research paper on marijuana in india

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Should india make cannabis legal, given its widespread use and the ancient and well-established culture of marijuana consumption in this country, it's time for a conversation on decriminalising the drug..

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Indeed, cannabis consumption is common across the country and does not attract the kind of stigma attached to other narcotic drugs and psychotropic substances being consumed illegally in India. In a 2019 study commissioned by the social justice and empowerment ministry, 31 million people in India were reported to have consumed a cannabis product in the past year, of which 13 million had used weed and hash. Cannabis consumption was higher in Uttar Pradesh, Punjab, Sikkim, Chhattisgarh and Delhi than the national average. Based on the annual figures held by the United Nations Office on Drugs and Crime (UNoDC), a 2018 study by German data firm ABCD placed Delhi third on the list of 120 cities with the highest consumption of cannabis, ahead of Los Angeles, Chicago and London. Mumbai was sixth.

Indian Journal of Law and Legal Research ISSN: 2582-8878 | PIF: 6.605 Indexed at Manupatra, Google Scholar, HeinOnline & ROAD

Indian Journal of Law and Legal Research

• Apr 27, 2023

The Legalisation Of Marijuana In India: A Boon Or A Bane?

Sai Srivatsav S , School of Law, Christ University, Bengaluru

Since before recorded history, when the presence of humans were first appeared, marijuana was being used and it’s use was closely related to the past of the first known advances. In India, it is associated with rigid traditions and practises that date back to the heyday of gods and goddesses. After the Narcotic Drugs and Psychotropic Substances Act of 1985 was implemented, making the sale and possession of marijuana illegal throughout India, the notion that cannabis should be sanctioned has continuously been a simple one to disprove despite its use in the clinical field, no concrete steps have been taken forward. Following the US presidential elections in 2020, marijuana use for recreational purposes was approved in two US states, a wave of liberal ideas was erupted across the country. This research paper aims to do a thorough examination with regards to the use of cannabis followed by a comparative analysis with the rest of the globe to determine whether India should legalise marijuana. The purpose of this research paper is to introduce the topic of legalising marijuana in India, including its background, benefits and drawbacks on both an individual and in terms of societal level, the country's current legal status, the factors that led to the drug's legalisation and commercialization, and any conclusions that can be drawn from the topic as a whole.

Keywords : Cannabis, commercialisation, NDPS Act, bhang, charas, legalisation, India.

• Volume V Issue II

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Abbreviation : IJLLR

ISSN: 2582-8878

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JOURNAL FOR LAW STUDENTS AND RESEARCHERS

ISSN[0] : 2582-306X

LEGALIZATION OF CANNABIS IN INDIA by Shivangini Shrivastava

Author:  Shivangini Shrivastava, Student at Renaissance Law College, Indore (M.P.).

The main objective of the research paper is about to study and analyze the legalization of cannabis in India. Cannabis also had a pre historic value mentioned in Ayurveda as a ingredient for  pain relieve  and erotic, but in small quantities and it holds great religious connect with people this era. This research deals with benefits that government will derive after legalizing cannabis as it would significantly increase revenue, would also decrease unemployment in India. It also explains the medicinal usage of cannabis. We have also discussed that before1985 use of cannabis is legal in India. But it was banned by our late Prime Minister Rajiv Gandhi under the immense pressure of us. After the enactment of the narcotic drug and psychotropic substance act 1985, legalization of cannabis is always a questionable subject matter .and sale and possession of such drug has been illegalized all over India. This research paper covers the petition filed by non-profit research organization whose aim is to legalize the use of cannabis for industrial, medicinal, recreational purpose in India. But now as we know there are numerous benefits of cannabis which can help in field of healthcare industry and it help for curing some serious diseases like cancer, aids, etc. But only legalizing would not help, a regulatory body should be established which shall keep a check on sale of cannabis and should also keep a record on use of cannabis that it is only being used the above said purpose, not for any other purpose.

Keywords: Cannabis, Legalization, Medicinal Purpose, Recreational, Drugs, Substances.

INTRODUCTION

Cannabis (marijuana) is a plant and its dried leaves, seed oil and other parts of this cannabis plant are used for recreational and medicinal drugs. The legality of the use of this cannabis plant varies amongst the state laws. The people who are using cannabis based products should be check first whether it is legal or not in their states.

The narcotics drugs and psychotropic substances act, 1985 defines the laws of India on cannabis & its by-products. The cultivation, the sale, possession and transportation of cannabis is prohibited under this ndps act 1985 law in certain forms in India .in ndps act 1985 has also defines that in what form the cannabis are sold and there is a defines given under section 2 (3) of the ndps act 1985 .

The cannabis is not prohibited in all over India because according to our ancient Indian history there is some description in the Vedas that the plant named cannabis leaves and its  others parts were used for medicinal purpose and   the mention of cannabis also referred in Ayurveda as a ingredient for  pain relieve  and erotic, but in small quantities. And it is also said that the Hindu god Shiva have chosen the cannabis as his favorite food. Bhang is a traditional Indian cannabis fill drink. Primarily link with the worship of the god lord Shiva and now bhang is widely used as the official drink in the festival of Holi and its celebration. It is also believed that  the lord Shiva is always be in the deep meditation and  to stay  in the state  of complete bliss and concentrated   he consumes bhang .

In India before 1985 the buying and selling and cultivation of the cannabis is legal but under the enormous of America of banning the cannabis the Rajiv Gandhi leading government had passed the act in 1985 called the narcotic drugs and psychotropic substances act and under this law the government had banned Charas, hashish, ganja, and any combination with or without any natural mixture. Under this law, all the state governments got the power to grant permission, authority, and modulate the cultivation of cannabis plants along with production, manufacture, possession, transport, import and export of the plant and its by-products between states only the state government and its authorized personnel have permission to cultivate the plant.

HISTORY OF CANNABIS IN INDIA

Cannabis is now banned in India but cannabis has a very long ancient history of using it in India, rooted in legends and religions .in our sacred Hindu texts or in Vedas there is a mention of the cannabis and the compilation of these writings are date from 2000 to 1400 BC.

There is mentioned in our Vedas that the cannabis plant was one of the five scared plant and its leaves contained the savior particles in it. In the Vedas, cannabis has been described as a joyous, joy-giving, savior, which was mercifully given to humans to, helps us attain happiness and lose fear & it relieves anxiety.

The god, lord Shiva is always linked to cannabis by the Indian peoples and which is called bhang in India. According to the myth, the lord Shiva wandered into the fields after an angry discourse with his family, troubled by the family conflicts and strong rays of sunlight; he slept under a leafy plant. When he woke up, his curiosity prompted him to sample the leaves of the plant. Immediately after the rejuvenation, the lord Shiva declared the plant as his favorite food and after that he known as the god of bhang. [1]

Cannabis which was legal in India till 1985, but it was banned by our late Prime Minister Rajiv Gandhi under the immense pressure of America; the United States forced to ban narcotics (including cannabis) in India which we also call as ganja. Now the question arises- why America forced India?  The reason in the back of the ban was to control the involvement of the assembled crime in cultivation, distribution, and uses of drugs and there is also another reason in back of the ban was the possible industrial application of the plant. Under article 28 of the single convention on narcotics drug, 1961, America started a campaign in 1960s to foist the ban on cannabis, at the United Nations. And the signatory states mentioned the cannabis in the list of highly regulated substances. And during this convention the decisions made that only those personnel can cultivate and trade the cannabis in their country after obtaining the license for it. [2]

America pressurized India because in 1961 treaty between nations to ban narcotics which includes cannabis. India was not the signatory member of it. And at that period of time Rajiv Gandhi government was on lead and under the pressure of United States they had passed the narcotic drugs and psychotropic substances act in 1985.

Under the law, the state government got the power to permit, control, and regulates the cultivation of cannabis plants along with production, manufacture, possession, transport, inter-state import and export of the plant and its derivatives. Only the state government and its permitted personnel have the licensed permission to cultivate the plant. [3]

CANNABIS (MARIJUANA)

Cannabis is a type of plant and it contains the chemical compound the (delta-9 tetrahydrocannabinol), which is responsible for psychoactive effects of cannabis that leads to the “high” that is experienced when cannabis is consumed. But, not all the components of cannabis are psychoactive. [4]

The flower and dry leaves of the cannabis plant are known as marijuana, which can be smoked (by pipe or, small paper hand rolled, or consumed in an edible (like-, cookies, brownies, etc). The resinous excretions of the plant are known as hashish, which can be smoked or eaten. The fiber of the cannabis plant is cultivated as industrial hemp which is used in textile manufacturing. The compounds which have a structure similar to THC are known as cannabinoids. [5]

Mainly cannabis has two categories – indica, and sativa, cannabis indica – it effects in whole body such as it gives deep relaxation and also reduces the insomnia .cannabis sativa – the consumption of the sativa leads high, and helps to reduce anxiety or stress by giving some energizing effects. [6]

Advantages of cannabis

Certain benefits of marijuana cannot be misled:

• Medicinal purpose – according to various studies there are numerous benefits of cannabis such as it prevents the spread of cancer in various parts of the body. It also treats glaucoma, reduces anxiety and boosts metabolism and is well known to regenerate innovation in our brain. Smoking cannabis also provides relief to the patients from serious diseases, but it also helps to avoid certain disease if it is consumed with proper caution. . Some of the benefits of consuming cannabis include medicinal breakthroughs.
• Less Harmful Than Alcohol – when compared with alcohol, marijuana is less harmful, as it does not drive the person aggressive, reckless or uncontrollable like alcohol. Addiction of cannabis is uncommon, contrary to common stereotypes, but only few people are seen as an addicted to the same. [7]

Disadvantage of cannabis

Cannabis once consumed has physiological and psychoactive effects. Apart from this, alteration in vision is caused and, most importantly fluctuations in mood, some common symptoms are increased heart rate, increased appetite, lowered blood pressure, weakness and lack of coordination between mind and body. These were some short term effects of consuming cannabis. Long term effects are the use of chronic cannabis documents comparatively few adverse clinical health effects.

• Unsteadiness and Migraines – people experience short term unsteadiness and sometimes chronic headache are consequences of using cannabis. Consumption of this drug can also be deadly because many people opt to drive under the influence of cannabis. Sometimes a person loses his control and can result in a major accident
• Respiratory issues – the active element in cannabis is a carcinogen that damages the respiratory system. When a person smokes a pot he exposes his lungs to huge quantity of smoke that is rich in carcinogens. Frequent use of this drug can lead to cancer and various life endangering situations while casual users may experience cough and other breathing issue.
• Creating dependency – While many people consider this drug as harmless that is only when it is consume casually , but medical evidences represents that frequent use of marijuana will lead the individual into a state where became a drug addict . People who seek to quit use of cannabis at a later stage will experience immigrate symptoms of withdrawal including eating disorders, emotional outbursts, anxiety and depression. [8]

LEGALIZATION OF BHANG

Bhang is not covered by the definition of cannabis (hemp) as described in section 2(3) of the ndps act, 1985. The act only prohibits the usage of certain sections and cannabis plant preparations, including hash resin produced from the plant, or its buds. The act provides for the usage of leaves of the plant, is the precise component that is used while making of bhang.

