s going to maximize safety and not tax revenue.”

Separate operational and regulatory control

Layon included separating operational control and regulatory oversight of cannabis shops in her amendment due to fears they would not be able to implement the agency or franchise model the legislature is suggesting because of federal government rules. 

“It might technically be legal but not actually be legal,” she said. While states have been legalizing recreational use of cannabis since 2012, it is still illegal under federal law, and she thinks the government could go after the state for having too much oversight of the industry.

If that were to happen, having a separate operational control would allow the state to pivot to a different model that would be allowed.

Layon said separating the two is also “good practice.”

“You also don’t want somebody who’s a business partner overseeing regulatory compliance,” she said.

NH penalties for people using cannabis in public being worked out, too

Issues over criminal charges still in place for cannabis consumption were brought up by representatives and the ACLU of New Hampshire.

"This bill not only keeps the current misdemeanor charges for people smoking in public, but it also increases the second-violation fines," said Rep. Heath Howard, D-Strafford.

To address this, Rep. Peter Leishman amendment, 1339H, changes the unspecified “misdemeanor” charge for the third offense of smoking or vaporizing cannabis in a public place (which could be charged as a Class A misdemeanor and lead to jail time) to a Class B misdemeanor, which would impose a $1,200 fine but no jail time. 

No, you can't legally smoke marijuana at your favorite Ohio beer garden. Here's why

The first Ohio spring with legal recreational marijuana is upon us, but don't expect a cloud of haze over your favorite beer garden.

The state's new recreational marijuana law took effect late last year after voters approved Issue 2 on the November ballot. Ohioans 21 and older can now buy, possess and grow cannabis, although legal sales aren't expected until September at the earliest.

Much of the program remains in flux. The Division of Cannabis Control is setting rules to implement the initiated statute, which includes making license applications available to growers, processors and dispensaries by June. Gov. Mike DeWine and some state lawmakers wanted to change the law, but those conversations stalled and appear unlikely to resume any time soon.

Still, state officials have made one thing clear: Ohioans shouldn't smoke marijuana in public, even in places that allow outdoor tobacco smoking.

Here's what you need to know.

Can I smoke marijuana in public in Ohio?

No. Smoking marijuana falls under the  state's smoking ban . That law prohibits people from smoking plant material in enclosed areas open to the public, with exceptions for outdoor patios, smoke shops and hotel rooms designated for smoking.

"The smoking ban in public places really is controlling," Jim Canepa, superintendent of the Division of Cannabis Control, told Cincinnati Edition last month. "Whether it's cannabis that is being smoked or cigarettes that are being smoked or cigars being smoked, there are places you can and cannot do that."

What are the rules for bars and restaurants?

That doesn't mean people can light up on the patio − or pop an edible at the bar, for that matter.

Bars and restaurants with liquor permits can't knowingly allow or facilitate the use of controlled substances, which includes marijuana. Permitholders who violate this rule could face an administrative fine, according to the Division of Liquor Control .

The agency sent guidance to businesses after a Columbus pizza place invited customers to use marijuana on its patio in December. After holding a few weekly events, GoreMade Pizza asked people to "partake ahead of time" instead of at the restaurant.

"One thing has been made clear. If we encourage the use of Marijuana on our pizza patio, we could lose our liquor license and face some hefty fines," GoreMade posted on Instagram .

Representatives for GoreMade declined to be interviewed.

What about places that don't have liquor permits?

The new law allows "any public place" to decide whether to allow or prohibit marijuana. It also says anyone who uses marijuana in public areas is guilty of a minor misdemeanor.

"It is left up to the property owner to determine how or whether to address cannabis consumption on their property," said Tom Haren, an attorney who worked on the campaign to pass Issue 2.

Division spokesman Jamie Crawford said businesses, when setting their policies, should remember that the law bans public use and doesn't change marijuana's classification as a controlled substance. One of DeWine's top priorities has been to clarify the statute's language around public consumption.

Haren said he expects specific policies to develop as the division's rules go into effect.

Has anyone gotten in trouble?

Despite the hiccup with GoreMade, the Division of Liquor Control hasn't issued any administrative citations for marijuana use on a liquor permit premises. Officials are separately investigating a state liquor store employee accused of illegally selling marijuana to customers.

A spokesman for the liquor division said he could not provide additional details or records about the ongoing investigation.

Haley BeMiller is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.