Cannabis use is a complex issue impacting family medicine, patient health, and public health. In 2020, more than 4% of the global population of people aged 15 to 64 years (approximately 209 million people) used cannabis, maintaining its status as one of the most widely used substances worldwide.1 In 2022, for the first time, more people reported daily or near-daily use of cannabis than of alcohol (42.3% compared with 10.9%).2
Cannabinoids are chemical compounds derived from cannabis plants that affect the body in various ways. The most common cannabinoids are delta-9 tetrahydrocannabinol, or THC, and cannabidiol, or CBD.3
There is not complete consensus regarding terminology. “Cannabis” is a general term used to refer to a variety of products and chemical compounds derived from Cannabis sativa or Cannabis indica plants.10 Although the terms “marijuana” and “cannabis” can be used interchangeably, “cannabis” is generally the preferred term in scientific and medical contexts for all products containing intoxicating amounts of THC.11 The term “hemp” refers to plants bred from a combination of male and female cannabis plants that have a THC concentration of no more than 0.3%, as well as products derived from these plants. Hemp plants are more commonly used for textiles, food products and building materials.12
Cannabis use disorder, or CUD, is diagnosed for mild, moderate or severe issues with cannabis use. A diagnosis of CUD is based on the presence of clinically significant impairment or distress occurring within 12 months, manifested by at least two of the following criteria13:
The American Academy of Family Physicians (AAFP) acknowledges that cannabinoids may have l therapeutic benefits but also recognizes that cannabis use may have negative public health and patient health outcomes.14 High-quality research on the effects of cannabis use on special populations, public health and the environment is limited. Therefore, the AAFP advocates for further research regarding the overall safety and health effects of cannabis use.
The AAFP recognizes that many states have legalized the possession and use of cannabis products and supports the decriminalization of cannabis possession. In addition, the AAFP recognizes the importance of intervention and treatment for cannabis misuse in lieu of incarceration for all people, including youth. The AAFP advocates for further research regarding the effects of cannabis regulation on patient, community and environmental health.
Call to Action
Family physicians have a vested interest in policies that advance and protect the health of their patients and the public. The regulatory environments related to medical cannabis, recreational cannabis , THC and CBD are rapidly changing.However,this shift has not been accompanied by robust scientific research regarding the health effects – both therapeutic and detrimental – of cannabis. The AAFP recognizes the need for substantial clinical, public health and evidence-based policy research regarding cannabisd CBD to inform evidence-based practice and public health impact.
Advocacy
In the Exam Room
Both medical and recreational cannabis use have been prevalent throughout history. Extensive evidence indicates cannabis was used by ancient civilizations, dating back more than 5,000 years.17 In the 19th and early 20th centuries, cannabis was frequently used in the United States for medicinal purposes and was often prescribed by clinicians. In 1850, it was listed in the U.S. Pharmacopoeia17 which indicated use of cannabis as an analgesic, hypnotic and anticonvulsant agent.18 However, following passage of the Marihuana Tax Act of 1937, cannabis was removed from the U.S. Pharmacopoeia in 1942.18
With varying levels of cannabis legalization in the United States, . attitudes toward its use and perceived risk have changed. Surveying cannabis use is essential to gauge the public health implications of increased access to cannabis products. Data from the National Institute on Drug Abuse’s Monitoring the Future Survey indicate the following:
Forms and Use of Cannabis
The most abundant cannabinoids are delta-9-tetrahydrocannabinol, or THC, which is commonly known for its psychoactive properties, and cannabidiol, or CBD, which is considered to be largely nonpsychoactive.21 The biological system responsible for the synthesis and degradation of cannabinoids in mammals is referred to as the endocannabinoid system.22 It is largely comprised of two G protein-coupled receptors: CB1 and CB2. These GPCRs are found in many bodily tissues; however, CB1 is most concentrated in the neural tissues. While CB2 is found in the brain, it is primarily found in immune cells, including those derived from macrophages (e.g., microglia, osteoclasts and osteoblasts).18,22
Cannabis-derived products are commonly consumed via inhalation, ingestion and topical absorption.11,18
The route or method of cannabis administration affects the onset and duration of effect.26 When cannabis is smoked or vaped, the onset of effect is within 5 to 10 minutes with a duration of 2 to 4 hours. When it is ingested, the onset of effect is within 60 to 180 minutes with a duration of 6 to 8 hours. Cannabis absorbed via the oromucosal route has an onset of effect of 15 to 45 minutes with a duration of 6 to 8 hours. Topically administered cannabis has variable onset and duration of effect.
It is known that cannabis cultivation affects water use and quality, air quality, land and energy use, waste production and carbon dioxide emissions,27,28 but relatively few scholarly citations regarding its environmental impacts exist. Given that 61.8 million Americans used cannabis at least once in 2023,29 and legalization of recreational cannabis is increasingly becoming the norm throughout the United States, the environmental impacts of cannabis cultivation need to be assessed and regulated. Policies and guidelines pertaining to water use and quality, air quality, land use, energy use and pesticides should be established using best practices for resource management. In addition, zoning policies in urban areas must ensure communities that have been made vulnerable are not disproportionately affected by the environmental impacts of cannabis cultivation facilities (e.g., air and water pollution).27
Vigorous research regarding cannabis cultivation should be done in order to ensure environmental safety. Systemic and cumulative analyses of the impacts of cannabis cultivation are warranted because current studies have been confined to single environmental elements (e.g., land, water, indoor or outdoor air). Additionally, researchers should undertake systemic assessment of pesticide contamination, indoor air quality and biogenic volatile organic compound emissions within the cannabis industry.
Water Use and Quality
Cannabis plants are grown legally and illegally in indoor, outdoor and mixed-light settings. Regardless of the cultivation method, the potential for water misuse is significant. When best management practices are used, indoor cultivation requires 1 gallon of water to yield 4.5 g of cannabis flower.30 Outdoor cultivation of cannabis uses twice as much water as soybean, wheat or maize crops.28 Estimates indicate that a single cannabis plant consumes an average of 6 gallons of water per day from June to October.
