How Marijuana Legalization Impacts Statewide Mental Health

Medical marijuana laws and recreational marijuana legalization have only been present in the United States for less than ten years. For many states, marijuana legalization (for recreational or medicinal use) was implemented less than five years ago.

There are few longitudinal health studies about regular cannabis use among Americans. There is also insufficient clinical data to determine how cannabis use may impact physical and mental health or what types of cannabis potencies and intake methods may present the most risk of causing adverse effects.

When it comes to some types of mental health conditions, cannabis use is contraindicated or not recommended. That includes patients diagnosed with schizophrenia or psychosis, which are two serious mental health diagnoses that can worsen with regular use of controlled substances, including alcohol and marijuana.

What happens after medical marijuana laws are established in the United States? Do people with access to legalized marijuana have a higher risk of developing mental health problems? Or does cannabis legalization have a positive effect, allowing patients to explore alternative health options that may work better for mental health symptoms?

Let’s dive into some important facts you need to know about medical cannabis and mental health conditions and how it may help with symptom management. We will also look at specific mental health conditions where medical cannabis is not recommended for use.

How Many Americans Are Using Cannabis On A Regular Basis?

Back in 2016, when the first state medical marijuana laws advanced and patient programs were established, there was a lot of concern about the impact of cannabis legalization on mental health. The federal branch in charge of behavioral health is The Substance Abuse and Mental Health Services Administration or SAMHSA.

According to SAMHSA’s annual report: “Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health, the number of Americans using cannabis was nominal:

• 6.5% of teens aged 12-17 engaged in adolescent marijuana use.
• 20.8% of young adults aged 12-17 years had used cannabis in the month prior to the survey.
• 7.2% of adults aged 26 or older had used cannabis in the preceding thirty-day period.

Fast forward to the same survey conducted by The Substance Abuse and Mental Health Services Administration in 2022, now that the majority of United States jurisdictions have legalized medicinal cannabis.

• 14.3% of teens aged 12-17 were active cannabis users.
• 40.9% of young adults aged 18-25 years engaged in cannabis use.
• 23.7% of adults aged 26 or older had used cannabis in the 30-day period before the survey.

Legalized marijuana did what public health officials thought it would do: increase the number of Americans using cannabis on a regular basis, either medicinally or recreational marijuana use.

There are many studies that evaluate whether increased use has had a detrimental effect on mental health outcomes in states where legalized marijuana is available. Suppose you are looking for a straight answer. In that case, there is research that supports the benefits of medical cannabis for mental health conditions, and others that warn cannabis may exacerbate mental health issues or make symptoms worse.

Recent Study States No Increase in Mental Health Disorders Caused by Cannabis Use

Cannabis use disorder is tracked, like other types of drug and alcohol dependence statistics, to evaluate public health implications. An individual may be diagnosed with cannabis use disorder if they are consuming cannabis on a daily basis in excess of what is needed to help manage symptoms.

In January 2023, an important study was published called: “State Cannabis Legalization and Psychosis-Related Health Care Utilization.” The study evaluated almost 64 million Americans and Medicare Advantage and other commercial insurance claims made for mental healthcare-related services.

The study found that state legalization (both medical and recreational laws) had no impact and did not show a significant increase in the rates of psychosis-related mental health diagnoses. The report also revealed that there was no increase in prescribed antipsychotic medications from 2003 to 2017 in states where medical or recreational marijuana was available.

Cannabis Use Disorder May Increase The Risk Of Developing Schizophrenia

Studies by the National Institutes of Health (NIH) are monitoring another aspect of mental health outcomes that may be negatively impacted by cannabis use disorder. In a news release from NIH on May 4, 2024, researchers suggested a link between diagnoses of schizophrenia and cannabis use disorder.

The discussion in “Young men at highest risk of schizophrenia linked with cannabis use disorder” was based on fifty years of data reviewed by the National Institute on Drug Abuse (NIDA) and the Mental Health Services in the Capital Region of Denmark. More than 6 million patient health records were reviewed.

Researchers discovered a strong association between cannabis use disorder and schizophrenia. The presence of CUD increases the risk of developing schizophrenia. Cannabis use disorder is defined as individuals who are unable to stop using cannabis, even when marijuana use may be having a negative impact on their health and lives.

The study also indicated that the association between cannabis use disorder and schizophrenia was higher among young men compared to female patients. The authors of the study estimated that as many as 30% of diagnosed cases of schizophrenia among men aged 21-30 may have been prevented by avoiding or successfully treating cannabis use disorder.

What States Have The Highest Rate of Mental Health Diagnoses?

