[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.172.195.82. Please contact the publisher to request reinstatement.
[Skip to Content Landing]

Association of State Recreational Marijuana Laws With Adolescent Marijuana Use

Educational Objective
To examine the association between the legalization of recreational marijuana use in Washington and Colorado in 2012 and the subsequent perceived harmfulness and use of marijuana by adolescents.
1 Credit CME
Key Points

Question  How did the prevalence of adolescent marijuana use change in Washington and Colorado following legalization of recreational marijuana use?

Findings  In this difference-in-difference analysis of 253 902 adolescents in 47 states, marijuana use among eighth and 10th graders in Washington increased 2.0% and 4.1%, respectively, between 2010-2012 and 2013-2015; these trends were significantly different from trends in states that did not legalize marijuana. In Colorado, the prevalence of marijuana use prelegalization and postlegalization did not differ.

Meaning  A cautious interpretation of the findings suggests investment in adolescent substance use prevention programs in additional states that may legalize recreational marijuana use.

Abstract

Importance  Historical shifts are occurring in marijuana policy. The effect of legalizing marijuana for recreational use on rates of adolescent marijuana use is a topic of considerable debate.

Objective  To examine the association between the legalization of recreational marijuana use in Washington and Colorado in 2012 and the subsequent perceived harmfulness and use of marijuana by adolescents.

Design, Setting, and Participants  We used data of 253 902 students in eighth, 10th, and 12th grades from 2010 to 2015 from Monitoring the Future, a national, annual, cross-sectional survey of students in secondary schools in the contiguous United States. Difference-in-difference estimates compared changes in perceived harmfulness of marijuana use and in past-month marijuana use in Washington and Colorado prior to recreational marijuana legalization (2010-2012) with postlegalization (2013-2015) vs the contemporaneous trends in other states that did not legalize recreational marijuana use in this period.

Main Outcomes and Measures  Perceived harmfulness of marijuana use (great or moderate risk to health from smoking marijuana occasionally) and marijuana use (past 30 days).

Results  Of the 253 902 participants, 120 590 of 245 065(49.2%) were male, and the mean (SD) age was 15.6 (1.7) years. In Washington, perceived harmfulness declined 14.2% and 16.1% among eighth and 10th graders, respectively, while marijuana use increased 2.0% and 4.1% from 2010-2012 to 2013-2015. In contrast, among states that did not legalize recreational marijuana use, perceived harmfulness decreased by 4.9% and 7.2% among eighth and 10th graders, respectively, and marijuana use decreased by 1.3% and 0.9% over the same period. Difference-in-difference estimates comparing Washington vs states that did not legalize recreational drug use indicated that these differences were significant for perceived harmfulness (eighth graders: % [SD], −9.3 [3.5]; P = .01; 10th graders: % [SD], −9.0 [3.8]; P = .02) and marijuana use (eighth graders: % [SD], 5.0 [1.9]; P = .03; 10th graders: % [SD], 3.2 [1.5]; P = .007). No significant differences were found in perceived harmfulness or marijuana use among 12th graders in Washington or for any of the 3 grades in Colorado.

Conclusions and Relevance  Among eighth and 10th graders in Washington, perceived harmfulness of marijuana use decreased and marijuana use increased following legalization of recreational marijuana use. In contrast, Colorado did not exhibit any differential change in perceived harmfulness or past-month adolescent marijuana use following legalization. A cautious interpretation of the findings suggests investment in evidence-based adolescent substance use prevention programs in any additional states that may legalize recreational marijuana use.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Magdalena Cerdá, DrPH, MPH, Department of Emergency Medicine, University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA 95817 (cerda@ucdavis.edu).

Accepted for Publication: September 21, 2016.

Published Online: December 27, 2016. doi:10.1001/jamapediatrics.2016.3624

Author Contributions: Dr Wall and Ms Feng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Cerdá, Wall, Schulenberg, O’Malley, Pacula, Galea, Hasin.

Acquisition, analysis, or interpretation of data: Cerdá, Wall, Feng, Keyes, Sarvet, Schulenberg, O’Malley, Pacula.

Drafting of the manuscript: Cerdá, Wall.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wall, Feng, Keyes, Sarvet, Pacula.

Obtained funding: Schulenberg, O’Malley, Hasin.

Administrative, technical, or material support: Schulenberg, Pacula, Galea.

Study supervision: Cerdá, Schulenberg, Galea, Hasin.

Conflict of Interest Disclosures: None reported.

