essay on marijuana

March 1, 2024

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

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

By Jesse Greenspan

Cappi Thompson/Getty Images

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

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

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

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

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

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

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

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

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

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

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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THREE ESSAYS ON THE EFFECT OF LEGALIZING MARIJUANA ON HEALTH, EDUCATION, AND SOCIAL SECURITY

The legalization of marijuana has emerged as a critical public policy issue, with far-reaching implications for health, education, and government programs at both the state and federal levels. The three essays of this dissertation show that medical marijuana legalization (MML) has a negative effect in each of these areas. The first essay shows, that the enactment of MMLs can exacerbate the crisis of overdose deaths in the United States. The study analyzes three key areas: the rate of overdose deaths caused by both legal and illegal drugs, the impact of MML on social norms regarding the perceived harm of marijuana, and an investigation into the gateway theory by examining the use of other addictive drugs. I find that MMLs increase deaths attributed to overdose by 21.5% population. MMLs s also indicate increase the number of deaths due to prescribed opioids by 44.6%, and deaths from all opioids (heroin and cocaine in addition to prescribed opioids) by 37.2 % Results suggest an overall increase in the use of marijuana, primarily due to lower perceived risk among adolescents. Additionally, results show an increase in hospital admissions due to substance abuse. The analysis suggests that legalizing medical marijuana may exaggerate the current problem of drug overdose in the United States. The second essay examines the impact of improved access to medical marijuana, measured by the proximity of schools to the nearest dispensary, on the academic performance of high school students in California. Students in schools farther from a marijuana dispensary have higher academic performance as measured through AP, ACT, SAT scores, and average GPA, and lower number of suspensions due to violence and illicit drug use. To show this, I construct the first geocoded dataset on marijuana dispensary and high school locations, use newly developed difference-in-differences estimators that rule out any bias due to heterogeneous treatment effects over time, and explore dynamic responses. This essay reveals the importance of ensuring a largest possible distance between schools and dispensaries to protect adolescents from the potential harm caused by medical marijuana. Finally, the third essay shows that in the long term, MMLs increase the number of disabled workers who receive Social Security Disability Income (SSDI) because of mental health issues. SSDI is a major social insurance program that provides benefits to workers who become disabled, and understanding how policy changes in other areas may impact this program is important. In this study, there were important differences between the results of a two-way fixed effects model and a new model by Callaway and Santa’Anna. MMLs, in theory, could either increase or decrease the number of SSDI recipients, and traditional fixed effects models suggest both could be at play; however, only the negative effect is robust to correction for heterogeneous effects. This highlights the need for future research to understand the true impact of medical marijuana legalization

Contributors

Degree grantor, degree level, submission id, usage metrics.

• Health economics
• Welfare economics
• Epidemiology
• Health policy
• Public policy
• Medical and health law

Marijuana Legalization - Free Essay Examples And Topic Ideas

Marijuana legalization is a contentious issue with implications for health, economy, and society. Essays might explore the arguments for and against legalization, the experiences of regions where marijuana has been legalized, and the legal, economic, and social ramifications of legalization. Additionally, discussions might extend to the medical uses of marijuana, its impact on the criminal justice system, and its societal perceptions. We have collected a large number of free essay examples about Marijuana Legalization you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Marijuana Legalization and Regulation

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Medical Marijuana and Marijuana Legalization

Thursday, June 09, 2011 Much debate has been conducted regarding the legalization of marijuana, with an unusual amount of contradicting research. There are many perspectives to take into account, and they always seem to come down to the personal motives of the debater. Whether it's being argued from a medical, political, or economical perspective; it continually comes down to whether Federal Government should be our dictators or we should be responsible for our actions. The Canadian medical Association Journal reports […]

Marijuana should be Legalized?

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Medical Marijuana Legalization the Good Bad and Ugly

The legalization of medical marijuana has been discussed amongst the country's states for decades. Medical marijuana legalization has taken a positive shift throughout these years and is now legal in 20 states and the District of Columbia. The initial drug, marijuana, was band for the dangerous effects it brought to people. Throughout the year's people have turned to marijuana to ease anxiety, pain, and stress. Legalizing marijuana has brought multiple perspectives on the topic. Differences such as medical marijuana legalization, […]

Medical Marijuana Legalization

Marijuana legalization has become a topic of relevance in the United States as recent changes in various state legislations fuel the controversial issue relating to its effects on society. With more than thirty states legalizing marijuana for medicinal or recreational uses, the once taboo topic has reemerged into the spotlight for policymakers to consider the benefits and adverse effects of cannabis for state legislation. Although the legal status is changing nationwide, the uncertainties surrounding marijuana today stem from the political […]

Pros and Cons of Legalizing Marijuana

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Against Marijuana Legalization

In my high school years I met a lot of people, I’ve meet hundreds of people who ruined their lives by just “trying” a drug. One of those friends is named Carmen, my dear friend Carmen smokes marijuana recreationally everyday, she’s tried everything under the rainbow; pot brownies, gummi bears, cookies, anything that you can think of is probably an edible. She’s even forced me to try marijuana when we were in high school once. It was the worst experience […]

Marijuana Legalization in Texas: an In-Depth Examination of the Ongoing Debate

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Legalization of Marijuana: Good or Bad

The legalization of marijuana is a hot topic these days. Marijuana has been legalized in many different states. Colorado legalized marijuana for recreational use in 2012. Since then, Texas has been talking of legalizing it as well. Although the legalization of marijuana has brought quite a bit of controversy over the nation, I believe the good outweigh the bad. Marijuana is used for different medical reasons, ranging from anxiety all the way to helping some side effects of cancer. Many […]

Legalization of Recreational Marijuana

Marijuana, also known as pot, weed, kush, or dank, is a debated topic nationwide. Surveys have shown that " more than half of American adults have tried marijuana at least once in their lives ...nearly 55 million of them, or twenty two percent, currently use it"(Ingraham). Many people believe that there are only few negative effects affiliated with smoking weed, but there are many poor and preventable outcomes that are not always taken into consideration. The effects of marijuana on […]

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In the United States, marijuana is one of the most commonly used drugs that should have been legalized a long time ago along with alcohol. Although, 15 states in the United States have already legalized the use of marijuana, many others still lag behind at the thought of even legalizing Cannabis. In addition, many people think that marijuana is a bad drug, while on the other hand, people like myself believe for many reasons that it should be legalized. Marijuana […]

Pro-Legalization of Marijuana

Marijuana has always been a much-discussed subject that has sparked heated discussions among experts and officials, in addition to a perpetual dialogue among family and associates. This is primarily due to the fact that people are still divided on whether cannabis should be legalized or not. While many people are aware of the dangers of cannabis for recreational purposes, many states are pushing for the legalization of medical cannabis. Several studies of cannabinoid elements have revealed its medicinal qualities, which […]

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The Legalization of Marijuana Today

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Legalization of Marijuana: the Current Situation

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Marijuana Decriminalization in all States

The government should legalize marijuana on the federal use due to the multifaceted health, economic, and criminal benefits now outweigh the outdated downsides of use. Many researchers have come to the conclusion of outdated research not being correct. "One function of government is to protect citizens from harm, whether it is from foreign enemies or from internal causes such as poisonous food or contaminated water." Researchers believe that legalizing marijuana will not help the people only harm them and the […]

The Cost and Benefit of Legalization of Marijuana

In recent years, marijuana has become a controversial topic, and the United States government has been struggling to find a solution for the legalization of marijuana. Some argue that the government should legalize marijuana because it is less harmful than alcohol and tobacco. They also believe legalizing marijuana will decrease crime rates, especially drug trafficking. It is because marijuana is illegal in most states, and its penalties are often quite harsh, which can deter people from committing related crimes. Others […]

Legalization of Marijuana Throughout States

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The Impacts of Legalizing Marijuana

The impacts of legalizing marijuana have been far reaching. Legal or not, there are health issues to consider when it comes to medicinal purposes or recreational purposes. Studies show that non-medical marijuana users are at an increased risk for physical ailments involving the respiratory system and pulmonary functions. Psychological problems are also a concern, involving depression, insomnia, anxiety, and drug addiction. Other things associated with marijuana use are criminal justice involvement and lower academic achievement and functioning (Lankenau, et al., […]

Legalization of Marijuana and Economic Growth

These would make occupations as well as set the ball moving for financial action in the pot business in these regions. On account of states like California and Nevada where such foundation as of now exists, the financial effect has turned out to be more quantifiable as the part has developed. A RCG Economics and Marijuana Policy Group consider on Nevada says that legitimizing recreational marijuana in the state could bolster more than 41,000 employments till 2024 and produce over […]

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How To Write an Essay About Marijuana Legalization

Introduction to marijuana legalization.

When embarking on an essay about marijuana legalization, it's crucial to begin with a comprehensive overview of the topic. Marijuana legalization is a multifaceted issue that encompasses legal, medical, social, and economic dimensions. Your introduction should briefly touch upon the history of marijuana use and its legal status over time, setting the stage for a deeper exploration of the arguments for and against legalization. Establish your thesis statement, outlining the specific aspect of marijuana legalization you will focus on, whether it's the potential medical benefits, the social implications, or the economic impact of legalizing marijuana.

Examining the Arguments for Legalization

In this section, delve into the arguments commonly made in favor of legalizing marijuana. These arguments often include the potential medical benefits of marijuana, such as its use in pain management and treatment of certain medical conditions. Discuss the viewpoint that legalization could lead to better regulation and quality control of the substance, as well as potentially reduce crime rates related to illegal drug trade. It's also important to consider the economic aspect, such as the revenue generated from taxing legal marijuana sales. Provide well-researched evidence and examples to support these arguments, ensuring that your essay presents a balanced and informed perspective.

Exploring the Counterarguments

Next, address the arguments against marijuana legalization. These may include concerns about the health risks associated with marijuana use, such as potential impacts on mental health and cognitive function, especially among young people. Discuss the fears that legalization might lead to increased usage rates, particularly in adolescents, and the potential for marijuana to act as a gateway drug. There's also the argument regarding the challenges of enforcing regulations and controlling the quality and distribution of legal marijuana. Like the previous section, ensure that you present these counterarguments with supporting evidence and a fair analysis, demonstrating an understanding of the complexities of the issue.