Groundwater extraction and groundwater diversion are employed in growing and harvesting cannabis, and both of these methods have been shown to negatively impact freshwater systems. Extraction affects water tables over time. Diversion reduces stream flow, causing changes in water depth, temperature and oxygen content that increase aquatic species’ risk of predation and susceptibility to disease.28 Researchers have noted that “…in the absence of regulation, cannabis irrigation could significantly exacerbate water stresses in drought-prone regions.”27
As of 2024, no notable studies regarding water pollution caused by the cannabis industry have been published. However, in urban areas where cannabis is cultivated, water system effluent has been found to contain compounds related to cannabis production.27
Air Quality
The impact of cannabis cultivation on air quality must also be considered. The crop has the potential to cause ozone levels in indoor facilities to rise as biogenic volatile organic compounds — specifically terpenes — are converted not only to ozone but also to particulate matter.30,31 The effects of these compounds on workers have not been studied.
Pesticides
Although the detrimental effects of pesticides on ecosystems and human health are well established for other crops, there are no standardized guidelines for pesticide use in legal cannabis cultivation.27 There are also no international or national standardized testing protocols for pesticide residue in cannabis products. Because cannabis presents unique human exposure pathways for contaminant residues, experts assert that pesticide control measures for cannabis cultivation should exceed those employed in traditional agriculture. They recommend the development of rigorous testing standards for contaminant residues on legal cannabis products.
Land Use
Land use by cannabis producers only accounts for a small percentage of the land used within agricultural industries.27 However, experts are concerned that cannabis cultivation may contribute to increased forest fragmentation. Additionally, because cannabis products are typically packaged in single-use plastics, it is estimated that 1 g of dried cannabis uses approximately 70 g of plastic,30 thereby adding plastic waste to landfills and contributing to pollution and environmental degradation.
Energy Use
Energy use and resulting greenhouse gas emissions in cannabis cultivation have a direct impact on climate change and must be examined. Nationwide, current legal cannabis production carries a $6 billion annual energy cost, which is approximately 1% of U.S. electricity consumption.32 In addition, a study of energy use in U.S. indoor cannabis cultivation found that production of 1 kg of dried cannabis resulted in life-cycle greenhouse gas emissions ranging from 2,283 kg to 5,184 kg of carbon dioxide equivalent.33
Social Impacts of Cannabis
The social impacts of legalized recreational cannabis are debatable. However, it is understood that legalization has led to increased cannabis use.34 Evidence also indicates an increased incidence of marijuana-positive trauma patients and higher rates of pediatric emergency department visits related to cannabis.35,36 Studies do not demonstrate a significant increase in traffic fatalities following the legalization of recreational cannabis, but they do show an increase in DUI offenses.34 Recreational cannabis legalization is not associated with an increase in overall crime, and violent crime tends to decrease.34,37 While overall arrests increase, perhaps due to increased police activity, drug-related arrests decrease.34
Opioid Use
More rigorous studies (e.g., randomized controlled trials) are needed to fully understand the relationship between cannabis use and opioid use because current retrospective and observational studies cannot determine causality.10 In particular, data regarding the effects of medical cannabis legalization on opioid prescribing are mixed, and additional research is still needed. One longitudinal analysis found that access to medical marijuana was associated with a decrease in opioid prescribing under Medicare Part D.38 Other data indicate that recreational and medical cannabis legalization has no effect on opioid prescribing or opioid-related mortality, except for a possible association between the implementation of recreational cannabis laws and a reduction in synthetic opioid deaths.39
Most medical cannabis laws already include a provision allowing state health departments to add qualifying medical conditions for medical cannabis as needed. In 2018, New York, Illinois, Pennsylvania and New Jersey became the first states to expressly allow use of medical cannabis to treat opioid use disorder.40 The New York State Department of Health’s stated position is that adding OUD as a qualifying condition allows people who use opioids to potentially substitute medical marijuana as a treatment option for severe pain.41 This treatment may offer a reduced risk of dependence and limit the risk of fatal overdose associated with opioid medications.
Economic Effects
The economic effects of the cannabis industry are modest. Data indicate that legalization of recreational cannabis may increase tax revenue, but its impact on gross domestic product and employment varies by state.37 Studies have found that states in which recreational marijuana is legal have fewer workers’ compensation claims, lower rates of nontraumatic workplace injury and lower incidence of work-limiting disabilities.34 In addition, older adults in these states, especially those with conditions that qualify for a medical cannabis prescription, work more hours.34 Researchers theorize that the decrease in workers' compensation claims and the increase in work capacity are likely attributable to access to an alternative pain management option in these states.
A number of systematic reviews and meta-analyses have reported on the uses, efficacy and safety of cannabis and cannabinoid-containing products, including dronabinol, nabilone and nabiximols (an oromucosal spray containing THC and CBD that is approved for use in the United Kingdom).18,42,43 The evidence is most substantial for their efficacy in treating chemotherapy-induced nausea and vomiting, chronic pain, muscle spasticity and intractable seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.18,44 There is moderate evidence that cannabis is effective for improving short-term sleep outcomes. There is limited evidence regarding cannabis use for post-traumatic stress disorder, anxiety, or appetite stimulation and weight gain associated with HIV/AIDS. The side effects of cannabis, such as dizziness, drowsiness, transient cognitive impairment and nausea, must also be considered.
FDA-Approved Cannabis Drug Products
As of July 2024, the FDA had approved three medical formulations of cannabis for use in the United States45:
Dronabinol and nabilone were both approved by the FDA in 1985 for the treatment of refractory chemotherapy-induced nausea and vomiting.6,18 Dronabinol is also indicated for the treatment of anorexia associated with weight loss in patients with AIDS.5 Traditionally, it has been prescribed to mitigate weight loss in patients who have HIV/AIDS and to treat anorexia-cachexia syndrome associated with cancer and anorexia nervosa, despite limited or insufficient evidence that it or other oral cannabinoids are effective.18
Epidiolex was approved by the FDA in 2018 for the treatment of refractory seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.47 In 2020, it was also approved for the treatment of seizures associated with tuberous sclerosis complex.48 Use of this drug is associated with significant seizure reduction when compared with placebo.49-51 At this time, available evidence does not support use of cannabis products to treat other seizure disorders.
