legalization of marijuana's philippines research paper

Philippine Legal Research

A Study Concerning the Legalization of Medical Marijuana

By Teofilo Gensoli, Benedict Estrella, Andrei Manzon and Lou Villaluna

INTRODUCTION

The cultivation and use of cannabis is punishable under Republic Act 9165. Despite this, the Dangerous Drug Board found that cannabis is the most commonly abused drug in the country, with a rating of 57%. Although President Rodrigo Duterte expressed his support for the use of medical marijuana and his admission to occasional drug use, his administration pursued a violent crackdown on illegal drugs. Various groups such as Philippine Cannabis Compassion Society and Philippine Organization for the Reform of Marijuana Laws have been lobbying for the legalization of medical marijuana in the country.

Pursuant to Section 11, Article XIII of the 1987 Philippine Constitution, it shall be the policy of the State to adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost. The State shall protect and promote the right to health of the people and instill health consciousness among them.

The Philippines has already made development in research and allowance of compassionate use of drugs that are unregistered in the country through FDA Administrative Order 1992.

House Bill 6517 is being proposed which provides the prohibition, decriminalization, and legalization policies regarding the possession, use, distribution, and research of medical marijuana. Its aim is to push for the legalization and regulation of the medical use of cannabis which has been confirmed to have beneficial and therapeutic uses to treat medical conditions.

CHAPTER TWO

Statement of the Problem

The House of Representatives on Tuesday passed on third and final reading a measure that would allow the use of and research in medical marijuana in the country – House Bill No. 6517 – “The Philippine Compassionate Medical Cannabis Act” .

This study aims to determine the impact of legalizing medical marijuana in the Philippines. Specifically, this research aimed to answer the following questions:

• How many drug users in the Philippines use marijuana?
• What are the crimes committed by those who use marijuana?
• What are duties of the doctors in providing medical marijuana?
• Whether or not there will be a clear distinction between medical marijuana and recreational marijuana
• Whether or not there will be a decrease of crimes if medical marijuana is legalized

Significance of the Study

The findings of this study hoped to serve as a basis for future legislation in protecting those seeking treatment through medical marijuana and reducing crimes committed by those who distribute or sell marijuana.

Doctors.  To remind them of the significance of their role in providing proper care to those seeking medical intervention through marijuana; to provide them a  process regarding medical marijuana research; to provide information on the proposed House Bill 6517 and the importance of their participation;

Patients.  To inform them of their privileges, liabilities, and limitations when it comes to the procurement of medical marijuana.

Legislators.  To help them determine the factors that need more attention and requiring certain measures to safeguard the law to avoid abuse from patients and distributors.

Future Researchers.  To aid them in their research, provide information, and serve as a guide in attaining the objectives of their study.

Scope and Limitations

To date, only FDA Administrative Order 1992 enables the compassionate use of drugs that are unregistered in the country. There are no other laws that enable the use of marijuana legally so the researches are unable to provide Philippine data regarding medical marijuana. Proposed House Bill 6517, known as Philippine Compassionate Medical Cannabis Act, legalize the use, distribution, and research of medical marijuana. This research will assess whether there’s a need to legalize medical marijuana.

Definition of Terms

• Cannabis sativa L., Cannabis Americana, hashish, bhang, guaza, churrus, ganjab and embraces every kind, class and character of marijuana, whether dried or fresh and flowering, flowering or fruiting tops, or any part or portion of the plant and seeds thereof, and all its geographic varieties, whether as a reefer, resin, extract, tincture or in any form or whatsoever.
• Medical Cannabis – the use of cannabis including its constituents, THC, and other cannabinoids, as a physician-recommended form of medicine or herbal therapy. Medical cannabis shall not be used in its raw form.
• Medical use – the delivery, possession, transfer, transportation, or use of cannabis and its devices to treat or alleviate a registered qualified patient’s medical condition or symptoms associated with the patient’s medical condition or symptoms associated with the patient’s debilitating disease or its acquisition, administration, cultivation, or manufacturing for medical purposes.

CHAPTER III

Methodology

Descriptive research is a type of research that is used to describe the characteristics of a population. It collects data that are used to answer a wide range of what, when, and how questions pertaining to a particular population or group.

Discussions and Findings

            Data released by the Dangerous Drugs Board around 1.67 million Filipinos aged 10 to 69 are current users of drugs. Cannabis, at 57%, was found to be the most commonly abused dangerous drug.

            In Journal of Interpersonal Violence, it was found that marijuana use was associated with a doubling of domestic violence in the U.S. However, there’s still a lack of study in the Philippines regarding the correlation of marijuana use and crimes. The statistics provided does not create a distinction on illegal drugs used to commit a felony or crime.

            Section 6 of House Bill 6517 provides that to be considered competent to certify a patient’s medical need to use cannabis for treatment and to prescribe such treatment, a physician shall possess the following qualifications:

• Has an established bona fide relationship with patient;
• Is licensed by the PDEA to prescribe medical cannabis to qualified cannabis patients; and
• Professional knowledge of the use of medical cannabis

Section 2 of The Comprehensive Dangerous Drugs Act provides that the State shall provide measures to achieve a balance in the national drug control program so that the patients with debilitating medical condition may receive adequate amount of treatment and appropriate medications from the regulated use of dangerous drugs.

Section 2 of The Traditional and Alternative Medicine Act of 1997 provides that it shall be the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system. It also provides that the State shall seek a legally workable basis by which indigenous societies would own their knowledge of traditional medicine.

FDA Administrative Order No. 4 S. 1992 entitled “Policy and Requirements for Availing of Compassionate Special Permit for Restricted Use of Unregistered Drug and Device Product/Preparation” recognizes the need for drugs and devices product/preparation which are not registered or are in the process of registration in the Philippines by patients who are terminally or seriously ill. Access to these products for these patients is morally, socially, and ethically justified when there is no existing superior alternative therapy that can likely cure or adequately control their conditions.

House Bill 6517, known as Philippine Compassionate Medical Cannabis Act, provides the prohibition, decriminalization, and legalization policies regarding the possession, use, distribution, and research of medical marijuana. Its aim is to push for the legalization and regulation of the medical use of cannabis which has been confirmed to have beneficial and therapeutic uses to treat medical conditions. The passing of House Bill 6517 would enable Filipinos who have certain medical conditions to purchase marijuana safely and without criminal penalties.

            Section 4 of House Bill 6517 provides two (2) regulatory agencies. The Department of Health, in consultation with the FDA, shall be the principal regulatory agency for the use of medical cannabis. It shall register and issue licenses to qualified entities engaged in activities related to the use of medical cannabis. The Philippine Drug Enforcement Agency shall have a key role in monitoring and regulating the dispensation of medical cannabis in health facilities. It shall maintain a registry of qualified medical cannabis physicians and caregivers licensed to prescribe and administer medical cannabis to qualified patients under this Act.

            Through the aforementioned regulatory agencies and policies, it is easier to create a clear cut distinction between medical marijuana and recreational marijuana.

Due to no legalization of medical marijuana policies in the country yet, there are no studies regarding the impact of legalization of marijuana to the crime rate. But in studies that have been conducted overseas, the researchers stated that the results off their study indicate that medical marijuana laws result in significant reductions in both violent and property crime rates, with larger effects in Mexican border states,” and that “While these results for violent crime rates are consistent with previously reported evidence, we are the first paper to report such an effect on property crime as well. Moreover, the estimated effects of MMLs on property crime rates are substantially larger, which is not surprising given property crimes are more prevalent.”

