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The Evidence—and Lack Thereof—About Cannabis

Research is still needed on cannabis’s risks and benefits. 

Lindsay Smith Rogers

Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread.

Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. 

In this Q&A, adapted from the August 25 episode of Public Health On Call , Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS , associate professor of Mental Health , about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. 

Do you think medicinal cannabis paved the way for legalization of recreational use?

The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use.

But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders.

Does cannabis have viable medicinal uses?

The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer.

There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. 

And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication.

What do we know about the risks of marijuana use?  

Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. 

It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. 

What benefits do you see to legalization?

When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. 

And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations.

What big questions about cannabis would you most like to see answered?

We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted.

Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence.

Are there studies looking into the risks you mentioned?

Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder.

If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about?

I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.

Lindsay Smith Rogers, MA, is the producer of the Public Health On Call podcast , an editor for Expert Insights , and the director of content strategy for the Johns Hopkins Bloomberg School of Public Health.

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The benefits and harms of marijuana, explained by the most thorough research review yet

A new report looks at more than 10,000 studies on marijuana. It has good and bad news for pot users.

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Marijuana has been with humans in some way or another for thousands of years. But after all this time, there is still a lot of public debate about what, exactly, pot’s risks and benefits are.

A recent review of the research from the National Academies of Sciences, Engineering, and Medicine attempts to fill the gap in our knowledge. By combing through more than 10,000 studies published since 1999, the review, conducted by more than a dozen experts, provides the clearest look at the scientific evidence on marijuana yet.

The research finds both some strong benefits and major downsides to cannabis. It seems to be promising for chronic pain, multiple sclerosis, and cancer patients. But it also seems to pose a significant risk for respiratory problems if smoked, schizophrenia and psychosis, car crashes, lagging social achievement in life, and perhaps pregnancy-related problems.

The findings aren’t just for marijuana; they’re for marijuana or cannabinoids, chemical compounds commonly found in pot. It’s possible that, down the line, some of the benefits in particular will be split from the marijuana leaf itself — although many drug experts believe that there’s an “entourage effect” with marijuana in which all of its cannabinoids and chemicals, which number in the hundreds , work together to make its effects as potent as possible.

One major caveat to this: The report is, by its own admission, only a best guess for a lot of its findings, because much of the research out there just isn’t very good. The report pins the lack of good research largely on government policies — particularly regulatory barriers linked to marijuana’s federal classification as a highly restricted Schedule 1 substance — that make it hard to conduct good studies on the drug. The National Academies ultimately calls for these barriers to be cut down and more research to be funded so we can get a better idea of what pot is capable of, especially as more states legalize it for both medical and recreational uses.

Still, the report is the best look at marijuana yet. It is nearly 400 pages; if you want a really deep dive into the benefits and harms of marijuana, you should read it in full . But here I’ve provided a summary of what the researchers found.

What are marijuana’s benefits?

Since the mid-1990s, 28 states have legalized marijuana for medical uses. But in all that time, the benefits of pot have remained hazy. Despite some research showing that it can be good for pain and muscle stiffness, many of the claims about what pot can do for other ailments — such as epilepsy and irritable bowel syndrome — are based on anecdotal evidence and have yet to be scientifically proven.

The report can’t fully validate or invalidate all of the claims about marijuana’s medical benefits, given that there are still no studies on some of these questions, and many of the studies that are out there are bad or lacking. But it does have some solid findings.

For one, the review confirms what previous studies have found: There is “substantial evidence” that marijuana is good for treating chronic pain. This is one of the most common reasons cited for marijuana’s medical use — particularly in light of the opioid painkiller epidemic , which has spawned in part as patients turn to opioids to try to treat debilitating pain. The report concludes that marijuana can treat chronic pain. And that may allow it to substitute more dangerous, deadlier opioid painkillers.

The report also found “conclusive evidence” that marijuana is effective for treating chemotherapy-induced nausea and vomiting. Coupled with the findings on pain, this suggests that marijuana really is a potent treatment for cancer patients in particular, who can suffer from debilitating pain and severe nausea as a result of their illness.

And the report found “substantial evidence” that marijuana can improve patient-reported multiple sclerosis spasticity symptoms. But it only found “limited evidence” for marijuana improving doctor-reported symptoms of this kind.

Beyond the strongest findings, the report found “moderate evidence” that marijuana is effective for “improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.” It also found “limited evidence” for marijuana’s ability to treat appetite and weight loss associated with HIV/AIDS, improving Tourette syndrome symptoms, improving anxiety symptoms in individuals with social anxiety disorders, and improving PTSD. And there’s “limited evidence” of a correlation between marijuana and better outcomes after a traumatic brain injury.

The report also disproved — or at least cast a lot of doubt — on some of the claimed benefits of pot. It found “limited evidence” that marijuana is ineffective for treating symptoms associated with dementia and glaucoma, as well as depressive symptoms in individuals with chronic pain or multiple sclerosis.

And it found “no or insufficient evidence” for marijuana as a treatment for cancers, cancer-associated anorexia, irritable bowel syndrome, epilepsy, spasticity in patients with paralysis due to spinal cord injury, amyotrophic lateral sclerosis, Huntington’s disease, Parkinson’s disease, dystonia, drug addiction, and schizophrenia. This doesn’t mean that marijuana can’t treat any of these — some patients, who are prescribed pot for these ailments today, will swear that marijuana helped treat their epilepsy, for example — but that there’s just not enough evidence so far to evaluate the claims.

Overall, the report suggests that, as far as therapeutic benefits go, marijuana is a solid treatment for multiple symptoms associated to chronic pain, chemotherapy-induced nausea and vomiting, and multiple sclerosis. Everything else, from epilepsy to HIV/AIDS, needs more research before pot is more definitively shown to be effective or ineffective.

What are marijuana’s harms?

Marijuana is often described as one of the safest drugs out there, in part because it’s never been definitively linked to an overdose death and it’s broadly safer than other drugs like alcohol, tobacco, cocaine, and heroin. And while the National Academies’ report doesn’t find evidence of a marijuana overdose death, it does add a few wrinkles to the narrative of marijuana as a safe drug.

For one, the report finds “substantial evidence” of marijuana’s negative effects for a few conditions. For long-term marijuana smokers, there’s a risk of worse respiratory symptoms and more frequent chronic bronchitis episodes. For pregnant women who smoke pot, there’s a risk of lower birth weight for the baby. For marijuana users in general, there’s a greater risk of developing schizophrenia and other psychoses. And there’s a link between marijuana use and increased risk of car crashes.

The report also found “limited evidence” of links between marijuana use and several other negative outcomes, including an increased risk of testicular cancer, triggering a heart attack, chronic obstructive pulmonary disease, and pregnancy complications. And it found “moderate” to “limited” evidence that marijuana use might worsen symptoms or risk for some mental health issues, including depressive disorders, bipolar disorder, suicidal ideation and suicide attempts among heavier users, and anxiety disorders, particularly social anxiety disorder among regular users.

Besides medical conditions, the report found evidence for some psychosocial problems. There’s “moderate evidence” that acute marijuana use impairs learning, memory, and attention. There’s “limited evidence” of marijuana use and worse outcomes in education, employment, income, and social functioning.

There was some good news: The report found “moderate evidence” of no link between marijuana smoking and lung cancer or marijuana use and head and neck cancers, which are commonly linked to tobacco. There was also “moderate evidence” of better cognitive performance among individuals with psychotic disorders and a history of marijuana use.

The report, however, couldn’t find sufficient evidence for pot’s links to a lot of problems: other types of cancer, an increased chronic risk of heart attack, asthma, later outcomes for infants born of mothers that used marijuana during pregnancy, deadly pot overdoses, and PTSD.

With the problems specifically linked to smoking marijuana, it’s worth noting that other forms of consumption — vaping and edibles in particular — may not carry the same risk. More research will be needed to evaluate that, particularly for vaping.

The report also found some “substantial evidence” that more pot use can lead to problematic marijuana use — what one typically thinks of as excessive use or even dependence. It also outlined, with “limited” to “substantial” evidence, some of the risk factors for problematic marijuana use, including being male, smoking cigarettes, a major depressive order, exposure to combined use of other drugs, and use at an earlier age. But it also cited “limited” to “moderate” evidence to rule out a few risk factors, including anxiety, personality, and bipolar disorders, adolescent ADHD, and alcohol or nicotine dependence.

It also found a “limited” to “moderate” evidence of a correlation between marijuana use and use of other illicit drugs. This is the typical evidence cited for the so-called “gateway” effect: that marijuana use may lead to the use of harder drugs.

One caveat to much of the research: correlation is not always causation. For example, in the case of the “gateway” effect, other researchers argue that the correlation between pot and harder drug use may just indicate that people prone to all sorts of drug use only start with marijuana because it’s the cheapest and most accessible of the illicit drugs. If cocaine or heroin were cheaper and more accessible, there’s a good chance people would start with those drugs first.

Still, the bottom line is that marijuana does pose some harms — particularly for people at risk of developing mental health disorders, pregnant women, those vulnerable to respiratory problems, and anyone getting into a car. And while some of these harms may be overcome by marijuana’s benefits or curtailed by consuming pot without smoking it, the evidence shows that weed’s reputation as a safe drug is undeserved.

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Regions & Countries

Most americans favor legalizing marijuana for medical, recreational use, legalizing recreational marijuana viewed as good for local economies; mixed views of impact on drug use, community safety.

Pew Research Center conducted this study to understand the public’s views about the legalization of marijuana in the United States. For this analysis, we surveyed 5,140 adults from Jan. 16 to Jan. 21, 2024. Everyone who took part in this survey is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATP’s methodology .

Here are the questions used for the report and its methodology .

As more states pass laws legalizing marijuana for recreational use , Americans continue to favor legalization of both medical and recreational use of the drug.

An overwhelming share of U.S. adults (88%) say marijuana should be legal for medical or recreational use.

Nearly six-in-ten Americans (57%) say that marijuana should be legal for medical and recreational purposes, while roughly a third (32%) say that marijuana should be legal for medical use only.

Just 11% of Americans say that the drug should not be legal at all.

Opinions about marijuana legalization have changed little over the past five years, according to the Pew Research Center survey, conducted Jan. 16-21, 2024, among 5,14o adults.

The impact of legalizing marijuana for recreational use

While a majority of Americans continue to say marijuana should be legal , there are varying views about the impacts of recreational legalization.

About half of Americans (52%) say that legalizing the recreational use of marijuana is good for local economies; just 17% think it is bad and 29% say it has no impact.

More adults also say legalizing marijuana for recreational use makes the criminal justice system more fair (42%) than less fair (18%); 38% say it has no impact.

However, Americans have mixed views on the impact of legalizing marijuana for recreational use on:

• Use of other drugs: About as many say it increases (29%) as say it decreases (27%) the use of other drugs, like heroin, fentanyl and cocaine (42% say it has no impact).
• Community safety: More Americans say legalizing recreational marijuana makes communities less safe (34%) than say it makes them safer (21%); 44% say it has no impact.

