Abstract

Introduction
Methods
Results
Discussion
Conclusion
References

Abstract
Background: Marijuana is one of the most widely used illicit substances in countries throughout
the world. Most countries have a prohibitive outlook on the production and use of cannabis,
while some others have legalized or decriminalized the status of marijuana. Objectives: This
paper reviews the literature available on the recent studies on marijuana legalization and
analyses the socio-economic, public health impacts of existing decriminalization and legislative
policies in different scenarios. Method: This literature review was conducted on research
papers from peer-reviewed publications. The paper analyzed the current legalization policy and
its impacts in the United States and Canada as case studies. Results: The current legislative
models, based on prohibition and criminal conviction, do not significantly impact usage. The
open competitive market model is a better socio-economic alternative to other prohibition-based
models. The economic, social, and health costs outweigh the supposed benefits of such a
model. The legalization of marijuana, as indicated in the case studies, has not shown a uniform
trend over the long term.

Keywords: cannabis, marijuana, substance use, illicit drugs, cannabis legalization,

decriminalization, socio-economic impact, public health, legislative models

Introduction
Marijuana is a psychoactive drug used for both recreational and medical purposes (Wikipedia
page of Cannabis (drug)). Since prohibition and the illegal status of marijuana have done little to
curb its production, possession, and use, there have been growing debates towards its
decriminalization and legalization.

Legalization has been promoted by the goals of controlling consumption, eliminating illegal
markets, and generating tax revenues. However, some other factors that have been missing
from these conversations are the market participation of producers, sellers, and home
cultivators. Consumer interest should also play a key role in decision-making. The aim should
be to include the present stakeholders instead of replacing them so that they do not seek other
forms of participation in the illegal market (Gettamn et al.,2014).
The legality around its medical and recreational use varies by country. Changes in marijuana
laws have been prompted by voter initiative campaigns, increasing and majority public support
and departure from the absolute prohibition laws (Gettamn et al.,2014). 68% of Canadians
favored relaxation in marijuana laws in a poll done by Forum Research (Hajizadeh, 2016). In
America alone, there are 54% of voters would prefer legalization without limits, and 81% in favor
of using marijuana for medical purposes (Bridgeman et al., 2017). A total of 46 out of 50 states
have legalized usage in some capacity (WebMD, 2018).

However, trends in alcohol and tobacco regulations historically suggest that with an increase in
access to legal cannabis, there will be an increase in the frequency of use in the short term. The
legalization of marijuana has also brought forward many concerns such as - increase in the
number of car accidents under marijuana intoxication, unintentional overdosing, and an increase
in patients being admitted to the emergency department due to acute psychotic symptoms.
Other health effects include hyperemesis syndrome, abdominal pain, cyclical vomiting, and an
increased risk of cardiovascular diseases (Hall et al., 2020).

Methods
A review of the literature scoping everything was done systematically using research papers
ranging from the year of publication of 2000 to 2020. Only the literature belonging to the last ten
years was taken to obtain the most recent studies on marijuana legalization. A combination of
the following search terms was used: marijuana legalization, social impact, impact on youth,
cannabis, economic effects, crime, medical marijuana.
The inclusion principle for the research papers in this review included:
1. After-effects of marijuana legalization.
2. English language.
3. Peer-reviewed publication.
4. Published in the last decade.
The initial search had over 100 papers, from which about 30 papers were shortlisted based on
the inclusion-exclusion criteria. A more thorough shortlisting was then done, considering the
year of publication, the number of citations, and the conference in which the paper is published.
A total of 11 papers were finalized for review, with papers covering the impact on society and the
country because of marijuana legalization.
Results

US
The United States of America is a relatively large country with climatic conditions favorable for
cultivation; its proximity to other regions of Colombia and South America provides it with a
well-developed market for the production and sale of cannabis.
In the United States, the primary jurisdiction over the laws over the use of cannabis lies with the
state governments. Consequently, some American states have decriminalized cannabis.
Full legalization of Marijuana (production, sale, and consumption) in the US started in 2012 with
the states of Colorado and Washington. By the end of 2017, about 22% of the US population
including 9 states had legalized recreational cannabis use(‘ Alaska, Oregon, and Washington
DC in 2014, Maine, California, Nevada, and Massachusetts in 2016, and Vermont in 2017.’)
(Dragone et al., 2018).

In the case of the United States, however, this term is a misnomer as the decriminalization of
cannabis because the possession of cannabis is still very much against the law and involves
criminal conviction. Contrary to popular belief, this "decriminalization", which involves penalties
less than imprisonment for the possession of small amounts for personal use, does not have a
significant deterrent effect on the overall cannabis possession among individuals.