So until House Bill 6517 is signed, we won’t see the impact it will have on crime rates.

Recommendations

Implement and enforce better and more effective drug policies that would encourage people to avoid the use of recreational marijuana. To lessen the chances of abuse, the law must impose more qualifications for doctors to be able to prescribe medical marijuana.

With the violent crackdown on illegal drugs, they should provide certifications or identification that one is eligible to purchase medical marijuana.

Conclusions

There is still a lot of research that needs to be put into medical marijuana. Studies made overseas are not conclusive when it comes to the correlation between legalization of medical marijuana and crime rates.

Sources and References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461328/

https://www.ddb.gov.ph/newsroom/511-2019-drug-survey-shows-drug-use-prevalence-rate-falls-to-2-05

https://www.pna.gov.ph/articles/1060435

https://ottawape.dfa.gov.ph/index.php/2016-04-13-06-16-59/advisories/1403-philippine-food-and-drug-administration-fda-administrative-order-no-4-s-1992-entitled-policy-and-requirements-for-availing-of-compassionate-special-permit-csp-for-restricted-use-of-unregistered-drug-and-device-product-preparation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358421/

http://thesis.honors.olemiss.edu/1490/1/THE%20ECONOMIC%20EFFECTS%20OF%20NATIONAL%20MARIJUANA%20LEGALIZATION.pdf

Click to access Philippine-Compassionate-Medical-Cannabis-Act.pdf

https://www.theguardian.com/world/2016/jul/01/philippines-president-rodrigo-duterte-urges-people-to-kill-drug-addicts

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Home > ETD > ETD_BACHELORS > 5613

Bachelor's Theses

Highway to health: a study on the legalization of medical marijuana in the philippines.

Juan Paolo Agoncillo Alyssa May Mariano

Date of Publication

Document type.

Bachelor's Thesis

Degree Name

Bachelor of Science in Legal Management

Subject Categories

Medical Jurisprudence

Ramon V. Del Rosario College of Business

Department/Unit

Commercial Law

Thesis Adviser

Erickson H. Balmes

Defense Panel Chair

Antonio A. Ligon

Defense Panel Member

Zenaida S. Manalo Christopher E. Cruz

Abstract/Summary

A growing number of states, however, have legalized the use and/or cultivation of marijuana for medical purposes thereby removing any criminal penalties from doctors who prescribe the drug or from patients who use it within the bounds set by state law. California was the first to legalize medical marijuana in 1996 when it passed Proposition 215, also called the Compassionate Use Act. The law allows the possession and cultivation of marijuana for medical purposes upon a doctor's recommendation. Other countries that have legalized medical marijuana include: Alaska, Colorado, Connecticut, Hawaii, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington. Medical marijuana is a hotly debated issue that affects patients, health care providers, lawyers, and law enforcement officials alike. Because medical marijuana laws vary, it is important to check the specific laws of a particular country. Now, the Philippine government is seeking for more progressive health services and innovation for an accessible medication for those who are in need. As the country upholds the constitutional provision of right to health of the people, Cong. Rodolfo Albano proposed the House Bill 4477 The Compassionate Use of Medical Cannabis Act. This is intended, out of compassion to help qualified patients suffering from chronic or debilitating medical conditions. This thesis dwelled on the question of law whether or not House Bill 4477 in allowing the use of cannabis for medicinal purposes for debilitating medical conditions is in accordance with the state's duty to protect and promote the right to health of the people and instill health consciousness among them. This revolves around the study of those who will benefit from the health accessibility of medical cannabis upon its enactment into law.

Abstract Format

Accession number, shelf location.

Archives, The Learning Commons, 12F, Henry Sy Sr. Hall

Physical Description

7, 103 leaves, 29 cm.

Marijuana—Therapeutic use—Law and legislation--Philippines

Recommended Citation

Agoncillo, J., & Mariano, A. (2016). Highway to health: A study on the legalization of medical marijuana in the Philippines. Retrieved from https://animorepository.dlsu.edu.ph/etd_bachelors/5613

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RESEARCH REPORT LEGALIZATION OF MARIJUANA IN THE PHILIPPINES ABM-LOYALTY LEGALIZATION OF MARIJUANA IN THE PHILIPPINES

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International Journal of Health Policy and Management IJHPM

Notwithstanding a century of prohibition, marijuana is the most widely used illicit substance in Canada. Due to the growing public acceptance of recreational marijuana use and ineffectiveness of the existing control system in Canada, the issue surrounding legalizing this illicit drug has received considerable public and political attentions in recent years. Consequently, the newly elected Liberal Government has formally announced that Canada will introduce legislation in the spring of 2017 to start legalizing and regulating marijuana. This editorial aims to provide a brief overview on potential economic, social, and public health impacts of legal marijuana in Canada. The legalization could increase tax revenue through the taxation levied on marijuana products and could also allow the Government to save citizens’ tax dollars currently being spent on prohibition enforcement. Moreover, legalization could also remove the criminal element from marijuana market and reduce the size of Canada’s black market and its consequences for the society. Nevertheless, it may also lead to some public health problems, including increasing in the uptake of the drug, accidents and injuries. The legalization should be accompanied with comprehensive strategies to keep the drug out of the hands of minors while increasing awareness and knowledge on harmful effects of the drug. In order to get better insights on how to develop an appropriate framework to legalize marijuana, Canada should closely watch the development in the neighboring country, the United States, where some of its states viz, Colorado, Oregon, Washington, and Alaska have already legalized recreational use of marijuana.

IJAR Indexing

Marijuana is one of the most abused drugs in the United States. In recent years, it has become one of the most discussed topics with massive media coverage. The principal reason for its nationwide coverage is a constant debate over its legalization. At present, nine states and Washington, D.C. have legalized recreational marijuana. It has been around six years since marijuana was legalized in Colorado and Washington. Also, medical marijuana is legal in thirty states. However, there is a big divide between people?s beliefs on the matter of marijuana legalization. Proponents of marijuana legalization argue that it would allow people to use a relatively safe substance without the threat of arrest, raise new revenue from marijuana sales, and redirect resources to fund new programs. Opponents of marijuana legalization argue that it is too dangerous to use, lacks FDA approval, and has adverse health consequences, and increased societal costs. The goal of this study is to offer an up-to-date overview of the existing information available on the impact of marijuana legalization on the society in marijuana-legal states. An accurate view of this subject would contribute to increased knowledge and improved awareness among people towards marijuana. However, the nationwide effect of legalizing marijuana remains an open question requiring further research and studies.

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Legalizing medical marijuana in the Philippines: A pharmacist’s perspective

In the past few days, Sen. Robinhood Padilla has been making headlines for pushing the legalization of medical marijuana for compassionate use in the Philippines.

This news is not new to me since I’ve been following its legalization process since 2017 when the House of Representatives granted the medical marijuana bill, a step forward to becoming law despite the Duterte administration’s war on drugs.

Marijuana or cannabis is legal in some countries like Uruguay and Canada, and in some US states like Colorado. Thailand is the first Southeast Asian nation to decriminalize the growing and selling of cannabis. Thais even celebrate a cannabis festival that undoubtedly attracts tourists and helps boost their economy, especially in the post-pandemic era.

Like marijuana, some of the substances that we are consuming can be habit-forming. These include alcohol, tobacco, and coffee. They are “gateway drugs” whose use can lead to the dependence on a harder drug such as cocaine or heroin.

