Currently, eleven U.S. states have enacted legislation legalizing recreational marijuana use for adults (Hammond et al., 2020), with the earliest being Colorado and Washington in 2012. These policies have generally been promoted in terms of their social benefits. Among the potential benefits proposed by advocates of legalization of recreational marijuana are decreases in the number of drug-related arrests and convictions, environmental and business regulation of production and distribution, and the generation of tax revenue. The potential health-related outcomes are therefore varied and complex, including, to name a few: decreased exposure to pesticides in farm workers; increased availability of employer-provided health insurance, as producers who have previously employed workers under the table move (in theory) to legal employment; availability of funds that have been earmarked for social or public health programs; and the individual- and community-level impacts of decreased police surveillance.
Industry workers are therefore one population of interest to study. Marijuana is of course also a psychoactive drug, and its health effects are not well understood. Of particular concern are the developmental consequences of marijuana use during adolescence, making adolescents another important affected population. Finally, it is well-established that individuals and communities of color in the United States have been disproportionately penalized for the use and distribution of marijuana, and proponents hope that legalization will begin to redress this inequity. Given the unequivocal health impacts of carceral involvement (Cloud et al., 2020), as well as growing evidence for the health impacts of discrimination by law enforcement, it will also be important to examine the health consequences of legalization for communities of color. These consequences will include the more direct health impacts discussed above, as well as health impacts related to justice- and carceral-involvement and structural and perceived racism. Because the discourse around legalization has focused particularly on benefits for communities of color, I believe that it will be especially important to monitor for actual benefits, versus the continuation/perpetuation of structural racism or the shifting of the modes by which structural racism is carried out.
The variation in marijuana legality by state offers an ideal “natural experiment” to examine the impacts of the legalization of marijuana on health outcomes. Furthermore, differences by county in the implementation of state-level legislation (for example, county-level variations in the location and type of production facilities and sale outlets permitted) could allow for more focused analyses. Regarding the potential amelioration of racial/ethnic discrimination in marijuana related justice involvement, I would propose a difference-in-differences approach. This could compare the differences in arrest-to-conviction ratios and severity of sentencing pre- and post-legalization for Black individuals to pre- and post-legalization differences for White individuals. As with any social policy, it is difficult to make causal inferences related to its health outcomes due to the influence of a multitude of other societal and individual level factors for health.
Cloud, D. H., Bassett, M. T., Graves, J., Fullilove, R. E., & Brinkley-Rubinstein, L. (2020). Documenting and Addressing the Health Impacts of Carceral Systems. American Journal of Public Health, 110(S1), S5–S5. doi:10.2105/AJPH.2019.305475
Hammond, C. J., Chaney, A., Hendrickson, B., & Sharma, P. (2020). Cannabis use among US adolescents in the era of marijuana legalization: A review of changing use patterns, comorbidity, and health correlates. International Review of Psychiatry, Advance online publication, 1-14. doi:10.1080/09540261.2020.1713056