Since the social and cultural utilization of the cannabis (or marijuana, or weed, or hemp) in India, that is why the Indian delegation opposed British India to criminalization of the cannabis under the single convention of narcotics drugs, 1961. And after that in the definition of cannabis it was included that “ flowering or fruiting tops (excluding seeds and leaves when not accompanied by tops) from which resin is not extracted ”. This permitted India to continue the consumption of bhang in a large scale and after exemption period of 25 years same definition of cannabis was adopted and the ndps act was passed by India. [9]

States have the power to make laws on cannabis and give permission to use seeds and leaves which is popularly used to make  bhang in India. For example the states named UP and Rajasthan has the government licensed shop to sell the bhang in their state. Thandai, a milkshake made with bhang is especially popular in UP. On the festival of Holi and use of bhang is also well known in festivals such as Mahashivratri. Among Sikh Nihangs, bhang is popular, especially during hula Mohalla. According to Sufis of India the spirit of Khidr was placed within the plant of cannabis and they consume bhang. Hence under the ndps act the bhang is legal because of definition of cannabis according to this act., however legality of bhang varies from state to state as per there state laws . In 2018, under state laws the commercial cultivation of hemp is permitted in Uttarakhand. The cannabis sativa plant is especially cultivated for the commercial and industrial use of for its bio-products. [10]

Under section 3 of the “Assam ganja and bhang prohibition act, 1958” this act forbids the retail, purchase, possession and eat up ganja or bhang in Assam.

In the state of Maharashtra, without a license manufacturing ,possession , consumption of bhang or any bhang containing substance are prohibited under section 66(1) (b) of “ the Bombay prohibition act ,1949” [11]

In the case of ,     Arjun Singh v. State of Haryana , -the Chandigarh high court affirmed that, according to the ndps act, bhang is not “cannabis (hemp)” under the statute, but is a “cannabis plant.” Thus, it is not illegal to use or consume leaves of the cannabis plant under the rule. [12]

“THE GREAT LEGALIZATION MOVEMENT

The Great Legalization Movement (GLM) is a non – profit research organization whose main objective is to legalize the use of the cannabis (or marijuana) for industrial and medicinal purpose in India.

• For the protection of the environment of India and of all its bionomics.
• To bring back an ancient medicinal purpose and to invent the current healthcare approach.
• To re-establish a national biological product modification and to redevelop the toxic industrial framework.
• To eliminate human suffering , poverty ,unemployment and diseases,
• To entitle and develop a new agricultural setup for farmers.
• To safeguard fundamental rights of peoples and prospect their responsiveness means of natural plants.
• To create ecological and biological technologies for a safer future. [13]

As other countries legalize the recreational use of cannabis similarly there has been a booming clamorous by non-governmental organization in India .for the same. The government nonprofit organization filed the petition in Delhi high court on 7 November .2019 to legalize the recreational use of cannabis in India. The great legalization movement trust wants to remove the cannabis from the ndps act. The organization believes that the legalization of cannabis can help to fight from stress, improvise the concentration power of human, resolve medicinal issues and provide sustainable agricultural income, among other. [14]

BENEFITS OF LEGALIZATION OF CANNABIS IN INDIA

GOVERNMENT REVENUE

If country like India legalizes the cannabis then our government of India can earn a lot of revenue from cannabis by imposing taxes on sale duties on the marketing of cannabis.

In India there are a lot people who consume cannabis for recreational purpose and most of them are youngsters and which is hard to stop.  There are mafia’s who were doing black marketing of cannabis and they have a huge business of it and they generate a lot of money from it.  These mafias were surviving in India because there are a lot of people who wishfully buy the cannabis and also ready to pay the money whatever are demanded by the mafias. If cannabis is legalize in India then the Indian government can imposes taxes on sales of it and if India legalize the cannabis then there would be cannabis producing industries and the workmen would be needed in industry and so many unemployed peoples gets jobs , ultimately it would enlarge the employment . The revenue generated by legalizing the cannabis can be used for the education for those children whose parents are not capable to give education because of the bad financial condition.  .

REDUCTION IN CRIME RATES

As we know that day by day crime rate is increasing in India and by legalizing the cannabis the crime rate of illegal trade will decreased in India and when the cannabis is legalize there would be no black marketing, no illegal trade , no illegal production and distribution.

This would be helpful because then there will be strict rules and regulations for the possession, production or trade of cannabis and it will be managed by the governments, merchants and retailers and not by the drug peddlers. Cannabis is easily available in India before the narcotic drug and psychotropic substance act, 1985 and also after the enactment of this act. As there exists a huge supply chain of black market for cannabis from cultivation to harvesting to transportation and this distribution to the final consumer .by this illegal activity drug peddlers are making a lot of money. And if we will not legalize it, we would simply end up giving money in the wrong hands rather than this money can be used by government for public welfare.

It is time to end war on drugs and social ailments that comes with it: crimes, health issues, homelessness and premature death. [15]

MEDICINAL USE OF CANNABIS

According to various studies there are numerous medicinal benefits of cannabis such as it prevents the spread of cancer in various parts of the body. It also treats glaucoma, reduces anxiety and boosts metabolism and is well known to regenerate innovation in our brain. Smoking cannabis also provides relief to the patients from serious diseases, but it also helps to avoid certain disease if it is consumed with proper caution. . Some of the benefits of consuming cannabis include medicinal breakthroughs.

Whereas, the use of cannabis is still considered as illegal in India .and medicinal use of cannabis is still illegal in various countries but there are several medicinal advantages of medical cannabis .this is the right time for India to think about the legalizing the cannabis for medicinal purpose and can help those patients who really wants therapy by the treatment of cannabis. [16]

LEGAL ASPECTS

The Narcotic Drugs and Psychotropic Substance Act, 1985, under section 2(3) of the NDPS act, defines the meaning of the cannabis

(a) Charas:  it is the separated adhesive, which can either be in unrefined or authentic form which is procured from the cannabis plant. This also comprises the strenuous composition and adhesive known as hashish lubricant or fluid hash.

(b) Ganja:  it is the flower or fruit peak part of the cannabis plant (which does not includes the seeds and leaves which is not go along with the tops)

(c) Any mixture  with or without any impartial substance, and of the above forms of cannabis or any liquid refreshment prepared there from. [17]

Section 2(4) of the ndps act defines that – cannabis plant means any plant of the genus cannabis;

The NDPS act forbids the selling & making of cannabis resin and flowers. However, it does not forbid the usage of the seeds and leaves of the cannabis plant. [18]

Under section 10 of the NDPS act permits the states to allow and to control the cultivation of any cannabis plant, production, manufacture, possession, transport, import and export inter-state, sale, consumption or use of cannabis (excluding Charas). [19]

Under section 14 of the NDPS act, this section had a special provision for cannabis, where the government may permit the cultivation of a cannabis plant “for industrial purposes only of obtaining fiber or seed or for horticultural purposes.” [20]

PUNISHMENT FOR CANNABIS POSSESSION

According to ndps act, if any person is caught in possession of drugs (cannabis) which are banned will constitute an offence. The amount of sentence will relay upon the number of drugs which are in trafficking if a drug addict or a person who is caught with drugs willingly wants to undergo rehabilitation therapy the person will not be subjected to charges.

The punishment for offence related not only to consumption but also related to farming purchasing transporting interstate importing ,inter states exporting except for medicinal or scientific purpose , is given under section 20 of the narcotics drugs and psychotropic substances act 1985. The punishment for the above said is as follows-

For Small Quantity , Rigorous confinement for a term, that may extend to six months or a fine that may extend to Rupees.10, 000 or both.

For Larger Than Small Quantity But Lesser Than Commercial Quantity – rigorous confinement may extends to ten years with a fine that may extends to Rupees, 100000 ,

For Commercial Quantity , rigorous confinement will not be less than 10 years, but may extend to 20 years and a fine of not less than rs100000. (Which can be extended to 200000),

As for juveniles; under the ndps act juveniles below 18 years cannot be prosecuted, there is a separate law for juveniles under section 18 of the juvenile justice act [21]

Under section 29 punishments for abetment and criminal conspiracy –

 (1) whoever abets, or is a party to a criminal conspiracy to commit an offence punishable under this chapter, shall, whether such offence be or be not committed in consequence of such abetment or in pursuance of such criminal conspiracy, and notwithstanding anything contained in section 116 of the Indian penal code (45 of 1860), be punishable with the punishment provided for the offence.

(2) A person abets, or is a party to a criminal conspiracy to commit, an offence, within the meaning of this section, which, in India abets or is a party to the criminal conspiracy to the commission of any act in a place without and beyond India which; (a) Would constitute an offence if committed within India; or, (b) Under the laws of such place, is an offence relating to narcotic drugs or psychotropic substances having all the legal conditions required to constitute it such an offence the same as or analogous to the legal conditions required to constitute it an offence punishable under this chapter, if committed within India. [22]

The above mention section states that if any person abets the other person to do an act which is in contravention to law. For example if anybody attempts to abet the person for sale of cannabis or enter into a conspiracy with relation to cannabis would be punishable under the NDPS act 1985.

In the case of Hira Singh v. union of india , a three judges bench of the supreme court held that, “in case of seizure of a drug or narcotic mixture with one or more neutral substances, the weight of the neutral material must be taken into consideration with the weight of offending drug”, while determining that it is in “small quantity” or in “commercial quantity” and overruled the judgment of the two judges bench in E. Michael Raj v. Intelligence officer, Narcotic Control bureau. , here the division bench considered that the quantity of neutral substances should not be taken into account when determine the mixture fell into small or commercial quantities . It took only the actual weight of the drug or substance as relevant.  [23]

JUDICIAL ASPECT

In the year 2015, Tathagata Satpathy Lok Sabha mp from odisha commented against the criminalization of marijuana. He has admitted in a social media that he had smoked cannabis or hashish in his young age with his friends and he is  neither regret it nor have any contrition about it . And he does not support the ban on marijuana. According to him cannabis should be legalize in India because it would be helpful for those people who were addicted to alcohol which is more harmful than marijuana. [24]

In the year 2017, Maneka Gandhi, the union women and child development minister, she suggested that cannabis should be legalized in India for medicinal purpose because it is a psychoactive drug. As other countries like us, the legalization will help in restrain the drug abuse. She also quoted that legalization of cannabis would in the treatment of cancer patients.  She suggested this at a meeting of group of ministers who had met to examine the national drug demand reduction policy. She added example of countries like America, Canada and Australia. [25]

In the year 2019, politics on the disruption of traditional drugs has become a trend again as Dharamvira Gandhi , the Patiala mp , has taken to his hells , adding that the regulated use of traditional drugs like opium and cannabis be approved legally. According to him, such a move could help people in Punjab and other parts of the country avoid addicts liked heroin, methamphetamine (ice), opium-based cough syrup and habit forming capsules and pills.

