medical marijuana essay conclusion

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The Benefits of Medical Marijuana, Essay Example

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Marijuana has been used in many spiritual healings and for recreational use for many years. Marijuana has been used as early as 2900 BC when Chinese Emperor Fu His referenced marijuana (Cannabis) as a popular medicine of the time. According to Richard Boire, and Kevin Feeney (2007), “In the 19th Century, marijuana emerged as a mainstream medicine in the West. Studies in the 1840s by a French doctor by the name of Jacques-Joseph Moreau [a French psychiatrist] found that marijuana suppressed headaches, increased appetites, and aided people to sleep.” (“Medical Marijuana,” 2009, n.p.).However, not until recently had it even crossed the minds of many medical professionals to be used in order to help patients who have been diagnosed with many diseases where relief is very seldom. It is now being legalized in many states in order to help with many medical diseases and chronic pain.“Medical marijuana clinics operate in 20 states and the District of Columbia, and its recreational use is now legal in Colorado and Washington” (Brody, 2013, n.p.). Even with the many medical clinics supporting the use of medicinal marijuana, there are still many different views by different people on whether marijuana should be used for medical purposes. Many believe that it shouldn’t be used as it is still considered a drug that may have adverse effects on the brain and other organs in the body. However, there are many people who support the use of marijuana as long as it is used for medical purposes. It is all a matter of opinion for many at this point. However, there are many benefits for the use of marijuana in the medical field today.

The real use of medicinal marijuana was introduced by W.B. O’Shaughnessy, a surgeon who learned that marijuana could be used to help alleviate pain and many other medical problems. According to the National Cancer Institute (2013), “its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects” (p. 1).Cancer is one of the largest medical problems in our society today and many clinical trials of medical marijuana have shown that it helps with the effects of chemotherapy such as vomiting and nausea under a generic name called dronabinol (National Cancer Institute, 2013). “Clinical trials determined that dronabinol was as effective as or better than other antiemetic agents available at the time” (National Cancer Institute, 2013, p. 1). Cancer and chemotherapy are just two of the aspects of the medical field that marijuana benefits. According to the former US Surgeon General, Jocelyn Elders (2004), “the evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS — or by the harsh drugs sometimes used to treat them” (“Medical Marijuana,” 2009, n.p.). Not only does marijuana help with the side effects of chemotherapy, but there is evidence that a chemical that is found in marijuana stops cancer from spreading. In 2007, the California Pacific Medical Center in San Francisco did a study that proved that cannabidiol prevents cancer cells from spreading (Astaiza, 2012). Astaiza (2012) states that cannabidiol by turning off the Id-1 gene in the person’s body. “The researchers studied breast cancer cells in the lab that had high expression levels of Id-1 and treated them with cannabidiol. After treatment the cells had decreased Id-1 expression and were less aggressive spreaders” (Astaiza, 2012, n.p.).

Many individuals are living with pain each and every day of their lives. This pain can stem from the smallest things such as back aches and headaches to larger problems such as multiple sclerosis as stated above. Randy Astaiza (2012) states the following in reference to how marijuana helps patients with multiple sclerosis:

Jody Corey-Bloom studied 30 multiple sclerosis patients with painful contractions in their muscles. These patients didn’t respond to other treatments, but after smoking marijuana for a few days they were in less pain. The THC in the pot binds to receptors in the nerves and muscles to relieve pain. Other studies suggest that the chemical also helps control the muscle spasms (n.p.).

Pain management is one of the largest parts of the medical field as well and many are beginning to say that marijuana helps alleviate much of the pain that patients feel. According to Jane E. Brody (2013), “the strongest evidence for the health benefits of medical marijuana or its derivatives involves the treatment of chronic neuropathic pain and the spasticity caused by multiple sclerosis” (p. 1).One of these pains, among many, is peripheral neuropathy which consists of many symptoms that can significantly deteriorate a person’s quality of life. According to Igor Grant (2013), this is something that can be treated by the use of medical marijuana. Grant (2013) describes painful peripheral neuropathy in the following paragraph:

Painful peripheral neuropathy comprises multiple symptoms that can severely erode quality of life. These include allodynia (pain evoked by light stimuli that are not normally pain-evoking) and various abnormal sensations termed dysesthesias (e.g., electric shock sensations, “pins and needles,” sensations of coldness or heat, numbness, and other types of uncomfortable and painful sensations). Common causes of peripheral neuropathy include diabetes, HIV/AIDS, spinal cord injuries, multiple sclerosis, and certain drugs and toxins (p. 466).

Many individuals that are suffering from these diseases attempt to get treatment and sometimes that treatment does work. However, many scientists and doctors that support the use of medical marijuana state that many of these patients would have better results if prescribed marijuana is small doses. In addition, researchers and physicians are also beginning to state that marijuana helps those patients with arthritis. This drug alleviates pain and discomfort as well as reduces the inflammation that many arthritis patients deal with on a daily basis. For example, “Researchers from rheumatology units at several hospitals gave their patients, sativex, a cannabinoid-based pain-relieving medicine. After a two week period, people on Sativex had a significant reduction in pain and improved sleep quality compared to placebo users” (Astaiza, 2012, n.p.).

In addition, marijuana can help with diseases such as epilepsy, anxiety disorders, and Alzheimer’s disease.  According to Astaiza (2012), “Cannabinoids like the active ingredient in marijuana, tetrahydrocannabinol (also known as THC), control seizures by binding to the brain cells responsible for controlling excitability and regulating relaxation” (n.p.). This is one of the most amazing benefits of medicinal marijuana as there are many individuals that suffer from epileptic seizures on a daily basis. It is also said that marijuana helps reduce anxiety. According to researchers at the Harvard Medical school, marijuana helps a person’s mood and “acts as a sedative in low doses” (Astaiza, 2012, n.p.). Finally, it is said that marijuana helps slow the process of Alzheimer’s disease. Astaiza (2012) states the following to prove this:

The 2006 study, published in the journal Molecular Pharmaceutics, found that THC, the active chemical in marijuana, slows the formation of amyloid plaques by blocking the enzyme in the brain that makes them. These plaques are what kill brain cells and cause Alzheimer’s (n.p.).

Many focus on the fact that marijuana is an illegal drug, that it can be addictive, and that many individuals will abuse the use of the drug if it is ever legalized (either recreationally or through medical use). When looking at only the negative aspects of something, it is not easy to approach a concept with a positive means of change.Many people are not taking the time to look at the benefits that it may have on the people who have to deal with chronic pain and irreversible diseases. These individuals go day to day with pain that they are not able to relieve even with legalized medications. The more research and studies that are done can certainly help make believers out of those that are against the use of marijuana for medical purposes. If a substance can be used to alleviate discomfort and pain, where there are proven studies that show its positive effects, many would think that the drug should be used to help patients. Unfortunately, too many people are focusing on the negative effects that this drug could have on a person’s body. One must open his or her mind to the idea that something could be beneficial even if they do not completely believe in its use.

In conclusion, marijuana can be very beneficial for the chronically ill. It also has benefits for those individuals that deal with chronic pain and other diseases such as epilepsy, AIDS, multiple sclerosis, fibromyalgia and much more. If used in a medical sense, with the right amount of dosage and the proper treatment by a physician, the use of marijuana could change the lives of many who are suffering. Unfortunately, this takes the work of many doctors, nurses, government officials, and supporters that will back up the ideas and the many negative contradictions with positive feedback about the drug when used properly. If this could take place and many could see the actual benefits, the use of marijuana in the medical field could help many individuals who continue to suffer on a daily basis.

Astaiza, R. (2012, November 08). All the reasons pot is good for you. Business Insider , Retrieved from http://www.businessinsider.com/health-benefits-of-medical-marijuana-2012-11?op=1

Brody, J. E. (2013, November 04). Tapping medical marijuana’s potential. The New York Times . Retrieved from http://well.blogs.nytimes.com/2013/11/04/tapping-medical-marijuanas-potential/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1

Grant, I. (2013). Medicinal cannabis and painful sensory neuropathy. American Medical Association Journal of Ethics , 15(5), 466-469. Retrieved from http://virtualmentor.ama-assn.org/2013/05/oped1-1305.html

Medical marijuana. (2009, May 06). Retrieved from http://medicalmarijuana.procon.org/view.resource.php?resourceID=000141

National Cancer Institute. (2013, November 21). Cannabis and Cannabinoids . Retrieved from http://www.cancer.gov/cancertopics/pdq/cam/cannabis/healthprofessional/page2

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THREE ESSAYS ON THE EFFECT OF LEGALIZING MARIJUANA ON HEALTH, EDUCATION, AND SOCIAL SECURITY

The legalization of marijuana has emerged as a critical public policy issue, with far-reaching implications for health, education, and government programs at both the state and federal levels. The three essays of this dissertation show that medical marijuana legalization (MML) has a negative effect in each of these areas. The first essay shows, that the enactment of MMLs can exacerbate the crisis of overdose deaths in the United States. The study analyzes three key areas: the rate of overdose deaths caused by both legal and illegal drugs, the impact of MML on social norms regarding the perceived harm of marijuana, and an investigation into the gateway theory by examining the use of other addictive drugs. I find that MMLs increase deaths attributed to overdose by 21.5% population. MMLs s also indicate increase the number of deaths due to prescribed opioids by 44.6%, and deaths from all opioids (heroin and cocaine in addition to prescribed opioids) by 37.2 % Results suggest an overall increase in the use of marijuana, primarily due to lower perceived risk among adolescents. Additionally, results show an increase in hospital admissions due to substance abuse. The analysis suggests that legalizing medical marijuana may exaggerate the current problem of drug overdose in the United States. The second essay examines the impact of improved access to medical marijuana, measured by the proximity of schools to the nearest dispensary, on the academic performance of high school students in California. Students in schools farther from a marijuana dispensary have higher academic performance as measured through AP, ACT, SAT scores, and average GPA, and lower number of suspensions due to violence and illicit drug use. To show this, I construct the first geocoded dataset on marijuana dispensary and high school locations, use newly developed difference-in-differences estimators that rule out any bias due to heterogeneous treatment effects over time, and explore dynamic responses. This essay reveals the importance of ensuring a largest possible distance between schools and dispensaries to protect adolescents from the potential harm caused by medical marijuana. Finally, the third essay shows that in the long term, MMLs increase the number of disabled workers who receive Social Security Disability Income (SSDI) because of mental health issues. SSDI is a major social insurance program that provides benefits to workers who become disabled, and understanding how policy changes in other areas may impact this program is important. In this study, there were important differences between the results of a two-way fixed effects model and a new model by Callaway and Santa’Anna. MMLs, in theory, could either increase or decrease the number of SSDI recipients, and traditional fixed effects models suggest both could be at play; however, only the negative effect is robust to correction for heterogeneous effects. This highlights the need for future research to understand the true impact of medical marijuana legalization

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The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017)

Chapter: summary.

Over the past 20 years there have been substantial changes to the cannabis policy landscape. To date, 28 states and the District of Columbia have legalized cannabis for the treatment of medical conditions ( NCSL, 2016 ). Eight of these states and the District of Columbia have also legalized cannabis for recreational use. These landmark changes in policy have markedly changed cannabis use patterns and perceived levels of risk. Based on a recent nationwide survey, 22.2 million Americans (12 years of age and older) reported using cannabis in the past 30 days, and between 2002 and 2015 the percentage of past month cannabis users in this age range has steadily increased ( CBHSQ, 2016 ).

Despite the extensive changes in policy at the state level and the rapid rise in the use of cannabis both for medical purposes and for recreational use, conclusive evidence regarding the short- and long-term health effects (harms and benefits) of cannabis use remains elusive. A lack of scientific research has resulted in a lack of information on the health implications of cannabis use, which is a significant public health concern for vulnerable populations such as pregnant women and adolescents. Unlike other substances whose use may confer risk, such as alcohol or tobacco, no accepted standards exist to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.

Within this context, in March 2016, the Health and Medicine Division

(formerly the Institute of Medicine [IOM] 1 ) of the National Academies of Sciences, Engineering, and Medicine (the National Academies) was asked to convene a committee of experts to conduct a comprehensive review of the literature regarding the health effects of using cannabis and/or its constituents that had appeared since the publication of the 1999 IOM report

__________________

1 As of March 2016, the Health and Medicine Division continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM).

Marijuana and Medicine . The resulting Committee on the Health Effects of Marijuana consisted of 16 experts in the areas of marijuana, addiction, oncology, cardiology, neurodevelopment, respiratory disease, pediatric and adolescent health, immunology, toxicology, preclinical research, epidemiology, systematic review, and public health. The sponsors of this report include federal, state, philanthropic, and nongovernmental organizations, including the Alaska Mental Health Trust Authority; Arizona Department of Health Services; California Department of Public Health; CDC Foundation; Centers for Disease Control and Prevention (CDC); The Colorado Health Foundation; Mat-Su Health Foundation; National Highway Traffic Safety Administration; National Institutes of Health/National Cancer Institute; National Institutes of Health/National Institute on Drug Abuse; Oregon Health Authority; the Robert W. Woodruff Foundation; Truth Initiative; U.S. Food and Drug Administration; and Washington State Department of Health.

In its statement of task, the committee was asked to make recommendations for a research agenda that will identify the most critical research questions regarding the association of cannabis use with health outcomes (both harms and benefits) that can be answered in the short term (i.e., within a 3-year time frame), as well as steps that should be taken in the short term to ensure that sufficient data are being gathered to answer long-term questions. Of note, throughout the report the committee has attempted to highlight research conclusions that affect certain populations (e.g., pregnant women, adolescents) that may be more vulnerable to potential harmful effects of cannabis use. The committee’s full statement of task is presented in Box S-1 .

STUDY CONTEXT AND APPROACH

Over the past 20 years the IOM published several consensus reports that focused on the health effects of marijuana or addressed marijuana within the context of other drug or substance abuse topics. 2 The two IOM reports that most prominently informed the committee’s work were Marijuana and Health , published in 1982, and the 1999 report Marijuana and Medicine: Assessing the Science Base. Although these reports differed in scope, they were useful in providing a comprehensive body of evidence upon which the current committee could build.

The scientific literature on cannabis use has grown substantially since the 1999 publication of Marijuana and Medicine. The committee conducted an extensive search of relevant databases, including Medline, Embase,

2 See https://www.nap.edu/search/?year=1995&rpp=20&ft=1&term=marijuana (accessed January 5, 2017).

the Cochrane Database of Systematic Reviews, and PsycINFO, and they initially retrieved more than 24,000 abstracts that could have potentially been relevant to this study. These abstracts were reduced by limiting articles to those published in English and removing case reports, editorials, studies by “anonymous” authors, conference abstracts, and commentaries. In the end, the committee considered more than 10,700 abstracts for their relevance to this report.

Given the large scientific literature on cannabis, the breadth of the statement of task, and the time constraints of the study, the committee developed an approach that resulted in giving primacy to recently published systematic reviews (since 2011) and high-quality primary research for 11 groups of health endpoints (see Box S-2 ). For each health endpoint,

systematic reviews were identified and assessed for quality using published criteria; only fair- and good-quality reviews were considered by the committee. The committee’s conclusions are based on the findings from the most recently published systematic review and all relevant fair- and good-quality primary research published after the systematic review. Where no systematic review existed, the committee reviewed all relevant primary research published between January 1, 1999, and August 1, 2016. Primary research was assessed using standard approaches (e.g., Cochrane Quality Assessment, Newcastle–Ontario scale) as a guide.

The search strategies and processes described above were developed and adopted by the committee in order to adequately address a broad statement of task in a limited time frame while adhering to the National

Academies’ high standards for the quality and rigor of committee reports. Readers of this report should recognize two important points. First, the committee was not tasked to conduct multiple systematic reviews, which would have required a lengthy and robust series of processes. The committee did, however, adopt key features of that process: a comprehensive literature search; assessments by more than one person of the quality (risk of bias) of key literature and the conclusions; prespecification of the questions of interest before conclusions were formulated; standard language to allow comparisons between conclusions; and declarations of conflict of interest via the National Academies conflict-of-interest policies. Second, there is a possibility that some literature was missed because of the practical steps taken to narrow a very large literature to one that was manageable within the time frame available to the committee. Furthermore, very good research may not be reflected in this report because it did not directly address the health endpoint research questions that were prioritized by the committee.

This report is organized into four parts and 16 chapters. Part I: Introduction and Background , Part II: Therapeutic Effects (Therapeutic Effects of Cannabis and Cannabinoids), Part III: Other Health Effects , and Part IV: Research Barriers and Recommendations . In Part II , most of the evidence reviewed in Chapter 4 derives from clinical and basic science research conducted for the specific purpose of answering an a priori question of whether cannabis and/or cannabinoids are an effective treatment for a specific disease or health condition. The evidence reviewed in Part III derives from epidemiological research that primarily reviews the effects of smoked cannabis. It is of note that several of the prioritized health endpoints discussed in Part III are also reviewed in Part II , albeit from the perspective of effects associated with using cannabis for primarily recreational, as opposed to therapeutic, purposes.

Several health endpoints are discussed in multiple chapters of the report (e.g., cancer, schizophrenia); however, it is important to note that the research conclusions regarding potential harms and benefits discussed in these chapters may differ. This is, in part, due to differences in the study design of the reviewed evidence, differences in characteristics of cannabis or cannabinoid exposure (e.g., form, dose, frequency of use), and the populations studied. As such, it is important that the reader is aware that this report was not designed to reconcile the proposed harms and benefits of cannabis or cannabinoid use across the report’s chapters. In drafting the report’s conclusions, the committee made an effort to be as specific as possible about the type and/or duration of cannabis or cannabinoid exposure and, where relevant, cross-referenced findings from other report chapters.

