LESSONS LEARNED FROM

STATE MARIJUANA
LEGALIZATION

M A Y 2 0 1 9

CA WA CO OR AK DC NV MA

Reviewed by researchers from:

University of Colorado at Denver
Harvard Medical School
Boston Children’s Hospital preventing another big tobacco
University of Connecticut
Yale University www.learnaboutsam.org
University of Kansas
and more
preventing another big tobacco
 EXECUTIVE
HIGHLIGHTS
Today’s highly potent marijuana represents a growing and significant
threat to public health and safety, a threat that is amplified by a new
marijuana industry intent on profiting from heavy use.

State laws allowing marijuana sales and consumption have permitted

the marijuana industry to flourish, and in turn, the marijuana industry has
influenced both policies and policy-makers. While the consequences
of these policies will not be known for decades, early indicators are
troubling.

This report, reviewed by prominent scientists and researchers, serves as

an evidence-based guide to what we currently observe in various states.
We attempted to highlight studies from all the “legal” marijuana states
(i.e., states that have legalized the non-medical use of marijuana).
Unfortunately, data does not exist for several “legal” states, and so this
document synthesizes the latest research on marijuana impacts in states
where information is available.
 YOUTH AND SCHOOL IMPACTS
While rates of almost every other drug are decreasing among youth, marijuana use remains stubbornly high. A
new marijuana industry – teaming up with Big Pharma, Big Alcohol and Big Tobacco executives – is facilitating and
encouraging this trend, presenting teens with new and appealing ways to ingest highly potent marijuana. According to
the University of Michigan Monitoring the Future survey of American youth, between 2017 and 2018, the percentage of
8th and 10th graders who report “vaping” marijuana has increased 63%. Over the same timeframe, the percent of 12th
graders who report vaping marijuana has increased by 53% (Johnston, Miech, Bachman, Schulenberg, & Patrick, 2018).

2018 YOUTH VAPING USE IN "LEGAL"

15 2017 STATES, 2017 VS. 2018

12 7.5%
7.0%
9

6
2.6% 4.3%, 4.9%
3
1.6%
0 8th Grade 10th Grade 12th Grade
4
 The percentage of youth aged 12-17 years old using marijuana is declining faster in states
where marijuana is not “legal,” and overall use is up in “legal” states while declining
in non-legal states. According to a uniform survey of marijuana use conducted by the
federal government across all states, the percentage of youth aged 12-17-years-old using
marijuana in states where marijuana is “legal” was 7.7%, versus 6.2% in non-legal states
(NSDUH State Reports 2016-2017).

YOUTH USE IN "LEGAL" STATES, YOUTH USE IN “NON-LEGAL”

2016 VS. 2017 STATES, 2016 VS. 2017.
8
10
7 7.5%
7.0%
8 8.9% 4.3%, 9.1% 6
6.75% 6.46%
5
6
4
4 3
2
2
1
0 2016 2017
0
2016 2017

5
 MENTAL HEALTH
OUTCOMES
Furthermore, 2019 Colorado toxicology
reports show the percentage of
adolescent suicide victims testing positive
for marijuana continues to increase.
Between 2011 and 2013, 20.7% of suicide
victims between the ages of 10 and 19
tested positive for marijuana (compared
with 12.7% who tested positive for
alcohol). Between 2014-2016, 22.4%
tested positive for marijuana (compared
with 9.3% for alcohol) (Colorado
Department of Public Health and
Environment, 2019). In two cross-sectional
studies of Colorado youth in outpatient
substance use treatment facilities,
approximately one half to three quarters
reported using diverted marijuana –
marijuana accessed by adolescents from
adults for purported medical purposes
with legal access to it (Wilkinson, Yarnell,
Radhakrishnan, Ball, & D’Zouza, 2016).

6
 IMPACT ON SOCIAL JUSTICE
Marijuana proponents predicted that legalizing marijuana would meaningfully mitigate disparities in criminal enforcement
and enhance social justice. Unfortunately, these predictions have been unrealized, as ethnic and racial disparities in law
enforcement persist.

In Washington D.C., between 2015 and 2017 (the years immediately following legalization), although total marijuana-related
arrests have gone down, distribution and public consumption arrests more than tripled. Among adults, 89% of marijuana
distribution or public consumption arrestees were African American (DC Metropolitan Policy Department, 2018). Juvenile
marijuana-related arrests increased 114% between the three years before and after marijuana legalization.

DISTRIBUTION PUBLIC AND

CONSUMPTION ARRESTS
1000
907

800

600

400
299
200 2015 2017
Between 2015 and 2017- the years immediately following legalization in Washington, D.C.,
distribution and public consumption arrests more than tripled from 299 to 907. Nearly all
of those arrested for distribution and public consumption in D.C. were African American
(DC Metropolitan Policy Department, 2018).
7
 IMPACT ON SOCIAL JUSTICE
The 2017 marijuana-related African American arrest rate in Colorado is nearly twice that of Caucasians (233 in 100,000
versus 118 in 100,000) (Colorado Department of Public Safety, 2018). In Colorado, 39% of African American marijuana-
related arrests in 2017 were made without a warrant, while only 18% of Caucasians were arrested without one (Colorado
Department of Public Safety, 2018). Drug suspension rates in Colorado schools with 76% or more students of color are over
two times higher compared to Colorado schools with fewer than 25% students of color (Colorado Department of Public
Safety, 2016). In Denver, the average number of annual Hispanic arrests for marijuana increased by 98% since legalization
(107 average annual arrests pre-legalization vs 212.25 post-legalization); the average number of arrests for African
Americans increased 100.3% from 82.5 per year to 165.25 per year (Colorado Department of Public Safety, 2018).

AVERAGE HISPANIC AVERAGE AFRICAN AMERICAN

ARRESTS IN ARRESTS IN COLORADO*
250 COLORADO* 200
7.5%
200 4.3%, 212.25/year 7.0%
150 165.25/year
150
100
100
107/year 82.5/year
50
50

0 Pre-Legalization 2012-13 Post Legalization 2014-17

0
Pre-Legalization 2012-13 Post Legalization 2014-17

*This figure uses data from an official report by the Colorado Division of Criminal Justice. However, due to issues with
the reporting of marijuana-related crimes in Denver between 2012 and 2014, it is likely that the number of marijuana
arrests made in the pre-legalization period are underestimated.
8
 Across Colorado, minority juveniles suffered. The average number of marijuana-related arrests among Hispanic
juveniles increased 7.3% (770/year to 825/year), and the average number of marijuana-related arrests among
African-American juveniles increased 5.9% (230/year to 243.5/year) (Colorado Department of Public Safety,
2018).

