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Published: 06 February 2025

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Medicine that’s Smoked? Who is ‘Prescribing’ this Toxin?

The growing acceptance of medicinal cannabis has led to increased prescription rates worldwide, with smoking remaining the predominant administration method despite mounting scientific evidence questioning its safety and efficacy. Recent research has revealed significant concerns about particulate matter emissions, inconsistent drug delivery, and potential long-term health consequences that challenge the therapeutic validity of this administration route. This analysis examines the current scientific evidence regarding smoked medicinal cannabis, highlighting critical concerns that healthcare providers and patients should consider.

Particulate Matter Emissions: A Major Health Risk

Recent comparative studies between cannabis and tobacco cigarettes have revealed alarming data about particulate matter (PM) emissions. Laboratory analysis demonstrates that cannabis smoke contains substantially higher PM levels in second-hand smoke than tobacco cigarettes, with PM1 emissions exceeding reference cigarettes by 105%. Cannabis mixed cigarettes similarly showed elevated emissions, with PM10 levels 93% higher than reference cigarettes. These findings are particularly concerning given that the largest proportion of particle mass consists of particles with diameters less than 1μm.

The implications of these elevated PM levels extend beyond the immediate user. Second-hand cannabis smoke presents a significant environmental health hazard, with PM concentrations often exceeding safety thresholds established for indoor air quality. The higher PM emissions from cannabis suggest that even in well-ventilated spaces, bystanders may be exposed to potentially harmful levels of particulate matter.

Research indicates that these fine particles can penetrate deep into lung tissue, potentially causing both acute and chronic respiratory issues. The smaller particle size distribution in cannabis smoke compared to tobacco smoke suggests these particles may reach deeper into the respiratory system, potentially causing more significant damage to alveolar tissue.

Pharmacokinetic Complexities and Delivery Inconsistencies

Detailed pharmacokinetic studies reveal fundamental problems with smoking as a delivery method for medicinal compounds. THC delivery yields through smoking are remarkably inefficient, with studies showing yields ranging from just 7.2% to 28.0%. This inefficiency stems from multiple factors: up to 50% of cannabinoids are lost in side-stream smoke, 30% are destroyed by pyrolysis, and approximately 10% remain trapped in the cigarette butt.

The pharmacokinetic profile of smoked cannabis follows a complex three-compartment model, leading to highly variable absorption rates and unpredictable blood concentration levels. This variability makes it extremely difficult for healthcare providers to establish reliable dosing protocols or predict therapeutic outcomes.

Temperature-Dependent Composition Changes

Recent research has uncovered significant changes in cannabis cigarette composition during the smoking process. As smoking progresses, a temperature gradient develops along the cigarette, ranging from 470°C to 812°C at the burning tip to under 100°C at the mouth end. This gradient creates a complex series of chemical transformations that fundamentally alter the therapeutic profile of the medicine. Laboratory analysis demonstrates that the neighbouring section to the burning tip maintains temperatures above 300°C, while the following section ranges between 100°C and 300°C, creating distinct zones of chemical activity.

The temperature variation leads to complex fluid dynamics within the cigarette structure. As hot air is drawn through the glowing end during inhalation, it creates thermal convection currents that affect compound distribution. Research shows that air temperature during inhalation typically exceeds the temperature of the fixed cannabis matter, leading to additional compound mobilisation and potential degradation. These thermal dynamics significantly impact the consistency of drug delivery and create unpredictable concentration gradients throughout the cigarette.

Decarboxylation and Compound Migration

The high temperatures near the burning tip cause rapid decarboxylation of cannabinoids, converting THCA to THC. However, this process is not uniform throughout the cigarette. Analysis shows that sections closer to the mouth end contain higher concentrations of active compounds, as these molecules evaporate from the hot zones and recondense in cooler regions. Research demonstrates that after smoking just one quarter of a cigarette, the fraction of decarboxylated THC increases from 0.05 to 0.47 in sections closest to the burning end.