Chronic Pain
Cannabinoids have been assessed for use in managing forms of chronic pain that include cancer and chemotherapy-induced pain, fibromyalgia, neuropathic pain, rheumatoid arthritis, noncancer pain, gynecologic pain and musculoskeletal pain. Several studies have shown an association between inhaled and oral cannabis products and pain reduction.18,44 However, limitations of these studies include the use of variable doses of THC and CBD. The products studied are unregulated and are not approved by the FDA.
Anxiety and PTSD
The use of medical cannabis to manage anxiety and PTSD has not been extensively studied. Limited data have shown that cannabis can reduce use of benzodiazepines to manage anxiety.52 Use of cannabis to treat PTSD has primarily been studied in veterans. There is limited evidence that cannabis — and specifically nabilone — is associated with a decrease in nightmares.53
Sleep Problems
Some people experience shorter sleep onset times and fewer nighttime awakenings when using cannabis.52 Concerns exist regarding increased REM sleep disruption, which can negatively impact sleep quality over time. Additionally, maintaining consistent sleep improvements may require increasing doses of cannabis. Data indicate that dronabinol can reduce the apnea-hypopnea index of people who have obstructive sleep apnea.54,55 However, their maintenance of wakefulness test scores did not change, so it is unclear if the drop in AHI is clinically significant.55
Palliative Care
ithin palliative care, there is low-quality evidence that cannabis use has possible benefits for the management of pain, nausea and vomiting, loss of appetite, sleep difficulties, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer.56 Positive treatment effects were also seen for appetite and agitation in patients with dementia, as well as for appetite, nausea and vomiting in patients with AIDS.
Health Risks of Cannabis Use
Known adverse effects of cannabis use can impact multiple organ systems. Acute effects can impair a person’s neurocognitive and psychomotor abilities. Longer-term effects on the body and mind can lead to chronic health conditions or exacerbate existing conditions.
One study found that people who use cannabis had a 22% increased risk of all-cause ED visit or hospitalization compared with nonusers.57 Data from the Drug Abuse Warning Network (DAWN) show that there were an estimated 896,418 cannabis-related ED visits in the United States in 2023, which was a 4.6% increase from 2022.58 A common reason for presentation to the ED is cannabinoid hyperemesis syndrome, which is characterized by abdominal pain, nausea and vomiting in a cyclical pattern within 24 hours after the last use of cannabis.59,60 Symptoms can be reduced by taking a hot shower or bath. Ultimately, the treatment of this condition is cessation of cannabis use.
Patients may also present to the ED with acute cannabis intoxication, which can lead to pulmonary, cardiac and psychiatric complications. Cannabis use increases heart rate, produces orthostatic hypotension and causes chest pain, and it can increase feelings of anxiety and panic in some people.61,62 These effects can lead to severe respiratory depression, myocardial infarction, arrhythmia, stroke and psychosis. Oral ingestion of cannabis can increase a person’s risk of intoxication because it takes longer to take effect,26 which may lead a person to ingest more than they should. In addition, because oral formulations of cannabis can mimic candy, children may be more likely to ingest these and subsequently present to the ED with signs of acute cannabis intoxication.63
Cannabis can contribute to and/or exacerbate chronic health conditions involving the lungs, heart and brain. Chronic cannabis use has been associated with chronic bronchitis and an increased risk for pneumonia and lung injury, but it has not been shown to be associated with chronic obstructive pulmonary disease.64 From a cardiac standpoint, there is concern that regular cannabis use is associated with an increased risk of coronary artery disease and incident heart failure and that cannabinoids can interfere with the action of multiple classes of cardiovascular medications.65-67 Evidence regarding a link between cannabis use and anxiety or depression is mixed, but regular use has been linked to psychosis and to the presence of more intense symptoms in people with an existing diagnosis of schizophrenia.68
Impaired Driving
After alcohol, cannabis is the substance most often associated with impaired driving.69 It slows reaction time and decision-making, substantially increasing the risk of traffic accidents.70 Following cannabis use, people should not drive, operate machinery, or put themselves or others at occupational risk. In the United States, there is no standardized definition of impairment for driving after cannabis use.71 In addition, data related to driving under the influence of THC are lacking. Some states have zero-tolerance laws that prohibit driving with any level of THC in the body, while other states have per se laws that prohibit driving with a specific detectable amount of THC in the body (e.g., 2 ng per mL of blood).
Cannabis Use Disorder
It is estimated that approximately three in 10 people who use cannabis have cannabis use disorder.72 People who start using cannabis before age 16 and people who use higher potency THC have an increased risk of CUD.73,74 Diagnosis of CUD is based on the presence of clinically significant impairment or distress occurring within 12 months, manifested by at least two of the following criteria13:
Children and Adolescents
Studies suggest that exposure to cannabis and THC can have long-term effects on brain development in children and adolescents, causing potential attention deficits, reduced coordination, and problems with emotions, problem-solving, memory and learning, as well as impacting academic and social life.75
Marijuana use in children and adolescents is both a public health concern and a medical issue, especially as more alternative forms of cannabis become available and THC potency and use of electronic vapor devices increase.76 Data indicate that children younger than 17 years who begin using marijuana are at increased risk of developing a substance use disorder. Adolescents may prefer blunts (marijuana leaves rolled in a tobacco-laced medium such as a cigar wrapper) over joints (marijuana leaves rolled in cigarette paper) because cigars are easier to obtain, hold more marijuana, offer different flavor options and have a slower burn time.76,77 Even if they have removed the tobacco from the cigar wrapper, people smoking blunts are still consuming nicotine and are at increased risk of developing nicotine dependence.77
Children who accidentally ingest cannabis can experience life-threatening symptoms of acute cannabis intoxication, such as respiratory distress and coma. Data show that the number of cases of pediatric edible cannabis exposure has steadily increased in the United States since 2017, and the percentage of these patients admitted to critical and noncritical care units has also increased.78 During the COVID-19 pandemic, cannabis-involved ED visits among youth aged 14 years and younger increased and remained elevated above prepandemic levels.79 Studies have shown that in the United States and Canada, rates of unintentional cannabis poisoning in children increased following the legalization of cannabis.78,80 Additionally, detectable THC metabolites have been found in young children exposed to marijuana smoke by someone who lives in their home or is their caretaker.81
Epidiolex is the only CBD medication approved by the FDA for use in children; it is indicated for treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome or tuberous sclerosis complex in children 1 year and older.45 There is limited research on the safety and efficacy of other CBD products for children. Potential risks associated with CBD use in children include the following82:
Pregnant Patients
Estimated rates of cannabis use among pregnant people in the United States range from 2% to 16%.76,83 Commonly used forms of cannabis in pregnancy include inhaled cannabis, edibles, transdermals and suppositories.84 Commonly reported reasons for cannabis use in pregnancy include treatment of nausea and vomiting, pain, insomnia, anxiety and depression, and poor appetite.76,85,86 People may perceive cannabis as a “natural” alternative to prescription medications that poses little to no harm during pregnancy.85,86 However, there is no known safe level of cannabis use during pregnancy.83
Abrupt cessation or reduction in cannabis use is associated with withdrawal symptoms including anger, irritability, anxiety, depression and loss of appetite.87 Symptoms often begin 24 to 48 hours after abrupt cessation or reduction of use and peak within 6 days, and they may require pharmacological treatment.
