This is the literature review part of my Bachelor Thesis. the topic is the effects of marijuana on physical and mental health. In the literature review, it is important to include a comparison of the different methods and data used, as well as the important results found, and to contrast the papers. Below, please find the thesis proposal of the paper.
`The effects of Marijuana
on physical and mental health in the USA
Marijuana is illegal for non-medical use in most countries and there are many reasons why governments criminalize the drug. It consists of the dried flowers and leaves that come from the hemp plant. The plant contains the chemical THC (Tetrahydrocannabinol), the component in marijuana that causes the high, characterized as mind-altering, as well as other similar compounds. Marijuana brings a pleasantfeeling of being relaxed if smokedor eaten (Cambridge, n.d.). In fact, the drug is illegal partly because it is assumed to harm mental health and to cause changes in the behavioral aspects of individuals as well (Mönckeberg, 2014). According to previous literature, it also affects physical health. Research found that marijuana use may increase the risk of catching a variety of infectious diseases, cancer diseases, and cause several other adverse physical health issues (Gordon et al., 2013). These effects can occur from the occasional use of marijuana, as well as persistent marijuana use. Marijuana, after alcohol, is the psychotropic drug most widely used in the United States and its use is particularly prevalent among youth (NSDUH,2020). Nevertheless, more and more countries and/or states are moving towards legalizing the substance as they consider marijuana to be a “soft drug”, differentiating it from more harmful ones (Mönckeberg, 2014).
For instance, recently, in September 2019, the Australian Capital Territory, Canberra, became the first city in Australia to legalize the non-medical use of marijuana (Hollingsworth, 2019). There are many other examples of countries that legalized marijuana all around the world. Also, among the countries where marijuana is deemed illegal, there are still disparities in the way the law is enforced. Although in most countries, marijuana is simply illegal, there remain a few that decriminalize it, and others where marijuana is illegal, however frequently unenforced (World population review. 2020).
Figure 1. Countries Where Weed Is Illegal Population. (2020). World Population Review. Retrieved from http://worldpopulationreview.com/countries/countries-where-weed-is-illegal/
This paper and its data analysis deals with the US population, and as indicated in Figure 1, marijuana in the USA is illegal but decriminalized. However, this map is limited to a country level and gives no indication about the legalization of marijuana depending on the states. In fact, the US policy regarding marijuana is quickly moving. Despite the fact that marijuana is still illegal under the country’s government law, in February 2017, 28 US states, as well as the District of Columbia (DC) have authorized marijuana for clinical use. Furthermore, Alaska, California, Colorado, DC, Maine, Massachusetts, Nevada, Oregon and Washington, have legalized cannabis for recreational use by anyone over 21 years old (as cited in National Conference of State Legislatures, 2017).
With the growing popularity of vaping devices, teens have started vaping THC with almost 4% of 12th graders claiming they vape THC on a daily basis.
A total of 12.9% of respondents reported smoking marijuana, 6% reported using edibles, 4.7% reported vaping, Smoking was the most prevalent form of marijuana use (55%) in 2017. Among persons who used multiple forms, 53% reported smoking and using edibles whereas 31% reported smoking and vaping. The prevalence of use of edibles was 11% (CI, 9.4% to 12.6%) in states where recreational use is legal, 5.1% (CI, 4.1% to 6.0%) in states where medical use is legal, and 4.2% (CI, 3.4% to 4.9%) in states where no use is legal. Baked goods/pastries and candies were the most common forms of edibles used by U.S. adults (Table 2).
Moreover, the number of young people who claim that the daily use of marijuana is dangerous is decreasing (Johnston et al., 2016). Such views may be influenced by the legalization of marijuana for medical use or adult recreational consumption in a rising number of states. That being said, over time, many societies have opened up to the idea of legalizing marijuana. In fact, McGinty et al. (2016) reported that only 12% of Americans were in favor of marijuana legalization for non-medical use by adults in 1969 (as cited in Pew Research Center, 2015), compared to 54% of Americans reported in June 2016 (as cited in Quinnipiac University, 2016).
