Since cannabis is now legal for recreational and medical use in over half of the states in the United States, it is of the utmost importance to do a thorough examination of these evolving regulations.
Jakarta, IO – Since cannabis is now legal for recreational and medical use in over half of the states in the United States, it is of the utmost importance to do a thorough examination of these evolving regulations to see how they will affect public health and if they can be responsibly implemented in countries like Indonesia.
To begin with, cannabis, or marijuana, was illegal in the United States. European and American legislators began to prohibit the use of drugs in 1910, followed by the actual cannabis prohibition in 1920 (Narconon International, 2018). Moreover, the Boggs Act (1952) demonstrated that the government had increased the penalties for marijuana consumption, while the Controlled Substances Act (1970) categorized marijuana as a Schedule I drug, indicating its high potential for abuse, lack of recognized medical use, and the need for supervised consumption. Cannabis use has increased significantly, according to a 2023 survey performed by the National Institute on Drug Abuse, which found that 81% of American people believed marijuana had at least one medical advantage. In 1996, California was the first state to authorize medicinal marijuana usage. Washington, Alaska, and Oregon followed in 1998. Colorado and Washington were the first states to allow marijuana usage for recreational purposes in 2012. However, a movement advocating for the legalization of marijuana emerged in the late 1960s, aiming to modify the federal laws controlling its usage (Single, 1989).
In the context of evaluating cannabis legalization policies in the United States, the application of the RE-AIM Framework provides a strong foundation for holistically understanding the impact of these policies on medical and recreational access, effectiveness in addressing public health issues, and the level of adoption, implementation, and maintenance of these policies. By examining all five domains: reach (proportion of the population with access), effectiveness (impact on public health), adoption (number of states legalizing), implementation (fidelity to policy), and maintenance (long-term sustainability), RE-AIM offers a comprehensive picture.
Reach analysis could explore which types of individuals have benefited from this policy. The legalization policy is believed to offer benefits to multiple parties, particularly in recreational aspects, where cannabis or marijuana is seen as advantageous for local communities in the United States as it boosts the state’s tax revenue (Pew Research Center, 2024). Although there are multiple perspectives on cannabis use, this policy could be beneficial for those who suffer from neurological conditions, seizures, nausea, or cancer-related appetite loss (Rogers, 2023). The exact number of people directly benefiting is unknown, but it’s evident that economically and from a medical perspective, a broader stratum of society is impacted.
Effectiveness might examine the policy through changes in public outcomes. According to a policy analysis by Dills et al. (2021), the legalization of marijuana has proven to enhance tax revenue in states like California, Colorado, Washington, and Oregon shortly after its legalization, with Washington, for instance, generating nearly $70 million in tax revenue solely from recreational marijuana sales within the first year. Moreover, Felix (2022) clarifies that recreational sales of marijuana are more likely to be much higher compared to medical sales. Although opinions on the medicinal advantages of marijuana are still divided, research has shown that states that have legalized marijuana for recreational use did so because of the drug’s ability to treat medical conditions (Brown et al., 2023; Pratt et al., 2019). Cannabis or marijuana has to be used under prohibition; if not, it can cause cannabis dependence (Budney et al., 2019) and psychiatric disorders (Marconi et al., 2016). In the domain of adoption, the analysis focuses on the quantity aspect. As per DISA (2023), the majority of states in the U.S. have adopted fully legalized marijuana for both recreational and medical purposes, while only four states continue to maintain its illegal status.
The implementation and maintenance domains are designed to examine the policy enactment process and how governments ensure the ongoing effectiveness of policies. According to the journal by Schauer (2021), licensing restrictions are implemented in several states for activities related to the production, processing, and sale of cannabis, with limited availability of licenses, except in the state of Washington, which prohibits financial ties between different industry segments. By having licenses and rules, governments can control who can do certain activities related to cannabis. Furthermore, he clarifies that state governments also establish taxes on marijuana products related to recreational usage to avoid criminalization, with the resulting tax revenues showing promise for state budgets.
Sales and purchases of marijuana also require all states to mandate testing for cannabis products based on the ISO 17025 standard before they can be sold to ensure public safety. Consumption is also regulated so that legal cannabis is typically restricted to private residences. While using it in rental properties or government housing is often prohibited, some states are exploring allowing consumption at licensed cannabis stores or other designated businesses. Cannabis or marijuana use under prohibition can lead to cannabis dependence (Budney et al., 2019) and psychiatric disorders (Marconi et al., 2016). The government now also regulates homegrown cannabis, with Illinois and Washington only allowing cultivation for medical purposes. However, other states that permit fully recreational cannabis consumption allow their residents to grow marijuana plants. Regulations for These retail stores aim to balance consumer access with public health and safety concerns. These regulations may include location restrictions, age verification measures, limitations on selling non-cannabis products, and, as seen in Nevada, even mandatory lockboxes (Schauer, 2021). However, it has been discussed in another journal that some limitations exist as the cases of fraud in the industry occur, such as documented instances of “lab shopping,” where businesses seek out laboratories that provide the highest THC test results (Schwabe et al., 2023).