Thirty-six states have legalized medical marijuana and 14 states have legalized the use of marijuana for recreational purposes. In this paper, we review the literature on the public health consequences of legalizing marijuana, focusing on studies that have appeared in economics journals as well as leading public policy, public health, and medical journals. Among the outcomes considered are: youth marijuana use, alcohol consumption, the abuse of prescription opioids, traffic fatalities, and crime. For some of these outcomes, there is a near consensus in the literature regarding the effects of medical marijuana laws (MMLs). As an example, leveraging geographic and temporal variation in MMLs, researchers have produced little credible evidence to suggest that legalization promotes marijuana use among teenagers. Likewise, there is convincing evidence that young adults consume less alcohol when medical marijuana is legalized. For other public health outcomes such as mortality involving prescription opioids, the effect of legalizing medical marijuana has proven more difficult to gauge and, as a consequence, we are less comfortable drawing firm conclusions. Finally, it is not yet clear how legalizing marijuana for recreational purposes will affect these and other important public health outcomes. We will be able to draw stronger conclusions when more post-treatment data are collected in states that have recently legalized recreational marijuana.

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The Public Health Effects of Legalizing Marijuana


Background. We extend the model introduced by Anderson et al. [M.D. Anderson, D.I. Rees, J.J. Sabia, American Journal of Public Health 104, 2369-2376] to evaluate the public mental health implications of new developments in marijuana policy, such as recreational marijuana access and additional years of data on suicide mortality.

Methods. We obtained state-level suicide data from the National Vital Statistics System9s Mortality Detail Files for 1999-2018. We used panel regression analysis to examine the association between suicides per 100 000 population and both medical and recreational marijuana access. Three specifications of the equation were employed as a robustness test.

Results. After adjusting for economic conditions, alcohol taxes and consumption, time effects, state fixed effects, and state-specific linear time trends, the legalization of recreational marijuana was associated with a 2.9% (95% confidence interval [CI] = -5.6, -.03) reduction in the suicide rate for the most rigorous specification, but didn9t pass the robustness check at the P < .05 level for the other two specifications. However, recreational marijuana legalization was associated with a 5.4% reduction (95% CI = -9.4%, -1.4%) in suicide rates for males in the 40 to 49 age group, passing the robustness check for all specifications.

Conclusion. Suicide rates among men in the 40 to 49 age group fell after recreational marijuana legalization compared with those in states that did not legalize, which is consistent with the results found by Anderson et al. for medical marijuana when that same population was younger.
There was no consistent relationship between medical marijuana legalization and suicide rates for any population. Additionally, mental health indicators at the state level were unaffected by either recreational or medical marijuana legalization. We confirm the findings of Anderson et al. (2014), observing no consistent relationship between marijuana legalization and observable mental health outcomes. However, suicide rates increase at lower rates on average relative to other states following recreational marijuana legalization.

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The Relationship Between Cannabis Legalization, Suicide and Mental Health Remains Unchanged After Recreational Access

On June 1, 2020, Massachusetts became the first state in the US to ban all flavored tobacco product sales, including menthol cigarettes. Recent research has estimated the reduction in cigarette sales in Massachusetts following the comprehensive tobacco flavor ban, but noted that missing data on border states was a major limitation of the findings. This letter replicates the procedures of Asare et al. with 1540 state months and then adds Asare et al.'s missing states with 2420 total observations for the period January 2017 to July 2021. The replication confirms Asare et al.'s adjusted estimate for the reduction in menthol cigarettes, which falls within their 95% confidence interval. However, assigning Massachusetts and its bordering states as a single treatment group leads to an increase of 191.95 (95% CI, 96.82 to 287.09) total cigarette packs sold per 1000 people in the six-state region. In the 12-month period following the comprehensive flavor ban in Massachusetts, the state sold 29.96 million fewer cigarette packs compared to the prior period. However, a total of 33.36 million additional cigarette packs were sold during the same post-ban period in the counties that bordered Massachusetts. Given decreasing rates of smoking in all five bordering states between 2019 and 2020, the increase in border-state cigarette sales following the comprehensive flavor ban should be interpreted as a lower-bound estimate for cigarettes that were ultimately consumed in Massachusetts.

Jacob James Rich

Papers

The Relationship Between Cannabis Legalization, Suicide and Mental Health Remains Unchanged After Recreational Access

Estimates of Cross-Border Menthol Cigarette Sales Following the Comprehensive Tobacco Flavor Ban in Massachusetts