The movement of compounds away from high-temperature zones is critical for preserving therapeutic molecules that would otherwise be destroyed. Studies indicate that without this migration, most cannabinoids would be fully oxidised to CO2 and water in the highest temperature zones. However, the migration process itself introduces new variables affecting drug delivery. Cannabinoid vapours can exceed saturation in cooler regions, leading to condensation and the formation of small droplets. Some droplets reach the inhaled smoke, while others become trapped in the cigarette matrix, creating inconsistent delivery patterns.

Differential Vaporisation Effects

The varying boiling points of different compounds lead to a sequential release pattern during smoking. Monoterpenes, with their lower boiling points, reach the smoke first, followed by sesquiterpenes and cannabinoids. This staged release means early puffs contain primarily monoterpenes, while later puffs deliver higher concentrations of cannabinoids. Research shows that THC and CBD, with boiling points around 425°C, have partial vapor pressures of approximately 6.7 and 40 Pa at 155°C and 190°C respectively, affecting their release patterns.

The temperature gradient also influences the spatial distribution of compounds within the cigarette. Studies reveal that monoterpenes, due to their higher volatility, can move further from the hot zone and often concentrate in the bottom section of the cigarette. In contrast, sesquiterpenes and cannabinoids tend to recondense in closer proximity to their evaporation point. This differential movement creates zones of varying therapeutic compound ratios throughout the cigarette, making each puff potentially different in composition from the last.

Clinical Efficacy and Therapeutic Limitations

The inconsistent nature of smoked cannabis delivery has significant implications for clinical efficacy. Studies of pain management outcomes show highly variable results, partly due to the unpredictable nature of compound delivery through smoking. Research indicates that if one half of a cigarette is used in the morning and the other half at night, the evening dose might contain nearly twice the concentration of active compounds compared to the morning dose. This variability makes it extremely difficult for healthcare providers to establish reliable dosing protocols.

These delivery inconsistencies particularly impact patients using cannabis for chronic conditions requiring precise dosing. Clinical studies demonstrate that the variable ratio of cannabinoids to terpenes throughout the smoking session can affect the entourage effect, potentially altering therapeutic outcomes. Furthermore, research shows that terpenes, which may contribute to the analgesic effects of cannabis, are often inhaled before cannabinoids due to their lower boiling points, potentially reducing the synergistic benefits of these compounds.

The timing and sequence of compound delivery also affect therapeutic outcomes. Studies indicate that monoterpenes, which may have anxiolytic and anti-inflammatory properties, are largely delivered in the early stages of smoking. This means that patients seeking specific therapeutic effects might receive inconsistent benefits depending on how much of the cigarette they consume and in what timeframe. Additionally, research shows that delivery yields vary significantly based on smoking parameters, with factors such as puff frequency, puff length, and puff volume all affecting the concentration and ratio of therapeutic compounds in the inhaled smoke.

Cost-Effectiveness Considerations

While some analyses suggest potential cost-effectiveness for specific conditions like neuropathic pain, these studies often fail to account for several critical factors. The high wastage rate of active compounds during smoking significantly impacts the economic efficiency of this delivery method. Additionally, the potential long-term healthcare costs associated with respiratory issues from chronic smoke exposure are rarely factored into these analyses.

A comprehensive cost analysis reveals that when accounting for product wastage, healthcare costs, and variable absorption rates, smoking may be less economically viable than alternative delivery methods. The need for larger quantities of cannabis to achieve therapeutic effects due to poor bioavailability further impacts cost-effectiveness.

Long-Term Health Implications

The chronic effects of medicinal cannabis smoking present complex health concerns that extend beyond immediate therapeutic benefits. Research demonstrates that regular exposure to cannabis smoke results in significant changes to respiratory tissue structure and function. Laboratory studies have identified that cannabis smoke causes distinctive damage patterns to small blood vessels in lung tissue, with observed scarring patterns different from those seen in tobacco smoke exposure. This vascular damage may have cumulative effects over time, potentially leading to reduced gas exchange efficiency and compromised respiratory function.