For Gandhi, a former medical officer in Punjab health department and in medicine, exemption in laws on opium and cannabis is the best answer to Punjab’s drug menace.  This is not the only issue raised by Gandhi, who, in his first term, proposed an amendment to the narcotic drugs and psychotropic substances (ndps) act to reduce the use and possession of two banned substances.  His personal bill has been cleared by the legislative branch of parliament, but it has not yet been introduced in the lower house. [26]

Gandhi during his tenure is building his election campaign for the development work done by him in Patiala and the Punjab rights over river water. Gandhi contested and won the 2014 Lok Sabha elections on an AAP ticket, but was later suspended by the party. In the area and neighborhoods of Patiala, he has raised the issue of undermining opium and marijuana. [27]

In year 2020, the UN commission has voted to remove the cannabis resin from the list of hazardous drug and India was the 27 country who voted in the favor of the legalizing the cannabis. And by doing so the Indian government signaled in favor of to legalize the recreational or medicinal purpose of cannabis, , now it should be followed through  with the amendment in the NDPS ACT that  considers the spirit of its vote of the un commission on narcotics drugs . The justification for legalization of cannabis goes far beyond the legitimacy of India’s international obligations. Aesthetically, cannabis has been a part of India’s religious and social fabric, which is used for medicinal and recreational purposes. A large number of people voluntarily accepted to use of cannabis products in government surveys should indicate both the prevalence and acceptability of the substance criminalizing the use of such a wide material as in whose mental and physical health has been proved to be far less injurious than legal stimulants such as alcohol and tobacco- only an overworked serves the burden to criminal justice system and in many cases gives undue power to police agencies such as narcotics control board. [28]

  CRITICAL ANALYSIS OF THE EFFECTS OF CANNABIS

The effects of cannabis drugs is too high, it badly affects whole body and mind of the consumer. Its consumption makes the consumer’s body used to it and it gives relief and relaxation to mind and body to those consumers who were addicted for it.

There are certain kinds of effects which affect the human body badly:

• Hallucination means when a person feels , hear, taste, sees, or smells thing which does not exists or which are imaginary , it happens when you have taken some kind of drugs .
• Increased heart rate means when a person feels stress or anxiety the heat beat of the person will be increased.
• Short-term memory issue is a problem faced when you are taking high dose medicines or drugs for a period of time for example- forgets the small amount of information for a particular period of time.
• Coordination problems means problems facing by people to coordinate their mind and body at the same time, or facing problems in talking clearly, or listen and framed it wrong.
• Addiction- the word addiction means addicted or habitual of something which you cannot control or stop using / consuming.
• Reduced it- the consumption of drug directly affect the sense organ of brain and it reduces the power nervous system, it makes brain incapable to send and receive the information of what is happening around the body.
• Loss of memory – it is one of the part of the long term effects which means consumption of drugs makes you in-capacious to remember the events for a certain period of time .
• Impaired thinking – it is also called as cognitive disorder a type of mental health , which affects brain and  because of the disorder  , created in brain  confusion , identity confusion, makes  poor coordination of brain and body , the person loss his memory for short term as well as for long term  .  [30]  
• Positive Effects
• Euphoria- it is a state of mind in which a person gets extreme level of happiness, comfort, or great pleasure and it is a side – effect after consuming large amount of drugs.
• Relaxation or decreased anxiety –the consumption of the drugs provide relaxation and reduced your nervousness, anxiety, or stress of your body
• Enhanced sensory experiences- consumption of the drugs improves your sensory experience (like taste, touch or, smell) for a certain period of time.
• Talkativeness is one of the effects of drugs consuming, the people start talk to themselves and they freely share their feelings to themselves.
• Altered senses – it is a state of consciousness in any state in which persons view point or concepts are different than normal
• Mood alterations- it means the sudden change in mood or mood swings (roller coaster of feelings), which shows the speedily and intensely fluctuation in emotions and feelings of a person like change in emotion of happiness to anger, irritation and sometimes depression.
• Tooth discoloration – it a side effect of consumption of drugs which changes color of your teeth into gray/ black. [31]

‘Some drugs like morphine, cocaine, LSD, and alcohol are much more harmful than marijuana. Research says that the consumption of other drugs leads the consumer to physical aggression and losing control over their sense while cannabis leads to comfort and relaxation of senses.

Indian government can likely in future re-legalize cannabis as our country is taking positive steps towards the promotion of legalizing cannabis to expand the medicinal, commercial and industrial purpose.

Legalization of cannabis in India would substantially lead to increase the revenue of the government as taxing weed would contribute huge amount of money to the government and would also help in increase in growth of GDP. It is also the source of income for many localites in areas like himachal Pradesh and Tamil nadu, where the cannabis plant is cultivated.  It is scientifically proven that cannabis is comparatively less harmful than alcohol   . Dope heads, unlike alcoholics, don’t engage in abusive fights or reckless behavior instead under the influence of cannabis they tend to be more calm and friendly.

But there are few pointers upon which the government should look on before legalizing the cannabis in India.  A rule should be made according to which a person above 25 years of age shall only possess cannabis for recreational purpose. A limit should be set for a person beyond which if he possess such drug should be punished strictly.

In the contemporary time there is existence of black market and drug mafia and there are earning a lot of money by selling this drug because people are willing to buy it at any cost and if cannabis gets legalized in India the government would earn money instead of mafia and this money can be used for development of our country. It will also reduce the rate of unemployment of our country. As till now we have studied through various reasons for which use of cannabis should be made legal .as like many states of us, India should also do the same.

[1] Jann Gumbiner , History of Cannabis in India , psychology today, (June 16, 2011), https://www.psychologytoday.com/us/blog/the-teenage-mind/201106/history-cannabis-in-india.

[2] Cannabis: What is it, why it is banned in India and how Rajiv Gandhi played a role in its ban , rahul raj and kumar kamal, (Sep23, 2020), https://www.opindia.com/2020/09/cannabis-what-is-it-how-it-was-banned-in-india-during-rajiv-gandhi-govt/.

[3] Id at 2.

[4] Marijuana drug facts , NATIONAL Institute on Drug Abuse, (July 2, 2020), https://www.drugabuse.gov/publications/drugfacts/marijuana.

[6] Kathleen Davis, Everything You Need to Know about Cannabis , healthline media, (Dec. 30, 2020, 8:54 PM), https://www.medicalnewstoday.com/articles/246392.

[7] Diganth Raj Sehgal, Legalization of Marijuana: India V. World, iPleaders.com, (July9, 2020), https://blog.ipleaders.in/legalization-marijuana-india-v-world/.

[8] Id at 7

[9] Single Convention on Narcotic Drugs, 1961, art.1 (1) (b), Mar.30, 1961, 520, U.N.T.S. 151.

[10] Nilufer Bhateja , Cannabis: Your Guide for what’s Legal and what’s Not In India , SCC Online Blog, (Sep25, 2020), https://www.scconline.com/blog/post/2020/09/25/cannabis-your-guide-to-whats-legal-and-whats-not-in-india/.

[11] Id at 10.

[12] Arjun Singh vs. State Of Haryana , (2005) 4 , S.C.C. 253, (India).

[13]   Id at 10.

[14] Sonali Acharjee, Should India Make Cannabis legal? , India Today, (Sep 28, 2020), https://www.indiatoday.in/magazine/cover-story/story/20200928-should-india-make-cannabis-legal-1723088-2020-09-19.

[15] Larry Russell, Legalize Cannabis and Other Drugs to Reduce Crime and Improve Health , Gannett co., (Mar.11, 2018, 6:00AM), https://www.redding.com/story/opinion/readers/2018/03/11/legalize-cannabis-and-other-drugs-reduce-crime-and-improve-health/408531002/.

[16] Surya Solanki, 10 Reasons Why Marijuana Should Be Legalized In India , Scoop Whoop Media PVT.LTD. (Nov.19, 2014, 8:25AM), https://www.scoopwhoop.com/inothernews/legalize-marijuana/.

[17] The Narcotic Drug and Psychotropic Act, 1985 No. 61, Acts of Parliament, 1985, (India), § 2(3).

[18] The Narcotic Drug and Psychotropic Substance Act, 1985 No.61, Acts of Parliament, 1985, (India), § 2(4).

[19] The Narcotic Drug and Psychotropic Act, 1985, No.61, Acts of Parliament, 1985, (India), § 10.

[20] The Narcotic Drug and Psychotropic Substance Act.1985, No.61, Acts of Parliament, 1985, (India), § 14.

[21] The Narcotic Drug and Psychotropic Substance Act, 1985, No. 61, Acts of parliament, 1985, (India), § 20.

[22] The Narcotic Drug and Psychotropic Substance Act, 1985, No. 61, Acts of Parliament, 1985, (India), § 29.

[23] Hira Singh v. Union of India , (2017)8, S.C.C. 162 (India )

[24] Deeptiman Tiwary, Cannabis Ban Is Elitist. It Should Go: Tathagata Satpathy , BENNETT, COLEMAN & co.ltd., (Mar. 29, 2015, 12:34 PM), https://m.timesofindia.com/india/cannabis-ban-is-elitist-it-should-go-tathagata-satpathy/articleshow/46732106.cms.

[25] Make Marijuana Legal for Medical Needs: Maneka Gandhi , BENNETT, COLEMAN & co.ltd., (July31, 2017, 4:50PM), https://m.timesofindia.com/india/make-marijuana-legal-for-medical-needs-maneka-gandhi/amp_articleshow/59838664.cms.

[26] Manish sirhindi, decriminalize traditional drugs, says MP, dharamvira Gandhi , BENNETT, COLEMAN & co.ltd., (Mar28, 2019, 11:29AM), https://m.timesofindia.com/city/ludhiana/opium-marijuana-decriminalisation-figure-in-patiala-mps-poll-plank/amp_articleshow/68605692.cms.

[27] Id at 26.

[28] Prabhash K Dutta, Will India Legalize Cannabis after UN Vote? , BENNETT, COLEMAN & co.ltd., (Dec 4, 2020, 5:32PM), https://www.indiatoday.in/news-analysis/story/will-india-legalise-cannabis-after-un-vote-1746631-2020-12-04.