Concluding the Essay

Conclude your essay by summarizing the main points from both sides of the argument. This is your opportunity to reinforce your thesis and provide a final analysis of the issue based on the evidence presented. Reflect on the potential future of marijuana legalization, considering the current trends and policy changes. A well-crafted conclusion should provide closure to your essay and encourage the reader to continue contemplating the nuanced aspects of marijuana legalization. Your concluding remarks might also suggest areas for further research or consideration, underscoring the ongoing nature of the debate surrounding marijuana legalization.

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Benefits and harms of medical cannabis: a scoping review of systematic reviews

Misty pratt.

1 Knowledge Synthesis Group, Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8 L6 Canada

Adrienne Stevens

2 TRIBE Graduate Program, University of Split School of Medicine, Split, Croatia

Micere Thuku

Claire butler.

3 Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec H3A 2B4 Canada

Becky Skidmore

4 Ottawa, Canada

L. Susan Wieland

5 Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD USA

Mark Clemons

6 School of Epidemiology and Public Health, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada

7 Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada

Salmaan Kanji

8 Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada

9 Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada

Brian Hutton

Associated data.

All data generated or analyzed during this study are included in this published article (and its supplementary information files).

There has been increased interest in the role of cannabis for treating medical conditions. The availability of different cannabis-based products can make the side effects of exposure unpredictable. We sought to conduct a scoping review of systematic reviews assessing benefits and harms of cannabis-based medicines for any condition.

A protocol was followed throughout the conduct of this scoping review. A protocol-guided scoping review conduct. Searches of bibliographic databases (e.g., MEDLINE®, Embase, PsycINFO, the Cochrane Library) and gray literature were performed. Two people selected and charted data from systematic reviews. Categorizations emerged during data synthesis. The reporting of results from systematic reviews was performed at a high level appropriate for a scoping review.

After screening 1975 citations, 72 systematic reviews were included. The reviews covered many conditions, the most common being pain management. Several reviews focused on management of pain as a symptom of conditions such as multiple sclerosis (MS), injury, and cancer. After pain, the most common symptoms treated were spasticity in MS, movement disturbances, nausea/vomiting, and mental health symptoms. An assessment of review findings lends to the understanding that, although in a small number of reviews results showed a benefit for reducing pain, the analysis approach and reporting in other reviews was sub-optimal, making it difficult to know how consistent findings are when considering pain in general. Adverse effects were reported in most reviews comparing cannabis with placebo (49/59, 83%) and in 20/24 (83%) of the reviews comparing cannabis to active drugs. Minor adverse effects (e.g., drowsiness, dizziness) were common and reported in over half of the reviews. Serious harms were not as common, but were reported in 21/59 (36%) reviews that reported on adverse effects. Overall, safety data was generally reported study-by-study, with few reviews synthesizing data. Only one review was rated as high quality, while the remaining were rated of moderate ( n = 36) or low/critically low ( n = 35) quality.

Conclusions

Results from the included reviews were mixed, with most reporting an inability to draw conclusions due to inconsistent findings and a lack of rigorous evidence. Mild harms were frequently reported, and it is possible the harms of cannabis-based medicines may outweigh benefits.

Systematic review registration

The protocol for this scoping review was posted in the Open Access ( https://ruor.uottawa.ca/handle/10393/37247 ).

Interest in medical applications of marijuana ( Cannabis sativa ) has increased dramatically during the past 20 years. A 1999 report from the National Academies of Sciences, Engineering, and Medicine supported the use of marijuana in medicine, leading to a number of regulatory medical colleges providing recommendations for its prescription to patients [ 1 ]. An updated report in 2017 called for a national research agenda, improvement of research quality, improvement in data collection and surveillance efforts, and strategies for addressing barriers in advancing the cannabis agenda [ 2 ].

Proponents of medical cannabis support its use for a highly varied range of medical conditions, most notably in the fields of pain management [ 3 ] and multiple sclerosis [ 4 ]. Marijuana can be consumed by patients in a variety of ways including smoking, vaporizing, ingesting, or administering sublingually or rectally. The plant consists of more than 100 known cannabinoids, the main ones of relevance to medical applications being tetrahydrocannabinol (THC) and cannabidiol (CBD) [ 5 ]. Synthetic forms of marijuana such as dronabinol and nabilone are also available as prescriptions in the USA and Canada [ 6 ].

Over the last decade, there has been an increased interest in the use of medical cannabis products in North America. It is estimated that over 3.5 million people in the USA are legally using medical marijuana, and a total of USD$6.7 billion was spent in North America on legal marijuana in 2016 [ 7 ]. The number of Canadian residents with prescriptions to purchase medical marijuana from Health Canada–approved growers tripled from 30,537 in 2015 to near 100,000 in 2016 [ 8 ]. With the legalization of recreational-use marijuana in parts of the USA and in Canada in October 2018, the number of patients using marijuana for therapeutic purposes may become more difficult to track. The likely increase in the numbers of individuals consuming cannabis also necessitates a greater awareness of its potential benefits and harms.

Plant-based and plant-derived cannabis products are not monitored as more traditional medicines are, thereby increasing the uncertainty regarding its potential health risks to patients [ 3 ]. While synthetic forms of cannabis are available by prescription, different cannabis plants and products contain varied concentrations of THC and CBD, making the effects of exposure unpredictable [ 9 ]. While short-lasting side effects including drowsiness, loss of short-term memory, and dizziness are relatively well known and may be considered minor, other possible effects (e.g., psychosis, paranoia, anxiety, infection, withdrawal) may be more harmful to patients.

There remains a considerable degree of clinical equipoise as to the benefits and harms of marijuana use for medical purposes [ 10 – 13 ]. To understand the extent of synthesized evidence underlying this issue, we conducted a scoping review [ 14 ] of systematic reviews evaluating the benefits and/or harms of cannabis (plant-based, plant-derived, and synthetic forms) for any medical condition. We located and mapped systematic reviews to summarize research that is available for consideration for practice or policy questions in relation to medical marijuana.

A scoping review protocol was prepared and posted to the University of Ottawa Health Sciences Library’s online repository ( https://ruor.uottawa.ca/handle/10393/37247 ). We used the PRISMA for Scoping Reviews checklist to guide the reporting of this report (see Additional file 1 ) [ 15 ].

Literature search and process of study selection

An experienced medical information specialist developed and tested the search strategy using an iterative process in consultation with the review team. Another senior information specialist peer-reviewed the strategy prior to execution using the PRESS Checklist [ 16 ]. We searched seven Ovid databases: MEDLINE®, including Epub Ahead of Print and In-Process & Other Non-Indexed Citations, Embase, Allied and Complementary Medicine Database, PsycINFO, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, and the Health Technology Assessment Database. The final peer-reviewed search strategy for MEDLINE was translated to the other databases (see Additional file 2 ). We performed the searches on November 3, 2017.

The search strategy incorporated controlled vocabulary (e.g., “Cannabis,” “Cannabinoids,” “Medical Marijuana”) and keywords (e.g., “marijuana,” “hashish,” “tetrahydrocannabinol”) and applied a broad systematic review filter where applicable. Vocabulary and syntax were adjusted across the databases and where possible animal-only and opinion pieces were removed, from the search results.

Gray literature searching was limited to relevant drug and mental health databases, as well as HTA (Health Technology Assessment) and systematic review databases. Searching was guided by the Canadian Agency for Drugs and Technologies in Health’s (CADTH) checklist for health-related gray literature (see Additional file 3 ). We performed searches between January and February 2018. Reference lists of overviews were searched for relevant systematic reviews, and we searched for full-text publications of abstracts or protocols.

Management of all screening was performed using Distiller SR Software ® (Evidence Partners Inc., Ottawa, Canada). Citations from the literature search were collated and de-duplicated in Reference Manager (Thomson Reuters: Reference Manager 12 [Computer Program]. New York: Thomson Reuters 2011), and then uploaded to Distiller. The review team used Distiller for Levels 1 (titles and abstracts) and 2 (full-text) screening. Pilot testing of screening questions for both levels were completed prior to implementation. All titles and abstracts were screened in duplicate by two independent reviewers (MT and MP) using the liberal accelerated method [ 17 ]. This method requires only one reviewer to assess an abstract as eligible for full-text screening, and requires two reviewers to deem the abstract irrelevant. Two independent reviewers (MT and MP) assessed full-text reports for eligibility. Disagreements during full-text screening were resolved through consensus, or by a third team member (AS). The process of review selection was summarized using a PRISMA flow diagram (Fig. ​ (Fig.1) 1 ) [ 18 ].

PRISMA-style flow diagram of the review selection process

Review selection criteria

English-language systematic reviews were included if they reported that they investigated harms and/or benefits of medical or therapeutic use of cannabis for adults and children for any indication. Definitions related to medical cannabis/marijuana are provided in Table ​ Table1. 1 . We also included synthetic cannabis products, which are prescribed medicines with specified doses of THC and CBD. Reviews of solely observational designs were included only in relation to adverse effects data, in order to focus on the most robust evidence available. We considered studies to be systematic reviews if at least one database was searched with search dates reported, at least one eligibility criterion was reported, the authors had assessed the quality of included studies, and there was a narrative or quantitative synthesis of the evidence. Reviews assessing multiple interventions (both pharmacological and complementary and alternative medicine (CAM) interventions) were included if the data for marijuana studies was reported separately. Published and unpublished guidelines were included if they conducted a systematic review encompassing the criteria listed above.

Context for the use of cannabis-related terms during the review selection process

We excluded overviews of systematic reviews, reviews in abstract form only, and review protocols. We further excluded systematic reviews focusing on recreational, accidental, acute, or general cannabis use/abuse and interventions such as synthetic cannabinoids not approved for therapeutic use (e.g., K2 or Spice).

Data collection and quality assessment

All data were collected electronically in a pre-developed form using Microsoft Excel software (Microsoft Corporation, Seattle, USA). The form was pilot tested on three included reviews by three people. One reviewer (MP or CB) independently extracted all data, and a second reviewer (MT) verified all of the items collected and checked for any omitted data. Disagreements were resolved by consensus and consultation with a third reviewer if necessary. A data extraction form with the list of included variables is provided in Additional file 4 . All collected data has also been made available in the online supplemental materials associated with this report.