Although, it is important to note that the media influences the public’s view regarding policy issues. Extensively, the news media can impact a population’s awareness and view about marijuana legalization (McGinty et al., 2016). Among the arguments in favor of legalizing marijuana regarding how the public views the debate is that, as there would be the creation of a new legal market of marijuana, this would lead to a rise in tax revenue, which appeals to policymakers as the potential tax revenue surplus is also important when facing state budget shortfalls (as cited in Fairchild, 2013). Furthermore, in 2016, it was expected that legalizing marijuana would save 8 billion dollars in the US in law enforcement, implementing marijuana prohibitions around the country.
Another argument in favor of legalizing marijuana is that the policy would reduce overcrowding in prisons. Also, some research suggests that legalizing marijuana would be beneficial from an economic point of view as the existence of the industry creates new jobs. It is also said that legalizing marijuanawould decrease racial differences in marijuana arrests as even though blacks and whites are similarly likely to use marijuana, it is still almost four times more likely for blacks to be arrested than whites for non-violent crimes related to marijuana.(McGinty et al., 2017)
Having said that, it is interesting to understand why some countries decide to legalize marijuana, and others consider the topic to be completely taboo. Regarding one’s health, can it be deteriorated by the legalization of marijuana or is the latter solely a myth? The research question that this paper aims to answer is, therefore, the following:
What is the effect of marijuana on one’s mental and physical health outcomes?
Despite years of study on marijuana and its effects on the human body, there are significant gaps in the literature. The differences range from the drug’s true therapeutic benefits (which vary greatly from study to study) and its effect on mental and physical health. This research aims to complete two tasks. Firstly, highlight the correlation between the effects of marijuana use and its physical and mental health effects. Secondly, it will assess the prevalence of the use of marijuana and see whether there is a statistically important relationship between the use of marijuana and the increased prevalence of negative mental health consequences in adult life.
There already exists literature that is more or less related to the intended research. For instance, Marie and Zölitz (2017) investigated how legal access to marijuana affects the academic performance of students. It has been repeatedly suggested that mental health and educational performance are closely related to one another. The latter is shown by the works of Bostani, Nadri, and Nasab (2014). Moreover, other literature showed that marijuana use leads to physical health problems. One of the main issues marijuana consumption causes is that the drug can reportedly generate problems of a respiratory nature, in the long term (Feeney &Kampman, 2016). Indeed, in the paper “The Real Dangers of Marijuana”, Caulkins reported that among the reasons why individuals oppose the legalization of marijuana, is because marijuana contains known carcinogens (2016). The latter has in fact been proposed by many pieces of literature. For instance, marijuana users are associated with a greater risk of contracting lung cancer, even though the risk is still inferior to tobacco users (Gordon et al., 2013). Not only are marijuana users exposed to the risk of lung cancer, but they are also associated with a greater risk of getting bladder cancer (as cited in Nieder et al., 2006). Furthermore, tuberculosis outbreaks (as cited in Munckhof et al., 2003; Oeltmann et al., 2006) were shown to be common for users of marijuana.
Nonetheless, not all research only denounces the negative effects of marijuana use on health. After all, if more and more countries are legalizing recreational marijuana, that must mean that there is a significant amount of people that are in favor of legalizing the substance. One of the mentioned benefits of legalizing marijuana is also regarding one’s physical and mental health, specifically that a policy implementation as such would decrease prescription opioid overdose (Bachhuber et al., 2014). Given the mental health aspect of this research, not many papers have studied the effect of marijuana on the latter. Although, in a study about marijuana and mental health in the state of Colorado in 2012, it was concluded that there is a higher number of psychosocial issues for people that co-use tobacco and marijuana (Peters et al., 2012). Unlike pharmaceuticals, relatively few clinical trials have been performed on the medical use of marijuana, resulting in a lack of information about possible health benefits or risks, as well as appropriate dosage and levels of potency. (Iversen, 2001)
The dataset used for this research is secondary data and comes from the Substance Abuse and Mental Health Data Archive, specifically, from The National Survey on Drug Use and Health (NSDUH). The NSDUH is a crucial source of statistical data related to alcohol, tobacco, and illicit drug use. It also includes data related to mental and physical health, and the data presented is specific to the general civilian population of the US, that is aged 12 or older. The survey includes data from 2002 to 2018 and since 2002, participants were rewarded with 30 US dollars each for participating in the data questionnaire. The questions asked in the NSDUH relate to the usage of several drugs, including marijuana, cocaine, and heroin. The survey also covers measures of mental disorders that can be used as a proxy for mental health. Furthermore, respondents were also questioned about sources and amounts of personal and family income, access to and coverage of health services, criminal activity and reports of convictions, issues resulting from drug use, perceptions of risks, and needle sharing. Finally, the demographic data extracted from this questionnaire includes gender, race, age, ethnicity, educational level, job status, income level, veteran status, household composition, and population density.
