Public Health and Cannabis Legalization

In 2022, the Maryland General Assembly (MGA) is very likely taking up the issue of cannabis legalization again, which will require a greater look into its potential public health impacts.

The Department of Legislative Services (DLS) provided an in-depth analysis of the public health ramifications of cannabis legalization in an issue paper, examining cannabis use disorder, youth usage, and driving under the influence, among other public health considerations. Cannabis use disorder (CUD) “is a medical diagnosis when an individual has a problematic pattern of cannabis use leading to clinically significant impairment or distress.” DLS notes mixed results with respect to CUD after legalization, finding an increase in CUD diagnoses among adolescents in Alaska, Colorado, Oregon, and Washington, but finding a decline in Washington among adults (ages 26 and older) experiencing CUD.

With respect to youth usage, DLS states, “Findings in Colorado, Washington, and Massachusetts are consistent with national trends in which overall cannabis use among teens in all states has decreased. However, youth perception of the harms associated with cannabis use has also decreased post-legalization.” In Colorado, DLS provided several observations regarding driving under the influence after cannabis legalization:

Since legalization, traffic deaths involving drivers who tested positive for marijuana more than doubled (from 55 in 2013 to 129 in 2019), and the percentage of all traffic deaths that were marijuana-related increased from 15% in 2013 to 25% in 2019.

According to DLS, several states have enacted legislation to address potential health issues arising from the legalization of cannabis including Connecticut, New Mexico, New York, Virginia, and Washington. Connecticut and Washington both require regular reports on the public health impacts of cannabis usage. Examples of policies enacted to counter potentially negative health impacts of cannabis legalization include the following:

  • Establishing a program to collect information on cannabis-associated adverse events, injuries, and poisoning. (Connecticut)
  • Requiring reports on the impacts of legalization on education, mental health, and the social and emotional health of those younger than 21. (Connecticut)
  • Prohibiting advertising on television, radio, and mass transit, and advertisers may not use predatory marketing targeting minors. (New Mexico)
  • Creating an Office of Cannabis Management (OCM) to implement quality assurance regulations for the manufacturing, packaging, labeling, advertising, and testing. (New York)
  • Developing and implementing a comprehensive public health monitoring and surveillance program to measure indicators such as frequency of use, quantity used, youth use, traffic safety impacts, substitution effects, emergency room visits, and other health and safety metrics. (New York)
  • Creating a Cannabis Public Health Advisory Council to advise the Cannabis Control Authority on health-related matters. (Virginia)
  • Allocating 25% of cannabis sales tax revenues for substance abuse prevention and treatment and 5% for public health programs. (Virginia)
Should Maryland legalize cannabis, the Maryland Medical Cannabis Commission (MMCC) advises that “consideration… be given to funding for improved data collection, potency and strength restrictions, penalties for sales to minors and compliance check systems, training and use of drug recognition experts, and public outreach through prevention and education campaigns.” Additionally, currently in-place regulations regarding medical cannabis including independent testing and advertising restrictions should be extended to adult use cannabis.
Altogether, the Maryland General Assembly has much to consider as it moves toward legalizing cannabis.

Read the full DLS issue paper.