Quality assessment of systematic reviews was performed using the AMSTAR-2 [ 20 ] tool. One reviewer (MP or CB) independently assessed quality, while a second reviewer (MT) verified the assessments. Disagreements were resolved by consensus and consultation with a third reviewer if necessary. The tool consists of 16 items in total, with four critical domains and 12 non-critical domains. The AMSTAR-2 tool is not intended to generate an overall score, and instead allows for an overall rating based on weaknesses in critical domains. Reviews were rated as high (no critical flaws with zero or one non-critical flaw), moderate (no critical flaws with ≥ 1 non-critical flaw), low (one critical flaw with/without non-critical weakness), or critically low (> 1 critical flaw with/without non-critical weakness) quality.

Evidence synthesis

We used a directed content analytic approach [ 21 ] with an initial deductive framework [ 22 ] that allowed flexibility for inductive analysis if refinement or development of new categorization was needed. The framework used to categorize outcome data results is outlined in Table ​ Table2. 2 . Where reviews had a mix of narrative and quantitative data, results from meta-analyses were prioritized over count data or study-by-study data. The extraction and reporting of data results was performed at a high level and did not involve an in-depth evaluation, which is appropriate for a scoping review [ 14 ]. Review authors’ conclusions and/or recommendations were extracted and reported narratively.

Outcome result categorization

Changes from the study protocol

For feasibility, we decided to limit the inclusion of systematic reviews of only observational study designs to those that addressed adverse events data. All other steps of the review were performed as planned.

Search findings

The PRISMA flow diagram describing the process of review selection is presented in Fig. ​ Fig.1. 1 . After duplicates were removed, the search identified a total of 1925 titles and abstracts, of which 47 references were located through the gray literature search. Of the total 1925 citations assessed during Level 1 screening, 1285 were deemed irrelevant. We reviewed full-text reports for the 640 reviews of potential relevance, and of these, 567 were subsequently excluded, leaving a total of 72 systematic reviews that were included; the associated data collected are provided in Additional file 5 . A listing of the reports excluded during full-text review is provided in Additional file 6 .

Characteristics of included reviews

There were 63 systematic reviews [ 4 , 19 , 23 – 83 ] and nine guidelines with systematic reviews [ 84 – 92 ]. Overall, 27 reviews were performed by researchers in Europe, 16 in the USA, 15 in Canada, eight in Australia, two in Brazil, and one each in Israel, Singapore, South Africa, and China. Funding was not reported in 29 (40%) of the reviews, and the remaining reviews received funding from non-profit or academic ( n = 20; 28%), government ( n = 14; 19%), industry ( n = 3; 4%), and mixed ( n = 1; 1%) sources. Five reviews reported that they did not receive any funding for the systematic review. Tables ​ Tables3, 3 , ​ ,4, 4 , ​ ,5, 5 , ​ ,6, 6 , ​ ,7, 7 , ​ ,8, 8 , ​ ,9, 9 , ​ ,10, 10 , ​ ,11, 11 , ​ ,12, 12 , and ​ and13 13 provide an overview of the characteristics of the 72 included systematic reviews.

Multiple sclerosis

MS multiple sclerosis, NICE National Institute for Health and Care Excellence, No . number, NR not reported, NRS numerical rating scale, QoL quality of life, RMI Rivermead Mobility Index, SBS study-by-study, VAS visual analog scale

*A colon indicates that there were separate analyses for each comparator

Movement disorders

HD Huntington’s disease, MS multiple sclerosis, NR not reported, PD Parkinson’s disease, SBS study-by-study, SCL-90R Symptoms Checklist-90 Revised, QoL quality of life, STSSS Shapiro Tourette Syndrome Severity Scale, THC tetrahydrocannabinol, TS-CGI Tourette Syndrome Clinical Global Impressions, TSSL Tourette’s Syndrome Symptom List (patient rated), VAS visual analog scale, YGTSS Yale Global Tic Severity Scale

AE : adverse effect, NICE National Institute for Health and Care Excellence, NNT numbers needed to treat, NP neuropathic pain, NR not reported, QoL quality of life, QST quantitative sensory testing, SBS study-by-study, VAS visual analog scale

*A colon indicates that there were separate analyses for each comparator; a “+” sign indicates placebo was combined with another comparator

AE adverse effect, NP neuropathic pain, NR not reported, NRS numerical rating scale, QoL quality of life, THC tetrahydrocannabinol, SIGN Scottish Intercollegiate Guidelines Network, SBS study-by-study

Rheumatic disease

AE adverse event, FM fibromyalgia, NR not reported, NRS numerical rating scale, OA osteoarthritis, RA rheumatoid arthritis, SBS study-by-study

NP neuropathic pain, NR not reported, QoL quality of life, SBS study-by-study

Mental health

PTSD posttraumatic stress disorder, SBS study-by-study

NP neuropathic pain, NR not reported, SBS study-by-study

Neurological conditions

AE adverse effect, ALS amyotrophic lateral sclerosis, CADTH Canadian Agency for Drugs and Technologies in Health, NR not reported

Various conditions

AE adverse effect, AD Alzheimer’s disease, ALS amyotrophic lateral sclerosis, CADTH Canadian Agency for Drugs and Technologies in Health, CGI-C Clinical Global Impression of Change scale, COPD Chronic Obstructive Pulmonary Disease, FIQ fibromyalgia impact questionnaire, FM fibromyalgia, HD Huntington’s disease, IBD inflammatory bowel disease, MS multiple sclerosis, NP neuropathic pain, NR not reported, PD Parkinson’s disease, PTSD posttraumatic stress disorder, RA rheumatoid arthritis, SBS study-by-study, SCI spinal cord injury

Other conditions

CADTH Canadian Agency for Drugs and Technologies in Health, IBS irritable bowel syndrome, NR not reported, QoL quality of life, SBS study-by-study, VAS visual analog scale

The reviews were published between 2000 and 2018 (median year 2014), and almost half (47%) were focused solely on medical cannabis. Four (6%) reviews covered both medical and other cannabis use (recreational and substance abuse), 19 (26%) reported multiple pharmaceutical interventions (cannabis being one), six (8%) reported various CAM interventions (cannabis being one), and nine (13%) were mixed pharmaceutical and CAM interventions (cannabis being one). Multiple databases were searched by almost all of the reviews (97%), with Medline/PubMed or Embase common to all.

Cannabis use

Figure ​ Figure2 2 illustrates the different cannabis-based interventions covered by the included reviews. Plant-based cannabis consists of whole plant products such as marijuana or hashish. Plant-derived cannabinoids are active constituents of the cannabis plant, such as tetrahydrocannabinol (THC), cannabidiol (CBD), or a combination of THC:CBD (also called nabiximols, under the brand name Sativex) [ 3 ]. Synthetic cannabinoids are manufactured rather than extracted from the plant and include drugs such as nabilone and dronabinol.

Review coverage of the various cannabis-based interventions

Twenty-seven reviews included solely interventions from plant-derived cannabinoids, 10 studied solely synthetic cannabinoids, and eight included solely studies on plant-based cannabis products. Twenty-four reviews covered a combination of different types of cannabis, and the remaining three systematic reviews did not report which type of cannabinoid was administered in the included studies.

The systematic reviews covered a wide range of conditions and illnesses, the most notable being pain management. Seventeen reviews looked at specific types of pain including neuropathic [ 31 , 42 , 62 , 69 , 85 , 90 ], chronic [ 26 , 32 , 52 , 58 , 80 ], cancer [ 84 , 87 ], non-cancer [ 41 , 68 ], and acute [ 38 ] types of pain (one review covered all types of pain) [ 65 ]. Twenty-seven reviews (38%) also focused on management of pain as a symptom of conditions such as multiple sclerosis (MS) [ 6 , 23 , 27 , 43 , 46 , 52 , 63 , 85 , 92 ], injury [ 29 , 35 , 36 , 69 ], cancer [ 37 , 43 , 65 , 88 ], inflammatory bowel disease (IBD) [ 28 ], rheumatic disease (RD) [ 49 , 51 , 73 ], diabetes [ 68 – 70 ], and HIV [ 48 , 53 , 67 ]. In Fig. ​ Fig.3, 3 , the types of illnesses addressed by the set of included reviews are graphically represented, with overlap between various conditions and pain. Some systematic reviews covered multiple diseases, and therefore the total number of conditions represented in Fig. ​ Fig.3 3 is greater than the total number of included reviews.

Conditions or symptoms across reviews that were treated with cannabis. IBD inflammatory bowel disease, MS multiple sclerosis, RD rheumatic disease

One review included a pediatric-only population, in the evaluation of marijuana for nausea and vomiting following chemotherapy [ 54 ]. Although trials in both adult and child populations were eligible for thirteen (18%) reviews, only two additional reviews included studies in children; these reviews evaluated cannabis in cancer [ 60 ] and a variety of conditions [ 25 ]. Many of the reviews ( n = 25, 35%) included only adults ≥ 18 years of age. Almost half of the reviews ( n = 33, 46%) did not report a specific population for inclusion.

Cannabis was prescribed for a wide range of medical issues. The indication for cannabis use is illustrated in Fig. ​ Fig.4. 4 . Pain management ( n = 27) was the most common indication for cannabis use. A number of reviews sought to address multiple disease symptoms ( n = 12) or explored a more holistic treatment for the disease itself ( n = 11). After pain, the most common symptoms being treated with cannabis were spasticity in MS, movement disturbances (such as dyskinesia, tics, and spasms), weight or nausea/vomiting, and mental health symptoms.

Indications for cannabis use across included reviews

Figure ​ Figure5 5 summarizes the breadth of outcomes analyzed in the included reviews. The most commonly addressed outcomes were withdrawal due to adverse effects, “other pain,” neuropathic pain, spasticity, and the global impression of the change in clinical status. Many outcomes were reported using a variety of measures across reviews. For example, spasticity was measured both objectively (using the Ashworth scale) and subjectively (using a visual analog scale [VAS] or numerical rating scale [NRS]). Similarily, outcomes for pain included VAS or NRS scales, reduction in pain, pain relief, analgesia, pain intensity, and patient assessment of change in pain.

Quality of the systematic reviews

Quality assessments of the included reviews based upon AMSTAR-2 are detailed in Additional file 7 and Additional file 8 . Only one review was rated as high quality [ 45 ]. All other reviews were deemed to be of moderate ( n = 36) or low/critically low ( n = 35) methodological quality. Assessments for the domains deemed of critical importance for determining quality ratings are described below.

