The Impact of Marijuana as More States Look to Legalize

Marijuana is linked to mental health issues, some health benefits, and public safety concerns. The debates persist as more states move to lift prohibitions.

A man stands with a sign in New York's Times Square telling people he needs cash to buy marijuana on June 7, 2023. Richard Moore/The Epoch Times

At 17, Jokabel Del Villar puffed a marijuana cigarette for the first time at a party, reveling in the “high” that yielded an unexpected and immediate feeling of calm.

But what started as a welcome mental escape for the young artist soon became an addiction the teen couldn’t shake.

For 12 years, staying high robbed her of the motivation to pursue her goals, the Pennsylvania woman says now. She recalls drifting through early adulthood, craving puffs on a “joint” to prepare for even the most menial tasks. To unwind after completing those tasks, she puffed again, she told The Epoch Times.

Now, through an account on TikTok, she joins others across the nation who warn about the potentially harmful effects of marijuana.

Meanwhile, others tout its medicinal benefits and say arguments against marijuana use are overblown.

Two states are poised to join 24 others and the nation’s capital, which have made recreational use of the drug legal.

Activists on all sides of the issue offer persuasive arguments.

Some argue that using marijuana is risky and shouldn’t be legal for anyone to use.

Others say marijuana and its derivatives should be allowed only for medicinal use, and the plant’s properties should be further explored for those purposes.

And some say marijuana should be available for anyone who wants to use it.

Who’s Using Marijuana?

A total of 61.9 million Americans used marijuana in 2022, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). That was about 22 percent of the U.S. population at the time.

Among Americans aged 12 or older, 6.7 percent (or 19.0 million people) had a marijuana-use disorder in 2022, SAMHSA reports.

“Approximately 1 in 10 people who use marijuana will become addicted. When they start before age 18, the rate of addiction rises to 1 in 6,” SAMHSA states.

But some experts insist marijuana isn’t just for those looking to get high on the drug, which is usually smoked or baked into “edibles” such as brownies.

They point to research suggesting bonafide medicinal value in the marijuana plant—also known by part of its scientific name, cannabis. Currently, it’s used to treat a range of conditions, including multiple sclerosis, glaucoma, epilepsy, and chronic pain.

Another cannabis component called cannabidiol (CBD) is used medically. CBD is a non-addictive and non-psychoactive component of cannabis.

Recreational marijuana is different from medical marijuana in that its potency is higher, and the users’ goal is divergent, according to Staci Gruber, associate professor of psychiatry at Harvard Medical School.

“Recreational users typically seek products high in THC, given their goal to ‘alter their current state of being’ or ‘get high,’” Ms. Gruber said in a previous interview. “In contrast, medical marijuana patients are typically not interested in getting high, but instead seek symptom relief.”

But research also points to troubling effects of marijuana use, especially recreational use.

Studies link marijuana use to cognitive decline in teenagers and young adults. Users are more likely to drop out of high school, score lower on college entrance exams, develop schizophrenia, and become addicted, studies show.

Where it’s legal, car crashes and crash fatalities involving marijuana are increasing sharply, some research shows.

Users also may experience psychotic episodes that lead to violence, a tragic case illustrates.

While high on marijuana for the first time, a California woman fatally stabbed her boyfriend 108 times. Her attorneys blamed “marijuana-induced psychosis.” Medical experts agreed.

In 24 states and the District of Columbia, it's legal for adults at least 21 years old to possess marijuana for recreational use. Another 13 states allow only medical use with a recommendation from a doctor. Illustration by Jacob Burg via Infogram

Where It’s Legal

Thirteen U.S. states have legalized marijuana only for medical use with a recommendation from a doctor. Those states are Alabama, Arkansas, Florida, Hawaii, Louisiana, Mississippi, New Hampshire, North Dakota, Oklahoma, Pennsylvania, South Dakota, Utah, and West Virginia.

So far, 24 U.S. states and the District of Columbia have legalized recreational marijuana use.

Adults 21 and older can purchase the drug from licensed stores or dispensaries in Alaska, Arizona, California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Mexico, New Jersey, New York, Ohio, Oregon, Rhode Island, and Vermont, Virginia, and Washington.

Laws in Nebraska and North Carolina prohibit sales of marijuana for recreational and medical use. But both states recently decriminalized possession of small amounts.

In North Carolina, possession of a half-ounce or less of marijuana now is a Class 3 misdemeanor and has a maximum fine of $200. Nebraskans caught with less than an ounce of marijuana aren’t charged.

Under federal law, the use, possession, and sale of marijuana is still illegal, despite state laws. However, in states that have legalized marijuana, it’s a low priority for federal law enforcement, which has instead focused on stringent regulation.