Partisan differences on impact of recreational use of marijuana

There are deep partisan divisions regarding the impact of marijuana legalization for recreational use.

Majorities of Democrats and Democratic-leaning independents say legalizing recreational marijuana is good for local economies (64% say this) and makes the criminal justice system fairer (58%).

Fewer Republicans and Republican leaners say legalization for recreational use has a positive effect on local economies (41%) and the criminal justice system (27%).

Republicans are more likely than Democrats to cite downsides from legalizing recreational marijuana:

• 42% of Republicans say it increases the use of other drugs, like heroin, fentanyl and cocaine, compared with just 17% of Democrats.
• 48% of Republicans say it makes communities less safe, more than double the share of Democrats (21%) who say this.

Demographic, partisan differences in views of marijuana legalization

Sizable age and partisan differences persist on the issue of marijuana legalization though small shares of adults across demographic groups are completely opposed to it.

Older adults are far less likely than younger adults to favor marijuana legalization.

This is particularly the case among adults ages 75 and older: 31% say marijuana should be legal for both medical and recreational use.

By comparison, half of adults between the ages of 65 and 74 say marijuana should be legal for medical and recreational use, and larger shares in younger age groups say the same.

Republicans continue to be less supportive than Democrats of legalizing marijuana for both legal and recreational use: 42% of Republicans favor legalizing marijuana for both purposes, compared with 72% of Democrats.

There continue to be ideological differences within each party:

• 34% of conservative Republicans say marijuana should be legal for medical and recreational use, compared with a 57% majority of moderate and liberal Republicans.
• 62% of conservative and moderate Democrats say marijuana should be legal for medical and recreational use, while an overwhelming majority of liberal Democrats (84%) say this.

Views of marijuana legalization vary by age within both parties

Along with differences by party and age, there are also age differences within each party on the issue.

A 57% majority of Republicans ages 18 to 29 favor making marijuana legal for medical and recreational use, compared with 52% among those ages 30 to 49 and much smaller shares of older Republicans.

Still, wide majorities of Republicans in all age groups favor legalizing marijuana at least for medical use. Among those ages 65 and older, just 20% say marijuana should not be legal even for medical purposes.

While majorities of Democrats across all age groups support legalizing marijuana for medical and recreational use, older Democrats are less likely to say this.

About half of Democrats ages 75 and older (53%) say marijuana should be legal for both purposes, but much larger shares of younger Democrats say the same (including 81% of Democrats ages 18 to 29). Still, only 7% of Democrats ages 65 and older think marijuana should not be legalized even for medical use, similar to the share of all other Democrats who say this.

Views of the effects of legalizing recreational marijuana among racial and ethnic groups

Substantial shares of Americans across racial and ethnic groups say when marijuana is legal for recreational use, it has a more positive than negative impact on the economy and criminal justice system.

About half of White (52%), Black (53%) and Hispanic (51%) adults say legalizing recreational marijuana is good for local economies. A slightly smaller share of Asian adults (46%) say the same.

Criminal justice

Across racial and ethnic groups, about four-in-ten say that recreational marijuana being legal makes the criminal justice system fairer, with smaller shares saying it would make it less fair.

However, there are wider racial differences on questions regarding the impact of recreational marijuana on the use of other drugs and the safety of communities.

Use of other drugs

Nearly half of Black adults (48%) say recreational marijuana legalization doesn’t have an effect on the use of drugs like heroin, fentanyl and cocaine. Another 32% in this group say it decreases the use of these drugs and 18% say it increases their use.

In contrast, Hispanic adults are slightly more likely to say legal marijuana increases the use of these other drugs (39%) than to say it decreases this use (30%); 29% say it has no impact.

Among White adults, the balance of opinion is mixed: 28% say marijuana legalization increases the use of other drugs and 25% say it decreases their use (45% say it has no impact). Views among Asian adults are also mixed, though a smaller share (31%) say legalization has no impact on the use of other drugs.

Community safety

Hispanic and Asian adults also are more likely to say marijuana’s legalization makes communities less safe: 41% of Hispanic adults and 46% of Asian adults say this, compared with 34% of White adults and 24% of Black adults.

Wide age gap on views of impact of legalizing recreational marijuana

Young Americans view the legalization of marijuana for recreational use in more positive terms compared with their older counterparts.

Clear majorities of adults under 30 say it is good for local economies (71%) and that it makes the criminal justice system fairer (59%).

By comparison, a third of Americans ages 65 and older say legalizing the recreational use of marijuana is good for local economies; about as many (32%) say it makes the criminal justice system more fair.

There also are sizable differences in opinion by age about how legalizing recreational marijuana affects the use of other drugs and the safety of communities.

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Table of contents, most americans now live in a legal marijuana state – and most have at least one dispensary in their county, 7 facts about americans and marijuana, americans overwhelmingly say marijuana should be legal for medical or recreational use, clear majorities of black americans favor marijuana legalization, easing of criminal penalties, religious americans are less likely to endorse legal marijuana for recreational use, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

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The Benefits of Medical Marijuana, Essay Example

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Marijuana has been used in many spiritual healings and for recreational use for many years. Marijuana has been used as early as 2900 BC when Chinese Emperor Fu His referenced marijuana (Cannabis) as a popular medicine of the time. According to Richard Boire, and Kevin Feeney (2007), “In the 19th Century, marijuana emerged as a mainstream medicine in the West. Studies in the 1840s by a French doctor by the name of Jacques-Joseph Moreau [a French psychiatrist] found that marijuana suppressed headaches, increased appetites, and aided people to sleep.” (“Medical Marijuana,” 2009, n.p.).However, not until recently had it even crossed the minds of many medical professionals to be used in order to help patients who have been diagnosed with many diseases where relief is very seldom. It is now being legalized in many states in order to help with many medical diseases and chronic pain.“Medical marijuana clinics operate in 20 states and the District of Columbia, and its recreational use is now legal in Colorado and Washington” (Brody, 2013, n.p.). Even with the many medical clinics supporting the use of medicinal marijuana, there are still many different views by different people on whether marijuana should be used for medical purposes. Many believe that it shouldn’t be used as it is still considered a drug that may have adverse effects on the brain and other organs in the body. However, there are many people who support the use of marijuana as long as it is used for medical purposes. It is all a matter of opinion for many at this point. However, there are many benefits for the use of marijuana in the medical field today.

The real use of medicinal marijuana was introduced by W.B. O’Shaughnessy, a surgeon who learned that marijuana could be used to help alleviate pain and many other medical problems. According to the National Cancer Institute (2013), “its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects” (p. 1).Cancer is one of the largest medical problems in our society today and many clinical trials of medical marijuana have shown that it helps with the effects of chemotherapy such as vomiting and nausea under a generic name called dronabinol (National Cancer Institute, 2013). “Clinical trials determined that dronabinol was as effective as or better than other antiemetic agents available at the time” (National Cancer Institute, 2013, p. 1). Cancer and chemotherapy are just two of the aspects of the medical field that marijuana benefits. According to the former US Surgeon General, Jocelyn Elders (2004), “the evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS — or by the harsh drugs sometimes used to treat them” (“Medical Marijuana,” 2009, n.p.). Not only does marijuana help with the side effects of chemotherapy, but there is evidence that a chemical that is found in marijuana stops cancer from spreading. In 2007, the California Pacific Medical Center in San Francisco did a study that proved that cannabidiol prevents cancer cells from spreading (Astaiza, 2012). Astaiza (2012) states that cannabidiol by turning off the Id-1 gene in the person’s body. “The researchers studied breast cancer cells in the lab that had high expression levels of Id-1 and treated them with cannabidiol. After treatment the cells had decreased Id-1 expression and were less aggressive spreaders” (Astaiza, 2012, n.p.).

Many individuals are living with pain each and every day of their lives. This pain can stem from the smallest things such as back aches and headaches to larger problems such as multiple sclerosis as stated above. Randy Astaiza (2012) states the following in reference to how marijuana helps patients with multiple sclerosis:

Jody Corey-Bloom studied 30 multiple sclerosis patients with painful contractions in their muscles. These patients didn’t respond to other treatments, but after smoking marijuana for a few days they were in less pain. The THC in the pot binds to receptors in the nerves and muscles to relieve pain. Other studies suggest that the chemical also helps control the muscle spasms (n.p.).

Pain management is one of the largest parts of the medical field as well and many are beginning to say that marijuana helps alleviate much of the pain that patients feel. According to Jane E. Brody (2013), “the strongest evidence for the health benefits of medical marijuana or its derivatives involves the treatment of chronic neuropathic pain and the spasticity caused by multiple sclerosis” (p. 1).One of these pains, among many, is peripheral neuropathy which consists of many symptoms that can significantly deteriorate a person’s quality of life. According to Igor Grant (2013), this is something that can be treated by the use of medical marijuana. Grant (2013) describes painful peripheral neuropathy in the following paragraph:

Painful peripheral neuropathy comprises multiple symptoms that can severely erode quality of life. These include allodynia (pain evoked by light stimuli that are not normally pain-evoking) and various abnormal sensations termed dysesthesias (e.g., electric shock sensations, “pins and needles,” sensations of coldness or heat, numbness, and other types of uncomfortable and painful sensations). Common causes of peripheral neuropathy include diabetes, HIV/AIDS, spinal cord injuries, multiple sclerosis, and certain drugs and toxins (p. 466).

Many individuals that are suffering from these diseases attempt to get treatment and sometimes that treatment does work. However, many scientists and doctors that support the use of medical marijuana state that many of these patients would have better results if prescribed marijuana is small doses. In addition, researchers and physicians are also beginning to state that marijuana helps those patients with arthritis. This drug alleviates pain and discomfort as well as reduces the inflammation that many arthritis patients deal with on a daily basis. For example, “Researchers from rheumatology units at several hospitals gave their patients, sativex, a cannabinoid-based pain-relieving medicine. After a two week period, people on Sativex had a significant reduction in pain and improved sleep quality compared to placebo users” (Astaiza, 2012, n.p.).

In addition, marijuana can help with diseases such as epilepsy, anxiety disorders, and Alzheimer’s disease.  According to Astaiza (2012), “Cannabinoids like the active ingredient in marijuana, tetrahydrocannabinol (also known as THC), control seizures by binding to the brain cells responsible for controlling excitability and regulating relaxation” (n.p.). This is one of the most amazing benefits of medicinal marijuana as there are many individuals that suffer from epileptic seizures on a daily basis. It is also said that marijuana helps reduce anxiety. According to researchers at the Harvard Medical school, marijuana helps a person’s mood and “acts as a sedative in low doses” (Astaiza, 2012, n.p.). Finally, it is said that marijuana helps slow the process of Alzheimer’s disease. Astaiza (2012) states the following to prove this:

The 2006 study, published in the journal Molecular Pharmaceutics, found that THC, the active chemical in marijuana, slows the formation of amyloid plaques by blocking the enzyme in the brain that makes them. These plaques are what kill brain cells and cause Alzheimer’s (n.p.).