THC and other cannabinoids cross the placenta and may interfere with the fetal nervous and immune systems, potentially resulting in neurodevelopmental and neuropsychiatric abnormalities.84 Evidence indicates that increased fetal exposure to cannabis increases a child’s risk of generalized psychopathology, anxiety in early childhood and autism spectrum disorder.88-90 These neurodevelopmental findings that manifest in early childhood may be based on the effect of prenatal THC on the placental transcriptome and fetal epigenome.89,91 In addition, data suggest that cannabis use during pregnancy increases the risk of preterm birth, low birth weight and neonatal intensive care unit admission.92-94
Breastfeeding Patients
There is no known safe level of cannabis use during lactation.83 THC and other cannabinoids cross into human milk; for example, THC has been detected in breast milk for up to 6 days following cannabis use.95 There is limited evidence regarding the long-term effects of using cannabis while breastfeeding. Although more research is needed, emerging evidence suggests that infants exposed to cannabis through breastfeeding may experience reduced growth and development.96 However, it is unclear if these findings are specific to infants who also have a history of in utero exposure to cannabis.
The current regulatory environment for cannabis creates prohibitive barriers to meaningful patient-centered research that explores the therapeutic benefits and negative impacts of marijuana and cannabinoid products. Because the Drug Enforcement Administration designates marijuana as a Schedule I controlled substance, researchers must follow a complicated application process above and beyond their institutional boards’ requirements.97 Federal law mandates that applicants submit an Investigational New Drug application to the FDA. The FDA then determines the proposal’s scientific validity and assesses research subjects’ rights and safety.
Investigators must also follow the regulatory procedures of the National Institute on Drug Abuse (NIDA) to obtaincannabis for research purposes.98 They may only use cannabis supplied by the University of Mississippi, the single NIDA-approved source for cannabis research. Relying on one source of cannabis restricts its availability, as well as access to its byproducts. While the University of Mississippi cultivates several strains of cannabis, it cannot supply the multitude of cannabis strains of cannabis strains and products with varying levels of THC and CBD that are found in the evolving retail environment.18,
Researchers require additional funding and increased capacity to obtain approval from all pertinent regulatory bodies and must remain in legal and procedural compliance while conducting cannabis-related research. The mandated processes and procedures are restrictive burdens that dissuade investigators from pursuing this research. Barriers to clinical and public health investigations regarding cannabis compromise patient care and the health of the public.
In 2021, federal legislation was proposed that would reduce marijuana from a Schedule I drug to a Schedule III drug.99 In 2024, the Department of Justice also recommended rescheduling marijuana from a Schedule I controlled substance to a Schedule III controlled substance under the Controlled Substances Act.100 In 2022, the U.S. House of Representatives passed the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, which would remove marijuana from the federal list of controlled substances altogether and eliminate criminal penalties for manufacturing, distributing or possessing it.101 The bill, which had not been passed by the Senate as of March 2025, would also establish a process to expunge convictions and review sentences for federal cannabis-related offenses. If any of these proposed changes are successful, they may open opportunities for independent cannabis researchers to better understand the beneficial and harmful effects of medical and recreational cannabis. To facilitate clinical and public health cannabis research, the AAFP calls for decreased regulatory barriers, including reclassification of marijuana so that it is not a Schedule I controlled substance. In order to address the research gaps, the AAFP calls for a comprehensive review of regulations and procedures related to obtaining approval for cannabis research. Regulatory bodies, including the DEA, NIDA, FDA, Department of Health and Human Services, National Institutes of Health, and the Centers for Disease Control and Prevention, are encouraged to collaborate with nongovernmental stakeholders to determine protocols that decrease the burden of applying for approval of cannabis-related research while maintaining appropriate regulatory safeguards. To protect public health and inform evidence-based practices, the AAFP advocates for further studies on the use of medical marijuana and related compounds, the overall safety and health effects of recreational marijuana use, and the impact of recreational use laws on patient and societal health.16 The AAFP also calls for increased funding from both public and private sectors to support rigorous scientific research on cannabis.
Cannabis was federally regulated in the early 1900s for consumer and safety standards and labeling requirements.18 The Marihuana Tax Act of 1937 was the first federal regulation to impose a fine and imprisonment for the nonmedical supply or use and distribution of cannabis. In 1970, the DEA classified marijuana as a Schedule I drug, which is defined as a drug with no current acceptable medical use and a high potential for abuse.102 Other Schedule 1 drugs include heroin, LSD, ecstasy, methaqualone, and peyote. Because they are designated as having no medical use, Schedule 1 controlled substances cannot be legally prescribed, and there is no medical coverage for them.