JUVENILE ARREST RATE

AVERAGE HISPANIC AVERAGE AFRICAN AMERICAN
ARRESTS IN COLORADO* ARRESTS IN COLORADO*
1000 250
243.5/year
800 200 230/year 7.0%
4.3%, 825/year
600 770/year 150

400 100

200 50

0 0
Pre-Legalization 2012-13 Post Legalization 2014-17 Pre-Legalization 2012-13 Post Legalization 2014-17

*This figure uses data from an official report by the Colorado Division of Criminal Justice. However, due to issues with the reporting
of marijuana-related crimes in Denver between 2012 and 2014, it is likely that the number of marijuana arrests made in the pre-
legalization period are underestimated.
9
 IMPACT ON HOSPITAL
AND ED VISITS
In the year immediately
following recreational marijuana
legalization in Colorado, calls
to poison centers statistically MARIJUANA EXPOSURE CALLS MARIJUANA EXPOSURES AMONG
significantly increased by 80% TO COLORADO POISON 0-8 YEAR-OLDS REPORTED TO
(Wang, et al., 2017). CONTROL CENTERS COLORADO POISON CONTROL CENTERS

Since legalization, total

marijuana exposure calls to 80
poison control centers have 2012
110 Calls 70
64
more than doubled. The 60
largest increase is among 50
children 0-8-years-old with 40
unintentional exposure 2018 222 Calls
30
to marijuana (Colorado 20
05 0 100 150 200 250
16
Department of Public Health
10 2012 2018
and Environment, 2019). Since legalization, total marijuana exposure calls to Colorado poison control centers have
more than doubled (110 calls in 2012 to 222 calls in 2018). The largest increase is among
Marijuana exposures among 0-8 year-olds reported to Colorado poison control have qua-
Marijuana exposures among children 0-8 years old that suffered unintentional exposure to marijuana
(Colorado Department of Pulic Health and Environment, 2019). drupled since legalization, with 16 calls made in 2012 and 64 calls made in 2018 (Colorado
Department of Pulic Health and Environment, 2019)
0-8-year-olds reported to
Colorado poison control
have increased by 230%
since legalization (Colorado
Department of Public Health
and Environment, 2019).

10
In Colorado, the annual
rate of marijuana-related

271%
emergency department

70%
visits increased by 62% from
2012 to 2017 (Colorado
Department of Public Health
and Environment, 2019).
increase
Marijuana-related poisoning
hospitalization rates in
Colorado rose by 143% from Washington State has seen a 70% increase
2012 to 2017 (Colorado in marijuana-related calls to the Washington
Marijuana-related cases for children under poison center between the three years before
Department of Public Health 5 year old reported to the Oregon Poison
and Environment, 2019). and after legalization (Washington State
Center rose by 271% between 2014 and Office of Financial Management, 2017).
2017 (Oregon Poison Center, 2018).

OREGON’S ANNUAL RATE

OF MARIJUANA-RELATED
2012
14 Cases EMERGENCY DEPARTMENT WASHINGTON STATE’S
VISITS FOR CHILDREN 5 AND INCREASE IN MARIJUANA-
UNDER RELATED CALLS
300
250
200
268
52 Cases 150
Calls
2015
100 155
50 Calls
0 10 20 30 40 50 60 0 2011-2013 2014-2016

Washington State has seen a 73% increase in marijuana-related calls between three-year
averages before and after legalization (from an average of 155 between 2011 and 2013 to
Marijuana-related cases for children under 5 years reported to the Oregon Poison Center an average of 268 call between 2014 and 2016) (Washington State Office of Financial
Management, 2017)
rose by 271% from 14 cases in 2014 to 52 cases in 2017 (Oregon Poison Center, 2018)

11
 IMPACT ON THE BLACK MARKET
Several different agencies across states have found that marijuana production in recreational marijuana states far exceeds the
consumption demand in those states. For example, estimates from a law enforcement task force found that Oregon’s current
production capacity is between 5 and 10 times the consumption demands of the state (ORIDHIDTA, 2018). A 2019 audit by Oregon’s
Secretary of State found that the volume of marijuana produced in
Oregon is approximately 7 times higher than its local consumption
(Oregon Secretary of State, 2019). A report published by the
California Department of Food and Agriculture found that the
state produced 15.5 million pounds of marijuana in 2018 but only
consumed 2.5 million pounds. Legal production is far higher than
legal consumption likely because legal marijuana can be sold for
higher prices on the black market, either within the same state or in
states that have not legalized marijuana. The Oregon Secretary of
State finds that black market prices for marijuana are several times
higher than the legal market, thus making sales more profitable
(Oregon Secretary of State, 2019), and many have suggested that
California’s excess legal marijuana is likely smuggled to states
without recreational cannabis laws where black market prices can
be far higher (Fuller, 2019).
California’s projected marijuana tax revenue by July 2019 is
nearly half of what was originally expected when the state began
retail sales in 2018, since most consumers continue to purchase
marijuana from the black market in order to avoid high taxes
(Blood, 2019; Fuller, 2019).
Rates of marijuana investigative seizures in Colorado are over 9
times higher since legalization (Rocky Mountain HIDTA Strategic
Intelligence Unit, 2018).
The average number of highway seizures of Colorado marijuana has
increased 39% since legalization (Rocky Mountain HIDTA Strategic Intelligence Unit, 2018).
In Colorado, marijuana concentrates accounted for 26% of total marijuana seizures in 2017 and edibles accounted for another 16%. In
2012, concentrates and edibles combined made up only 10% of total seizures (Colorado Department of Public Safety, 2018).
12
 IMPACT ON CRIME

84.8
In 2017, the number of court filings charged with the Colorado Organized Crime
Control Act that were linked to a marijuana charge increased 284% since 2012
(Colorado Department of Public Safety, 2018). A study funded by the National
Institutes of Health (NIH) showed that the density of marijuana dispensaries was
linked to increased property crimes in nearby areas. Researchers found that in
Denver, Colorado, neighborhoods adjacent to marijuana businesses saw 84.8 more
property crimes each year than neighborhoods without a marijuana shop nearby
MORE PROPERTY CRIMES EACH
(Freisthler, Gaidus, Tam, Ponicki, & Gruenewald, 2017). Motor vehicle theft rates in
YEAR
Alaska rose by over 100% between 2015, when recreational marijuana was legalized,
and 2017 (Spears, 2018).

Colorado’s crime rate in

2016 increased 11 times
faster than the 30 largest
cities in the nation since

11
legalization (Mitchell, 2017),
with the Colorado Bureau
of Investigation reporting
an 8.2% increase in violent
times crimes (19,928 in 2015 to
faster 21,570 in 2016) and a 5.3%
increase in property crimes
(171,404 in 2015 to 180,501
in 2016) between 2015 and
2016 (Colorado Bureau of
Investigation, 2017).

13
 A recent roadside study of 2,355 drivers in Washington State found that, six months after introducing
STONED DRIVING
recreational sales of marijuana, the proportion of daytime drivers testing positive for THC (the
hallucinogenic ingredient in marijuana) almost tripled from 8% to 23% (Eichelberger, 2019).

The percent of traffic fatalities that involved drivers intoxicated with marijuana in Colorado rose by 86%
between 2013 and 2017, with over one-fifth of all traffic fatalities involving a driver testing positive for
marijuana by 2017 (National Highway Traffic Safety Administration, 2006-2011; Colorado Department of
Transportation, 2012-2017).

65% of Coloradan drivers testing positive for marijuana in 2017 combined marijuana with alcohol
and/or other illicit drugs (National Highway Traffic Safety Administration, 2006-2011; Colorado
Department of Transportation, 2012-2017).

Over 20% of 2018 DUI arrests in Colorado also involved testing positive for marijuana (Colorado
Department of Transportation, 2017).

Research by the Highway Loss Data Institute finds that following legalization of recreational marijuana in
Colorado, Oregon and Washington, collision claims in these three states were significantly higher than in
comparable, neighboring, non-legal states (Highway Loss Data Institute, 2018).
In Oregon, 50% of all drivers assessed by Drug Recognition Experts in 2015 tested positive for THC.
Toxicology reports show that the rate of drivers testing positive for THC has consistently increased,
indicating an increase in instances of THC-related impaired driving (Oregon Liquor Control Commission,
2016).