Many focus on the fact that marijuana is an illegal drug, that it can be addictive, and that many individuals will abuse the use of the drug if it is ever legalized (either recreationally or through medical use). When looking at only the negative aspects of something, it is not easy to approach a concept with a positive means of change.Many people are not taking the time to look at the benefits that it may have on the people who have to deal with chronic pain and irreversible diseases. These individuals go day to day with pain that they are not able to relieve even with legalized medications. The more research and studies that are done can certainly help make believers out of those that are against the use of marijuana for medical purposes. If a substance can be used to alleviate discomfort and pain, where there are proven studies that show its positive effects, many would think that the drug should be used to help patients. Unfortunately, too many people are focusing on the negative effects that this drug could have on a person’s body. One must open his or her mind to the idea that something could be beneficial even if they do not completely believe in its use.

In conclusion, marijuana can be very beneficial for the chronically ill. It also has benefits for those individuals that deal with chronic pain and other diseases such as epilepsy, AIDS, multiple sclerosis, fibromyalgia and much more. If used in a medical sense, with the right amount of dosage and the proper treatment by a physician, the use of marijuana could change the lives of many who are suffering. Unfortunately, this takes the work of many doctors, nurses, government officials, and supporters that will back up the ideas and the many negative contradictions with positive feedback about the drug when used properly. If this could take place and many could see the actual benefits, the use of marijuana in the medical field could help many individuals who continue to suffer on a daily basis.

Astaiza, R. (2012, November 08). All the reasons pot is good for you. Business Insider , Retrieved from http://www.businessinsider.com/health-benefits-of-medical-marijuana-2012-11?op=1

Brody, J. E. (2013, November 04). Tapping medical marijuana’s potential. The New York Times . Retrieved from http://well.blogs.nytimes.com/2013/11/04/tapping-medical-marijuanas-potential/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1

Grant, I. (2013). Medicinal cannabis and painful sensory neuropathy. American Medical Association Journal of Ethics , 15(5), 466-469. Retrieved from http://virtualmentor.ama-assn.org/2013/05/oped1-1305.html

Medical marijuana. (2009, May 06). Retrieved from http://medicalmarijuana.procon.org/view.resource.php?resourceID=000141

National Cancer Institute. (2013, November 21). Cannabis and Cannabinoids . Retrieved from http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page2

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2018 Theses Doctoral

Essays on Cannabis Legalization

Thomas, Danna Kang

Though the drug remains illegal at the federal level, in recent years states and localities have increasingly liberalized their marijuana laws in order to generate tax revenue and save resources on marijuana law enforcement. Many states have adopted some form of medical marijuana and/or marijuana decriminalization laws, and as of 2017, Washington, Colorado, Maine, California, Oregon, Massachusetts, Nevada, Alaska, and the District of Columbia have all legalized marijuana for recreational use. In 2016 recreational marijuana generated over $1.8 billion in sales. Hence, studying marijuana reforms and the policies and outcomes of early recreational marijuana adopters is an important area of research. However, perhaps due to the fact that legalized recreational cannabis is a recent phenomenon, a scarcity of research exists on the impacts of recreational cannabis legalization and the efficacy and efficiency of cannabis regulation. This dissertation aims to fill this gap, using the Washington recreational marijuana market as the primary setting to study cannabis legalization in the United States. Of first order importance in the regulation of sin goods such as cannabis is quantifying the value of the marginal damages of negative externalities. Hence, Chapter 1 (co-authored with Lin Tian) explores the impact of marijuana dispensary location on neighborhood property values, exploiting plausibly exogenous variation in marijuana retailer location. Policymakers and advocates have long expressed concerns that the positive effects of the legalization--e.g., increases in tax revenue--are well spread spatially, but the negative effects are highly localized through channels such as crime. Hence, we use changes in property values to measure individuals' willingness to pay to avoid localized externalities caused by the arrival of marijuana dispensaries. Our key identification strategy is to compare changes in housing sales around winners and losers in a lottery for recreational marijuana retail licenses. (Due to location restrictions, license applicants were required to provide an address of where they would like to locate.) Hence, we have the locations of both actual entrants and potential entrants, which provides a natural difference-in-differences set-up. Using data from King County, Washington, we find an almost 2.4% decrease in the value of properties within a 0.5 mile radius of an entrant, a $9,400 decline in median property values. The aforementioned retail license lottery was used to distribute licenses due to a license quota. Retail license quotas are often used by states to regulate entry into sin goods markets as quotas can restrict consumption by decreasing access and by reducing competition (and, therefore, increasing markups). However, license quotas also create allocative inefficiency. For example, license quotas are often based on the population of a city or county. Hence, licenses are not necessarily allocated to the areas where they offer the highest marginal benefit. Moreover, as seen in the case of the Washington recreational marijuana market, licenses are often distributed via lottery, meaning that in the absence of an efficiency secondary market for licenses, the license recipients are not necessarily the most efficient potential entrants. This allocative inefficiency is generated by heterogeneity in firms and consumers. Therefore, in Chapter 2, I develop a model of demand and firm pricing in order to investigate firm-level heterogeneity and inefficiency. Demand is differentiated by geography and incorporates consumer demographics. I estimate this demand model using data on firm sales from Washington. Utilizing the estimates and firm pricing model, I back out a non-parametric distribution of firm variable costs. These variable costs differ by product and firm and provide a measure of firm inefficiency. I find that variable costs have lower inventory turnover; hence, randomly choosing entrants in a lottery could be a large contributor to allocative inefficiency. Chapter 3 explores the sources of allocative inefficiency in license distribution in the Washington recreational marijuana market. A difficulty in studying the welfare effects of license quotas is finding credible counterfactuals of unrestricted entry. Therefore, I take a structural approach: I first develop a three stage model that endogenizes firm entry and incorporates the spatial demand and pricing model discussed in Chapter 2. Using the estimates of the demand and pricing model, I estimate firms' fixed costs and use data on locations of those potential entrants that did not win Washington's retail license lottery to simulate counterfactual entry patterns. I find that allowing firms to enter freely at Washington's current marijuana tax rate increases total surplus by 21.5% relative to a baseline simulation of Washington's license quota regime. Geographic misallocation and random allocation of licenses account for 6.6\% and 65.9\% of this difference, respectively. Moreover, as the primary objective of these quotas is to mitigate the negative externalities of marijuana consumption, I study alternative state tax policies that directly control for the marginal damages of marijuana consumption. Free entry with tax rates that keep the quantity of marijuana or THC consumed equal to baseline consumption increases welfare by 6.9% and 11.7%, respectively. I also explore the possibility of heterogeneous marginal damages of consumption across geography, backing out the non-uniform sales tax across geography that is consistent with Washington's license quota policy. Free entry with a non-uniform sales tax increases efficiency by over 7% relative to the baseline simulation of license quotas due to improvements in license allocation.

• Cannabis--Law and legislation
• Marijuana industry
• Drug legalization
• Drugs--Economic aspects

More About This Work

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Cannabis (Marijuana) Research Report Is marijuana safe and effective as medicine?

The potential medicinal properties of marijuana and its components have been the subject of research and heated debate for decades. THC itself has proven medical benefits in particular formulations. The U.S. Food and Drug Administration (FDA) has approved THC-based medications, dronabinol (Marinol ® ) and nabilone (Cesamet ® ), prescribed in pill form for the treatment of nausea in patients undergoing cancer chemotherapy and to stimulate appetite in patients with wasting syndrome due to AIDS.

In addition, several other marijuana-based medications have been approved or are undergoing clinical trials. Nabiximols (Sativex ® ), a mouth spray that is currently available in the United Kingdom, Canada, and several European countries for treating the spasticity and neuropathic pain that may accompany multiple sclerosis, combines THC with another chemical found in marijuana called cannabidiol (CBD).

The FDA also approved a CBD-based liquid medication called Epidiolex ®  for the treatment of two forms of severe childhood epilepsy, Dravet syndrome and Lennox-Gastaut syndrome. It’s being delivered to patients in a reliable dosage form and through a reproducible route of delivery to ensure that patients derive the anticipated benefits. CBD does not have the rewarding properties of THC.

Researchers generally consider medications like these, which use purified chemicals derived from or based on those in the marijuana plant, to be more promising therapeutically than use of the whole marijuana plant or its crude extracts. Development of drugs from botanicals such as the marijuana plant poses numerous challenges. Botanicals may contain hundreds of unknown, active chemicals, and it can be difficult to develop a product with accurate and consistent doses of these chemicals. Use of marijuana as medicine also poses other problems such as the adverse health effects of smoking and THC-induced cognitive impairment. Nevertheless, a growing number of states have legalized dispensing of marijuana or its extracts to people with a range of medical conditions.

An additional concern with "medical marijuana" is that little is known about the long-term impact of its use by people with health- and/or age-related vulnerabilities—such as older adults or people with cancer, AIDS, cardiovascular disease, multiple sclerosis, or other neurodegenerative diseases. Further research will be needed to determine whether people whose health has been compromised by disease or its treatment (e.g., chemotherapy) are at greater risk for adverse health outcomes from marijuana use.

Medical Marijuana Laws and Prescription Opioid Use Outcomes

A 2019 analysis, also funded by NIDA, re-examined this relationship using data through 2017. Similar to the findings reported previously, this research team found that opioid overdose mortality rates between 1999-2010 in states allowing medical marijuana use were 21% lower than expected. When the analysis was extended through 2017, however, they found that the trend reversed, such that states with medical cannabis laws experienced an overdose death rate 22.7% higher than expected. 79 The investigators uncovered no evidence that either broader cannabis laws (those allowing recreational use) or more restrictive laws (those only permitting the use of marijuana with low tetrahydrocannabinol concentrations) were associated with changes in opioid overdose mortality rates.

These data, therefore, do not support the interpretation that access to cannabis reduces opioid overdose. Indeed, the authors note that neither study provides evidence of a causal relationship between marijuana access and opioid overdose deaths. Rather, they suggest that the associations are likely due to factors the researchers did not measure, and they caution against drawing conclusions on an individual level from ecological (population-level) data. Research is still needed on the potential medical benefits of cannabis or cannabinoids.

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Risks and Benefits of Marijuana Use

Current Author Addresses: Drs. Keyhani and Cohen, Ms. Steigerwald, Ms. Vali, Ms. Dollinger, and Ms. Yoo: San Francisco VA Medical Center, 4150 Clement Street, Box 111A1, San Francisco, CA 94121.

Dr. Ishida: San Francisco VA Medical Center, 4150 Clement Street, Box 111J, San Francisco, CA 94121.

Dr. Cerdá: Department of Emergency Medicine, University of California, Davis, 4150 V Street, Suite 2100, Sacramento, CA 95817.

Dr. Hasin: Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 228F, New York, NY 10032.