REPORT CONCLUSIONS ON THE ASSOCIATION BETWEEN CANNABIS USE AND HEALTH

From their review, the committee arrived at nearly 100 different research conclusions related to cannabis or cannabinoid use and health. Informed by the reports of previous IOM committees, 3 the committee developed standard language to categorize the weight of evidence regarding whether cannabis or cannabinoid use (for therapeutic purposes) is an effective or ineffective treatment for the prioritized health endpoints of interest, or whether cannabis or cannabinoid use (primarily for recreational purposes) is statistically associated with the prioritized health

3 Adverse Effects of Vaccines: Evidence and Causality ( IOM, 2012 ); Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence ( IOM, 2008 ); Veterans and Agent Orange: Update 2014 ( NASEM, 2016 ).

endpoints of interest. Box S-3 describes these categories and the general parameters for the types of evidence supporting each category. For a full listing of the committee’s conclusions, please see this chapter’s annex .

REPORT RECOMMENDATIONS

This is a pivotal time in the world of cannabis policy and research. Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives. The committee has put forth a substantial number of research conclusions on the health effects of cannabis and cannabinoids. Based on their research conclusions, the committee members formulated four recommendations to address research gaps, improve research quality, improve surveillance capacity, and address research barriers. The report’s full recommendations are described below.

Address Research Gaps

Recommendation 1 : To develop a comprehensive evidence base on the short- and long-term health effects of cannabis use (both beneficial and harmful effects), public agencies, 4 philanthropic and professional organizations, private companies, and clinical and public health research groups should provide funding and support for a national cannabis research agenda that addresses key gaps in the evidence base. Prioritized research streams and objectives should include, but need not be limited to:

Clinical and Observational Research

• Examine the health effects of cannabis use in at-risk or under-researched populations, such as children and youth (often described as less than 18 years of age) and older populations (generally over 50 years of age), pregnant and breastfeeding women, and heavy cannabis users.
• Investigate the pharmacokinetic and pharmacodynamic properties of cannabis, modes of delivery, different concentrations, in various populations, including the dose–response relationships of cannabis and THC or other cannabinoids.
• Determine the harms and benefits associated with understudied cannabis products, such as edibles, concentrates, and topicals.
• Conduct well-controlled trials on the potential beneficial and harmful health effects of using different forms of cannabis, such

4 Agencies may include the CDC, relevant agencies of the National Institutes of Health (NIH), and the U.S. Food and Drug Administration (FDA).

• as inhaled (smoked or vaporized) whole cannabis plant and oral cannabis.
• Characterize the health effects of cannabis on unstudied and understudied health endpoints, such as epilepsy in pediatric populations; symptoms of posttraumatic stress disorder; childhood and adult cancers; cannabis-related overdoses and poisonings; and other high-priority health endpoints.

Health Policy and Health Economics Research

• Identify models, including existing state cannabis policy models, for sustainable funding of national, state, and local public health surveillance systems.
• Investigate the economic impact of recreational and medical cannabis use on national and state public health and health care systems, health insurance providers, and patients.

Public Health and Public Safety Research

• Identify gaps in the cannabis-related knowledge and skills of health care and public health professionals, and assess the need for, and performance of, continuing education programs that address these gaps.
• Characterize public safety concerns related to recreational cannabis use and evaluate existing quality assurance, safety, and packaging standards for recreational cannabis products.

Improve Research Quality

Recommendation 2 : To promote the development of conclusive evidence on the short- and long-term health effects of cannabis use (both beneficial and harmful effects), agencies of the U.S. Department of Health and Human Services, including the National Institutes of Health and the Centers for Disease Control and Prevention, should jointly fund a workshop to develop a set of research standards and benchmarks to guide and ensure the production of high-quality cannabis research. Workshop objectives should include, but need not be limited to:

• The development of a minimum dataset for observational and clinical studies, standards for research methods and design, and guidelines for data collection methods.
• Adaptation of existing research-reporting standards to the needs of cannabis research.
• The development of uniform terminology for clinical and epidemiological cannabis research.
• The development of standardized and evidence-based question banks for clinical research and public health surveillance tools.

Improve Surveillance Capacity

Recommendation 3 : To ensure that sufficient data are available to inform research on the short- and long-term health effects of cannabis use (both beneficial and harmful effects), the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Association of State and Territorial Health Officials, National Association of County and City Health Officials, the Association of Public Health Laboratories, and state and local public health departments should fund and support improvements to federal public health surveillance systems and state-based public health surveillance efforts. Potential efforts should include, but need not be limited to:

• The development of question banks on the beneficial and harmful health effects of therapeutic and recreational cannabis use and their incorporation into major public health surveys, including the National Health and Nutrition Examination Survey, National Health Interview Survey, Behavioral Risk Factor Surveillance System, National Survey on Drug Use and Health, Youth Risk Behavior Surveillance System, National Vital Statistics System, Medical Expenditure Panel Survey, and the National Survey of Family Growth.
• Determining the capacity to collect and reliably interpret data from diagnostic classification codes in administrative data (e.g., International Classification of Diseases-10 ).
• The establishment and utilization of state-based testing facilities to analyze the chemical composition of cannabis and products containing cannabis, cannabinoids, or THC.
• The development of novel diagnostic technologies that allow for rapid, accurate, and noninvasive assessment of cannabis exposure and impairment.
• Strategies for surveillance of harmful effects of cannabis for therapeutic use.

Address Research Barriers

Recommendation 4 : The Centers for Disease Control and Prevention, National Institutes of Health, U.S. Food and Drug Administration, industry groups, and nongovernmental organizations should fund the convening of a committee of experts tasked to produce an objective and evidence-based report that fully characterizes the impacts of regulatory barriers to cannabis research and that proposes strategies for supporting development of the resources and infrastructure necessary to conduct a comprehensive cannabis research agenda. Committee objectives should include, but need not be limited to:

• Proposing strategies for expanding access to research-grade marijuana, through the creation and approval of new facilities for growing and storing cannabis.
• Identifying nontraditional funding sources and mechanisms to support a comprehensive national cannabis research agenda.
• Investigating strategies for improving the quality, diversity, and external validity of research-grade cannabis products.

CBHSQ (Center for Behavioral Health Statistics and Quality). 2016. Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf (accessed December 5, 2016).

IOM (Institute of Medicine). 2008. Treatment of postraumatic stress disorder: An assessment of the evidence . Washington, DC: The National Academies Press.

IOM. 2012. Adverse effects of vaccines: Evidence and causality . Washington, DC: The National Academies Press.

NASEM (National Academies of Sciences, Engineering, and Medicine). 2016. Veterans and agent orange: Update 2014 . Washington, DC: The National Academies Press.

NCSL (National Conference of State Legislatures). 2016. State medical marijuana laws. November 9. http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx (accessed November 21, 2016).

Report Conclusions 5

Chapter 4 conclusions—therapeutic effects of cannabis and cannabinoids.

There is conclusive or substantial evidence that cannabis or cannabinoids are effective:

• For the treatment of chronic pain in adults (cannabis) (4-1)
• As antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)
• For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)

There is moderate evidence that cannabis or cannabinoids are effective for:

• Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis (cannabinoids, primarily nabiximols) (4-19)

There is limited evidence that cannabis or cannabinoids are effective for:

• Increasing appetite and decreasing weight loss associated with HIV/AIDS (cannabis and oral cannabinoids) (4-4a)
• Improving clinician-measured multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)
• Improving symptoms of Tourette syndrome (THC capsules) (4-8)
• Improving anxiety symptoms, as assessed by a public speaking test, in individuals with social anxiety disorders (cannabidiol) (4-17)
• Improving symptoms of posttraumatic stress disorder (nabilone; a single, small fair-quality trial) (4-20)

___________________

5 Numbers in parentheses correspond to chapter conclusion numbers.

There is limited evidence of a statistical association between cannabinoids and:

• Better outcomes (i.e., mortality, disability) after a traumatic brain injury or intracranial hemorrhage (4-15)

There is limited evidence that cannabis or cannabinoids are ineffective for:

• Improving symptoms associated with dementia (cannabinoids) (4-13)
• Improving intraocular pressure associated with glaucoma (cannabinoids) (4-14)
• Reducing depressive symptoms in individuals with chronic pain or multiple sclerosis (nabiximols, dronabinol, and nabilone) (4-18)

There is no or insufficient evidence to support or refute the conclusion that cannabis or cannabinoids are an effective treatment for:

• Cancers, including glioma (cannabinoids) (4-2)
• Cancer-associated anorexia cachexia syndrome and anorexia nervosa (cannabinoids) (4-4b)
• Symptoms of irritable bowel syndrome (dronabinol) (4-5)
• Epilepsy (cannabinoids) (4-6)
• Spasticity in patients with paralysis due to spinal cord injury (cannabinoids) (4-7b)
• Symptoms associated with amyotrophic lateral sclerosis (cannabinoids) (4-9)
• Chorea and certain neuropsychiatric symptoms associated with Huntington’s disease (oral cannabinoids) (4-10)
• Motor system symptoms associated with Parkinson’s disease or the levodopa-induced dyskinesia (cannabinoids) (4-11)
• Dystonia (nabilone and dronabinol) (4-12)
• Achieving abstinence in the use of addictive substances (cannabinoids) (4-16)
• Mental health outcomes in individuals with schizophrenia or schizophreniform psychosis (cannabidiol) (4-21)

Chapter 5 Conclusions—Cancer

There is moderate evidence of no statistical association between cannabis use and:

• Incidence of lung cancer (cannabis smoking) (5-1)
• Incidence of head and neck cancers (5-2)

There is limited evidence of a statistical association between cannabis smoking and:

• Non-seminoma-type testicular germ cell tumors (current, frequent, or chronic cannabis smoking) (5-3)

There is no or insufficient evidence to support or refute a statistical association between cannabis use and:

• Incidence of esophageal cancer (cannabis smoking) (5-4)
• Incidence of prostate cancer, cervical cancer, malignant gliomas, non-Hodgkin lymphoma, penile cancer, anal cancer, Kaposi’s sarcoma, or bladder cancer (5-5)
• Subsequent risk of developing acute myeloid leukemia/ acute non-lymphoblastic leukemia, acute lymphoblastic leukemia, rhabdomyosarcoma, astrocytoma, or neuroblastoma in offspring (parental cannabis use) (5-6)

Chapter 6 Conclusions—Cardiometabolic Risk

There is limited evidence of a statistical association between cannabis use and:

• The triggering of acute myocardial infarction (cannabis smoking) (6-1a)
• Ischemic stroke or subarachnoid hemorrhage (6-2)
• Decreased risk of metabolic syndrome and diabetes (6-3a)
• Increased risk of prediabetes (6-3b)

There is no evidence to support or refute a statistical association

between chronic effects of cannabis use and:

• The increased risk of acute myocardial infarction (6-1b)

Chapter 7 Conclusions—Respiratory Disease

There is substantial evidence of a statistical association between cannabis smoking and:

• Worse respiratory symptoms and more frequent chronic bronchitis episodes (long-term cannabis smoking) (7-3a)

There is moderate evidence of a statistical association between cannabis smoking and:

• Improved airway dynamics with acute use, but not with chronic use (7-1a)
• Higher forced vital capacity (FVC) (7-1b)

There is moderate evidence of a statistical association between the cessation of cannabis smoking and:

• Improvements in respiratory symptoms (7-3b)
• An increased risk of developing chronic obstructive pulmonary disease (COPD) when controlled for tobacco use (occasional cannabis smoking) (7-2a)

There is no or insufficient evidence to support or refute a statistical association between cannabis smoking and:

• Hospital admissions for COPD (7-2b)
• Asthma development or asthma exacerbation (7-4)

Chapter 8 Conclusions—Immunity

• A decrease in the production of several inflammatory cytokines in healthy individuals (8-1a)

There is limited evidence of no statistical association between cannabis use and:

• The progression of liver fibrosis or hepatic disease in individuals with viral hepatitis C (HCV) (daily cannabis use) (8-3)
• Other adverse immune cell responses in healthy individuals (cannabis smoking) (8-1b)
• Adverse effects on immune status in individuals with HIV (cannabis or dronabinol use) (8-2)
• Increased incidence of oral human papilloma virus (HPV) (regular cannabis use) (8-4)

Chapter 9 Conclusions—Injury and Death

There is substantial evidence of a statistical association between cannabis use and:

• Increased risk of motor vehicle crashes (9-3)

There is moderate evidence of a statistical association between cannabis use and:

• Increased risk of overdose injuries, including respiratory distress, among pediatric populations in U.S. states where cannabis is legal (9-4b)
• All-cause mortality (self-reported cannabis use) (9-1)
• Occupational accidents or injuries (general, nonmedical cannabis use) (9-2)
• Death due to cannabis overdose (9-4a)

Chapter 10 Conclusions—Prenatal, Perinatal, and Neonatal Exposure

There is substantial evidence of a statistical association between maternal cannabis smoking and:

• Lower birth weight of the offspring (10-2)

There is limited evidence of a statistical association between maternal cannabis smoking and:

• Pregnancy complications for the mother (10-1)
• Admission of the infant to the neonatal intensive care unit (NICU) (10-3)

There is insufficient evidence to support or refute a statistical association between maternal cannabis smoking and:

• Later outcomes in the offspring (e.g., sudden infant death syndrome, cognition/academic achievement, and later substance use) (10-4)

Chapter 11 Conclusions—Psychosocial

• The impairment in the cognitive domains of learning, memory, and attention (acute cannabis use) (11-1a)
• Impaired academic achievement and education outcomes (11-2)
• Increased rates of unemployment and/or low income (11-3)
• Impaired social functioning or engagement in developmentally appropriate social roles (11-4)

There is limited evidence of a statistical association between sustained abstinence from cannabis use and:

• Impairments in the cognitive domains of learning, memory, and attention (11-1b)

Chapter 12 Conclusions—Mental Health

• The development of schizophrenia or other psychoses, with the highest risk among the most frequent users (12-1)
• Better cognitive performance among individuals with psychotic disorders and a history of cannabis use (12-2a)
• Increased symptoms of mania and hypomania in individuals diagnosed with bipolar disorders (regular cannabis use) (12-4)
• A small increased risk for the development of depressive disorders (12-5)
• Increased incidence of suicidal ideation and suicide attempts with a higher incidence among heavier users (12-7a)
• Increased incidence of suicide completion (12-7b)
• Increased incidence of social anxiety disorder (regular cannabis use) (12-8b)
• Worsening of negative symptoms of schizophrenia (e.g., blunted affect) among individuals with psychotic disorders (12-2c)
• An increase in positive symptoms of schizophrenia (e.g., hallucinations) among individuals with psychotic disorders (12-2b)
• The likelihood of developing bipolar disorder, particularly among regular or daily users (12-3)
• The development of any type of anxiety disorder, except social anxiety disorder (12-8a)
• Increased symptoms of anxiety (near daily cannabis use) (12-9)
• Increased severity of posttraumatic stress disorder symptoms among individuals with posttraumatic stress disorder (12-11)

There is no evidence to support or refute a statistical association between cannabis use and:

• Changes in the course or symptoms of depressive disorders (12-6)
• The development of posttraumatic stress disorder (12-10)

Chapter 13 Conclusions—Problem Cannabis Use

There is substantial evidence that:

• Stimulant treatment of attention deficit hyperactivity disorder (ADHD) during adolescence is not a risk factor for the development of problem cannabis use (13-2e)
• Being male and smoking cigarettes are risk factors for the progression of cannabis use to problem cannabis use (13-2i)
• Initiating cannabis use at an earlier age is a risk factor for the development of problem cannabis use (13-2j)

There is substantial evidence of a statistical association between:

• Increases in cannabis use frequency and the progression to developing problem cannabis use (13-1)
• Being male and the severity of problem cannabis use, but the recurrence of problem cannabis use does not differ between males and females (13-3b)

There is moderate evidence that:

• Anxiety, personality disorders, and bipolar disorders are not risk factors for the development of problem cannabis use (13-2b)
• Major depressive disorder is a risk factor for the development of problem cannabis use (13-2c)
• Adolescent ADHD is not a risk factor for the development of problem cannabis use (13-2d)
• Being male is a risk factor for the development of problem cannabis use (13-2f)
• Exposure to the combined use of abused drugs is a risk factor for the development of problem cannabis use (13-2g)
• Neither alcohol nor nicotine dependence alone are risk factors for the progression from cannabis use to problem cannabis use (13-2h)
• During adolescence the frequency of cannabis use, oppositional behaviors, a younger age of first alcohol use, nicotine use, parental substance use, poor school performance, antisocial behaviors, and childhood sexual abuse are risk factors for the development of problem cannabis use (13-2k)

There is moderate evidence of a statistical association between:

• A persistence of problem cannabis use and a history of psychiatric treatment (13-3a)
• Problem cannabis use and increased severity of posttraumatic stress disorder symptoms (13-3c)

There is limited evidence that:

• Childhood anxiety and childhood depression are risk factors for the development of problem cannabis use (13-2a)

Chapter 14 Conclusions—Cannaabis Use and the Abuse of Other Substances

• The development of substance dependence and/or a substance abuse disorder for substances, including alcohol, tobacco, and other illicit drugs (14-3)
• The initiation of tobacco use (14-1)
• Changes in the rates and use patterns of other licit and illicit substances (14-2)

Chapter 15 Conclusions—Challenges and Barriers in Conducting Cannabis Research

There are several challenges and barriers in conducting cannabis and cannabinoid research, including

• There are specific regulatory barriers, including the classification of cannabis as a Schedule I substance, that impede the advancement of cannabis and cannabinoid research (15-1)
• It is often difficult for researchers to gain access to the quantity, quality, and type of cannabis product necessary to address specific research questions on the health effects of cannabis use (15-2)
• A diverse network of funders is needed to support cannabis and cannabinoid research that explores the beneficial and harmful health effects of cannabis use (15-3)
• To develop conclusive evidence for the effects of cannabis use on short- and long-term health outcomes, improvements and standardization in research methodology (including those used in controlled trials and observational studies) are needed (15-4)

Part I Introduction and Background

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Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk.