14
 POSITIVE ORAL-FLUID TEST RESULTS
10
FOR MARIJUANA USE IMPACT ON THE
8
75% increase
between the two
years.
8.9 WORKFORCE
6
Between 2013 and 2016, positive oral-fluid test
4 5.1 results for recent marijuana use among the general
U.S. workforce increased almost 75%, from 5.1 to
2 8.9 percent (Quest Diagnostics, 2017). [Figure 15]
Increases in positive urine test results for marijuana
0 2013 2016
in Washington and Colorado doubled the national
average between 2015 and 2016. The rate of
In the 3-year period following legalization in Colorado and Washington positive test results for marijuana use increased by
(2013– 2016), positive oral-fluid test results for marijuana use increased
almost 75%, from 5.1 to 8.9 percent (Quest Diagnostics, 2017) 11% in Colorado and 9% in Washington, while the
national rate increased only 4% (Quest Diagnostics,
2017).
Between 2016 and 2017, positivity rates for
marijuana in the workforce increased 43% in Nevada,
14% in Massachusetts, and 11% in California (Quest
Diagnostics, 2017).
Workforce marijuana-positivity rates in all “legal”
states but one (Alaska) are above the national
average. For example, 2018 positivity rates in
Maine (5.0%), Oregon (4.3%), Nevada (4.0%),
Massachusetts (3.3%), Colorado (3.0%), California
(2.5%), and Washington (2.4%) are higher than the
national average (2.3%) (Quest Diagnostics, 2019).
Most states that have legalized marijuana show an
increasing trend in positivity rates.

15
 preventing another big tobacco

16
DATA AND POLICY
BACKGROUND

17
 DATA AND POLICY BACKGROUND
Contrary to federal law, under which the use and sale of marijuana for any purpose is illegal (Controlled Substances
Act), Colorado and Washington voted to legalize recreational marijuana in 2012. Alaska and Oregon followed by
legalizing marijuana in 2014. The District of Columbia legalized cultivation and possession in 2014. California,
Massachusetts and Nevada legalized recreational sales in 2016. Each state took 1-2 years to implement the
supply/production side of their policies. Maine legalized recreational marijuana in 2016 and has yet to begin
implementation. Michigan is the most recent state to legalize marijuana, having done so in the fall of 2018, though
implementation is yet to begin. Despite these apparent victories for the legalization movement, many states –
including Maryland, Arizona, New Mexico, Minnesota, North Dakota, Ohio, Delaware, New Hampshire, and Vermont
– have continued to reject recreational marijuana initiatives since 2012, and the vast majority of localities in “legal”
states have banned marijuana production and retail sales outright.
We now have six years of data, providing real-world evidence of the negative impacts of a legal marijuana industry
on families and communities. During this time, it has become apparent that the goal of this new industry is to
successfully convert young, casual users into heavy, more frequent users.
Given this nation’s overdose epidemic—driven largely by a massive increase in the use of opioids—the rise of lax
legalization policies comes at an especially inopportune time. Peer-reviewed research has revealed early marijuana
use more than doubles the likelihood of illegal non-marijuana drug use later in life (Olfson, Wall, Liu, & Blanco, 2017;
Secades-Villa, Garcia-Rodriguez, Jin, Wang, & Blanco, 2015), and according to the National Survey on Drug Use and
Health, 95%-97% of people who used cocaine or heroin started with marijuana (NSDUH, 2018).
There has been a lot of conversation surrounding the topic of medical marijuana as a substitute for opioids in the
treatment of pain. A 4-year prospective study in the highly respected journal, The Lancet Public Health, followed
patients with chronic non-cancer pain and found no evidence that marijuana use mitigated pain severity or
interference or that marijuana affected rates of opioid prescribing or opioid discontinuation (Campbell, et al., 2018).
Further, there is evidence to suggest that marijuana use, particularly chronic use, is associated with poor pain control.
Researchers found that patients reporting marijuana use actually experienced more pain on average when admitted
to the hospital following a traumatic injury than those who did not. Compared to non-users, marijuana users required
more opioid medication to cope with the pain and consistently rated their pain higher during the duration of their
stay (Salottolo, et al., 2018).
18
Although the full picture resulting from legalization will not be clear for decades, we need not wait that long to
understand some key consequences.
The states that have legalized marijuana have among the highest rates of marijuana use in the country. These
states also have:
• Higher rates of marijuana-related driving fatalities.
• More marijuana-related emergency department visits, hospitalizations, and accidental exposures.
• Expansion of a lucrative criminal market.
• Increases in marijuana-related crimes and juvenile offenses.
• Increases in workplace problems, including labor shortages and accidents.
In 2013, the U.S. Department of Justice (DOJ) decided to take a hands-off approach toward legalization at the
state level. Officially, the DOJ stated it would only get involved if any of eight requirements laid out in the Cole
Memo (e.g., sales to minors, increased drugged driving) were violated. Unfortunately, according to the U.S.
Government Accountability Office (GAO), the DOJ took no meaningful action even as states were routinely in
violation of the Cole Memo” to Unfortunately, according to the U.S. Government Accountability Office (GAO),
the DOJ took no meaningful action even as states routinely violated the Cole Memo.”
However, public health and safety departments and law enforcement agencies in states where legalization has
been in place the longest have produced primary data and impact reports that shine a light on how current
marijuana policies are failing to protect the health of the general population (Oregon-Idaho High Intensity
Drug Trafficking Area [ORHIDTA], 2018; Rocky Mountain High Intensity Drug Trafficking Area [RMHIDTA],
2018; Northwest High Intensity Drug Trafficking Area [NWHIDTA], 2016; Washington State Office of Financial
Management, 2017; Oregon Public Health Division, 2016; Alaska State Troopers, 2017; Grondel, 2018;
Colorado Department of Public Safety, 2016; Oregon State Police - Drug Enforcement Section, 2017).
In 2018, the DOJ rescinded the Cole Memo policies, signaling an uncertain future for the marijuana industry. In
legalizing marijuana, states continue to violate federal laws and thus risk felony charges.

19
 The rise of commercialization has inundated legalized communities with marijuana companies
and paraphernalia.
In Colorado, legalization has led to more marijuana stores than McDonald’s and Starbucks
A GROWING CONCERN combined (1,018 retail marijuana outlets, with 486 located within medical marijuana outlets,
COMMERCIALIZATION:
versus 600 McDonald’s and Starbucks) (RMHIDTA, 2018). These numbers are even more
unsettling in the context that many local communities have opted out of legally selling
marijuana in their neighborhoods. Both medical and retail marijuana licensing are banned in
65% of Colorado’s local jurisdictions (RMHIDTA, 2018), and so nearly 70% of the total 3,101
licensed marijuana businesses in Colorado are concentrated in just four counties: Denver
(1,226), El Paso (370), Pueblo (303), and Boulder (216) (Colorado Department of Public Health
and Environment [CDPHE], 2018).
While many American voters reflect upon the marijuana they or their peers smoked in their
youth, the products on today’s market are vastly different. Since legalization of marijuana and
creation of a commercialized market, the average THC potency of a typical marijuana flower
product increased substantially. ElSohly et al. reported an average THC potency of 11.5%
among marijuana flower products in 2014 (ElSohly, et al., 2016), while Smart et al. found an
average THC potency among marijuana flower products for sale in Washington State between
2014 and 2016 of 20.6% (Smart, Caulkins, Kilmer, Davenport, & Midgette, 2017). This does
not even address the alarming trends of high potency products seen with concentrates and
edibles; concentrates in these products can reach up to 95% THC potency (Prince & Conner,
2018).
The market for marijuana flower hybrids and concentrates continues to rise with the increase
in demand for products with higher THC potency levels. In Washington State, market share
for flower products with 10-15% THC had declined by 60.4% between 2014 and 2017, while
the market share for flower products with more than 20% THC increased by 48.8% during that
same period (Smart, Caulkins, Kilmer, Davenport, & Midgette, 2017).
On its face, a regulated market should assume high quality testing of consumable products;
however, emerging evidence suggests marijuana product regulation is poor. Numerous
peer-reviewed studies have taken issue with the absence of regulation (Yates & Speer, 2018;
Peace, Butler, Wolf, Poklis, & Poklis, 2016; Lamy, et al., 2016). Furthermore, due to convoluted
regulatory systems largely driven by marijuana business’ demands rather than the public
20
interest, laboratory testing facilities are
incentivized to produce results favorable
to the marijuana industry.
Even more alarming is the rampant
mislabeling of the active cannabinoid