Author Contributions: Conception and design: S. Keyhani, S. Steigerwald, J. Ishida, M. Cerdá, C. Dollinger, S.R. Yoo. Analysis and interpretation of the data: S. Keyhani, S. Steigerwald, J. Ishida, M. Vali, M. Cerdá, D. Hasin, B.E. Cohen.

Critical revision for important intellectual content: S. Keyhani,S. Steigerwald, J. Ishida, M. Cerdá, D. Hasin, B.E. Cohen. Final approval of the article: S. Keyhani, S. Steigerwald, J. Ishida, M. Vali, M. Cerdá, D. Hasin, C. Dollinger, S.R. Yoo, B.E. Cohen.

Statistical expertise: M. Vali.

Collection and assembly of data: S. Keyhani, S. Steigerwald.

Background:

Despite insufficient evidence regarding its risks and benefits, marijuana is increasingly available and is aggressively marketed to the public.

To understand the public’s views on the risks and benefits of marijuana use.

Probability-based online survey.

United States, 2017.

Participants:

16 280 U.S. adults.

Measurements:

Proportion of U.S. adults who agreed with a statement.

The response rate was 55.3% ( n = 9003). Approximately 14.6% of U.S. adults reported using marijuana in the past year. About 81% of U.S. adults believe marijuana has at least 1 benefit, whereas 17% believe it has no benefit. The most common benefit cited was pain management (66%), followed by treatment of diseases, such as epilepsy and multiple sclerosis (48%), and relief from anxiety, stress, and depression (47%). About 91% of U.S. adults believe marijuana has at least 1 risk, whereas 9% believe it has no risks. The most common risk identified by the public was legal problems (51.8%), followed by addiction (50%) and impaired memory (42%). Among U.S. adults,29.2% agree that smoking marijuana prevents health problems. About 18% believe exposure to secondhand marijuana smoke is somewhat or completely safe for adults, whereas 7.6% indicated that it is somewhat or completely safe for children. Of the respondents, 7.3% agree that marijuana use is somewhat or completely safe during pregnancy. About 22.4% of U.S. adults believe that marijuana is not at all addictive.

Limitation:

Wording of the questions may have affected interpretation.

Conclusion:

Americans’ view of marijuana use is more favorable than existing evidence supports.

M arijuana is legal in 30 states and the District of Columbia for medicinal purposes and in 8 states for recreational use ( 1 ). These legal changes have been accompanied by an increase in daily marijuana use, as well as in marijuana dependence, among adults in the U.S. population ( 2 ). Further, the prevalence of past-year marijuana use in the adult general population doubled in the past decade, reaching 13.3% in 2014 ( 3 ).

With legalization of recreational marijuana, rapid commercialization has ensued. Retail marijuana sales exceed $1 billion annually in Colorado and Washington, the first 2 states to legalize marijuana for recreational purposes ( 4 , 5 ). Extensive media coverage of the business, agricultural, and financial aspects of recreational legalization may be desensitizing the public to safety concerns ( 6 , 7 ). Marijuana is being described on the Internet as a product that may be consumed safely during pregnancy; a product with preventive benefits that improves indices of metabolism, such as glucose and lipid levels; and a potential cure for cancer ( 8 , 9 ).

Whereas the marketing of tobacco and alcohol to consumers is heavily regulated, promotion of marijuana products has no such constraints. Mass marketing of marijuana to the public has not been accompanied by public health messages about the potential risks of these products, because the evidence base describing both benefits and harms is limited ( 10 , 11 ). In the past few years, a substantial effort has been made to identify the risks and benefits of marijuana, as well as the gaps in evidence. Several recent systematic reviews found insufficient evidence to support the use of cannabinoids for treating musculoskeletal pain and low-strength evidence that marijuana use is effective in managing neuropathic pain ( 12 ). A recent meta-analysis concluded that heavy cannabis use increases the risk for psychotic outcomes and that “there is sufficient evidence to justify harm reduction prevention programs” ( 13 ). Although low-strength evidence suggests that marijuana smoking is associated with cough and sputum production, data are insufficient regarding how daily marijuana use might affect long-term physical health, including the effects of frequent or heavy use on cardiovascular outcomes (such as stroke and myocardial infarction), obstructive lung disease, pulmonary function, and cancer ( 14 , 15 ). Available data are also insufficient on the effect of marijuana use among older persons and adults with chronic health conditions ( 12 ). Several studies reported neurocognitive risks with marijuana use, including effects on memory, attention, educational outcomes, and life satisfaction, as well as risk for dependence, but the evidence base is limited and debate continues on whether use in adolescence is associated with an irreversible adverse effect on IQ and cognition ( 16 , 17 ). Emerging data suggest that marijuana may adversely affect treatment of depression and anxiety and that regular marijuana use is associated with emergency department visits and fatal vehicle crashes ( 16 ).

Because of the dearth of data on the adverse consequences of marijuana use and the increasing avail ability of cannabis products, understanding how the public perceives marijuana use is important ( 11 ). National surveys suggest that the perception of “great risk” from weekly marijuana use dropped from 50.4% in 2002 to 33.3% in 2014 ( 3 ). However, we have little understanding of public perceptions of other domains of marijuana use, including specific risks and benefits, potential preventive health benefits, and societal effects (such as exposure to secondhand smoke and driving under the influence). In addition, we have little information on how Americans view marijuana compared with tobacco and alcohol, 2 commonly used substances for which decades of research has created a robust understanding of the potential risks. Finally, no data exist on how perceptions of risks and benefits may vary according to the history of marijuana use.

We conducted a national survey to develop a more comprehensive understanding of the views of U.S. adults toward marijuana use to help public health leaders and state and federal policymakers improve communication regarding risks, benefits, and current gaps in knowledge.

Survey Development

We reviewed existing federal surveys, peer-reviewed literature, and media reports to identify questions used to assess perceived risks and benefits of marijuana use ( 16 , 18 – 20 ). In addition, 2 of the authors (S.K and S.S.) interviewed professionals in various fields, including substance abuse and mental health experts, medical dispensary staff, and marijuana distributors, to understand forms of consumption and potential reasons for marijuana use among the public. On the basis of our review of existing national surveys, our literature review, interviews with professionals in the field, and the investigative team’s experiences (including personal interaction with the public), we drafted survey items that focused on improving our understanding of the general public’s views on marijuana and specifically addressed content areas not covered by federally sponsored surveys. These content areas included perceptions of specific risks and benefits of marijuana use, possible preventive health benefits of different methods of marijuana consumption (smoking, vaping, ingestion), addiction potential, safety of use during pregnancy, and societal effects (including secondhand smoke and driving under the influence). We also developed survey items to compare the perceived safety of marijuana versus alcohol and tobacco. The purpose of these questions was to gauge how Americans view the safety of daily use of marijuana relative to that of commonly used substances with a more established risk profile. The items were motivated partly by the team’s observation (shared by other groups) that marijuana smoking and secondhand exposure to marijuana smoke are common and tolerated in certain areas of California ( 21 ). The survey also included items de signed to capture forms of marijuana use, frequency of use, reasons for use, and knowledge and behaviors associated with use. Overall, 27 questions were designed to capture opinions and 54 to capture use. We designed the survey to include a spectrum of answer options to enable respondents to identify the statement most closely aligned with their beliefs. Because many of the questions did not have clear-cut, scientific answers, we specifically did not include an “I don’t know” option to ensure that respondents chose a statement closest to their current views. Survey items and content were written at an eighth-grade level and tested with online software ( 22 ). Cognitive testing of the items was done with a convenience sample of 40 adults of different ages and education levels, including marijuana users and nonusers, to iteratively refine the content.

Sampling Strategy

To survey U.S. adults, we used Growth from Knowledge (GfK) KnowledgePanel, a probability-based, nationally representative online panel of the civilian, non-institutionalized U.S. population ( 23 ). Growth from Knowledge created KnowledgePanel by randomly sampling addresses. This address-based panel covers 97% of the United States and represents a statistical sample of the country’s population. Households without Web access are provided with an Internet connection and a tablet to ensure participation. All panel members are sampled with a known probability of selection; no one can volunteer to participate. Sampling of participants was stratified by the legalization status (recreational, medical, or nonlegal) of their states to allow comparisons across states. We oversampled 2 groups (California residents and adults aged 18 to 26 years) to support additional research questions. Sampling weights were provided by GfK. Further details on KnowledgePanel’s sampling strategy are provided at www.knowledgenetworks.com/knpanel/docs/knowledgepanel(R)-design-summary-description.pdf .

Survey Administration

The survey was piloted in a random sample of 20 participants to review and refine online administration. The Internet survey was launched on 27 September 2017 to 16 280 U.S. adults aged 18 years and older. Data collection was completed on 9 October 2017. The Committee of Human Subject Research of the University of California, San Francisco, exempted GfK’s conduct of the survey from review.

Statistical Analysis and Weighting

The response rate, determined by using methods outlined by the American Association for Public Opinion Research, was the ratio of respondents to all participants who received the survey ( 24 ). Growth from Knowledge provided final survey weights to account for oversampling of California residents and for nonresponse. Results were weighted by using weights provided by GfK to approximate the U.S. population on the basis of age, sex, race, ethnicity, education level, household income, home ownership, and metropolitan area. Respondents who did not answer all the questions were dropped from the analysis. All analyses used weighting commands based on variables provided by GfK to generate national estimates. To assess how well our sample correlated with federally sponsored surveys, we compared the sociodemographic characteristics of our respondents with those of participants in the 2015 National Survey on Drug Abuse and Health (NSDUH), which provides information on the epidemiology of substance abuse and marijuana use in the United States ( 18 , 20 ). We combined responses to present views as appropriate. The decision to combine results was made at the design stage and was geared toward gauging the direction a respondent was leaning in his or her views. Descriptive statistics were calculated for all items, and results were categorized by time of last marijuana use and age. All analyses were performed with R statistical software, version R-3.4.0 (The R Foundation).

Role of the Funding Source

The funders played no role in the design, conduct, and reporting of the research or in the decision to submit the manuscript for publication.

Response Rate and Participant Characteristics

Overall, 9003 persons responded to the survey, a response rate of 55.3%. The response rate did not vary with regard to legalization status of the state (55.2%, 55.4%, and 55.3%, respectively, for states with recreational, medically legal, and nonlegal status). The rate of missing data or refusal by survey question varied from 0% to 3.9%. Mean age of the sample was 48 years (range, 18 to 94 years). Among the respondents, 52% were women, 64% were white, 12% were black, 16% were Hispanic, and 8% were of other races. Sociodemographic characteristics, including age, sex, race, education level, employment status, and household size, were largely similar to those of NSDUH respondents. Some differences were seen in income level, with KnowledgePanel participants having slightly higher incomes than NSDUH respondents ( Table 1 ).About 14.6% of U.S. adults reported using marijuana in the past year.

Baseline Characteristics of KP Respondents Compared With NSDUH Respondents *

KP = KnowledgePanel; NSDUH = National Survey on Drug Use and Health.