Funding/Support: The design, conduct, data collection, and management of the Monitoring The Future study was sponsored by the National Institute on Drug Abuse and the US National Institutes of Health and carried out by the Institute for Social Research at the University of Michigan, funded by grant R01DA001411. The analysis, interpretation of the data; and preparation, review, and approval of the manuscript was funded by grant R01DA034244 from the National Institute on Drug Abuse. Additional support is acknowledged from grants K01DA030449 and R01DA040924 from the National Institute on Drug Abuse (Dr Cerdá), grant K01AA021511 from the National Institute on Alcohol Abuse and Alcoholism (Dr Keyes), and the New York State Psychiatric Institute (Drs Hasin and Wall).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study.

References
1.
Center for Behavioral Health Statistics and Quality.  Results From the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2013. http://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf. Accessed April 1, 2016.
2.
Jones JM; Gallup. In US, 58% back legal marijuana use. http://www.gallup.com/poll/186260/back-legal-marijuana.aspx. Accessed April 19, 2016.
3.
NORML. Medical marijuana. http://norml.org/legal/medical-marijuana-2. Accessed November 29, 2016.
4.
NORML. Election 2016: marijuana ballot results. http://norml.org/election-2016. Accessed August 25, 2016.
5.
Hall  W, Lynskey  M.  The challenges in developing a rational cannabis policy.  Curr Opin Psychiatry. 2009;22(3):258-262.PubMedGoogle ScholarCrossref
6.
Hall  W, Weier  M.  Assessing the public health impacts of legalizing recreational cannabis use in the USA.  Clin Pharmacol Ther. 2015;97(6):607-615.PubMedGoogle ScholarCrossref
7.
Room  R.  Legalizing a market for cannabis for pleasure: Colorado, Washington, Uruguay and beyond.  Addiction. 2014;109(3):345-351.PubMedGoogle ScholarCrossref
8.
US News. Should marijuana use be legalized? http://www.usnews.com/debate-club/should-marijuana-use-be-legalized. Accessed November 20, 2015.
9.
The Editorial Board. The New York Times calls for marijuana legalization. http://www.nytimes.com/interactive/2014/07/27/opinion/sunday/high-time-marijuana-legalization.html. Accessed July 27, 2014.
10.
Brook  JS, Lee  JY, Finch  SJ, Seltzer  N, Brook  DW.  Adult work commitment, financial stability, and social environment as related to trajectories of marijuana use beginning in adolescence.  Subst Abus. 2013;34(3):298-305.PubMedGoogle ScholarCrossref
11.
Meier  MH, Caspi  A, Ambler  A,  et al.  Persistent cannabis users show neuropsychological decline from childhood to midlife.  Proc Natl Acad Sci U S A. 2012;109(40):E2657-E2664.PubMedGoogle ScholarCrossref
12.
Renard  J, Krebs  MO, Jay  TM, Le Pen  G.  Long-term cognitive impairments induced by chronic cannabinoid exposure during adolescence in rats: a strain comparison.  Psychopharmacology (Berl). 2013;225(4):781-790.PubMedGoogle ScholarCrossref
13.
Arseneault  L, Cannon  M, Poulton  R, Murray  R, Caspi  A, Moffitt  TE.  Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study.  BMJ. 2002;325(7374):1212-1213.PubMedGoogle ScholarCrossref
14.
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
15.
Lev-Ran  S, Roerecke  M, Le Foll  B, George  TP, McKenzie  K, Rehm  J.  The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies.  Psychol Med. 2014;44(4):797-810.PubMedGoogle ScholarCrossref
16.
Maggs  JL, Staff  J, Kloska  DD, Patrick  ME, O’Malley  PM, Schulenberg  J.  Predicting young adult degree attainment by late adolescent marijuana use.  J Adolesc Health. 2015;57(2):205-211.PubMedGoogle ScholarCrossref
17.
Hasin  DS, Wall  M, Keyes  KM,  et al.  Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys.  Lancet Psychiatry. 2015;2(7):601-608.PubMedGoogle ScholarCrossref
18.
Wall  MM, Poh  E, Cerdá  M, Keyes  KM, Galea  S, Hasin  DS.  Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear.  Ann Epidemiol. 2011;21(9):714-716.PubMedGoogle ScholarCrossref
19.
Harper  S, Strumpf  EC, Kaufman  JS.  Do medical marijuana laws increase marijuana use? replication study and extension.  Ann Epidemiol. 2012;22(3):207-212.PubMedGoogle ScholarCrossref
20.
Khatapoush  S, Hallfors  D.  “Sending the wrong message”: did medical marijuana legalization in California change attitudes about and use of marijuana?  J Drug Issues. 2004;34:751-770. doi:10.1177/002204260403400402Google ScholarCrossref