A GROWING CONCERN
COMMERCIALIZATION:
ingredients in concentrates and
edibles (Peace, Butler, Wolf, Poklis,
& Poklis, 2016). The Food and Drug
Administration (FDA) has published
warning letters on the severe and
consistent mislabeling of commercial
products on the market since 2015 (U.S.
Food and Drug Administration, 2017).
The industry has prospered in selling
marijuana-infused “edibles” that come
in the form of cookies, candy, ice cream,
sodas, and other sweet treats that
are particularly appealing to children.
The marketing tactics used for their
packaging mimic those of Big Tobacco,
by using bright colors and catchy names
and even by replicating images or re-
appropriating the names of well-known
commercial food products. For example,
“Pop Tarts,” a widely consumed kid-
friendly breakfast product, has been re-
appropriated by one marijuana producer to market “Pot Tarts.”
Unfortunately, these products are thought to be contributing to the increased accidental
marijuana-exposures among children and others.

21
 ADVERSE HEALTH EFFECTS OF
As commercialization increases in legalized states, false advertising of marijuana products
as being “natural” and “healthier” than alcohol and tobacco have greatly decreased the
perceived risk of harm related to marijuana use. Between 2015/2016 and 2016/2017, the
percentage of youth aged 12-17-years-old who report a “great risk” from using marijuana once
per month remains at 26% in non-legal states, compared to 19.4% in “legal” states (NSDUH,
2016-2017).
The main psychoactive ingredient in marijuana, THC, has now been observed to cause many
different types of mental and physiological health problems— especially in children and youth.
Direct associations have been made between the frequency of marijuana use and higher
MARIJUANA

THC potency with the development of mental health issues (psychosis, depression, anxiety,
suicidality, reshaping of brain matter, and addiction) (Fischer, et al., 2017; Pierre, Gandal, &
Son, 2016). Links to lung damage and serious cardiovascular problems have also been found
(hypertension, myocardial infarction, cardiomyopathy, arrhythmias, stroke, and cardiac arrest)
(Pacher, Steffens, Hasko, Schindler, & Kunos, 2017; Bigay-Game, et al., 2018; Hall & Lynskey,
2016). Marijuana use during pregnancy has also been shown to negatively affect the cognitive
development of children by increasing their risk of hyperactivity, impulsivity, and inability to
focus (Wang, et al., 2017; Huizink & Mulder, 2006).
These results are not surprising, as daily marijuana use among youth who begin before the age
of 17 significantly increases the risk of suicide attempts (Silins, et al., 2014).
Dr. Nora Volkow, the director of the National Institute of Health’s National Institute on Drug
Abuse, published a report in response to an alarming trend developing across the country
of increased marijuana use during pregnancy and warned of the detrimental health risks of
in utero cannabis exposure (Volkow, Han, Compton, & Blanco, 2017). Even more alarming,
a recent study conducted in Colorado found that 70% of the 400 dispensaries surveyed in
a “mystery caller” method were recommending marijuana products to expecting mothers
experiencing morning-sickness in their first trimester (Dickson, et al., 2018).
Chronic adolescent marijuana use has been correlated with cognitive impairment and
worsened academic or work performance (Schuster, et al., 2018; Finn, 2015; Meier, Hill,
Small, & Luthar, 2015; Arria, Cladeira, Bugbee, Vincent, & O’Grady, 2015; Meier, et al., 2012).
Marijuana has a variety of other interactions with mental health, particularly during young

22
adulthood. For example, marijuana use during young adulthood carries the highest risk of
developing psychosis (Leadbeater, Ames, & Linden-Carmichael, 2018; Borodovsky, et al., 2017).

ADVERSE HEALTH EFFECTS OF

In the fall of 2018, the highly respected journal, Addiction, published an extensive review of the
evidence surrounding the age-varying effects of marijuana use on mental health. The authors
of the study found that regular use of marijuana correlated with significant increased risk of
depressive symptoms in users between the ages 16-20, and for those older than 25. Chronic
marijuana use increased the likelihood of anxiety in adults in their late twenties and older, and
those who met the criteria for cannabis use disorder (CUD) had a high risk of all mental health
symptoms across all ages (Leadbeater, Ames, & Linden-Carmichael, 2018).
While the popular view holds that marijuana is not addictive, researchers generally do not agree

MARIJUANA
(Volkow, Baler, Compton, & Weiss, 2014). Brain scans of marijuana users show changes in the
structure of the brain’s reward center to be consistent with addiction (Gilman et al., 2014), and
heavy users frequently experience withdrawal symptoms when they cease use (Hasin, et al., 2008).
Furthermore, several studies have identified marijuana’s role in the pathway to other substance
abuse (Keyes, Rutherford, & Miech, 2019). For example, a groundbreaking study of over 30,000
Americans showed that participants who reported marijuana use in the previous year were 2.6
times more likely to abuse prescription opioids (Olfson, Wall, Liu, & Blanco, 2017).

23
 IMPACT OF LEGALIZATION
ON SCHOOLS & YOUTH
The most reliable survey on the prevalence of drug use at 20.8% (NSDUH, 2016-2017). Additionally, one recent
among U.S. households is the National Survey on Drug study showed that longer duration of legalization
Use and Health (NSDUH). According to NSDUH data, in all and higher dispensary density was associated with
jurisdictions with legalized recreational marijuana (Alaska, increased use of vaping and edibles by 14-18-year-olds
California, Colorado, the District of Columbia, Maine, (Borodovsky, et al., 2017).
Massachusetts, Michigan, Nevada, Oregon, Vermont,
though only personal use and growing is legal there, and In Nevada, where recreational marijuana was legalized in
Washington), past-month drug use among youth aged 12- 2016, past-month and past-year use among adolescents
17 continues to sit above the national average (NSDUH, (12-17 years) has increased between 2015/2016 and
2016-2017). Colorado, where recreational marijuana has 2016/2017 (NSDUH, 2015-2016; NSDUH, 2016-2017).
been legal since 2012, has the highest rate of first-time The marijuana industry has capitalized on the extensive
marijuana use among youth (ages 12-17) and young adults marketing campaigns by tobacco vaping companies like
(ages 18-25) (NSDUH State Estimates, 2016-2017). Juul, which successfully made e-cigarettes into a chic
The percentage of youth aged 12-17 years old using and trendy lifestyle choice among teens, by promoting
marijuana is declining in states where marijuana is not marijuana vaping.
“legal,” unlike in “legal” states; in 2016/2017, the rate of
past month 12-17-year-old marijuana use in “legal” states
was 7.7%, versus 6.2% in non-legal states.1 (NSDUH State
Reports 2016-2017). [Figure 2] The national rate of 18-to-
25-year-old past month marijuana use is 21.5%. The rate for
“legal” states, however, is much higher -- 29.2%. The rate
in non-legal states is close to the national average, standing
These calculations represent unweighted prevalence, calculated as the simple average of
prevalence across states by legalization status as of 2016. These changes/differences are calculated
within state first and then averaged. (Weighted prevalence by population also found similar results;
increases in “legal” states and decreases in non-legal states.)
 ANCHORAGE, SCHOOL SUSPENSIONS FOR MARIJUANA USE AND POSSESSION
200