The oldest evidence of marijuana use can be traced back to a 2,500-year-old cemetery in China. Even old texts such as “Ebers Papyrus” from Ancient Egypt and “De Materia Medica” by Greek physician Dioscorides described medical cannabis. Cannabis was also used in religious practices such as in India and is allegedly used as a component of holy anointing oil mentioned in some parts of the Bible like Exodus.

It is important to note that marijuana contains the principal mind-altering constituent called tetrahydrocannabinol (THC). This is the cannabinoid responsible for the “high” feeling and can interrupt critical tasks such as driving and machine operation. However, there are existing drug forms of THC, such as dronabinol, used to treat nausea and vomiting caused by cancer chemotherapy and to increase appetite in people with HIV/AIDS.

Aside from THC, cannabidiol (CBD) is also a prevalent cannabinoid and is essential in medical marijuana. In humans, CBD exhibits no effects indicative of any addiction and some clinical studies suggest that CBD has broad therapeutic uses, including rare forms of epilepsy and chronic pain.

Currently, marijuana in the country is classified as a dangerous drug under the Republic Act No. 9165 or the Comprehensive Dangerous Drugs Act of 2002. Despite this, terminally ill patients may apply for a special permit from the Food and Drug Administration (FDA) for compassionate purposes.

By account, marijuana is not the only medicinal plant that has a history of addiction. Opium poppy is the plant source of the powerful painkiller, morphine, especially used for cancer-related pain. Another is the coca plant, which is the source of the psychoactive stimulant, cocaine, that was once used for anesthesia. Before it was banned, cocaine was, in fact, the main ingredient in soft drinks.

While marijuana will only be used for medical purposes, the problem when it is legalized is the implementation of the law. Unfortunately, the Philippines is excellent at making a law, but not at implementing it. It could be prone to regulatory oversight. The ways in which medical marijuana has to be approved, prescribed, dosed, stored, and made available to the public will be very different from other prescription drugs. This will require a series of research and validations. Even though there is an enormous amount of research about marijuana from other countries like the US, these studies cannot be deemed similar to the marijuana grown on Philippine soil. Marijuana plants that are not cultivated in the same soil and environment would have a different plant chemistry and will not produce similar compounds even though they look morphologically the same. Because of this variation, results might have different safety profiles and might not exert the same therapeutic effects. There will still be a long journey before we see definite results.

Although the training of medical cannabis physicians and pharmacists is part of the bill, it is also critical that marijuana use should be taught in detail in medical and pharmacy schools, especially on treatment, dose, and route of administration.

Nevertheless, let us be open to the potential wonders of this disputed plant. If legalized, I hope it will be patient-oriented and research-oriented, with proper regulation and taxation.

Teresa Bandiola,

licensed pharmacist,

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Law students debate on legalizing medical marijuana in PH

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This is AI generated summarization, which may have errors. For context, always refer to the full article.

MANILA, Philippines – Is it time to legalize the medical use of marijuana in the Philippines? 

Debaters from the Ateneo de Manila University Law School and the University of Sto Tomas (UST) Law School discussed the issue at  “The Law and Policy Debate: An Inter-university Dialogue”  held at the House of Representatives on Tuesday, June 9.

It has been more than a year since Isabela 1st District Representative Rodolfo Albano III filed House Bill 4477 or the Compassionate Use of Medical Cannabis Bill, and it already has 69 co-authors to date.

The two debate teams argued on the necessity to passs  HB 4477 , with Ateneo on the affirmative side, and UST on the negative side. (READ:  PH doctors say no to medical marijuana bill )

While no team was declared a winner, Ateneo’s second affirmative speaker Pearl Simbulan was chosen as both Best Speaker and Best Interpellator.

Simbulan argued that legalizing medical marijuana will provide more options to patients who need it. It will also allow research and development on the “better uses” of marijuana  to continue.

The adjudicators were former Philippine Permanent Representative to the World Trade Organization Manuel Teehankee, Likhaan director and co-founder Junice Melgar, and Malou Tiquia, host of CNN Philippines’ current affairs program Agenda.

Debate arguments

Below are the arguments of each speaker:

ATENEO LAW SCHOOL

1st affirmative speaker: John Michael Villanueva

• There is a necessity to pass this bill in order to comply with the constitutional mandates and international obligations of promoting the right to health.
• There is a need to distinguish between the ill and the criminals, which can only be done by this bill.

2nd affirmative speaker: Pearl Simbulan

• Legalizing medical marijuana is the only and the best comprehensive approach to health. What we think in legalizing medical marijuana is that we provide the optimal care: [providing] a range of options that a physician who is in the best position to make these decisions can do for the patient.
• Because we illegalized blanketly marijuana, research on these kinds of things stopped, and it has become harder for us to discover even better uses of marijuana.

3rd affirmative speaker: Patrick Vincent Cocabo

“The q uestion should not be whether marijuana is good or bad, but rather, how can we control it? What is the best strategy to save lives?”

• Government regulation is important. 
• The bill provides an important mechanism of checks and balances of citizen accountability. 

UST LAW SCHOOL

1st negative speaker: Marie Sybil Tropicales

• Medical marijuana should not be legalized because at present, its detriments outweigh its benefits.  Medical marijuana is not necessary for legislation because essentially, it is not a cure in itself.

2nd negative speaker: John Paul Fabella

“The contentious documented benefits of medical marijuana cannot outweigh its adverse effects to the government and society.”

• On a socio-political level: Legalization sends a wrong message to public, especially to the youth, that marijuana is medically benevolent and not a harmful drug. The state cannot afford to risk our society to the dangers of increased marijuana use by implying a stance that it is not harmful.
• Legalizing medical marijuana is not advantageous to the government.
• Documented benefits are highly contentious at the moment and inconclusive.
• It undermines law enforcement by forcing officers to distinguish medical users and recreational users.

3rd negative speaker: Jackielyn Bana

• Is government ready for this? There are too much gray areas in the policy implementation at present, that no matter how noble the objective of the law is, that no matter how flawless its features are, it all go to waste because of the corrupt implementation of the laws.
• Example: Regulating tobacco, alocohol, sleeping pills, and prescription drugs
• This country has a problem with strict and faithful implementation of government policies and regulations. 
• What guarantee do we have that a seriously addictive drug could be regulated when simple regulations on tobacco and alcohol products prove to be impossible to impose?
• Once marijuana is legalized, there is no possibility of regulating it.

Adjudicators comment

The adjudicators welcomed the law students’ interest in discussing the advantages and disadvantages of legalizing medical marijuana in the Philippines. (READ:  Solon: Let’s start talking about medical marijuana )

“I’m happy that the youth are taking positions especially on an issue which is very, very real in your sector,” Tiquia said after all interpellations were done. She lauded the bill for being “very rigid,” and disagreed with UST’s Fabella that regulating marijuana means legitimizing it. 

Melgar noted how “selective” the bill is on legalizing marijuana only for medical use. (READ:  When medicines fail, marijuana is moms’ last hope )

“All the public knows about marijuana is the stereotype, that it’s all for getting high, and nobody shines a light on the few instances where it is the most compassionate for children who have epilepsy, for patients who have cancer,” Melgar added.

HB 4477 is still pending with the House committee on health. Albano said it is possible to enact the bill during the 16th Congress, but admitted the probability is “iffy” and will depend “on how fast they will settle the issue on the BBL (Bangsamoro Basic Law).”

Albano said Congress is “focused” on the Bangsamoro Basic Law, which  reached the House plenary on June 1. 