Perceptions of Specific Risks and Benefits

Overall, 81% of U.S. adults believe that marijuana has at least 1 benefit, whereas 17% believe it has no benefit. The benefit most commonly cited by respondents was pain management (65.7%), followed by treatment of dis eases, such as epilepsy and multiple sclerosis (47.9%), and relief from anxiety, stress, and depression (46.8%). When respondents were asked which benefit is most portant, they most commonly endorsed pain management (34.8%), followed by treatment of diseases, such epilepsy and multiple sclerosis (25.2%), and relief stress, anxiety, and depression (11.7%) ( Table 2 ).

Views on Risks and Benefits of Marijuana Use Among U.S. Adults Aged 18 Years or Older, by Past-Year Use *

Overall, 91% of U.S. adults believe marijuana has at least 1 risk, whereas 9% believe it has no risks. The most common risk identified by respondents was legal problems (51.8%), followed by addiction (50%) and impaired memory (42%). When asked about the most important risk, respondents most commonly indicated addiction (21.3%), followed by legal problems (20.7%) and increased use of other drugs (18%).

Overall, more past-year users than nonusers of marijuana agreed with statements indicating that marijuana use has benefits, as well as statements suggesting that marijuana use has no risks. About 1 in 10 marijuana users agreed that addiction is the most important risk associated with marijuana use. Far more nonusers than users agreed that marijuana use has no benefits, and fewer nonusers agreed that marijuana use has no risks.

Preventive Health Benefits

More than a third (36.9%) of U.S. adults strongly or somewhat strongly agree that edible marijuana prevents health problems. More than a quarter (29.2%) strongly or somewhat strongly agree that smoking or vaping marijuana prevents health problems ( Figure 1 ).

Views of U.S. adults aged 18 years or older on whether different forms of marijuana prevent health problems.

Full distribution of responses: Among participants, 7.4% strongly agreed, 29.5% somewhat agreed, 32.7% somewhat disagreed, and 29.2% strongly disagreed that edible marijuana prevents health problems; 5.7% strongly agreed, 23.5% somewhat agreed, 33.9% somewhat disagreed, and 35.7% strongly disagreed that vaping marijuana prevents health problems; and 6.3% strongly agreed, 22.9% somewhat agreed, 30.6% somewhat disagreed, and 39.2% strongly disagreed that smoking marijuana prevents health problems.

Overall, 76% of U.S. adults agree that marijuana is somewhat or very addictive, and 22.4% agree that it is not at all addictive ( Table 3 and Appendix Figure 1 , available at Annals.org ).

Views of Persons in the United States on Important Public Health Domains Pertaining to Marijuana Use *

Among the survey respondents, 92.1% agree that using marijuana during pregnancy is completely or somewhat unsafe. Only 7.3% agree that it is somewhat or completely safe ( Table 3 and Appendix Figure 2 , available at Annals.org ).

Beliefs Toward Secondhand Smoke

About 18% of U.S. adults agree that exposure to secondhand marijuana smoke is safe for adults, and 7.6% agree it is safe for children ( Table 3 and Figure 2 ).

Views among U.S. adults about the safety of secondhand marijuana smoke.

Comparisons Between Marijuana and Other Substances

More than 1 in 3 adults (37.3%) believe that secondhand smoke from marijuana is safer than that from tobacco. More than 1 in 3 (38.2%) agree that smoking 1 marijuana joint a day is much safer or somewhat safer than smoking 1 cigarette a day. About 13.5% agree that smoking 1 marijuana joint per day is safer than drinking 1 glass of wine per day ( Table 3 and Appendix Figure 3 , available at Annals.org ).

The distribution of views on driving under the influence of marijuana is relatively normal. About 27.6% agree that driving under the influence of marijuana is somewhat safer or much safer than driving under the influence of alcohol. About 44.4% agree that driving under the influence of marijuana is as safe as driving under the influence of alcohol, and about 24.7% agree that it is somewhat or much less safe ( Appendix Figure 3 ).

Belief Patterns by Marijuana Use Status and Age

Overall, the rates of agreement with statements suggesting a lack of harm from marijuana use ( Table 3 ) are higher among marijuana users and generally higher among younger adults (aged 18 to 34 years) than in older groups ( Table 3 ).

Most Americans believe that marijuana has both risks and benefits. Although many survey respondents agreed that marijuana may have therapeutic benefits in managing some conditions (such as pain or multiple sclerosis), for which limited evidence of benefit exists, they also believe that marijuana is beneficial in treating insomnia, depression, and anxiety, for which efficacy and safety have not been established and possible harms may exist ( 12 , 25 , 26 ). In addition, a sizable group of survey participants responded that marijuana has no risks or addiction potential and that smoking marijuana prevents health problems.

The survey questions comparing marijuana use with drinking a glass of wine daily provide a useful context in which to evaluate the public’s beliefs. About 13.5% of respondents indicated that daily marijuana smoking is safer than a daily glass of wine. Although excessive alcohol use is associated with many health risks, moderate alcohol intake may prevent coronary heart disease ( 27 , 28 ); however, not enough data exist to support the notion that marijuana use in any form prevents health problems. That 29.2% of U.S. adults strongly or somewhat strongly agree that smoking marijuana prevents health problems is concerning.

The comparisons of daily tobacco versus marijuana use in this study also were informative. Although some investigators reported that marijuana smoking is not detrimental to lung function, the participants in those studies had a low cumulative lifetime exposure and the researchers examined risks in younger cohorts that used marijuana only 2 to 4 times per month over a 20-year follow-up ( 29 , 30 ). More research is needed to inform our understanding of the long-term health effects of daily marijuana smoking. Despite insufficient evidence for potential harms from daily marijuana smoking, media coverage of existing studies with low cumulative exposure may be creating the impression among the public that smoking marijuana, even on a daily basis, is harmless ( 10 ). Likewise, many Americans do not believe that secondhand marijuana smoke is as toxic as secondhand tobacco smoke and believe it is safe to expose adults to secondhand marijuana smoke. Although data on these comparisons are limited or lacking, these views are nonetheless concerning given the evidence that inhalation of particulate matter in any form (for example, breathing smog or secondhand tobacco smoke or smoking) is associated with increased cardiovascular risk ( 31 , 32 ). The public seems to have a more favorable view of marijuana smoking or exposure to secondhand marijuana smoke than is warranted by our current understanding of the detrimental health effects of inhaling particulate matter ( 31 ).

That the American public overall has a favorable view of marijuana use may not be surprising. Several historical trends (including the advocacy for decriminal ization given the societal costs of the war on drugs, evidence that cannabinoids have therapeutic and palliative effects for some intractable conditions ( 12 , 33 ), aggressive marketing of cannabis to the public, and slanted media coverage of marijuana) and ongoing public conversation surrounding legalization of marijuana for recreational use may be sending an overall message that it is safe to use marijuana ( 6 , 7 , 10 , 34 , 35 ). The current, largely state-based regulatory structure to protect consumers is inadequate. The lack of a coherent national policy regulating the sale and promotion of marijuana has left a vacuum that commercial interests can exploit.

This study had several limitations. The survey response rate was 55.3%; however, this rate is similar to that of other national Internet surveys ( 36 – 39 ). Use of an Internet survey might limit generalizability, because persons who choose to join an ongoing Internet panel may differ from those who choose not to. However, studies examining nonresponse to panel recruitment in GfK’s KnowledgePanel found no evidence of nonresponse bias in the panel with regard to core demographic and socioeconomic variables ( 40 ). In addition, although some differences were observed in income distribution between our sample and the NSDUH respondents, the members of both panels were very similar in terms of age, sex, race, education level, household size, and employment status. Finally, we did not conduct reliability testing of the opinion questions, and it is possible that wording of these items introduced bias, which may have affected respondents’ interpretation. Future research should include more psychometric testing of the items to minimize directional bias introduced by the content of the questions.

The gaps in our understanding of the health effects and safety of daily marijuana use are extensive, and the public may be underestimating its long-term risks. These national data underscore the need to invest in further research to better understand both the health effects of marijuana use and the public health investment necessary to better communicate potential health risks to the public.

Acknowledgments

Grant Support: In part by the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant R01HL130484–01A1. Dr. Keyhani’s administrative funds provided by the Northern California Institute for Research and Education also supported this work. Dr. Ishida was supported by career development award K23DK103963 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Reproducible Research Statement: Study protocol: Blank survey tool available from Dr. Keyhani upon request (e-mail, [email protected] ). Statistical code: Not available. Data set: Will be available at https://phprg.ucsf.edu/ before 1 June 2019.

Primary Funding Source: National Heart, Lung, and Blood Institute.

Appendix Figure 1. Responses to the question, “How addictive is marijuana?” among U.S. adults.

Appendix Figure 2. Responses to the question, “How safe is it for pregnant women to use marijuana?” among U.S. adults.

Appendix Figure 3. Views among U.S. adults about driving under the influence of marijuana compared with alcohol, and comparisons of marijuana with tobacco and wine.

Publisher's Disclaimer: Disclaimer: The views expressed in this article are those of the authors and do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0810 .

Usage and Effects of Marijuana Essay

Introduction, reasons for discussion, origins and history, effects and properties, production, use, legalization.

Cannabis, or marijuana, has been a subject of discussions for decades. Emerging from earliest societies, the drug has had considerable presence in all kinds of industries and applications – ranging from medical to spiritual uses. In the modern world, more and more countries are recognizing the role of cannabis in bringing benefits to the population. As a result, discussions of legalization and decriminalization emerge with increased force. However, the actual relationship between society and marijuana is complex. The substance can have both positive and negative effects on the population. For some, it is a source of relief, for others it is a difficult habit that affects their daily functioning. For the purposes of better understanding the drug and navigating the modern realities, it is necessary to discuss marijuana in more detail.

As mentioned previously, marijuana plays an increasingly large role in society. Efforts or legalizing the drug bring forth challenges connected with the best way to regulate its distribution, usage and production. In cases of decriminalization, governments also struggle to choose the correct way to implement their policies. The process is hampered by the need to navigate the needs of diverse populations. In order to build a structure upon which the distribution and production of marijuana can be built, legislators must consider the wishes of companies and the populace alike.

At the same time, the population itself reaches a new level of understanding cannabis use. After a considerable period of being considered taboo and misunderstood, marijuana is entering the mainstream thought. Researchers, scholars and enthusiasts alike are searching for more ways of applying the plant, while also discussing its effects on the population.

Cannabis has a storied history. First appearing in Asia, the plant was popularized by Chinese emperors. From China, it quickly spread to surrounding countries, such as India, where it became a prominent part of culture and myth. Earliest uses of the substance are connected with medical remedies and rituals to appease gods. Europeans got into contact with marijuana much later, closer to the 19 th century, when explorers, seafarers and travelers started interacting with China. Much like the Asian continent, Europeans and Americans used marijuana for its medicinal purposes. However, it was slowly pushed out of the market by taxation and regulation.