Correlations with marijuana usage:

Dilley et al., 2019; Anderson et al ., 2019) have reviewed the research on the relationship
between medical marijuana legalization and marijuana usage among teenagers.
However, the literature by Anderson and authors(2019) was not able to establish associations
between medical marijuana legalization and increased marijuana usage. More research with
representative state samples is needed to fully examine links between medical marijuana
legalization and marijuana usage (Dilley et al., 2019).

Another study noted that in the states allowing medical marijuana there were higher chances of
increased adolescent usage of hard drugs like cocaine, heroin in the previous 12 months (Wong
and Lin, 2019). However, it was not established that the legalization of marijuana had anything
to do with it (Wong and Lin,2019). Bachhuber and authors(2014) concluded that medical
marijuana legalization drastically reduced the state-level opioid overdose deaths, and
Hockenberry and Wen(2018) concluded it led to a 5.88% reduction in opioid prescriptions.

Research conducted by Lee and authors (2020) on adult participants, concluded positive
associations of medical marijuana legalization with illicit drug use and the combination of illicit
drug use and prescription drug misuse. Medical marijuana legalization was not linked with the
abuse of prescription drugs, although when compared to states without medical marijuana
legalization, those with legalization were more likely to report illicit drug usage. Alcohol usage
was not linked with illicit drug use, however, it was positively linked with prescription drug
misuse and a combination with illicit drug use (Lee et al., 2020). The NSDUH dataset used is
cross-sectional in nature thus the impact of medical marijuana legalization on illicit drug use,
prescription drug use, or a combination of both is not fully deterministic. Further, the data used
is self-reported which affects the quality of data.

Lee and authors (2020) concluded no relation between medical marijuana legalization and
prescription drug misuse in adults, and in adolescents, the same was concluded by Wong and
Lin (2019). Thus the trend may not be uniform across both adults and adolescents (Lee et al.,
2020).

Canada
Marijuana was the most widely used illicit psychoactive substance in Canada until its
legalization in 2018. While it was legal to use marijuana as a potential therapy since 2001, the
Government of Canada passed the Cannabis Act (Bill C-45) on October 17, 2018, to legalize
and regulate cannabis for non-medical purposes. According to the National Cannabis Survey
(NCS), marijuana usage in Canada ranged from 14% in the first quarter of 2018 to 17.5% in
2019 (Canadian Centre on Substance Use and Addiction [CCSA], 2020). The use reported was
maximum in the age group of 15-24 years.

Retailers sold about $908 million worth of cannabis products between October 2018 and
September 2019. The average expenditure of Canadians on cannabis between January 2018
and December 2019 was $6.94 per gram (CCSA, 2020). Post legalization, 43% of the reported
83,483 drug offenses were associated with marijuana. The number of violations had reduced
significantly from 2017, with a decline of 14% in the first 9.5 months itself. Meanwhile, cases of
drug-impaired driving increased in most places, with the highest increase recorded in Ontario
(36%) and Alberta (34%) (Moreau, 2019).

Cannabis was found to be the most common substance associated with substance-related
hospitalizations among people aged 10-24 between 2017-2018 (Canadian Institute for Health
Information, 2019). 14.7% of the NCS respondents reported driving within two hours of
consuming marijuana between October 2018 and April 2019. Roadside surveys conducted in
British Columbia and Ontario revealed that about 6% and 8.6% of drivers tested positive for
cannabis, respectively. A study in 2015 detected cannabis in 42.5% of the 405 fatally injured
drivers who tested positive for drugs in their system (Brown et al., 2019).

Lastly, 13.4% of the people consuming marijuana reported doing it at or before work in the first
six months of legalization (NCS). It was also the third most used drug among individuals
receiving treatment, accounting for about 30%.
Discussion
This paper aimed to evaluate the outcome of legalizing and regulating the consumption of
marijuana. According to the WHO, marijuana is the most widely used illicit drug. Consequently,
associated prohibition policies have had little impact on its consumption. The legalization of
marijuana has the potential to generate tax revenues and reduce expenditure on enforcement of
such policies. It would eliminate a significant section of the black market too. However, it can
also have adverse effects on public health. As of November 2021, recreational use of marijuana
is legal in Canada, Georgia, Mexico, South Africa, Uruguay, and parts of the United States and
Australia.