166 Students
In Anchorage, Alaska,
150 school suspensions
for marijuana use and
possession increased more
than 141% from 2015
100 (when legalization was
implemented) to 2017
(Wohlforth, 2018).
69 Students
50 2015 2017

While many assume Juul and other e-cigarette companies are only in the business of marketing nicotine, these assumptions
are wrong. Recently, Marlboro-owner, Altria (formerly Philip Morris), purchased a 35% stake in Juul, shortly after acquiring
a 45% stake in Cronos, one of the largest distributors of marijuana in Canada and internationally (LaVito & Hirsch, 2018).
The results? According to one of the most well-respected longitudinal youth behavioral surveys conducted, the University
of Michigan’s Monitoring the Future (MTF) survey, marijuana vaping is increasing rapidly among youths. Between 2017 and
2018, past-month marijuana vaping increased from 1.6%, 4.3%, and 4.9% of 8th, 10th and 12th graders, respectively, to
2.6%, 7.0%, and 7.5%, reflecting a 63% increase among 8th and 10th graders, and a 53% increase among 12th graders
(Johnston, Miech, Bachman, Schulenberg, & Patrick, 2018).
Colorado toxicology reports show the percentage of adolescent suicide victims testing positive for marijuana continues to
increase. 20.7% of suicide victims between the ages of 10 and 17 tested positive for marijuana between 2011 and 2013;
by 2014-2016, this number had increased to 22.4% (Colorado Department of Public Health and Environment, 2019). In
comparison, only 9.3% of suicide victims between the ages of 10 and 17 tested positive for alcohol between 2014 and 2016.
This trend does not suggest direct causation, but the rise is concerning. Another study in Colorado found that 50%-75%
of youth in outpatient substance abuse treatment reported using diverted marijuana – marijuana accessed by adolescents
from adults with legal access to it (Wilkinson, Yarnell, Radhakrishnan, Ball, & D’Zouza, 2016). And in Anchorage, school
suspensions for marijuana use and possession increased more than 141% from 69 students in 2015 (when legalization was
implemented) to 166 students in 2017 (Wohlforth, 2018).
25
 SELLING TO MINORS
It is illegal for youth to purchase marijuana in “legal”
states. Among Oregon 11th graders who currently
use marijuana, 67% reported obtaining marijuana
from a friend (Oregon Public Health Division, 2016).
Furthermore, 37.2% of 8th and 49.5% of 11th
graders reported being exposed to online marijuana
advertisements in the past 30 days (Oregon Health
Authority, 2018). 30% of 8th and 62% of 11th graders
reported that it is “sort of easy” or “very easy” to
obtain marijuana (Oregon Public Health Division,
2016).
Additionally, marijuana dispensary density has been
linked to more use among youth, with 16% of 11th
graders reporting marijuana use in areas with less
dispensary density compared to 24.3% of the same
age group reporting use in more retail-dense areas
(Hatch, 2017).
Washington State law enforcement has documented
a total of 2,887 violations among licensed marijuana
businesses. Of these, 251 violations pertained
to selling marijuana to minors and 231 violations
were for allowing minors access to a restricted area
(Washington State Liquor and Cannabis Board).
In January of 2018, the Oregon Liquor Control
Commission conducted a random inspection of
licensed marijuana retailers and found that 11% of the
businesses were selling marijuana to minors (Oregon
Liquor Control Commission, 2018).

26
 IMPACTS OF
LEGALIZATION ON YOUTH
& YOUNG ADULTS

Often overlooked, the percentage of young adults

(18-25-year-olds) reporting past-month marijuana use
increased between 2015/2016 and 2016/2017 at a
higher rate in “legal” states versus non-legal ones
(NSDUH, 2016-2017). The national rate of 18-to-25-
year-old past month marijuana use is 21.5%, while the
rate for “legal” states is much higher – 29.2%. The rate
in non-legal states is close to the national average,
standing at 20.8% (NSDUH, 2016-2017).
Researchers from Oregon State University found that
college students who are binge drinkers under the
age of 21 saw relatively large increases in marijuana
use after legalization (Kerr, Bae, Phibbs, & Kern, 2017).
Nationally, youth and young adults continue to report
lower perceptions of risk from smoking marijuana once
a month than years past (NSDUH, 2016-2017).
In Nevada, past-year use among young adults rose by
6.4 percentage points between 2015/16 and 2016/17,
while past month-use rose by 7.6 percentage points
(NSDUH, 2015-2016; NSDUH, 2016-2017). The trend
of young adults using marijuana will have implications
for future generations.

27
 BLACK MARKET ACTIVITY SINCE
Commercialization advocates have long argued that legalization will reduce black market marijuana
activity in legalized states. However, criminal activity has only been amplified as highway interdiction
seizures and confiscations of illegal marijuana growing operations become increasingly common.
Oregon has been a hub of black market activity since legalization. A 2019 audit by Oregon’s Secretary
of State finds that black market prices for marijuana are several times higher than the legal market,
thus making sales on the black market more profitable. The report finds that the volume of marijuana
produced in Oregon is nearly 7 times its local consumption (Oregon Secretary of State, 2019). The
Oregon Police Department reported that at least 70% of marijuana sales in 2016 were on the black
market and that around three to five times the amount of marijuana sold in Oregon leaves the state for
LEGALIZATION

illegal sales (Hughes, 2017; Associated Press, 2017a, August 14; OSPDES, 2017).
The U.S. Attorney in Oregon reported in 2018 that Oregon has “an identifiable and formidable
marijuana overproduction and diversion problem” (Flaccus, 2018). It is estimated that Oregon has a
production capacity of approximately 2 million pounds, well over the estimated consumption capacity
of the state (approx. 275,000 pounds) (ORIDHIDTA, 2018). Between July 2015 and January 2018,
14,550 pounds of illegally trafficked Oregon marijuana was seized en route to 37 different states,
approximately $48 million worth (ORIDHIDTA, 2018). In 2017 alone, Colorado law enforcement
confiscated 14,692 pounds of bulk marijuana en route to 24 states, more than double the 7,116
pounds confiscated in 2016 (RMHIDTA, 2018). These confiscations come in conjunction with an
increase of approximately 50% in illegal grow operations across rural areas in the state (Stewart, 2017).
In the last half of 2017, $1 million in cash linked to marijuana transactions was seized at Portland
International Airport (Williams, 2018). Law enforcement across 16 states have reported seizing
marijuana coming from Oregon (Flaccus, 2018). In Colorado, concentrates accounted for 26% of
total marijuana seizures in 2017 and edibles accounted for another 16%. For comparison, in 2012,
concentrates and edibles combined made up only 10% of total seizures (Colorado Department of
Public Safety, 2018).
Legalization has made it easier for the black market to thrive in rural areas due to the difficulties
involved in distinguishing between legal and criminal marijuana farms. About $6.5 million worth of
illegal marijuana was destroyed by federal agencies in the White River National Forest in Aspen,
Colorado, and 9,200 illegal marijuana plants were found growing on islands in the middle of the
Colorado River (Associated Press, 2017b; Roy, 2017). There is now a strong presence of cartel activity
in Alaska (Alaska State Troopers, 2016), perhaps because the ability to hide black market activity in
legalized states has encouraged drug trafficking organizations (DTOs) and Mexican cartels to begin
28
growing marijuana illegally within the United States.
Lancaster County sheriff’s deputies in Nebraska arrested a licensed marijuana processor from Oregon
who was intending to distribute the 110 pounds of raw marijuana and 25 pounds of shatter (super-