Only 20% of reviews used a comprehensive search strategy; another 47% were given a partial score because they had not searched the reference lists of the included reviews, trial registries, gray literature, and/or the search date was older than 2 years. The remaining reviews did not report a comprehensive search strategy.

Over half of the reviews (51%) used a satisfactory technique for assessing risk of bias (ROB) of the individual included studies, while 35% were partially satisfactory because they had not reported whether allocation sequence was truly random and/or they had not assessed selective reporting. The remaining reviews did not report a satisfactory technique for assessing ROB.

Most reviews (71%) could not be assessed for an appropriate statistical method for combining results in a meta-analysis, as they synthesized study data narratively. Approximately 19% of reviews used an appropriate meta-analytical approach, leaving 10% that used inappropriate methods.

The final critical domain for the AMSTAR-2 determines whether review authors accounted for ROB in individual studies when discussing or interpreting the results of the review. The majority of reviews (83%) did so in some capacity.

Mapping results of included systematic reviews

We mapped reviews according to authors’ comparisons, the conditions or symptoms they were evaluating, and the categorization of the results (see Table ​ Table2). 2 ). In some cases, reviews contributed to more than one comparison (e.g., cannabis versus placebo or active drug). As pain was the most commonly addressed outcome, we mapped this outcome separately from all other endpoints. This information is shown for all reviews and then restricted to reviews of moderate-to-high quality (as determined using the AMSTAR-2 criteria): cannabis versus placebo (Figs. ​ (Figs.6 6 and ​ and7), 7 ), cannabis versus active drugs (Figs. ​ (Figs.8 8 and ​ and9), 9 ), cannabis versus a combination of placebo and active drug (Figs. ​ (Figs.10 10 and ​ and11), 11 ), one cannabis formulation versus other (Figs. ​ (Figs.12 12 and ​ and13), 13 ), and cannabis analyzed against all other comparators (Fig. ​ (Fig.14). 14 ). Details on how to read the figures are provided in the corresponding figure legends. The median number of included studies across reviews was four, and ranged from one to seventy-nine (not shown in figures).

Cannabis vs. placebo. Authors’ presentations of the findings were mapped using the categorization shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. placebo, high and moderate quality reviews. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. active drugs. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. active drugs, high and moderate quality reviews. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. placebo + active drug. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. placebo + active drug, high and moderate quality reviews. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

One cannabis formulation vs. other. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

One cannabis formulation vs. other, high and moderate quality reviews. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis vs. all comparators combined. Authors’ presentations of the findings were mapped using the categorizations shown in Table ​ Table2. 2 . According to the reviews’ intended scope for the condition being treated, outcomes were mapped into “pain,” “non-pain outcomes,” and “adverse events.” For each condition and outcome pair (i.e., each row in the grid), the number of reviews reporting findings is shown according to the results categorization. For pain, reviews numbered in different categories signal discordant findings across those reviews. For non-pain outcomes, reviews presenting findings in the different categories would signal different results for different outcomes, as well as discordant findings within and across reviews. Adverse events are grouped as a whole and “favors intervention” would be interpreted as a decrease in events with cannabis when compared with the control group. Favors int = favors intervention; Favors Ctrl = favors control; Not stat sig = not statistically significant

Cannabis versus placebo

Most reviews (59/72, 82%) compared cannabis with placebo. Of these reviews, 34 (58%) addressed pain outcomes and 47 (80%) addressed non-pain outcomes, with most outcomes addressed by three reviews or fewer (Fig. ​ (Fig.6). 6 ). Some reviews had a mix of quantitative syntheses and study-by-study data reported (13/59, 22%), while another group of reviews (14/59, 24%) only reported results study-by-study. Overall, 24% (14/59) of the cannabis versus placebo reviews had only one included study.

• i. Reviews focused on addressing pain across conditions. In most cases, findings were discordant across reviews for the pain outcomes measured. For chronic non-cancer pain, however, two reviews favored cannabis over placebo for decreasing pain. One review assessing acute pain for postoperative pain relief found no difference between various cannabinoid medications and placebo. The distribution of findings was similar when restricting to moderate-to-high-quality reviews.
• ii. Reviews focused on treating a condition or family of related conditions . Various results were observed for pain. For MS and HIV/AIDS, one review each reported quantitative results favoring cannabis for decreased pain but with other reviews reporting results study-by-study, it is difficult to know, broadly, how consistent those findings are. For cancer, two reviews reported results favoring cannabis for decreased pain. For rheumatic disease, findings are discordant between two reviews, and another two reviews reported results study-by-study. One review that included studies of MS or paraplegia found no difference in pain between groups. For treating injury, one review showed that the placebo group had less pain and one review reported data study-by-study. No reviews addressed pain in movement disorders, neurological conditions, and IBD.

For those reviews assessing pain as part of a focus on treating a range of conditions, two showed cannabis reduced pain [ 43 , 52 ], but one showed mixed results depending on how pain was measured [ 43 ]. These reviews covered several different conditions, including injury, chronic pain, rheumatoid arthritis, osteoarthritis, fibromyalgia, HIV/AIDS, cancer, and MS or paraplegia.

When restricting to moderate-to-high-quality reviews, only one review each in multiple sclerosis and HIV/AIDS with a study-by-study analysis on pain remained. One review on cancer favored cannabis for pain reduction. Findings remained the same for MS or paraplegia and rheumatic disease. No review for injury and paint outcomes was of higher quality.

• 2. Non-pain outcomes

The types of non-pain outcomes included in the reviews varied by condition/illness. The most commonly reported outcomes (see Fig. ​ Fig.5 5 for overall outcomes) when comparing cannabis to placebo included muscle- or movement-related outcomes ( n = 20), quality of life ( n = 14), and sleep outcomes ( n = 10).

There was no consistent pattern for non-pain outcomes either within or across medical conditions. Many ( n = 24, 33%) reviews assessing non-pain outcomes reported the results of those analyses study-by-study. Conflicting results are observed in some cases due to the use of different measures, such as different ways of quantifying spasticity in patients with multiple sclerosis [ 56 , 91 ]. One review each addressing neurological conditions [ 50 ] (outcome: muscle cramps) and MS/paraplegia [ 27 ] (outcomes: spasticity, spasm, cognitive function, daily activities, motricity, and bladder function) showed no difference between groups.

• 3. Adverse effects

Adverse effects were reported in most reviews comparing cannabis with placebo (49/59, 83%). Most adverse events were reported study-by-study, with few reviews ( n = 16/59, 27%) conducting a narrative or quantitative synthesis. Serious adverse effects were reported in 21/59 (36%) reviews, and minor adverse effects were reported in 30/59 (51%) reviews. The remaining reviews did not define the difference between serious and minor adverse events. The most commonly reported serious adverse events included psychotic symptoms ( n = 6), severe dysphoric reactions ( n = 3), seizure ( n = 3), and urinary tract infection ( n = 2). The most commonly reported minor adverse events included somnolence/drowsiness ( n = 28), dizziness ( n = 27), dry mouth ( n = 20), and nausea ( n = 18). Many reviews ( n = 37/59, 63%) comparing cannabis to placebo reported both neurocognitive and non-cognitive adverse effects. Withdrawals due to adverse events were reported in 22 (37%) reviews.

Of the moderate-/high-quality reviews, adverse effect analyses were reported in reviews on pain, multiple sclerosis, cancer, HIV/AIDS, movement disorders, rheumatic disease, and several other conditions. Two reviews on pain showed fewer adverse events with cannabis for euphoria, events linked to alternations in perception, motor function, and cognitive function, withdrawal due to adverse events, sleep, and dizziness or vertigo [ 58 , 90 ]. One review on MS showed that there was no statistically significant difference between cannabis and placebo for adverse effects such as nausea, weakness, somnolence, and fatigue [ 91 ], while another review on MS/paraplegia reported fewer events in the placebo group for dizziness, somnolence, nausea, and dry mouth [ 27 ]. Within cancer reviews, one review found no statistically significant difference between cannabis and placebo for dysphoria or sedation but reported fewer events with placebo for “feeling high,” and fewer events with cannabis for withdrawal due to adverse effects [ 40 ]. In rheumatic disease, one review reported fewer total adverse events with cannabis and found no statistically significant difference between cannabis and placebo for withdrawal due to adverse events [ 51 ].

Cannabis versus other drugs

Relatively fewer reviews compared cannabis with active drugs ( n = 23/72, 32%) (Fig. ​ (Fig.8). 8 ). Many of the reviews did not synthesize studies quantitatively, and results were reported study-by-study. The most common conditions in reviews comparing cannabis to active drugs were pain, cancer, and rheumatic disease. Comparators included ibuprofen, codeine, diphenhydramine, amitriptyline, secobarbital, prochlorperazine, domperidone, metoclopramide, amisulpride, neuroleptics, isoproterenol, megestrol acetate, pregabalin, gabapentin, and opioids.

• i. Reviews focused on addressing pain across conditions. When comparing across reviews, a mix of results are observed (see Fig. ​ Fig.8), 8 ), and some were reported study-by-study. One review found no statistically significant difference between cannabinoids and codeine for nociceptive pain, postoperative pain, and cancer pain [ 65 ]. Another review favored “other drugs” (amitriptyline and pregabalin) over cannabinoids for neuropathic pain [ 90 ]. The distribution of findings was similar when restricting to moderate-to-high-quality reviews.
• ii. Reviews focused on treating a condition or family of related conditions. One review on cancer compared cannabinoids and codeine or secobarbital and reported pain results study-by-study. Another review on fibromyalgia comparing synthetic cannabinoids with amitriptyline also reported pain data study-by-study [ 39 ].
• Non-pain outcomes

Two reviews on cancer favored cannabinoids over active drugs (prochlorperazine, domperidone, metoclopramide, and neuroleptics) for patient preference and anti-emetic efficacy [ 40 , 60 ]. Non-pain outcomes were reported study-by-study for the outcome of sleep in neuropathic pain [ 90 ] and rheumatic disease [ 39 , 49 ]. In a review covering various conditions (pain, MS, anorexia, cancer, and immune deficiency), results were unclear or indeterminate for subjective measures of sleep [ 46 ].