21.
Mason  WA, Hanson  K, Fleming  CB, Ringle  JL, Haggerty  KP.  Washington State recreational marijuana legalization: parent and adolescent perceptions, knowledge, and discussions in a sample of low-income families.  Subst Use Misuse. 2015;50(5):541-545.PubMedGoogle ScholarCrossref
22.
Bachman  JG, Johnston  LD, O’Malley  PM, Schulenberg  JE, Miech  RA.  The Monitoring the Future Project After Four Decades: Design and Procedures: Paper No. 82. Ann Arbor: Institute for Social Research at The University of Michigan; 2015. http://monitoringthefuture.org/pubs/occpapers/mtf-occ82.pdf. Accessed May 30, 2016.
23.
Johnston  LD, O’Malley  PM, Miech  RA, Bachman  JG, Schulenberg  JE.  Monitoring the Future National Survey Results on Drug Use: 1975-2015. Ann Arbor: Institute for Social Research at The University of Michigan; 2016. http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf. Accessed May 30, 2016.
24.
Johnston  LD, O’Malley  PM, Bachman  JG, Schulenberg  JE.  Monitoring the Future: National Survey Results on Drug Use, 1975-2010. Vol I. Ann Arbor: Institute for Social Research at The University of Michigan; 2011.
25.
Keyes  KM, Schulenberg  JE, O’Malley  PM,  et al.  The social norms of birth cohorts and adolescent marijuana use in the United States, 1976-2007.  Addiction. 2011;106(10):1790-1800.PubMedGoogle ScholarCrossref
26.
United States Census Bureau. Metropolitan and micropolitan statistical areas main. https://www.census.gov/population/metro/. Accessed April 15, 2014.
27.
Bieler  GS, Brown  GG, Williams  RL, Brogan  DJ.  Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data.  Am J Epidemiol. 2010;171(5):618-623.PubMedGoogle ScholarCrossref
28.
Angrist  J, Krueger  AB. Empirical strategies in labor economics. In: Ashenfelter  O, Card  D, eds.  Handbook of Labor Economics, Vol 3A. Amsterdam, the Netherlands: Elsevier; 1999:1277-1366.
29.
Mason  WA, Fleming  CB, Ringle  JL, Hanson  K, Gross  TJ, Haggerty  KP.  Prevalence of marijuana and other substance use before and after Washington State’s change from legal medical marijuana to legal medical and nonmedical marijuana: cohort comparisons in a sample of adolescents.  Subst Abus. 2016;37(2):330-335.PubMedGoogle ScholarCrossref
30.
Pacula  RL, Kilmer  B, Wagenaar  AC, Chaloupka  FJ, Caulkins  JP.  Developing public health regulations for marijuana: lessons from alcohol and tobacco.  Am J Public Health. 2014;104(6):1021-1028.PubMedGoogle ScholarCrossref
31.
Wallach  P, Hudak  J. Legal marijuana: comparing Washington and Colorado. http://www.brookings.edu/blogs/fixgov/posts/2014/07/08-washington-colorado-legal-marijuana-comparison-wallach-hudak. Accessed November 20, 2015.
32.
Davis  JM, Mendelson  B, Berkes  JJ, Suleta  K, Corsi  KF, Booth  RE.  Public health effects of medical marijuana legalization in Colorado.  Am J Prev Med. 2016;50(3):373-379.PubMedGoogle ScholarCrossref
33.
Spoth  RL, Randall  GK, Trudeau  L, Shin  C, Redmond  C.  Substance use outcomes 5½ years past baseline for partnership-based, family-school preventive interventions.  Drug Alcohol Depend. 2008;96(1-2):57-68.PubMedGoogle ScholarCrossref
34.
Botvin  GJ, Griffin  KW, Diaz  T, Ifill-Williams  M.  Drug abuse prevention among minority adolescents: posttest and one-year follow-up of a school-based preventive intervention.  Prev Sci. 2001;2(1):1-13.PubMedGoogle ScholarCrossref
35.
Botvin  GJ, Griffin  KW, Diaz  T, Scheier  LM, Williams  C, Epstein  JA.  Preventing illicit drug use in adolescents: long-term follow-up data from a randomized control trial of a school population.  Addict Behav. 2000;25(5):769-774.PubMedGoogle ScholarCrossref
36.
Stice  E, Rohde  P, Seeley  JR, Gau  JM.  Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: a randomized efficacy trial.  J Consult Clin Psychol. 2008;76(4):595-606.PubMedGoogle ScholarCrossref
37.
Lewis  KM, Bavarian  N, Snyder  FJ,  et al.  Direct and mediated effects of a social-emotional and character development program on adolescent substance use.  Int J Emot Educ. 2012;4(1):56-78.PubMedGoogle Scholar
38.
Rohrbach  LA, Sun  P, Sussman  S.  One-year follow-up evaluation of the Project Towards No Drug Abuse (TND) dissemination trial.  Prev Med. 2010;51(3-4):313-319.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Topics
State Requirements