Recreational marijuana legalization
Policies that legalize marijuana for recreational use allow possession of a limited amount of marijuana for personal, non-medical use by adults. Marijuana use is illegal in the United States at the federal level. About half of U.S. states allow recreational use; allowances regarding home cultivation, maximum possession and purchase amounts, marketing and advertising restrictions, and taxes on marijuana products vary1, 2, 3.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced opioid prescribing
Reduced alcohol use
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced crime
Improved mental health
What does the research say about effectiveness?
There is mixed evidence about the effects of recreational marijuana laws (RMLs) on opioid-related outcomes and alcohol use. More research is needed to determine the effects of legalizing recreational marijuana on long-term health, safety, and socioeconomic outcomes4.
RMLs increase marijuana use in adults5, 6, 7, 8, 9 and may modestly increase use in young adults, particularly among college students5, 6, 8, 10. RMLs may have no significant impact on adolescent marijuana use5, 7, 8, 11; however, inconsistent findings across studies highlight the need for more research on youth use5, 6, 12. RMLs are associated with increased risk of marijuana-related emergency visits and healthcare utilization among youth (i.e. unintentional toxic ingestions of marijuana products)6, 8, 13, 14. RMLs may be associated with increases in use among women who are pregnant6.
RMLs may be associated with reductions in opioid prescribing but its effect on other opioid-related mortality and use is unclear, with studies finding mixed effects across various opioid-related outcomes6, 7, 8, 15, 16, 17. Most evidence of the effect of RMLs on alcohol use suggests it may be associated with either no impact or reductions6, 7, 8. RMLs are not associated with increases in crime and in some cases may be associated with reductions in crime6, 7, 18. RMLs impact on traffic safety outcomes is uncertain: Studies have found either little to no impact on traffic safety or increases in traffic crashes and fatalities after the enactment of RMLs6, 7, 8. There is insufficient evidence of its effect on mental health and suicides6, 8, 19.
Experts and healthcare professionals have several concerns about legalization. Smoking marijuana may increase the risk of marijuana dependence (e.g., cannabis use disorder),3, 20, 21, 22, respiratory problems, heart attacks, and cancers23, 24. Marijuana use may increase the risk of psychotic and schizophrenic symptoms25, 26. Marijuana initiation before adulthood may increase the likelihood of dependence and related harms25, 26, 27; initiation over the age of 25 rarely results in dependence26.
The American Academy of Pediatrics (AAP) recommends routine screening and counseling for parents and youth about potential harms including damage to brain development, psychiatric illness, dropout, and suicide, particularly if recreational marijuana use is legal28, 29.
One study suggests that 10% of state marijuana tax revenues can be attributed to individuals who live in a state without an RML traveling to a state with an RML30.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact recreational marijuana legalization could have on disparities in marijuana-related arrests and harms34, 35. Some recreational marijuana laws (RMLs) include racial justice policy reforms that seek to rectify the disproportionate impacts of past marijuana prohibition, such as automatic expungement for certain marijuana-related crimes34. While RMLs have been enacted in 25 states, marijuana remains a federally classified Schedule I narcotic, making possession or use of marijuana a criminal act under federal code33. More research is needed to determine effects of RMLs and, when enacted, the impact of racial justice reforms.
Marijuana prohibition has disproportionately impacted communities of color, despite similar rates of marijuana usage and distribution among racial groups. Nationally, a Black person is almost four times more likely to be arrested for possession than a white person, a disparity that increased by 32.7% from 2001 to 201035. Enforcement practices differ widely at the local level; in some states, Black people were more than six times as likely as whites to be arrested for possession and in some counties the magnitude reached 10, 15, and even 3035. Even after legalization, disparities in arrest rates persist6. For example, after Colorado legalized recreational marijuana, Black adults and juveniles still outpaced whites and Latinos in every kind of marijuana arrest (e.g. on-view, warrant, citations/summons) between 2012 and 2017. In the first two years after marijuana reform in Colorado, Black individuals were arrested for possession of marijuana at the highest rates of any group in state history34, 36. Disparities extend to convictions, as well. For example, in Washington, D.C. between 2001 and 2010 over 90% of individuals prosecuted for marijuana crimes were Black35.
Some adolescent minority populations that experience discrimination based on their race, gender, or sexual identity may be more likely to use marijuana37. Experts suggest that those seeking to advance health equity should understand the unique patterns of marijuana use across identities and develop tailored strategies38.