[29] Id at 2.

[30] Id  at 29.

[31] Id at 29.

• VOLUME 2, ISSUE 2

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The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review

Kyra n farrelly.

1 Department of Psychology, York University, Toronto, ON, Canada

2 Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada

Jeffrey D Wardell

3 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada

4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Emma Marsden

Molly l scarfe, peter najdzionek, jasmine turna.

5 Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

James MacKillop

6 Homewood Research Institute, Guelph, ON, Canada

Background:

Recreational cannabis legalization has become more prevalent over the past decade, increasing the need to understand its impact on downstream health-related outcomes. Although prior reviews have broadly summarized research on cannabis liberalization policies (including decriminalization and medical legalization), directed efforts are needed to synthesize the more recent research that focuses on recreational cannabis legalization specifically. Thus, the current review summarizes existing studies using longitudinal designs to evaluate impacts of recreational cannabis legalization on cannabis use and related outcomes.

A comprehensive bibliographic search strategy revealed 61 studies published from 2016 to 2022 that met criteria for inclusion. The studies were predominantly from the United States (66.2%) and primarily utilized self-report data (for cannabis use and attitudes) or administrative data (for health-related, driving, and crime outcomes).

Five main categories of outcomes were identified through the review: cannabis and other substance use, attitudes toward cannabis, health-care utilization, driving-related outcomes, and crime-related outcomes. The extant literature revealed mixed findings, including some evidence of negative consequences of legalization (such as increased young adult use, cannabis-related healthcare visits, and impaired driving) and some evidence for minimal impacts (such as little change in adolescent cannabis use rates, substance use rates, and mixed evidence for changes in cannabis-related attitudes).

Conclusions:

Overall, the existing literature reveals a number of negative consequences of legalization, although the findings are mixed and generally do not suggest large magnitude short-term impacts. The review highlights the need for more systematic investigation, particularly across a greater diversity of geographic regions.

Introduction

Cannabis is one of the most widely used substances globally, with nearly 2.5% of the world population reporting past year cannabis use. 1 Cannabis use rates are particularly high in North America. In the U.S., 45% of individuals reported ever using cannabis and 18% reported using at least once annually in 2019. 2 , 3 In Canada, approximately 21% of people reported cannabis use in the past year use in 2019. 4 In terms of cannabis use disorder (CUD), a psychiatric disorder defined by clinically significant impairment in daily life due to cannabis use, 5 ~5.1% of the U.S. population ages 12+ years met criteria in 2020, with ~13.5% of individuals ages 18 to 25 years meeting criteria. 6

Overall, rates of cannabis use have shown long-term increasing trends among several age groups in North America. 7 - 9 Moreover, research has revealed recent cannabis use increases in at risk populations, such as individuals with depression and pregnant women. 10 , 11 Parallel to increased cannabis use over time, rates of cannabis-related consequences have also increased across Canada and the U.S., including cannabis dependence and CUD, 8 , 12 crime rates (eg, increased possession charges), 8 and cannabis-impaired driving (and, lower perception of impairment and risk from cannabis use). 11 , 13 , 14 Further, cannabis use poses a risk for early-onset or use during adolescence as there is evidence that cannabis use in adolescence is linked with poorer cognitive performance, psychotic disorders, and increased risk of mood and addictive disorders. 15 With the rates of negative consequences from cannabis use increasing, particularly in North America where cannabis has become legal in many parts of the US and all of Canada, understanding the role of cannabis legalization in these changes is crucial to inform ongoing changes in cannabis policies worldwide.

The legal status of cannabis varies widely across countries and regions. Although cannabis is largely illegal at the global level, policies surrounding cannabis use are becoming steadily liberalized. Decriminalization (reduced penalties for self-use but not distribution) is more widespread worldwide, including in the Netherlands, Portugal, and parts of Australia. Medical legalization is also seen in Peru, Germany, New Zealand, the Netherlands and across many U.S. states. To date, Canada, Uruguay, and Malta are the only 3 countries to legalize recreational cannabis use at the national level. Further, individual U.S. states began legalizing recreational cannabis in 2012, with nearly half of U.S. states having legalized recreational cannabis by 2023. As national and subnational recreational legalization continues to gain support and take effect, understanding the consequences of such major regulatory changes is crucial to informing ongoing policy changes.

There are arguments both for and against recreational cannabis legalization (RCL). Common pro-legalization arguments involve increasing regulatory control over product distribution, weakening organized crime, reducing burden and inequality in the criminal justice system, and generating economic benefits such as tax revenues and commercial activity. 16 Furthermore, as cannabis obtained from illicit markets is of varying and unknown potency, 17 cannabis legalization may help better regulate the potency and quality of cannabis products. 18 On the other hand, there are anti-legalization arguments such as the possibility of legalization leading to increased use among youth and increased cannabis-impaired driving. 16 A nationally representative survey in the U.S. found that pro-legalization arguments were perceived to be more persuasive than public health anti-legalization arguments in a U.S. nationally representative survey, 19 suggesting policymaker concerns regarding RCL do not seem to hold as much weight in the general public. However, while research may be increasing surrounding the impacts of RCL, the general consensus of if RCL leads to more positive or negative consequences is unclear.

With RCL becoming more prevalent globally, the impacts it may have on a variety of health-related outcomes are of critical importance. Prevalence of cannabis use is of course a relevant issue, with many concerned that RCL will cause significant spikes in rates of cannabis use for a variety of groups, including youth. However, current studies have revealed mixed evidence in the U.S., 20 , 21 thus there is a need to synthesize the extant literature to better understand the balance of evidence and potential impacts of RCL across different samples and more diverse geographic areas. Another common question about RCL is whether it will result in changes in attitudes toward cannabis. These changes are of interest as they might forecast changes in consumption or adverse consequences. Similarly, there are concerns surrounding RCL and potential spill-over effects that may influence rates of alcohol and other substance use. 22 Thus, there remains a need to examine any changes in use of other substance use when studying effects of RCL.

Beyond changes in cannabis and other substance use and attitudes, health-related impacts of RCL are important to consider as there are links between cannabis use and adverse physical and mental health consequences (eg, respiratory and cardiovascular diseases, psychosis). 23 Additionally, emergency service utilization associated with cannabis consumption is a frequent concern associated with RCL, particularly due to the spikes in admissions following RCL in Colorado. 24 However, the rates of cannabis-related emergency service admissions more globally (eg, in legal countries like Canada and Uruguay) have not been fully integrated into summaries of the current literature. Finally, another health-related consequence of RCL is potential impacts on opioid use. While opioid-related outcomes can fall into substance use, they are considered health-related for this review as much of the discussion surrounding RCL and opioids involve cannabis substituting opioid use for medicinal reasons or using cannabis as an alternate to prescription opioids in the healthcare system. The current opioid crisis is a global public health problem with serious consequences. While there is evidence that medicinal cannabis may reduce prescription opioid use 25 and that cannabis may be a substitute for opioid use, 26 the role of recreational cannabis legalization should also be examined as the 2 forms of cannabis use are not interchangable 27 and have shown unique associations with prescription drug use. 28 Thus, there is a need to better understand how and if RCL has protective or negative consequences on opioid-related outcomes.

Due to the impairing effects of cannabis on driving abilities and the relationship with motor vehicle accidents, 29 another important question surrounding RCL is how these policy changes could result in adverse driving-related outcomes. An understanding of how RCL could influence impaired driving prevalence is needed to give insight into how much emphasis jurisdictions should put on impaired driving rates when considering RCL implementation. A final consequence of RCL that is often debated but requires a deeper understanding is how it impacts cannabis-related arrest rates. Cannabis-related arrests currently pose a significant burden on the U.S. and Canadian justice system. 30 , 31 Theoretically, RCL may ease the strain seen on the justice system and have positive trickle-down effects on criminal-related infrastructure. However, the overall implications of RCL on arrest rates is not well understood and requires a systematic evaluation. With the large number of RCL associated outcomes there remains a need to synthesize the current evidence surrounding how RCL can impact cannabis use and other relevant outcomes

Present review

Currently, no reviews have systematically evaluated how RCL is associated with cannabis-use changes across a variety of age groups as well as implications on other person- or health-related outcomes. The present review aims to fill an important gap in the literature by summarizing the burgeoning research examining a broad range of consequences of RCL across the various jurisdictions that have implemented RCL to date. Although previous reviews have considered the implications of RCL, 32 , 33 there has recently been a dramatic increase in studies in response to more recent changes in recreational cannabis use policies, requiring additional efforts to synthesize the latest research. Further, many reviews focus on specific outcomes (eg, parenting, 34 adolescent use 35 ). There remains a need to systematically summarize how RCL has impacted a variety of health-related outcomes to develop a more comprehensive understanding of the more negative and positive outcomes of RCL. While a few reviews have examined a broad range of outcomes such as cannabis use, related problems, and public health implications, 32 , 33 some reviews have been limited to studies from a single country or published in a narrow time window. 32 Thus, a broader review is necessary to examine multiple types of outcomes from studies in various geographic regions. Additionally, a substantial amount of the current literature examining the impact of RCL relies on cross-sectional designs (eg, comparing across jurisdictions with vs without recreational legalization) which severely limit any conclusions about causal associations. Thus, given its breadth, the current systematic review is more methodologically selective by including only studies with more rigorous designs (such as longitudinal cohort studies), which provide stronger evidence regarding the effects of RCL. In sum, the aim of the current review was to characterize the health-related impacts of RCL, including changes in these outcomes in either a positive or negative direction.

The review is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 36 ). Full-text extraction was initiated immediately following article search, therefore the protocol was not registered with PROSPERO. Relevant articles on cannabis legalization were principally identified using the Boolean search terms (“cannabis” OR “marijuana” OR “THC” OR “marihuana”) AND “legalization” AND (“recreational” OR “non-medical” OR “nonmedical”) AND (“longitudinal” OR “pre-post” OR “prospective” OR “timeseries” OR “cohort”). The search was conducted using PubMed/MEDLINE, EMBASE, and PsycINFO through November 2022. Relevant studies identified through secondary means (eg, prior knowledge of a relevant publication, articles brought to the authors’ attention) were also included for screening. Titles and abstracts resulting from the initial search were screened in Covidence (Veritas Health Innovation Inc) by 2 reviewers for suitability for full-text review and final inclusion. Conflicts were discussed by both reviewers and a final decision was made by consensus. Following screening, reviewers read and extracted relevant data. To be included, an article was required to meet the following criteria: (i) an original empirical research article published in a peer-reviewed journal; (ii) written in (or available in) English; (iii) RCL serves as an independent variable; (iv) quantitative study design that clearly permitted the evaluation of the role of RCL with a more rigorous non-cross-sectional study design (eg, pre- vs post-legalization, longitudinal, cohort, interrupted time series, etc.); and (v) reports on health-related outcomes (ie, changes in consumption or attitudes, as opposed to changes in price or potency).