Adverse effects were reported in 20/24 (83%) of the reviews comparing cannabis to active drugs, and only 6/20 (30%) reported a narrative or quantitative synthesis. Many reviews that reported narrative data did not specify whether adverse effects could be attributed to a placebo or active drug comparator.

Of the moderate-to-high-quality reviews, two pain reviews found no statistically significant difference for cannabis compared to codeine or amitriptyline for withdrawals due to adverse events [ 65 , 90 ]. Results from one cancer review were mixed, with fewer adverse events for cannabis (compared to prochlorperazine, domperidone, or metoclopramide) or no difference between groups, depending on the type of subgroup analysis that was conducted [ 40 ].

Cannabis + active drugs versus placebo + active drugs

Two reviews compared cannabis with placebo cannabis in combination with an active drug (opioids and gabapentin) (Figs. ​ (Figs.10 10 and ​ and11). 11 ). Both were scored to be of moderate quality. Although one review showed that cannabis plus opioids decreased chronic pain [ 80 ], another review on pain in MS included only a single study [ 81 ], precluding the ability to determine concordance of results. Cannabis displayed varied effects on non-pain outcomes, including superiority of placebo over cannabis for some outcomes. One review reported withdrawal due to adverse events study-by-study and also reported that side effects such as nausea, drowsiness, and dizziness were more frequent with higher doses of cannabinoids (data from two included studies) [ 80 ].

Cannabis versus other cannabis comparisons

Six (8%) reviews compared different cannabis formulations or doses (Figs. ​ (Figs.12 12 and ​ and13). 13 ). Almost all were reported as study-by-study results, with two reviews including only one RCT. One review for PTSD found only observational data [ 33 ] and another review on anxiety and depression combined data from one RCT with cross-sectional study data [ 19 ]. A single review on MS reported a narrative synthesis that found a benefit for spasticity. However, it was unclear if the comparator was placebo or THC alone [ 56 ]. Four reviews reported adverse effects study-by-study, with a single review comparing side effects from different dosages; in this review, combined extracts of THC and CBD were better tolerated than extracts of THC alone [ 56 ].

Cannabis versus all comparators

One review combined all comparators for the evaluation (Fig. ​ (Fig.14). 14 ). The review (combining non-users, placebo and ibuprofen) covered a range of medical conditions and was rated as low quality [ 30 ]. No adverse effects were evaluated for this comparison.

Mapping the use of quality assessment and frameworks to interpret the strength of evidence

Although 83% of reviews incorporated risk of bias assessments in their interpretation of the evidence, only 11 (15%) reviews used a framework such as GRADE to evaluate important domains other than risk of bias that would inform the strength of the evidence.

Mapping authors’ conclusions or recommendations

Most reviews (43/72 60%) indicated an inability to draw conclusions, whether due to uncertainty, inconsistent findings, lack of (high quality) evidence, or focusing their conclusion statement on the need for more research. Almost 15% of reviews (10/72) reported recommendations or conclusions that included some uncertainty. One review (1%) provided a statement of the extent of the strength of the evidence, which differed according to outcome.

Eleven reviews provided clearer conclusions (14%). Four indicated that cannabis was not effective or not cost-effective compared to placebo in relation to multiple sclerosis, acute pain, cancer, and injury. Three reviews addressing various conditions provided varying conclusions: one stated cannabis was not effective, one indicated it was modestly safe and effective, and one concluded that cannabis was safe and efficacious as short-term treatment; all reviews were of low quality. The three remaining reviews stated moderate or modest effects for improving chronic pain, compared with placebo or other analgesia; two of those reviews were of medium AMSTAR-2 quality, and one used the GRADE framework for interpreting the strength of the evidence.

The eight remaining included reviews (11%) did not provide a clear conclusion statement or reported only limitations.

Mapping authors’ limitations of the research

Several of the reviews indicated that few studies, small sample sizes, short duration of treatment, and issues related to outcomes (e.g., definition, timing, and types) were drawbacks to the literature. Some reviews noted methodological issues with and heterogeneity among studies as limitations. A few authors stated that restricting eligibility to randomized trials, English-language studies, or full publications may have affected their review results.

With the increasing use of medical cannabis, an understanding of the landscape of available evidence syntheses is needed to support evidence-informed decision-making, policy development, and to inform a research agenda. In this scoping review, we identified 72 systematic reviews evaluating medical cannabis for a range of conditions and illnesses. Half of the reviews were evaluated as being of moderate quality, with only one review scoring high on the AMSTAR-2 assessment tool.

There was disparity in the reported results across reviews, including non-synthesized (study-by-study) data, and many were unable to provide a definitive statement regarding the effectiveness of cannabis (as measured by pain reduction or other relevant outcomes), nor the extent of increased side effects and harms. This is consistent with the limitations declared in general across reviews, such as the small numbers of relevant studies, small sample sizes of individual studies, and methodological weaknesses of available studies. This common theme in review conclusions suggests that while systematic reviews may have been conducted with moderate or high methodological quality, the strength of their conclusions are driven by the availability and quality of the relevant underlying evidence, which was often found to be limited.

Relatively fewer reviews addressed adverse effects associated with cannabis, except to narratively summarize study level data. Although information was provided for placebo-controlled comparisons, none of the comparative effectiveness reviews quantitatively assessed adverse effects data. For the placebo-controlled data, although the majority of adverse effects were mild, the number of reviews reporting serious adverse effects such as psychotic symptoms [ 25 , 42 ] and suicidal ideation [ 68 , 85 ] warrants caution.

A mix of reviews supporting and not supporting the use of cannabis, according to authors’ conclusions, was identified. Readers may wish to consider the quality of the reviews, the use of differing quality assessment tools, additional considerations covered by the GRADE framework, and the potential for spin as possible reasons for these inconsistencies. It is also possible that cannabis has differing effects depending on its type (e.g., synthetic), dose, indication, the type of pain being evaluated (e.g., neuropathic), and the tools used for outcome assessment, which can be dependent on variations in condition. Of potential interest to readers may be a closer examination of the reviews evaluating chronic pain, in order to locate the source(s) of discordance. For example, one review was deemed of moderate quality, used the GRADE framework, and rated the quality of evidence for the effectiveness of cannabis for reducing neuropathic pain as moderate, suggesting that further investigation of cannabis for neuropathic pain may be warranted [ 80 ]. The exploration aspects outlined in this paragraph are beyond the purview of scoping review methodology; a detailed assessment of the reviews, including determining the overlap of included studies among similar reviews, potential reasons for the observed discordance of findings, what re-analysis of study-by-study analyses would yield, and an undertaking of missing GRADE assessments would fall outside the bounds of a scoping review and require the use of overview methodology [ 14 ].

Our findings are consistent with a recently published summary of cannabis-based medicines for chronic pain management [ 3 ]. This report found inconsistent results in systematic reviews of cannabis-based medicines compared to placebo for chronic neuropathic pain, pain management in rheumatic diseases and painful spasms in MS. The authors also concluded that cannabis was not superior to placebo in reducing cancer pain. Four out of eight included reviews scored high on the original AMSTAR tool. The variations between the two tools can be attributed to the differences in our overall assessments. Lastly, the summary report included two reviews that were not located in our original search due to language [ 93 ] and the full-text [ 94 ] of an abstract [ 95 ] that was not located in our search.

This scoping review has identified a plethora of synthesized evidence in relation to medical cannabis. For some conditions, the extent of review replication may be wasteful. Many reviews have stated that additional trials of methodologically robust design and, where possible, of sufficient sample size for precision, are needed to add to the evidence base. This undertaking may require the coordination of multi-center studies to ensure adequate power. Future trials may also help to elucidate the effect of cannabis on different outcomes.

Given authors’ reporting of issues in relation to outcomes, future prospective trials should be guided by a standardized, “core” set of outcomes to strive for consistency across studies and ensure relevance to patient-centered care. Development of those core outcomes should be developed using the Core Outcome Measures in Effectiveness Trials (COMET) methodology [ 96 ], and further consideration will need to be made in relation to what outcomes may be common across all cannabis research and which outcomes are condition-specific. With maturity of the evidence base, future systematic reviews should seek and include non-journal-published (gray literature) reports and ideally evaluate any non-English-language papers; authors should also adequately assess risk of bias and undertake appropriate syntheses of the literature.

The strengths of this scoping review include the use of an a priori protocol, peer-reviewed search strategies, a comprehensive search for reviews, and consideration of observational designs for adverse effects data. For feasibility, we restricted to English-language reviews, and it is unknown how many of the 39 reviews in other languages that we screened would have met our eligibility criteria. The decision to limit the inclusion of reviews of observational data to adverse effects data was made during the process of full-text screening and for pragmatic reasons. We also did not consider a search of the PROSPERO database for ongoing systematic reviews; however, in preparing this report, we performed a search and found that any completed reviews were already considered for eligibility or were not available at the time of our literature search. When charting results, we took a broad perspective, which may be different than if these reviews were more formally assessed during an overview of systematic reviews.

Cannabis-based medicine is a rapidly emerging field of study, with implications for both healthcare practitioners and patients. This scoping review is intended to map and collate evidence on the harms and benefits of medical cannabis. Many reviews were unable to provide firm conclusions on the effectiveness of medical cannabis, and results of reviews were mixed. Mild adverse effects were frequently but inconsistently reported, and it is possible that harms may outweigh benefits. Evidence from longer-term, adequately powered, and methodologically sound RCTs exploring different types of cannabis-based medicines is required for conclusive recommendations.

Supplementary information

Acknowledgements.

Not applicable.

Abbreviations

Authors’ contributions.

MP, AS, and BH drafted the initial version of the report. BS designed and implemented the literature search. MP, MT, and CB contributed to review of abstracts and full texts as well as data collection. MP, AS, and BH were responsible for analyses. All authors (MP, AS, MT, CB, BS, SW, MC, SK, BH) contributed to interpretation of findings and revision of drafts and approved the final version of the manuscript.

Research reported in this publication was supported by the National Center for Complementary and Integrative Health of the National Institutes of Health under award number R24AT001293. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Availability of data and materials

Ethics approval and consent to participate, consent for publication, competing interests.

BH has previously received honoraria from Cornerstone Research Group for provision of methodologic advice related to the conduct of systematic reviews and meta-analysis. All other authors declare that they have no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Misty Pratt, Email: ac.irho@ttarpim .

Adrienne Stevens, Email: ac.irho@snevetsda .

