International Perspectives on the Implications of Cannabis Legalization: A Systematic Review & Thematic Analysis

The legality, recreational and medical use of cannabis varies widely by country and region but remains largely prohibited internationally. In October 2018, Canada legalized the recreational use of cannabis—a move many viewed as controversial. Proponents of legalization have emphasized the potential to eradicate the marijuana black market, improve quality and safety control, increase tax revenues, improve the availability of medical cannabis, and lower gang-related drug violence. Conversely, opponents of legalization have stressed concerns about cannabis’ addictive potential, second-hand cannabis exposure, potential exacerbation of underlying and established mental illnesses, as well as alterations in perception that affect safety, particularly driving. This systematic review synthesizes recent international literature on the clinical and public health implications of cannabis legalization.

• Publication year

  2019

• Venue

  International Journal of Environmental Research and Public Health

• Publication date

  2019-08-26

• Fields of study

  Sociology, Medicine, Political Science

• Identifiers
  DOI 10.3390/ijerph16173095PMID 31454942PMCID 6747067
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Prevalence and correlates of selling illicit cannabis among people who use drugs in Vancouver, Canada: A ten-year prospective cohort study.

  2019cited by this paper
• Emergency Department Visits From Edible Versus Inhalable Cannabis

  2019cited by this paper
• Prescription of Controlled Substances: Benefits and Risks

  2019cited by this paper
• Six policy lessons relevant to cannabis legalization

  2019cited by this paper
• Women's perspectives about cannabis use during pregnancy and the postpartum period: An integrative review.

  2019cited by this paper
• Cannabis Legalization Does Not Influence Patient Compliance with Opioid Therapy.

  2019cited by this paper
• Trends and Related Factors of Cannabis-Associated Emergency Department Visits in the United States: 2006-2014.

  2019influential reference
• Did marijuana legalization in Washington State reduce racial disparities in adult marijuana arrests?

  2019influential reference
• Early-Stage Cannabis Regulatory Policy Planning Across Canada’s Four Largest Provinces: A Descriptive Overview

  2019cited by this paper
• Recreational Marijuana Legalization and Its Impact on Newborn Birth Weight in Washington State: A Retrospective Study

  2018cited by this paper
• Examining the relationship between medical cannabis laws and cardiovascular deaths in the US.

  2018cited by this paper
• Second-Hand Exposure of Staff Administering Vaporised Cannabinoid Products to Patients in a Hospital Setting

  2018cited by this paper
• Cigarillo sales in legalized marijuana markets in the U.S.

  2018cited by this paper
• Reefer madness or much ado about nothing? Cannabis legalization outcomes among young adults in the United States.

  2018cited by this paper
• Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado

  2018cited by this paper
• Consumer agency in cannabis supply - Exploring auto-regulatory documents of the cannabis social clubs in Spain.

  2018cited by this paper
• The impact of the legalization of recreational marijuana on college students.

  2018cited by this paper
• Implications of Cannabis Legalization on Youth and Young Adults

  2018cited by this paper
• Availability and approval of cannabis‐based medicines for chronic pain management and palliative/supportive care in Europe: A survey of the status in the chapters of the European Pain Federation

  2018cited by this paper
• Cannabis regulatory science: risk–benefit considerations for mental disorders

  2018cited by this paper
• Medical cannabis legalization and state-level prevalence of serious mental illness in the National Survey on Drug Use and Health (NSDUH) 2008–2015

  2018cited by this paper
• Oregon Recreational Marijuana Legalization: Changes in Undergraduates’ Marijuana Use Rates From 2008 to 2016

  2018cited by this paper
• Marketplaces, Markets, and Market Design.

  2018cited by this paper
• Medical marijuana laws and workplace fatalities in the United States.

  2018cited by this paper
• Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

  2018cited by this paper
• Exploring the association of legalisation status of cannabis with problematic cannabis use and impulsivity in the USA

  2018cited by this paper
• The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

  2018cited by this paper
• Cannabis use and suicide attempts among 86,254 adolescents aged 12–15 years from 21 low- and middle-income countries

  2018cited by this paper
• Crime and the legalization of recreational marijuana

  2018influential reference
• Trends and correlates of cannabis use in pregnancy: a population-based study in Ontario, Canada from 2012 to 2017

  2018cited by this paper
• Saying no to weed: Public opinion towards cannabis legalisation in Uruguay

  2018cited by this paper
• Marijuana Legalization and Crime Clearance Rates: Testing Proponent Assertions in Colorado and Washington State

  2018cited by this paper
• Cannabis and pregnancy: Maternal child health implications during a period of drug policy liberalization.