However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively.

Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agenda—outlining gaps in current knowledge and opportunities for providing additional insight into these issues—that summarizes and prioritizes pressing research needs.

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2018 Theses Doctoral

Essays on Cannabis Legalization

Thomas, Danna Kang

Though the drug remains illegal at the federal level, in recent years states and localities have increasingly liberalized their marijuana laws in order to generate tax revenue and save resources on marijuana law enforcement. Many states have adopted some form of medical marijuana and/or marijuana decriminalization laws, and as of 2017, Washington, Colorado, Maine, California, Oregon, Massachusetts, Nevada, Alaska, and the District of Columbia have all legalized marijuana for recreational use. In 2016 recreational marijuana generated over $1.8 billion in sales. Hence, studying marijuana reforms and the policies and outcomes of early recreational marijuana adopters is an important area of research. However, perhaps due to the fact that legalized recreational cannabis is a recent phenomenon, a scarcity of research exists on the impacts of recreational cannabis legalization and the efficacy and efficiency of cannabis regulation. This dissertation aims to fill this gap, using the Washington recreational marijuana market as the primary setting to study cannabis legalization in the United States. Of first order importance in the regulation of sin goods such as cannabis is quantifying the value of the marginal damages of negative externalities. Hence, Chapter 1 (co-authored with Lin Tian) explores the impact of marijuana dispensary location on neighborhood property values, exploiting plausibly exogenous variation in marijuana retailer location. Policymakers and advocates have long expressed concerns that the positive effects of the legalization--e.g., increases in tax revenue--are well spread spatially, but the negative effects are highly localized through channels such as crime. Hence, we use changes in property values to measure individuals' willingness to pay to avoid localized externalities caused by the arrival of marijuana dispensaries. Our key identification strategy is to compare changes in housing sales around winners and losers in a lottery for recreational marijuana retail licenses. (Due to location restrictions, license applicants were required to provide an address of where they would like to locate.) Hence, we have the locations of both actual entrants and potential entrants, which provides a natural difference-in-differences set-up. Using data from King County, Washington, we find an almost 2.4% decrease in the value of properties within a 0.5 mile radius of an entrant, a $9,400 decline in median property values. The aforementioned retail license lottery was used to distribute licenses due to a license quota. Retail license quotas are often used by states to regulate entry into sin goods markets as quotas can restrict consumption by decreasing access and by reducing competition (and, therefore, increasing markups). However, license quotas also create allocative inefficiency. For example, license quotas are often based on the population of a city or county. Hence, licenses are not necessarily allocated to the areas where they offer the highest marginal benefit. Moreover, as seen in the case of the Washington recreational marijuana market, licenses are often distributed via lottery, meaning that in the absence of an efficiency secondary market for licenses, the license recipients are not necessarily the most efficient potential entrants. This allocative inefficiency is generated by heterogeneity in firms and consumers. Therefore, in Chapter 2, I develop a model of demand and firm pricing in order to investigate firm-level heterogeneity and inefficiency. Demand is differentiated by geography and incorporates consumer demographics. I estimate this demand model using data on firm sales from Washington. Utilizing the estimates and firm pricing model, I back out a non-parametric distribution of firm variable costs. These variable costs differ by product and firm and provide a measure of firm inefficiency. I find that variable costs have lower inventory turnover; hence, randomly choosing entrants in a lottery could be a large contributor to allocative inefficiency. Chapter 3 explores the sources of allocative inefficiency in license distribution in the Washington recreational marijuana market. A difficulty in studying the welfare effects of license quotas is finding credible counterfactuals of unrestricted entry. Therefore, I take a structural approach: I first develop a three stage model that endogenizes firm entry and incorporates the spatial demand and pricing model discussed in Chapter 2. Using the estimates of the demand and pricing model, I estimate firms' fixed costs and use data on locations of those potential entrants that did not win Washington's retail license lottery to simulate counterfactual entry patterns. I find that allowing firms to enter freely at Washington's current marijuana tax rate increases total surplus by 21.5% relative to a baseline simulation of Washington's license quota regime. Geographic misallocation and random allocation of licenses account for 6.6\% and 65.9\% of this difference, respectively. Moreover, as the primary objective of these quotas is to mitigate the negative externalities of marijuana consumption, I study alternative state tax policies that directly control for the marginal damages of marijuana consumption. Free entry with tax rates that keep the quantity of marijuana or THC consumed equal to baseline consumption increases welfare by 6.9% and 11.7%, respectively. I also explore the possibility of heterogeneous marginal damages of consumption across geography, backing out the non-uniform sales tax across geography that is consistent with Washington's license quota policy. Free entry with a non-uniform sales tax increases efficiency by over 7% relative to the baseline simulation of license quotas due to improvements in license allocation.

• Cannabis--Law and legislation
• Marijuana industry
• Drug legalization
• Drugs--Economic aspects

More About This Work

• DOI Copy DOI to clipboard

Essays on the Effects of Medical Marijuana Laws

• Smart, Rosanna
• Advisor(s): Lleras-Muney, Adriana

Over half of the US states have adopted "medical marijuana" laws (MMLs), and 58% of Americans now favor marijuana legalization. Despite public support, federal law continues to prohibit the use and sale of marijuana due to public health concerns of increased dependence and abuse, youth access, and drugged driving. These essays contribute toward understanding the likely health consequences of marijuana liberalization using evidence from MMLs.

Chapter 1 -- Growing Like Weed: Explaining Variation in Medical Marijuana Market Size provides a comprehensive analysis of the determinants of growth in legal medical marijuana markets. Newly collected data on medical marijuana patient registration rates shows that there is substantial heterogeneity in medical marijuana participation over time and across states. This variation is primarily driven by the combined effects of federal enforcement policy and state supply restrictions on legal production costs. Chapter 2 -- The Kids Aren't Alright: Effects of Medical Marijuana Market Growth on Marijuana Use then studies the effect of growth in legal medical marijuana markets on recreational use. Findings show that expansion of legal medical marijuana market size significantly increases the prevalence of recreational cannabis use by both adults and adolescents. Reaching the median state's legal market size would increase the prevalence of marijuana use in the past month by 6% for adolescents aged 12-17, by 9% for 18-25 year-olds, and by 18% for adults over age 25.

The welfare implications of these changes largely depend on the externalities and internalities associated with marijuana use. To study this, Chapter 3 -- On the Health Consequences of Increased Medical Marijuana Access examines the effects of increased marijuana availability on traffic fatalities and mortality related to opioid and alcohol poisonings. In the aggregate, greater medical marijuana access decreases mortality from these causes. However, the aggregate effect masks an important welfare trade-off generated by age differences in the elasticity of substitution between marijuana and alcohol. For adults aged 45-64, greater marijuana availability reduces mortality related to alcohol and opioid poisonings by 7-11% and 12-16% respectively. In contrast, for youths aged 15-20, marijuana access generates negative externalities in the form of a 6% increase in traffic fatalities, with large and significant effects on alcohol- and cannabis-related accidents.

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Conclusions About Cannabis Use and Harms

• In the last half century recreational use of cannabis has become widely established among teenagers and young adults in a broad range of developed countries and in some developing countries. In developed countries with the longest history of use, a substantial minority of users continue their use into middle age and beyond.
• There are a number of health harms from smoking cannabis. Cannabis use impairs functioning in exacting tasks, and use before driving probably increases the risk of a traffic crash.  About 10 percent of those who try cannabis develop dependence on the drug, and they have a higher risk of respiratory disorders, of impaired cognitive functioning (at least in the short term), and of developing psychotic symptoms or a psychotic disorder. Early and heavy use by adolescents may increase the risks of poor educational and other psychosocial outcomes in young adulthood.
• The probability and scale of harm among heavy cannabis users is modest compared with that caused by many other psychoactive substances, both legal and illegal, in common use, namely, alcohol, tobacco, amphetamines, cocaine and heroin.
• Recently, concerns have been expressed about increased potency of cannabis products. Average THC content in many countries probably has increased, at least in part because of the illegality of cannabis production. The health consequences of any such increases will depend on the extent to which users can titrate the dose of THC.
• There are variations over time in rates of cannabis use within and between countries, but these variations do not seem to be affected much by the probability of arrest or penalties for use or sale, however draconian.  The widespread pattern of cannabis use indicates that many people gain pleasure and therapeutic or other benefits from use.
• It is probable that cannabis users who drive while intoxicated can harm others.  Measuring tools are now available to establish whether a driver is under the influence of cannabis and regulations and enforcement to deter this behaviour should be broadly implemented.  Other harms to others from cannabis use are less well established.  Role-failures from cannabis dependence (in work and family life) are probably the most important.

Conclusions About the Effects of Current Policies

• There have been long standing efforts to deter cannabis use by prohibition and policing.  Enforcement efforts in most countries have focused on the arrest  of users.  In developed countries with large cannabis-using populations, the criminal penalties actually imposed for possession and use are usually modest by comparison with those possible by law. Moreover the probability of being arrested for any one incident of cannabis use is in the order of less than one in one thousand. The enforcement effort has not had much success in deterring use.
• The rationale for severe penalties for possession offenses is weak on both normative and practical grounds. In many developed countries a majority of adults born in the past half-century have used cannabis.  Control regimes that criminalize users are intrusive on privacy, socially divisive and expensive.  Thus it is worth considering alternatives.
• In addition to the substantial government resources expended in enforcing a prohibition regime, such a regime imposes very large secondary costs and suffering at the personal level.  For example, a criminal conviction for cannabis possession can exclude an individual from certain jobs and activities, and arrest can impose personal and family humiliation.  In countries where data are available, arrest rates are sharply higher for many minority and socially disadvantaged groups.
• Measures to reduce penalties or to decriminalize possession and use have been adopted in numerous jurisdictions without an upsurge in use.  Moreover these reform measures have had some success in ameliorating the adverse consequences of prohibition.  However, the benefits of decriminalization can be undercut by police practices which may increase the number of users penalized, or by discriminatory enforcement of the law.

Beyond the International Treaties

• The present international treaties have inhibited depenalization and prevented more thoroughgoing reforms of national cannabis regimes.  Regimes which do go beyond depenalization or decriminalization have been characterized by inconsistencies and paradoxes.  For example, the Dutch coffee shops may sell cannabis products through the front door, but are not supposed to buy their supplies at the back door.
• That which is prohibited cannot easily be regulated’. There are thus advantages for governments in moving toward a regime of regulated legal availability under strict controls, using the variety of mechanisms available to regulate a legal market, such as taxation, availability controls, minimum legal age for use and purchase,  labeling and potency limits. Another alternative, which minimizes the risk of promoting cannabis use, is to allow only small scale cannabis production for one’s own use or gifts to others
• There are four main choices for a government seeking to make cannabis available in a regulated market in the context of the international conventions: (1) In some countries (those that follow the expediency principle), it is possible to meet the letter of the international conventions while allowing  de facto legal access.  The Dutch model is an example.
• Opting for a regulated availability regime which frankly ignores the conventions.  A government that follows this route must be prepared to withstand   substantial international pressure.
• Denouncing the 1961 and 1988 conventions, and re-acceding with reservations with respect to cannabis.
• Along with other willing countries, negotiating a new cannabis convention on a supra-national basis.
• The record is mixed concerning whether making cannabis use and sale legal in a highly regulated market would lead to increased harm from cannabis use in the long run. Experience with control regimes for other psychoactive substances teaches that lax regimes and allowing extensive commercial promotion can result in high levels of use and of harm, while stringent control regimes can hold down levels of use and of harm.
• A nation wishing to make cannabis use and sale legal in a regulated market should draw on the substantial experience with other relevant control regimes for psychoactive substances.  These include pharmacy and prescription regimes, alcohol sales monopolies, labelling and licensing, availability and taxation controls.  Special attention should be paid to limiting the influence and promotion of use by commercial interests. Attention should also be paid to the negative lessons from the minimal market controls which have often applied for tobacco and alcohol, as well as to the positive examples.

Principles for Policy Analysis

• Our policy recommendations below are guided by general ethical principles of public health action: measures to reduce harm should be proportional to the harm they aim to prevent, they should as far as possible have positive consequences and avoid negative ones, they should minimize effects on individual autonomy and they should be fairly enforced, particularly with regard to the less powerful or more marginalized groups.
• Current cannabis policies may do some good, but there is a dearth of evidence in support of that claim. They clearly do harm to the many individuals who are arrested, they abridge individual autonomy and they are often applied unjustly. The enforcement of cannabis prohibition is also costly.  The task is to devise policies that do better, taking all these aspects into account.  We recognize the importance of the constraints imposed on policy by popular opinion which usually supports a retention of prohibition.
• The principal aim of a cannabis control system should be to minimize any harms from cannabis use.  In our view this means grudgingly allowing use and attempting to channel such use into less harmful patterns (e.g. by delaying onset of use until early adulthood and encouraging all users to avoid daily use or driving a car after using).

Policy Recommendations

• Making policy recommendations involves value judgements and assessments of uncertainties.  We offer our own recommendations for what constitutes good policy toward cannabis, recognizing that reasonable people can differ on the relevant values and in their assessments of contingencies.

Actions inside the box of the current international control regime:

Under the current international control regime, the cannabis policy options available to governments are arguably limited to varying the severity of penalties for use. Given that more than minimal enforcement of prohibitions seems to do little to reduce use, the principal policy concern should be to minimize the adverse consequences of prohibition.

• If a nation chooses to use the criminal law for controlling cannabis use, there is no justification for incarcerating an individual for a cannabis possession or use offence, nor for creating a criminal conviction. Retaining a criminal law on possession on the books as a handy tool for discretionary police use tends to result in discriminatory application of the law against the disadvantaged. Police should give very low priority to enforcing laws against cannabis use or possession.
• A better option, the acceptability of which is more questionable under the international conventions, is to process violations administratively outside the criminal justice system.  Fines should be low, and alternative sanctions such as referral to education or counseling should not be onerous, reflecting the proportionality principle.

Setting the international conventions aside:

• The international drug control regime should be changed to allow a state to adopt, implement and evaluate its own cannabis regime within its borders.  This would require changes in the existing conventions, or the adoption of a new pre-emptive convention.
• In the absence of such changes, a state can act on its own by denouncing the conventions and re-acceding with reservations, or by simply ignoring at least some provisions of the conventions.
• Any regime which makes cannabis legally available should involve state licensing or state operation of entities producing, wholesaling and retailing the drug (as is true in many jurisdictions for alcoholic beverages).  The state should, either directly or through regulation, control potency and quality, assure reasonably high prices and control access and availability in general and particularly to youth.
• The state should ensure that appropriate information is available and actively conveyed to users about the harms of cannabis use.  Advertising and promotion should be banned or stringently limited to the extent possible.
• The impacts of any changes, including any unintended adverse effects, should be closely monitored, and there should be the possibility for prompt and considered revision if the policy increased harm.
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• v.4(1); 2021 Jun

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

Sebastian jugl.

a Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA

b Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA

Aimalohi Okpeku

Brianna costales, earl j. morris, golnoosh alipour-haris, juan m. hincapie-castillo, nichole e. stetten.

c Occupational Therapy, University of Florida, Gainesville, Florida, USA

Ruba Sajdeya

d Epidemiology, University of Florida, Gainesville, Florida, USA

Shailina Keshwani

Verlin joseph, yahan zhang, lauren adkins.

e Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA

Almut G. Winterstein

Amie goodin, associated data.

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016–2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Introduction

Medical cannabis is available to patients by physician order in 33 states and territories in the USA as of 2020. However, at the federal level, cannabis remains classified as a schedule I controlled substance, which limits efficacy and safety investigations [ 1 ]. Collectively, “medical cannabis” encompasses various terms used in reference to medical marijuana, cannabis-derived products from the cannabis plant (including cannabinoids), and synthetic cannabinoids (e.g., synthetic delta-9-tetrahydrocannabinol (THC) or dronabinol). States that permit physician-ordered medical cannabis typically require a diagnosed medical condition that is considered qualifying by respective state law permitting its use as treatment or adjuvant. Currently, over 50 medical conditions have been granted a qualifying medical condition status by individual state laws, though there is significant variation between each state's approved conditions [ 2 ]. The most frequent medical conditions for approved medical cannabis use nationally are chronic noncancer pain, multiple sclerosis (MS) and other motor neuron disorders, epilepsy, cancer and cancer symptoms, mental health disorders (primarily anxiety disorders such as posttraumatic stress disorder [PTSD]), glaucoma, and symptoms related to irritable bowel diseases [ 3 , 4 ].

Approximately 12.9% of Americans report past-year cannabis use, with 90.2% using for nonmedical purposes only, 6.2% for medical purposes only, and 3.6% for both purposes [ 5 ]. The amount of medical-only cannabis users is higher in states that have enacted medical marijuana laws, where around 17% of cannabis users consumed cannabis for medical reasons in those states [ 6 ]. The most common routes of administration of cannabis use in the USA are oral/peroral (e.g., edibles), pulmonary (e.g., smoking, or vaping), and topical [ 7 ].