Impact on Economy
When the consumption of marijuana is illegal, the government has to incur costs and spend a
considerable amount of money on enforcing federal laws and imprisoning offenders. Moreover,
the selling price, in this case, includes both direct charges for production and transport as well
as indirect costs to cover the risk of arrest and prosecution. The cost is subject to inflation due
to being sold in the illegal market where there is no protection or price cap in favour of the
consumers. The repressive laws only have a limited impact. So, the consumers bear these high
costs, while the suppliers live in constant fear of penalties and arrest. The legalization of
marijuana drastically reduces the costs incurred by the government, the consumers, and the
suppliers. Legalization also allows the government to collect taxes on the sale of marijuana. The
high demand for marijuana ensures that its consumption will lead to considerable tax revenue.
The taxes are imposed in a manner that keeps competition in check. The generated revenue
can be used for allocating resources to other fields like public education and awareness
programs. However, the lethality of marijuana is much less than alcohol so taxing at a higher
margin than alcohol does not seem justified.

Impact on Society
The widespread use of marijuana around the world along with its illegal status has created a
huge black market to meet consumer demands. Many people are engaged in the illegal job of
arranging for the drug, and with zero accountability. Anyone willing to bear the cost is free to
enter the market. The legalization and regulation of marijuana will restrict the black market for
the drug. A large amount of criminal activity going on in these markets can thus be controlled.
The reduction in crime rate can also be due to the sedative effect of cannabis. The alternatives,
like alcohol, are much more aggressive. The reallocation of the police effort to other types of
offenses contributes to the overall decline in crime as well.
Possession of cannabis, when against the law, involves criminal conviction. The penalty is out of
proportion to the nature of the offense. Legalizing the possession of marijuana ensures that
minor offenders do not incur a high negative social impact. This includes family discord over
conviction or arrest, adverse effect on employment opportunities, etc.

Impact on Public Health

Legalization of marijuana results in easy access to the drug. This leads to an increase in the
frequency of use of cannabis in the short term. There is evidence available for the therapeutic
use of marijuana in neuropathic pain, chemotherapy, and inflammatory diseases. However,
regular consumption of marijuana can have adverse health effects. Car accidents increase if
more cannabis users drive under the influence. Potent cannabis products such as extracts
cause overdose, and more cannabis users are presented to emergency departments with acute
psychotic symptoms. An increase in the recreational use of marijuana leads to an increased risk
of motor vehicle accidents, symptoms of schizophrenia, addiction problems, etc. Other
symptoms that may develop are hyperemesis syndrome, abdominal pain, cyclical vomiting, and
an increased risk of cardiovascular diseases. An increase in legal marijuana around households
is also a cause of concern for unintentional ingestion by children.

<Conclusion>
Risks and harms are associated with the consumption of marijuana irrespective of whether it is
used for medical or non-medical purposes.
[Advantages + Disadvantages of Legalization, Suggested Strategies]
---