RCL related outcomes that were considered were those specifically involving the behavior, perceptions, and health of individuals. Population-level outcomes (eg, health-care utilization or impaired driving) were considered eligible for inclusion as they involve the impacts that legalization has on individual behavior. Thus, economic- or product-level outcomes that do not involve individual behavior (eg, cannabis prices over time, changes in cannabis strain potency) were considered out of scope. The outcome groups were not decided ahead of time and instead 5 main themes in outcomes emerged from our search and were organized into categories for ease of presentation due to the large number of studies included.

Studies that examined medicinal cannabis legalization or decriminalization without recreational legalization, and studies using exclusively a cross-sectional design were excluded as they were outside the scope of the current review. The study also excluded articles that classified RCL as the passing of legal sales rather than implementation of RCL itself as RCL is often distinct from introduction of legal sales, or commercialization. Thus, we excluded studies examining commercialization as they were outside the scope of the current review.

Characteristics of the literature

The search revealed 65 relevant articles examining RCL and related outcomes (see Figure 1 ). There were 5 main themes established: cannabis use and other substance use behaviors ( k  = 28), attitudes toward cannabis ( k  = 9), health-related outcomes ( k  = 33), driving related impacts ( k  = 6), and crime-related outcomes ( k  = 3). Studies with overlapping themes were included in all appropriate sections. Most studies (66.2%) involved a U.S. sample, 32.3% examined outcomes in Canada, and 1.5% came from Uruguay. Regarding study design, the majority (46.2%) utilized archival administrative data (ie, hospital/health information across multiple time points in one jurisdiction) followed by cohort studies (18.5%). The use of administrative data was primarily used in studies examining health-related outcomes, such as emergency department utilization. Studies examining cannabis use or attitudes over time predominantly used survey data. Finally, both driving and crime related outcome studies primarily reported findings with administrative data.

Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) study flow diagram.

Changes in cannabis and other substance use

Cannabis and other substance use changes represented the second largest number of studies, with 28 articles identified. Studies examining changes in cannabis use behaviors were divided by subpopulation (ie, adolescents, young adults, general population adults, clinical populations, and maternal use; see Table 1 ). Finally, we separately summarized studies reporting changes in concurrent use of other substances, and routes of cannabis administration.

Studies investigating the role of recreational cannabis legalization on cannabis and other substance consumption.

Author, author of article; Year, publication year of article; Location, jurisdiction article data was collected in; Date of Legalization, year legalization was enacted in jurisdiction; Sample, total N of article sample; RCL, Recreational Cannabis Legalization.

Cannabis use changes in adolescents (~12-17)

Ten studies examined changes in cannabis use among adolescents and found that changes in the rates of use were inconsistent following RCL. Gunadi et al 37 found an association between RCL and more pronounced transition from non-use to cannabis use when compared to states with no legalization and those with medical cannabis legalization ( P  ⩽ .001) combined, but not when compared to states with medical cannabis legalization only. Another study found that in states with RCL adolescents who never used cannabis but used e-cigarettes were more likely to use cannabis at follow-up than those living in states without RCL (aOR = 18.39, 95% CI: 4.25-79.68vs aOR = 5.09, 95% CI: 2.86-9.07, respectively) suggesting a risk of cannabis initiation among legal states. 38 Among adolescents reporting recent alcohol and cannabis co-use, one study found a significant increase in the frequency of past 30-day cannabis use following RCL ( b  = 0.36, SE = 0.07, P  ⩽ .001). 39 In a Canadian study using a repeated cross-sectional design as well as a longitudinal design to examine changes in cannabis use, results revealed that adolescents had increased odds of ever using cannabis in the year following RCL in the cross-sectional data ( P  = .009). 40 However, the longitudinal sample revealed no significant differences in the odds of ever use, current use, and regular use of cannabis post-legalization. There is also evidence of RCL impacts on adolescent cannabis use consequences, as a Washington study found a significant indirect effect of RCL on cannabis consequences through perceived risk as a mediator ( B  = 0.37, P  ⩽ .001). 41

On top of the above evidence, there were multiple studies examining cannabis use changes over time among adolescents in Washington and Oregon that found higher rates of cannabis use associated with cohorts examined during RCL compared to non-legal cohorts, 42 - 44 although the differences across legal cohorts were not significant in all cases. 42 Furthermore, in another study, RCL did not impact initiation of use, but for current users the RCL group had significantly greater increased rates of cannabis use compared to the pre-RCL group (RR = 1.26, 95% CI = 1.10, 1.45). 43 For the final study, cannabis use increased in the post-RCL group but patterns of use (frequency; daily vs weekly use) were similar across groups. 44 Overall, the preceding 8 studies reveal some evidence that RCL was associated with increasing rates of cannabis use in adolescent. However, 5 studies point to some inconsistent associations of RCL and cannabis use and suggest that overall relationship of RCL and adolescent cannabis as mixed.

Three studies add to these inconsistent findings and point to lack of an association between RCL and changes in cannabis use among adolescents. Two studies found no significant increase in the frequency of or prevalence of cannabis use following RCL. 41 , 45 Finally, a study examining trends of adolescent cannabis use and associations with period effects (ie, external world events that could influence use) suggests laws and regulations associated with RCL were not associated with cannabis use changes. 46 The current research reveals conflicting evidence about the role of RCL on adolescent cannabis use.

Cannabis use changes in young adults (~18-25)

Young adulthood, typically defined as ages 18 to 25 and also known as emerging adulthood, is commonly associated with decreased parental supervision, increased availability of substances, and greater substance experimentation making it a key developmental period for the onset of cannabis use. 47 Four studies examined the impact of RCL on cannabis use among young adults, 2 of which found significant associations between RCL and increased cannabis use in college students. 47 , 48 Barker and Moreno 48 found the rate of students ever using cannabis did not change. However, in those who had used cannabis prior to RCL, the proportion of students using in the past 28-days increased faster following RCL in Washington (legal-state) when compared with the rate of increase in Wisconsin (non-legal state; P  ⩽ .001). 48 Further, in college students from Oregon, rates of cannabis use increased significantly from before to after RCL ( P  = .0002). 47 Another study looked at changes in cannabis use in a sample of young adults from the U.S. who had never vaped cannabis at the time of recruitment. 49 Results revealed that cannabis use in the past year did not differ in states with or without RCL, although, those living in states with RCL did show a larger increase in rates of cannabis vaping across time, compared to those in non-RCL states. Finally, in a sample of youth from Oregon and Washington, RCL predicted a higher likelihood of past-year cannabis use ( P  = .001). 50 In contrast to the adolescent literature, studies examining cannabis use in young adult samples fairly consistently point to an association between RCL and increasing rates of cannabis use.

Cannabis use changes in general population adults

Five studies examined changes in cannabis use in adults (without further age subclassification) associated with RCL. Four of these studies suggested higher rates of cannabis use in adults for RCL jurisdictions compared to non-legal states post-RCL, or increased use following RCL. 37 , 45 , 51 , 52 Past 30-day cannabis use increased significantly 1-month post-RCL and remained elevated 6-months post-RCL (ps = 0.01) in a sample of adults from California. 51 Another study found an association between RCL and transition from non-users to cannabis users and non-users to weekly users when compared to states with no medical legalization or RCL ( P  ⩽ .001) and states with no legalization combined with those with medical cannabis legalization ( P  ⩽ .001). 37 Meanwhile, in Canada, a significant increase in prevalence of cannabis use was observed following RCL. 45 Additionally, in those reporting no cannabis use prior to RCL in Canada, there were significant increases in cannabis use frequency, quantity of cannabis used, and severity of cannabis misuse following RCL. 52 The opposite pattern was seen for those reporting cannabis use prior to RCL, with significant decreases in frequency of use, quantity, and misuse. 52 However, not all studies found RCL was associated with increased cannabis use. For instance, a repeated cross-sectional study of adult in the U.S. found no association between RCL and frequency of cannabis use. 53

A benefit of the extant literature examining general population cannabis use is that it covers a variety of jurisdictions and study designs, albeit with some heterogeneity and mixed findings. On balance, the evidence within the current literature, generally suggests an increase in cannabis use for adults in the general population following RCL with 80% of the reviewed studies supporting this conclusion.

Maternal use

Three studies examined whether rates of cannabis use during pregnancy have increased following RCL. Two studies suggested increased cannabis use during pregnancy associated with RCL. In one study urine screen-detected cannabis use during pregnancy increased from 6% to 11% following RCL in California ( P  = .05). 54 Another study in a sample of women participating in an intensive case management program for heavy alcohol and/or drug use during pregnancy, examined cannabis use among those exiting from the program before versus after RCL. Findings revealed women exiting after RCL were more likely to report using cannabis in the 30 days prior to exit compared to those pre-RCL (OR = 2.1, P  ⩽ .0001). 55 One study revealed no significant difference in cannabis or alcohol use associated with RCL in women living with HIV during pregnancy or the postpartum period. 56 Overall, the evidence from these three studies suggests there may be increases in perinatal cannabis use following RCL, but the small number of studies and unique features of the samples suggests a need for more research.

Clinical populations use

Six studies examined cannabis use in clinical populations. One study investigated use and trauma admissions for adults and pediatric patients in California. 57 Results showed an increase in adult trauma patients with THC+ urine tests from pre- to post-RCL (9.4% to 11.0%; P  = .001), but no difference for pediatric trauma patients. A study based in Colorado and Washington, found that cannabis use rates in inflammatory bowel disease patients significantly increased from 107 users to 413 ( P  ⩽ .001) pre to post-RCL. 58 A Canada-based study of women with moderate-to-severe pelvic pain found an increase in the prevalence of current cannabis use following RCL (13.3% to 21.5%; P  ⩽ .001). 59 Another Canadian study showed an increase in the prevalence of current cannabis use after RCL among cancer patients (23.1% to 29.1%; P  ⩽ .01). 60 Finally, two studies examined changes in cannabis use among individuals receiving treatment for a substance use disorder. In a sample of Canadian youth in an outpatient addictions treatment program, there was no change in the rate of cannabis use following RCL. 61 Further, in a sample of individuals receiving treatment for opioid use disorder, cannabis use was compared for those recruited 6 months before or after RCL with no significant changes in the prevalence or frequency of self-reported ( P  = .348 and P  = .896, respectively) or urine screen-detected ( P  = .087 and P  = .638, respectively) cannabis use following RCL. 62 Although these studies only represent a small number of observations, their findings do reveal associations between RCL and increasing cannabis use within some clinical samples.