Of all regions in the United States, Montana had the highest rate of mental illness per capita, based on 2021 data. Approximately 26% of residents living in Montana were living with a mental illness diagnosis, while almost 7% reported having a serious mental health disorder.

By comparison, the state with the lowest incident rate of mental illness was New Jersey, at 18.74%. In New Jersey, only 3.99% of adults disclosed they had been diagnosed with a serious mental health disorder.

The Top Five States With The Worst Mental Health Care Services

One of the biggest predictors of increased rates of mental health diagnoses is the availability of mental health care. Typically, some mental health services are covered by private health insurance plans. However, not every American has access to quality, affordable healthcare coverage.

In May of 2023, Forbes published an article called “The Worst States for Mental Health Care Ranked,” and it revealed some unsurprising statistics. In America, the states that provide the fewest number of mental health treatment centers and those with the highest number of citizens who lack health insurance had high mental illness incident rates.

Discover which states offer the worst levels of mental health care for patients, according to Forbes:

1. Texas

The Lonestar State had the highest percentage of adults with a mental disorder diagnosis who lack health insurance, averaging just above 21%. That made Texas the worst state for mental health care in the country in 2023.

Texas also has the fifth-lowest number of mental health treatment facilities for residents and the fourth-highest percentage of minors without access to mental health services. The article reported that 40.65% of adults with a cognitive disability could not receive treatment due to out-of-pocket costs in Texas that year. Alarmingly, 73.1% of Texas youth diagnosed with a major depressive episode in the previous twelve months did not receive mental health treatments or support.

2. Mississippi

Mississippi earned the ranking of the second worst state in America for mental health conditions, with the second lowest number of treatment centers (36.33 per 10,000 businesses). Approximately 72% of Mississippi youth who had a major depressive disorder in the previous twelve months did not receive any treatment or support.

The number of adults living with a mental illness who do not have health insurance in Mississippi was just over 18% of the population. That made Mississippi the fourth highest in terms of adults without health insurance.

3. Alabama

The state of Alabama earned second place with the highest percentage of adults with mental illnesses who did not have health insurance (19.3%). Alabama also has the third lowest number of mental health treatment centers out of all states, with 38.33 per 10,000 businesses).

Approximately 12.5% of adolescents in Alabama have private health insurance that offers no mental health or emotional treatment services.

4. Georgia

In terms of patients with mental health needs who did not receive treatment from 2022 to 2023, Georgia tied for second place. Approximately 64% of patients diagnosed with a mental health condition went without professional care or resources in Georgia that year.

Patients who had a cognitive disability in Georgia also struggled to receive mental health care, with 39% of patients who could not see a doctor during that same period. Georgia also has the fifth highest percentage of youth who were diagnosed with a major depressive episode who did not receive care, at 67.8%.

5. Florida

The state of Florida tied with Georgia for the second-highest number of adults with a diagnosed mental illness who did not receive treatment. Approximately 64% of patients did not have access to mental health treatment planning or support.

Florida has the sixth-highest percentage of adults with mental health disorders who do not have health insurance. Lack of insurance impacts 17.8% of patients in the Sunshine State. Additionally, from 2022 to 2023, over one-third of Florida adults who were diagnosed with a cognitive disability were unable to seek treatment due to the cost of care.

Public health information on mental health conditions and the impact that cannabis may have (positive or negative) on disorders must be evaluated with a number of considerations. The leading cause of untreated mental health conditions is a lack of affordable care and support programs, which varies by state.

Can Medical Marijuana Help Patients Cope With Symptoms of Mental Health Disorders?

Chronic pain remains the leading reason why Americans try medical cannabis. However, providing help with symptoms of depression or moderate to severe anxiety and stress are also common reasons that patients get a medical cannabis card.

Here are some of the emotional self-care needs that may prompt patients to get a medical card:

1. Reducing Stress and Anxiety with Medical Cannabis

If you are feeling a little more generalized stress than normal, you aren’t alone. A recent report from the American Psychological Association (APA) indicates that 27% of Americans are experiencing days when the impact of external stressors is so great that they cannot function.

The results from the poll were published in October 2022, and the causes of stress were varied. Americans responded that extreme emotional stress was caused by four primary factors:

• 83% responded that inflation and increased cost of living were the primary source of stress.
• 75% reflected that growing violent crime had substantially increased chronic stress levels.
• 66% of Americans felt the current political climate was causing high stress.
• 62% felt that racial tension was a significant source of stress.

When stressors are external, they are often beyond the control of the individual to improve. Since you cannot change the sources of stress and anxiety, finding ways to relax and cope with stress is very important. Cannabis may be an effective way to unwind, relax, and take a break from some of the existential sources of stress around you.