Cannabidiol is one of the two primary active part of cannabis, one that is responsible for affecting individual’s nervous and cardio systems. Instead of stimulating receptors, like it was assumed, the substance works as an antagonist, potentially affecting the effectiveness of HTC, another active ingredient in cannabis.

The effectiveness of consuming cannabis or its extracts depends on how they entered the body – inhaling or smoking works quicker than eating products containing marijuana.

There are a number of potential effects that a person will feel after consuming cannabis. Depending on the individual, cannabis can produce different effects. Altered sense of smell, sense or perception is common, as well as an inability to properly understand time. The individual usually feels relaxed, or experiences quick mood changes. In addition, speech impairment, trouble moving and hallucinations can be common symptoms.

Each country chooses how to handle the process of legalizing/decriminalizing cannabis differently. Depending on the president/ruling party, the process can be restrictive or overarching. In some countries, focus is made on managing marijuana use, while in others possession itself is the target.

• Cannabis is difficult to discuss or ascribe morally.
• The drug affects a person’s mental and physical condition.
• Antagonizing one’s brain receptors, cannabis has relaxing properties.
• Efforts of decriminalization and legalization help populations that need cannabis.
• Certain populations are endangered by marijuana decriminalization.

Barton, Allen W., et al. “Trajectory classes of cannabis use and heavy drinking among rural African American adolescents: multi-level predictors of class membership.” Addiction , vol. 113, no. 8, 2018, pp. 1439-1449.

Carliner, Hannah, et al. “Cannabis use, attitudes, and legal status in the U.S.: A review.” Preventive Medicine , vol. 104, 2017, pp. 13-23.

Goode, Erich. “ Pot and the Myth of Shen Nung .” The New York Review of Books , Web.

Halperin, Alex. “ Cannabis Capitalism: Who is Making Money in the Marijuana Industry? ” The Guardian , Web.

Kicman, Aleksandra, and Marek Toczek. “The Effects of Cannabidiol, a Non-Intoxicating Compound of Cannabis, on the Cardiovascular System in Health and Disease.” International Journal of Molecular Sciences , vol. 21, no. 18, 2020, p. 6740.

Knaappila, Noora, et al. “Changes in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015.” Journal of Cannabis Research , vol. 2, no. 1, 2020.

“Legality of cannabis by country.” Map. Wikimedia Commons , Van De Voorde, Nick T., et al. “Denver’s Green Mile: Marijuana gentrification as a process of urban change.” Journal of Urban Affairs , 2021, pp. 1-19.

• Chicago (A-D)
• Chicago (N-B)

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Bibliography

IvyPanda . "Usage and Effects of Marijuana." December 14, 2023. https://ivypanda.com/essays/usage-and-effects-of-marijuana/.

• Decriminalization of Marijuana
• The Decriminalization of Marijuana
• The Arguments For and Against Marijuana Decriminalization
• Declaiming Drugs Decriminalization
• Decriminalization of Drugs: Affirmative Side
• The Decriminalization of Sex Work
• Marijuana Legalization: Controversial Issue in Canada
• Drugs Decriminalization and Legalization Issues
• The Marijuana Usage Legislation
• Cannabis or Marijuana for Medical Use
• Health Policy: Identification and Definition
• Health and Fitness: Developing a Healthy Community
• Promoting Healthy Lifestyles in a Community
• Health Care Spending Over Time
• Substance (Heroin) Use as Community Problem

From free-for-all to business as usual: How marijuana sales have evolved in Fort Collins

When cannabis became legal in Colorado more than a decade ago, it quickly turned into a cash cow with sales tax revenue piling up as if the state were printing money.

The state taxed the industry heavily, with much of the revenue going to help schools with infrastructure needs. With the distinction of being the first state to legalize the sale of recreational marijuana, communities working without a road map scrambled to write local regulations to restrict when and where dispensaries opened and operated. Opponents worried about the potential increase in crime in the predominantly cash business. Employers fretted about people coming to work high.

Some communities banned dispensaries from the start. Others embraced them.

Fort Collins was among those that had a tumultuous start, first imposing a moratorium, then approving, banning and shuttering dispensaries before ultimately approving them again as voters' wishes ebbed and flowed.

Now, the "free-for-all" early days have turned into business as usual. Fears never played out.

Those who opposed legalization of a drug the federal government still considers illegal couldn't deny the financial windfall.

From 2014 through August 2023, cannabis sales surpassed $15 billion statewide, according to the Colorado Department of Revenue. Fort Collins racked up nearly $1.5 billion, resulting in more than $24 million in sales tax revenue. Larimer County, with only two dispensaries, collected more than $6 million in sales tax revenue.

How the pandemic impacted marijuana sales in Colorado

Annual sales at the state, county and local levels peaked through 2021 before trending down in 2022 and 2023.

Steve Ackerman, owner of Organic Alternatives, said the spike, which he attributed to the pandemic, has now leveled out. "I'm sure it had something to do with people having extra time on their hands from not going anywhere," he said.

Most people were stuck at home — some out of work, others furloughed — and anxiety was high. Sales and use of alcohol and cannabis spiked as people found different ways to cope with the new reality. Liquor stores and dispensaries were considered essential businesses that were allowed to stay open while most other businesses were shuttered.

"There was a lot of self-medicating going on," said Ginny Sawyer, the city's project and policy manager, who has been on this journey since the beginning.

Prices also went up as much as 50%, said Dawn Thilmany, professor of agricultural economics at Colorado State University. So, the increased revenue may not be solely due to increased use, she said. When cannabis was first legalized, the price of buds was nearly $2,000. That dropped to about $750 pre-COVID, then rose again before dropping in the middle of 2022.

According to the Colorado Department of Revenue, which tracks the median market price, the median price per pound of buds is expected to be about $750 for the second quarter of 2024. The price rose to $2,007, its highest price, in January 2015. Prices remained under $1,000 in 2018 and 2019 before cresting that mark in January 2020. Prices remained over $1,000 per pound until January 2022 when they fell to $948. The price dipped to its lowest point of $649 in April 2023.

"During COVID, the market really shot up and demand shot up," Ackerman said. "Because of that, more people were enticed to enter the market as producers ... there was a great deal more supply on the market."

When the pandemic abated, the market kind of sunk back to where it was before, Ackerman said. "It's at a level that we can anticipate it is going to remain at."

Another factor in the decrease could be more home horticulturists who got into growing during the pandemic. Consumers are allowed to have 12 plants for personal use.

"Just like home gardening, people may have realized they could produce enough for themselves at home," said Thilmany. Customers can "go into stores and say, yeah this is great that it's now legal, but it's way costlier," she said. "We don't know how much it's driven home production."

Fort Collins currently has 42 cannabis-related licenses — 11 medical and 11 retail licenses, 12 cultivation licenses and eight product manufacturing licenses, according to the city.

Sales taxes collected from cannabis sales jumped from $3.2 million in 2019, to $3.8 million in 2020 and to $4.1 million in 2021. As life started to resemble normalcy in 2022, sales tax revenue dropped to $3.7 million and last year topped out at $3.3 million, still over pre-pandemic levels but down drastically from 2021.

As big as the total sounds, the city has a $500 million annual budget, so even at its highest point, marijuana sales tax revenue was only a small portion. "All money is helpful, and we want to support all business, but I don't know there's a reliance on that," Sawyer said.

Being first came with new challenges

Being the first to legalize marijuana, demand soared both from Colorado residents and tourists who wanted to buy legal marijuana, and it attracted international and out-of-state entrepreneurs who wanted to set up business, Thilmany said. And because Colorado had a monopoly, the state "taxed it pretty heavily knowing it was such a unique boutique thing that they could do it."

Fort Collins never jumped on the tax bandwagon, however. It taxes medical and recreational pot at the same rate as other retail goods. So, whether customers are buying $100 of marijuana at Organic Alternatives or a $100 sweater at Foothills mall, they'll pay the same $4.35 in city sales tax.

And when staff offered City Council the option of increasing the tax on pot to raise money for high priorities like affordable housing and recreation in 2023, council rejected the notion.

Now, 24 states and the District of Columbia allow recreational and medicinal cannabis sales and use. Only six states — Wyoming, Nebraska, Idaho, Kansas, North Carolina and South Carolina — totally ban both. The remaining states have a mix of laws, including some that allow medicinal use or CBD oils.

The past and future of marijuana in Fort Collins

In 2010, a court ruling created a loophole that allowed for more sale of medical marijuana and the city saw a "huge influx" of people getting home occupation licenses to grow marijuana for medical purposes, Sawyer said, leading to a moratorium to give the city time to develop zoning and land use regulations. "We didn't look at a number (of licenses) necessarily but looked at the use type, what zoning was appropriate and how and what we wanted to license," she said.

At the time, Fort Collins had no other governmental entities from whom to model codes. "There was a lot of unknowns and a lot of anxiety," Sawyer said. "Locally, the biggest challenge was in the banking arena."

Because cannabis was illegal under federal law and banks are federally regulated, most did not accept deposits from cannabis businesses. "There was nowhere for those businesses to bank," Sawyer said. "Literally, we had people coming in with $10,000 in cash to pay for their licenses and applications. That piece was problematic."

By October 2011, the city had 20 licensed medical marijuana centers, most of which had their own city-mandated grow facility, Sawyer said. "We didn't want people just coming to Fort Collins to grow marijuana alone and taking up small industrial warehouses. We tried to say if you have a grow, you have to have a (sales) center," she said.

Dispensaries could buy from whomever they wanted, but if people wanted to grow marijuana, they had to have a sales center.

In November 2011, city voters passed a ballot measure banning all marijuana businesses, which led to the closure of all dispensaries and grow operations. A year later, voters reversed the 2011 decision and approved the sale and use of medical and recreational marijuana.

More: A timeline of marijuana laws in Colorado, Fort Collins

Under the ballot initiative, one medical center was allowed for every 500 registered medical marijuana patients in the county. At the time, there were roughly 5,200 Larimer County residents with medical marijuana cards, which is how the city came to allow 11 dispensaries in addition to two that were grandfathered in. There are two dispensaries in unincorporated Larimer County.

Loveland, Windsor, Estes Park and Timnath ban dispensaries, but Loveland City Council has been discussing a future ballot initiative that, if passed, would allow the sale of medical and recreational marijuana.

Berthoud allows them, and after Wellington voters repealed the town's ban on marijuana dispensaries by one vote in 2021, Smokin' Cowboy, a drive-thru recreational cannabis dispensary, opened this year.

Since Fort Collins already had the medical marijuana framework in place, it tied its recreational licenses to medical licenses as a way to limit the numbers, Sawyer said. "Only medical marijuana centers could apply for a retail license. That is still true today," she said.

Now that you don't need a medical marijuana card to buy cannabis, there's "not even 3,800" medical marijuana card holders in Larimer County, Sawyer said.

