Senate Bill 846, which proposes to legalize adult recreational marijuana use in Pennsylvania, is still around. It was referred to the Senate Law & Justice Committee on July 6, 2023, but has not come before the committee for consideration … yet. Medical marijuana has been available in PA since February of 2018, but moving on to recreational legalization seems to have stalled. And while some may be frustrated that the state hasn’t yet gone ‘full Colorado,’ this delay may turn out to be a good thing. The evidence for adverse effects from marijuana use is increasing and the optimistic promises of legalization where it has occurred hasn’t come true.
A Gallup poll in August of 2024 found that Americans’ views of the effects of marijuana have worsened since 2022. Slim majorities now think it negatively impacts both society as a whole (54%) and most people who use it (51%). This was a reversal of Gallup’s 2022 findings, when the public was almost evenly divided. See the following chart from the article.
Several demographic groups (young adults 18-34, Democrats, those who have tried marijuana, those who rarely attend religious services) believe marijuana has a positive effect on those who use it. But others (adults 55 and older, Republicans, those who never tried marijuana and those who attend religious services at least monthly) think marijuana has had a negative effect on those who use it. “All of the groups have become less likely since 2022 to say marijuana has a positive effect on users.” See the following chart from the article.
Marijuana is legal for recreational use in 24 states, and the U.S. Justice Department has recently begun the process to reclassify marijuana as a less-dangerous drug. Although U.S. adults are less likely to call marijuana “harmful” than to say this about seven other substances, slim majorities now believe marijuana has a negative effect on its users and society as a whole.
Problems with Legalizing Recreational Marijuana
There are a number of problems developing as recreational marijuana use becomes legal in more states. For starters, there is an association between cannabis use and psychosis, more people are at risk of developing a cannabis use disorder, and cannabinoid hyperemesis syndrome (CHS) is increasing. There has been a proliferation of unlicensed cannabis shops after legalization in New York City, and the location of cannabis shops near middle schools is associated with student discipline referrals for substance use.
The Associated Press reported the number of Americans who use marijuana daily surpassed the number who drink that often. A national survey indicated in 2022 that an estimated 17.7 million people reported daily marijuana use compared to 14.7 million daily or near-daily drinkers. In 1992, less than 1 million people said they used marijuana nearly every day. The per capita rate of marijuana use, from 1992 to 2022, increased 15-fold. “A good 40% of current cannabis users are using it daily or near daily, a pattern that is more associated with tobacco use than typical alcohol use.”
Research shows that high-frequency users are more likely to develop a cannabis use disorder, and the number of daily users suggests that more people are at risk. “High frequency use also increases the risk of developing cannabis-associated psychosis.” A study in The Lancet by Marti Di Forti et al indicated there was a strong link between high-potency marijuana and psychosis. Professor Robin Murray said previously no one thought cannabis increased the risk of psychosis. “But now the evidence is pretty clear.”
See “Gambling with Cannabis and Psychosis” and “Cannabis and Psychosis: More Reality Than Satire” for more information.
Medscape reported cannabinoid hyperemesis syndrome (CHS) is increasing in the U.S. CHS is triggered by chronic cannabis use (more than 4 times weekly), more than 1 year before symptom onset. Its adverse effects are nausea, episodic vomiting, and abdominal pain. A 2011 review article by Galli et al, Cannabinoid Hyperemesis Syndrome, noted CHS was new clinical condition associated with increased cannabis use. It is a recurrent disorder with symptom-free periods. There are three phases: pre-emetic or prodromal, hyperemetic and recovery.
During the hyperemetic phase, the patient has spasms of intense and persistent nausea and vomiting, often without warning—up to five times per hour. Patients typically take numerous hot showers throughout the day, which seems to be a way of bringing some symptom relief, but it rapidly becomes a compulsive behavior. The phase only lasts for 24 to 48 hours, but the risk of relapse is high if the patient continues using cannabis. For more information on CHS, see “Marijuana Makes You Nauseous?”
Gulcan Cil et al examined the effects of cannabis dispensaries being located near schools in “Legalization and retail availability of recreational marijuana and adolescent use in schools.” They looked at changes in student office discipline referrals for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana in July of 2015. They compared this to schools in other states with no legal cannabis and then examined whether having a cannabis dispensary within 1-mile was associated with an increase in referrals.
In an interview with The Conversation, “Here’s what happens when a school is located near a cannabis dispensary,” Cil said they found the number of office discipline referrals (ODRs) for substance use increased in middle schools when dispensaries were located within 1-mile of the schools. There weren’t any statistically discernible changes in high school ODRs. They couldn’t say with certainty whether the increase in substance use referrals in middle schools was from cannabis use. However, cannabis is one of the most commonly used substances by adolescents.
Middle school students receiving an office discipline referral for substance use is relatively rare. An average middle school had three to four referrals of substance use per year. But those near an outlet experienced a 44% increase after legalization and had one to two additional referrals on average each year.
The New York Times said the recreational cannabis market hasn’t taken off as planned. Three years after New York State legalized recreational marijuana, it has awarded few licenses to applicants wanting to open cannabis businesses. “Illicit shops far outnumber licensed dispensaries.” There are over 2,000 illegal shops in New York City, compared to about 85 licensed dispensaries statewide.
For years, New York has had a problem with empty real estate. You can go down streets in the city and see empty storefronts where a bank or a cafe used to be. When legalization passed, there was a sort of cash grab, and landlords began renting to unlicensed sellers. At the time, there wasn’t a lot of clarity about their legal status because there weren’t regulations. The Office of Cannabis Management had not been set up. By the time the state clarified that these shops were illegal because they were not licensed, a lot of stores were already open. Enforcement didn’t follow.
Enforcement against unlicensed vendors was not part of legalization law because the people writing it did not anticipate these rogue shops cropping up. So one of the things that held up enforcement as unlicensed shops were multiplying was the need to sort out who was ultimately responsible. That was assigned to the state cannabis and tax agencies, but their resources are limited. So lawmakers now want to give more power to local authorities. It’s high on the agenda of current budget negotiations.
In December of 2018, then governor of Pennsylvania, Tom Wolf (not Josh Shapiro), thought it was time for Pennsylvania to take a serious and honest look at recreational marijuana, partly because a survey suggested a majority of Pennsylvanians supported legalization. See “Into the Fire with Recreational Marijuana in PA.” But it seems polls are indicating people now believe marijuana has had a negative effect on its users and society as a whole; and there are problems emerging where it has been legalized. Fortunately, the state hasn’t gone ‘full Colorado’ yet. And now we have the opportunity to look where recreational marijuana has been legalized and see what the consequences have been. More in Part 2.
