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Monitoring Marijuana Use in the United StatesChallenges in an Evolving Environment

Educational ObjectiveTo review the evolving environment of marijuana use in the United States.
1 Credit CME

In 2014, an estimated 22.2 million Americans aged 12 years or older had used marijuana in the past month.1 Under federal law, marijuana is considered an illegal Schedule I drug. However, over the last 2 decades, more than half of the states have allowed limited access to marijuana or its components, Δ9-tetrahydrocannabinol (THC) and cannabidiol, for medical reasons.2 More recently, 4 states and the District of Columbia have legalized marijuana for recreational purposes. Currently, evidence for the therapeutic benefits of marijuana are limited to treatment and improvements to certain health conditions (eg, chronic pain, spasticity, nausea).3 Recreational use of marijuana is established by patterns of individual behaviors and lifestyle choices. In either case, use of marijuana or any of its components, especially in younger populations, is associated with an increased risk of certain adverse health effects, such as problems with memory, attention, and learning, that can lead to poor school performance and reduced educational and career attainment, early-onset psychotic symptoms in those at elevated risk, addiction in some users, and altered brain development.47

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Article Information

Corresponding Author: Alejandro Azofeifa, DDS, MSc, MPH, Substance Abuse and Mental Health Services Administration, 5600 Fisher Ln, Room 15E-29D, Rockville, MD 20857 (alejandro.azofeifa@samhsa.hhs.gov).

Published Online: September 1, 2016. doi:10.1001/jama.2016.13696

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Disclaimer: The conclusions of this article are those of the authors and do not necessarily represent the official position of the Substance Abuse and Mental Health Services Administration or the CDC.

References
1.
Center for Behavioral Health Statistics and Quality. Behavioral Health Trends in the United States: Results From the 2014 National Survey on Drug Use and Health. September 2015. DHHS publication SMA 15-4927; NSDUH series H-5. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed September 1, 2016.
2.
National Conference of State Legislatures. State medical marijuana laws. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed September 1, 2016.
3.
Whiting  PF, Wolff  RF, Deshpande  S,  et al.  Cannabinoids for medical use: a systematic review and meta-analysis.  JAMA. 2015;313(24):2456-2473.PubMedGoogle ScholarCrossref
4.
Volkow  ND, Baler  RD, Compton  WM, Weiss  SR.  Adverse health effects of marijuana use.  N Engl J Med. 2014;370(23):2219-2227.PubMedGoogle ScholarCrossref
5.
Hall  W, Degenhardt  L.  The adverse health effects of chronic cannabis use.  Drug Test Anal. 2014;6(1-2):39-45.PubMedGoogle ScholarCrossref
6.
Batalla  A, Bhattacharyya  S, Yücel  M,  et al.  Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings.  PLoS One. 2013;8(2):e55821.PubMedGoogle ScholarCrossref
7.
National Institute on Drug Abuse. Research Report Series: Marijuana. March 2016. NIH publication 16-3859. https://www.drugabuse.gov/sites/default/files/mjrrs_3_2016.pdf. Accessed September 1, 2016.
8.
Azofeifa  A, Mattson  ME, Schauer  G, McAfee  T, Grant  A, Lyerla  R.  National estimates of marijuana use and related indicators—National Survey on Drug Use and Health, United States, 2002-2014.  MMWR Surveill Summ. 2016;65(SS-11):1-25. http://dx.doi.org/10.15585/mmwr.ss6511a1.Google Scholar
9.
ElSohly  MA, Mehmedic  Z, Foster  S, Gon  C, Chandra  S, Church  JC.  Changes in cannabis potency over the last 2 decades (1995-2014): analysis of current data in the United States.  Biol Psychiatry. 2016;79(7):613-619.PubMedGoogle ScholarCrossref
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