Particulate matter exposure from cannabis smoke shows unique characteristics that may pose specific health risks. Studies reveal that cannabis smoke particles have different size distributions and chemical compositions compared to tobacco smoke, with a higher proportion of particles in the sub-micron range. These smaller particles can penetrate deeper into lung tissue and may have greater potential for systemic distribution throughout the body. Research indicates that particles smaller than 1μm can cross the blood-brain barrier and potentially impact neurological function over time.

The cardiovascular implications of long-term cannabis smoke exposure are particularly concerning. Studies have documented changes in blood vessel function and inflammatory markers in regular cannabis smokers, even in the absence of tobacco use. Research shows that cannabis smoke exposure can lead to increased blood pressure variability and altered heart rate patterns, potentially contributing to long-term cardiovascular risk. These effects appear to be independent of the therapeutic benefits of cannabinoids and may represent a distinct risk factor for cardiovascular disease.

Emerging research suggests potential immune system effects from chronic cannabis smoke exposure. Laboratory studies have identified alterations in immune cell function and inflammatory response patterns in regular cannabis smokers. These changes may have implications for susceptibility to respiratory infections and other immune-mediated conditions. Studies indicate that regular cannabis smoking can modify the expression of immune system genes, potentially affecting long-term immune function.

The potential for dependency and tolerance development presents another long-term concern. Research utilising intracranial self-stimulation (ICSS) models demonstrates that chronic cannabis smoke exposure can lead to significant changes in reward system function. Studies show that after continuous exposure, administration of CB1 receptor antagonists induces dose-dependent increases in ICSS thresholds, suggesting the development of physical dependence. This adaptation may affect both therapeutic efficacy and the potential need for dose escalation over time.

Epigenetic changes associated with long-term cannabis smoke exposure represent a newly recognised area of concern. Research indicates that regular exposure to cannabis smoke can alter DNA methylation patterns and histone modifications in respiratory tissue. These changes may persist even after cessation of smoking and could potentially influence disease susceptibility and therapeutic response patterns. Studies suggest that these epigenetic modifications may affect not only respiratory function but also systemic inflammation and immune response patterns.

The interaction between chronic cannabis smoke exposure and aging presents additional complexities. Research indicates that older individuals may be more susceptible to the negative effects of particulate matter exposure and may experience different patterns of cardiovascular and respiratory complications. Studies show that the combination of age-related changes in lung function and cannabis smoke exposure may accelerate certain aspects of respiratory aging, potentially leading to earlier onset of age-related respiratory conditions.

Respiratory System Impact

The high temperature of cannabis smoke and its particulate composition can cause direct damage to respiratory tissue. Studies indicate that cannabis smoke exposure leads to:

• Inflammation and damage to small blood vessels in lung tissue
• Potential scarring and reduced gas exchange efficiency
• Increased susceptibility to respiratory infections

These findings are particularly relevant given that many medical cannabis users consume the drug daily for extended periods. The cumulative effect of chronic exposure to high-temperature smoke and elevated PM levels may lead to progressive respiratory dysfunction.

Cannabis smoke contains many of the same carcinogenic compounds found in tobacco smoke, but often in higher concentrations. While definitive longitudinal studies are lacking, the biological plausibility for increased cancer risk cannot be ignored, especially given the high temperature of cannabis combustion and increased tar exposure per inhalation.

Safety Protocols and Quality Control

The lack of standardised safety protocols for medicinal cannabis smoking presents critical concerns that extend beyond basic quality control issues. Research reveals significant variations in product composition, with THC content varying from 14.3% to 23.5% even in controlled studies. This variability is compounded by differences in cigarette construction, with studies showing that factors such as filter design dramatically impact compound delivery. For instance, analysis of commercial products found that star-shaped cutouts in filters, intended to improve airflow, actually decrease filtration efficiency and lead to increased particulate matter exposure.