Experts suggest that tax revenue could help address past harms related to drug enforcement activities. For example, Illinois, Massachusetts, New Jersey, and New York all dedicate a portion of their cannabis tax revenue to programs that support economic and workforce development in communities disproportionally harmed by previous drug laws and enforcement39.
What is the relevant historical background?
Marijuana was first introduced in the U.S. during the early 1600s for hemp production and was commonly used by physicians to treat a variety of health ailments until the early 20th century33. States started to ban marijuana in the 1910s when marijuana began to be negatively associated with both Black people and Mexican immigrants35. These efforts culminated with federal marijuana prohibition in 193735. The federal ban of the possession, consumption, and sale of marijuana led to openly racist enforcement tactics that have disproportionately harmed people of color35.
In 1971 President Nixon’s administration launched the “War on Drugs”33, 35. Proponents of the “War on Drugs” used coded language (e.g., “tough on crime” and “law and order”) to reference and exploit white concerns about racial minorities, social movements, and perceived disorder by using the lens of drug crimes35. Some of these “dog whistle” politics and negative stereotyping continue to be perpetuated in the current legalization landscape40. Marijuana was classified as a Schedule I drug, making marijuana possession or use a criminal act under the federal code. This classification led to a massive expansion in marijuana criminalization with significant racial disparities in enforcement33, 35. Simultaneously, some states enacted decriminalization and depenalization laws intended to eliminate incarceration as a penalty for possession of a small quantity of marijuana. Scholars and experts highlight these efforts as a whitening of marijuana use in response to increases in young white adults smoking marijuana to decrease their risk of incarceration35.
Significant disparities in enforcement of marijuana laws have imposed arrests, prosecutions, and convictions on individuals and communities, separated families, and deprived individuals of child custody, immigration status, voting rights, eligibility for public housing, financial aid for education, and access to employment34, 35. Legalizing marijuana is seen as a way to rectify the harms of marijuana prohibition, however, the interests of the most impacted have yet to be fully addressed34. Only three states include automatic expungement for certain marijuana-related crimes as a part of their legislative design34.
Disparities exist in the emerging $1 billion marijuana industry because communities of color have borne the consequences of marijuana prohibition. It is estimated that about 80% of marijuana business owners are white, highlighting how states prohibit people with marijuana convictions from receiving business licenses34, 35. Additionally, potential Black and Latino entrepreneurs are more likely to be denied small-business loans because of discriminatory lending practices, and to be charged higher interest rates and subjected to predatory terms when they receive a line of credit34. There are some state efforts to address these barriers, such as Illinois’ Adult-Use Social Equity program to increase the awarding of marijuana dispensary licenses to those that have been systematically excluded from the marijuana industry34.
Equity Considerations
- If your state has recreational marijuana laws, do they have components that address past harms of marijuana prohibition, such as automatic expungement of certain marijuana-related offenses?
- If your state is considering legalizing marijuana, who can you contact to make sure the perspectives of those harmed by marijuana prohibition are included in the legislative design? What stakeholders could you engage to support equitable implementation of such legislation?
- If your state has recreational marijuana laws, do current laws systematically exclude those harmed by previous marijuana prohibition from the legalized marijuana industry? How can you advocate for change so those harmed by previous marijuana prohibition can participate in the legalized marijuana industry?
Implementation Examples
As of November 2023, recreational marijuana is legal for a person age 21 or older in twenty-four states and Washington, D.C.1. These states also regulate licensing and location of recreational marijuana dispensaries; detailed regulations on the maximum amount of marijuana possession, use, transfer, and home grow vary by state1. Most states apply an excise tax on the sale of marijuana at either the retail or wholesale level, or both levels, and base it on price, weight, or potency31. Furthermore, states may direct tax revenue toward public health purposes to balance the potential public health impacts of marijuana use32.
As of April 2023, medical marijuana is legal in 38 states, three U.S. territories and Washington, D.C.; these states also have comprehensive medical marijuana and cannabis programs. Nine states allow limited use of low tetrahydrocannabinols (known as THC), high cannabidiol (CBD) products for specific medical conditions1. As of December 2022, 27 states and the District of Columbia have adopted decriminalization laws. In early October 2022, President Joe Biden issued a pardon to all individuals with a federal conviction for marijuana possession and urged all state governors to do the same with respect to state convictions33.