BLACK MARKET ACTIVITY SINCE

high potency THC wax) in his vehicle (Johnson R. , 2017).
Notably, California’s projected marijuana tax revenue by July 2019 is nearly half of what was originally
expected when the state permitted retail sales in 2018, since most consumers continue to purchase
marijuana from the black market in order to avoid high taxes (Blood, 2019; Fuller, 2019).
Black market challenges abound in legalized states, with data too exhaustive to include in this report.
Some final highlights:
• The number of edibles seized in Colorado tripled since 2016, going from 2,111 in 2016 to

LEGALIZATION
6,462 in 2017 (RMHIDTA, 2018).
• Rates of marijuana investigative seizures in Colorado are over 9 times higher since legalization
(Rocky Mountain HIDTA Strategic Intelligence Unit, 2018).
• The number of highway seizures of Colorado marijuana has increased by 39% since legalization,
from an average of 242 seizures between 2009 and 2012, to an average of 336 seizures
between 2013 and 2017 (Rocky Mountain HIDTA Strategic Intelligence Unit, 2018). [Figure 11]
• The U.S. mail system has also been affected by the black market, seeing a 1,042% increase in
marijuana seizures since legalization in Colorado (U.S. Postal Inspection Service, 2018).
• Between July 2015 through January 2018, Oregonian law enforcement identified 64 illegal
cannabinoid extraction laboratories (ORHIDTA, 2018).
• It is estimated that Oregon has a production capacity of approximately 2 million pounds, well
over the estimated consumption capacity of the state (approx. 275,000 pounds) (ORHIDTA,
2018).
• In Colorado, concentrates accounted for 26% of total marijuana seizures in 2017 and edibles
accounted for another 16%. In 2012, concentrates and edibles combined made up only 10% of
total seizures (Colorado Department of Public Safety, 2018).
• Narcotics officers in Colorado have been forced to respond to an approximate 50% increase in
illegal grow operations across rural areas of the state.

29
 TRENDS IN CRIME
that the density of marijuana dispensaries was linked to
increased property crimes in nearby areas. Researchers
found that in Denver, Colorado, neighborhoods adjacent

SINCE LEGALIZATION to marijuana businesses saw 84.8 more property crimes

each year than neighborhoods without a marijuana shop
nearby (Freisthler, Gaidus, Tam, Ponicki, & Gruenewald,
Apart from black market activity, legalization has 2017).
potentially exacerbated other crimes, as well. Though The number of court filings charged with the Colorado
it cannot be said that crime has increased because of Organized Crime Control Act that were linked to a
legalization, some trends are worth noting. marijuana charge increased 284% from 31 in 2012 to 119
Colorado’s crime rate in 2016 increased 11 times in 2017 (Colorado Department of Public Safety, 2018)
faster than the 30 largest cities in the nation since (Colorado Department of Public Safety, 2018). In Alaska,
legalization (Mitchell, 2017), with the Colorado Bureau crime rose 6% from 2016 and 2017 (Spears, 2018) and
of Investigation reporting an 8.2% increase in violent compared to 2013, the property crime rate in Alaska was
crimes (19,928 in 2015 to 21,570 in 2016) and a 5.3% up last year by 22 percent and violent crime rate was
increase in property crimes (171,404 in 2015 to 180,501 up 34 percent (Zak & Hopkins, 2018). Moreover, motor
in 2016) between 2015 and 2016 (Colorado Bureau vehicle theft rates rose by over 100% since legalization in
of Investigation, 2017). While this is not evidence of 2015 from 278 per 100,000 persons to 577 per 100,000
causation, the trend must be noted. In addition, a 2019 persons (Spears, 2018).
study conducted in Denver finds that the existence of
both recreational and medical marijuana dispensaries in 600 588 per 100,000
Denver neighborhoods are significantly and positively
associated with increased crime (Hughes, Schaible, &
Jimmerson, 2019). Along with the increase in property 500
crimes, the Boulder Police Department reported a
176% increase in public consumption of marijuana 400
citations by the third year after legalization (Boulder
Policy Department, 2017).
300
277 per 100,000
A link between looser laws and crime has been
explored in the scientific literature. A study funded by 200 2015 2017
the National Institutes of Health (NIH) showed
Alaskan motor vehicle theft rates in 2017 rose by over 100% since legalization in 2015. From
277 per 100,000 persons to 588 per 100,000 persons (Spears, 2018)
30
 “
“Because it’s legal in the community, I think, the stigma around
marijuana use is decreasing,” said Joe Zawodny, director of secondary
education for the [Anchorage] school district. “The data would seem to
say there is increasing use” (Wohlforth, 2018).

The percentage of Colorado school suspensions for marijuana is 23%, the highest number for any school offense.
The proportion of 18-25-year old probationers testing positive for THC increased, from 32% in 2012 and 41% in 2017.
Further, between 2012 and 2014, the percentage of 10 to 14-year-olds who tested positive for THC once or twice
increased from 19% to 23%, and those who tested positive for THC three or more times increased from 18% to 25%.
In the same time frame, the percentage of 15- to 17-year-olds who tested positive for THC once or twice decreased
from 26% to 25% and those testing positive for THC three or more times increased from 23% to 25%.
(Munoz, Flick, & English, 2017). 103 law enforcement agencies reported 6,727 qualifying incidents in 554 public schools
during the 2015-16 academic year (Munoz, Flick, & English, 2017).
In Colorado, the number of cases with a marijuana-related felony as the top charge has doubled since 2014, a
phenomenon at odds with what pro-legalization advocates promised (Colorado Department of Public Safety, 2018).

31
 IMPACTS OF LEGALIZATION ON
COMMUNITIES OF COLOR AND
LOW-INCOME POPULATIONS
With the advent of legalization, communities of color are subject to disproportionate targeting by
the marijuana industry. As pro-marijuana lobbyists argue that legalization will improve social justice
in legalized states, disparities among use and criminal offense rates persist across race, ethnicity,
and income levels.
The 2017 marijuana-related African American arrest rate in Colorado is nearly twice that of
Caucasians (Colorado Department of Public Safety, 2018). 39% of African American marijuana-
related arrests in 2017 were made without a warrant, while only 18% of Caucasians were arrested
without one (Colorado Department of Public Safety, 2018).
In Washington D.C., between 2015 and 2017 (the years immediately following legalization),
although total marijuana-related arrests have gone down, distribution and public consumption
arrests more than tripled. Among adults, 89% of marijuana distribution or public consumption
arrestees were African American (DC Metropolitan Policy Department, 2018). Juvenile marijuana-
related arrests increased 114% between the three years before and after marijuana legalization.
Colorado schools that had 25% or fewer youth of color had 313 marijuana-related suspensions per
100,000 students compared to 658 marijuana-related suspensions per 100,000 students for schools
comprised of populations with 76% or more youth of color (Colorado Department of Public Safety,
2016). Between 2012 and 2014, the percentage of Hispanic and African American arrests for teens
under 18 years old increased 29% and 58%, respectively (Colorado Department of Public Safety,
2016).

32
 “
“All this bill means is that the rich are going to get
richer and the poor are going to get poorer ... I
know what racism is and I know what injustice is
and this stinks of it.”
– New Jersey State Senator Ronald Rice, November 27, 2018 https://www.njspotlight.com/stories/18/11/27/amid-
complaints-curtailed-comments-and-confusion-recreational-marijuana-bill-goes-to-full-senate/

In Los Angeles, the majority of dispensaries have opened primarily in African-American communities (Thomas
& Feisthler, 2017). Additionally, an overlay of socioeconomic data with the geographic location of pot shops in
Denver shows marijuana stores are located disproportionately in disadvantaged neighborhoods (Hamm, 2016).
In Oregon, the state conducted an analysis on the distribution of state-sanctioned dispensaries and found that
sites were disproportionately concentrated among low-income and historically disenfranchised communities
(McVey, 2017; Smith, 2017).
A study by the American College of Obstetricians and Gynecologists reported that young, urban women from
lower income levels have a 15–28% rate of marijuana use during pregnancy. Between 34 and 60% of marijuana
users continue marijuana use throughout pregnancy due to a decreased perception of risk and stigma (The
American College of Obstetricians and Gynecologists, 2017).