The physical characteristics of cannabis cigarettes significantly influence mainstream smoke composition and therapeutic delivery. Laboratory studies demonstrate that paper type, paper porosity, and filter composition can alter cannabinoid delivery by up to 40%. Research indicates that recycled, less robust wrapping materials may influence carbonyl quantities in smoke, while differences in filters impact the reduction of harmful volatile constituents. Fast-burning, bleached, and flavoured papers have been shown to contribute to higher levels of aerosol toxicants, with formaldehyde levels particularly elevated in products using certain paper types.

Quality control challenges extend to the cultivation and processing of medical cannabis. Studies show that terpenoid content can vary by up to 40-fold across different cannabis varieties, even when grown under standardised conditions. This variation significantly impacts both therapeutic efficacy and potential health risks, as different terpenoid profiles alter the formation of harmful compounds during combustion. Additionally, research indicates that storage conditions and product age can significantly affect cannabinoid degradation rates and the formation of potentially harmful compounds like cannabinol (CBN).

Future Directions and Research Needs

Current research gaps in smoked medicinal cannabis are substantial and multifaceted. Longitudinal studies examining carcinogenic potential and other health hazards are notably absent, with most existing data derived from recreational use patterns. Studies indicate that while there isn’t conclusive evidence linking cannabis smoking to cancer, biological plausibility exists for multiple adverse health outcomes, including testicular germ cell cancer and cardiovascular complications.

Pharmacokinetic research reveals critical areas requiring investigation. Studies using three-compartment pharmacokinetic models show complex distribution patterns that aren’t fully understood. Current data indicates that chronic cannabis smoke exposure has rewarding properties that may complicate therapeutic use, with studies showing significant changes in intracranial self-stimulation thresholds after repeated exposure. This suggests a need for research into dependency potential and its impact on therapeutic applications.

Alternative Delivery Systems

Recent research into alternative delivery methods has yielded promising results that warrant further investigation. Electronic drug-delivery systems (EDDS) and whole plant vaporisers have demonstrated lower toxicant yields compared to combusted material. Studies show that vaporised pure CBD produces significantly greater subjective drug effects and pleasant drug effects compared to oral administration, while causing less respiratory irritation than smoking.

The development of temperature-controlled vaporisation systems shows particular promise. Research indicates that precise temperature control can selectively vaporise desired compounds while minimising the formation of harmful byproducts. Studies demonstrate that vaporisation between 160-180°C effectively releases cannabinoids while producing significantly fewer polyaromatic hydrocarbons compared to smoking. However, challenges remain in standardising these devices and ensuring consistent delivery across different cannabis preparations.

Standardisation Protocols

The development of comprehensive quality control standards requires addressing multiple technical challenges. Research indicates that conventional cigarette manufacturing is highly automated with established quality metrics, but cannabis products lack similar standardisation. Studies show that quality control measures must account for complex interactions between product characteristics and delivery efficiency.

Analytical methods for assessing product quality need refinement. Current research employs various techniques including high-performance liquid chromatography (HPLC) and gas chromatography (GC) analysis, but standardised protocols for measuring critical parameters are lacking. Studies demonstrate that methods must be validated for at least 12 cannabinoids and 25 terpenes to adequately characterise product composition. Additionally, research indicates that current methods for measuring delivery efficiency, which show variations from 7.2% to 28.0%, need standardisation to ensure consistent therapeutic delivery.

Recommendations

The scientific evidence strongly suggests that smoking medical cannabis, despite its widespread use, presents significant health risks and therapeutic limitations that outweigh its potential benefits for most medical applications. The combination of high particulate matter emissions, poor delivery efficiency, inconsistent drug absorption, and potential long-term health consequences makes it a problematic choice for medical treatment.