Micere Thuku, Email: ac.irho@ukuhtm .

Claire Butler, Email: ac.irho@reltublc .

Becky Skidmore, Email: moc.sregor@eromdiksb .

L. Susan Wieland, Email: moc.liamg@dnaleiwsl .

Mark Clemons, Email: ac.hot@snomelcm .

Salmaan Kanji, Email: ac.hot@ijnaks .

Brian Hutton, Email: ac.irho@nottuhb .

Supplementary information accompanies this paper at 10.1186/s13643-019-1243-x.

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Marijuana Argumentative Outline

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103 Marijuana Legalization Essay Topic Ideas & Examples

🏆 best marijuana legalization topic ideas & essay examples, 👍 good essay topics on marijuana legalization, ⭐ most interesting marijuana legalization topics to write about, ✅ simple & easy marijuana legalization essay titles.

• Reason Why Marijuana Should Be Legal This is an important consideration since data on the prevalence of Marijuana indicates that the US is still the world’s largest single market for the drug.
• Legalizing Marijuana: Pros and Cons The focus of this paper will be on the impact of the legalization of the U.S.economy with possible positive and negative sides of the matter.
• Should Marijuana Be Legal? It is perhaps very essential to be acquainted with an account of laws that surround marijuana in order to understand the reasons why the drug ought to be legalized.
• Political Opinion on Legalization of Marijuana On the other hand, the case introduces the man as a member of the Methodist Church, and this community is known for its strict opinion about marijuana as a gateway drug.
• Analysis of Arguments: Should Marijuana Be Legalized? Pro Arguments: The majority of Americans agree on the necessity to legalize marijuana. This initiative is accompanied by concerns regarding the actual use of marijuana.
• The Issue of Legalization of Marijuana The issue of the legalization of marijuana in the territory of the state is not unambiguous, therefore it is analyzed by a large number of specialists.
• Marijuana Legalization: Controversial Issue in Canada Canada became the second country in the world to legalize the cultivation and consumption of cannabis in 2018. Besides, the substance is addictive, and it is challenging to stop consuming it.
• Marijuana Legalization and Issues to Consider If marijuana is fully legalized, there might be a rise in use among youth, which is dangerous from the physiological point of view, and there will be no legal justification to end it.
• The Relationships Between Marijuana and the Legal System The most common ideas discussed within a framework of this debate are connected to the issues of permission to keep marijuana at home for personal needs such as medical needs, and a total ban on […]
• Pros and Cons of Legalization of Medical Marijuana It is evident that medical treatment with the use of marijuana would be beneficial for both: patients and the government because of the opportunity to earn on taxation.
• Legalization of Recreational Use of Marijuana The role of the Supreme Court in the specified case boils down to stating the conditions, in which the prescription and the following use of marijuana by the patient, can be deemed as legitimate.
• Marijuana Legalization: Chronic Seizure Treatment With that said, despite numerous states already having legalized one or both applications, the federal government remains opposed to either form of legalization, and marijuana possession and use remain federal offenses.
• Legalized Marijuana: Negative and Positive Sides The economy and finance from the very beginning were anticipating that this law will bring the largest income to the state’s budget and create plenty of job opportunities under the rule of law.
• Ethical Perspective of the Legalization of Marijuana In spite of a popular view of the medical benefits of marijuana, doctors insist that the use of marijuana provides the same dangerous effect as other drugs.
• Marijuana Legalize: Advanatages and Disadvantages The truth that marijuana is illegal and prohibited is suitably caused by the number of funds invested in the war against drugs.
• Arguments for Banning the Legalization of Marijuana Marijuana is a dangerous drug that should not be legalized even if it is in the context of it containing the medicinal value.
• Logical Benefits of Legalizing Marijuana This will be a source of revenue to the government; when the revenues increase, it means that gross domestic product for the country increases. It will be a source of income not only to the […]
• Medical Marijuana: Pros of Legalizing It must be admitted that at the time of the passage of these laws, histories from some, but not all, heroin users indicated that the use of marijuana had preceded the use of heroin.
• Marijuana: To Legalize or Not to Legalize? Marijuana, which is also known under dozens of nicknames such as weed or pot, is now the most widespread illegal drug across the US. Moreover, the vast majority of marijuana abusers claim pot to be […]
• Marijuana Legalization and Consumption Among Youth The most popular excuse among drug consumers is the instrumental use of the drug. As long as the drug influence is undermined, the number of college students willing to experience the marijuana effects will be […]
• Legalization of Medical Marijuana: Help or Harm? Nowadays, a majority of people worldwide support the legalization of marijuana, and it is possible to predict that this support will keep getting stronger in the future.
• Medical Marijuana Legalization Concerns This change raises political concerns and requires the government to review its economy to adapt to the use of MM. The representation of the legal process highlighted the history of previous legislations and reported on […]
• Medical Marijuana: Legal and Research Concerns However, while the purpose of recreational marijuana is often disconnected from its long-term effects on people’s health in scholarly discussions, the use of medical marijuana is viewed from the point of patient’s health and the […]
• Should Marijuana Be Legalized? Marijuana legalization is a topic of social trends and beliefs that are based not only on health but political and economic factors as well.
• Marijuana Legalization and Its Benefits for Society The example of several states that have already introduced the appropriate law provides the ground for vigorous debates about the absence of the expected deterioration of the situation and emergence of multiple problems associated with […]
• Marijuana Legalization in 5 Policy Frameworks The legalization of marijuana is still one of the debatable issues at the federal and state levels. For instance, the use of marijuana is prohibited at the federal level while the recreational and medical use […]
• Marijuana Legalization in California The muscle relaxation effect of marijuana also appears to be a positive effect that should be used to argue for its legalization.
• Medical Marijuana Legalization by National Football League However, it must be realized that some of these players are usually in excruciating pain to the point that some may have lost consciousness.
• Medical Marijuana Legalization Rebuttal The claim of fact is that A.C.A.continues to be beneficial despite the arguments of Republican politicians and current challenges. The claim of policy is the appeal to Republicans and Democrats to work together on the […]
• Legal Marijuana Market Analysis and Taxes Impact Consequently, the primary goal of this paper is to understand the impact of taxes on the financial stability of the market for legal marijuana with the help of the law of supply and demand and […]
• Controversy Around Medical Marijuana Legalization The consideration of the problem of marijuana legalization from the perspective of public safety involves such points as crime rates and traffic accidents. The fact of economic benefits of the Cannabis legalization is also apparent: […]
• The Legalization of Marijuana: Regulation and Practice It is imperative to note that legalization of marijuana is a topic that has been quite controversial and has led to numerous discussions and disagreements.
• Concepts of Legalizing Marijuana Although in most cases, most individuals associate Marijuana with numerous health complications and social problems, for example, brain damage, and violent behavior hence, supporting its illegalization, such individuals take little consideration of its significance in […]
• Marijuana Legalization in Illinois The case for legalization of marijuana in Colorado evidences the need to alter federal laws prohibiting marijuana for its legalization law to have both statutory and federal backing in the state of Illinois.
• Public Safety and Marijuana Legalization Some of the states have failed to tax marijuana. Hence, it is difficult to get the precise figures in terms of tax values that states could collect from marijuana.
• History and Effects of Legalization of Marijuana As predicted, the legalization of marijuana in several states has led to an increase of marijuana abuse among youngsters Studies have shown a pattern of the use of cannabis and risky behavior of the individuals.
• Debates Around Legalization of Medical Marijuana The supporters and opponents of the legalization of marijuana have opted to focus on either the positive or the negative aspects of the effects of the drug to support their views on policies to legalize […]
• How New York Would Benefit From Legalized Medical Marijuana The arrests resulting from possession of marijuana in New York is quite huge compared to those in California and New Jersey states in America.
• Should Be It Legal to Sell the Marijuana in the United States? What I want to know is the reasons of why so many people use such serious psychoactive drug as marijuana of their own accord and do not want to pay special attention to their activities […]
• Supporting of Marijuana Legalization Among the Adult Population Proponents argue that legalization of marijuana will lead to increased revenues for the government amid economic challenges. Legalizing marijuana will not lead to cancer and deaths but will spark the debate for apparent effects of […]
• Marijuana: The Issues of Legalization in the USA To understand all the possible effects of the marijuana legalization, it is necessary to pay attention to the definition and classification of the drug with references to determining the most important social and legal aspects […]
• Reasons for Legalization of Marijuana The legalization of the drug would bring to an end the discrimination of the African Americans in marijuana-related arrests, reduce the sales of the drug and its use among teenagers, encourage the development of hemp […]
• Legalizing Marijuana: Arguments and Counter-Arguments On the other hand, many groups have outlined that the legalization of marijuana would lead to an increase in the rate of crime in addition to opening up of the gateway to the abuse of […]
• Should We Legalize Marijuana For Medical Use? In addition to that, the use of Marijuana especially by smoking either for medical reasons or to heal ailments, is a social activity that will help bring them together and improve their social ties.
• Why Marijuana Should Be Legalized? The government should save that money it uses in prohibiting the use of marijuana as it has no proved harm to the users.
• Arguments on Why Marijuana Should Be Illegalized The greater part of the population believes that the sustained use of this product is beneficial in numerous ways. Therefore, it is clear that the negative effects of the drug outdo the constructive ones.
• A Case for Legalizing Marijuana Marijuana is one of the drugs that the government policy targets and as it currently stands, the government uses a lot of resources in prosecuting and punishing marijuana consumers through the legal system.
• Federal Government Should Not Legalize the Use of Marijuana On the other hand the use of marijuana actually increased in the country. It is not only the DEA or the federal government that is reluctant in the legalization of marijuana.
• Issues with Marijuana Legalization in the United States This is the reason why the debate on the legalization of marijuana has been on the increase since the past 10 years.
• Does Legalizing Marijuana Help or Harm the United States? The latter measure is not merely being advocated by the proponents of marijuana use since the legalization of marijuana has been supported by NAACP not because it fully backs the smoking of marijuana.
• The Debates on the Legal Status of Marijuana This means that the use of marijuana encourages the consumption of other drugs such as alcohol and cigarettes. Additionally, the use of marijuana is associated with increase in crime and consumption of other illicit drugs.
• Argument About Legalizing Marijuana in America Therefore, if at all the government of the United States is to prohibit the use of marijuana in the country, it should be ready to cater for the high costs that come in hand with […]
• The Moral and Ethical Reasons Why Marijuana should be legal It is my humble opinion that the billions of dollars being spent on the war against marijuana should be diverted to more useful projects like feeding the less fortunate in the society.
• The Problem of Legalization of Marijuana and Hemp Many individuals tend to believe that the use of Marijuana is morally wrong as it alters the mental state of the user and leads to dangerous addictions and actions in the end.
• Minor and Major Arguments on Legalization of Marijuana Premises 1: If marijuana were to be legalized it would be impossible to regulate its’ sell to, and use by the minors. Making marijuana illegal is denying them a right to the use of this […]
• The Reasons Why Marijuana Should be Made Legal Among the reasons that support the legalization of marijuana include: the medical basis that marijuana has some benefits and that the state could gain revenue from the trade of marijuana as opposed to the costs […]
• Why Is Marijuana Legalized In Some States And Not Others? I consider the legalization of marijuana to be a positive step as its prohibition entails intrusion of personal freedom and just like any other substance it is only harmful when it is not taken in […]
• Marijuana Legalization and Crime Rates The possible outcome of this effort will be the safe consumption of the drug, easy monitoring, and creation of awareness to the public on the dangers of excessive use of the drug and lastly the […]
• The Effect of Legalization of marijuana in the Economy of California It has been predicted that if the government legalizes the drug, there will be a lot of changes pertaining to the demand for the drug in the market and as a result, there will be […]
• Marijuana Must Not Be Legalized According to the national institute of drug abuse, the active chemical in marijuana, tetrahydrocannabinol, act on the region of the brain responsible for time awareness, sensory, attention, thoughts, memory and pleasure.
• Policy Brief: Why Marijuana Use Should Be Legalized in the Us In this perspective, it is valid to argue that marijuana users may be undergoing long incarcerations in US jails due to the misconceived fantasies that took root in the public mind in the 1930’s, and […]
• Analyzing Arguments Against Marijuana Legalization
• America Requirements Medicinal Weed: Marijuana Legalization
• Arguing for Medical Marijuana Legalization
• Benefits Associated With Marijuana Legalization
• Analysis of Marijuana Legalization in Canada
• The Relationships Between Marijuana Legalization and the DEA
• Governmental Regulation of the Marijuana Legalization
• Exploring the Pros and Cons of Marijuana Legalization
• Defining the First Steps Toward Marijuana Legalization
• Going Green: Analyzing Marijuana Legalization
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• Debate on Whether It’s Time for Marijuana Legalization
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• Link Between Marijuana Legalization and National Debt
• The Relationships Between Marijuana Legalization and Taxation
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Guest Essay