Changes in polysubstance and other substance use

One study examined simultaneous cannabis and alcohol use among 7th, 9th, and 11th grade students in the U.S. 39 This study found that RCL was associated with a 6% increase in the odds of past 30-day alcohol and cannabis co-use. The association was even stronger in students with past 30-day alcohol use and heavy drinking. However, among past 30-day cannabis users, RCL was associated with a 24% reduction in co-use. This study suggests at least a modest association between RCL and concurrent cannabis and alcohol use among adolescents.

Numerous studies examined changes of alcohol and other substance use pre to post RCL. With regard to alcohol, one study from Colorado and Washington found a decrease in alcohol consumption among adolescents following RCL, 42 whereas another Washington study found RCL predicted a higher likelihood of alcohol use among youth. 50 A Canadian study also found no significant effect of RCL on rates of alcohol or illicit drug use among youth. 61 Finally, in a sample of trauma patients in California the findings around changes in substance use were mixed. 57 In adult patients, the rates of positive screens for alcohol, opiates, methamphetamine, benzodiazepine/barbiturate, and MDMA did not change following RCL, but there was an increase in positive screens for cocaine. In pediatric patients, increases were seen in positive screens for benzodiazepine/barbiturate, but positive screens for alcohol, opiates, methamphetamine, and cocaine did not change. 57 The current evidence is divided on whether RCL is associated with increased alcohol and other substance use, with 40% of studies finding an association and 60% not observing one or finding mixed results.

In the case of cigarettes, Mason et al 42 did find significant cohort effects, where the post-RCL cohort was less likely to consume cigarettes compared to the pre-RCL one (Coefficient: − 2.16, P  ⩽ .01). However, these findings were not echoed in more recent studies. Lack of an effect for cigarette use is supported by an Oregon study that found RCL was not associated with college student’s cigarette use. 47 Similarly, RCL was not significantly associated with past-year cigarette use in a sample of young adults from Oregon and Washington. 50 On balance, there is little evidence that RCL is linked with changes in cigarette smoking.

Route of administration

The increase in smoke-free alternative routes of cannabis administration (eg, vaping and oral ingestion of edibles) 63 , 64 make method of cannabis consumption an important topic to understand in the context of RCL. Two studies examined differences in route of cannabis consumption as a function of cannabis policy. One study examined changes in the number of different modes of cannabis use reported by high school students in Canada. 65 Results showed that from pre-to-post RCL 31.3% of students maintained a single mode of use, 14.3% continued to use cannabis in multiple forms, while 42.3% expanded from a single mode to multiple modes of administration and 12.1% reduced the number of modes they used. Another study found that smoking, vaping, and edibles (in that order) were the most frequent modes of cannabis use pre- and post-RCL in California, suggesting minimal impact of RCL on mode of cannabis use. 51 However, the least common mode of cannabis use was blunts, which did decline following RCL (13.5%-4.3%). 51 Overall, the evidence suggests RCL may be associated with changes in modes of cannabis consumption, but as the evidence is only from two studies there still remains a need for more studies examining RCL and cannabis route of administration.

Nine studies examined RCL and cannabis attitudes (see Table 2 ). Regarding cannabis use intentions, one U.S. study found that for both a non-RCL state and a state that underwent RCL, intention to use in young adults significantly increased post-RCL, suggesting a lack of RCL specific effect, 48 and that aside from the very first time point, there were no significant differences between the states in intention to use. Further, attitudes and willingness to use cannabis, between the RCL and non-RCL state remained similar overtime ( P s ⩾ .05), although both states reported significantly more positive attitudes toward cannabis following RCL ( P  ⩽ .001). 48 However, another study U.S. from found differences in adolescent use intentions across RCL, whereby those in the RCL cohort in jurisdictions that allowed sales were less likely to increase intent to use cannabis ( P  = .04), but the RCL cohort without sales were more likely to increase intent to use ( P  = .02). 43 The pre-RCL cohort in communities that opted out of sales were also less likely to increase willingness to use compared to the cohort with legal sales ( P  = .02). 43 Both studies reveal contrasting findings surrounding RCL’s relationship with cannabis use intentions and willingness to use.

Studies examining recreational cannabis legalization and attitudes surrounding cannabis.

Looking at cannabis use motives, one study found a non-significant increase in recreational motives for cannabis use post-RCL. 60 Similarly following RCL in Canada, 24% of individuals previously reporting cannabis use exclusively for medical purposes declared using for both medical and non-medical purposes following RCL, and 24% declared use for non-medical purposes only, 66 suggesting RCL can influence recreational/nonmedicinal motivations for cannabis use among those who previously only used for medical reasons.

In studies examining perceived risk and perceptions of cannabis use, one U.S. study found an indirect effect between RCL and increased consequences of use in adolescents through higher perceived risk ( P  ⩽ .001), but no association with frequency of use. 41 Another U.S. study revealed mixed results and found that RCL was not associated with perceived harm of use in youth. 50 Further, youth in one study did not report differences in perceptions of safety of cannabis, ease of accessing cannabis use or on concealing their use from authority, 61 which contrasts with another study finding increased reports of problems accessing cannabis post-RCL ( P  ⩽ .01). 60 Regarding health perceptions, a California study found that cannabis use was perceived as more beneficial for mental health, physical health, and wellbeing in adults at 6 months post-RCL compared to pre-RCL and 1-month post-RCL ( P  = .02). 51 Mental health perceptions of cannabis use increased from being perceived as “slightly harmful” pre-RCL to perceived as “slightly beneficial” at 6 months post-RCL. 51 However, in a sample of treatment seeking individuals with an opioid use disorder, the vast majority of participants reported beliefs that RCL would not impact their cannabis use, with no difference in beliefs pre- to post-RCL (85.9% reported belief it would have no impact pre-RCL and 85.7%, post-RCL). 62 The combined results of the studies suggest potential associations of RCL with risk and benefit perceptions of cannabis use, however as 55% of studies suggest a lack of or inconsistent association with RCL, on balance the literature on RCL’s impact on cannabis attitudes is mixed.

Health-related outcomes

We identified 33 articles that examined various health-related outcomes associated with RCL (see Table 3 ). The largest number involved hospital utilization (ie, seeking emergency services for cannabis-related problems such as unintentional exposure, CUD, and other harms). Other health-care outcomes included opioid-related harms, mental health variables, and adverse birth outcomes.

Studies investigating the relationship of recreational cannabis legalization and health-related outcomes.

Author, Author of article; Year, Publication year of article; Location, Jurisdiction article data was collected in; Date of Legalization, Year legalization was enacted in jurisdiction; Sample, Total N of article sample; CDC, Center for Disease Prevention; WONDER, Wide-Ranging Online Data for Epidemiologic Research; RCL, Recreational Cannabis Legalization.

Emergency service utilization

Seventeen studies examined the association between RCL and use of emergency services related to cannabis (eg, hospital visits, calls to regional poison centers). Regarding emergency service rates in youth, a Colorado study found the rate of pediatric cannabis-related emergency visits increased pre- to post-RCL ( P  ⩽ .0001). 67 Similarly, cannabis-related visits requiring further evaluation in youth also increased. 67 This increasing need for emergency service related to cannabis exposure in youth following RCL was supported in 4 other U.S. studies. 68 - 71 A Canadian study supported the U.S. studies, finding a 2.6 increase in children admissions for cannabis poisonings post-RCL. 72 In contrast, overall pediatric emergency department visits did not change from pre- to post-RCL in Alberta, Canada, 73 but there was a non-significant increase of the rate and proportion of children under 12 presenting to the emergency department. However, unintentional cannabis ingestion did increase post-RCL for children under 12 (95% CI: 1.05-1.47) and older adolescents (1.48, 95% CI: 1.21-1.81). 74 Taken together, these studies do suggest a risk for increasing cannabis-related emergency visits in youth following RCL, with 75% of studies finding an association between RCL and increasing emergency service rates in youth.

There is also evidence of increased hospital utilization in adults following RCL. Five studies found evidence of increased emergency service utilization or poison control calls from cannabis exposure associated with RCL in the U.S. and Canada. 24 , 69 , 74 - 76 Finally, a Colorado study saw an increase in cannabis involved pregnancy-related hospital admissions from 2011 to 2018, with notable spikes after 2012 and 2014, timeframes associated with state RCL. 77

However, some evidence points to a lack of association between RCL and emergency service utilization. A chart review in Ontario, Canada found no difference in number of overall cannabis emergency room visits pre- versus post-RCL ( P  = .27). 78 When broken down by age group, visits only increased for those 18 to 29 ( P  = .03). This study also found increases in patients only needing observation ( P  = .002) and fewer needing bloodwork or imaging services (both P s ⩽.05). 78 Further in a California study that found overall cannabis exposure rates were increasing, when breaking these rates down by age there was no significant change in calls for those aged 13 and up, only for those 12 and under. 69 An additional Canadian study found that rates of cannabis related visits were already increasing pre-RCL. 79 Following RCL, although there was a non-significant immediate increase in in cannabis-related emergency visits post-RCL this was followed a significant drop off in the increasing monthly rates seen prior to RCL. 79 Another Canadian study that examined cannabis hyperemesis syndrome emergency visits found that rates of admissions were increasing prior to RCL and the enactment of RCL was not associated with any changes in rates of emergency admissions. 80 As this attenuation occurred in Canada prior to commercialization where strict purchasing policy was in place, it may suggest that having proper regulations in place can prevent the uptick in cannabis-related emergency visits seen in U.S. studies.

Other hospital-related outcomes examined included admissions for cannabis misuse and other substance use exposure. One study found decreasing CUD admission rates over time (95% CI: −4.84, −1.91), with an accelerated, but not significant, decrease in Washington and Colorado (following RCL) compared to the rest of the U.S. 81 In contrast, another study found increased rates of healthcare utilization related to cannabis misuse in Colorado compared to New York and Oklahoma ( P s ⩽.0005). 82 With respect to other substance use, findings revealed post-RCL increases in healthcare utilization in Colorado for alcohol use disorder and overdose injuries but a decrease in chronic pain admissions compared to both controls ( P  ⩽ .05). 82 However, two Canadian studies found the rate of emergency department visits with co-ingestant exposure of alcohol, opioid, cocaine, and unclassified substances in older adolescents and adults decreased post-RCL. 73 , 77 Another Canadian study found no change in cannabis-induced psychosis admissions nor in alcohol- or amphetamine-induced admissions. 83

Finally, three studies examined miscellaneous hospital-related outcomes. A study examining hospital records in Colorado to investigate facial fractures (of significance as substance impairment can increase the risk of accidents) showed a modest but not significant influence of RCL. 84 The only significant increases of facial trauma cases were maxillary and skull base fracture cases ( P s ⩽ .001) suggesting a partial influence of RCL on select trauma fractures. The second study found increased trauma activation (need for additional clinical care in hospital) post-RCL in California ( P  = .01). 57 Moreover, both adult and pediatric trauma patients had increased mortality after RCL ( P  = .03; P  = .02, respectively). 57 The final study examining inflammatory bowel disease (IBD) outcomes in the U.S. found more cannabis users on total parenteral nutrition post-RCL (95% CI: 0.02, 0.89) and lower total hospital costs in users post-RCL (95% CI: −15 717, −1119). 58 No other IBD outcomes differed pre- to post-RCL (eg, mortality, length of stay, need for surgery, abscess incision and drainage).