Tuesday’s debate was organized by the Teehankee Center for the Rule of Law and Ateneo’s St Thomas More Debate and Advocacy Society, in partnership with the Office of Representative Albano and the Office of Ang Nars party-list Representative Leah Paquiz.  – Rappler.com

Medical marijuana image from Shutterstock

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Philippine senator seeks to legalize medical marijuana

Rookie lawmaker files bill that would make country 2nd in Asia to permit cannabis use

MANILA -- A rookie senator is hoping that the Philippines can follow Thailand in becoming only the second Asian country to legalize the use of marijuana for medical purposes.

Former movie star and newly elected lawmaker Robin Padilla last month filed a Senate bill to "legalize and regulate the medical use of cannabis, which has been confirmed to have beneficial and therapeutic uses for known debilitating medical conditions."

Smoke signals: Thailand blazes trail for cannabis in wary Asia

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PDEA ‘thumbs up’ on legalizing medical marijuana; DDB defers to health experts’ position

MANILA, Philippines — The Philippine Drug Enforcement Agency (PDEA) has given a “thumbs up” to the legalization of medical marijuana in the country, but the Dangerous Drug Board (DDB) said its position would be determined by its counterparts in the health sector

PDEA director general Wilkins Villanueva and DDB Secretary Catalino Cuy presented their stance on this issue when asked by Senator Robin Padilla during the finance subcommittee deliberations on the proposed 2023 budget of both agencies on Wednesday.

Even though Villanueva quickly approved of legalizing medical marijuana usage, Cuy said the DBB’s position on the issue would be determined by its health expert members.

“Remember, ang DBB ay board. Meron po kaming members diyan katulad ng Department of Health (DOH) na sila po ang mga eksperto sa bagay na iyan. Mga medical matter. Kaya we defer sa position and recommendation ng DOH [at] ng Philippine Medical Association,” Cuy explained.

(Remember, DBB is a board. We have members from the DOH, who are experts in these medical matters, so we defer to the position and recommendation of the DOH and the Philippine Medical Association.)

He assured them that the DBB would back any research into medical marijuana’s potential benefits and noted that the drug is already legal in the country for “compassionate use.”

Under the Comprehensive Dangerous Drugs Act of 2022, marijuana is classified as a dangerous drug, but terminally ill patients may apply for a special permit from the Food and Drug Administration for compassionate purposes.

The neophyte lawmaker noted, however, that only the rich and those with connections could enjoy such a privilege.

“Hindi nakikinibang ang mahihirap na tao dito. Nakakalungkot po ito kasi ang presyo po nito, kapag dumaan sa inyong butihing opisina at binigyan niyo po ng permit. Bibilhin sa abroad. Nagkakahalaga po ito ng $30,000 per year. Hindi po ito kayang bilhin ng mga mahihirap na tao,” he said.

(Poor people cannot benefit from this. It’s sad because the cost of this once it goes through your good office, then is granted a permit, and later bought abroad amounts to $30,000 per year. Poor people will not be able to afford this.)

Padilla stressed that the poor should not be denied the benefits of medical marijuana.

“Ito naman po ay medical. Hindi po ito patungkol sa recreation. Hindi po natin ine-encourage iyan,” he added. (This is medical, not recreational. We don’t encourage the latter.)

Padilla then restated a part of his earlier filed Senate Bill No. 230 or the “Medical Cannabis Compassionate Access Act of the Philippines,” which aims to legalize the selling of medical marijuana only in capsules or oil and never without a prescription from a doctor.

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Once legal, the government will also designate a place where marijuana can be planted and regulated by authorized farmers.

Senator Bong Go, meanwhile, said a more in-depth discussion on the matter will soon be done before the upper chamber’s committee on health, which he leads.

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Senators support legalization of medical marijuana use

THREE SENATORS on Wednesday expressed support to the proposed legalization of medical marijuana use in the Philippines, citing therapeutic benefits and potential economic gains for growers and the government.  

During the Finance hearing on the budget of the Dangerous Drugs Board (DDB), Senator Robinhood Ferdinand “Robin” C. Padilla, who earlier filed a bill seeking to legalize medical cannabis, questioned the stance of said agencies to his proposal.   

He cited that the United Nations Commission has voted to remove cannabis from a list that categorized it as one of the most dangerous drugs, recognizing the plant as having medicinal value.   

DDB Secretary Catalino S. Cuy, in response, said the United Nations Office on Drugs and Crimes, which the Philippines is part of, found that although it could be used for medical purposes, risks remain.    

For this reason, their position is to defer to the recommendations of the Department of Health and the Philippine Medical Association. 

“ But at present, medical use, experiment and procedure are allowed, especially what we call compassionate use, ” Mr. Cuy said, “ but we support further medical research for possible medical use of marijuana. ”   

Mr. Padilla said while there are government procedures currently allowing for compassionate use, it was too costly.  

“ Let us not be selfish towards the poor when there are benefits that can be given by medical cannabis, ” the senator said in Filipino. “ This is medical, this is not about recreation, we are not encouraging that. ”   

Senator Ronald M. Dela Rosa, who chaired the subcommittee, said a recent conversation with the head of the police regional office in the Cordillera Administrative Region was an “ eye-opener ” for him on the extent of marijuana production in the mountain area.  

“ If we are able to exploit this economically, if for example the medical marijuana becomes legal in the country, this will become a big source of income for the people in Cordillera as it naturally grows in their mountains, ” Mr. Dela Rosa said.    

The government will also be able to collect taxes from marijuana sales.     

Senator Christopher Lawrence “ Bong ” T. Go, who chairs the Senate Health and Demography Committee, also supported the proposal but cautioned that strong regulatory measures should be in place to avoid abuse and criminal activities.     

The committee endorsed the agency ’ s P447.41 million proposed budget for 2023 to the Senate plenary. — Alyssa Nicole O. Tan  

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• Research article
• Open access
• Published: 04 February 2020

Marijuana legalization and historical trends in marijuana use among US residents aged 12–25: results from the 1979–2016 National Survey on drug use and health

• Xinguang Chen 1 ,
• Xiangfan Chen 2 &
• Hong Yan 2  

BMC Public Health volume  20 , Article number:  156 ( 2020 ) Cite this article

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Marijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization.

Data ( n  = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979–2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model.

After controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979–1992 and 2001–2006, and increases in 1992–2001 and 2006–2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954–1972, a sudden increase in 1972–1984, followed by a decline in 1984–2003.

The model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Peer Review reports

Introduction

Marijuana use and laws in the united states.

Marijuana is one of the most commonly used drugs in the United States (US) [ 1 ]. In 2015, 8.3% of the US population aged 12 years and older used marijuana in the past month; 16.4% of adolescents aged 12–17 years used in lifetime and 7.0% used in the past month [ 2 ]. The effects of marijuana on a person’s health are mixed. Despite potential benefits (e.g., relieve pain) [ 3 ], using marijuana is associated with a number of adverse effects, particularly among adolescents. Typical adverse effects include impaired short-term memory, cognitive impairment, diminished life satisfaction, and increased risk of using other substances [ 4 ].

Since 1937 when the Marijuana Tax Act was issued, a series of federal laws have been subsequently enacted to regulate marijuana use, including the Boggs Act (1952), Narcotics Control Act (1956), Controlled Substance Act (1970), and Anti-Drug Abuse Act (1986) [ 5 , 6 ]. These laws regulated the sale, possession, use, and cultivation of marijuana [ 6 ]. For example, the Boggs Act increased the punishment of marijuana possession, and the Controlled Substance Act categorized the marijuana into the Schedule I Drugs which have a high potential for abuse, no medical use, and not safe to use without medical supervision [ 5 , 6 ]. These federal laws may have contributed to changes in the historical trend of marijuana use among youth.