In 2017, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a comprehensive scientific review on the effects of cannabis and cannabinoids in the treatment of medical conditions frequently cited for medical cannabis use [ 8 ]. The NASEM report included an evidence review of studies evaluating the efficacy and safety of cannabis for selected conditions based on the frequency of use, hypothesized effectiveness, and/or eligibility of the condition for medical cannabis certification across several states. The NASEM report evaluated the body of evidence published in the literature through the year 2016, and the objective of this study is to further expand this work by examining the most recently available evidence. Therefore, the objectives of this review are to (1) identify and map the most recently published clinical and scientific evidence across approved conditions for medical cannabis and (2) evaluate the quality of identified recent systematic reviews.

Topic Selection

Clinical conditions were selected based on inclusion within the NASEM report, relevance to current trends in medical cannabis-eligible diagnoses, and consultation with subject matter experts and relevant stakeholders (e.g., physicians, patients, and community input). Relevant stakeholders perceived needs in research priorities, and evidence gaps as related to clinical outcomes were assessed via preliminary surveys, interviews, and open-ended discussion. Stakeholders recommended including medical conditions approved in the US state jurisdiction of the study team, in addition to emerging trends in use of medical cannabis applications based on discussion with physicians who were certified to order medical cannabis in this locale. Based on this process, the clinical conditions determined for inclusion for this review were amyotrophic lateral sclerosis (ALS), autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus (HIV)/AIDS, MS, Parkinson's disease, and PTSD.

Literature Search and Identification

The search strategy was developed in collaboration with the University of Florida Health Sciences Center Library. For this mapping review, we conducted a systematic search using the following databases: PubMed, Embase, Web of Science, the Cochrane Library, and clinicaltrials.gov . We restricted our search to studies that were published after the NASEM report's inclusion period, between May 2016 and October 2019. Search strings from the NASEM report were replicated, and additional keywords and Medical Subject Headings terms were identified in collaboration with subject matter experts and through literature cross-referencing. Since autism was the only included condition that was not evaluated by NASEM, we employed rapid review strategies and adjusted our date restriction inclusion period from the year 2000 to October 2019 for this condition. We limited our search to English language literature only. Complete search strings are available for all conditions in the see online suppl. files. (For all online suppl. material, see www.karger.com/doi/10.1159/000515069 .)

Literature Screening

Screening for eligible studies was conducted in 2 phases. In each phase, publications were either classified as include, exclude, or uncertain. In the first phase, for each clinical indication, one reviewer screened the identified abstracts for eligibility. Abstracts that were classified as “uncertain” were then screened by a second reviewer. If the second abstract reviewer also classified the abstract as uncertain, the publication was advanced for full-text screening. In the second phase, full-text publications were screened for eligibility for each clinical indication. Publications classified as “uncertain” during full-text screening were then screened by a second reviewer. If the publication was still classified as “uncertain” following a second full-text screening, group review and discussion were required until consensus regarding eligibility was achieved. Other discrepancies between reviewers were resolved via discussion and by a third reviewer, when necessary. Publications were included in qualitative synthesis if they were published between 27 May 2016 and 22 September 2019 and investigated the therapeutic effect, a patient or provider perspective, or utilization of medical cannabis in any form in one of the identified 11 indications or conditions. Additionally, the study had to be conducted in humans. Publications were excluded if they included only preclinical data, if the primary research was conducted exclusively outside the USA, clinical case studies, abstracts-only, letters to the editors, opinion pieces, or editorials.

Data Extraction

The study team created a standardized data extraction tool in Microsoft Excel to capture elements from all included studies. An initial pilot run with the underlying data extraction table was performed in a group setting for training purposes and to ensure consistency. Afterward, for each condition, one reviewer extracted the following data from the eligible studies into the tool: study design, study setting, cannabis intervention type, study period, inclusion and exclusion criteria, indicators for whether special populations were included (e.g., pediatrics and geriatrics), outcomes assessed, outcome definition, change in outcome, and summary of findings. Reviewers presented uncertainties in data extraction in a group discussion meeting for resolution. In instances where a single study was identified as eligible for data extraction for multiple conditions, data were independently extracted as relevant for each condition covered within the study; however, these studies were not counted more than once in overall counts of assessed studies.

Quality of Evidence Assessment

Studies that were classified as systematic reviews with or without meta-analysis were evaluated using the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) instrument. The Assessing the Methodological Quality of Systematic Reviews-2 tool was developed to grade the quality of evidence reviewed, organized, and presented within systematic reviews [ 9 ]. It consists of 16 items that evaluate the methodological quality of systematic reviews and the risk of bias via a checklist, and each item can be answered with “yes,” “partial yes,” “no,” or “no meta-analysis conducted.” Based on weaknesses in critical domains, systematic reviews are then rated as a high-, moderate-, low-, or critically low-quality review. Two reviewers for each condition conducted the evidence grading independently. Disagreements were resolved by a third reviewer, and when necessary, classifications of study design were re-evaluated. Additional reviewers examined studies when needed until the majority consensus on both study design classification and quality of evidence rating was achieved.

Evidence Synthesis

Findings from identified studies were reported in accordance with PRISMA guidelines. Search, screening, and evaluation were conducted in accordance with systematic literature review best practices; however, the structure of this review is more appropriately classified as a mapping review to allow for its broad scope [ 10 ].

Studies in each condition were classified according to whether they assessed efficacy and/or safety outcomes. (See online suppl. Tables for outcome definitions.) Studies assessing relevant efficacy outcomes were classified into 1 of 5 categories based on the following classification scheme. Studies were classified as “outcome improved” when the condition improved following medical cannabis treatment; as “outcome worsened” when the condition worsened; as “none” when there was no significant observable change; as “inconclusive” if they specifically indicated that results were inconclusive in their results and discussion section and/or there were multiple outcomes assessed but not all reported in findings; or as “mixed” in cases where multiple outcomes were assessed, but some indicated improvement and others indicated no change or worsening. Study outcome definitions for efficacy by condition were summarized (online suppl. Table 1 ).

Studies reporting safety outcomes were classified into 4 different categories. Studies were classified as “worsening” when an increase in adverse events as compared to placebo, active comparator, or both groups were reported, or single-arm studies reported side effects or adverse events that might be associated with exposure; as “mixed” when different safety outcomes were assessed, but some indicated no change, while others indicated worsening; as “no change” when no significant changes in safety outcomes when measured against the comparator group were reported, or in the case of single-arm studies, studies not reporting any side effects that might be associated with exposure; or as “inconclusive” when studies specifically described results as inconclusive in the results and discussion section and/or if there were multiple outcomes assessed, but not all reported in findings were classified analogous to the efficacy outcome.

Studies that did not fit into the presented classification scheme assessed outcomes unrelated to efficacy and safety, employed a cross-sectional design, or were utilization studies, all of which were summarized separately. Cross-sectional studies were not included in the classification scheme due to their lack of longitudinal assessment, thus limiting the interpretability of findings for quantifying the evidence base in regard to efficacy and safety. Studies that were classified as “other nonsystematic reviews” (e.g., clinical, narrative, scoping, or undefined) were captured in our search strategy but were not evaluated using the classification schemes described herein.

For visualization purposes, all systematic reviews assessing safety or efficacy outcomes were compiled into an evidence map figure consisting of 5 different dimensions (Fig. ​ (Fig.1). 1 ). The bubble size is proportional to the number of included studies within each condition topic area. The bubble color represents the underlying medical condition. The x -axis describes the effect of cannabis in each condition. The y -axis represents the quality of evidence assessment score, and notations within the bubbles indicate whether the systematic reviews included meta-analysis. For a more comprehensive insight into the efficacy and safety-related findings of eligible studies, studies were finally organized by the condition-specific outcome, study design type, and directions of findings.

Quality of evidence among systematic reviews assessing medical cannabis efficacy, effectiveness, and safety outcomes in selected conditions. MS, multiple sclerosis; ALS, amyotrophic lateral sclerosis; PTSD, posttraumatic stress disorder; HIV, human immunodeficiency virus.

A total of 15,917 studies were identified across all searched databases during the study period, where searches were conducted for each of the included clinical conditions. Following stratification by clinical condition relevance and screening for eligibility, 438 studies remained (see online suppl. materials for PRISMA flow diagrams for individual clinical conditions). We then further restricted qualitative synthesis to studies that reported primary results or systematically reviewed prior work ( n = 198), meaning that 240 studies were narrative reviews or other types of nonsystematic reviews. Table ​ Table1 1 summarizes efficacy findings as stratified by study design type and condition, and Table ​ Table2 2 summarizes the same for safety findings. Table ​ Table3 3 summarizes cannabis agents administered or observed in randomized controlled trials (RCTs) and observational studies by agent and route of administration for each condition. Below, we summarize condition-specific findings.

Medical cannabis study efficacy outcome findings, 1 by condition and study design type

ALS, amyotrophic lateral sclerosis; HIV, human immunodeficiency virus; PTSD, posttraumatic stress disorder; RCT, randomized controlled trial; MS, multiple sclerosis. 1 Findings for efficacy outcomes were classified for cannabis/cannabinoid treatment relative to placebo or active comparator according to the following: “improvement” if outcome improved, “worsening” if outcome worsened, “mixed” if multiple efficacy outcomes were assessed with divergent findings for each, “no change” if no change observed, and “inconclusive” if outcomes were unable to be assessed.

Medical cannabis safety outcome findings, 1 by condition and study design type

ALS, amyotrophic lateral sclerosis; HIV, human immunodeficiency virus; PTSD, posttraumatic stress disorder; RCT, randomized controlled trial; MS, multiple sclerosis. 1 Safety outcomes were defined in all studies as proportion of adverse events relative to placebo/active comparator, frequency of adverse events, or severity of adverse events relative to placebo/active comparator. Findings for safety outcomes were classified for cannabis/cannabinoid treatment according to the following: “worsening” if outcome worsened, “mixed” if multiple safety outcomes were assessed with divergent findings for each, “no change” if no change observed, and “inconclusive” if outcomes were unable to be assessed. 2 A secondary endpoint from one RCT, was deemed appropriate for inclusion in safety outcomes [ 136 ].

Counts of agents in reviewed studies by routes of administration and condition

No studies were eligible in the area of ALS, glaucoma, and MS. THCA, tetrahydrocannabinolic acid; ALS, amyotrophic lateral sclerosis; HIV, human immunodeficiency virus; PTSD, posttraumatic stress disorder; THC, tetrahydrocannabinol. 1 Buccal, tincture, oromucosal, rectal, and other not specified. 2 When more than one agent was investigated, but the route of administration was not distinguished between the agents. 3 THCA oil.

Amyotrophic Lateral Sclerosis

As depicted in the flow diagrams (online suppl. files), the use of medical cannabis in patients with ALS was investigated in 9 eligible publications. Among those were 2 systematic reviews without meta-analysis, 2 observational/quasi-experimental studies, and 5 other types of reviews. Of all studies investigating medical cannabis and ALS, 2 studies used cramp intensity/frequency as the primary outcome [ 11 , 12 ] and 2 investigated other outcomes or used a cross-sectional design [ 13 , 14 ]. Among those studies that investigated cramp intensity/frequency, one indicated no change [ 11 ] and one study indicated inconclusive findings [ 11 , 12 ]. (More detailed information about each study type and summary of findings can be found in Tables ​ Tables1 1 and ​ and2 2 and in the online suppl. files.) Other outcomes assessed in this condition included an examination of trajectories of ALS cases [ 13 ], and one cross-sectional study assessed patient characteristics in a dispensary and dispensary staff recommendations [ 14 ].

Medical cannabis in patients with autism was investigated in 17 eligible publications. Among those were one systematic review with meta-analysis, 8 observational/quasi-experimental studies, and 8 other types of reviews. Of all studies investigating medical cannabis and autism, 3 studies used symptom mitigation (see online suppl. Table 1 for outcome definitions) as the primary outcome [ 15 , 16 , 17 ] and 6 investigated other outcomes or used a cross-sectional design [ 18 , 19 , 20 , 21 , 22 , 23 ]. The latter studies and other types of reviews are summarized in the online suppl. files. Among those studies that investigated symptom mitigation, 2 indicated an improvement [ 16 , 17 ] and one study indicated no change in symptoms [ 15 ]. Other outcomes assessed in this condition were assessed in 6 studies, of which one used a cross-sectional study design. Among those outcomes that were assessed by more than 1 study, 2 studies assessed the brain activity in response to CBD with functional magnetic resonance imaging and magnetic resonance spectroscopy [ 22 , 23 ].

Medical cannabis in patients with cancer was investigated in 138 eligible publications. Among those were 6 systematic reviews with meta-analysis, 10 systematic reviews without meta-analysis, 4 RCTs, 31 observational/quasi-experimental studies, and 86 other types of reviews. Of all studies investigating medical cannabis and cancer, 13 studies investigated cancer-related pain reduction as the primary outcome [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]; 2 studies investigated cancer-related nausea and vomiting [ 27 , 36 ]; 3 studies investigated weight change, appetite increase, or caloric intake [ 27 , 37 ]; 17 studies investigated safety outcomes [ 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 ]; and 31 studies investigated other outcomes or used a cross-sectional design [ 3 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ]. Among studies that investigated cancer-related pain, 5 indicated an improvement [ 24 , 25 , 28 , 29 , 36 ], 2 studies indicated no change [ 34 , 35 ], and 6 were inconclusive [ 26 , 27 , 30 , 32 , 74 , 75 ]. Among studies that investigated cancer-related nausea and vomiting, one indicated an improvement [ 36 ] and one was inconclusive [ 27 ]. In studies that investigated weight change, appetite increase, or caloric intake, one indicated an improvement [ 36 ] and 2 were inconclusive [ 27 , 37 ]. Of the 17 studies assessing safety outcomes of medical cannabis in cancer patients, 11 studies indicated worsening [ 24 , 26 , 28 , 29 , 34 , 35 , 36 , 38 , 39 , 40 , 43 ], one indicated mixed findings [ 41 ], and 5 studies were inconclusive [ 27 , 30 , 32 , 42 , 74 ]. For 2 RCTs, results are still pending at this time [ 76 , 77 ]. Other outcomes assessed in this condition were assessed in 31 studies, of which 24 used a cross-sectional study design. Among those outcomes that were assessed by more than one study, 10 studies investigated patients or provider perceptions of cannabis benefits and side effects [ 47 , 52 , 53 , 56 , 60 , 62 , 64 , 67 , 68 , 69 ] and 7 investigated patterns of cannabis consumption [ 48 , 49 , 55 , 57 , 63 , 71 , 72 ].

Chronic Noncancer Pain

Medical cannabis in patients with chronic noncancer pain was investigated in 120 publications. Among those were 8 systematic reviews with meta-analysis, 8 systematic reviews without meta-analysis, 3 RCTs, 36 observational/quasi-experimental studies, and 63 other types of reviews. Of all studies investigating medical cannabis and chronic noncancer pain, 17 studies investigated pain reduction or quality of life as the primary outcome, 9 studies investigated safety outcomes, and 35 investigated other outcomes or used a cross-sectional design [ 14 , 68 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 ]. Among those studies that investigated pain reduction or quality of life, 10 indicated an improvement [ 25 , 111 , 112 , 113 , 114 , 115 ], one study indicated mixed findings [ 42 ], 3 studies indicated no change [ 116 , 117 , 118 ], and 3 were inconclusive [ 30 , 119 , 120 ]. Of the 9 studies investigating safety outcomes of medical cannabis in patients with chronic noncancer pain, 6 studies indicated a worsening [ 111 , 112 , 117 , 119 , 121 , 122 ], 1 indicated mixed findings [ 25 ], and 2 were inconclusive [ 30 , 114 ]. For 3 RCTs, results are still pending (see online suppl. Table 2 ) [ 123 , 124 , 125 ]. Thirty-five eligible studies, including 27 cross-sectional studies, investigated other outcomes. Among those outcomes that were assessed by more than 1 study, 9 studies investigated patients or provider perceptions of cannabis benefits and side effects [ 84 , 85 , 88 , 92 , 100 , 102 , 103 , 106 , 107 ], 8 studies investigated different relationships between cannabis use and opioid use [ 79 , 81 , 87 , 96 , 101 , 105 , 108 , 109 ], 6 studies investigated cannabis use patterns [ 78 , 82 , 83 , 90 , 97 , 110 ], 2 examined consumer characteristics [ 89 , 93 ], and 2 explored reasons for medical cannabis use [ 68 , 99 ].

Crohn's Disease

Twenty-five publications investigated medical cannabis in patients with Crohn's disease. Among those were 2 systematic reviews without meta-analysis, 1 RCT, and 8 observational/quasi-experimental studies. Of all studies investigating medical cannabis in patients with Crohn's disease, 3 studies investigated symptom mitigation as the primary outcome, 1 study investigated safety outcomes, and 6 investigated other outcomes or used a cross-sectional design [ 14 , 116 , 126 , 127 , 128 , 129 ]. In studies that investigated symptom mitigation, 1 study indicated an improvement [ 130 ], 1 study indicated mixed findings [ 61 ], and one was inconclusive [ 131 ]. Safety outcomes were reported by one study, which indicated worsening safety outcomes [ 132 ]. The RCT has recently been withdrawn due to inadequate funding [ 133 ]. Six eligible studies, including 3 cross-sectional studies, investigated other outcomes. Outcomes that were assessed by more than one study included patient perceptions of cannabis benefits and side effects, which was assessed by 2 studies [ 127 , 128 ], and cannabis use patterns, which was investigated by 2 studies [ 126 , 129 ].