Legal Weed Is Coming. It’s Time to Come Up With Some Rules.

By Maia Szalavitz

Ms. Szalavitz is a contributing Opinion writer who covers addiction and public policy.

The beginning of the end of illegal weed is here.

On May 16 the Justice Department formally moved to reclassify marijuana from Schedule I of the Controlled Substances Act to Schedule III. This move will not affect the legality of recreational use and sales on the federal level. It is, however, the biggest step yet toward abolishing the legal fiction that cannabis is as dangerous as heroin. And it puts marijuana — used more than any other illicit drug in the world — on a pathway for fully legal recreational use, which a majority of Americans support .

Nothing short of full legalization will end the injustice that leads to hundreds of thousands of arrests annually for marijuana offenses and leaves millions of people of color disproportionately scarred by criminalization.

But the recent move will ease research, permit sellers in states that have legalized to deduct business expenses on their federal taxes and allow the Food and Drug Administration to regulate medical marijuana if it chooses to do so. It also offers an opportunity to start ironing out the details of what federal cannabis oversight ought to look like if the time comes — both to redress past harms and protect public health. Effective regulation requires balancing opposing risks to reduce the harm we’ve seen caused by dangerous black-market products while preventing misleading marketing from promoting excessive use.

Learning from the experiences of states that have legalized marijuana is essential. For one, they have not seen the much-feared explosion of youth use. An April 2024 study in JAMA Psychiatry analyzed survey data from 1993 to 2021 and found that teen cannabis use was no more common in the 24 states that legalized adult recreational use than elsewhere. According to a systematic review published in 2022, 10 earlier studies found increases in adolescent use, but 10 others showed no effect, and two showed reductions.

Other drug use didn’t increase, either. Use of the deadliest drugs — opioids — dropped significantly among youth as marijuana legalization spread. Prescription opioid misuse by 12th graders fell from 9.5 percent in 2004 to 1 percent in 2023; heroin use declined similarly. Most states showed little change or even a decline in opioid misuse and overdoses after passage of recreational or medical marijuana laws. And legalized cannabis products have not been linked to fatal poisonings or injuries. (Deaths linked to lung injuries from vape pens seem to have been caused by illegal products and tended to be less common in legal states.)

Legalization isn’t without risks, of course. Some studies show that it increases stoned driving, with one linking a 16 percent rise in fatalities with recreational legalization. Others, however, find no effects or even a reduction , due perhaps to people using cannabis instead of alcohol. And some studies have associated marijuana with psychosis in some populations, but there has been no spike in psychotic disorders in legalized states, as evidenced by a recent study of medical records in 64 million Americans age 16 or older.

Bottom line: The most dire predictions about legalizing marijuana have not been borne out at the state level, which bodes well for federal legalization.

One serious issue that federal regulation is needed to resolve is the persistence of the black market. Historically, West Coast states have supplied most of the domestically grown cannabis in the United States. Since federal law bars interstate sales, Western markets are oversupplied with cannabis, keeping prices low. This makes it difficult for growers to profit without diverting some cannabis to the illegal market. Individual state licensing policies have also inadvertently protected black markets: New York, for example, is now flooded with illegal weed stores because it was slow in licensing legal ones.

Experience with regulation of other substances could guide the creation of federal marijuana policy. One key finding from alcohol and tobacco research is that price matters . Taxes that elevate prices reduce youth use and lower consumption by those who have substance use disorders, in part because the heaviest users pay the most. But to be effective, taxes on marijuana must target potency and not just quantity — and may have to be adjusted regularly to deal with introductions of products with varied strengths. Regulators need to find sweet spots where prices are low enough to minimize illicit sales but high enough to discourage overconsumption.

Federal oversight also matters in managing the relative risks associated with psychoactive substances. Marijuana is generally less harmful than alcohol, tobacco and opioids — and if consumers are incentivized through pricing and regulation, some can be nudged into picking the less dangerous high. But when relative risks are ignored, disaster can strike: Cutting the supply of medical opioids pushed many people who were misusing them onto far more dangerous street drugs, and overdose death rates more than doubled.

The government can further curb risky behavior by putting controls on advertising. The opioid crisis has shown that current restrictions on pharmaceutical promotion are too lax. Alcohol and tobacco products are also too freely marketed. It would make little sense to hold marijuana alone to a higher standard, given that these other products can do more harm than cannabis does. Instead, marketing for all these substances should be far more restricted, if not banned entirely.

Regulators should also pay particularly close attention to potent new cannabis products, which some states allow without much oversight. Stronger products are more likely to be addictive and therefore pose a greater hazard to health. Protecting consumers requires finding a way to regulate these substances that isn’t as arduous and expensive as F.D.A. approval for pharmaceuticals but controls quality and minimizes harmful exposures.

On May 1 the Senate majority leader, Chuck Schumer, reintroduced a bill that would end federal criminalization of the drug, expunge certain marijuana-related offenses and create a framework for regulating recreational-use products.

Though the bill is unlikely to pass Congress this term, the current clash between federal and state policies is not sustainable — all while public support for change remains strong. To move forward, we must find a middle ground between inundating children with marijuana advertisements and incarcerating people for smoking or selling weed. The Biden administration has taken only the first step.

Maia Szalavitz (@maiasz) is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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• Copy URL https://www.pbs.org/newshour/health/daily-marijuana-use-is-now-more-common-than-daily-alcohol-use-in-the-u-s-new-study-finds

Daily marijuana use is now more common than daily alcohol use in the U.S., new study finds

Daily and near-daily marijuana use is now more common than similar levels of drinking in the U.S., according to an analysis of national survey data over four decades.

Alcohol is still more widely used, but 2022 was the first time this intensive level of marijuana use overtook high-frequency drinking, said the study’s author, Jonathan Caulkins, a cannabis policy researcher at Carnegie Mellon University.

READ MORE: What is cannabinoid hyperemesis syndrome? Here’s what to know, and why experts say it’s on the rise

“A good 40 percent of current cannabis users are using it daily or near daily, a pattern that is more associated with tobacco use than typical alcohol use,” Caulkins said.

The research, based on data from the National Survey on Drug Use and Health, was published Wednesday in the journal Addiction. The survey is a highly regarded source of estimates of tobacco, alcohol and drug use in the United States.

Graphic by Megan McGrew/PBS NewsHour

In 2022, an estimated 17.7 million people used marijuana daily or near-daily compared to 14.7 million daily or near-daily drinkers, according to the study. From 1992 to 2022, the per capita rate of reporting daily or near-daily marijuana use increased 15-fold.

The trend reflects changes in public policy. Most states now allow medical or recreational marijuana, though it remains illegal at the federal level. In November, Florida voters will decide on a constitutional amendment allowing recreational cannabis, and the federal government is moving to reclassify marijuana as a less dangerous drug.

Research shows that high-frequency users are more likely to become addicted to marijuana, said Dr. David A. Gorelick, a psychiatry professor at the University of Maryland School of Medicine, who was not involved in the study.

The number of daily users suggests that more people are at risk for developing problematic cannabis use or addiction, Gorelick said.

“High frequency use also increases the risk of developing cannabis-associated psychosis,” a severe condition where a person loses touch with reality, he said.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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White house's drug czar on the benefits of shifting marijuana to a schedule 3 drug.

Dr. Rahul Gupta, director of the Office of National Drug Control Policy, talks about the changes in marijuana science over the past half-century.

The Department of Justice recently announced that the next step for rescheduling marijuana has taken place.

Marijuana has historically been classified as a Schedule 1 drug — those with no medical use and a high potential for abuse.

The Biden administration is working to move marijuana to a Schedule 3 drug, those that have a medical use and moderate to low potential for abuse.

WGCU's Cary Barbor spoke to Dr. Rahul Gupta, director of the Office of National Drug Control Policy, to get more detail on this change.