The sample of this study, however, consists of 56,313 participants (at least 18 years old) at the time of the cross-sectional survey. With concerns about statistical analysis, this research depends on descriptive and inferences analysis such as gender, ethnicity, age, education level, and income descriptive statistics. A Chi-square test will be performed to identify potential associations and confounders among demographic variables; multiple logistic regression modeling will be used to analyze research questions and to determine the odds ratios of associations between the independent variable and the dependent variables. All analyses were conducted at the α=.05 level of significance.
It is important to mention that generally, the NSDUH does not provide analysts with state identification details at the individual level. Since eleven states legalized recreational use of marijuana, the NSDUH is of limited use when attempting to estimate the effect of legalization on marijuana use. That is why this paper focuses primarily on the effects of marijuana use on physical and mental health outcomes.
This dataset will then be analyzed from an econometric point of view. That being said, the latter contains many variables that are relevant to look at and there is already a clear plan of the causal relationships that are to be tested. In order to proceed, it is important to mention a crucial element of this paper. Two hypotheses are proposed in order to support the research question aforementioned and to address this paper’s topic:
H1: Marijuana use leads to a deterioration of physical health outcomes
H2: Marijuana use leads to a deterioration of mental health outcomes
With regards to H1, and considering the dataset’s variables and possibilities, it would be of interest to statistically test what the literature proposes. To emphasize, based on the literature mentioned above, the unique dataset used for this paper includes variables about many different physical and mental health outcomes. It is therefore possible to test each phenomenon in a different context and with a different sample to check whether or not it would still be valid elsewhere. Some variables are about lung/bladder cancer, but also regarding pulmonary diseases, opioid consumption, psychological distress, tuberculosis, and many other measures. Thereupon, this research aims at guiding policymakers to apply proper legislation regarding the legalization of cannabis.
Bostani, M., Nadri, A., &Nasab, A. R. (2014). A study of the relation between mental health and academic performance of students of the Islamic Azad University Ahvaz branch. Procedia-Social and Behavioral Sciences, 116(21), 163-165.
Cambridge Dictionary. (2020, April 15). marijuana definition: 1. a drug, illegal in many countries, that is made from the dried leaves and flowers of the hemp…. Learn more. Retrieved from https://dictionary.cambridge.org/dictionary/english/marijuana
Feeney, K. E., &Kampman, K. M. (2016). Adverse effects of marijuana use. The Linacre Quarterly, 83(2), 174-178.
Gordon, A. J., Conley, J. W., & Gordon, J. M. (2013). Medical consequences of marijuana use: a review of current literature. Current Psychiatry Reports, 15(12), 419.
Hollingsworth, J. C. (2019, September 25). Canberra becomes the first city in Australia to legalize marijuana. Retrieved from https://edition.cnn.com/2019/09/25/asia/australia-cannabis-legal-intl-scli-hnk/index.html
Iversen, L. L. (2001). The science of marijuana. Oxford University Press.
Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use. Institute for social research.
Marie, Olivier, and Ulf Zölitz. “High” achievers? cannabis access and academic performance.” The Review of Economic Studies 84, no. 3 (2017): 1210-1237.
McGinty, E. E., Niederdeppe, J., Heley, K., & Barry, C. L. (2017). Public perceptions of arguments supporting and opposing recreational marijuana legalization. Preventive medicine, 99, 80-86
Mönckeberg, F. B. (2014). Pros and cons of legalizing marijuana. Revistachilena de pediatria, 85(2), 229-237.
National Survey on Drug Use and Health. (2019, August 20). 2018 NSDUH Detailed Tables | CBHSQ Data. Retrieved from https://www.samhsa.gov/data/report/2018-nsduh-detailed-tables
The National Survey on Drug Use and Health. (2020). NSDUH-2002-2018-DS0001 (NSDUH-2002-2018-DS0001) | SAMHDA [Dataset]. Retrieved from https://datafiles.samhsa.gov/study-dataset/nsduh-2002-2018-ds0001-nsduh-2002-2018-ds0001-nid18772
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