As Fort Collins looks to the future, Sawyer said there's probably room for another dispensary and perhaps the city doesn't need to tie grow operations to the sales counter any longer. And adding delivery service could be something down the road if residents and council are interested.

Liquor stores began home delivery during the pandemic and the state now allows cannabis home delivery as well. But municipalities have to opt in to the program and thus far, Fort Collins has not taken that step.

Cannabis goes corporate

The other change? Cannabis went corporate. The first stores to open in Fort Collins were all local mom-and-pop shops that were small-town people who had an interest in horticulture and the ability to open these businesses, Sawyer said. Now, the small independent stores have been largely bought out. "A majority are corporate ... the industry has become professionalized," she said.

The corporate influence has been positive, said Jim Lenderts, Fort Collins Police Service's marijuana enforcement officer.

"Corporate stores probably have a better business model," he said. "They design their stores to look like stores. That doesn't mean bigger is always better. Sometimes corporate stores and corporate lawyers come in and test us."

Lenderts has been on the job for eight years and spent much of that time bridging the gap between police and store owners. It's taken a lot of communication, awareness and training, he said.

"Eight years ago, it was very much a 'we vs. them' mentality on both sides," Lenderts said. Police worried stores would be selling to minors or shipping out of state. Stores worried they'd be harassed by police who didn't want the stores in the city. That thinking has all but disappeared, thanks to that bridge Lenderts helped build.

Now, police routinely bring new trainees to dispensaries to look around and get a feel for the business, Lenderts said.

In a college town, it's not unusual for those under 21 to have fake IDs to get into bars and dispensaries. So, it takes regular training to teach cannabis store employees how to spot a fake ID. If they spot a fake identification, they seize it and send it to police.

Last year, between bars, liquor stores and cannabis stores, 700 fake IDs were seized and sent to police, Lenderts said. In the last four years, all cannabis stores have passed the city's compliance check, which involves sending an underage Police Explorer with a valid ID to try to enter the store or buy product.

Eight years ago, 30% of stores failed the check and let the person in, Lenderts said. For the last four years, they've all passed the check. "They will run my kid out and that's a big win," Lenderts said. "We're partnering with them and holding them accountable."

If an employee fails to check an ID and allows access to a minor, the employee typically gets fired, he said. "It's a pretty high standard. That's how seriously we take selling to minors."

Now law enforcement perceives cannabis stores and cultivation facilities not as a threat but just as a another business in the community. "They know if they operate as a legitimate business, they'll get treated with respect, " Lenderts said.

A common misconception is that cannabis would bring crime to the community, Lenderts said. "That hasn’t proven accurate in our community." It's been at least seven years since there's been a burglary at a marijuana store, fewer than other businesses in the community, he said.

That's due in part to the requirement that cannabis stores have video surveillance and the manager on site has to know how to print a still photo from the video immediately. "I've been to bank robberies where no one on site knows how to run the video," he said. "It's significant in law enforcement. If there's a crime at your business, give us the tools to help you."

Criminals have figured that out and know if they commit a crime there, they'll be on camera, he said.

Poudre School District sees some benefits from marijuana taxes

With the passage of Amendment 64, which legalized recreational marijuana in Colorado, voters approved a 28% sales tax on retail marijuana products. That included a 15% excise tax to benefit K-12 education in Colorado.

Of that 15%, the first $40 million each year went to Building Excellent Schools Today, or BEST, a capital construction fund boosted by sales tax revenues from marijuana in Colorado. In fiscal 2015-16, voters approved a one-time bump to the BEST fund, bringing the total pot to $80 million. 

That changed again in 2019 when House Bill 1055 mandated that 100% of the excise tax on retail marijuana be collected for school construction.

BEST also gets money from Land Board proceeds, the Colorado Lottery and interest from the Public School Capital Construction Assistance Fund.

The BEST program prioritizes health, safety and security issues such as asbestos removal, new roofs, building code violations and poor indoor air quality. BEST grants are competitive, awarded annually and in most cases must be supplemented with local district matching funds. 

A statewide facility assessment completed in 2009 inventoried more than 8,000 facilities, with more than 123 million square feet assessed, and revealed $13.9 billion in capital construction needs. This need has grown every year since, according to the Colorado Department of Education.

From 2017 through 2023, Poudre School District received about $1.35 million in funds from marijuana revenue, including $187,163 from the BEST program used for air quality improvements; $811,837 from the Expelled and At-Risk Student Services, or EARSS program; and $310,900 from the Ninth Grade Success program, to ensure that students enrolled in ninth grade develop the skills they need to move on to 10th grade.

An email from the district said it had no public records about grants through the bullying prevention, early literacy grant program, the school health professional grant or the state public school fund.

Previous Coloradoan reporting detailed PSD receiving the following grants from marijuana revenue:

• 2014-15: $81,556 from the Colorado Department of Education School Health Professionals Grant Program. The district used the funds for substance abuse prevention. In 2015-16, the district applied for the grant again and received $98,353.
• 2016: $437,824 for 2 ½ years of bullying prevention activities at Lesher, Wellington, Blevins and Preston middle schools. That money went toward funding school counselors to implement bullying prevention curricula and activities at each school.
• 2016: $216,740 for drop-out prevention and student engagement programs at three high schools. The district also received $93,058 from the same grant fund to provide a second year of funding.
• $1,155,060 over three years to fund counselors at Rocky Mountain, Poudre and Fort Collins high schools to work on behavioral health and disciplinary issues as well as counselors at Irish and Laurel Elementary for substance abuse prevention and behavioral health issues.

BEST distributes funds through grants for construction. Schools with needs involving health, safety and security issues are priority. Districts often must match BEST funds with local district money.

How marijuana is taxed statewide in Colorado

Excise tax: 15% due when retail marijuana is transferred from a cultivator to a processor or distributor. If a processor, distributor and cultivator are the same business, the excise tax is applied to a wholesale price calculated by the state Department of Revenue.

Special sales tax: 15% paid by consumers when retail marijuana is sold. It is similar to a general sales tax.

State sales tax : Medical marijuana is not subject to the excise tax or special sales tax, only the state's standard 2.9% general sales tax.

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Heart Pump Is Linked to 49 Deaths, the F.D.A. Warns

The agency faulted the device maker for delayed notice of mounting complications, citing increasing reports of how use of the device perforated the walls of the heart.

By Christina Jewett

A troubled heart pump that has now been linked to 49 deaths and dozens of injuries worldwide will be allowed to remain in use, despite the Food and Drug Administration’s decision to issue an alert about the risk that it could puncture a wall of the heart.

The tiny Impella pumps, about the width of a candy cane, are threaded through blood vessels to take over the work of the heart in patients who are undergoing complex procedures or have life-threatening conditions.

The F.D.A. said the manufacturer of the device, Abiomed, should have notified the agency more than two years ago, when the company first posted an update on its website about the perforation risk. Such a notice, the F.D.A. added, would have led to a much broader official agency warning to hospitals and doctors.

The alert is the latest of concerns raised in recent years about the deadly side effects of cardiac devices, especially those that take over the heart’s role in circulating blood. It is the third major F.D.A. action for an Impella device in a year.

A series of studies suggested that the Impella heart devices heighten the risk of death in patients with unstable medical conditions. Meanwhile, the device maker has spent millions of dollars promoting the device and awarding consulting payments to cardiologists and grants to hospitals.

Since Abiomed’s first notice about the Impella’s complications in October 2021, the F.D.A. received 21 additional reports of heart-wall tears linked to patient deaths, according to Audra Harrison, a spokeswoman for the agency.

The F.D.A. classified the alert sent last week as the most serious type of action it could take for a product that can result in death or serious injury, short of removal from the market. The alert still permits use of the device, with an update on the risks requested for the 243-page instruction manual that accompanies the pump.

There are currently 66,000 Impella pumps in the United States and 26,000 such devices in Australia, Canada, France, India and other countries.

The number of Impella-related injuries struck some cardiologists as troubling. Some doctors said that the role of the pumps was already being questioned, citing a lack of high-quality studies that would establish whether the devices offered more benefit than harm. Some also questioned whether the call for enhanced caution in a dense instruction booklet would prevent deaths.

“I think cardiologists are already extremely careful,” said Dr. Rita F. Redberg, a cardiologist and a professor at the University of California, San Francisco, who has been critical of the devices. “To say that you’re addressing 49 deaths by saying ‘be careful’ is not addressing the problem at all.”

Johnson & Johnson MedTech bought Abiomed in 2022. Dr. Seth D. Bilazarian, a senior vice president of Abiomed, said in a statement that 300,000 Impella devices had been used in patients worldwide in more than a decade. There were no reported instances of heart-wall perforations related to product design or manufacturing, he said.

“We are proud of the positive impact our technology is having on patients facing life-threatening conditions,” Dr. Bilazarian said.

Asked why Abiomed did not report the deadly risk earlier, Johnson & Johnson MedTech said it was putting broad improvements in place. The company said the heart-wall tears were rare and are a “known complication during invasive cardiology procedures.”

Since 2013 , research has highlighted the potential for the device to sever vessels and cause serious bleeding .

F.D.A. records show that the company has attributed the heart-wall tears to “operator handling,” urging to couple use of the device with imaging tools to avoid puncturing delicate heart tissue. Older adults, women and people with heart disease are particularly at risk, the agency said.

The pumps are temporary implants, tailored to the right or left heart chamber with different levels of pumping power. They are often used after a patient has had a major heart attack and the heart loses its ability to move blood through the body. The devices tend to be used on very ill patients, many with a mortality risk of about 40 to 50 percent.

If a wall of the heart is torn by a device, “it’s a surgical emergency that very rarely people survive from,” said Dr. Boback Ziaeian, a cardiologist and an assistant professor of medicine at University of California, Los Angeles.

The F.D.A.’s new alert stems from a lengthy agency inspection last year at Abiomed’s Massachusetts headquarters that resulted in a warning letter in September. Inspectors turned up numerous complaints that the agency said should have been reported, and also discovered a bulletin dated October 2021 that outlined the tearing risk, according to the F.D.A.

The bulletin , which the company said it posted on its website and on an app, described the heart-wall perforations as a “rare complication” that was first noted in January 2018. Abiomed should have filed a “report of correction or removal” to the F.D.A. within 10 days of that notice, according to Ms. Harrison, the agency spokeswoman.

Abiomed said that it had incorporated advice on how to use the device safely in its physician training and that it had sent an alert letter to doctors late last December.

Dr. Bilazarian said that Abiomed counted all tears of walls in the heart’s left chamber that had occurred during a procedure “regardless of whether they were directly related to the patient outcome.”

The company initiated two other major warnings last year of Impella pumps that the F.D.A. deemed to be linked to risk of serious injury or death.

In June, the company warned that the pump could malfunction if it hit an artificial heart valve, linking it to four deaths and 26 injuries. The company also addressed that problem with an update to the device instructions, F.D.A. records show .