The Agriculture Improvement Act of 2018 (also called the 2018 Farm Bill) reclassified Cannabis sativa plants with a THC concentration of no more than 0.3% as hemp and removed hemp from the Controlled Substances Act.103,104 As a result, CBD sourced from hemp plants is not a controlled substance under federal law. The U.S. Domestic Hemp Production Program establishes federal regulatory oversight of the production of hemp in the United States. With only Epidiolex, dronabinol and nabilone currently approved for use by the FDA, the AAFP calls upon the FDA to take swift action to regulate all legal cannabinoid products in order to protect the health of the public.
Recreational marijuana and medical marijuana are illegal under federal law. Penalties cover cultivation, distribution, sale and possession of the drug, as well as possession or distribution of related paraphernalia. Under the Obama administration, the Department of Justice made prosecuting people for marijuana possession in states that had legalized it for recreational or medical use a low priority.105 In 2013, the first Trump administration reversed this directive in a document known as the Cole Memo.106 It encouraged federal authorities to actively indict and prosecute people for marijuana possession and distribution, even in states which the drug had been legalized. In October 2022, the Biden administration granted a pardon to all people convicted of simple marijuana possession under federal law.107
The AAFP supports decriminalization of possession of marijuana for personal use.16 Many states have decriminalized or legalized cannabinoids, medical marijuana and recreational marijuana.108-110 Decriminalization laws may reduce fines for possession of small amounts of marijuana, reclassify criminal infractions as civil infractions, exclude infractions from criminal records, and expunge prior offenses and convictions related to marijuana.108 Decriminalizing and legalizing marijuana can decrease the number of people arrested and prosecuted for possession and/or use.109 It is important to note that racial disparities cannabis-related arrest rates exist. Evidence shows that people of color, particularly Black people, are much more likely to be arrested for marijuana possession than white people.111,112,
Incarceration impacts health. People who are incarcerated have significantly higher rates of disease than those who are not, and they are less likely to have access to adequate medical care.113 Therefore, the AAFP recognizes the benefits of intervention and treatment for the recreational use of marijuana, in lieu of incarceration for all people, including youth.16 The AAFP calls for family physicians to advocate to prevent unnecessary incarceration by diverting eligible people from the justice system into substance abuse and/or mental health treatment.113
Children are at risk of unintended exposure to edibles, which may be appealing because they come in brightly colored packaging and mimic the appearance and taste of treats that do not contain cannibinoids (e.g., candy, baked goods).114 Effective legislation requiring childproof packaging for edible cannabis products can help mitigate and prevent unintentional exposure.115 Family physicians should discuss the safe storage of all cannabis products with their patients who live with or serve as primary caregiver for a childr. Because marijuana is a Schedule 1 controlled substance, some experts support mandated reporting by physicians–who are mandated reporters of suspected child abuse and neglect under the Child Abuse Prevention and Treatment Act–after childhood exposures to cannabis.116,117
Evidence indicates that adolescents who have higher levels of exposure to medical marijuana advertising are more likely to report past use and expected future use of marijuana and have positive expectations of the drug.118 They are also more likely to have a positive view of marijuana, such as the belief that it helps people relax and escape their problems. In addition, they are more likely to report negative consequences associated with marijuana use, including school absences and concentration issues. The AAFP calls for immediate regulation of advertising of all marijuana and cannabinoid products to decrease youth exposure and thereby help prevent initiation of marijuana use and subsequent use by young people.
An interdisciplinary, evidence-based approach to the medical and recreational use of cannabis is essential to support patient-centered care, promote public health and inform policy.In partnership with public health and policy professionals, family physicians can play a key role in addressing the changing cannabis landscape in the following ways: .
1. United Nations Office on Drugs and Crime. World Drug Report 2022. United Nations; 2022.
2. Caulkins JP. Changes in self-reported cannabis use in the United States from 1979 to 2022. Addiction. 2024;119(9):1648-1652.
3. U.S. Food and Drug Administration. What you need to know (and what we’re working to find out) about products containing cannabis or cannabis-derived compounds, including CBD. March 5, 2020. Accessed January 17, 2025. https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis
4. Ferguson S. What Is delta-9? Healthline. November 27, 2024. Accessed January 17, 2025. https://www.healthline.com/health/what-is-delta-9
5. U.S. Food and Drug Administration. Syndros (dronabinol) oral solution. February 16, 2018. Accessed January 17, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/205525Orig1s000TOC.cfm
6. U.S. Food and Drug Administration. Cesamet (nabilone) capsules for oral administration. May 2006. Accessed January 17, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/018677s011lbl.pdf
7. Grinspoon P. Cannabidiol (CBD): What we know and what we don’t. Harvard Health Publishing. April 4, 2024. Accessed January 17, 2025. https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
8. U.S. Food and Drug Administration. Epidiolex (cannabidiol) oral solution. March 2024. Accessed January 17, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/210365s021lbl.pdf
9. Laurence E. Your guide to CBD legalization by state. Forbes. September 7, 2023. Accessed January 17, 2025. https://www.forbes.com/health/cbd/cbd-legalization-by-state/
10. Slawek DE, Curtis SA, Arnsten JH. Clinical approaches to cannabis. Med Clin North Am. 2022;106(1):131-152.
11. National Institute on Drug Abuse. Cannabis (marijuana). September 24, 2024. Accessed January 17, 2025. https://nida.nih.gov/research-topics/cannabis-marijuana
12. Lee M. The legalization of hemp. Food and Drug Law Institute (FDLI). Accessed January 17, 2025. https://www.fdli.org/2019/02/the-legalization-of-hemp/
13. Centers for Disease Control and Prevention. Understanding your risk for cannabis use disorder. December 5, 2024. Accessed January 17, 2025. https://www.cdc.gov/cannabis/health-effects/cannabis-use-disorder.html
14. Solmi M, Toffol MD, Kim JY, et al. Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies. BMJ. 2023;382:e072348.
15. American Academy of Family Physicians. Substance use disorders. 2019. Accessed January 17, 2025. https://www.aafp.org/about/policies/all/substance-use-disorders.html
16. American Academy of Family Physicians. Marijuana possession for personal use. 2019. Accessed January 17, 2025. https://www.aafp.org/about/policies/all/marijuana-possession.html
17. Bridgeman MB, Abazia DT. Medicinal cannabis: history, pharmacology, and implications for the acute care setting. P T. 2017;42(3):180-188.
18. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. National Academies Press; 2017.
19. Miech RA, Johnston LD, Patrick ME, et al. Monitoring the Future national survey results on drug use, 1975-2023: secondary school students. Monitoring the Future Monograph Series. Institute for Social Research, University of Michigan; 2023.
20. Patrick M, Miech R, Johnston L. Monitoring the Future Panel Study annual report: national data on substance use among adults ages 19 to 65, 1976-2023. Monitoring the Future Monograph Series. Institute for Social Research, University of Michigan; 2024.
21. Chayasirisobhon S. Mechanisms of action and pharmacokinetics of cannabis. Perm J. 2020;25:1-3.
22. Mackie K. Cannabinoid receptors: where they are and what they do. J Neuroendocrinol. 2008;20(s1):10-14.
23. Drug Policy Alliance. Marijuana facts. 2017. Accessed January 17, 2025. https://drugpolicy.org/wp-content/uploads/2023/06/dpa_marijuana_booklet_january2018_0.pdf
24. Peschel W. Quality control of traditional cannabis tinctures: pattern, markers, and stability. Sci Pharm. 2016;84(3):567-584.
25. American Cancer Society. What cannabis products are available? October 29, 2024. Accessed January 17, 2025. https://www.cancer.org/cancer/managing-cancer/treatment-types/complementary-and-integrative-medicine/marijuana-and-cancer/cannabis-products.html
26. MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49:12-19.
27. Wartenberg AC, Holden PA, Bodwitch H, et al. Cannabis and the environment: what science tells us and what we still need to know. Environ Sci Technol Lett. 2021;8(2):98-107.
28. Zheng Z, Fiddes K, Yang L. A narrative review on environmental impacts of cannabis cultivation. J Cannabis Res. 2021;3(1):35.
29. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2023 National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, SAMHSA; 2024. HHS publication no. PEP24-07-021, NSDUH Series H-59. Accessed April 17, 2025. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report
30. The hidden cost of cannabis: environmental impact. June 15, 2022. Accessed January 17, 2025. https://www.youtube.com/watch?v=C0Rl6s74JcA
31. Gonzales S. The importance of air quality in cannabis cultivation. Cannabis Science and Technology. 2023;6(4):32-33.
32. Mills E. The carbon footprint of indoor Cannabis production. Energy Policy. 2012;46:58-67.
33. Summers HM, Sproul E. Quinn JC. The greenhouse gas emissions of indoor cannabis production in the United States. Nat Sustain. 2021;4:644-650.
34. Brown JP, Cohen ED, Felix A. Economic benefits and social costs of legalizing recreational marijuana. Federal Reserve Bank of Kansas City. June 7, 2024. Accessed January 17, 2025. https://www.kansascityfed.org/Research%20Working%20Papers/documents/9825/rwp23-10browncohenfelix.pdf
35. Farrelly KN, Wardell JD, Marsden E, et al. The impact of recreational cannabis legalization on cannabis use and associated outcomes: a systematic review. Subst Abuse. 2023;17:11782218231172054.
36. Grigorian A, Lester E, Lekawa M, et al. Marijuana use and outcomes in adult and pediatric trauma patients after legalization in California. Am J Surg. 2019;218(6):1189-1194.
37. Dills A, Goffard S, Miron J, et al. The effect of state marijuana legalizations: 2021 update. Cato Institute; 2021. Policy analysis 908. Accessed January 17, 2025. https://www.cato.org/policy-analysis/effect-state-marijuana-legalizations-2021-update
38. Bradford AC, Bradford WD, Abraham A, et al. Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population. JAMA Intern Med. 2018;178(5):667-672.
39. Nguyen HV, McGinty EE, Mital S, et al. Recreational and medical cannabis legalization and opioid prescriptions and mortality. JAMA Health Forum. 2024;5(1):e234897.
40. Maryland Medical Cannabis Commission. Legislative report. Treatment of opioid use disorder with medical cannabis. Accessed January 17, 2025. https://www.medchi.org/Portals/18/files/Events/MedCan2017/MD%20Medical%20Cannabis%20Commission%20Legislative%20Report%202019.pdf
41. New York State Department of Health announces opioid use to be added as a qualifying condition for medical marijuana. Press release. June 18, 2018. Accessed January 17, 2025. https://www.health.ny.gov/press/releases/2018/2018-06-18_opioid_use.htm
42. Jugl S, Okpeku A, Costales B, et al. A mapping literature review of medical cannabis clinical outcomes and quality of evidence in approved conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids. 2021;4(1):21-42.
43. Multiple Sclerosis Trust. Sativex (nabiximols). Accessed January 17, 2025. https://mstrust.org.uk/a-z/sativex-nabiximols
44. Klein TA, Clark CS. Therapeutic use of cannabis in the US. Nurse Pract. 2022;47(12):16-25.
45. U.S. Food and Drug Administration. FDA regulation of cannabis and cannabis-derived products, including cannabidiol (CBD). July 16, 2024. Accessed January 17, 2025. https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd
46. U.S. Food and Drug Administration. Marinol (dronabinol) capsules, for oral use. January 2023. Accessed January 17, 2025. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/018651s033lbl.pdf
47. U.S. Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. News release. June 25, 2018. Accessed January 17, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
48. U.S. Food and Drug Administration. FDA approves new indication for drug containing an active ingredient derived from cannabis to treat seizures in rare genetic disease. News release. July 31, 2020. Accessed January 17, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-new-indication-drug-containing-active-ingredient-derived-cannabis-treat-seizures-rare
49. Devinsky O, Cross JH, Laux L, et al. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med. 2017;376(21):2011-2020.
50. Devinsky O, Patel AD, Cross JH, et al. Effect of cannabidiol on drop seizures in the Lennox–Gastaut syndrome. N Engl J Med. 2018;378(20):1888-1897.
51. Thiele EA, Bebin EM, Bhathal H, et al. Add-on cannabidiol treatment for drug-resistant seizures in tuberous sclerosis complex: a placebo-controlled randomized clinical trial. JAMA Neurol. 2021;78(3):285-292.