Overall, these studies point to increased cannabis-related health-care utilization following RCL for youth and pediatrics (75% finding an increase). However, the impact of legalization on adult rates of cannabis-related emergency visits is mixed (44% finding lack of an association with RCL). As findings also varied across different countries (ie, Canada vs the U.S.), it suggests the importance of continually monitoring the role of RCL across different jurisdictions which may have different cannabis regulations in place. These studies also suggest there may be other health consequences associated with RCL. Further research should be done to examine trends of other emergency service use that could be influenced by RCL.

Two studies reported a weak or non-existent effect of RCL on opioid related outcomes. 85 , 86 First, a U.S. administrative study found no association of RCL and opioid prescriptions from orthopedic surgeons. 85 The second study found that, of U.S. states that passed RCL, those that passed policies before 2015 had fewer Schedule III opioid prescriptions ( P  = .003) and fewer total doses prescribed ( P  = .027), 86 but when compared to states with medicinal cannabis legislation, there were no significant differences. However, 3 studies suggested a potential protective effect of RCL, with one study finding a significant decrease for monthly opioid-related deaths following RCL (95% CI: –1.34, –0.03), compared to medical cannabis legalization and prohibition. 87 A Canadian study examining opioid prescription claims also found an accelerated decline in claims for public payers post-RCL compared to declines seen pre-RCL ( P  ⩽ .05). 88 Next a study examining women with pelvic pain found that post-RCL patients were less likely to report daily opioid use, including use for pain ( P  = .026). 59 These studies indicate some inconsistencies in relationships between RCL, opioid prescriptions and use indicators in the current literature, while the literature on balance points to a potential relationship with RCL (60%), the overall evidence is still mixed as 40% of studies support a weak association with RCL.

Adverse birth outcomes

Changes in adverse birth outcomes including small for gestational age (SGA) births, low birth weight, and congenital anomalies were examined in two studies. The first study, which examined birth outcomes in both Colorado and Washington, found that RCL was associated with an increase in congenital anomaly births for both states ( P  ⩽ .001, P  = .01 respectively). 89 Preterm births also significantly increased post-RCL, but only in Colorado ( P  ⩽ .001). Regarding SGA outcomes, there was no association with RCL for either state. 89 Similarly, the second study did find an increase in the prevalence of low birth weight and SGA over time, but RCL was not directly associated with these changes. 90 Although the current literature is small and limited to studies in Washington and Colorado, the evidence suggests minimal changes in adverse birth outcomes following RCL.

Mental health outcomes

Six studies examined mental health related outcomes. A Canadian study examining psychiatric patients did not see a difference in rates of psychotic disorders pre- to post-RCL. 45 Similarly, another Canadian study did not see a difference in hospital admissions with schizophrenia or related codes post-RCL. 83 However, the prevalence of personality disorders and “other” diagnoses was higher post-RCL ( P  = .038). 45 In contrast, another Canadian study found that rates of pediatric cannabis-related emergency visits with co-occurring personality and mood-related co-diagnoses decreased post-RCL among older adolescents. 73 A U.S. study examining the relationship between cannabis use and anxious mood fluctuations in adolescents found RCL had no impact on the association. 91 Similarly, another Canadian study found no difference in mental health symptomology pre- to post-RCL. 61 In contrast, anxiety scores in women with pelvic pain were higher post-RCL compared to pre-RCL ( P  = .036). 59 The small number and mixed findings of these studies, 66.7% finding no association or mixed findings and 33.3% finding an association but in opposite directions, identify a need for further examination of mental health outcomes post-RCL.

Miscellaneous health outcomes

Three studies examined additional health-related outcomes. First, a California study examined changes in medical cannabis status across RCL. Post-RCL, 47.5% of medical cannabis patients remained medical cannabis patients, while 73.8% of non-patients remained so. 92 The transition into medical cannabis patient status post-RCL represented the smallest group (10%). Cannabis legalization was the most reported reason for transition out of medical cannabis patient status (36.2%). 92 Next, a study examining pelvic pain in women found that post-RCL patients reported greater pain catastrophizing ( P  ⩽ .001), less anti-inflammatory ( P  ⩽ .001) and nerve medication use ( P  = .027), but more herbal pain medication use ( P  = .010). 59 Finally, a Canadian study that examined cannabinoids in post-mortem blood samples reported that post-RCL deaths had higher odds of positive cannabis post-mortem screens compared to pre-RCL (95% CI: 1.09-1.73). 93 However, the majority of growth for positive cannabinoid screens took place in the two years prior to RCL implementation. In sub-group analyses, only 25- to 44-year-olds had a significant increase in positive cannabinoid screens (95% CI: 0.05-0.19). Additional post-mortem drug screens found an increase in positive screens for amphetamines ( P  ⩽ .001) and cocaine ( P  = .042) post-RCL. These additional health outcomes demonstrate the wide-ranging health impacts that may be associated with RCL and indicate a continued need to examine the role of RCL on a variety of outcomes.

Driving-related outcomes

Six studies examined rates of motor vehicle accidents and fatalities (see Table 4 ). Two U.S. studies found no statistical difference in fatal motor vehicle collisions associated with RCL. 94 , 95 Further, a California-based study examining THC toxicology screens in motor vehicle accident patients, did find a significant increase in positive screens, but this increase was not associated with implementation of RCL. 96 However, three studies suggest a negative impact of RCL, as one U.S. study found both RCL states and their neighboring states had an increase in motor vehicle fatalities immediately following RCL. 97 Additionally, a Canadian study did find a significant increase in moderately injured drivers with cannabis positive blood screens post-RCL. 98 Finally, a study in Uruguay found RCL was associated with increased immediate fatal crashes for cars, but not motorcycles; further investigation suggested this effect was noticeable in urban areas, but not rural areas. 99 While the overall evidence was inconsistent, current evidence does suggest a modest increase, seen in two studies, in motor vehicle accidents associated with RCL. Further longitudinal research in more jurisdictions is needed to understand the long-term consequences of RCL on motor vehicle accidents.

Studies looking at recreational cannabis legalization and driving related outcomes.

Crime-related outcomes

Three studies explored crime-related outcomes associated with RCL (see Table 5 ). A Washington study examining cannabis-related arrest rates in adults did find significant drops in cannabis-related arrests post-RCL for both 21+ year olds (87% drop; P  ⩽ .001) and 18 to 20-year-olds (46% drop; P  ⩽ .001). 100 However, in another study examining Oregon youth this post-RCL decline for arrests was not seen; cannabis-related allegations in youth actually increased following RCL (28%; 95% CI = 1.14, 1.44). 101 Further, declines in youth allegations prior to RCL ceased after RCL was implemented. In contrast, a Canadian study did find significant decreases in cannabis-related offenses in youth post RCL ( P  ⩽ .001), but rates of property and violent crime did not change across RCL. 102 These studies highlight the diverse effects of RCL across different age groups. However, there remains a need for a more comprehensive evaluation on the role of RCL on cannabis-related arrests.

Studies investigating recreational cannabis legalization and crime related outcomes.

Author, Author of article; Year, Publication year of article; Location, Jurisdiction article data was collected in; Date of Legalization, Year legalization was enacted in jurisdiction; Sample, Total N of article sample; RCL, Recreational Cannabis Legalization.

Notably, two studies also examined race disparities in cannabis-related arrests. For individuals 21+ relative arrest disparities between Black and White individuals grew post-RCL. 100 When looking at 18 to 20-year-olds, cannabis-related arrest rates for Black individuals did slightly decrease, albeit non-significantly, but there was no change in racial disparities. 100 In youth ages 10 to 17, Indigenous and Alaska Native youth were more likely than White youth to receive a cannabis allegation before RCL (95% CI: 2.31, 3.01), with no change in disparity following RCL (95% CI: 2.10, 2.81). 101 On the other hand, Black youth were more likely to receive a cannabis allegation than White youth prior to RCL (95% CI: 1.66, 2.13), but the disparity decreased following RCL (95% CI: 1.06, 1.43). 101 These studies suggest improvements in racial disparities for cannabis-related arrests following RCL, although there ware only two studies and they are limited to the U.S.

The aim of this systematic review was to examine the existing literature on the impacts of RCL on a broad range of behavioral and health-related outcomes. The focus on more rigorous study designs permits greater confidence in the conclusions that can be drawn. The literature revealed five main outcomes that have been examined: cannabis use behaviors, cannabis attitudes, health-related outcomes, driving-related outcomes, and crime-related outcomes. The overall synthesizing of the literature revealed heterogenous and complex effects associated with RCL implementation. The varied findings across behavioral and health related outcomes does not give a clear or categorical answer as to whether RCL is a negative or positive policy change overall. Rather, the review reveals that while a great deal of research is accumulating, there remains a need for more definitive findings on the causal role of RCL on a large variety of substance use, health, attitude-related, driving, and crime-related outcomes.

Overall, studies examining cannabis use behavior revealed evidence for cannabis use increases following RCL, particularly for young adults (100%), peri-natal users (66%), and certain clinical populations (66%). 47 , 54 , 59 While general adult samples had some mixed findings, the majority of studies (80%) suggested increasing rates of use associated with RCL. 51 Of note, the increasing cannabis use rates found in peri-natal and clinical populations are particularly concerning as they do suggest increasing rates in more vulnerable samples where potential adverse consequences of cannabis use are more pressing. 103 However, for both groups the overall literature revealed only a few studies and thus requires further examination. Further, a reason to caution current conclusions surround RCL impacts on substance use, is that there is research suggesting cannabis use rates were increasing prior to RCL in Canada. 104 Thus, there still remains a need to better disentangle causal consequences of RCL on cannabis use rates.

