Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence

Background: Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence. Methods: We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ (n = 34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of similar to 68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence. Results: In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% Cl: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% Cl: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% Cl: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use. Conclusions: States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use. (C) 2011 Elsevier Ireland Ltd. All rights reserved.