52. Slawek D, Meenrajan SR, Alois MR, et al. Medical cannabis for the primary care physician. J Prim Care Community Health. a2019;10:2150132719884838.
53. Babson KA, Sottile J, Morabito D. Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.
54. Prasad B, Radulovacki MG, Carley DW. Proof of concept trial of dronabinol in obstructive sleep apnea. Front Psychiatry. 2013;4:1.
55. Carley DW, Prasad B, Reid KJ, et al. Pharmacotherapy of apnea by cannabimimetic enhancement, the PACE Clinical Trial: effects of dronabinol in obstructive sleep apnea. Sleep. 2018;41(1):zsx184.
56. Doppen M, Kung S, Maijers I, et al. Cannabis in palliative care: a systematic review of current evidence. J Pain Symptom Manage. 2022;64(5):e260-e284.
57. Vozoris NT, Zhu J, Ryan CM, et al. Cannabis use and risks of respiratory and all-cause morbidity and mortality: a population-based, data-linkage, cohort study. BMJ Open Respir Res. 2022;9(1):e001216.
58. Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network: National Estimates from Drug-Related Emergency Department Visits, 2023. Center for Behavioral Health Statistics and Quality, SAMHSA; 2024.
59. Habboushe J, Rubin A, Liu H, et al. The prevalence of cannabinoid hyperemesis syndrome among regular marijuana smokers in an urban public hospital. Basic Clin Pharmacol Toxicol. 2018;122(6):660-662.
60. Cue L, Chu F, Cascella M. Cannabinoid hyperemesis syndrome. In: StatPearls. StatPearls Publishing; 2023.
61. Takakuwa KM, Schears RM. The emergency department care of the cannabis and synthetic cannabinoid patient: a narrative review. Int J Emerg Med. 2021;14(1):10.
62. Miller SC, Fielin DA, Rosenthal RN, et al. The ASAM Principles of Addiction Medicine. 6th ed. Wolters Kluwer; 2018.
63. Pepin LC, Simon MW, Banerji S, et al. Toxic tetrahydrocannabinol (THC) dose in pediatric cannabis edible ingestions. Pediatrics. 2023;152(3):e2023061374.
64. Khoj L, Zagà V, Amram DL, et al. Effects of cannabis smoking on the respiratory system: a state-of-the-art review. Respir Med. 2024;221:107494.
65. Paranjpe I, Lan R, Jaladanki S, et al. Association of cannabis use disorder with risk of coronary artery disease: a Mendelian randomization study. JACC. 2023;81(8_Supplement):1685.
66. Bene-Alhasan Y, Osei AD, Tammara A, et al. Abstract 13812: daily marijuana use is associated with incident heart failure: “All of Us” Research Program. Circulation. 2023; 148 (Suppl_1):A13812.
67. DeFilippis EM, Bajaj NS, Singh A, et al. Marijuana use in patients with cardiovascular disease: JACC Review topic of the week. J Am Coll Cardiol. 2020;75(3):320-332.
68. Urits I, Gress K, Charipova K, et al. Cannabis use and its association with psychological disorders. Psychopharmacol Bull. 2020;50(2):56-67.
69. Azofeifa A, Rexach-Guzmán BD, Hagemeyer AN, et al. Driving under the influence of marijuana and illicit drugs among persons aged ≥16 years - United States, 2018. MMWR Morb Mortal Wkly Rep. 2019;68(50):1153-1157.
70. Centers for Disease Control and Prevention. Cannabis and driving. February 22, 2024. Accessed January 17, 2025. https://www.cdc.gov/cannabis/health-effects/driving.html
71. National Conference of State Legislatures. Drugged driving | marijuana-impaired driving. March 27, 2024. Accessed January 17, 2025. https://www.ncsl.org/transportation/drugged-driving-marijuana-impaired-driving
72. Hasin DS, Saha TD, Kerridge BT, et al. Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013. JAMA Psychiatry. 2015;72(12):1235-1242.
73. Leung J, Chan GCK, Hides L, et al. What is the prevalence and risk of cannabis use disorders among people who use cannabis? a systematic review and meta-analysis. Addict Behav. 2020;109:106479.
74. Petrilli K, Ofori S, Hines L, et al. Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022;9(9):736-750.
75. Centers for Disease Control and Prevention. Cannabis and brain health. February 15, 2024. Accessed January 17, 2025. https://www.cdc.gov/cannabis/health-effects/brain-health.html
76. Dharmapuri S, Miller K, Klein JD. Marijuana and the pediatric population. Pediatrics. 2020;146(2):e20192629.
77. Kong G, Cavallo DA, Goldberg A, et al. Blunt use among adolescents and young adults: informing cigar regulations. Tob Regul Sci. 2018;4(5):50-60.
78. Tweet MS, Nemanich A, Wahl M. Pediatric edible cannabis exposures and acute toxicity: 2017-2021. Pediatrics. 2023;151(2):e2022057761.
79. Roehler DR, Smith H 4th, Radhakrishnan L, et al. Cannabis-involved emergency department visits among persons aged <25 years before and during the COVID-19 pandemic — United States, 2019–2022. MMWR Morb Mortal Wkly Rep. 2023;72(28):758-765.
80. Myran DT, Tanuseputro P, Auger N, et al. Edible cannabis legalization and unintentional poisonings in children. N Engl J Med. 2022;387(8):757-759.
81. Wilson KM, Torok MR, Wei B, et al. Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 2017;81(4):589-592.
82. Martinelli K. CBD: what parents need to know. Child Mind Institute. Accessed January 17, 2025. https://childmind.org/article/cbd-what-parents-need-to-know/
83. Badowski S, Smith G. Cannabis use during pregnancy and postpartum. Can Fam Physician. 2020;66(2):98-103.
84. Hayer S, Mandelbaum AD, Watch L, et al. Cannabis and pregnancy: a review. Obstet Gynecol Surv. 2023;78(7):411-428.
85. Skelton K, Nyarko S, Iobst S. Perceptions, barriers, and facilitators of cannabis screening during pregnancy and labor: a qualitative study. Drug Alcohol Depend Rep. 2024;12:100274.