In contrast to studies of adults, studies of adolescents pointed to inconsistent evidence of RCL’s influence on cannabis use rates, 38 , 45 with 60% of studies finding no change or inconsistent evidence surrounding adolescent use following RCL. Thus, a key conclusion of the cannabis use literature is that there is not overwhelming evidence that RCL is associated with increasing rates of cannabis among adolescents, which is notable as potential increases in adolescent use is a concern often voiced by critics of RCL. 16 This might suggest that current RCL policies that limit access to minors may be effective. However, a methodological explanation for the discrepancy between findings for adolescents and adults is that adults may be more willing to report their use of cannabis following RCL as it is now legal for them to use. However, for adolescents’ cannabis use remained illicit, which may lead to biased reporting from adolescents. Thus, additional research using methods to overcome limitations of self-reports may be required.

With regard to other substance use, primarily alcohol and cigarettes, there is little evidence that RCL is associated with increased use rates and may even be associated with decreased rates of cigarette use. 42 , 61 The lack of a relationship with RCL and increasing alcohol and other substance use, seen in 60% of studies, is relevant due to concerns of RCL causing “spill-over” effects to substances other than cannabis. However, the decreasing rates on cigarette use associated with RCL seen in 33% of studies may also suggest a substitution effect of cannabis. 105 It is possible that RCL encourages a substitution effect where cannabis is used to replace use other substances such as cigarettes, but 66% of studies found no association of RCL and cigarette use so further research examining a potential substitution effect is needed. In sum, the literature points to a heterogenous impact of RCL on cannabis and other substance use rates, suggesting complex effects of RCL on use rates that may vary across age and population. However, the review also highlights that there are still limited studies examining RCL and other substance use, particularly a lack of multiple studies examining the same age group.

The current evidence for the impact of RCL on attitudes surrounding cannabis revealed mixed or limited results, with 44% studies finding some sort of relationship with attitudes and RCL and 55% studies suggest a lack of or inconsistent relationship. Studies examining cannabis use attitudes or willingness to use revealed conflicting evidence whereas some studies pointed to increased willingness to use associated with RCL, 43 and others found no change or that changes were not specific to regions that implemented RCL. 48 For attitude-related studies that did reveal consistent findings (eg, use motivation changes, perceptions of lower risk and greater benefits of use), the literature was limited in the number of studies or involved heterogenous samples, making it difficult to make conclusive statements surrounding the effect of RCL. As cannabis-related attitudes (eg, perceived risk, intentions to use) can have implications for cannabis use and consequences 106 , 107 it is interesting that current literature does not reveal clear associations of cannabis-related attitudes and RCL. Rather, this review reveals a need for more research examining changes in cannabis-attitudes over time and potential impacts of RCL.

In terms of health outcomes, the empirical literature suggests RCL is associated with increased cannabis-related emergency visits 24 , 67 , 70 , 76 and other health consequences (eg, trauma-related cases 57 ). The literature also suggests there may be other potential negative health consequences associated with RCL, such as increasing adverse birth outcomes and post-mortem cannabis screens. 45 , 89 Synthesizing of the literature points to a well-established relationship of RCL and increasing cannabis-related emergency visits. While some extant literature was mixed, on balance most studies included in the review (70.6%) found consistent evidence of increased emergency service use (eg, emergency department admissions and poison control calls) for both adolescents and adults with only 31% of studies finding mixed or no association with RCL. This points to a need for stricter RCL policies to prevent unintentional consumption or hyperemesis such as promoting safe or lower risk use of cannabis (eg, using lower THC products, avoiding deep inhales while smoking), clearer packaging for cannabis products, and safe storage procedures.

However, the literature on health outcomes outside of emergency service utilization is limited and requires more in-depth evaluations to be fully understood. Additionally, not all health-outcomes indicated negative consequences associated with RCL. There is emerging evidence of the potential of RCL to help decrease CUD and multiple substance hospital admissions 74 , 82 Furthermore, while some findings were mixed and the number of studies limited, 60% of studies found potential for RCL to have protective effects for opioid-related negative consequences. 87 , 88 However, opioid-related findings should be considered in the context of population-level changes in opioid prescriptions and shifting opioid policy influence. 108 Thus, findings may be a result of changes driven by the response to the opioid epidemic rather than RCL, and there remains a need to better disentangle RCL impacts on opioid-related consequences. It is also worth noting that some opioid and cannabis studies are underwritten by the cannabis industry, so the findings should be interpreted with caution due to potential for conflicts of interest. 88 In sum, the overall literature suggests that RCL is associated with both negative and positive health-related consequences and reveals a need to examine the role of RCL across a wide range of health outcomes.

The findings from the driving-related literature do suggest RCL is associated with increased motor vehicle accidents (50% of studies) although the literature was quite evenly split as higher accident rates were not seen across all studies (50% studies). These results point to potential negative consequence associated with RCL and may indicate a need for better measures to prevent driving while under the influence of cannabis in legalized jurisdictions. However, as the evidence was split and predominately in the U.S. additional studies spanning diverse geographical jurisdictions are still needed.

On the other hand, the findings from crime-related outcomes showed some inconsistencies. While one study did suggest minimal decreases for substance-use related arrests in adults, the findings were not consistent across the two studies examining arrest-rates in youth. 100 - 102 These potential decreases in arrest rates for adults can have important implications as cannabis-related crime rates make up a large amount of overall crime statistics and drug-specific arrests. 30 , 31 This discrepancy in youth findings between a U.S. and Canadian study are notable as Canadian RCL policies do include stipulations to allow small scale regulations in youth. Thus, it suggests RCL policies that maintain prohibition of use among underage youth do not address issues related to arrests and crime among youth. In fact, the current literature suggests that cannabis-related charges are still being enforced for youth under the legal age of consumption in the U.S. Another important outcome revealed is racial disparities in cannabis-related arrests. Previous evidence has shown there are racial disparities, particularly between Black, Indigenous, and Hispanic individuals compared to White counterparts, in cannabis-related charges and arrests. 109 , 110 Regarding racial disparities and RCL, there was very little evidence of decreases in disparities for cannabis-related arrests following RCL. 100 , 101 This racialized arresting is significant as it can be associated with additional public health concerns such as physical and mental health outcomes, harm to families involved, and to communities. 111 This finding is particularly concerning as it suggests racialized arrests for cannabis are still occurring despite the intentions of liberalization of cannabis policies to help reduce racial disparities in the criminal justice system. However, it is important to note that there were only 2 studies of racial disparities in cannabis-related arrests and both were conducted in the U.S. Thus, additional research is required before drawing any firm conclusions about the ability of RCL to address systemic issues in the justice system.

Limitations

The findings should be considered within context of the following limitations. The research was predominately from North America (U.S. and Canada). While both countries have either federal or state RCL, findings only from two countries that are geographically connected may not reflect the influence of RCL across different cultures and countries globally. The majority of studies also relied on self-report data for cannabis-related outcomes. Thus, there is a risk that any increases in use or other cannabis-related outcomes may be due to an increased comfort in disclosing cannabis use due to RCL.

Given the large number of studies on multiple outcomes, we chose to focus on implementation of RCL exclusively, rather than related policy changes such as commercialization (ie, the advent of legal sales), to allow for clearer conclusions about the specific impacts on RCL. However, a limitation is that the review does not address the impact of commercialization or changes in product availability. While outside the scope of the current review, it does limit the conclusions that can be drawn about RCL overall as some jurisdictions implemented features of commercialization separately from legalization. For example, in Ontario, Canada, storefronts and edible products became legal a year after initial RCL (when online purchase was the exclusive modality), which may have had an additional impact on behavioral and health-related outcomes. Additionally, the scope of the review was limited to recreational legalization and did not consider other forms of policy changes such as medicinal legalization or decriminalization, as these have been summarized more comprehensively in prior reviews. 112 - 114 Further, this review focused on behavioral and health outcomes; other important outcomes to examine in the future include economic aspects such as cannabis pricing and purchasing behaviors, and product features such as potency. Finally, as this review considered a broad range of outcomes, we did not conduct a meta-analysis which limits conclusions that can be drawn regarding the magnitude of the associations.

Conclusions

The topic of RCL is a contentious and timely issue. With nationwide legalization in multiple countries and liberalizing policies across the U.S., empirical research on the impacts of RCL has dramatically expanded in recent years. This systematic review comprehensively evaluated a variety of outcomes associated with RCL, focusing on longitudinal study designs and revealing a wide variety of findings in terms of substance use, health, cannabis attitudes, crime, and driving outcomes examined thus far. However, the current review highlights that the findings regarding the effects of RCL are highly heterogenous, often inconsistent, and disproportionately focused on certain jurisdictions. With polarizing views surrounding whether RCL is a positive or negative policy change, it is noteworthy that the extant literature does not point to one clear answer at the current time. In general, the collective results do not suggest dramatic changes or negative consequences, but instead suggest that meaningful tectonic shifts are happening for several outcomes that may or may not presage substantive changes in personal and public health risk. Furthermore, it is clear that a more in-depth examinations of negative (eg, frequent use, CUD prevalence, ‘gateway’ relationships with other substance use), or positive consequences (eg, therapeutic benefits for mental health and/or medical conditions, use of safer products and routes of administration), are needed using both quantitative and qualitative approaches.

Acknowledgments

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding support from the Peter Boris Chair in Addictions Research and a Canada Research Chair in Translational Addiction Research (JM). Funders had no role in the design or execution of the review.

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: James MacKillop discloses he is a principal and senior scientist in Beam Diagnostics, Inc, and a consultant to ClairvoyantRx. No other authors have disclosures.

Author Contributions: The author’s contribution is as follows: study conceptualization and design: KF, JW, JT, JM; data collection and interpretation: KF, EM, MS; manuscript writing and preparation: KF, EM, MS, PN; manuscript reviewing and editing: JW, JT, JM. All authors have reviewed and approved the final manuscript.

Banking on Trust: Supervisory Transparency and Depositors’ Actions

We explore the role of institutional trust in influencing depositors’ reactions to bank super-visory actions in India. Utilizing a unique event that led to unexpected penalties on banks and the quasi-random nature of branch locations, we find news of penalties on some banks leading to deposit withdrawals from offending and neighboring nonoffending branches. Such withdrawals are more pronounced in regions with lower trust in public institutions, including trust in courts and banks. Trust is associated with information access and the quality of local services. We find limited evidence that credit and economic activity also decline in regions with deposit withdrawals.

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Communication and Intelligent Systems

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Book Title : Communication and Intelligent Systems

Book Subtitle : Proceedings of ICCIS 2023, Volume 3

Editors : Harish Sharma, Vivek Shrivastava, Ashish Kumar Tripathi, Lipo Wang

Series Title : Lecture Notes in Networks and Systems

DOI : https://doi.org/10.1007/978-981-97-2082-8

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Number of Illustrations : 39 b/w illustrations, 161 illustrations in colour

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