Marijuana Legalization

Approved by Council on April 15, 2014

By the Substance Abuse and Addiction Committee

The American Academy of Child and Adolescent Psychiatry (AACAP) advocates for careful consideration of potential direct and downstream effects of marijuana policy changes on children and adolescents, and involvement of the medical and research community in policy-related discussions.  Legalization of marijuana for medicinal or recreational purposes, even if restricted to adults, is likely to be associated with (a) decreased adolescent perceptions of marijuana’s harmful effects, (b) increased marijuana use among parents and caretakers, and (c) increased adolescent access to marijuana, all of which reliably predict increased rates of adolescent marijuana use and associated problems.1,2 Marijuana use during pregnancy raises additional concerns regarding child and adolescent development.3

AACAP is aware that, among hundreds of chemical constituents, marijuana contains select individual compounds that, if safely administered in reliable doses, may potentially convey therapeutic effects for specific conditions in specific populations.  Advocacy regarding potential cannabinoid therapeutics, alongside social justice, public policy, and economic concerns, have contributed to marijuana policy changes.  Amid these factors, AACAP remains focused on the specific issue of marijuana use in adolescence, a critical period of ongoing brain maturation.

Marijuana use is not benign, and adolescents are especially vulnerable to its many known adverse effects.4,5 One in six adolescent marijuana users develop cannabis use disorder, a well characterized syndrome involving tolerance, withdrawal, and continued use despite significant associated impairments.6,7 Heavy use during adolescence is associated with increased incidence and worsened course of psychotic, mood, anxiety, and substance use disorders across the lifespan.7-10 Furthermore, marijuana’s deleterious effects on adolescent brain development, cognition, and social functioning may have immediate and long-term implications, including increased risk of motor vehicle accidents, sexual victimization, academic failure, lasting decline in intelligence measures, psychopathology, addiction, and psychosocial and occupational impairment.11-18

As child and adolescent mental health advocates, AACAP (a) opposes efforts to legalize marijuana, (b) supports initiatives to increase awareness of marijuana’s harmful effects on adolescents, (c) supports improved access to evidence-based treatment, rather than emphasis on criminal charges, for adolescents with cannabis use disorder, and (d) supports careful monitoring of the effects of marijuana-related policy changes on child and adolescent mental health.


  1. Joffe, A., & Yancy, W. S. (2004). Legalization of marijuana: potential impact on youth. Pediatrics, 113, e632-e638.
  2. Johnston, L. D., O’Malley, P. M., Miech, R. A., et al. (2014). Monitoring the Future national results on drug use: 1975-2013: Overview, Key Findings on Adolescent Drug Use., Ann Arbor: Institute for Social Research, The University of Michigan.
  3. Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., Abdel-Latif, M. E., Feller, J. M., & Oei, J. L (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, doi: 10.1038/jp.2013.180.
  4. Schneider, M. (2008). Puberty as a highly vulnerable developmental period for the consequences of cannabis exposure. Addiction Biology, 13(2), 253-263.
  5. Jager, G., & Ramsey, N. F. (2008). Long-term consequences of adolescent cannabis exposure on the development of cognition, brain structure and function: an overview of animal and human research. Current Drug Abuse Reviews, 1(2), 114-123.
  6. Anthony, J., Warner, L. A., & Kessler, R. C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2, 244-268.
  7. Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry, 170, 834-851.
  8. Hayatbakhsh, M. R., Najman, J. M., Jamrozik, K., et al. (2007). Cannabis and anxiety and depression in young adults: a large prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(3), 408-417.
  9. Moore, T. H., Zammit, S., Lingford-Hughes, A., et al. (2007). Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 370(9584), 319-328.
  10. Rubino, T., Zamberletti, E., & Parolaro, D. (2012). Adolescent exposure to cannabis as a risk factor for psychiatric disorders. Journal of Psychopharmacology, 26, 177-188.
  11. Hartman, R. L., & Huestis, M. A. (2013). Cannabis effects on driving skills. Clinical Chemistry, 59, 478-492.
  12. Champion, H. L., Foley K. L., DuRant, R. H., Hensberry, R., Altman, D., & Wolfson, M. (2004). Adolescent sexual victimization, use of alcohol and other substances, and other health risk behaviors. Journal of Adolescent Health, 35, 321-328.
  13. Lynskey, M. T., & Hall, W. D. (2000). The effects of adolescent cannabis use on educational attainment. Addiction, 96, 433-443.
  14. Fergusson, D. M., Horwood, L. J., & Swain-Campbell, N. (2002). Cannabis use and psychosocial adjustment in adolescence and young adulthood. Addiction, 97, 1123-1135.
  15. Meier, M. H., Caspi, A., Ambler, A., et al. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Science of the United States of America, 109, E2657-E2664.
  16. Hall, W., & Degenhardt, L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374, 1383-1391.
  17. Shapiro, G. K., & Buckley-Hunter, L. (2010). What every adolescent needs to know: cannabis can cause psychosis. Journal of Psychosomatic Research, 69, 533-539.
  18. Fergusson, D. M., & Boden, J. M. (2008). Cannabis use and later life outcomes. Addiction, 103, 969-976.