Medical cannabis in patients with epilepsy was investigated in 72 eligible publications. Among those were 3 systematic reviews with meta-analysis, 2 systematic reviews without meta-analysis, 3 RCTs, 17 observational/quasi-experimental studies, and 47 other types of reviews. Of all studies investigating medical cannabis and epilepsy, 19 studies investigated the effect on seizures (i.e., reductions in number of seizures and seizure frequency) as the primary outcome, 2 studies assessed health-related quality of life, 18 studies investigated safety outcomes, and 3 studies investigated other outcomes or used a cross-sectional design. Among those studies that investigated the effect on seizures as outcomes, 13 studies indicated an improvement [ 116 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 ], 4 studies indicated no change [ 144 , 146 , 147 , 148 ], and 2 studies were inconclusive [ 149 , 150 ]. In those studies that investigated health-related quality of life or quality of life as the primary outcome, both studies indicated an improvement [ 144 , 146 ] and one study indicated no change [ 146 ]. Among those 18 studies that investigated safety outcomes, 10 studies indicated worsening [ 134 , 136 , 138 , 140 , 142 , 145 , 151 , 152 , 153 , 154 ], 1 indicated mixed findings [ 155 ], 5 indicated no change [ 135 , 141 , 144 , 156 ], and 2 were inconclusive [ 149 , 150 ]. Three eligible studies, including 1 cross-sectional study, investigated other outcomes. One study assessed potential pharmacokinetic interactions [ 157 ], one investigated perception about cannabis use and benefits [ 158 ], and the third assessed doses of cannabidiol [ 116 ].

Medical cannabis in patients with glaucoma was investigated in 14 eligible publications, including one systematic review without meta-analysis and one book section. (Detailed information about the latter and the 12 other types of reviews can be found in the online suppl. files.) Of all studies, one investigated the effect of medical cannabis on intraocular pressure, and this study indicated no change in the outcome [ 116 ].

Human Immunodeficiency Virus/AIDS

Medical cannabis in patients with HIV/AIDS was investigated in 25 eligible publications, among those were 3 systematic reviews with meta-analysis, 19 observational/quasi-experimental studies, and 3 other types of reviews. Of all studies within this section, 2 studies investigated symptom mitigation (see online suppl. material) as the primary outcome, 4 studies investigated the effect on adherence to antiretroviral therapy, 2 studies investigated the effect on viral suppression, 5 studies investigated safety outcomes, and 12 studies investigated other outcomes or used a cross-sectional design [ 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 ]. Among the 2 studies that investigated symptom mitigation, one indicated an improvement [ 120 ] and one was inconclusive [ 115 ]. Among the 5 studies examining the effect of cannabis use on adherence to antiretroviral therapy, 2 indicated worsening [ 171 , 172 ], 2 reported no change [ 160 , 173 ], and 1 reported inconclusive findings [ 174 ]. One study examining the effect on viral suppression indicated no change [ 173 ], and 1 study indicated inconclusive findings [ 174 ]. Of the 5 studies investigating safety outcomes, 3 studies indicated worsening [ 120 , 175 , 176 ] and 2 studies indicated no change [ 176 , 177 ]. Twelve eligible studies, including 6 cross-sectional studies, investigated other outcomes. Among those outcomes that were assessed by more than one study, 5 studies assessed aspects of HIV care continuum measures [ 160 , 161 , 162 , 163 , 168 ] and 2 studies assessed the prevalence and correlates of substance use [ 165 , 178 ].

Multiple Sclerosis

Medical cannabis in patients with MS or related motor neuron disorders was investigated in 25 eligible publications. Among those were 5 systematic reviews with meta-analysis, 4 systematic reviews without meta-analysis, and 16 other types of reviews. Of all studies within this section, 6 studies investigated spasticity and spasm as the primary outcome, 4 studies investigated efficacy on MS-related pain, 3 studies investigated bladder function, 1 study examined the effect on gait function, and 6 studies investigated safety outcomes. (More information about the 17 other types of reviews can be found in the online suppl. files.) Among the 6 studies investigating spasticity and spasm, 3 indicated an improvement [ 179 , 180 , 181 ], one indicated mixed findings [ 182 ], one study reported no change [ 183 ], and one was inconclusive [ 30 ]. Among the 4 studies examining MS-related pain, one indicated improvement [ 180 ], one reported no change [ 183 ], and 2 reported inconclusive findings [ 30 , 115 ]. Of studies examining the effect on bladder function, 2 indicated improvement [ 180 , 184 ] and one reported no change [ 183 ]. One study investigating gait function reported inconclusive findings [ 185 ]. In studies investigating safety outcomes, 3 studies indicated worsening [ 180 , 183 , 184 ], 2 studies indicated no change [ 181 , 182 ], and 1 study reported inconclusive findings [ 30 ].

Parkinson's Disease

Medical cannabis in patients with Parkinson's disease was investigated in 17 eligible publications. Among those were one RCT and 4 observational/quasi-experimental studies. Of all studies, one study investigated the effect of medical cannabis on safety outcomes and indicated no change in the outcome [ 186 ]. For one RCT, results are still forthcoming [ 187 ]. Other outcomes were investigated by 3 cross-sectional studies. All of these studies investigated physicians or patient expectations or perceived benefits of cannabis on Parkinson's disease-related symptoms [ 83 , 188 , 189 ]. (More information about the studies that assessed other outcomes and the 12 other types of reviews can be found in the online suppl. files.)

Posttraumatic Stress Disorder

Medical cannabis in patients with PTSD was investigated in 50 eligible publications. Among those were 10 systematic reviews without meta-analysis, 5 RCTs, 3 observational/quasi-experimental studies, and 31 other types of reviews. Of all studies investigating medical cannabis in patients with PTSD, 8 studies investigated symptom mitigation (e.g., sleep disturbances, dissociative reactions or flashbacks, and hyperarousal) as the primary outcome, 3 studies investigated safety outcomes, and 3 assessed other outcomes or used a cross-sectional design [ 14 , 190 , 191 ]. Among those studies that investigated symptom mitigation, 2 indicated mixed findings [ 192 , 193 ] and 6 were inconclusive [ 12 , 122 , 194 , 195 , 196 , 197 ]. One study investigating safety outcomes indicated mixed findings [ 198 ], and 2 studies reported inconclusive findings [ 195 , 199 ]. Among those 5 RCTs, 1 study has been terminated, 2 were completed, but publications were not available at the time of literature search, and for 2, results are still pending. For 5 RCTs, results are still pending [ 200 , 201 , 202 , 203 , 204 ]. Three eligible studies, including 2 cross-sectional studies, investigated other outcomes. Two of 3 investigated cannabis dispensary staff or healthcare provider practices [ 14 , 191 ] and 1 study investigated cannabis use patterns and associated problems [ 190 ].

Cannabis Agents

The vast majority of RCTs and observational studies (including cross-sectional studies) that investigated the safety or efficacy of cannabis did not further specify the type of cannabis product that was investigated. A specific route of administration was also often not reported. Among those publications that specified the cannabis product, CBD was the most frequent investigated agent and mostly for investigations related to epilepsy or other seizure disorders. Whole plant cannabis was the least investigated drug. With respect to route of administration, studies investigating THC, CBD, or THC and CBD combinations typically employed oral/peroral, buccal, or sublingual administration. This is in contrast to those studies assessing unspecified agents, in which pulmonary and oral/peroral administrations were most common. We encountered only one study that assessed minor cannabinoids, namely, tetrahydrocannabinolic acid.

Evidence Map

The majority of identified systematic reviews were conducted on the topic areas of chronic noncancer pain, cancer, MS, epilepsy, and PTSD. The evidence map includes indications for conditions that were determined to have scarce recent evidence available. The quality of evidence varied widely among all eligible systematic reviews and differed between each condition. Reviews graded as either critically low or low quality, indicating serious risks of biases and/or methodological limitations, were mainly conducted in the areas of cancer, PTSD, and HIV/AIDS. Moderate-quality systematic reviews were represented in all conditions. Only the areas of chronic noncancer pain, epilepsy, and MS included systematic reviews graded as high quality. In terms of safety and efficacy outcomes, only a few systematic reviews in the area of ALS, cancer, chronic noncancer pain, Crohn's disease, glaucoma, and MS indicated worsening or no difference. The majority of included reviews reported inconclusive or mixed results, and only publications in the area of chronic noncancer pain, cancer, epilepsy, and MS reported improved outcomes. Furthermore, among high-quality reviews, only chronic noncancer pain and epilepsy reported improved outcomes (see Fig. ​ Fig.1 1 ).

Referring to the 11 investigated conditions, the NASEM report in 2017 concluded that there is conclusive or substantial evidence for cannabis in treating chronic noncancer pain, chemotherapy-induced nausea and vomiting (oral cannabinoids), and MS spasticity symptoms (via oral cannabinoids). In addition, limited evidence was reported for the efficacy of cannabis and cannabinoids for the purposes of increasing appetite and decreasing weight loss in patients with HIV/AIDS, improving clinician measures of MS spasticity symptoms (specifically, via oral cannabinoids), and improving symptoms of PTSD (specifically, with nabilone). NASEM also concluded that limited evidence was available that cannabis and cannabinoids were ineffective in improving intraocular pressure associated with glaucoma (specifically via cannabinoids). Furthermore, insufficient or no evidence existed to support or refute the effectiveness of cannabis or cannabinoids for a majority of examined indications. Those indications included cancer (cannabinoids), cancer-associated anorexia-cachexia syndrome and anorexia nervosa (cannabinoids), symptoms of irritable bowel syndrome (dronabinol), epilepsy (cannabinoids), symptoms associated with ALS, or Parkinson's disease-related symptoms or levodopa-induced dyskinesia (cannabinoids).

In the 4 years since the NASEM report, much has been published in the clinical and scientific literature regarding the safety and efficacy of cannabis and cannabinoids, but we identified few recent studies conducted within US populations and were of substantial rigor and quality to move the evidence base forward for many clinical conditions. In fact, across all condition topic areas, the most frequently identified study design was clinical/narrative review with a nonsystematic approach, and these reviews only recounted and compiled previous RCT and observational study findings. Many other identified studies, particularly observational studies, also had significant limitations when assessing the safety and efficacy of cannabis that potentially affected validity. Detailed information about the history of cannabis use, other substance use, concomitant medications, comorbidities, types of cannabis product (THC, CBD, THC/CBD, and whole plant), route of administration, and dosage was not captured in the majority of observational studies due to unavailable data or limited subject knowledge. Thus, confounding was a recurring threat to validity in many identified studies. Several observational studies, for example, suggest that cancer patients using medical cannabis tend to have more severe symptoms than those who did not consume medical or recreational cannabis [ 57 , 60 , 71 ]. However, it is unclear if cannabis is contributing to more severe symptoms or if the presence of severe symptoms prompted increases in cannabis utilization. In addition, patient-reported outcomes and behaviors may be more susceptible to recall bias and/or inaccurate reporting of dosage, duration, and frequency of use [ 205 , 206 ]. Patients also might not report nonmedical cannabis use due to perceived social norms.

Quality of Evidence

Our assessment of the quality of systematic reviews determined that high-quality systematic reviews were conducted only among the conditions of chronic noncancer pain, epilepsy, and MS. In the area of chronic noncancer pain, the most recent systematic reviews are in alignment with findings of the NASEM report, which reported substantial evidence for the use of cannabis as a treatment for chronic pain in adults.

In the area of epilepsy, one recently published high-quality systematic review included several newly published RCTs focusing on pediatrics and found significantly reduced seizure frequency with adjunctive CBD use in pediatric drug-resistant Dravet and Lennox-Gastaut syndromes, aligning with the FDA approval of Epidiolex. High-quality systematic reviews in the field of MS did not include any RCT results following the publication of the NASEM report and are, therefore, not expanding the evidence base.

Only 7 systematic reviews were graded as high quality, whereas almost one-third were graded as low- or critically low-quality systematic reviews. Common reasons for being rated as a moderate- or low-quality review were due to the absence of a prior established protocol, lack of a comprehensive literature search strategy, failing to report the source of funding of included studies, missing an adequate detailed description of excluded studies, inadequate accounting for the risk of bias assessment within result interpretation and discussion, absence of adequate discussion of heterogeneity, and absence of a quantitative synthesis or meta-analysis. In addition to these limitations, many identified systematic reviews also consisted of few RCTs.

Despite the limited evidence available from recent high-quality systematic reviews, it is promising that we identified 12 RCTs with registered protocols and trial registrations. The studies are covering the field of Crohn's disease, chronic noncancer pain, cancer, Parkinson's disease, and PTSD [ 76 , 77 , 123 , 124 , 125 , 133 , 187 , 200 , 201 , 202 , 203 , 204 ], and 2 of them have recently been withdrawn or terminated [ 133 , 202 ]. However, the remaining 10 RCTs have the potential to expand the evidence base. In addition, our review identified many studies that reported an increase in adverse events relative to placebo or an active comparator, which was consistent across most of the assessed medical conditions. Nevertheless, the vast majority of the reviewed studies reported that adverse event severity ranged from mild to moderate, and most adverse events were reversible with dose reduction or discontinuation. Medical cannabis was often referred to as “generally well tolerated.” However, information about long-term safety outcomes was scarce.

Gaps in Literature

We identified several persistent gaps in the literature during this review. Recent observational studies often lacked specific information about the route of administration, dosage, frequency, and cannabis product used. Clinical trials were mainly limited to peroral, oral, or sublingual administration and represented few formulations of available cannabis products. Studies investigating whole-plant cannabis products are needed to better understand the risks and benefits of cannabis in real-world settings as patients receiving medical cannabis in practice are typically receiving whole-plant products. In order to provide valuable information about the effectiveness and safety of medical cannabis, real-world studies must define cannabis products, the route of administration, and dosage precisely. In addition, it is unclear whether or not standardized products provided in RCTs are comparable to those products offered by dispensaries, where consistency in product dosing, concentrations, and even routes of administration offered are not necessarily guaranteed and are subject to variations in state regulations [ 207 ]. Furthermore, there remain other questions about the generalizability of existing evidence raised. For example, patients with substance use disorder histories were often excluded from randomized studies across several conditions, even though use by patients with these or similar underlying conditions is common (e.g., PTSD and chronic noncancer pain) [ 208 ].

Implications for Research, Clinicians, and Policy

The prevalence of medical cannabis and cannabis use for nonmedical reasons is increasing [ 209 ], while perceived risks associated with cannabis use are decreasing, particularly among younger persons [ 210 ]. Therefore, it is important to evaluate and disseminate the evidence widely to both clinicians and patients. Interestingly, there is also some evidence suggesting that the legalization of cannabis might not necessarily affect the compliance rate of primary therapies in patients with chronic noncancer pain under opioid therapy [ 211 ], so it is unclear whether the changing availability of licit nonmedical cannabis will impact clinical outcomes in patients receiving medical cannabis.

There remains a need for well-designed and conducted RCTs for most of the assessed medical conditions. However, there are several methodological and practical challenges in conducting RCTs specific to investigating efficacy and safety of cannabis and cannabinoids, including placebo effects, practical limitations in conducting blinding for cannabis products, and regulatory barriers. Expense and complicated implementation, meanwhile, render it difficult to design and perform high-quality RCTs even in the absence of cannabis-related regulatory barriers [ 212 , 213 ]. Studies assessing cannabis efficacy and safety for these conditions, or any condition, must consider the effect that different routes of administration can have on systemic exposure and ultimately on study outcomes. Studies must also clearly and precisely quantify active metabolites and ratio of metabolites (i.e., THC:CBD) with the same rigor as applied to other medication studies.

Questions also remain about medical cannabis safety, especially in terms of rare adverse drug events, long-term effects, the effects on patients with comorbidities (e.g., people with history of substance abuse), and the potential for interactions with prescription medications and other substances, particularly among patients most susceptible to adverse events from drug-drug interactions (e.g., geriatric populations). Future research will require the utilization of a combination of approaches and techniques to overcome the barriers associated with capturing these rare or long-term outcomes, including the use of real-world data and sophisticated pharmacoepidemiologic methods to overcome current limitations in reported studies for ascertaining exposures and outcomes.

The evolving and challenging legal status of cannabis remains a significant obstacle to the expansion of cannabis research in the USA. The schedule I controlled substance designation of whole-plant cannabis restricts research in this area due to regulatory barriers and limited feasibility, along with scarce federal research funding allocated to the investigation of constituent compounds [ 214 ]. Furthermore, only a minority of the National Institute of Health's budget is earmarked for therapeutic cannabis research, while more is available for investigations of problematic uses and/or abuse potential, making it challenging to get US funding for investigation of therapeutic potential [ 215 , 216 ]. The complicated legal status of cannabis in the USA restricts cultivation and production to a single federally permitted institution; thus, a narrow amount of cannabis products can be tested, and these may not mirror constituents and concentrations of products available to consumers on the market [ 217 , 218 ]. Thus, policies would need revision to permit handling or production of dispensary-available cannabis products for research purposes and expand funding mechanism to support urgently needed research on clinical outcomes of medical cannabis.

