Cannabis legalisation in the United States. Towards a regulated market?

Although cannabis is still prohibited at federal level, 8 American states and the District of Columbia have made unprecedented changes to their cannabis regulations with the legalisation of cultivation, sale, possession and use of cannabis for non-medical (i.e. recreational) purposes from the age of 21. These changes in the legal status of "recreational" cannabis have arisen even though "medical" use is already permitted in 29 states. Hence, in the third most populated country in the world, one in five inhabitants is currently (or will be) experiencing a legal regime authorising the purchase and use of cannabis for recreational use by adults (i.e. 65 million citizens).

After five full years of reform in Colorado and Washington State (2014-2018), first outcomes can be reported - although it is not clear whether they are directly attributable to cannabis being legalised. The most significant effects relate to the quick and large-scale industrial expansion of the cannabis supply chain. However, this economic boom has also seen the emergence of three public health concerns:

• The substance is now aimed at all population profiles, from people who have never tried it to regular users and from young people to seniors. The increase in supply and its diversification have increased the incentives to use it, which is only made worse by marketing strategies emphasising cannabis' "therapeutic virtues" or its dimension of socialisation. 
• The increase in the number of emergency calls and hospitalisations following acute intoxication highlights the difficulty of effectively regulating substances put on the market (particularly in terms of the concentration of active ingredients). At the same time, cannabis-related treatment demands have declined.
• The decline in both the perceived dangerousness of cannabis and retail prices have led to it becoming more accessible and the substance being "normalised" which, according to public health stakeholders, could ultimately increase the risks and harm associated with its use (particularly among the younger generation).