Impella heart pumps were first cleared for use in 2008, and their use was contested among cardiologists even before the recent spate of problematic reports. When the one model of the device was approved by the F.D.A. after additional review in 2015, company-sponsored studies found that 73 percent, or 44 of the 60 patients meeting the criteria for use, survived a month after the operation.

By 2022, a study mandated by the F.D.A. showed a similar outcome for 23 surviving patients in a group of 33. But of 70 other patients tracked in the same study, only 19 percent of them, or 13 people , survived a month after use of the Impella device.

The F.D.A. stood by the device but urged doctors not to use it in patients suffering from organ failure and major neurologic injury.

Impella devices have increasingly taken the place of intra-aortic balloon pumps, which were once used to pump blood through vessels of very sick patients and fell out of favor after a study in 2012 questioned their efficacy.

Yet several studies have since concluded that the Impella devices are associated with higher death rates than the balloon pumps — and with far more bleeding complications.

“When you go look at the quality of the evidence to support this device, it’s quite little to have for a high-risk device like this,” said Dr. Nihar Desai, the vice chief of cardiovascular medicine at Yale School of Medicine and an author of four studies on Impella devices.

The company has reported the benefits of deploying Impella devices in nonemergency procedures where doctors place stents, or tiny metal tubes, to open vessels near the heart. Other studies at a single hospital and with no comparison group have shown survival benefits.Supporters of the device say it can be helpful in certain patients.

Dr. Srihari S. Naidu, a professor of medicine at New York Medical College, said that Impella devices are valuable to have on hand. “The onus comes on us as physicians and the community to make sure that we’re approving the appropriate devices, we have enough evidence to support its use, that we use it in the areas where we have the most evidence and that we develop the skill set that keeps it safe,” he added.

Dr. Naidu said that he had not received funds from Abiomed.

Medicare pays hospitals about $71,000 each time the device is used on a patient. Medicare data for 2022, the most recent year available, shows that Abiomed spent $6.3 million on consulting, meals and research payments for doctors and grants of up to $50,000 to hospitals.

Those expenses were broken into about 24,000 payments, which were made to about 9,500 U.S. cardiologists who perform surgery. The company has made similar payments since at least 2016, spending $3.7 million to $7.5 million each year.

Johnson & Johnson MedTech bought Abiomed, which primarily sold Impella devices, in late 2022 for $16.6 billion. Johnson & Johnson reported $1.3 billion in sales of the devices for 2023 in a securities filing, largely driven by purchases of one Impella model listed in the recent alerts.

When reporting on outsize bleeding rates related to the Impella devices, Dr. Desai, of Yale, has also noted that its payments are far higher than the balloon pump, creating an urgent need for rigorous studies of how to best treat patients.

“You hate to think this is part of that story, but I think we would be naïve to think that that couldn’t be part of the story,” he said.

Christina Jewett covers the Food and Drug Administration, which means keeping a close eye on drugs, medical devices, food safety and tobacco policy. More about Christina Jewett

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Youngkin vetoes Virginia bills mandating minimum wage increase, establishing marijuana retail sales

FILE - Virginia Republican gubernatorial candidate Glenn Youngkin talks with supporters during a rally in Culpeper, Va., Oct. 13, 2021. The Republican governor of Virginia vetoed two top Democratic legislative priorities on Thursday, March 28, 2024: bills that would have allowed the recreational retail sales of marijuana to begin next year and measures mandating a minimum wage increase. (AP Photo/Steve Helber, File)

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RICHMOND, Va. (AP) — Republican Virginia Gov. Glenn Youngkin vetoed two top Democratic legislative priorities on Thursday: bills that would have allowed the recreational retail sales of marijuana to begin next year and measures mandating a minimum wage increase.

The development, which drew criticism from Democrats who control the General Assembly, did not come as a surprise. While Youngkin had not explicitly threatened to veto either set of bills, he told reporters he didn’t think the minimum wage legislation was needed and had repeatedly said he was uninterested in setting up retail marijuana sales.

In 2021, Virginia became the first Southern state to legalize marijuana , adopting a policy change that allowed adults age 21 and up to possess and cultivate the drug. But the state didn’t set up retail sales at the time and still hasn’t, due to shifts in partisan power and policy differences since then.

Advocates say the disconnect is allowing the illicit market to flourish, while opponents have health and safety concerns with further expanding access to the drug. In a statement, Youngkin said he shared those worries.

“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. It also does not eliminate the illegal black-market sale of cannabis, nor guarantee product safety,” he said in a veto statement attached to the bills.

Currently in Virginia, home cultivation and adult sharing of marijuana are legal. And patients who receive a written certification from a health care provider can purchase the product from a dispensary.

Under the bills, the state would have started taking applications on Sept. 1 for cultivating, testing, processing and selling the drug in preparation for the market to open May 1, 2025, with products taxed at a rate of up to 11.625%.

The legislation was supported by a range of industry interests and opposed by religious and socially conservative groups.

Democratic Sen. Aaron Rouse of Virginia Beach, who sponsored his chamber’s version of the bill, said Youngkin had adopted a “dismissive” stance toward the issue.

“This veto blocks a pivotal opportunity to advance public health, safety, and justice in our Commonwealth,” he said in a written statement.

Virginia first took on legalization at a time when Democrats were in full control of state government. Elections later that year changed that, with Youngkin winning and Republicans taking control of the House of Delegates for two years.

While there has been some Republican legislative support since the 2021 session for setting up legal recreational sales, bills to do so have failed in 2022 and 2023.

As for the wage legislation, which would have increased the current $12-per-hour minimum wage to $13.50 on Jan. 1, 2025, and then to $15 on Jan. 1, 2026, Youngkin said the bills would “imperil market freedom and economic competitiveness.”

The bills would “implement drastic wage mandates, raise costs on families and small businesses, jeopardize jobs, and fail to recognize regional economic differences across Virginia,” he said in a news release.

Virginia Democrats began an effort to increase the minimum wage in 2020. They passed legislation that year — which took effect with a delay due to the coronavirus pandemic — establishing incremental increases up to $12, with further bumps requiring another Assembly vote.

They and other advocates have argued the legislation would help working families afford basic necessities and keep up with inflation.

Democratic Sen. L. Louise Lucas said in a statement that the bill would have set “a standard that would affirm our commitment to the dignity of labor and the belief that everyone deserves a fair shot at economic stability.”

Youngkin took action on a total of 107 bills Thursday, according to his office. He signed 100, including measures that his office said would “strengthen law enforcement’s ability to prosecute child predators and expand Department of Corrections inmate access to quality health services.”

Besides the marijuana and wage bills, he vetoed three others. One would have removed an exemption for farmworkers from the state’s minimum wage law.

Another would have required that approximately 315 individuals incarcerated or on community supervision with a felony marijuana conviction receive a sentencing review, according to Youngkin’s office.

“Ninety-seven inmates convicted of a violent felony offense, such as first and second-degree murder, kidnapping, and robbery, would be eligible for a reduced sentence under this proposal,” he said in his veto statement.

Thursday’s final veto came for a bill that dealt with the type of evidence that can be considered in certain workers’ compensation claims. The governor said current law provides a “balanced approach” while the proposal would “create a disproportionate imbalance in favor of one party.”

The part-time General Assembly adjourned its regular session earlier this month and will meet again in Richmond for a one-day session April 17 to consider Youngkin’s proposed amendments to legislation. They could also attempt to override one or more vetoes, a move that requires a 2/3 vote of both chambers, which are only narrowly controlled by Democrats.

The marijuana legislation advanced mostly along party lines, and the minimum wage bills passed strictly on party lines, meaning any override attempt would be almost certain to fail.

Youngkin announced the vetoes a day after the public collapse of one of his top legislative priorities: a deal to bring the NHL’s Washington Capitals and NBA’s Washington Wizards to Alexandria. The teams’ majority owner announced they would instead be staying in D.C.

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Rotary essay contest leads to benefits for sixth graders.

Last week I had a volunteer opportunity, one that was well suited to my work with the printed word.

I helped to judge the local Rotary International essay contest for sixth graders from Marshall Middle School. I’ve judged it several times in the past five years, and each time I’ve been impressed with the writing skills of students.

An eight member committee composed of Rotarians and high school seniors judged a total of 24 finalist essays this year. They were all good. Everybody would have gotten at least a B-plus if I’d have had to give letter grades. There would have been many A’s.

The essays are based on Rotary’s Four-Way Test, a way of judging ethics in various situations. It asks the questions is it the truth, is it fair to all concerned, will it build goodwill and better friendship and will it be beneficial to all concerned.

The students were assigned to apply the four-way test to something in their lives or to a situation they experienced.

My personal favorite among all the essays was based on how the writer helped a little boy fix his sand castle after her sister knocked it down on her way to the water.

It stood out as a real act of kindness. She could have just decided that the little boy needed to act like a grown up and rebuild it himself. Instead she went out of her way to help.

It was also an interesting example of family dynamics. Her sister didn’t get in trouble for knocking over the castle, but she learned from the praise the writer received from her parents that it’s good to be considerate of others.

The other essays featured a wide range of topics. Some students talked about school activities like volleyball and dance. Others talked about having little brothers and sisters.

Several essays focused on cultural diversity. They explored whether our society is fair and beneficial to people from diverse racial and ethnic backgrounds.

Judging the essays leads me to have faith in our students and their teachers. All 24 finalists had a good command of the English language. Very few of them lost any points for spelling, grammar or punctuation errors.

The content of each entry indicated to me that the sixth graders also have very good interpersonal skills. Their application of the Four Way Test points to good critical thinking ability.

When we think in generalities it’s easy to conclude that communication skills aren’t as strong anymore. Technology gets heavy emphasis in eduction. Keyboarding is now taught in the lower elementary grades.

I never used a typewriter until I took a summer typing class in high school. I’m glad that my earlier learning experiences focused on real books and real activities. Still I liked having some exposure to computers starting in fifth grade. The Oregon Trail was one of my favorite games

It’s good to have events like Rotary’s essay contest to make us look beyond general perceptions. Clearly many of our young people are capable. They know how to express themselves.

Rotary members give over an hour of their time in the middle of a school day to serve as judges. It benefits the students, but it’s also an advantage for Rotarians.

It allows of for interaction with children and teenagers. When they see us serving as volunteers, it offers an incentive to consider someday joining a Rotary club.

I’m looking forward to next Wednesday when contest winners will be presented with awards. They’ve earned the recognition. Writing is a valuable skill that needs emphasis in many different classes. It’s a skill that should be developed and reinforced.

— Jim Muchlinski is a longtime reporter and contributor to the Marshall Independent.

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Home — Essay Samples — Law, Crime & Punishment — Marijuana Legalization — Marijuana: the Benefits are Well Worth the Risks

Marijuana: The Benefits Are Well Worth The Risks

• Categories: Marijuana Marijuana Legalization Medical Marijuana

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Words: 1719 |

Published: Apr 29, 2022

Words: 1719 | Pages: 4 | 9 min read

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