2. Alleviating Impact on Mood from Chronic Pain

Whenever you experience pain, it is likely to have a negative impact on your mood. How can you feel happy, energetic, or in a good mood when you are experiencing moderate to severe pain? Now imagine that the pain you experience is an everyday occurrence.

Chronic pain has a significant impact on mood because it never goes away. Patients who have chronic pain conditions may try a variety of different treatments without success. Some methods of treating chronic pain include prescription medications, which can also have a detrimental impact on mood, and in some cases, the drugs can exacerbate symptoms of depression.

Medical cannabis may provide relief as an analgesic that works differently than many prescription pain medications. Some patients also find that cannabis has fewer negative side effects compared to popular drugs used for pain management. Certain strains may not only temporarily reduce pain perception but elevate mood and energy.

3. Addressing Trauma with Medical Cannabis

Emotional trauma can have a lasting impact on mental health, leading to symptoms like flashbacks, nightmares, and emotional hypervigilance. Many patients struggle to cope with these symptoms, which can interfere with their ability to function in daily life.

Medical cannabis may offer relief by calming the nervous system and reducing the intensity of traumatic memories. This can help patients feel more grounded and present, allowing them to move forward with their lives and heal from past traumatic experiences.

4. Managing Symptoms of Depression

Depression can manifest in a variety of ways, including persistent sadness, loss of interest in activities, changes in appetite or sleep patterns, and feelings of worthlessness or guilt. These symptoms can be overwhelming and make it challenging to enjoy life or connect with others.

Medical cannabis may offer hope for patients living with moderate to severe depression. By boosting levels of specific neurotransmitters in the brain, cannabis can improve mood and promote feelings of inner peace and overall well-being. Some strains of cannabis can also provide a temporary boost in energy to help combat symptoms of chronic fatigue associated with depression.

Potential Adverse Effects of Cannabis On Mental Health

Patients should be aware that for some people diagnosed with mental health conditions, cannabis may exacerbate symptoms. While cannabis is well tolerated by many, there are specific types of mental health conditions that are contraindicated for cannabis use.

The reason stems from the way cannabis affects the human brain and neurotransmitter messaging through the central nervous system. As discussed, cannabis can act as both a stimulant and a depressant when consumed, which can create problems for people with different types of mental health diagnoses.

Here is a breakdown of potential adverse effects by mental health diagnosis and why individuals with these conditions should talk to a physician before using cannabis:

Anxiety Disorders

People who have been diagnosed with moderate to severe clinical anxiety can benefit from taking medical cannabis. In fact, anxiety management is one of the most common reasons why Americans turn to cannabis to improve their quality of life.

However, cannabis can also exacerbate the symptoms of anxiety disorders. That may cause increased paranoia and heightened anxiety levels, which can trigger panic attacks depending on different factors, including the type of strain (and mix of minor cannabinoids), the established level of tolerance to cannabis, and more.

Cannabis can either calm someone who has clinical anxiety or potentially increase levels of emotional unease. Patients who have been diagnosed with anxiety and are taking medical cannabis for the first time should observe their symptoms and consult with a healthcare provider regarding any adverse effects.

Treatment Resistant Depression (TRD)

Among all Americans diagnosed with depressive disorders, 30% of patients have treatment-resistant depression or TRD. This condition is characterized by severe depressive symptoms that do not respond to treatments, including cognitive behavioral therapy and psychotropic prescription medications.

Symptoms of treatment-resistant depression may be caused or exacerbated by:

• Genetic predisposition that causes resistance to some types of antidepressant medications.
• Other underlying mental health conditions, such as complex anxiety disorders, trauma, personality disorders, and substance abuse, which can limit the efficacy of standard treatments.
• Stressful live events that are ongoing, such as chronic medical conditions or pain, inadequate social support, work or family-related stressors, and more.

Some studies have suggested that medical cannabis use may help provide relief for patients who experience treatment-resistant depression. However, as cannabis may behave as both a stimulant and depressant when consumed, it also has the potential to exacerbate symptoms of depression.

A study called “Cannabis-induced oceanic boundlessness,” published in the Journal of Psychopharmacology in 2021, found that 17% to 19% of adults with treatment-resistant depression experienced positive mental health breakthroughs using doctor-supervised cannabis. Roughly 20% of individuals with this severe type of depression may experience relief, but other patients may not notice a difference in depression symptoms.

Bipolar Affective Disorder

There are a few mental health conditions that cannabis healthcare providers would not recommend for the use of medical marijuana. Bipolar affective disorder is one of them. Several studies indicate that cannabis use can destabilize the mood of individuals with bipolar disorders. Marijuana use may actually disrupt normal neurotransmitter systems for patients, leading to increased mood swings and difficulties with normal mood regulation.