Healthcare providers should prioritise alternative delivery methods when prescribing medicinal cannabis, particularly for chronic conditions requiring long-term use. Patient education about the risks associated with smoking should be mandatory, and development of standardised, safer administration methods should be prioritised by the medical and research communities.

The continued use of smoking as a primary delivery method for medicinal cannabis appears to be driven more by historical and cultural factors than by scientific evidence of safety or efficacy. As our understanding of cannabis pharmacology advances, the development of safer, more reliable administration methods becomes increasingly important for realising the full therapeutic potential of cannabis-based medicines. (Source: WRD News)

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Published: 04 February 2025

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One potential harm of increased access to cannabis is poisoning. It is widely believed that cannabis is safe in overdose,^{3 but it can cause central nervous system (CNS) excitation, CNS depression, hallucinations, psychosis, and cardiac dysrhythmias.4 The risk of severe toxicity is greater for children, in whom it can lead to apnoea and coma; in one United States study, 32 of 60 children (0–10 years) hospitalised with cannabis intoxication required intensive care.5 Several studies have reported increases in the number of poisonings following medicinal and recreational cannabis legalisation, particularly in children.6 Edibles are particularly high risk products because of their palatability and the possibility of large ingestions.2 Most reports on this problem are from North America.6}

In Australia, the medicinal use of cannabidiol (CBD) was legalised in June 2015, and that of cannabis and tetrahydrocannabinol (THC) in November 2016.^{7 We therefore evaluated recent cannabis poisoning exposures in Australia, stratified by ingestion intent, age group, and product type. We analysed data from the New South Wales Poisons Information Centre (NSWPIC), which receives about 50% of all calls to Australian poisons information centres; 65% of calls are from within NSW, 35% from other states.8 We extracted data on demographic and exposure characteristics, patient disposition, and cannabinoid product types for calls during 1 July 2014 – 30 June 2024. We calculated crude and age-adjusted population exposure call rates (Supporting Information, supplementary methods), and used Joinpoint regression (version 4.9.0.1) to estimate annual percentage changes (APCs) in age-adjusted rates and to detect trend change points. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2021/ETH00165).}

There were 3796 calls about cannabis poisoning exposures (2039 regarding exposures of boys or men, 54%) during 2014–24. The exposed person exhibited symptoms of poisoning at the time of the call in 3184 cases (84% of calls); 2783 people (74%) were in hospital at the time of the call or were referred to hospital (Supporting Information, table 1). The number of calls increased during 2014–24 by 12.8% per year (95% confidence interval [CI], 10.3–15.4% per year), and no trend change points were detected (Box 1). Intentional cannabis exposures were reported by 2981 calls (79% of calls), and the number increased by 9.2% (95% CI, 6.3–12.2%) per year. Unintentional cannabis exposures were re

The age-adjusted cannabis poisoning exposure rate was highest for adolescents (15–19 years; 11.4 calls per 100 000 population per year); the age-adjusted rate for unintentional exposures was highest for toddlers (1–4 years; 1.9 calls per 100 000 population per year) (Supporting Information, table 2).

We found that the number of cannabis poisonings reported increased significantly in Australia during 2014–24, particularly exposures of children and adolescents. The reported number of exposures to edibles, which pose a particular risk for young children,^{13 has increased. Our findings are relevant to discussions of increasing access to medicinal cannabis and legalising its recreational use. Lessons learned overseas with different legislative models could be applied in Australia. For example, the sale of edibles is not permitted in some Canadian provinces, and significantly more children are hospitalised with cannabis intoxication in provinces where they are sold.2 While using orally ingested cannabis forms may be less harmful in the long term than smoking cannabis, the acute poisoning risk posed by edible forms of cannabis must be considered. Particular caution needs to be applied to confectionery forms that are attractive for children.}

(For complete research - Source: The Medical Journal of Australia 2025)

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Published: 28 January 2025

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Cannabis & Driving – Whilst old school sobriety tests will confirm intoxication in most instances, the 'lollipop – lick sticks’ ensures the so called 'seasoned' users and those who call their intoxicating substance ‘medicinal’ are also taken off the road. No one should drive any vehicle intoxicated - ever.