Implementation Resources
‡ Resources with a focus on equity.
Addictions-Marijuana - Addictions.com. Marijuana addiction.
NCSL-Marijuana - National Conference of State Legislatures (NCSL). Marijuana overview.
US DHHS NCCIH-Marijuana - U.S. Department of Health and Human Services (U.S. DHHS), National Center for Complementary and Integrative Health (NCCIH). Cannabis (marijuana) and cannabinoids: What you need to know. 2019.
Footnotes
* Journal subscription may be required for access.
1 NCSL-Marijuana - National Conference of State Legislatures (NCSL). Marijuana overview.
2 Maxwell 2016 - Maxwell JC, Mendelson B. What do we know about the impact of the laws related to marijuana? Journal of Addiction Medicine. 2016;10(1):3-12.
3 Pacula 2017 - Pacula RL, Smart R. Medical marijuana and marijuana legalization. Annual Review of Clinical Psychology. 2017;13(1):397-419.
4 Campbell-Sevigny 2023 - Sevigny EL, Greathouse J, Medhin DN. Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map. Campbell Systematic Reviews. 2023;19(4).
5 Pawar 2024 - Pawar AKS, Firmin ES, Wilens TE, Hammond CJ. Systematic review and meta-analysis: Medical and recreational cannabis legalization and cannabis use among youth in the United States. Journal of the American Academy of Child and Adolescent Psychiatry. 2024.
6 Farrelly 2023 - Farrelly KN, Wardell JD, Marsden E, et al. The impact of recreational cannabis legalization on cannabis use and associated outcomes: A systematic review. Substance Abuse: Research and Treatment. 2023;17.
7 Anderson 2023 - Anderson DM, Rees DI. The public health effects of legalizing marijuana. Journal of Economic Literature. 2023;61(1):86-143.
8 Athanassiou 2023 - Athanassiou M, Dumais A, Zouaoui I, Potvin S. The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes. Frontiers in Psychiatry. 2023;13.
9 Sabia 2024 - Sabia JJ, Dave D, Alotaibi F, Rees DI. The effects of recreational marijuana laws on drug use and crime. Journal of Public Economics. 2024;234(January):105075.
10 Bae 2020 - Bae H, Kerr DCR. Marijuana use trends among college students in states with and without legalization of recreational use: initial and longer-term changes from 2008 to 2018. Addiction. 2020;115(6):1115-1124.
11 Melchior 2019 - Melchior M, Nakamura A, Bolze C, et al. Does liberalisation of cannabis policy influence levels of use in adolescents and young adults? A systematic review and meta-analysis. BMJ Open. 2019;9(7).
12 Cil 2024 - Cil G, Winters KC, Austin SC, et al. Legalization and retail availability of recreational marijuana and adolescent use in schools. Health Economics (United Kingdom). 2024;33(1):107-120.
13 RAND-Pacula 2017 - Pacula RL. Regulating medical marijuana markets: Insights from scientific evaluations of state experiments. Santa Monica: RAND Corporation; 2017.
14 Wilkinson 2016 - Wilkinson ST, Yarnell S, Radhakrishnan R, Ball SA, D’Souza DC. Marijuana legalization: Impact on physicians and public health. Annual Review of Medicine. 2016;67(1):453-466.
15 Nguyen 2024 - Nguyen HV, McGinty EE, Mital S, Alexander GC. Recreational and medical cannabis legalization and opioid prescriptions and mortality. JAMA Health Forum. 2024;5(1):E234897.
16 McMichael 2020 - McMichael BJ, Van Horn RL, Viscusi WK. The impact of cannabis access laws on opioid prescribing. Journal of Health Economics. 2020;69:102273.
17 Chan 2020b - Chan NW, Burkhardt J, Flyr M. The effects of recreational marijuana legalization and dispensing on opioid mortality. Economic Inquiry. 2020;58(2):589-606.
18 NBER-Sabia 2021 - Sabia J, Dave D, Alotaibi F, Rees DI. Is recreational marijuana a gateway to harder drug use and crime? National Bureau of Economic Research (NBER). 2021: Working Paper 29038.
19 Hammond 2024 - Hammond CJ, Hyer JM, Boustead AE, et al. Association between marijuana laws and suicide among 12- to 25-year-olds in the United States from 2000 to 2019. Journal of the American Academy of Child and Adolescent Psychiatry. 2024;63(3):345-354.