The U.S. Drug Enforcement Administration (DEA) lists it as a Schedule 1 substance under the Controlled Substances Act, along with LSD, heroin, and MDMA/ecstasy.

But President Joe Biden wants it reclassified as a less-regulated Schedule III substance.

That’s because “no one should be in jail just for using or possessing marijuana,” he said during a briefing at the White House on Oct. 6, 2022.

Cannabis plants grow at a Claudine Field Apothecary farm in Columbia County, New York on Oct. 7, 2022. Michael M. Santiago/Getty Images

Reclassifying marijuana as a Schedule III substance could allow for more medical research and spur the creation of new medicines derived from the plant, they say.

Legalization Fuels Addiction?

Still, the legalization debate continues.

When Floridians and South Dakotans select their choice for president this November, they will also decide whether recreational marijuana should be legalized in their states. Medical marijuana is already legal in both states.

That’s if the citizen-driven ballot initiatives are approved by their respective state supreme courts by April 1. Pro-marijuana activists had gathered the required number of voters’ signatures in both states to petition for a ballot initiative, which, if approved, would change their state constitutions.

Amy Ronshausen, executive director of the Drug Free America Foundation, is concerned that legalizing marijuana in more states could worsen a growing mental-health crisis across the nation and lead to more addiction..

Amy Ronshausen, executive director of the Drug Free America Foundation, Inc. and president of the World Federation Against Drugs. Courtesy of Amy Ronshausen

Dr. Stuart Gitlow, former president of the American Society of Addiction Medicine, shares Ms. Ronshausen’s concern about increased addictions if legalization spreads, though he’s not in favor of arresting people for using it.

Where it’s legal, twice as many people are likely to try marijuana, Dr. Gitlow told The Epoch Times. And though 85 percent of people can use marijuana without becoming addicted, he said, inevitably, some will.

But Harvard economics senior lecturer Jeffrey Miron, a lead researcher for the Cato Institute’s policy analysis on marijuana, doesn’t see cause for alarm.

In their 2021 report Mr. Miron and his coauthors wrote that: “New research finds that the strong claims made by both advocates and critics of state‐​level marijuana legalization are substantially overstated and in some cases entirely without real‐​world support.”

Still, for people like Ms. Del Villar, the prospect of more addiction across the country is worrisome.

She'd been an art student, surrounded by friends who abused alcohol and drugs, including marijuana. But because of her religious upbringing, she initially resisted those temptations, she said.

Then, at a high school party, she saw a look of apparent joy spread across a friend’s face moments after the girl smoked marijuana. Ms. Del Villar suddenly wanted to feel the same way.

She took a turn inhaling, and a feeling of ease quickly engulfed her body, flooding her mind with color and dissolving any negative thoughts she‘d been suppressing about trauma she’d experienced.

A marijuana high provided the temporary escape she craved.

But the drug quickly began to control her, she recalled, speaking with The Epoch Times 12 years later. Her use of marijuana morphed from an occasional party splurge into an expensive daily habit, kept alive by purchases from a dealer selling illegally.

Although illegal marijuana sales are hard to track, the legal purchase of an ounce of marijuana—enough for about 90 small cigarettes—usually costs $170–$500. Prices vary widely because states tax marijuana sales differently.

While Ms. Del Villar hid her habit well, every task brought about a need to get high.

“I wanted to smoke while I was getting ready for cooking” a meal, she said. “I wanted to smoke after my shower. It wasn’t a social thing anymore. It was just like medication.”

Looking back, she sees she was living a life of irresponsibility, “constantly being high.” She wasn’t cleaning her home as she should have. She wasn’t motivated. She wasn’t moving forward in life.

After 12 years of living in a virtual cloud of marijuana smoke, she'd finally had enough of the constant intoxication. The motivation to get sober, no matter the difficulty, came after an unexpected turn in her life.

Jokabel Del Villar, 29, poses with her partner's daughter, the inspiration for her life change. Courtesy of Jokabel Del Villar

In her late 20s, she fell in love with a man with a young daughter. The prospect of being a stepmother snapped her out of her haze. And as a worker in the mental health field, she knew she needed to get healthy to better help others.

But the work of quitting wasn’t easy.

Angry and anxious thoughts crowded her mind. Insomnia kept her awake at night. When she finally slept, her dreams were strange, even troubling.

But she pushed forward, telling herself the reason for the struggle was worth it. Now she’s been free of pot’s grip for almost a year.

Ms. Del Villar’s marijuana use ended in sobriety, self-awareness, and personal growth.

For others, there’s no happy ending.

After Bryn Spejcher tried marijuana for the first time at her boyfriend’s urging, it made her “involuntarily intoxicated,” her lawyers told the court where she was tried for the young man’s 2018 killing. Police responding to a 911 call found Ms. Spejcher hysterically crying over his body. She had serious, self-inflicted stab wounds, as well.