Conclusion
The current state of affairs indicates marijuana legalization is a positive step. This is due to the
inability of prohibition models in curbing the use of marijuana, promoting entering the illegal
markets as producers, sellers and consumers as long as the stakeholders are willing to bear the
risks, not being able to protect the vulnerable populations and limiting extensive research in the
concerned field. However, even though legalization or decriminalization is a step towards more
market control, better voluntary participation by users, and elimination of illegal markets, the
existing laws are not backed by enough research and are not extensive enough to take into
account all the participants and vulnerable populations. Moreover, the places that have legalized
marijuana have seen some unexpected health effects due to an increase in usage, and
inconsistent concentrations. If legalization of marijuana is not done in a systematically
researched manner, it may backfire and result in a similar situation like the one in the prohibition
model.
Directions for future research
The scarcity of studies on marijuana usage still leaves many concerns unresolved. The
increasing use of marijuana is an issue that necessitates surveillance and scientific examination
of marijuana use and related behaviors, such as (a) relations in marijuana use as legalization
expands, (b) motivations and opportunities behind marijuana usage, and (c) socioeconomic and
health-related outcomes. Furthermore, many conducted studies are cross-sectional in nature
which hinders establishing causality between events, so further research should be conducted
to resolve this limitation.
References
1. Bridgeman, Mary & Abazia, Daniel. (2017). Medicinal Cannabis: History, Pharmacology, And
Implications for the Acute Care Setting. P and T. 42. 180-188.
2. WebMD (2018). Medical Marijuana FAQ. [online] WebMD. Available at:
[Link]
3. Dilley, J., Richardson, S., Kilmer, B., Pacula, R., Segawa, M. and Cerdá, M., 2019. Prevalence of
Cannabis Use in Youths After Legalization in Washington State. JAMA Pediatrics, 173(2), p.192.
4. Anderson, D., Hansen, B., Rees, D. and Sabia, J., 2019. Association of Marijuana Laws With
Teen Marijuana Use. JAMA Pediatrics, 173(9), p.879.
5. Wong, S. and Lin, H., 2019. Medical marijuana legalization and associated illicit drug use and
prescription medication misuse among adolescents in the U.S. Addictive Behaviors, 90, pp.48-54.
6. Bachhuber, M., Saloner, B., Cunningham, C. and Barry, C., 2014. Medical Cannabis Laws and
Opioid Analgesic Overdose Mortality in the United States, 1999-2010. JAMA Internal Medicine,
174(10), p.1668.
7. Wen, H. and Hockenberry, J., 2018. Association of Medical and Adult-Use Marijuana Laws With
Opioid Prescribing for Medicaid Enrollees. JAMA Internal Medicine, 178(5), p.673.
8. Lee, Y., Chang, Y., Liu, C. and Arndt, S., 2020. Is Medical Marijuana Legalization Associated With
Prescription Drug Misuse, Illicit Drug Use, or Combination of Both Among Adults in the United
States?. Journal of Drug Issues, 50(4), pp.566-578.
9. Single, E., Christie, P. and Ali, R., 2000. The Impact of Cannabis Decriminalisation in Australia
and the United States. Journal of Public Health Policy, 21(2), p.157.
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cannabis use: the US experience. World Psychiatry, 19(2), pp.179-186.
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Harm Reduction Journal, 11(1), p.32.
12. Monte AA, Zane RD, Heard KJ. The Implications of Marijuana Legalization in Colorado. JAMA.
2015;313(3):241–242.
13. NIDA. 2020, June 25. Most Commonly Used Addictive Drugs. Retrieved from
[Link] on
2021, November 10, 2021
14. Dragone, D., Prarolo, G., Vanin, P. and Zanella, G., 2019. Crime and the legalization of
recreational marijuana. Journal of economic behavior & organization, 159, pp.488-501.
15. Paschall, M.J., Grube, J.W. and Biglan, A., 2017. Medical marijuana legalization and marijuana
use among youth in Oregon. The journal of primary prevention, 38(3), pp.329-341.
16. Hajizadeh, M., 2016. Legalizing and Regulating Marijuana in Canada: Review of Potential
Economic, Social, and Health Impacts. International journal of health policy and management,
5(8), pp.453–456.
Contribution
Yashasvi Chhabra
- Papers read
- Hajizadeh, M., 2016. Legalizing and Regulating Marijuana in Canada: Review of
Potential Economic, Social, and Health Impacts. International Journal of Health
Policy and Management, 5(8), pp.453-456.
- Canadian Centre on Substance Use and Addiction. 2020. Cannabis (Canadian
Drug Summary) | Canadian Centre on Substance Use and Addiction. [online]
Available at: <[Link] [Accessed 11
November 2021].
- Worked on ‘’Discussion”

Varun Upadhyay
- Papers read
- Lee, Y., Chang, Y., Liu, C. and Arndt, S., 2020. Is Medical Marijuana Legalization
Associated With Prescription Drug Misuse, Illicit Drug Use, or Combination of
Both Among Adults in the United States?. Journal of Drug Issues, 50(4),
pp.566-578.
- Wen, H. and Hockenberry, J., 2018. Association of Medical and Adult-Use
Marijuana Laws With Opioid Prescribing for Medicaid Enrollees. JAMA Internal
Medicine, 178(5), p.673.
- Worked on “Results” and “Directions for future research”
- Proofreader

Aditi Gupta
- Papers read
- Paschall, M.J., Grube, J.W. & Biglan, A. Medical Marijuana Legalization and
Marijuana Use Among Youth in Oregon. J Primary Prevent 38, 329–341 (2017).
[Link]
- Dragone, D., Prarolo, G., Vanin, P. and Zanella, G., 2019. Crime and the
legalization of recreational marijuana. Journal of economic behavior &
organization, 159, pp.488-501.
- Worked on “Methods” and “Conclusion”

Ananya Singh
- Papers read
- Gettman, J., Kennedy, M. Let it grow—the open market solution to marijuana
control. Harm Reduct J 11, 32 (2014). [Link]
- Monte AA, Zane RD, Heard KJ. The Implications of Marijuana Legalization in
Colorado. JAMA. 2015;313(3):241–242. doi:10.1001/jama.2014.17057
- Worked on “Introduction” and “Conclusion”
- Proofreader
Sudarshan Buxy
- Papers read
- A
- Worked on “Abstract” and “Results”