Limitations and Strengths

Our review has several limitations that should be considered in the interpretation of the findings. First, we restricted our search strategy to studies published between July 2016 and October 2019 and for our rapid review to studies published between 2000 and October 2019. Therefore, we assessed only a narrow period of the most recently available literature. Second, we excluded articles reporting primary research conducted exclusively outside the USA, in order to account for differences in cannabis product availability internationally as well as differences in regulatory barriers and access. We, therefore, have excluded potentially relevant recent literature conducted in countries with robust scientific and clinical research programs evaluating cannabis efficacy and safety. However, studies originating from the USA accounted for almost 2/3 of all publications between 2000 and 2017 [ 219 ]. Third, even though we conducted pilot runs and training with reviewers on the use of the data extraction tool, the data extraction step was only conducted by one reviewer with review by a second reviewer in cases of uncertainty. In addition, the screening process for each topic area was only conducted by a second reviewer for those articles categorized as “uncertain”; thus, selection bias might have been introduced during both stages. However, weekly meetings throughout the review process were used to clarify any questions and uncertainties throughout the screening and extraction process. Fourth, systematic reviews and meta-analyses were not excluded if they partially included studies that were not matching our criteria (e.g., a systematic review consisting of studies that were conducted between 2016 and 2019 but also prior to 2016 was still considered as eligible, since it was not feasible to disentangle the evidence synthesis without examining the underlying primary study). Therefore, our findings based on systematic reviews and meta-analyses might not be restricted to our country and time criteria. In order to account for this limitation, we stratified our findings by study design and also restricted our summary of cannabis agents to RCTs and observational studies. Fifth, we did not assess whether medical cannabis was used as adjuvant treatment or primary therapy. Subsequently, different directions of findings might be based on variation in co-medications. However, the regulatory environment in the US mainly restricts the use of medical cannabis products to adjuvants, and the objective of this study was not to assess safety and efficacy of medical cannabis. Last, although a standardized classification scheme was applied to categorize the outcomes, inter-rater variability might have introduced misclassification of the outcomes.

There are also several strengths of this review to consider, including the broad scope of assessed medical conditions, comprehensive search strategy that extended beyond RCTs, and adherence to the PRISMA statement for gathering and reporting findings. Furthermore, this review highlights recent research efforts by medical condition, and directions of findings, thus creating a comprehensive picture of the scientific landscape of clinical studies about cannabis. Moreover, we also identified several literature gaps that could be addressed in future research, and we assessed the quality of evidence available, which is essential information for policymaking. Additionally, input from an external expert panel ensured a wide range in scope of the literature covered, and this review gives an up-to-date overview about the current state of evidence quality in a readily interpretable map.

The large body of the literature recently published regarding medical cannabis masks a paucity of evidence related to efficacy and safety as treatment options for several conditions for which it is commonly prescribed. Across 11 conditions, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that certain dosage forms and routes of medical cannabis products likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). Gaps in the evidence remain significant for most examined conditions, but the identification of several registered forthcoming RCTs suggests that improved evidence will be available in the coming years.

Conflict of Interest Statement

The Consortium for Medical Marijuana Clinical Outcomes Research provided funding support for 4 contributors to this study, where S.J. and B.C. received graduate student stipend support in 2019–2020, and A.G., J.H.C., and A.W. received salary offset for serving as University of Florida faculty leads in 2019–2020. No other authors have conflicts of interest to declare.

Funding Sources

The consortium (described above) provided material support for 4 authors during the period of study completion (2019–2020). The funder did not have a role in decisions related to the preparation of data or the contents of this manuscript.

Author Contributions

S.J. prepared protocols for literature search, screening, and data extraction and drafted the manuscript. A.G. designed the study, supervised contributors, and critically revised the manuscript. L.A. performed literature searches and curated the reference library. The following contributors were topic lead reviewers for the following conditions: A.G. in amyotrophic lateral sclerosis, A.O. in human immunodeficiency virus (HIV)/AIDS, B.C. in Crohn's disease and posttraumatic stress disorder, E.J.M. in Parkinson's disease, G.A.H. in epilepsy, S.K. and S.J. in cancer, S.J. in chronic noncancer pain, Y.S. in autism and multiple sclerosis, and Y.Z. in glaucoma. R.S. developed figures. All other contributors were positioned in various roles as screeners, in data extraction, in reviewer resolutions, and in qualitative synthesis. All contributors critically revised and approved the manuscript.

Supplementary Material

Supplementary data

Acknowledgement

We thank and acknowledge the panel of scientific and clinical subject matter experts who provided comments on the protocols for topic selection, literature identification search strategies, literature screening, and data extraction procedures. Expert panelists were recruited as part of the Consortium for Medical Marijuana Clinical Outcomes Research activities, but the panelists have not contributed to the interpretation of the review findings.

Marijuana Legalization - Free Essay Examples And Topic Ideas

Marijuana legalization is a contentious issue with implications for health, economy, and society. Essays might explore the arguments for and against legalization, the experiences of regions where marijuana has been legalized, and the legal, economic, and social ramifications of legalization. Additionally, discussions might extend to the medical uses of marijuana, its impact on the criminal justice system, and its societal perceptions. We have collected a large number of free essay examples about Marijuana Legalization you can find in Papersowl database. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Marijuana Legalization and Regulation

Medications/Drugs are a part of everyday life. We take medications for various ailments, to return ourselves to good health. Yet, as time and healthcare technology have moved along, we have discovered that some medications or drugs are inherently good (i.e.: antibiotics, cancer medications, and insulin) and some are inherently bad or, at least, can be used for bad purposes (i.e.: mind altering substances such as LSD, and cocaine). The "bad" drugs can be deadly. They have effects that can addict […]

Medical Marijuana and Marijuana Legalization

Thursday, June 09, 2011 Much debate has been conducted regarding the legalization of marijuana, with an unusual amount of contradicting research. There are many perspectives to take into account, and they always seem to come down to the personal motives of the debater. Whether it's being argued from a medical, political, or economical perspective; it continually comes down to whether Federal Government should be our dictators or we should be responsible for our actions. The Canadian medical Association Journal reports […]

Marijuana should be Legalized?

We are living in an era where noxious things like alcohol, rum and cigarettes -that lead us to nothing but a dreadful death- are legal, and a plant which has no obnoxious effects on our body and mind is illegal. For years and years, marijuana has been used as a mean to achieve elation. The criterion to impose a ban on something, or to term it illegal, is that its cons should overshadow its pros; and that it will have […]

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Medical Marijuana Legalization the Good Bad and Ugly

The legalization of medical marijuana has been discussed amongst the country's states for decades. Medical marijuana legalization has taken a positive shift throughout these years and is now legal in 20 states and the District of Columbia. The initial drug, marijuana, was band for the dangerous effects it brought to people. Throughout the year's people have turned to marijuana to ease anxiety, pain, and stress. Legalizing marijuana has brought multiple perspectives on the topic. Differences such as medical marijuana legalization, […]

Medical Marijuana Legalization

Marijuana legalization has become a topic of relevance in the United States as recent changes in various state legislations fuel the controversial issue relating to its effects on society. With more than thirty states legalizing marijuana for medicinal or recreational uses, the once taboo topic has reemerged into the spotlight for policymakers to consider the benefits and adverse effects of cannabis for state legislation. Although the legal status is changing nationwide, the uncertainties surrounding marijuana today stem from the political […]

Pros and Cons of Legalizing Marijuana

When we first picked our topic for our presentations I had an idea of what we were going to do. Ideas from school shootings to you and human trafficking were some I was thinking of. The drug epidemic was what first came to thought but I felt that was to broad of of a topic. With state after state legalizing Medical or Recreational Marijuana it is becoming more likely within the near future will become federally legal. Today there are […]

Against Marijuana Legalization

In my high school years I met a lot of people, I’ve meet hundreds of people who ruined their lives by just “trying” a drug. One of those friends is named Carmen, my dear friend Carmen smokes marijuana recreationally everyday, she’s tried everything under the rainbow; pot brownies, gummi bears, cookies, anything that you can think of is probably an edible. She’s even forced me to try marijuana when we were in high school once. It was the worst experience […]

Marijuana Legalization in Texas: an In-Depth Examination of the Ongoing Debate

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Legalization of Marijuana: Good or Bad

The legalization of marijuana is a hot topic these days. Marijuana has been legalized in many different states. Colorado legalized marijuana for recreational use in 2012. Since then, Texas has been talking of legalizing it as well. Although the legalization of marijuana has brought quite a bit of controversy over the nation, I believe the good outweigh the bad. Marijuana is used for different medical reasons, ranging from anxiety all the way to helping some side effects of cancer. Many […]

Legalization of Recreational Marijuana

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A Legalized Drug in the United States

In the United States, marijuana is one of the most commonly used drugs that should have been legalized a long time ago along with alcohol. Although, 15 states in the United States have already legalized the use of marijuana, many others still lag behind at the thought of even legalizing Cannabis. In addition, many people think that marijuana is a bad drug, while on the other hand, people like myself believe for many reasons that it should be legalized. Marijuana […]

Pro-Legalization of Marijuana

Marijuana has always been a much-discussed subject that has sparked heated discussions among experts and officials, in addition to a perpetual dialogue among family and associates. This is primarily due to the fact that people are still divided on whether cannabis should be legalized or not. While many people are aware of the dangers of cannabis for recreational purposes, many states are pushing for the legalization of medical cannabis. Several studies of cannabinoid elements have revealed its medicinal qualities, which […]

Proposal One: Impact on Warren, MI’s Future

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The Legalization of Marijuana Today

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Legalization of Marijuana: the Current Situation

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Marijuana Decriminalization in all States

The government should legalize marijuana on the federal use due to the multifaceted health, economic, and criminal benefits now outweigh the outdated downsides of use. Many researchers have come to the conclusion of outdated research not being correct. "One function of government is to protect citizens from harm, whether it is from foreign enemies or from internal causes such as poisonous food or contaminated water." Researchers believe that legalizing marijuana will not help the people only harm them and the […]

The Cost and Benefit of Legalization of Marijuana

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Legalization of Marijuana Throughout States

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The Impacts of Legalizing Marijuana

The impacts of legalizing marijuana have been far reaching. Legal or not, there are health issues to consider when it comes to medicinal purposes or recreational purposes. Studies show that non-medical marijuana users are at an increased risk for physical ailments involving the respiratory system and pulmonary functions. Psychological problems are also a concern, involving depression, insomnia, anxiety, and drug addiction. Other things associated with marijuana use are criminal justice involvement and lower academic achievement and functioning (Lankenau, et al., […]

Legalization of Marijuana and Economic Growth

These would make occupations as well as set the ball moving for financial action in the pot business in these regions. On account of states like California and Nevada where such foundation as of now exists, the financial effect has turned out to be more quantifiable as the part has developed. A RCG Economics and Marijuana Policy Group consider on Nevada says that legitimizing recreational marijuana in the state could bolster more than 41,000 employments till 2024 and produce over […]

Marijuana as a Psychoactive Drug

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How To Write an Essay About Marijuana Legalization

Introduction to marijuana legalization.

When embarking on an essay about marijuana legalization, it's crucial to begin with a comprehensive overview of the topic. Marijuana legalization is a multifaceted issue that encompasses legal, medical, social, and economic dimensions. Your introduction should briefly touch upon the history of marijuana use and its legal status over time, setting the stage for a deeper exploration of the arguments for and against legalization. Establish your thesis statement, outlining the specific aspect of marijuana legalization you will focus on, whether it's the potential medical benefits, the social implications, or the economic impact of legalizing marijuana.

Examining the Arguments for Legalization

In this section, delve into the arguments commonly made in favor of legalizing marijuana. These arguments often include the potential medical benefits of marijuana, such as its use in pain management and treatment of certain medical conditions. Discuss the viewpoint that legalization could lead to better regulation and quality control of the substance, as well as potentially reduce crime rates related to illegal drug trade. It's also important to consider the economic aspect, such as the revenue generated from taxing legal marijuana sales. Provide well-researched evidence and examples to support these arguments, ensuring that your essay presents a balanced and informed perspective.

Exploring the Counterarguments

Next, address the arguments against marijuana legalization. These may include concerns about the health risks associated with marijuana use, such as potential impacts on mental health and cognitive function, especially among young people. Discuss the fears that legalization might lead to increased usage rates, particularly in adolescents, and the potential for marijuana to act as a gateway drug. There's also the argument regarding the challenges of enforcing regulations and controlling the quality and distribution of legal marijuana. Like the previous section, ensure that you present these counterarguments with supporting evidence and a fair analysis, demonstrating an understanding of the complexities of the issue.

Concluding the Essay

Conclude your essay by summarizing the main points from both sides of the argument. This is your opportunity to reinforce your thesis and provide a final analysis of the issue based on the evidence presented. Reflect on the potential future of marijuana legalization, considering the current trends and policy changes. A well-crafted conclusion should provide closure to your essay and encourage the reader to continue contemplating the nuanced aspects of marijuana legalization. Your concluding remarks might also suggest areas for further research or consideration, underscoring the ongoing nature of the debate surrounding marijuana legalization.

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Stop COVID Cohort: An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 (COVID-19) Infection

Collaborators.

• Sechenov StopCOVID Research Team : Anna Berbenyuk ,  Polina Bobkova ,  Semyon Bordyugov ,  Aleksandra Borisenko ,  Ekaterina Bugaiskaya ,  Olesya Druzhkova ,  Dmitry Eliseev ,  Yasmin El-Taravi ,  Natalia Gorbova ,  Elizaveta Gribaleva ,  Rina Grigoryan ,  Shabnam Ibragimova ,  Khadizhat Kabieva ,  Alena Khrapkova ,  Natalia Kogut ,  Karina Kovygina ,  Margaret Kvaratskheliya ,  Maria Lobova ,  Anna Lunicheva ,  Anastasia Maystrenko ,  Daria Nikolaeva ,  Anna Pavlenko ,  Olga Perekosova ,  Olga Romanova ,  Olga Sokova ,  Veronika Solovieva ,  Olga Spasskaya ,  Ekaterina Spiridonova ,  Olga Sukhodolskaya ,  Shakir Suleimanov ,  Nailya Urmantaeva ,  Olga Usalka ,  Margarita Zaikina ,  Anastasia Zorina ,  Nadezhda Khitrina

Affiliations

• 1 Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 2 Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
• 3 Soloviev Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
• 4 School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, United Kingdom.
• 5 Biobank, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 6 Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 7 Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
• 8 Department of Polymers and Composites, N. N. Semenov Institute of Chemical Physics, Moscow, Russia.
• 9 Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
• 10 Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
• 11 Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 12 Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 13 Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 14 Department of Internal Medicine No. 1, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 15 Department of Forensic Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 16 Department of Statistics, University of Oxford, Oxford, United Kingdom.
• 17 Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
• 18 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
• 19 Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
• 20 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• PMID: 33035307
• PMCID: PMC7665333
• DOI: 10.1093/cid/ciaa1535

Background: The epidemiology, clinical course, and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically diagnosed COVID-19 in real-life settings is lacking.

Methods: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow between 8 April and 28 May 2020.

Results: Of the 4261 patients hospitalized for suspected COVID-19, outcomes were available for 3480 patients (median age, 56 years; interquartile range, 45-66). The most common comorbidities were hypertension, obesity, chronic cardiovascular disease, and diabetes. Half of the patients (n = 1728) had a positive reverse transcriptase-polymerase chain reaction (RT-PCR), while 1748 had a negative RT-PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID-19. No significant differences in frequency of symptoms, laboratory test results, and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR. In a multivariable logistic regression model the following were associated with in-hospital mortality: older age (per 1-year increase; odds ratio, 1.05; 95% confidence interval, 1.03-1.06), male sex (1.71; 1.24-2.37), chronic kidney disease (2.99; 1.89-4.64), diabetes (2.1; 1.46-2.99), chronic cardiovascular disease (1.78; 1.24-2.57), and dementia (2.73; 1.34-5.47).

Conclusions: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features was sufficient to diagnose COVID-19 infection, indicating that laboratory testing is not critical in real-life clinical practice.

Keywords: COVID-19; Russia; SARS-CoV-2; cohort; mortality risk factors.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Publication types

• Observational Study
• Research Support, Non-U.S. Gov't
• Hospitalization
• Middle Aged

Grants and funding

• 20-04-60063/Russian Foundation for Basic Research

Moscow, Russia – Architectural Splendor at the Heart of Eurasia

Moscow, Russia – Most Populated Cities in the World

Moscow, the capital city of Russia, stands as an architectural testament to the country’s rich history and cultural legacy. This article explores the architectural landscape of Moscow, uncovering its unique blend of historical monuments, Soviet-era structures, and contemporary designs that define this vibrant metropolis.

Population Dynamics of Moscow

From medieval roots to megacity.

Moscow, with a population exceeding 12 million, has evolved from its medieval roots into a bustling megacity. The city’s demographic dynamism reflects its historical significance as a political, economic, and cultural center. Moscow’s urban growth presents challenges and opportunities for architects and urban planners, requiring a delicate balance between preservation and modernization.

Architectural Diversity in Moscow

Kremlin, red square, and the modern skyline.

Moscow’s architectural diversity is a harmonious blend of historical landmarks and contemporary structures. The iconic Kremlin, with its cathedrals and palaces, dominates the cityscape, while the neighboring Red Square provides a historical focal point. Beyond the historical core, Moscow’s skyline is adorned with modern skyscrapers like the Moscow International Business Center, symbolizing the city’s economic and architectural evolution.

Sustainable Architecture Initiatives

Green innovations amidst urban density.

As Moscow confronts environmental challenges and urban density, architects have championed sustainable solutions. Green building practices, energy-efficient designs, and eco-friendly materials are integral to Moscow’s architectural discourse. The city’s commitment to sustainability is evident in projects like Zaryadye Park, a green oasis in the heart of the city.

Urban Planning and Zoning Strategies

Preserving heritage amidst modernization.

Moscow’s urban planning endeavors to preserve its historical heritage while accommodating modern developments. The preservation of architectural gems like St. Basil’s Cathedral and the Pushkin Museum coexists with contemporary urban projects such as the Moscow City residential complexes. Urban planners in Moscow face the challenge of balancing the demands of a growing population with the need to protect the city’s cultural legacy.

Resilience in the Face of Urban Challenges

Adaptable architecture for harsh climates.