Movements to decriminalize and legalize marijuana use

Starting in the late 1960s, marijuana decriminalization became a movement, advocating reformation of federal laws regulating marijuana [ 7 ]. As a result, 11 US states had taken measures to decriminalize marijuana use by reducing the penalty of possession of small amount of marijuana [ 7 ].

The legalization of marijuana started in 1993 when Surgeon General Elder proposed to study marijuana legalization [ 8 ]. California was the first state that passed Medical Marijuana Laws (MML) in 1996 [ 9 ]. After California, more and more states established laws permitting marijuana use for medical and/or recreational purposes. To date, 33 states and the District of Columbia have established MML, including 11 states with recreational marijuana laws (RML) [ 9 ]. Compared with the legalization of marijuana use in the European countries which were more divided that many of them have medical marijuana registered as a treatment option with few having legalized recreational use [ 10 , 11 , 12 , 13 ], the legalization of marijuana in the US were more mixed with 11 states legalized medical and recreational use consecutively, such as California, Nevada, Washington, etc. These state laws may alter people’s attitudes and behaviors, finally may lead to the increased risk of marijuana use, particularly among young people [ 13 ]. Reported studies indicate that state marijuana laws were associated with increases in acceptance of and accessibility to marijuana, declines in perceived harm, and formation of new norms supporting marijuana use [ 14 ].

Marijuana harm to adolescents and young adults

Adolescents and young adults constitute a large proportion of the US population. Data from the US Census Bureau indicate that approximately 60 million of the US population are in the 12–25 years age range [ 15 ]. These people are vulnerable to drugs, including marijuana [ 16 ]. Marijuana is more prevalent among people in this age range than in other ages [ 17 ]. One well-known factor for explaining the marijuana use among people in this age range is the theory of imbalanced cognitive and physical development [ 4 ]. The delayed brain development of youth reduces their capability to cognitively process social, emotional and incentive events against risk behaviors, such as marijuana use [ 18 ]. Understanding the impact of marijuana laws on marijuana use among this population with a historical perspective is of great legal, social and public health significance.

Inconsistent results regarding the impact of marijuana laws on marijuana use

A number of studies have examined the impact of marijuana laws on marijuana use across the world, but reported inconsistent results [ 13 ]. Some studies reported no association between marijuana laws and marijuana use [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], some reported a protective effect of the laws against marijuana use [ 24 , 26 ], some reported mixed effects [ 27 , 28 ], while some others reported a risk effect that marijuana laws increased marijuana use [ 29 , 30 ]. Despite much information, our review of these reported studies revealed several limitations. First of all, these studies often targeted a short time span, ignoring the long period trend before marijuana legalization. Despite the fact that marijuana laws enact in a specific year, the process of legalization often lasts for several years. Individuals may have already changed their attitudes and behaviors before the year when the law is enacted. Therefore, it may not be valid when comparing marijuana use before and after the year at a single time point when the law is enacted and ignoring the secular historical trend [ 19 , 30 , 31 ]. Second, many studies adapted the difference-in-difference analytical approach designated for analyzing randomized controlled trials. No US state is randomized to legalize the marijuana laws, and no state can be established as controls. Thus, the impact of laws cannot be efficiently detected using this approach. Third, since marijuana legalization is a public process, and the information of marijuana legalization in one state can be easily spread to states without the marijuana laws. The information diffusion cannot be ruled out, reducing the validity of the non-marijuana law states as the controls to compare the between-state differences [ 31 ].

Alternatively, evidence derived based on a historical perspective may provide new information regarding the impact of laws and regulations on marijuana use, including state marijuana laws in the past two decades. Marijuana users may stop using to comply with the laws/regulations, while non-marijuana users may start to use if marijuana is legal. Data from several studies with national data since 1996 demonstrate that attitudes, beliefs, perceptions, and use of marijuana among people in the US were associated with state marijuana laws [ 29 , 32 ].

Age-period-cohort modeling: looking into the past with recent data

To investigate historical trends over a long period, including the time period with no data, we can use the classic age-period-cohort modeling (APC) approach. The APC model can successfully discompose the rate or prevalence of marijuana use into independent age, period and cohort effects [ 33 , 34 ]. Age effect refers to the risk associated with the aging process, including the biological and social accumulation process. Period effect is risk associated with the external environmental events in specific years that exert effect on all age groups, representing the unbiased historical trend of marijuana use which controlling for the influences from age and birth cohort. Cohort effect refers to the risk associated with the specific year of birth. A typical example is that people born in 2011 in Fukushima, Japan may have greater risk of cancer due to the nuclear disaster [ 35 ], so a person aged 80 in 2091 contains the information of cancer risk in 2011 when he/she was born. Similarly, a participant aged 25 in 1979 contains information on the risk of marijuana use 25 years ago in 1954 when that person was born. With this method, we can describe historical trends of marijuana use using information stored by participants in older ages [ 33 ]. The estimated period and cohort effects can be used to present the unbiased historical trend of specific topics, including marijuana use [ 34 , 36 , 37 , 38 ]. Furthermore, the newly established hierarchical APC (HAPC) modeling is capable of analyzing individual-level data to provide more precise measures of historical trends [ 33 ]. The HAPC model has been used in various fields, including social and behavioral science, and public health [ 39 , 40 ].

Several studies have investigated marijuana use with APC modeling method [ 17 , 41 , 42 ]. However, these studies covered only a small portion of the decades with state marijuana legalization [ 17 , 42 ]. For example, the study conducted by Miech and colleagues only covered periods from 1985 to 2009 [ 17 ]. Among these studies, one focused on a longer state marijuana legalization period, but did not provide detailed information regarding the impact of marijuana laws because the survey was every 5 years and researchers used a large 5-year age group which leads to a wide 10-year birth cohort. The averaging of the cohort effects in 10 years could reduce the capability of detecting sensitive changes of marijuana use corresponding to the historical events [ 41 ].

Purpose of the study

In this study, we examined the historical trends in marijuana use among youth using HAPC modeling to obtain the period and cohort effects. These two effects provide unbiased and independent information to characterize historical trends in marijuana use after controlling for age and other covariates. We conceptually linked the model-derived time trends to both federal and state laws/regulations regarding marijuana and other drug use in 1954–2016. The ultimate goal is to provide evidence informing federal and state legislation and public health decision-making to promote responsible marijuana use and to protect young people from marijuana use-related adverse consequences.

Materials and methods

Data sources and study population.

Data were derived from 31 waves of National Survey on Drug Use and Health (NSDUH), 1979–2016. NSDUH is a multi-year cross-sectional survey program sponsored by the Substance Abuse and Mental Health Services Administration. The survey was conducted every 3 years before 1990, and annually thereafter. The aim is to provide data on the use of tobacco, alcohol, illicit drug and mental health among the US population.