86. Satti MA, Reed EG, Wenker ES, et al. Factors that shape pregnant women’s perceptions regarding the safety of cannabis use during pregnancy. J Cannabis Res. 2022;4(1):16.
87. Connor JP, Stjepanović D, Budney AJ, et al. Clinical management of cannabis withdrawal. Addiction. 2022;117(7):2075-2095.
88. Paul SE, Hatoum AS, Fine JD, et al. Associations between prenatal cannabis exposure and childhood outcomes: results from the ABCD Study. JAMA Psychiatry. 2021;78(1):64-76.
89. Rompala G, Nomura Y, Hurd YL. Maternal cannabis use is associated with suppression of immune gene networks in placenta and increased anxiety phenotypes in offspring. Proc Natl Acad Sci U S A. 2021;118(47):e2106115118.
90. Tadesse AW, Ayano G, Dachew BA, et al. Exposure to maternal cannabis use disorder and risk of autism spectrum disorder in offspring: A data linkage cohort study. Psychiatry Res. 2024;337:115971.
91.Shorey-Kendrick LE, Roberts VHJ, D’Mello RJ, et al. Prenatal delta-9-tetrahydrocannabinol exposure is associated with changes in rhesus macaque DNA methylation enriched for autism genes. Clin Epigenetics. 2023;15(1):104.
92. Gunn JKL, Rosales CB, Center KE, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016;6(4):e009986.
93. Bailey BA, Wood DL, Shah D. Impact of pregnancy marijuana use on birth outcomes: results from two matched population-based cohorts. J Perinatol. 2020;40(10):1477-1482.
94. Rodriguez CE, Sheeder J, Allshouse AA, et al. Marijuana use in young mothers and adverse pregnancy outcomes: a retrospective cohort study. BJOG. 2019;126(12):1491-1497.
95. Bertrand KA, Hanan NJ, Honerkamp-Smith G, et al. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics. 2018;142(3):e20181076.
96. Graves L. Cannabis and breastfeeding. Paediatr Child Health. 2020;25(Suppl 1):S26-S28.
97. U.S. Food and Drug Administration. FDA and cannabis: research and drug approval process. February 27, 2023. Accessed January 17, 2025. https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process
98. National Institute on Drug Abuse. NIDA’s role in providing cannabis for research. March 27, 2020. Accessed January 17, 2025. https://nida.nih.gov/research/resources-grants-contracts/nidas-role-in-providing-cannabis-research
99. Marijuana 1-to-3 Act of 2021, HR 365, 117th Cong (2021-2022). Accessed January 17, 2025. https://www.congress.gov/bill/117th-congress/house-bill/365/text
100. Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: rescheduling of marijuana. Docket no. DEA-1362; A.G. order no. 5931-2024. Accessed January 17, 2025. https://www.dea.gov/sites/default/files/2024-05/Scheduling%20NPRM%20508.pdf
101. Marijuana Opportunity Reinvestment and Expungement Act, HR 3617, 117th Cong (2021-2022). Accessed January 17, 2025. https://www.congress.gov/bill/117th-congress/house-bill/3617/text
102. Schedules of controlled substances, 21 USC §812 (1970). Accessed January 17, 2025. https://uscode.house.gov/view.xhtml?req=(title:21%20section:812%20edition:prelim
103. U.S. Department of Agriculture. Hemp. Accessed January 17, 2025. https://www.usda.gov/farming-and-ranching/plants-and-crops/plant-breeding/hemp
104. Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to advance agency’s continued evaluation of potential regulatory pathways for cannabis-containing and cannabis-derived products. U.S. Food and Drug Administration. April 2, 2019. Accessed January 17, 2025. https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-new-steps-advance-agencys-continued-evaluation
105. Justice Department announces update to marijuana enforcement policy. Press release. August 29, 2013. Accessed March 15, 2025. https://www.justice.gov/archives/opa/pr/justice-department-announces-update-marijuana-enforcement-policy
106. Cole J. Memorandum for all United States attorneys. Guidance regarding marijuana enforcement. August 29, 2013. Accessed January 17, 2025. https://www.justice.gov/iso/opa/resources/3052013829132756857467.pdf
107. Statement from President Biden on marijuana reform. The White House. October 6, 2022. Accessed January 17, 2025. https://www.whitehouse.gov/briefing-room/statements-releases/2022/10/06/statement-from-president-biden-on-marijuana-reform/
108. Bryan K. Cannabis overview. National Conference of State Legislatures. June 20, 2024. Accessed January 17, 2025. https://www.ncsl.org/civil-and-criminal-justice/cannabis-overview
109. Bailey M. Criminal justice system impacts of cannabis decriminalization & legalization. June 2021. Accessed January 17, 2025. https://cjil.sog.unc.edu/wp-content/uploads/sites/19452/2021/06/Impacts-of-Cannabis-Decriminalization-Legalization-6.24.2021.pdf
110. Sacco LN, Lampe JR, Sheikh HZ. The federal status of marijuana and the policy gap with states. Congressional Research Service. May 2, 2024. Accessed January 17, 2025. https://crsreports.congress.gov/product/pdf/IF/IF12270
111. New ACLU report: despite marijuana legalization Black people still almost four times more likely to get arrested. Press release. American Civil Liberties Union. April 20, 2020. Accessed January 17, 2025. https://www.aclu.org/press-releases/new-aclu-report-despite-marijuana-legalization-black-people-still-almost-four-times
112. National Academies of Sciences, Engineering, and Medicine. Cannabis Policy Impacts Public Health and Health Equity. National Academies Press; 2024.
113. American Academy of Family Physicians. Incarceration and health: a family medicine perspective (position paper). January 2022. Accessed January 17, 2025. https://www.aafp.org/about/policies/all/incarceration.html
114. National Center on Addiction and Substance Abuse. Childhood poisoning: safeguarding young children from addictive substances. April 2018. Accessed January 17, 2025. https://www.issup.net/files/2018-04/Childhood%20Poisoning%20-%20Safeguarding%20Young%20Children%20from%20Addictive%20Substances.pdf
(July 2019 BOD) (October 2025 COD)