Legalizing Marijuana. What Does This Mean for Healthcare?

In 2018, voters in Michigan legalized recreational marijuana in a statewide referendum 56 percent to 44. Michigan joins ten other states to legalize it and is the first in the Midwest to do so. Voters had legalized marijuana for medical use in a referendum ten years earlier.

The new law permits anyone over the age of 21 to possess, use, and buy marijuana for recreational use, as well as grow up to 12 plants in their homes. It also creates a statewide regulatory system for marijuana sales and imposes a 10 percent sales tax.

Much of the conversation about legalization has focused on its economic impacts (i.e. tax revenue). However, as health professionals, we should consider how the law will impact public health.

Although medical use of marijuana was already legal in Michigan, access has been inconsistent throughout the state. Marijuana can be prescribed to treat pain, nausea due to chemotherapy, and seizure disorders. However, the recent closure of many provisioning centers has created a shortage of medical marijuana in Michigan, making it difficult for patients to get it.

Legalization should increase patients’ access to safe marijuana by easing the process of obtaining licensure for businesses to sell it.

But on top of that, we might expect legalization to decrease the stigma associated with use. Many patients report feeling stigmatized for using medical marijuana. By setting a legal norm, legalization may reduce this stigma and help patients feel more comfortable using their medicine and discussing the option with their health care providers.

This increased access and comfort could yield health benefits for many residents of Michigan, at least in the narrow context of medically prescribed use.

However, not all impacts may be positive.

For example, in Colorado, where marijuana for medical use has been available since 2000, some children have been unintentionallypoisoned by edible products. The degree of regulation in Michigan may shape the safety of available products. And the impacts of marijuana use do not end in medical contexts. While studies on the risk of impaired driving due to marijuana have yielded conflicting results, policy makers in Michigan must shape driving laws carefully.

Another big question mark is how legalization will interact with the ongoing opioid epidemic, which has claimed thousands of lives in Michigan. Some experts have argued that legalization will slow the epidemic; states that have legalized marijuana have lower rates of opioid misuse and overdoses. However, the data on the state level is in conflict with data on the individual level. People that use marijuana are more likely to misuse opioids, and the use of marijuana may increase the risk of mental health problems. The evidence is unclear.

Lastly, an important impact on health could come from structural legal changes. Much of the motivation for legalization focused on criminal justice. In the last five years, nearly 50,000 people in Michigan have been convicted of misdemeanor offenses involving marijuana. Besides costing taxpayer money to process, convictions for low-level offenses have also long been racially discriminatory. Drug arrests and convictions disproportionately impact people of color in the United States, not due to differential rates of use but, rather, racial bias.

The inequitable jailing of young men of color economically handicaps these communities. Income is the strongest predictor of health — stronger than medical access. Governor Gretchen Whitmer has raised the possibility of pardoning people convicted of low-level marijuana offenses. Returning thousands of people of color to the workforce could uplift the economic prospects of their communities, improving their health in the process.

To make the debate all the more complicated, our best estimates for the effects of marijuana legalization on patients and the state are fuzzy at best. Tight restrictions on marijuana research using federal dollars have limited our understanding of its use.

Nevertheless, as health professionals, we should approach the matter as we do for all policy developments that impact health: with an open mind and ceaseless advocacy for our patients.