Survey participants were noninstitutionalized US civilians 12 years of age and older. Participants were recruited by NSDUH using a multi-stage clustered random sampling method. Several changes were made to the NSDUH after its establishment [ 43 ]. First, the name of the survey was changed from the National Household Survey on Drug Abuse (NHSDA) to NSDUH in 2002. Second, starting in 2002, adolescent participants receive $30 as incentives to improve the response rate. Third, survey mode was changed from personal interviews with self-enumerated answer sheets (before 1999) to the computer-assisted person interviews (CAPI) and audio computer-assisted self-interviews (ACASI) (since 1999). These changes may confound the historical trends [ 43 ], thus we used two dummy variables as covariates, one for the survey mode change in 1999 and another for the survey method change in 2002 to control for potential confounding effect.

Data acquisition

Data were downloaded from the designated website ( https://nsduhweb.rti.org/respweb/homepage.cfm ). A database was used to store and merge the data by year for analysis. Among all participants, data for those aged 12–25 years ( n  = 749,152) were included. We excluded participants aged 26 and older because the public data did not provide information on single or two-year age that was needed for HAPC modeling (details see statistical analysis section). We obtained approval from the Institutional Review Board at the University of Florida to conduct this study.

Variables and measurements

Current marijuana use: the dependent variable. Participants were defined as current marijuana users if they reported marijuana use within the past 30 days. We used the variable harmonization method to create a comparable measure across 31-wave NSDUH data [ 44 ]. Slightly different questions were used in NSDUH. In 1979–1993, participants were asked: “When was the most recent time that you used marijuana or hash?” Starting in 1994, the question was changed to “How long has it been since you last used marijuana or hashish?” To harmonize the marijuana use variable, participants were coded as current marijuana users if their response to the question indicated the last time to use marijuana was within past 30 days.

Chronological age, time period and birth cohort were the predictors. (1) Chronological age in years was measured with participants’ age at the survey. APC modeling requires the same age measure for all participants [ 33 ]. Since no data by single-year age were available for participants older than 21, we grouped all participants into two-year age groups. A total of 7 age groups, 12–13, ..., 24–25 were used. (2) Time period was measured with the year when the survey was conducted, including 1979, 1982, 1985, 1988, 1990, 1991... 2016. (3). Birth cohort was the year of birth, and it was measured by subtracting age from the survey year.

The proportion of people covered by MML: This variable was created by dividing the population in all states with MML over the total US population. The proportion was computed by year from 1996 when California first passed the MML to 2016 when a total of 29 states legalized medical marijuana use. The estimated proportion ranged from 12% in 1996 to 61% in 2016. The proportion of people covered by RML: This variable was derived by dividing the population in all states with RML with the total US population. The estimated proportion ranged from 4% in 2012 to 21% in 2016. These two variables were used to quantitatively assess the relationships between marijuana laws and changes in the risk of marijuana use.

Covariates: Demographic variables gender (male/female) and race/ethnicity (White, Black, Hispanic and others) were used to describe the study sample.

Statistical analysis

We estimated the prevalence of current marijuana use by year using the survey estimation method, considering the complex multi-stage cluster random sampling design and unequal probability. A prevalence rate is not a simple indicator, but consisting of the impact of chronological age, time period and birth cohort, named as age, period and cohort effects, respectively. Thus, it is biased if a prevalence rate is directly used to depict the historical trend. HAPC modeling is an epidemiological method capable of decomposing prevalence rate into mutually independent age, period and cohort effects with individual-level data, while the estimated period and cohort effects provide an unbiased measure of historical trend controlling for the effects of age and other covariates. In this study, we analyzed the data using the two-level HAPC cross-classified random-effects model (CCREM) [ 36 ]:

Where M ijk represents the rate of marijuana use for participants in age group i (12–13, 14,15...), period j (1979, 1982,...) and birth cohort k (1954–55, 1956–57...); parameter α i (age effect) was modeled as the fixed effect; and parameters β j (period effect) and γ k (cohort effect) were modeled as random effects; and β m was used to control m covariates, including the two dummy variables assessing changes made to the NSDUH in 1999 and 2002, respectively.

The HAPC modeling analysis was executed using the PROC GLIMMIX. Sample weights were included to obtain results representing the total US population aged 12–25. A ridge-stabilized Newton-Raphson algorithm was used for parameter estimation. Modeling analysis was conducted for the overall sample, stratified by gender. The estimated age effect α i , period β j and cohort γ k (i.e., the log-linear regression coefficients) were directly plotted to visualize the pattern of change.

To gain insight into the relationship between legal events and regulations at the national level, we listed these events/regulations along with the estimated time trends in the risk of marijuana from HAPC modeling. To provide a quantitative measure, we associated the estimated period effect with the proportions of US population living with MML and RML using Pearson correlation. All statistical analyses for this study were conducted using the software SAS, version 9.4 (SAS Institute Inc., Cary, NC).

Sample characteristics

Data for a total of 749,152 participants (12–25 years old) from all 31-wave NSDUH covering a 38-year period were analyzed. Among the total sample (Table  1 ), 48.96% were male and 58.78% were White, 14.84% Black, and 18.40% Hispanic.

Prevalence rate of current marijuana use

As shown in Fig.  1 , the estimated prevalence rates of current marijuana use from 1979 to 2016 show a “V” shaped pattern. The rate was 27.57% in 1979, it declined to 8.02% in 1992, followed by a gradual increase to 14.70% by 2016. The pattern was the same for both male and female with males more likely to use than females during the whole period.

Prevalence rate (%) of current marijuana use among US residents 12 to 25 years of age during 1979–2016, overall and stratified by gender. Derived from data from the 1979–2016 National Survey on Drug Use and Health (NSDUH)

HAPC modeling and results

Estimated age effects α i from the CCREM [ 1 ] for current marijuana use are presented in Fig.  2 . The risk by age shows a 2-phase pattern –a rapid increase phase from ages 12 to 19, followed by a gradually declining phase. The pattern was persistent for the overall sample and for both male and female subsamples.

Age effect for the risk of current marijuana use, overall and stratified by male and female, estimated with hierarchical age-period-cohort modeling method with 31 waves of NSDUH data during 1979–2016. Age effect α i were log-linear regression coefficients estimated using CCREM (1), see text for more details

The estimated period effects β j from the CCREM [ 1 ] are presented in Fig.  3 . The period effect reflects the risk of current marijuana use due to significant events occurring over the period, particularly federal and state laws and regulations. After controlling for the impacts of age, cohort and other covariates, the estimated period effect indicates that the risk of current marijuana use had two declining trends (1979–1992 and 2001–2006), and two increasing trends (1992–2001 and 2006–2016). Epidemiologically, the time trends characterized by the estimated period effects in Fig. 3 are more valid than the prevalence rates presented in Fig. 1 because the former was adjusted for confounders while the later was not.

Period effect for the risk of marijuana use for US adolescents and young adults, overall and by male/female estimated with hierarchical age-period-cohort modeling method and its correlation with the proportion of US population covered by Medical Marijuana Laws and Recreational Marijuana Laws. Period effect β j were log-linear regression coefficients estimated using CCREM (1), see text for more details

Correlation of the period effect with proportions of the population covered by marijuana laws: The Pearson correlation coefficient of the period effect with the proportions of US population covered by MML during 1996–2016 was 0.89 for the total sample, 0.81 for male and 0.93 for female, respectively ( p  < 0.01 for all). The correlation between period effect and proportion of US population covered by RML was 0.64 for the total sample, 0.59 for male and 0.49 for female ( p  > 0.05 for all).