“Schedule 1, where marijuana currently resides, is one that is defined by having no medical benefit and high risk for addiction. It is in the company of drugs like heroin, LSD and ecstasy,” said Dr. Gupta.

“It's been quite a bit of science that has developed over the last few years, certainly since more than a half-century ago when those placements happened, that show us that this may not be where it belongs. So the move to Schedule 3, where there are recognizable medical benefits to a substance, is one that is a recommendation based on science and evidence.

"It does make sense to make sure that we're pursuing science and evidence when it comes to medications and use those medications for Americans with chronic illnesses, chronic pain, diseases like cancer. It also allows us to expand on the research and development both for users as well as for new drugs potential in the future for other ailments. And then finally, too many lives have been upended because of our failed approach to marijuana over the past more than a half-century. And that's why, back in 2022, President Biden had requested that Department of Justice and Health and Human Services services conduct this review.”

Dr. Gupta went on to explain that Biden has pardoned some people who were in prison on federal marijuana-related charges. A pardon for state charges locally would only be possible if Florida changes its laws.

If marijuana is moved from Schedule 1 to Schedule 3, it can be prescribed by a licensed provider.

“Any drug that is between Schedule 2 and Schedule 5 can be prescribed when appropriate by a licensed provider who has a (Drug Enforcement Administration) registration, like I do. For a full Schedule 1, there is no approved medical use. So this change would allow providers, clinicians across the country to be able to prescribe marijuana as a schedule 3 drug,” said Dr. Gupta.

Gupta goes on to say that research has shown that there are proper medical uses of marijuana.

“One of the things that we have to focus is the science. But today, the science takes us in a direction that there are some medical uses of marijuana. We must allow Americans to take advantage of that, for example, those who are suffering from chronic pain, other chronic illnesses, cancer, this may be something of a better option for them,” he said.

“At the same time, we must understand that for children whose brains are still developing, up to the age of 22 to 25, it's important that any illicit substance, whether it be marijuana or others, not interfere in the development of the brain. So prevention for young people of any drugs is still important and key.

"But at the same time, allowing us to be able to have appropriate science-based categorization of drugs that can help Americans is important. Of course, the increasing concentrations of THC and others are something that concerns all of us. And one way to address that is by having it as Schedule 3.”

Categorizing marijuana as a Schedule 3 drug, he says, will allow for more research.

A 60-day public comment period will begin soon, after which the Department of Justice will make a final scheduling determination.

Copyright 2024 WGCU

Teens who use marijuana are more likely to suffer psychotic disorders, study finds

Teenagers who used cannabis within the last year had a dramatically higher rate of developing a psychotic disorder, according to a study published Wednesday. 

The study, led by researchers from the University of Toronto, found an 11 times higher risk of developing a psychotic disorder among teenagers who used cannabis compared with those who did not. When the analysis was limited to just emergency room visits and hospitalizations, there was a 27-fold increase in psychotic disorders in teenagers who had used the drug. 

“When I see youths with psychotic symptoms, they’re almost always using lots of cannabis,” said Dr. Leslie Hulvershorn, a child psychiatrist and chair of the psychiatry department at Indiana University who was not involved with the study. “It would be unusual to see someone present with psychotic symptoms to a hospital and not have smoked cannabis.”

The paper adds to the growing body of research that links cannabis to an increased risk of psychotic disorders, particularly in adolescence. Use of marijuana, particularly higher-potency products, has been linked to a variety of mental health disorders, including schizophrenia, anxiety and depression .

“I think that there’s enough evidence out there for us to give recommendations that teens probably shouldn’t be using cannabis,” said the study’s lead author, Andre McDonald, a postdoctoral research fellow at McMaster University in Hamilton, Ontario. “If we can somehow ask teens to delay their use until their brain has developed a little further, I think that would be good for public health.”

While most teenagers who use cannabis will not develop psychotic disorders, McDonald said, the findings are concerning given how debilitating these conditions can be. 

The new study, like previous research on marijuana and psychosis, does not directly prove that marijuana is causing psychotic disorders. While it’s possible that teens who were prone to develop psychotic disorders could have also been more likely to use cannabis, it’s unlikely because of how striking the association was, Hulvershorn said. 

“The magnitude of the effect here is just hard to believe that it’s not related to cannabis,” Hulvershorn said. 

There was no association between cannabis use and psychotic disorders in people ages 20 to 33. 

“There’s something about that stage of brain development that we haven’t yet fully characterized — where there’s a window of time where cannabis use may increase the risk of psychosis,” said Dr. Kevin Gray, a professor of psychiatry and director of addiction sciences at the Medical University of South Carolina who was not involved with the study. “This study really puts a fine point on delaying cannabis use until your 20s may mitigate one of the most potentially serious risks.”

The Biden administration has been moving toward rescheduling marijuana from Schedule I to the less dangerous Schedule III, which would also acknowledge its medical benefits at the federal level. While the potential change is expected later this year, cannabis is currently legal in 24 states for recreational use.

Marijuana use among high school students has remained steady in recent years. Nearly 1 in 3 12th graders reported using it in the previous year, according to the 2023 Monitoring the Future Survey, an annual survey that measures drug and alcohol use among adolescent students nationwide. 

The new research, published in the respected journal Psychological Medicine, includes data from over 11,000 teens and young adults who were ages 12 to 24 at the beginning of the study.

The authors pulled from the annual Canadian Community Health Survey, focusing on 2009 to 2012. Participants were then followed for up to nine years after the initial survey to track any visits they may have had to doctors or emergency rooms or any times they were admitted to hospitals.. 

Of the teens who were hospitalized or visited emergency rooms for psychotic disorders, roughly 5 in 6 had reported previous cannabis use.

“We see this replicated over and over again that there’s this developmental window of adolescence that’s very high-risk,” Gray said. 

It’s not completely clear why, he added, but one theory is that disruptions to the endocannabinoid system in adolescence may make psychotic symptoms more likely. The endocannabinoid system is a complex signaling system in the brain that marijuana targets. That could make it harder to distinguish reality from what is going on inside the head, leading to symptoms such as hallucinations. 

The authors did not specifically look at how the potency of marijuana products affected the risk of mental disorders, although previous research has found an increased risk .

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

Letitia James

Attorney general james secures $15.2 million judgment against unlicensed cannabis store owner in upstate new york, “i’m stuck” dispensary chain owner david tulley fined $15.2 million for selling cannabis without a license and ignoring notices to stop operating, may 23, 2024.

NEW YORK – New York Attorney General Letitia James today secured a $15.2 million judgment in disgorgement and penalties against the owner of seven unlicensed cannabis dispensaries in Cayuga, Oswego, and Wayne counties for operating these stores without a license and for illegally selling cannabis to underage customers. David Tulley, the owner of the unlicensed dispensary chain called “I’m Stuck” and “Weed Warehouse,” ignored repeated notices and orders from the Office of Cannabis Management (OCM) to stop operating. Attorney General James, Governor Hochul, and OCM shut down Tulley’s unlicensed cannabis stores in July and secured eviction notices from the landlords where Tulley’s stores were located. The judgment secured today requires Tulley to pay $7 million in disgorgement, the illegal profits he got from selling cannabis without a license, and $8.2 million in penalties for operating without a license and ignoring OCM notices.

“David Tulley illegally sold cannabis in multiple stores across upstate and central New York and sold unregulated products to underage customers,” said Attorney General James . “These illegal and unlicensed stores are budding up throughout the state and are hurting our communities. Today, David Tulley is paying the $15 million price for his repeated illegal activity. This punishment should serve as a clear warning for all unlicensed cannabis stores in the state: we will enforce the law and shut down your operations.”

New York’s Cannabis Law requires any person who cultivates, processes, or sells any cannabis product to be registered and licensed by the New York State Cannabis Control Board (Cannabis Board).

The law imposes a $10,000 penalty for each day in which an individual sells cannabis without a license, and a $20,000 penalty for each day an individual continues to sell cannabis after receiving an order to cease operating from OCM. Tulley was fined $10,000 per day for selling cannabis without a license, totaling $3.89 million. He was also fined $20,000 per day for continuing to sell cannabis after receiving an order to cease from OCM, totaling $4.34 million. Tulley was ordered to pay $7.01 million in disgorgement for the illegal profits he made from the seven unlicensed cannabis stores. In total, Tulley is required to pay $15.2 million in disgorgement and penalties.

David Tulley operated retail cannabis stores in Cayuga, Oswego, and Wayne counties and was selling cannabis without a license since at least early 2022, before OCM began issuing licenses. Tulley’s stores that were fined were located at:

• 18-20 Canal Street, Lyons, NY
• 2020 Crane Brook, Auburn, NY
• 1944 State Route 104, Ontario, NY
• 4081 Ridge Road, Williamson, NY
• 9 East Genesee Street, Auburn, NY
• 1146 Route 31, Macedon, NY
• 4865 Jefferson Street, Pulaski, NY

Undercover investigators from the Office of the Attorney General (OAG) visited multiple “I’m Stuck” locations owned by Tulley and were able to purchase cannabis products. During the undercover operations, OAG investigators observed that multiple “I’m Stuck” stores sold cannabis to individuals under the age of 21.

Cannabis products sold by unlicensed businesses are not lab tested by OCM facilities, can be unsafe, and are not taxed. The OAG is authorized upon request by OCM to bring a proceeding against any person who violates the Cannabis Law.

Attorney General James thanks OCM for their collaboration.

In December, Attorney General James, Governor Hochul, and OCM shut down a cannabis store in Bay Ridge, Brooklyn, Big Chief Smoke Shop , for operating without a license. In November, Attorney General James, OCM, and DTF shut down an unlicensed cannabis store in Ontario County.

This matter was handled by Assistant Attorneys General Benjamin Bruce, Christopher Boyd, Kurtis Falcone, Judith Malkin, George Forbes, and Amaris Elliott-Engel of the Division of Regional Affairs with support from Investigators Andrea Buttenschon, Andrea Hughes, Jeffrey Jasewicz, Jennifer Terranova, Michelle Ortiz, and Jessica Holland and data analytics was handled by Senior Consumer Frauds Representative Emily Brightman. The Division of Regional Affairs is led by Deputy Attorney General Jill Faber and overseen by First Deputy Attorney General Jennifer Levy.

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