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Also see

1. Rising Need for Roadside Drug Testing
2. Cannabis and Driving: Victorian Law Change for ‘Medicinal’ Cannabis Users – But is Road Safety Seriously Compromised?

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Published: 27 January 2025

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Publication: Psychiatric News Volume 60, Number 1

With researchers continuing to find that cannabis in all its forms is helping fuel the youth depression and suicide epidemic, psychiatrists have a role to play in assessing and treating cannabis use—and countering disinformation.

There is mounting evidence that young people’s use of cannabis is fuelling depression and suicide in this population, according to experts who recently spoke during a session at the American Academy of Child and Adolescent Psychiatry’s annual meeting.

“Expanded cannabis product offerings, increasing potency, and an increase in state and local legalization laws are posing unprecedented exposure to young people during a critical period of brain development,” said esse D. Hinckley, M.D., Ph.D.J, associate clinical professor of psychiatry and co-founder of the addiction biology laboratory at the University of Colorado School of Medicine.

When it comes to youth, “cannabis prevention and early intervention are suicide prevention,” Jesse D. Hinckley, M.D., Ph.D., said. “There’s an even greater need for these programs in states that have passed recreational or medical cannabis laws, where youth cannabis use is more prevalent.”

Research has found a strong correlation between cannabis use and depression and suicidality in adults, and although the association is not as definitive in youth, Hinckley said that emerging data suggests that adolescents are similarly impacted.

Suicide is the second-leading cause of death among U.S. youth, accounting for one in five deaths in young people. Nearly one-third (30%) of female youth “seriously considered” suicide, while 13% attempted to die by suicide, according to the 2023 Youth Risk Behavior Survey, as did 14% and 7% of male youth, respectively. According to the National Institute of Mental Health, 20% of U.S. youth ages 12 to 17 experienced past-year major depressive disorder (MDD) in 2021.

“Cannabis has changed as legalization has progressed,” Hinckley said. “The biggest impact has been in the concentration or percentage of THC [tetrahydrocannabinol] within products, the types of products available, and the frequency of use of concentrates rather than [less-potent] flower-based products.”

Tests performed on confiscated cannabis have found it contains 10 times greater THC, the psychoactive compound that makes users feel high, than in the late 1970s. Back then, flower products were around 1% to 3% THC; as of 2023, they were 16% to 25% in most states, with one grower reportedly producing a plant that was 40% TCH. Concentrated products, such as vapes, edibles, and wax/dabs, are far more popular, and now routinely contain 60-90% THC, up from 20-30% a few decades prior.

“In other words, even products marketed as ‘concentrates’ 15 years ago weren’t as potent as many flower-based products are today,” Hinckley said.

Dose-Response Relationship: A study by Hinckley and colleagues issued by the Journal of the American Academy of Child and Adolescent Psychiatry in 2023 examined the results of a survey of 10,123 U.S. adolescents who provided data on their demographics, substance use, depression, suicidality, and mental health. They compared adolescents based on their cannabis use and found that cannabis users were:

• 2.35 times more likely to have MDD, 3.32 times more likely to have a past-12-month major depressive episode, and more likely to have greater depression severity.
• 3.7 times more likely to report suicide attempt—and those increased odds remained even after researchers controlled for whether the youth had depression.
• More likely to report feelings of guilt, appetite problems, and suicidal ideation. (However, researchers found no difference between adolescent cannabis users and never-users on other common mental health symptoms, such as anhedonia, sleep problems, and fatigue.)