  2017cited by this paper
• Cannabis use during pregnancy: Pharmacokinetics and effects on child development

  2017influential reference
• Can we make cannabis safer?

  2017cited by this paper
• Recreational Cannabis - Minimizing the Health Risks from Legalization.

  2017cited by this paper
• Early Impacts of Marijuana Legalization: An Evaluation of Prices in Colorado and Washington

  2017cited by this paper
• Recreational Cannabis - Minimizing the Health Risks from Legalization.

  2017cited by this paper
• Cannabis; Epidemiological, Neurobiological and Psychopathological Issues: An Update.

  2017cited by this paper
• Cannabis effects on driving lateral control with and without alcohol.

  2015cited by this paper
• Adverse health effects of marijuana use.

  2014cited by this paper
• Acute and long-term effects of cannabis use: a review.

  2014cited by this paper
• The Global Epidemiology and Contribution of Cannabis Use and Dependence to the Global Burden of Disease: Results from the GBD 2010 Study

  2013cited by this paper
• Sex Differences in the Effects of Marijuana on Simulated Driving Performance

  2010cited by this paper
• The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration

  2009cited by this paper
• Youth Gangs and Drugs

  2006cited by this paper
• Preventing cannabis users from driving under the influence of cannabis.

  2006cited by this paper
• Effect of cannabis use on cognitive functions and driving ability.

  1999cited by this paper

• Cannabidiol-Enriched Extract Oil for Postoperative Management of Chronic Pelvic Pain Secondary to Endometriosis: A Randomized Clinical Trial—DREAMLAND Study

  2026cites this paper
• Liquisolids as a platform for the formulation of cannabis tablets.

  2026cites this paper
• The power of zinc: excess and deficiency of Zn decrease cannabinoids in cannabis without Zn toxicity concerns to consumers.

  2026cites this paper
• Outdated tools, underestimated harm: Modernizing cannabis surveillance in a post-legalization era.

  2025cites this paper
• Effects of Prenatal Cannabis Exposure on Offspring Mental Health: A Focus on the Role of the Immune System.

  2025cites this paper
• Exploring the impact of drug decriminalization and legalization policies on mental health outcomes: A scoping review

  2025cites this paper
• Knowledge and attitude of college students towards cannabis use in urban India: A comparative perspective of users and non-users.

  2025cites this paper
• Age–period–cohort analysis of past 12‐month cannabis use in Germany (1995–2021)

  2025cites this paper
• Elucidating the acute effects of medically prescribed oral and vaporised delta‐9‐tetrahydrocannabinol on cognitive functions important for driving

  2025cites this paper
• Cannabis smoking is associated with persistent epigenome-wide disruptions despite smoking cessation

  2025cites this paper
• Impacto de Intensidad Lumínica en la Germinación y Crecimiento de Cannabis sativa en Acuaponía

  2025cites this paper
• The relationship between cannabis and cardiovascular disease: clearing the haze

  2025cites this paper
• Identification of Cannabis Product Characteristics and Pricing on Dark Web Markets.

  2025cites this paper
• Cannabis vaping elicits transcriptomic and metabolomic changes in inflammatory, oxidative stress and cancer pathways in human bronchial epithelial cells.

  2025cites this paper
• Cannabis Seeds Classification Using HOG Feature Extraction Based SVM Optimization

  2025cites this paper
• Drugs and Violence: High Risk Behavior

  2025cites this paper
• The association between cannabis use and neuroimaging measures in older adults: Findings from the UK Biobank

  2024cites this paper
• Acceptability, Feasibility, and Effectiveness of Concurrent High-Definition Transcranial Direct Current Stimulation and Cue Exposure in Cannabis Use Disorder

  2024cites this paper
• Efficiency of cannabis and cannabidiol in managing chronic pain syndromes: A comprehensive narrative review.

