Does legalization of marijuana lead to adolescent use?

While it remains illegal at the federal level, to date medical marijuana is legal in 36 states and recreational use legal in 18. Many states where marijuana has not been legalized will have upcoming ballots on the subject over the next 2 years. With this rapid increase in legalization, pediatric organizations such as the American Academy of Pediatrics fear it could encourage children and teens to use the substance, which, for brain development, could negatively affect areas of the prefrontal cortex. A new study using data from the Youth Risk Behavior Survey assessed whether those concerns have a factual basis

The researchers used data from the Youth Risk Behavior Survey for the period 1993-2019. Data on pre- and post-recreational marijuana laws were available for 10 states. Seven states had more than one wave of post-recreational data on the marijuana law and were also able to provide data before and after drug sales started.

The average age of the respondent was 15.9 years. The cohort skewed slightly more female (51.4%) as well as non-Hispanic whites (57.6%). Based on the pooled data, recreational marijuana law approval was not linked to frequent marijuana use (odds ratio.) [OR], 0.98; 95% CI, 0.90-1.07) or current marijuana use (OR, 1.00; 95% CI, 0.92-1.10). In addition, the approval of medical marijuana laws was linked to a 6% decrease in the likelihood of current marijuana use (OR, 0.94; 95% CI, 0.89-0.98) and a 7% decrease in the likelihood of current marijuana use. on frequent use (OR, 0.93). ; 95% CI, 0.87-0.99), in fully modified models. The association between the first recreational pharmacy and marijuana use was considered qualitatively comparable. A decrease in marijuana use was noted two or more years after the passing of recreational marijuana laws (OR 0.85; 95% CI 0.76, 0.95).

The researchers concluded that there appears to be little association between recreational or medical marijuana laws and increased marijuana use in children and adolescents, with the association between recreational laws and marijuana use being essentially zero. They did note that recreational marijuana laws are a fairly new occurrence, and with more data, firmer conclusions can be drawn about whether there is a link between the legalization of recreational marijuana and adolescent marijuana use.


1. Anderson D, Rees D, Sabia J, Safford S. Association of Marijuana Legalization with Marijuana Use Among U.S. High School Students, 1993-2019. JAMA Netw Open. 2021;4(9):e2124638. doi:10.1001/jamanetworkopen.2021.24638

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