Moscow’s architectural resilience is tested by the city’s harsh climate and urban challenges. Architects prioritize designs that can withstand extreme temperatures and adapt to the evolving urban landscape. The use of durable materials and innovative construction techniques showcases Moscow’s commitment to architectural adaptability.

Technological Integration in Moscow’s Architecture

Smart city initiatives and futuristic designs.

Moscow’s architectural landscape seamlessly integrates cutting-edge technology for enhanced urban living. Smart city initiatives, digital infrastructure, and futuristic designs like the Moscow Central Diameters (MCD) showcase the city’s commitment to technological innovation. Moscow positions itself as a global hub for modern architectural practices, leveraging technology to improve efficiency and sustainability.

Architectural Icons of Moscow

Kremlin and red square.

The Kremlin and Red Square, UNESCO World Heritage Sites, symbolize Moscow’s historical and political significance. The architectural ensemble, including the iconic St. Basil’s Cathedral and the State Historical Museum, reflects Russia’s cultural and religious heritage.

Moscow International Business Center (Moscow City)

Moscow City, with its futuristic skyscrapers, represents the city’s economic prowess and modern aesthetic. The complex includes iconic structures like the Federation Tower and Mercury City Tower, showcasing Moscow’s status as a global financial and architectural hub.

Moscow’s Future Architectural Landscape

As Moscow continues to evolve, the city’s architectural landscape is poised for further transformation. Urban planners and architects are exploring innovative solutions to accommodate the growing population while preserving the city’s unique identity. Moscow’s commitment to sustainable practices, technological integration, and resilient design will shape its architectural future.

In conclusion, Moscow, Russia, stands as a city where architectural marvels narrate the story of a nation’s history and progress. From medieval fortifications to contemporary skyscrapers, Moscow’s architectural landscape is a testament to its resilience and adaptability. As the city looks toward the future, its architectural canvas promises to be a captivating blend of tradition, modernity, and technological innovation at the heart of Eurasia.

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211 Marijuana Essay Topics & Examples

Should marijuana be legalized? This question is controversial and worth discussing!

🔝 Top 10 Marijuana Research Topics

🌱 marijuana essay: how to write, 🏆 best marijuana essay examples.

• 💡Interesting Cannabis Topics to Write about

🥇 Exciting Marijuana Essay Topics

🎓 controversial weed topics, 🔎 marijuana research paper topics, ❓ marijuana research questions.

Marijuana, also known as cannabis, is a psychoactive drug made from a plant and used for recreational and medical purposes. Being fully prohibited in some countries, it is fully legalized in others. In your essay about marijuana, you might want to focus on the pros and cons of its legalization. Another option is to discuss marijuana dependence. One more idea is to compare and contrast marijuana laws in various US states. Finally, you can discuss the business aspects of the issue.

Whether you have to write an argumentative, descriptive, or cause and effect essay, our article will be helpful. It contains marijuana topics to research and write about. You can use them for a paper, speech, or any other assignment. Best marijuana essay examples are added to inspire you even more.

• Mental and physical effects of cannabis
• Marijuana and mental ability: the correlation
• Cannabis consumption: the key modes
• Marijuana: short-term and long-term effects
• Cannabis and reproductive health
• History of cannabis
• Legal status of marijuana in various countries: compare and contrast
• Should cannabis be legalized?
• Cannabis as a gateway drug
• The use of marijuana for medical purposes

With the current-day process of drug legalization and the popularization of cannabis, writing a marijuana essay becomes more than a one-track, anti-drug endeavor.

Whether your stance is for or against recreational drug use, you should be able to call upon credible sources to form a well-rounded and informed opinion that may sway your readers toward your cause.

Starting from your pre-writing process and bibliography and until you write your conclusion, you need to keep in mind particular points that will make tackling any marijuana essay topics easy. From a structural and pre-writing viewpoint, you should:

• Brainstorm your ideas. Doing so will allow you to decide on a particular approach to your subject.
• Do your research, compiling your bibliography, and perusing various book and journals titles, as well as research papers, interviews, and statistics.
• Utilizing authoritative sources to support your argument will make your writing more academic and respectable.
• Write a marijuana essay outline, which should help you better your essay structurally.
• Compose an eye-catching title. Marijuana essay titles are already intriguing, so do your best not merely to draw your readers in but to prepare them for your argument by demonstrating your stance on the topic.

If you are still not sure how to begin your paper, look for sample ones online. Searching for good examples will help you understand the tools that work in essay writing, which ones you can apply to your issue, and which bore the audience.

Just remember that plagiarism is a punishable offense. However, gaining some inspiration from the work of others is not!

Now you are ready to begin, having carried out the research and created guidelines for your writing process. However, an intriguing title and an issue that may easily excite people is not enough to convince your readers of your subject’s validity.

Nonetheless, the potentially provocative nature of your paper provides you with the ability to write a fail-safe marijuana essay hook. Your introduction should build upon the sentiment expressed in your title and give your audience an initiative to read further.

You can start by providing surprising statistics or describing a present drug scenario. The goal of writing an introduction is to give your readers a brief understanding of your issue and present them with partial facts, making them want to continue reading.

Do not be afraid to expand your topics and link various data together while keeping in mind an academic approach.

Adverse societal effects of marijuana use may include an increase in the number of car accident cases, especially if there is no culture of safety around recreational drug use. However, trying to link it to society’s degradation may require more evidence than mere statistics.

Understand which approach is more likely to convince your audience and be ready to respond to potential counterarguments to your facts. Treating your audience as knowledgeable is one of the central characteristics of a good essayist.

Remember to write only sentences that are relevant to your argument. A sound mental practice when writing an essay is to continuously ask yourself, whether each phrase relates to your thesis statement.

If yes, does it help advance it forward? If the answers for these questions is no, you may have to rephrase, remove, or even re-research your facts to demonstrate a compelling understanding of the issue.

Need more essential tips to get your essay started? Use IvyPanda for all your academic needs!

• Reason Why Marijuana Should Be Legal This is an important consideration since data on the prevalence of Marijuana indicates that the US is still the world’s largest single market for the drug.
• Alcohol and Drugs Effects on High School Students According to Martin, “society also advertises the image of individual and social happiness for alcohol and drug users; this misconception results in the societal decrease of achievement, especially, of high school age students”.
• Advantages and Disadvantages of Marijuana Countries including Netherlands, Israel and Canada have lenient laws regarding the use of marijuana, cases in point that proponents of its legalisation have used to highlight the merits of legalising it.
• Legalization of Marijuana: Arguments For and Against It will therefore be difficult to regulate the use of marijuana among young people and other unauthorized people if it is legalized. It should be noted that marijuana has various negative effects to the health […]
• Legalizing Marijuana: Pros and Cons The focus of this paper will be on the impact of the legalization of the U.S.economy with possible positive and negative sides of the matter.
• How Does Marijuana Affect the Brain? One of the profound findings of the studies is on the negative effects of marijuana on the brain. Research findings on the brain show that abuse of marijuana for a long time affects the brain […]
• Should Marijuana Be Legal? It is perhaps very essential to be acquainted with an account of laws that surround marijuana in order to understand the reasons why the drug ought to be legalized.
• Marijuana and Its Effects on Mental Health The effects of the use of marijuana can be comparable to those exhibited by the removal of this important part of the brain.
• Marijuana Legalization and Crime Rates The possible outcome of this effort will be the safe consumption of the drug, easy monitoring, and creation of awareness to the public on the dangers of excessive use of the drug and lastly the […]
• Legal Marijuana Market Analysis and Taxes Impact Consequently, the primary goal of this paper is to understand the impact of taxes on the financial stability of the market for legal marijuana with the help of the law of supply and demand and […]
• Usage and Effects of Marijuana In the modern world, more and more countries are recognizing the role of cannabis in bringing benefits to the population. For the purposes of better understanding the drug and navigating the modern realities, it is […]
• Political Opinion on Legalization of Marijuana On the other hand, the case introduces the man as a member of the Methodist Church, and this community is known for its strict opinion about marijuana as a gateway drug.
• Discretion Powers Regarding Marijuana Laws Albeit, marijuana laws in New York are favorable for the users as marijuana was fully legalized in March of 2021, allowing for both medical and recreational use.
• Marijuana as an Alternative Medication for Pain Relief The PICOT question for the identified health care issue is the following: in a patient population requiring pain relief, does marijuana represent a viable alternative medication as compared to opioid-based prescription drugs for alleviating the […]
• Marijuana: Properties, Effects, and Regulation At the same time, a regulated cannabis industry slowly emerges, with companies attempting to profit off of the legalization and destigmatization of marijuana.
• Preventing Negative Effects of Marijuana Use The aim of the study is to ascertain specific interventions that would allow reducing cannabis use within the framework of the environment where marijuana is legal.
• Analysis of Arguments: Should Marijuana Be Legalized? Pro Arguments: The majority of Americans agree on the necessity to legalize marijuana. This initiative is accompanied by concerns regarding the actual use of marijuana.
• Risks and Benefits of Medical Marijuana The use of marijuana in the medical sphere is a highly debated and discussed topic. Patients with epilepsy claim that the use of marijuana prevents seizures and provides immense relief.
• Medical Marijuana: Issues & Ethical Considerations The use of medical marijuana in anxiety disorders and PTSD has many concerns. Prescribing medical cannabis can potentially benefit a patient but can cause additional health and legal issues.
• The Benefits of Medical Marijuana This paper aims to discuss that medical marijuana is helpful in the treatment and management of chronic pain conditions such as cancer and epilepsy.
• The Issue of Legalization of Marijuana The issue of the legalization of marijuana in the territory of the state is not unambiguous, therefore it is analyzed by a large number of specialists.
• Synthetic Marijuana: Physiological and Social Factors The report generated by Drug and Alcohol Dependence article in the year 2010 showed that the majority of the people who used synthetic marijuana were between the ages of 12 to 29.
• Cannabis or Marijuana for Medical Use In the West, for the first time, medical use became known thanks to the work of Professor O’Shaughnessy, who personally observed the process of her treatment in India.
• Marijuana Research: Personal Connection and Medical Use In the United States, military marijuana is prohibited, but initially, it was used for recreation and as a form of medicine in the twentieth century.
• Marijuana Possession in a High-School Student Case Her participation in the program will be an educational experience and put the juvenile offender in touch with professionals who can understand the motives of her behavior instead of giving Jane Doe an actual criminal […]
• Marijuana Legitimization and Medical Controversy The proponents of the legitimization of marijuana for medical use argue that it has numerous medical uses. Currently, in the US, there is a rather peculiar situation with the legalization of marijuana for medical use.
• Workplace Policy on Marijuana Use in Michigan The legalization and decriminalization of marijuana use in 23 states of the US lead to complicated issues when it comes to the consideration of workplace policies.
• Law: Legislation Regarding Marijuana Farming To evaluate the applicability of the proposed marijuana farming bill, the current marihuana production legislation needs to be reviewed, and the changes in social norms regarding criminal behavior are to be analyzed.
• Marijuana Legalization: Controversial Issue in Canada Canada became the second country in the world to legalize the cultivation and consumption of cannabis in 2018. Besides, the substance is addictive, and it is challenging to stop consuming it.
• Marijuana: Myths and Legal Justification Over the past decades, much attention has been drawn to the question of the categorization of marijuana in terms of the national systematization of drugs controlled by the US Drug Enforcement Administration.
• Marijuana Legalization and Issues to Consider If marijuana is fully legalized, there might be a rise in use among youth, which is dangerous from the physiological point of view, and there will be no legal justification to end it.
• Hip-Hop and Marijuana Use in College Students It has been estimated that over half of the college student population regularly use marijuana, while over 25% used it during past month.
• Marijuana Use among American and Bolivian Students The study is a perfect example of the use of theory in a research. As such, it is possible for college students in Bolivia to have a similar deviant behavior, which in this case is […]
• The Relationships Between Marijuana and the Legal System The most common ideas discussed within a framework of this debate are connected to the issues of permission to keep marijuana at home for personal needs such as medical needs, and a total ban on […]
• Should Marijuana Be a Medical Option? Medical marijuana is used to refer to the use of marijuana as a physician-recommended form of medication in its natural or synthetic form.