  2024cites this paper
• Changes in Cannabis-Related Health Care Use in Alberta After Cannabis Legalization Between 2018 and 2022: A Population-Based Interrupted Time Series Study

  2024cites this paper
• Finally Freed—Cannabis in South Africa: A Review Contextualised within Global History, Diversity, and Chemical Profiles

  2024influential citation
• The effect size and nonlinearity of the relationship between cannabis consumption and consumer self‐perceived mental health: A study based on eight national surveys in Canada

  2024cites this paper
• Suicidal Ideation in Medicinal Cannabis Patients: A 12-Month Prospective Study

  2024cites this paper
• Harm reduction strategies for cannabis-related problems: a literature review and typology

  2024cites this paper
• Cannabis use and its association with psychopathological symptoms in a Swiss adult population: a cross-sectional analysis

  2024cites this paper
• Envisaging challenges for the emerging medicinal Cannabis sector in Lesotho

  2024cites this paper
• Engaging caregivers to prevent substance use by at-risk adolescents in pediatric primary care

  2024cites this paper
• "Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression.

  2024cites this paper
• Is there anything beyond addiction psychotherapy in patients with cannabis use disorder? A rationale for prescribing medical marihuana as a harm reduction strategy

  2024cites this paper
• Recreational cannabis policy reform-What mental health nurses need to know about minimising harm and contributing to the reform debate.

  2023cites this paper
• Effective isolation of cannabidiol and cannabidiolic acid free of psychotropic phytocannabinoids from hemp extract by fast centrifugal partition chromatography

  2023cites this paper
• Controlled environments for cannabis cultivation to support "omics" research studies and production.

  2023cites this paper
• Standard operating procedures for the comprehensive and reliable analysis of cannabis terpenes.

  2023cites this paper
• Dataset of cannabis seeds for machine learning applications

  2023cites this paper
• Risk of Motor Vehicle Collisions and Culpability among Older Drivers Using Cannabis: A Meta-Analysis

  2023cites this paper
• Implications of Cannabis Legalization on Substance-Related Benefits and Harms for People Who Use Opioids: A Canadian Perspective

  2023cites this paper
• Crosstalk between cannabinoid receptor 2 and lysophosphatidic acid receptor 5.

  2023cites this paper
• Provider Intentions to Implement Cannabis Use Intervention in First Episode Psychosis Treatment

  2023cites this paper
• The Impact of Recreational Cannabis Legalization on Cannabis Use and Associated Outcomes: A Systematic Review

  2023cites this paper
• A Survey of Modern Greenhouse Technologies and Practices for Commercial Cannabis Cultivation

  2023cites this paper
• Why a distinct medical stream is necessary to support patients using cannabis for medical purposes

  2023influential citation
• Effects of Particle Size, Solvent Type, and Extraction Temperature on the Extraction of Crude Cannabis Oil, Cannabinoids, and Terpenes

  2023cites this paper
• Clinical studies with Cannabis in India – A need for guidelines for the investigators and ethics committees

  2023cites this paper
• Associations Between Monthly Cannabis Use and Myocardial Infarction in Middle-Aged Adults: NHANES 2009 to 2018

  2023cites this paper
• Cannabis use disorder and adverse cardiovascular outcomes: A population-based retrospective cohort analysis of adults from Alberta, Canada.

  2023cites this paper
• Optimizing Indoor Hemp Cultivation Efficiency through Differential Day–Night Temperature Treatment

  2023cites this paper
• Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023)

  2023cites this paper
• Challenges and considerations for treating PTSD with medicinal cannabis: the Australian clinician’s perspective

  2023cites this paper
• Attitudes of Swiss psychiatrists towards cannabis regulation and medical use in psychiatry: a cross-sectional study

  2023cites this paper
• Impacts of social restrictions on mental health and health behaviours of individuals with multimorbidity during Covid-19 pandemic

  2023cites this paper
• Light Quality Impacts Vertical Growth Rate, Phytochemical Yield and Cannabinoid Production Efficiency in Cannabis sativa

  2022cites this paper
• Is legalization of recreational cannabis associated with levels of use and cannabis use disorder among youth in the United States? A rapid systematic review

  2022cites this paper
• Postmortem THC in decedents following legalization of recreational cannabis in Clark County, Nevada

  2022cites this paper
• A Systematic Review and Narrative Synthesis of the Evolution of Adolescent and Young Adult Cannabis Consumption Before and After Legalization.

  2022cites this paper
• The medical cannabis regulatory framework in Canada: A narrative review

  2022cites this paper
• Regulation on coexisting legal and illegal markets with quality differentiation

  2022cites this paper
• Characteristics that influence purchase choice for cannabis products: a systematic review

  2022cites this paper
• Cannabis Stocks Returns: The Role of Liquidity and Investors’ Attention via Google Metrics

  2022cites this paper
• An efficient and simple SERS approach for trace analysis of tetrahydrocannabinol and cannabinol and multi-cannabinoid detection.