20 O’Grady 2024 - O’Grady MA, Iverson MG, Suleiman AO, Rhee TG. Is legalization of recreational cannabis associated with levels of use and cannabis use disorder among youth in the United States? A rapid systematic review. European Child and Adolescent Psychiatry. 2024;33(3):701-723.
21 Cerda 2020 - Cerdá M, Mauro C, Hamilton A, et al. Association between recreational marijuana legalization in the United States and changes in marijuana use and cannabis use disorder from 2008 to 2016. JAMA Psychiatry. 2020;77(2):165-171.
22 Smart 2019 - Smart R, Pacula RL. Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. American Journal of Drug and Alcohol Abuse. 2019;45(6):644-663.
23 NASEM 2017 - National Academies of Sciences, Engineering, and Medicine (NASEM). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, D.C.: The National Academies Press; 2017.
24 Leung 2011 - Leung L. Cannabis and its derivatives: Review of medical use. Journal of the American Board of Family Medicine. 2011;24(4):452-62.
25 Caulkins 2012 - Caulkins JP, Hawken A, Kilmer B, Kleiman MAR. Marijuana legalization: What everyone needs to know. New York: Oxford University Press; 2012.
26 Bostwick 2012 - Bostwick JM. Blurred boundaries: The therapeutics and politics of medical marijuana. Mayo Clinic Proceedings. 2012;87(2):172-86.
27 Wilsey 2008 - Wilsey B, Marcotte T, Tsodikov A, et al. A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain. Journal of Pain. 2008;9(6):506-21.
28 Ryan 2017 - Ryan SA, Ammerman SD, AAP Committee on Substance Use and Prevention. Counseling parents and teens about marijuana use in the era of legalization of marijuana. Pediatrics. 2017;139(3):e20164069.
29 AAP-Ammerman 2015 - Ammerman S, Ryan S, Adelman WP. The impact of marijuana policies on youth: Clinical, research, and legal update. Pediatrics. American Academy of Pediatrics (AAP). 2015;135(3):e769-e785.
30 Hansen 2020 - Hansen B, Miller K, Weber C. Federalism, partial prohibition, and cross-border sales: Evidence from recreational marijuana. Journal of Public Economics. 2020;187:104159.
31 NCSL-Brainerd 2021 - Brainerd J. State cannabis taxation. National Conference of State Legislatures (NCSL). 2021.
32 NCSL-PH Marijuana - National Conference of State Legislatures (NCSL). How four states incorporated public health into cannabis policy. 2022.
33 NBER-Dave 2022 - Dave D, Liang Y, Muratori C, Sabia J. The effects of recreational marijuana legalization on employment and earnings. National Bureau of Economic Research (NBER). 2022: Working Paper 30813.
34 Crawford 2021 - Crawford NN. We’d go well together: A critical race analysis of marijuana legalization and expungement in the United States. Public Integrity. 2021;23(5):459-483.
35 Schlussel 2017 - Schlussel D. The mellow pot-smoker: White individualism in marijuana legalization campaigns. California Law Review. 2017;105(3):885-928.
36 Males 2014 - Males M, Buchen L. Reforming marijuana laws: Which approach best reduces the harms of criminalization? A five-state analysis. San Francisco, CA: Center on Juvenile and Criminal Justice (CJCJ); 2014.
37 Wheldon 2023 - Wheldon CW, Watson RJ, Cunningham C, Fish JN. State marijuana laws and marijuana use among sexual and gender minority youth in the United States. LGBT Health. 2023;10(2):121-129.
38 Dai 2024 - Dai HD, Idoate R, Mahroke A, Abresch C. Racial disparities in patterns and modes of current and daily marijuana use among adults living with children. Journal of Racial and Ethnic Health Disparities. 2024.
39 TPC-Cannabis taxes - Briefing book: How do state and local cannabis (marijuana) taxes work? Washington, D.C.: Urban-Brookings Tax Policy Center (TPC); 2024.
40 Mortenson 2020 - Mortensen TM, Moscowitz L, Wan A, Yang A. The marijuana user in U.S. news media: An examination of visual stereotypes of race, culture, criminality and normification. Visual Communication. 2020;19(2):231-255.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/recreational-marijuana-legalization
To see all strategies:
countyhealthrankings.org/whatworks