Her attorneys said she'd heard voices and saw visions telling her to stab her boyfriend. They called it “cannabis-induced psychosis.”

Medical experts testified about the possibility of such a mental lapse, and in January, Ventura County Superior Court Judge David Worley ruled that Ms. Spejcher “had no control over her actions.” The 33-year-old woman was found guilty of involuntary manslaughter. To the dismay of the victim’s family, she was sentenced to two years of probation and 100 hours of community service.

Social media platforms were abuzz with worries that the verdict could give marijuana users a pass on crimes committed when under the influence of the drug.

Ms. Spejcher’s experience with marijuana was an uncommon, “anomalous reaction,” said Aaron Bloom, the CEO of DocMJ, a medical marijuana practice based in Florida.

People shouldn’t demonize marijuana use because of  “outlier cases” like Ms. Spejcher’s, Mr. Bloom told The Epoch Times. “Psychotic breaks” are possible, he said, after using a wide variety of medications and even after using alcohol.

Indeed, the National Institutes of Health (NIH) website offers a fact sheet on alcohol-related psychosis.

Many health professionals would have scoffed at a diagnosis of “marijuana-induced psychosis” a decade ago, Ms. Ronshausen said. With the availability now of high-potency cannabis products that cause more intense reactions, she said, it’s no longer considered ridiculous.

Marijuana, Mental Health, and Marketing

Opponents of legalized marijuana also point to studies that suggest marijuana use worsens chronic, common mental health problems.

But the research is mixed.

The National Academies of Sciences, Engineering, and Medicine (NASEM) released a systematic review in 2017 on marijuana and mental health, saying surging cannabis use is “likely to increase the risk of developing schizophrenia and other psychoses; the higher the use, the greater the risk.”

The review also found that heavy users of marijuana are “more likely to report thoughts of suicide than are nonusers,” and that regular cannabis use is likely to increase the risk of social anxiety disorder.

A man steps out of a legal cannabis dispensary in New York on June 16, 2023. Spencer Platt/Getty Images

A 2013 study from the University of Melbourne documented that “high-intensity” early cannabis use is linked to a drop in high school completion rates and in university entrance scores.

A 2012 study tracked a correlation between early cannabis use—prior to age 13—and a significant drop in IQ up to eight points, “suggestive of a neurotoxic effect.”

But a 2016 study found no correlation between early cannabis use and declining IQ scores.

And Mr. Miron said his extensive analysis of research on marijuana shows that its effects on mental health are “minimal.”

It’s true that scientific data “generally fail to substantiate a link between changes in cannabis’ legal status and increased rates of psychosis or mental illness,” said Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws (NORML). He points to studies in 2022 and 2023.

NORML supports the “repeal of federal cannabis prohibition” and the full removal of cannabis from the Controlled Substances Act so it can be regulated like alcohol, he told The Epoch Times.

And legalization of marijuana could create solutions and ease a range of problems, he said.

That’s because prohibition “financially burdens taxpayers, encroaches upon civil liberties, engenders disrespect for the law, impedes legitimate scientific research into the plant’s medicinal properties, and disproportionately impacts communities of color.”

But the more prevalent marijuana legalization becomes, the more it could lead to widespread advertising, which could be harmful, especially to children, who are the consumers of the future, some experts worry.

Already, those involved in producing and selling marijuana are “acting like [Big] Tobacco did 30 years ago,” Ms. Ronshausen said.

Tobacco companies notoriously advertised cigarettes in Hollywood films and on television shows for decades, and the companies were accused of targeting children with flavored products and sleek commercials.

An activist in favor of increased cannabis legalization holds up a marijuana cigarette during a rally on Capitol Hill in Washington on April 24, 2017. Mandel Ngan/AFP via Getty Images

And more legalization could add to a simmering employment crisis around the country, Ms Ronshausen said.

At a time when many employers nationwide struggle to maintain minimum staff levels, companies with a“drug-free workplace” requirement could attract fewer job applicants in places where marijuana use is legal, she said.

Also, marijuana intoxication on the job could affect safety, she said.

“We’re dealing with Big Tobacco 2.0 all over again,” said Jeff Hunt, director of the Centennial Institute at Colorado Christian University. His home state was the first to legalize marijuana for recreational use. He opposes furthering the spread of legalization to more states.

Prohibition: Helpful or Harmful?

“Prohibition works,” Mr. Hunt said. “Prohibition absolutely works.”

Dr. Gitlow, the addiction expert, agrees. More people drank after alcohol prohibition was lifted, he said. Still, he’s not in favor of putting people in jail for using marijuana, because it mostly affects their lives and not others.