  2022cites this paper
• Older adults experiences of using recreational cannabis for medicinal purposes following legalization.

  2022cites this paper
• Recreational cannabis use: regulatory aspects, public opinion and concerns for public health.

  2022cites this paper
• Systematic and Statistical Analysis of Public Knowledge of Marijuana Addiction and Psychosis Mental Health Outcome Youths in Calabar

  2022cites this paper
• Controversial Link between Cannabis and Anticancer Treatments—Where Are We and Where Are We Going? A Systematic Review of the Literature

  2022cites this paper
• Global Impacts of Legalization and Decriminalization of Marijuana and Cannabis

  2022cites this paper
• How High-Frequency Users Embraced Cannabis Regulation in Uruguay

  2022cites this paper
• Cannabinoids: Legal aspects, pharmacology, phytochemistry, probable targets from biological system, and therapeutic potential

  2022cites this paper
• Screening and Brief Intervention for Cannabis Misuse in Individuals on Buprenorphine Treatment for Opioid Use Disorder: Double-Blind Randomized Clinical Trial

  2022cites this paper
• Factors Associated With Past-year and Lifetime Prevalence of Cannabis Withdrawal: A Secondary Analysis

  2022cites this paper
• Cannabinoids and Their Role in Chronic Pain Treatment: Current Concepts and a Comprehensive Review.

  2022cites this paper
• Medical Marijuana Legalization and Opioid- and Pain-Related Outcomes Among Patients Newly Diagnosed With Cancer Receiving Anticancer Treatment.

  2022cites this paper
• Understanding and Rebalancing: A Rapid Scoping Review of Cannabis Research Among Indigenous People

  2022cites this paper
• The Efficiency of Marijuana Legalization: Uruguay versus Canada

  2022cites this paper
• Prevalence and predictors of illegal gambling in Canada

  2022cites this paper
• Cannabis and Cannabinoids in the Perioperative Period

  2022influential citation
• Don’t make a hash of it! A thematic review of the literature relating to outcomes of cannabis regulatory change

  2021cites this paper
• Genetic markers of the stress generation model: A systematic review.

  2021cites this paper
• Cannabis Legalisation and Control Bill: should doctors be concerned?

  2021cites this paper
• Inflammatory Bowel Disease and Cannabis: A Practical Approach for Clinicians

  2021cites this paper
• Pharmacotherapies for cannabis use disorder: A systematic review and network meta-analysis.

  2021cites this paper
• Shifting geographies of legal cannabis production in California

  2021cites this paper
• Cannabis: A Toxin-Producing Plant with Potential Therapeutic Uses

  2021cites this paper
• Cannabis and the Environment: What Science Tells Us and What We Still Need to Know

  2021cites this paper
• Genetic basis of cannabis use: a systematic review

  2021cites this paper
• What are the experiences of patients using cannabis for pain? A systematic review of qualitative studies

  2021cites this paper
• Online interventions for cannabis use among adolescents and young adults: Systematic review and meta‐analysis

  2021cites this paper
• The Prevalence of Cannabis Use Disorder Comorbidity in Individuals With Bipolar Disorder: A Systematic Review and Meta-Analysis

  2021cites this paper
• Comparing the regulation and incentivization of e-cigarettes across 97 countries.

  2021cites this paper
• The missed opportunity for real‐world evidence to shape our understanding of medical cannabis

  2020cites this paper
• Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

  2020influential citation
• The Association Between Cannabis Use and Schizophrenia: Causative or Curative? A Systematic Review

  2020cites this paper
• REVIEW OF SCIENTIFIC EVIDENCE ON EFFECTS OF MEDICAL AND NON-MEDICAL MARIJUANA LEGALIZATION ON PUBLIC HEALTH IN THE UNITED STATES

  2020cites this paper
• Association between gestational cannabis exposure and maternal, perinatal, placental, and childhood outcomes

  2020cites this paper
• A Review of Cases of Marijuana and Violence

  2020cites this paper
• Medicinal Applications of Cannabinoids Extracted from Cannabis sativa (L.): A new Route to Fight against COVID-19?

  2020cites this paper
• Endocannabinoid system and cannabis hyperemesis syndrome: a narrative update

  2020cites this paper
• Misuse and dependence of dimenhydrinate: A mixed studies systematic review.

  2020cites this paper