Hinckley and colleagues found a dose-response relationship, meaning that the greater the youth’s exposure to cannabis, the higher the odds of MDD, suicidality, and more severe depression. “For example, youth who used cannabis occasionally—once a month or less—in the past year were five times more likely to have attempted suicide than youth who did not use cannabis at all,” Hinckley said. “Meanwhile, youth who used cannabis one to two days a week or three to four days a week were seven and nine times more likely to have attempted suicide, respectively.”

Hinckley also reviewed several published meta-analyses and longitudinal studies on the topic that came to similar conclusions about the association. One study issued in Lancet Psychiatry by Edmund Silins and colleagues in 2014 found that daily users of cannabis before age 17 were nearly seven times more likely to have attempted suicide as an adult.

Hinckley said that overall, the data points to an increased need to screen all youth for suicidality as well as for cannabis use. When it comes to youth, “cannabis prevention and early intervention are suicide prevention,” Hinckley said. “There’s an even greater need for these programs in states that have passed recreational or medical cannabis laws, where youth cannabis use is more prevalent.”

With Legalization, Increasing Use: According to the 2024 Monitoring the Future (MTF) survey, cannabis use in recent decades by youth ages 12 to 17 has remained mostly flat yet substantial: 29% of 12th graders reported past-year cannabis use. However, this tells only part of the story. Expanding legalization has resulted in 43% of young adults 19 to 30 years old reporting past-year cannabis use in the 2024 MTF, amounting to a 40-year record.

“At age 18, our brains do not magically flip a switch and finish developing,” Hinckley said. “This is a population at risk, and [cannabis] use rates are still going up.”

Furthermore, in May 2024, the U.S. Department of Justice proposed reclassifying marijuana as a Schedule III drug, citing its “accepted medical use” and less potential for abuse-related harms than other Schedule I and II drugs. (APA opposes this rescheduling because of the potential to increase public acceptance and use, as well as lead to psychiatric harms.)

In 1995, just one state—California—had legalized cannabis, and only for medical use, noted Cristopher Joseph Hammond, M.D., Ph.D., an assistant professor of psychiatry at Johns Hopkins University. Now, the majority of U.S. states have legalized cannabis for medical and/or recreational purposes.

“Along with that has come a dramatic explosion of commercialization,” Hammons said, “including novel products, formulations, and methods of administration of cannabinoids … such as concentrates, solid concentrates, edibles, beverages, and topical forms.”

For example, a newer psychoactive hemp derivative known as Delta-8-TCH was used by 12% of twelfth graders in 2024, according to the MTF, which assessed the product’s uptake for the first time that year. Altogether, the U.S. cannabis industry is expected to take in about $42 billion in revenue in 2024.

Hammond reviewed a study for which he and colleagues examined the impact of state cannabis laws on the 113,512 U.S. youth suicides (among 12- to 25-year-olds) reported from 2000 to 2019. He and colleagues found an overall suicide rate of 10.9 per 100,000 youth during that timeframe, but a rate of 12.8 deaths in states allowing medical use of cannabis. The rate climbed to 16.7 deaths per 100,000 in states allowing recreational cannabis. That translates to 5,000 youth suicide deaths that can be attributed to cannabis legalization laws, even after controlling for confounding variables, according to their study issued by the Journal of the American Academy of Child and Adolescent Psychiatry in 2023.

Hammond said that there is a wide gulf between public perception and reality when it comes to cannabis’ impact on adolescent mental health. One recent study suggests psychiatrists have a role to play in educating young patients and their families on the subject, he said. Researchers recruited 150 parents and their children who were receiving treatment at mood disorders clinics in one of 11 states. They found that more than 75% of youth and 65% of their parents perceived cannabis and CBD to be safe and effective mental health treatments, with half of respondents believing that clinicians should be prescribing or recommending cannabis for their patients. (Source: https://psychiatryonline.org/doi/10.1176/appi.pn.2025.01.1.15)