33
 IMPACT OF
LEGALIZATION
ON HOMELESSNESS
The increased availability of marijuana after legalization
also appears to have a possible link to Colorado’s
growing homeless population. Colorado’s homelessness
rate appears to have increased with the expansion of
recreational marijuana. The U.S. Department of Housing
and Urban Development reported a 13% increase in
Colorado’s homeless population from 2015 and 2016,
while the national average decreased 3% (Burke & Acuna,
2017).
The number of homeless children in Colorado increased
50% between 2007/2008 and 2014/2015 (Zubrzycki,
2016).
Business owners and officials in Durango, Colorado,
have testified that the resort town “suddenly became a
haven for recreational pot users, drawing in transients,
panhandlers, and a large number of homeless drug
addicts” (Kolb, 2017).

34
ALCOHOL CONSUMPTION IS
RISING IN LEGAL STATES
Some industry backers also claim that loosening marijuana
laws will decrease alcohol use among consumers. But the
opposite has been observed in legalized states. According
to a 2018 report, Colorado has seen a 5% increase in the
gallons of beer consumed over the past five years – and
Washington has seen a 9% increase (Sauter, 2018) Other
studies show no meaningful decrease in alcohol use since
legalization (Haughwout & Slater, 2017). Further analysis found
that “Allowing for changes in the adult population over the
period 2005-2017, the data show a continuing increase in
wine servings alongside…legalization” (Pallechia, 2018). By
the end of 2018, the gallons of alcohol consumed in Colorado
was 12% higher than it was in 2013 (Colorado Department of
Revenue, 2013-2018).
A study of six universities in states without recreational
marijuana laws compared to a public university in Oregon
finds that for undergraduate students, rates of marijuana
use among binge drinkers are significantly higher among
Oregonian students compared to students at university in
non-legal states (Kerr, Bae, Phibbs, & Kern, 2017).
Furthermore, major alcohol interests are getting financially
involved in the marijuana industry. Constellation Brands, for
example, has invested $4 billion in marijuana. Molson Coors
and Blue Moon are other alcohol juggernauts who have made
substantial investments in the marijuana industry (Miller, 2018;
Hughes, 2018).

35
 The increase in marijuana availability due to legalization has led to increasing numbers of marijuana-related
poison control calls, hospitalizations, and ER visits.
In the two years immediately following recreational marijuana legalization in Colorado, calls to poison centers
significantly increased by over 100% from 110 in 2012 to 229 in 2015 (Wang, et al., 2017).
Since legalization, total marijuana exposure calls to Colorado poison control centers have more than doubled
(127 calls in 2013 to 265 calls in 2018). The largest increase is a 230% increase of children 0-8 years old that
HOSPITAL & ER VISITS
suffered unintentional exposure to marijuana since legalization, with 27 calls made in 2013 and 89 made in
2018 (Colorado Department of Public Health and Environment, 2019).
A recent study by the Colorado Department of Public Health and Environment found that in 2018, over
23,000 homes in the state had children aged 1-14 in the household and were storing marijuana products
unsafely (Colorado Department of Public Health and Environment, 2018). Research conducted by an
emergency medicine physician in Colorado finds that, between 2013 and 2018, overall drug use by Pueblo
County patients checking into the ER has increased by over 40%. Among those, patients who test positive for
cannabis have risen by over 55% (Randall, 2019).
A study conducted in Washington State found that the rate of pediatric exposures to marijuana (children aged
9 or under) was 2.3 times higher following retail sales than it was before legalization (Thomas, et al., 2019).
Other concerning healthcare indicators include:
• A recent study conducted in Colorado finds that following recreational marijuana commercialization
in 2013, marijuana-detection rates significantly increased among traumatic injury patients in Colorado
hospitals (Chung, et al., 2019).
• Washington has seen a 73% increase in poison control between three-year averages before and after
legalization (from an average of 155 between 2011 and 2013 to an average of 268 calls between 2014
and 2016) (Washington State Office of Financial Management, 2017).
• In Colorado, the annual rate of marijuana-related emergency department visits increased by 62%
from 701 per 100,000 visits in 2012 to 1,139 per 100,000 visits in 2017, and marijuana-related
hospitalizations in Colorado rose by 143% from 1,418 per 100,000 hospitalizations in 2012 to 3,439, per
100,000 hospitalizations in 2017 (Colorado Department of Public Health and Environment, 2019).
• Oregon Poison Control had 81 marijuana-related calls in the first quarter of 2018 alone (Oregon Poison
Center, 2018). For children 5 years or younger, the number rose by 271% from 14 cases in 2014 to 52
cases in 2017 (Oregon Poison Center, 2018).
• An independent investigation in San Diego found that nearly 30% of marijuana samples purchased from
36 licensed retailers in Southern California lab-tested positive for pesticides (Grover & Corral, 2019).
 COSTS RELATED TO HIGH
POTENCY THC
The increase in marijuana-related emergency department
visits includes a growing number of Butane Hash Oil (BHO)
burn victims. BHO is a marijuana concentrate that yields a
THC potency of 70–99% and is highly lucrative. Production of
BHO involves forcing raw marijuana and butane into a reaction
chamber, which creates a highly combustible liquid that easily
explodes when introduced to an ignition source.
The Oregon State Police claims that the growth of BHO
lab operations since legalization is “… arguably the most
immediate cannabis threat facing the state” (Oregon State
Police - Drug Enforcement Section, 2017). According to the
Oregon Burn Center, Butane Hash Oil explosions between
July 2015 to January 2018 has resulted in an estimated $9.6
million in total treatment costs (Legacy Emmanuel Oregon
Burn Center, 2013-2017). During this same period, Oregon
investigated 64 illegal extraction labs and 21 of them
resulted in either an explosion or fire (US Drug Enforcement
Administration, 2018).

37
 IMPACT OF LEGALIZATION
ON THE WORKFORCE Marijuana is the most commonly detected substance
and has the highest drug positivity rate among all
other tested substances across the majority of industry
Legalization of marijuana has had serious ramifications sectors in the U.S. (Quest Diagnostics, 2017). Among the
for businesses across legalized states. Increased top-ranking industries for the highest rates of positive
marijuana availability and use has also increased the marijuana testing, transportation and warehousing was
number of employees testing positive for marijuana number one with 33.3%. Meanwhile the construction
in the workforce. Workforce marijuana-positivity industry had an average of 26.7% positive marijuana
rates in all “legal” states but one (Alaska) are above testing (Quest Diagnostics, 2018).
the national average. For example, 2018 positivity
rates in Maine (5.0%), Oregon (4.3%), Nevada (4.0%), It is now difficult for employers to find job applicants who
Massachusetts (3.3%), Colorado (3.0%), California can pass a drug test. Colorado construction company
(2.5%), and Washington (2.4%) are higher than the GE Johnson was forced to hire out-of-state construction
national average (2.3%) (Quest Diagnostics, 2018). workers because too many Coloradans were failing pre-
employment drug tests (The Gazette, 2015).
Washington and Colorado had increases to the rate
of positive marijuana urine tests more than double the A study conducted in Washington during 2011-2014
increases for the nation (Quest Diagnostics, 2017). In found that the percentage of work-related injuries and
the 3-year period following legalization in Colorado illnesses was significantly higher among marijuana users
and Washington (2013– 2016), positive oral-fluid test (8.9%) compared to non-users (Marcum, Chin, Anderson,
results for marijuana use in the workplace increased & Bonauto, 2017). Insurance claims have become a
almost 75%, from 5.1 to 8.9 percent, nationwide. From growing concern among companies in legalized states
2015 and 2016, there was a nearly 10% increase in because, if marijuana use is allowed or drug testing
positivity rates for the safety-sensitive workforce, which ignored, employers are at risk of liability claims when a
includes pilots and bus drivers. marijuana-related injury or illness occurs onsite (Hlavac &
Easterly, 2016).