💡 Interesting Cannabis Topics to Write about

• Use of Marijuana for the Medicinal Purposes It is therefore quite evident that even though the marijuana legalization will go hand in hand with a set minimum age within which individuals will be allowed to use it, at the long run the […]
• The Medicinal Value of the Marijuana: There Are Potential Benefits to a Patient Other Than Risks This article provides an insight to the effects of chemotherapy treatment to the body of the cancer victims. It defines the drug in a lengthy way including what the drug is, the effects of taking […]
• Pros and Cons of Legalization of Medical Marijuana It is evident that medical treatment with the use of marijuana would be beneficial for both: patients and the government because of the opportunity to earn on taxation.
• Legalization of Recreational Use of Marijuana The role of the Supreme Court in the specified case boils down to stating the conditions, in which the prescription and the following use of marijuana by the patient, can be deemed as legitimate.
• The Chances of a Successful Appeal by a Marijuana Convict The Superior Court ruled that the Fourth Amendment rights of the defendant were violated; a decision that was upheld by the Court of Appeal.
• Marijuana Legalization: Chronic Seizure Treatment With that said, despite numerous states already having legalized one or both applications, the federal government remains opposed to either form of legalization, and marijuana possession and use remain federal offenses.
• Adverse Effects of Marijuana Use This paper aims to provide an analysis of the article that gives a perspective on the adverse health effects and harm related to marijuana use. Thus, the academic article on the adverse effects of marijuana […]
• “Adverse Health Effects of Marijuana Use” by Volkow et al. Based on national marijuana studies and DSM-IV, the researchers conclude that addiction to marijuana is a non-debatable statement and that starting marijuana use in adolescence doubles or even quadruples the risks of cannabis use disorder.
• Marijuana Use May Double the Risk of Accidents for Drivers According to the Department of Safety and Homeland Security, the number of Americans driving under the influence of illegal substances has risen drastically. The risk of a crash is also related to the number of […]
• Legalized Marijuana: Negative and Positive Sides The economy and finance from the very beginning were anticipating that this law will bring the largest income to the state’s budget and create plenty of job opportunities under the rule of law.
• Marijuana: Legislative History and Future The focus of the legislation in many states is to end the illegal sale of cannabis and monetize it for tax purposes and so that distribution can be controlled.
• Ethical Perspective of the Legalization of Marijuana In spite of a popular view of the medical benefits of marijuana, doctors insist that the use of marijuana provides the same dangerous effect as other drugs.
• Marijuana Legalize: Advanatages and Disadvantages The truth that marijuana is illegal and prohibited is suitably caused by the number of funds invested in the war against drugs.
• Arguments for Banning the Legalization of Marijuana Marijuana is a dangerous drug that should not be legalized even if it is in the context of it containing the medicinal value.
• Federalism and Medical Marijuana Needless to say, United States faced political and social challenges as well, and the disputes over federalism and over the legal use of marijuana in medicine are still the most burning and controversial issues in […]
• The Effects of Marijuana on the Body, Mind and Brain Cells A drug is a substance that changes the bodily function of a body when consumed, there are several definitions of the word drug but it is believed that the most important function of a drug […]
• College Students in UK and Marijuana The reasons for the punishments are very different but the result remains the same: marijuana is still used by the majority of students and is available for everyone.
• Decriminalizing Marijuana for Medicinal Use Because of inconsistent and problematical data, it is impracticable to access quantitatively to what extent that drugs encourage the incidence of crime.
• Psychological Effects of Marijuana Some people experience panic reactions, which tend to be temporary and often are triggered by a feeling of not being in control Marijuana’s psychological effects include a sense of euphoria or well-being, relaxation, altered time […]
• Logical Benefits of Legalizing Marijuana This will be a source of revenue to the government; when the revenues increase, it means that gross domestic product for the country increases. It will be a source of income not only to the […]
• Social Effects of Marijuana Research has shown that the use of marijuana affects the smoker’s day-to-day lifestyle in relation to society, the environment, and day-to-day activities.
• Federal vs. State Law: Medical Marijuana in the US The main problem is that these laws and regulations have not reduced the number of people who use marijuana for medical purposes.
• Medical Marijuana: Pros of Legalizing It must be admitted that at the time of the passage of these laws, histories from some, but not all, heroin users indicated that the use of marijuana had preceded the use of heroin.
• Marijuana: To Legalize or Not to Legalize? Marijuana, which is also known under dozens of nicknames such as weed or pot, is now the most widespread illegal drug across the US. Moreover, the vast majority of marijuana abusers claim pot to be […]
• Marijuana Legalization and Consumption Among Youth The most popular excuse among drug consumers is the instrumental use of the drug. As long as the drug influence is undermined, the number of college students willing to experience the marijuana effects will be […]
• Legalization of Medical Marijuana: Help or Harm? Nowadays, a majority of people worldwide support the legalization of marijuana, and it is possible to predict that this support will keep getting stronger in the future.
• Medical Marijuana Legalization Concerns This change raises political concerns and requires the government to review its economy to adapt to the use of MM. The representation of the legal process highlighted the history of previous legislations and reported on […]
• Medical Marijuana: Legal and Research Concerns However, while the purpose of recreational marijuana is often disconnected from its long-term effects on people’s health in scholarly discussions, the use of medical marijuana is viewed from the point of patient’s health and the […]
• Medical Marijuana in the Army: Addressing a Problematic Issue Denying the use of medicinal marijuana as one of the fastest and the most efficient ways of relieving pain in the military setting, one will inevitably infringe upon the rights of American troops.
• Should Marijuana Be Legalized? Marijuana legalization is a topic of social trends and beliefs that are based not only on health but political and economic factors as well.
• Marijuana Legalization and Its Benefits for Society The example of several states that have already introduced the appropriate law provides the ground for vigorous debates about the absence of the expected deterioration of the situation and emergence of multiple problems associated with […]
• Marijuana Legalization in 5 Policy Frameworks The legalization of marijuana is still one of the debatable issues at the federal and state levels. For instance, the use of marijuana is prohibited at the federal level while the recreational and medical use […]
• Marijuana Legalization in California The muscle relaxation effect of marijuana also appears to be a positive effect that should be used to argue for its legalization.
• Legalization of Marijuana in the United States It should not be forgotten that it is a cause of numerous tragedies. Also, some studies show that the use of marijuana is especially dangerous for young people.
• Medical Marijuana Legalization by National Football League However, it must be realized that some of these players are usually in excruciating pain to the point that some may have lost consciousness.
• Marijuana: Users, Desired Effects and Consequences The frequent users consist of youths and adults who have abused Marijuana to the extent they have become dependent on it.
• Effects of Marijuana on Memory of Long-Term Users The pivotal aim of the proposed study is to evaluate the impact of marijuana use on long-term memory of respondents. The adverse impact of marijuana after the abstinent syndrome refers to significant changes in prefrontal […]
• Trends in the Use of Marijuana The researchers claim that the legalization of marijuana in California led to the development of the acceptance of marijuana use as well as the increase in this drug consumption.
• Medical Marijuana Legalization Rebuttal The claim of fact is that A.C.A.continues to be beneficial despite the arguments of Republican politicians and current challenges. The claim of policy is the appeal to Republicans and Democrats to work together on the […]
• Marijuana Legislation and Americans’ Contribution To identify whether patients with intractable pain hold more favorable views regarding legislation of marijuana use than the general public, it is necessary to determine various inclusion and exclusion criteria that might influence the society’s […]
• Medical Marijuana Policy and Framing Approach This is a clear indication that different arguments can be presented by these actors to support the legalization and use of medical marijuana.
• Policy Analysis: Rules for Growing Medical Marijuana Overall, the main goal of the document is to address the health needs of people requiring marijuana to relieve the manifestations of their illness as well as the implications of growing marijuana for medical purposes.
• Marijuana Crime in California State and Federal Courts To compare the severity of the punishment that could be imposed by a federal court to what was announced at a state institution, it should be remembered that the investigation process would not take long […]
• Controversy Around Medical Marijuana Legalization The consideration of the problem of marijuana legalization from the perspective of public safety involves such points as crime rates and traffic accidents. The fact of economic benefits of the Cannabis legalization is also apparent: […]
• The Legalization of Marijuana: Regulation and Practice It is imperative to note that legalization of marijuana is a topic that has been quite controversial and has led to numerous discussions and disagreements.
• Marijuana History, Medical Purposes and Threats Although many people believe that marijuana is harmless and the access to it should be unlimited, it has a number of negative health effects and might lead to addiction.
• Marijuana Use and Serious Mental Illnesses 21% of the respondents of 18 years and above claimed to have used marijuana for the first time prior to their 12th birthday.
• Marijuana as an Unjustifiable Pain Reliever The debate on whether to legalize the use of marijuana has been there for the last 20 years. In addition to this, it causes panic and anxiety hence causing the user to hallucinate.
• The Safety of Using Medicinal Marijuana for Pain Relief Speaking about the introduction section of the study, it is important to note that it is rather short if compared to other parts of the article as the researchers were paying more attention to presenting […]
• Should Marijuana Be Treated Like Alcohol? Considering the benefits that would accompany the legalization of marijuana and its treatment like alcohol, I strongly agree with Buckley’s comparison; marijuana should be treated like alcohol. First, the use of marijuana affects the body […]
• Political Issues of Marijuana in America The largest demographic groups against the legalization of marijuana include the Republicans and the southerners. Most of the Democrats continue to support the legalization of marijuana in the country.
• Changes in Laws of Marijuana Regulation In addition, the study intends to uncover the impacts of the said laws and the accompanying changes. The case studies will be compared to assess the impacts of legislations on marijuana in the society.
• Concepts of Legalizing Marijuana Although in most cases, most individuals associate Marijuana with numerous health complications and social problems, for example, brain damage, and violent behavior hence, supporting its illegalization, such individuals take little consideration of its significance in […]
• Marijuana Legalization in Illinois The case for legalization of marijuana in Colorado evidences the need to alter federal laws prohibiting marijuana for its legalization law to have both statutory and federal backing in the state of Illinois.
• Public Safety and Marijuana Legalization Some of the states have failed to tax marijuana. Hence, it is difficult to get the precise figures in terms of tax values that states could collect from marijuana.
• Heroin and Marijuana Abuse and Treatment The success in the process of drug addiction treatment is only possible when the patient is willing to co-operate and has a desire to recover and defeat the habit.
• The Marijuana Usage Legislation This research paper is aimed at discussing the effects that can be produced by the changes in the legislation on the use, storage, and distribution of marihuana.
• Medical Marijuana Program in California The physicians should also do a periodic review of the treatment and how the patients respond to the medical marijuana. The medical marijuana is only restricted to patients who are qualified and recommended by a […]
• History and Effects of Legalization of Marijuana As predicted, the legalization of marijuana in several states has led to an increase of marijuana abuse among youngsters Studies have shown a pattern of the use of cannabis and risky behavior of the individuals.
• Debates Around Legalization of Medical Marijuana The supporters and opponents of the legalization of marijuana have opted to focus on either the positive or the negative aspects of the effects of the drug to support their views on policies to legalize […]
• Federal Drug Laws vs. State Medical Marijuana Acts A senate bill for the case of Los angeles is on the process of considering the use of marijuana for medical purpose.
• The Use of Marijuana and Its Benefits Criminalization of the use of marijuana and negative reviews as well as negative exposure from the media has driven marijuana use to the black markets with often negative consequences to the economy and society.
• Medical Marijuana use for Terminal Colon Cancer The author hopes to use this paper to highlight the uses of marijuana in management of colon cancer at its terminal stage.
• How New York Would Benefit From Legalized Medical Marijuana The arrests resulting from possession of marijuana in New York is quite huge compared to those in California and New Jersey states in America.
• Should Be It Legal to Sell the Marijuana in the United States? What I want to know is the reasons of why so many people use such serious psychoactive drug as marijuana of their own accord and do not want to pay special attention to their activities […]
• Supporting of Marijuana Legalization Among the Adult Population Proponents argue that legalization of marijuana will lead to increased revenues for the government amid economic challenges. Legalizing marijuana will not lead to cancer and deaths but will spark the debate for apparent effects of […]
• Marijuana: The Issues of Legalization in the USA To understand all the possible effects of the marijuana legalization, it is necessary to pay attention to the definition and classification of the drug with references to determining the most important social and legal aspects […]
• Reasons for Legalization of Marijuana The legalization of the drug would bring to an end the discrimination of the African Americans in marijuana-related arrests, reduce the sales of the drug and its use among teenagers, encourage the development of hemp […]
• Legalizing Marijuana: Arguments and Counter-Arguments On the other hand, many groups have outlined that the legalization of marijuana would lead to an increase in the rate of crime in addition to opening up of the gateway to the abuse of […]
• Drug use and misuse in western society: Effects of chronic marijuana use among young women and girls It is also based on the fears of the impacts of the drug use, concerns over the reduced productivity that’s likely to cause harm to the user and the society and so on.
• Medical Marijuana Policy in the United States The importance of legalization of medical marijuana is that, the government will be able to monitor and control marijuana in the country.
• The Arguments For and Against Marijuana Decriminalization The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it.
• The Illegal Use of Marijuana Canada is among the leading nations in the percentage use of illegal marijuana as stated in the World Drug Report of the year 2007.
• Marijuana and Its Economic Value in the USA The grim reality of the economic performance of the United States of America lies in the lengthy debate over the legalization of marijuana.
• Should We Legalize Marijuana For Medical Use? In addition to that, the use of Marijuana especially by smoking either for medical reasons or to heal ailments, is a social activity that will help bring them together and improve their social ties.
• Why Marijuana Should Be Legalized? The government should save that money it uses in prohibiting the use of marijuana as it has no proved harm to the users.
• Arguments on Why Marijuana Should Be Illegalized The greater part of the population believes that the sustained use of this product is beneficial in numerous ways. Therefore, it is clear that the negative effects of the drug outdo the constructive ones.
• A Case for Legalizing Marijuana Marijuana is one of the drugs that the government policy targets and as it currently stands, the government uses a lot of resources in prosecuting and punishing marijuana consumers through the legal system.
• The Marijuana Industry and Its Benefits Marijuana use also slows down the growth of cancerous tumors in the brain, lungs, and breasts; thus, it is valuable in the management of cancer.
• The Decriminalization of Marijuana One of the main reasons that the supporters of this argument have progressed is that by decriminalization of marijuana, the government would save huge amounts of money that it uses on enforcing laws that relate […]
• The Use of Marijuana in California The US government ensures that its use is limited to a minimum by enforcing harsh punishments to the dealers and users of marijuana.
• Federal Government Should Not Legalize the Use of Marijuana On the other hand the use of marijuana actually increased in the country. It is not only the DEA or the federal government that is reluctant in the legalization of marijuana.
• Issues with Marijuana Legalization in the United States This is the reason why the debate on the legalization of marijuana has been on the increase since the past 10 years.
• The history of marijuana According to the new set of legislation, it was considered illegal to be found in possession of 25 grams of marijuana.
• Does Legalizing Marijuana Help or Harm the United States? The latter measure is not merely being advocated by the proponents of marijuana use since the legalization of marijuana has been supported by NAACP not because it fully backs the smoking of marijuana.
• Marijuana, Heroin and Prescription Opiate Abuse and How Are They Related to the Society The core issues mentioned in the article revolves around addiction and abuse of opioid agents as well as its relation to the use of heroin and marijuana.
• Increasing Marijuana Use in High School The author’s concerns in the article are that the usage of marijuana is becoming prevalent among the American youth. It is evident that the author is against the publication and marketing of the medical marijuana […]
• The Union: The Business Behind Getting High by Brett Harvey Some other reasons advanced by the documentary include the ability of the government to control the sale of such drugs to minors and also collection of tax revenue. The documentary espouses a number of reasons […]
• The Debates on the Legal Status of Marijuana This means that the use of marijuana encourages the consumption of other drugs such as alcohol and cigarettes. Additionally, the use of marijuana is associated with increase in crime and consumption of other illicit drugs.
• Marijuana Is a Healthier Alternative to Cigarettes Cigarette smoking has also been reported to cause respiratory infections due to the damage caused in the cells that prevent entry of microorganisms into the respiratory system hence reducing the immunity of the system.
• Marijuana’s Negative Effects and Advantages Marijuana is the most commonly abused drug among the youths and adults in the United States and other countries in the world.
• Use of Marijuana and Its Consequences The plant was grown in the United States of America for agricultural purposes during the colonial period up to the beginning of the 20th century.
• Should Marijuana Drugs Be Decriminalized? The production, preparation, trade and use of marijuana has been prohibited in most parts of the world and a lot of resources are used every year to combat it. Thus, decriminalization of marijuana is likely […]
• Argument About Legalizing Marijuana in America Therefore, if at all the government of the United States is to prohibit the use of marijuana in the country, it should be ready to cater for the high costs that come in hand with […]
• Marijuana’s Positive and Negative Effects The main aim of creating these institutions is to evaluate the impact and the effects of marijuana on the abusers and on the environment.
• Limited and Controlled Use of Marijuana The question of legalizing marijuana refers to the legal use of marijuana both in private and public places for medical use or otherwise.
• The Moral and Ethical Reasons Why Marijuana should be legal It is my humble opinion that the billions of dollars being spent on the war against marijuana should be diverted to more useful projects like feeding the less fortunate in the society.
• The Problem of Legalization of Marijuana and Hemp Many individuals tend to believe that the use of Marijuana is morally wrong as it alters the mental state of the user and leads to dangerous addictions and actions in the end.
• Minor and Major Arguments on Legalization of Marijuana Premises 1: If marijuana were to be legalized it would be impossible to regulate its’ sell to, and use by the minors. Making marijuana illegal is denying them a right to the use of this […]
• The Reasons Why Marijuana Should be Made Legal Among the reasons that support the legalization of marijuana include: the medical basis that marijuana has some benefits and that the state could gain revenue from the trade of marijuana as opposed to the costs […]
• Why Is Marijuana Legalized In Some States And Not Others? I consider the legalization of marijuana to be a positive step as its prohibition entails intrusion of personal freedom and just like any other substance it is only harmful when it is not taken in […]
• The Effect of Legalization of marijuana in the Economy of California It has been predicted that if the government legalizes the drug, there will be a lot of changes pertaining to the demand for the drug in the market and as a result, there will be […]
• Marijuana Must Not Be Legalized According to the national institute of drug abuse, the active chemical in marijuana, tetrahydrocannabinol, act on the region of the brain responsible for time awareness, sensory, attention, thoughts, memory and pleasure.
• Decriminalization of Marijuana The decriminalization of marijuana resulted due to public outcry over the effects of marijuana. Among the disadvantages include the saving of money and time for other businesses, promotion of the judicial justice as the centre […]
• Policy Brief: Why Marijuana Use Should Be Legalized in the Us In this perspective, it is valid to argue that marijuana users may be undergoing long incarcerations in US jails due to the misconceived fantasies that took root in the public mind in the 1930’s, and […]
• Medical Uses of Marijuana The feelings of hallucination make one to lose consciousness and feel as though in very different world that is full of bliss.
• Should Marijuana Be Legalized in Canada?
• Drug Testing and Legalization of Marijuana
• Has the Time Come to Legalize Marijuana?
• Framing the User: Social Constructions of Marijuana Users
• Drugs and Legalization Drug Marijuana Dealing
• Decriminalization and Marijuana Smoking Prevalence
• Has Marijuana Become More Accepted in Today’s Culture?
• Get Ready for Americas Fastest-Growing Industry: Marijuana
• Clearing the Smoke Between Cigarettes and Marijuana
• Key Findings and Decriminalization of Marijuana
• Facts That Most People Don’t Know About Marijuana
• Issues Hampering the Legalization of Marijuana
• Economical Argument for the Legalization of Marijuana
• Juvenile Smoking and Marijuana Use
• All the Reasons Why Marijuana Should Be Legalized for Medical Purposes
• Exploring the Effects and After Effects of Marijuana
• Factors That Influences Teenagers to Use Marijuana
• College Students Attitude Toward Marijuana Use on Campus
• Drugs Case for Legalizing Marijuana
• Logical Reasoning for the Legalization Marijuana
• Future Trends and Marijuana for Medicinal Purposes
• Countering Anti-Medical Marijuana Efforts in Massachusetts
• Abnormal Psychology Problem: Excessive Use of Marijuana and Alcohol
• Food and Drug Administration Bans Use of Marijuana in the US
• Addiction and Smoking Marijuana Plays
• Analyzing Affordable Care Act and Marijuana
• Driving Under the Influence of Marijuana is Hazardous
• America Requirements Medicinal Weed: Marijuana Legalization
• Comparing and Contrasting Marijuana and Alcohol
• Many People Believe That Marijuana Should Be Legalized
• How Media Framing Effects Marijuana Prohibition and Legalization?
• How Can Legalize Marijuana Help the United States?
• How Does Military Jurisdiction Deal with Marijuana Now Would Legalization?
• How America Will Benefit from Legal Marijuana?
• How Legalizing Marijuana Will Impact Society?
• Does Marijuana Cause Brain Damage?
• How Marijuana Will Not Work in the US?
• Does Marijuana Have Any Medicinal Uses?
• How Many Individuals Smoke Marijuana in the United States?
• Does Previous Marijuana Use Increase the Use of Other Drugs?
• How Medical Marijuana Works?
• How the Social Contract Theory Prevents the Legalization of Marijuana?
• How Marijuana Affects Hauora?
• Why Do Americans Enjoy Marijuana?
• What are the Positive and Negative Effects of Legalizing Marijuana?
• What are the Benefits and Drawbacks of Legalising Marijuana?
• Does Legalizing Marijuana Make Sense?
• What Are the Medical Causes and Effects of Marijuana Use?
• How Are Employers Coping with Medical Marijuana Legislation?
• Does Marijuana Work the Treatment of Diseases?
• Does Marijuana Have Medicinal Purposes?
• How Does Marijuana Law Work in District of Columbia Class?
• Does Increasing the Beer Tax Reduce Marijuana Consumption?
• How Legalizing Marijuana Could Help Boost the Economy?
• Does Marijuana Have More Harmful or More Beneficial Effects?
• How Will Marijuana Legalization Affect Public Health?
• Does Marijuana Use Impair Human Capital Formation?
• How Gender and Age Effects Marijuana Usage and Brain Function?
• How Marijuana Affects Our Society?
• How American Children Start to Smoke Marijuana and Why?
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, February 29). 211 Marijuana Essay Topics & Examples. https://ivypanda.com/essays/topic/marijuana-essay-examples/

"211 Marijuana Essay Topics & Examples." IvyPanda , 29 Feb. 2024, ivypanda.com/essays/topic/marijuana-essay-examples/.

IvyPanda . (2024) '211 Marijuana Essay Topics & Examples'. 29 February.

IvyPanda . 2024. "211 Marijuana Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/marijuana-essay-examples/.

1. IvyPanda . "211 Marijuana Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/marijuana-essay-examples/.

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IvyPanda . "211 Marijuana Essay Topics & Examples." February 29, 2024. https://ivypanda.com/essays/topic/marijuana-essay-examples/.

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