Likewise, the estimated cohort effects γ k from the CCREM [ 1 ] are presented in Fig.  4 . The cohort effect reflects changes in the risk of current marijuana use over the period indicated by the year of birth of the survey participants after the impacts of age, period and other covariates are adjusted. Results in the figure show three distinctive cohorts with different risk patterns of current marijuana use during 1954–2003: (1) the Historical Declining Cohort (HDC): those born in 1954–1972, and characterized by a gradual and linear declining trend with some fluctuations; (2) the Sudden Increase Cohort (SIC): those born from 1972 to 1984, characterized with a rapid almost linear increasing trend; and (3) the Contemporary Declining Cohort (CDC): those born during 1984 and 2003, and characterized with a progressive declining over time. The detailed results of HAPC modeling analysis were also shown in Additional file 1 : Table S1.

Cohort effect for the risk of marijuana use among US adolescents and young adults born during 1954–2003, overall and by male/female, estimated with hierarchical age-period-cohort modeling method. Cohort effect γ k were log-linear regression coefficients estimated using CCREM (1), see text for more details

This study provides new data regarding the risk of marijuana use in youth in the US during 1954–2016. This is a period in the US history with substantial increases and declines in drug use, including marijuana; accompanied with many ups and downs in legal actions against drug use since the 1970s and progressive marijuana legalization at the state level from the later 1990s till today (see Additional file 1 : Table S2). Findings of the study indicate four-phase period effect and three-phase cohort effect, corresponding to various historical events of marijuana laws, regulations and social movements.

Coincident relationship between the period effect and legal drug control

The period effect derived from the HAPC model provides a net effect of the impact of time on marijuana use after the impact of age and birth cohort were adjusted. Findings in this study indicate that there was a progressive decline in the period effect during 1979 and 1992. This trend was corresponding to a period with the strongest legal actions at the national level, the War on Drugs by President Nixon (1969–1974) President Reagan (1981–1989) [ 45 ], and President Bush (1989) [ 45 ],and the Anti-Drug Abuse Act (1986) [ 5 ].

The estimated period effect shows an increasing trend in 1992–2001. During this period, President Clinton advocated for the use of treatment to replace incarceration (1992) [ 45 ], Surgeon General Elders proposed to study marijuana legalization (1993–1994) [ 8 ], President Clinton’s position of the need to re-examine the entire policy against people who use drugs, and decriminalization of marijuana (2000) [ 45 ] and the passage of MML in eight US states.

The estimated period effect shows a declining trend in 2001–2006. Important laws/regulations include the Student Drug Testing Program promoted by President Bush, and the broadened the public schools’ authority to test illegal drugs among students given by the US Supreme Court (2002) [ 46 ].

The estimated period effect increases in 2006–2016. This is the period when the proportion of the population covered by MML progressively increased. This relation was further proved by a positive correlation between the estimated period effect and the proportion of the population covered by MML. In addition, several other events occurred. For example, over 500 economists wrote an open letter to President Bush, Congress and Governors of the US and called for marijuana legalization (2005) [ 47 ], and President Obama ended the federal interference with the state MML, treated marijuana as public health issues, and avoided using the term of “War on Drugs” [ 45 ]. The study also indicates that the proportion of population covered by RML was positively associated with the period effect although not significant which may be due to the limited number of data points of RML. Future studies may follow up to investigate the relationship between RML and rate of marijuana use.

Coincident relationship between the cohort effect and legal drug control

Cohort effect is the risk of marijuana use associated with the specific year of birth. People born in different years are exposed to different laws, regulations in the past, therefore, the risk of marijuana use for people may differ when they enter adolescence and adulthood. Findings in this study indicate three distinctive cohorts: HDC (1954–1972), SIC (1972–1984) and CDC (1984–2003). During HDC, the overall level of marijuana use was declining. Various laws/regulations of drug use in general and marijuana in particular may explain the declining trend. First, multiple laws passed to regulate the marijuana and other substance use before and during this period remained in effect, for example, the Marijuana Tax Act (1937), the Boggs Act (1952), the Narcotics Control Act (1956) and the Controlled Substance Act (1970). Secondly, the formation of government departments focusing on drug use prevention and control may contribute to the cohort effect, such as the Bureau of Narcotics and Dangerous Drugs (1968) [ 48 ]. People born during this period may be exposed to the macro environment with laws and regulations against marijuana, thus, they may be less likely to use marijuana.

Compared to people born before 1972, the cohort effect for participants born during 1972 and 1984 was in coincidence with the increased risk of using marijuana shown as SIC. This trend was accompanied by the state and federal movements for marijuana use, which may alter the social environment and public attitudes and beliefs from prohibitive to acceptive. For example, seven states passed laws to decriminalize the marijuana use and reduced the penalty for personal possession of small amount of marijuana in 1976 [ 7 ]. Four more states joined the movement in two subsequent years [ 7 ]. People born during this period may have experienced tolerated environment of marijuana, and they may become more acceptable of marijuana use, increasing their likelihood of using marijuana.

A declining cohort CDC appeared immediately after 1984 and extended to 2003. This declining cohort effect was corresponding to a number of laws, regulations and movements prohibiting drug use. Typical examples included the War on Drugs initiated by President Nixon (1980s), the expansion of the drug war by President Reagan (1980s), the highly-publicized anti-drug campaign “Just Say No” by First Lady Nancy Reagan (early 1980s) [ 45 ], and the Zero Tolerance Policies in mid-to-late 1980s [ 45 ], the Anti-Drug Abuse Act (1986) [ 5 ], the nationally televised speech of War on Drugs declared by President Bush in 1989 and the escalated War on Drugs by President Clinton (1993–2001) [ 45 ]. Meanwhile many activities of the federal government and social groups may also influence the social environment of using marijuana. For example, the Federal government opposed to legalize the cultivation of industrial hemp, and Federal agents shut down marijuana sales club in San Francisco in 1998 [ 48 ]. Individuals born in these years grew up in an environment against marijuana use which may decrease their likelihood of using marijuana when they enter adolescence and young adulthood.

This study applied the age-period-cohort model to investigate the independent age, period and cohort effects, and indicated that the model derived trends in marijuana use among adolescents and young adults were coincident with the laws and regulations on marijuana use in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.

Limitations

This study has limitations. First, study data were collected through a household survey, which is subject to underreporting. Second, no causal relationship can be warranted using cross-sectional data, and further studies are needed to verify the association between the specific laws/regulation and the risk of marijuana use. Third, data were available to measure single-year age up to age 21 and two-year age group up to 25, preventing researchers from examining the risk of marijuana use for participants in other ages. Lastly, data derived from NSDUH were nation-wide, and future studies are needed to analyze state-level data and investigate the between-state differences. Although a systematic review of all laws and regulations related to marijuana and other drugs is beyond the scope of this study, findings from our study provide new data from a historical perspective much needed for the current trend in marijuana legalization across the nation to get the benefit from marijuana while to protect vulnerable children and youth in the US. It provides an opportunity for stack-holders to make public decisions by reviewing the findings of this analysis together with the laws and regulations at the federal and state levels over a long period since the 1950s.

Availability of data and materials

The data of the study are available from the designated repository ( https://nsduhweb.rti.org/respweb/homepage.cfm ).

Abbreviations

Audio computer-assisted self-interviews

Age-period-cohort modeling

Computer-assisted person interviews

Cross-classified random-effects model

Contemporary Declining Cohort

Hierarchical age-period-cohort

Historical Declining Cohort

Medical Marijuana Laws

National Household Survey on Drug Abuse

National Survey on Drug Use and Health

Recreational Marijuana Laws

Sudden Increase Cohort

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Department of Epidemiology, University of Florida, Gainesville, FL, 32608, USA

Bin Yu & Xinguang Chen

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BY designed the study, collected the data, conducted the data analysis, drafted and reviewed the manuscript; XGC designed the study and reviewed the manuscript. XFC and HY reviewed the manuscript. All authors read and approved the final version of the manuscript.