Banning something—including a substance, product, or activity—rarely results in a decrease in demand, Mr. Miron said.

“And it’s not just about drugs,” he said. “It seems to be a general phenomenon [whenever something is banned by a government], which is surprising.”

Prohibition of any kind also fuels illegal activity, studies show.

A man is accused of trying to smuggle 2,448 pounds of marijuana from Mexico to the United States on Dec. 30, 2017. Courtesy of U.S. Customs and Border Protection

Alcohol prohibition opened a “new illegal market for the gangster to develop and monopolize” an underground industry, and it led to the rise of organized crime and notorious crime bosses such as Al Capone, according to a University of Michigan report.

In states where marijuana is illegal, users can buy only from black-market dealers. Across the country, law enforcement agencies have warned in recent years that black-market marijuana may be contaminated with deadly amounts of fentanyl.

Marijuana was among the most profitable drugs Mexican cartels smuggled across the U.S. border. After several states legalized marijuana use, seizures at the border dropped by more than 50 percent between 2021 and 2023, according to the U.S. Customs and Border Protection drug seizures database.

Fewer seizures at the border don’t necessarily indicate a reduction in the illegal marijuana trade.

Cartels have expanded their business enterprises to include  growing more marijuana within the United States, and bringing fentanyl and other “hard drugs” across the border, according to a report from the Cato Institute.

Marijuana as Medicine

The modern concept of marijuana legalization began with the assertion that it has medicinal value.

California voters approved the Compassionate Use Act in 1996, legalizing medical marijuana for patients with certain ailments. Oregon, Washington, and Alaska voters followed in 1998.

A worker at Canopy Growth Corporation's medical marijuana facility in Smiths Falls, Ont., on Feb. 12, 2018. Sean Kilpatrick/The Canadian Press

In states where medical marijuana is legal, patients must get a physician’s “recommendation”—akin to a prescription—to use marijuana. Patients with that approval can obtain a special ID, called a medical marijuana card, from their state department of health. The card allows them to buy from dispensaries.

In adults with chronic pain, treatment with cannabis or cannabinoids—compounds inside the plant—can result in a “clinically significant reduction in pain symptoms,” a 2017 NASEM study found noting that effect on adults with multiple sclerosis.

The cannabis component CBD is used to treat some forms of severe childhood epilepsy, according to a Harvard Health report.

Dravet syndrome and Lennox-Gastaut syndrome don’t always respond to anti-seizure medications, the report said. But the report said CBD is effective at treating both.

That finding led to the FDA’s approval of Epidiolex, a drug containing CBD, as a treatment for rare, severe forms of epilepsy in 2018. It marked the first approval of a drug with an active component taken from the marijuana plant.

“But just like there are benefits to other natural things—people aren’t smoking willow bark off trees for aspirin—we synthesize the plant into a legitimate medicine and use it for legitimate health reasons,” Ms. Ronhausen said.

And though cannabinoids “within marijuana have been demonstrated to have value medically,” Dr. Gitlow said, smoking marijuana in its whole-plant form is not safe.

Numerous studies indicate smoking any substance is harmful to the lungs.

That’s why medical professionals encourage patients to avoid smoking marijuana to obtain therapeutic benefits, he said. Doctors are more likely to recommend pure CBD or THC tinctures—medicine suspended in glycerin or alcohol—that users place drops of under the tongue.

An edible marijuana-infused product by Dixie is displayed in front of marijuana tincture bottles at the Cannabis World Congress Conference in New York on June 16, 2017. Spencer Platt/Getty Images

Most of Mr. Bloom’s company doctors encourage patients to consume marijuana tinctures or edibles, he said.

Still, some patients prefer smoking or vaping marijuana to get quick pain relief, he said. The pain-relieving effects of marijuana edibles can take an hour to kick in because they have to pass through the liver to take effect.

Many patients also use marijuana to combat depression and anxiety, Mr. Bloom said. They report fewer side effects when using marijuana for treatment versus drugs such as antidepressants and benzodiazepines.

Patients also use marijuana to treat post-traumatic stress disorder and sleep disorders.

Despite the difficulties she faced to gain her sobriety, Ms. Del Villar defends marijuana’s medicinal potential, too.

A loved one with extreme attention-deficit/hyperactivity disorder uses the drug to focus, she said. Another with physical and mental disabilities eats food infused with marijuana to avoid using prescribed fentanyl for chronic severe pain.

“That helps her get through the day,” Ms. Del Villar said. “That helps her not want to think of death.”

Medicinal uses of marijuana make it “an amazing thing,” she said.

But not for her. Not now.

“I am still on the path,” she said, referring to her struggle for sobriety. “I’m still trying to journey back to myself. I’m still trying to get back to the little girl that I was, because I never gave her a chance.”