38
 STONED DRIVING
Drugged driving and motor vehicle fatalities have increased in states that have legalized recreational marijuana.
According to the biological results of Washington’s Roadside Survey, ”nearly one in five daytime drivers may be
under the influence of marijuana, up from less than one in 10 drivers prior to the implementation of marijuana retail
sales” (Grondel, 2018).
A 2019 study of over 2,000 drivers in Washington State reports that six months immediately after introducing retail
sales of marijuana, the proportion of THC-positive drivers was almost three times as great as the month before retail
sales (Eichelberger, 2019).
A statistically larger percentage of Colorado youth report driving after marijuana use than driving after alcohol use
(Colorado Department of Public Health and Environment, 2019).
The rate of traffic fatalities involving drivers who tested positive for marijuana in Colorado rose from 55 in 2013 to
138 people killed in 2017. Over one-fifth of all traffic fatalities in 2017 included a driver testing positive for marijuana
(National Highway Traffic Safety Administration, 2006-2011; Colorado Department of Transportation, 2012-2017).
From 2013 to 2016, THC-impaired driving in Washington State nearly tripled from 7.8% before retail sales to 19.4%
one year after sales (Grondel, 2018).
20 19.4%
2013-2017
2013
55 People Killed THE RATE OF TRAFFIC FATALITIES
INVOLVING DRIVERS WHO TESTED
POSITIVE FOR MARIJUANA IN 15
COLORADO

138 People Killed 10 THC-IMPAIRED DRIVING IN

2017
WASHINGTON STATE
7.8%

5 2013 2016
Between 2013 and 2016, the rate of THC-impaired driving in Washington State nearly
tripled from 7.8% to 19.4% (Grondel, 2018)
39
 STONED DRIVING
Driving under the influence of drugs (DUIDs) has also
risen in Colorado, with 74% of statewide DUIDs in
2017 involving marijuana, and 69% of marijuana users
admitting to driving high within the last year (Colorado
State Patrol, 2018). In Oregon, approximately half of all
drivers assessed by Drug Recognition Experts in 2015
tested positive for THC. Toxicology reports show that
testing positive for THC has consistently increased,
indicating an increase in THC-related impaired driving
(Oregon Liquor Control Commission, 2016).
Research by the Highway Loss Data Institute finds that
recreational legalization of marijuana in Colorado,
Oregon and Washington is significantly associated
with an increase in collision claims (Highway Loss Data
Institute, 2018).
Unfortunately, Alaska does not have reliable DUIDs data
available. While many factors contribute to pedestrian
fatalities, it turns out that states that legalized marijuana
for medical and/or recreational use saw a 16.4 percent
surge in such deaths in the first six months of 2017
compared to the first six months of 2016, while non-legal
states saw a drop of 5.8 percent in pedestrian fatalities
over the same time (Boudette, 2018).

40
 IMPACT OF LEGALIZATION ON THE ENVIRONMENT

The full effects of the industry on the natural environment are only beginning to be recognized. These impacts
occur even in a so-called “regulated” environment, as the vast amounts of water and electricity needed to power
marijuana farms are damaging to the environment.
Legalization, and the industry it has created, has caused irreparable damage to rainforests and other elements of the
ecosystem. In California, farms generating marijuana crops have polluted plants and other natural life to the point
of being hazardous to surrounding communities (Bernstein, 2017). Additionally, pollution caused by illegal grow
sites has inflicted animal casualties. The poison used to reduce rodent population at farms has in turn killed large
numbers of spotted owls, a species marked as “threatened” according to the Endangered Species Act (Chua, 2018).
The average mature cannabis plant consumes approximately 22.7 liters of water a day (Bauer, et al., 2015). The
Pacific Northwest has been facing drought and water shortages despite marijuana production for years, however,
with the new market, regions like the Rogue River Basin are under critical strain (Mann, 2016).
In 2017 alone, there were 80,826 plants seized off Colorado public lands, compared to 4,980 plants seized in 2013
(US Bureau of Land Management, 2017). For example, in 2015 the DOJ announced a wave of prosecutions, many
of which on federal land, resulting in seizure of 20,000 marijuana plants and over 300 kilograms of dried marijuana
in Colorado. Suspects included Mexican nationals with ties to transnational criminal groups (U.S. Attorney’s Office,
2015).
Power consumption is a similar story. In 2012, marijuana growing consumed 1% of the nation’s electricity, six times
the amount of power the entire U.S. pharmaceutical industry uses (Mills, 2012). Indoor cultivation of one kilogram of
marijuana releases carbon dioxide emissions comparable to that of a passenger car in one year and uses two times
as much energy as an average refrigerator in a year (US Environmental Protection Agency, 2018; Energy Star, 2018).
This enormous energy use derives from both the quantity of marijuana grown and the large amount of energy
it demands. Marijuana is almost four times more energy intensive than oil or coal (Mills, 2012). It uses so much
power that indoor marijuana production in Colorado is responsible for 2% of the state’s electrical load and 45%
of all new electricity demand coming online (Crombie, 2016). In fact, Mother Jones magazine indicated that the
marijuana market “has placed a huge burden on the grid that distributes electricity throughout the state” (Colorado
41
Department of Transportation, 2012-2017; Mock, 2015).
 RECOMMENDATIONS
Policy makers and the public need real-time data on both the consequences of legalization and the related
monetary costs. Meanwhile, the industry’s influence on policy should be significantly curtailed. SAM recommends
research efforts and data collection focus on the following categories:

• Emergency room and hospital admissions related to marijuana.

• Marijuana potency and price trends in the legal and illegal markets.
• School incidents related to marijuana, including representative data sets.
• Extent of marijuana advertising toward youth and its impact.
• Marijuana-related car crashes, including THC levels even when testing positive for alcohol.
• Mental health effects of marijuana.
• Admissions to treatment and counseling intervention programs.
• Cost of implementing legalization from law enforcement to regulators.
• Cost of mental health and addiction treatment related to increased marijuana use.
• Cost of needing but not receiving treatment.
• Effect on the market for alcohol and other drugs.
• Cost to workplace and employers, and impact on employee productivity.
• Track minority impacts, including arrests, placement of marijuana establishments, and quality of life
indicators.
• Track environmental impacts, including water and power usage.

42
 REFERENCE LIST

Agence France-Presse. (2015, November 27). Everyday Actions that experts. Thomson Reuters. Retrieved February 2019, from https://www.
Contribute to Carbon Dioxide Emissions. ABC-CBN.com. Retrieved February reuters.com/article/us-usa-marijuanaenvironment/toxic-waste-from-u-s-pot-
2019, from https://news.abs-cbn.com/focus/11/27/15/everyday-actions-that- farms-alarms-experts-idUSKBN1AM0C3
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CALIFORNIA, WASHINGTON,
COLORADO, OREGON, ARKANSAS,
preventing another big tobacco
DISTRICT OF COLUMBIA, NEVADA
AND MAINE