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Additional file 1: table s1..

Estimated Age, Period, Cohort Effects for the Trend of Marijuana Use in Past Month among Adolescents and Emerging Adults Aged 12 to 25 Years, NSDUH, 1979-2016. Table S2. Laws at the federal and state levels related to marijuana use.

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Yu, B., Chen, X., Chen, X. et al. Marijuana legalization and historical trends in marijuana use among US residents aged 12–25: results from the 1979–2016 National Survey on drug use and health. BMC Public Health 20 , 156 (2020). https://doi.org/10.1186/s12889-020-8253-4

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The Health Hazards of Legalizing Marijuana

I n a dramatic example of government yielding to public opinion the Senate has introduced legislation to legalize cannabis on the federal level . Though passage before the November election is unlikely, this long overdue legislative action seeks to update a statute stemming [pun intended] from marijuana’s demonized image as depicted in the 1936 documentary film “Reefer Madness” and better reflect public opinion and liberal social trends. Currently, under the Federal  Controlled Substances Act  (CSA) of 1970, cannabis is considered to have “no accepted medical use” and a high potential for abuse and physical or psychological dependence. This Federal statute contrasts with the claims of therapeutic benefits of cannabis’ biochemical constituents such as cannabidiol and THC (tetra-hydro-cannabinol) when the sole FDA indication for their use is a rare childhood (Lennox-Gasteau) seizure disorder.

While the scientific information to officially endorse cannabis products as having therapeutic benefits is lacking, a recent Pew Research Center Survey found that 88 percent of Americans felt that marijuana should be legal for medical or recreational use. This wave of popular opinion has led to marijuana’s approval in 38 states for medical use, in 24 states for recreational use and decriminalization in an additional seven states.

Who could have anticipated that in less than two decades, a naturally grown recreational intoxicant, cannabis sativa, would go from demonization (as) to mainstream, and begat a tsunami of popular demand for legalization and a gold-rush of commercialization fueled by $61 billion of investment. Some may see this as an impressive demonstration of social progress, while others consider it the result of reckless and ill-conceived policies that have created a tangled matrix of laws and conflicting incentives based on confused logic and incomplete knowledge.

Americans now have access to a recreational intoxicant that is arguably no more dangerous than alcohol or tobacco without fear of the disproportionately severe punishments previously meted out to those apprehended for possession and use. But at the same time, there are numerous inconsistencies and cross-purposes integral to the legalization and commercialization of cannabis products. The most obvious of these is the fact that Federal law considers the use, sale, and possession of cannabis illegal.

Read More: What Marijuana Reclassification Means for the United States

The consequence of the latter was not just that the exaggerated therapeutic claims were not born out by scientific research, but that it served as a “Trojan Horse” to galvanize public opinion and advance cannabis advocates ultimate goal of unfettered access. This came to fruition when the state legislatures of Colorado and Washington voted to legalize the commercial production and sale of cannabis products in 2012. This triggered a stunning demonstration of states’ rights in which a majority of states followed suit by liberalizing their cannabis laws despite Federal prohibitions. 

The legislative conflict between Federal and state laws is not ideal, but not a grievous problem in large part because the conflict is tolerated and not enforced. More onerous is the conflict between legislative reform and public health that has emerged. By acceding to public opinion and false claims of salutary effects, state governments are exposing their constituents to health hazards. Compounding this misguided policy is the fact that state governments are incentivized by the prospect of increased tax revenues.

In a glaring recent example of governmental missteps, on March 17, Gov. Kathy Hochul declared New York State’s commercialized cannabis licensing and distribution system “ a disaster ” and announced “a top-to-bottom review of the NYS Cannabis Control Board and its system for regulating legalized cannabis products.” The main purpose of the review was to process applications faster and enable more cannabis vendors to open. Just weeks before  Hochul’s executive order which was intended to give New Yorkers greater access to cannabis, the American Heart Association had issued a warning on the higher risks of cardiovascular events associated with heavy cannabis use. This was based on a National Institutes of Health (NIH)-funded study of nearly 435,000 American adults reported last November which found that “Daily use of cannabis –– was associated with a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared to non-use of the drug.”

Prior to that, the NIH issued the following warning: “Regular recreational marijuana users had psychotic disorders at a greater rate than any other recreational drug. More than cocaine, methamphetamine, amphetamine, LSD, PCP, or alcohol. The risk of negative mental health effects is increased about five times by regular use of high potency marijuana.” High potency refers to the fact that the commercialized pot sold legally today is not the same naturally grown weed smoked by constituents of the counterculture.

Such health hazards are not some abstract possibility or unconfirmed scientific speculation, but a growing current reality. As a practicing psychiatrist I have witnessed these effects first-hand as a burgeoning number of cannabis-induced medical and mental disturbances—particularly in young people—show up in our hospital emergency rooms and are referred to me for consultation.  And while the rising numbers of adverse effects occurring in the wake of legislative reform are disturbing, they are not surprising. Rather, they were anticipated.

At the start of the movement to liberalize access to cannabis in 2014, Roger Dupont, the founding director of the National Institute of Drug Abuse, and I published an article in the medical journal Science that predicted such adverse effects.“The debates over legalization, decriminalization, and medical uses of marijuana in the United States are missing an essential piece of information: scientific evidence about the effects of marijuana on the adolescent brain,” we wrote. “Much is known about the effects of recreational drugs on the mature adult brain, but there has been no serious investigation of the risks of marijuana use in younger users.”

Part of the argument for legalizing cannabis was that it was no more dangerous than other legal recreational intoxicants like alcohol and tobacco. However, as Kevin Sabet, National Drug Control Policy Advisor in the Bush and Obama administrations pointed out in his book SmokeScreen: What the marijuana industry doesn’t want you to know, legislators didn’t reckon on the possibility that commercialization of cannabis would lead to inconceivably high potencies (with THC concentrations in some products approaching levels up to 99.9% as compared to less than 10% in naturally grown pot sold on the black market).

This was revealed in an NBC News report on states enacting legislation to legalize cannabis in April 2022: “We were not aware when we were voting [in 2012] that we were voting on anything but the plant,” said Dr. Beatriz Carlini,  a research scientist at the University of Washington’s Addictions, Drug & Alcohol Institute. She has led the effort in Washington state to research high-potency pot and is now exploring policy options to limit access. Her team concluded in 2020 that “high-potency cannabis can have lifelong mental health consequences.”

So while possible therapeutic value has been the lever, tax revenue for states and profits for new industries—resulting from broad access—has clearly become the goal with unsuspecting users as the potential victims. This is the template now driving rapid legalization of a host of previously prohibited recreational drugs including MDMA (ecstasy) and psychedelics.

There are reasons to believe in, and support, the therapeutic potential and safe recreational use of cannabis. However, it is imperative that accurate knowledge derived from research carried out with scientific rigor, objectivity, and dispassion inform legislation and policy that will affect the lives of millions of Americans and particularly youth. Until we have this knowledge, we must be prepared to temper the irrational exuberance of advocates for unrestricted recreational use and restrain the commercial interests from expanding the user base and potency of cannabis products. The responsibility for this resides with government. Governors and legislators must hold the line and not succumb to the pressure of public opinion and temptation of additional tax revenues.

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