Some things for patients with bipolar affective disorder to consider as a potential negative effect of using medical cannabis include:

• Increased risk of symptoms of manic or hypomanic episodes.
• Increased risk of developing psychosis during manic phases.
• Contraindication of cannabis with many prescription antidepressants, antipsychotic medications, or mood-stabilizing drugs.
• Negative impact on cognitive functioning. Individuals with bipolar disorders can experience cognitive deficits during periodic mood episodes, and marijuana can increase cognitive impairment immediately following consumption.
• Possible risk of developing cannabis use disorder or addiction to other controlled substances. Individuals living with bipolar disorders have a statistically higher rate of substance abuse in the United States.

Patients with a diagnosis of bipolar disorder may not be certified by a cannabis healthcare provider if they wish to use medical cannabis. Talk to your provider to learn more about the risks and potential benefits of using medical marijuana to help with bipolar symptoms.

Psychosis and Schizophrenia Disorders

Cannabis use disorder (CUD) is statistically associated with an increased risk of developing psychosis and schizophrenia. For some people, THC can induce psychotic episodes; however, the highest risk appears to be chronic use of concentrates or high-potency cannabis products.

For people with a prior diagnosis of schizophrenia or psychosis, cannabis use can exacerbate symptoms in the following ways:

• May induce hallucinations, disorganized thinking, delusions, and feelings of paranoia.
• Cannabis may increase the risk of developing both psychosis and schizophrenia for vulnerable individuals who may have hereditary factors that increase susceptibility to severe mental health disorders.
• It may interfere with other treatments, including antipsychotic medications, making remission harder to achieve.
• It may increase cognitive impairment, including impairing higher executive functions of the brain, memory, focus, and attention skills.

Individuals diagnosed with psychosis and schizophrenia disorders have a statistically higher prevalence of substance abuse disorders. Cannabis use may present an additional addiction risk.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Some patients who have ADHD have reported that specific strains of cannabis may help with symptoms of anxiety. Other types of medical cannabis products may also help improve concentration and focus while reducing feelings of manic energy and mental activity.

There are three different types of attention-deficit hyperactivity disorder:

a) Predominantly Inattentive Presentation (ADHD-PI)

People diagnosed with ADHD-PI struggle primarily with attention and concentration. The symptoms can include organization problems and activities requiring sustained focus or attention to detail. Patients with ADHD-PI are most prone to being distracted by external stimuli and engage in avoidance behaviors to procrastinate on activities that disinterest them.

b) Predominantly Hyperactive-Impulsive Presentation (ADHD-PH)

Hyperactivity and impulsive behaviors are the associated symptoms of this type of ADHD. The behavioral symptoms can include fidgeting, difficulty engaging in quiet leisure activities, excessive talking (and interrupting others), and difficulty waiting even for short periods for reward or attention.

c) Combined Presentation (ADHD-C)

The last subtype of attention deficit hyperactivity disorder is a combination of a wide range of both ADHD-PH and ADHD-PI symptoms.

Individuals diagnosed with ADHD (or those who suspect they may have the mental health condition) should know that cannabis may have the potential to worsen symptoms. Cannabis can disrupt neurotransmitters, which can result in greater mood instability. When considering mental health and marijuana, it is important to consult with a healthcare provider to evaluate the potential advantages and risks associated.

Do State Mental Health Outcomes Improve After Medical Cannabis Becomes Available?

There is limited research available at the time of writing regarding medical marijuana, mental health therapy, and long-term improvements in the quality of life for patients. Some studies suggest that patients with moderate to severe mental health disorders should obtain from using any type of controlled substance, including doctor-supervised cannabis.

However, based on feedback from patients online, medical cannabis may play an important role in helping individuals better manage symptoms of depression and anxiety. There are extensive studies that suggest cannabidiol (CBD) can be very effective and help with moderating stress more effectively.

Now that most states have provided legalized cannabis access, it is important to look at your health history and treatment management goals and discuss the option of using medical cannabis with a licensed provider.

If you are currently taking medical cannabis on a regular basis, and you notice a change in any of your mental health symptoms, schedule an appointment as soon as possible with your cannabis healthcare provider.

Aaron Bloom

Aaron Bloom, an experienced healthcare attorney, serves as the CEO, overseeing the mission and growth of DocMJ and Medwell Health and Wellness Centers since 2016. Aaron’s passion for improving patients’ lives comes from his experience in healthcare. For more than 20 years, Aaron has owned, operated, and represented traditional healthcare organizations. This experience created a passion for finding improved ways to relieve suffering. His goal as CEO is to work daily to provide relief to all patients who seek better health and wellness through the medicinal benefits of medical cannabis and evidence-based alternative medicines.