Background: Adult-use cannabis legalization is being increasingly
embraced by various jurisdictions in the United States (US) and internationally. As
adolescents are particularly vulnerable to the negative consequences of cannabis, it
is essential to ensure that the effects of adult-use legalization are minimized.
Objectives: This review aimed to synthesize the extant literature exploring the
impact of adult-use legalization on adolescents and provide recommendations for
future action. We focused on the following domains: 1) prevalence of use, 2) highfrequency
use, 3) perceived harm, 4) perceived availability, 5) modes of use, 6)
potency, 7) mental health and medical outcomes, and 8) legal consequences.
Methods: Narrative review is focused on adult-use legalization in the US.
Results: Adolescent cannabis use prevalence in US legal (as well as illegal) states
has remained essentially stable since the advent of adult-use legalization. Criminal
penalties for adolescents have not decreased in legal states and maybe increasing;
out-of-school suspensions for cannabis use may also be increasing. It is uncertain
whether reported decreases in national rates of perceived harm and availability and
increases in cannabis frequency and potency of use in adolescents differ between
legal and illegal states. The impact of legalization on adolescent health outcomes
Conclusion: At this early stage of adult-use legalization, we recommend that
jurisdictions implement real-time, detailed monitoring to assess adolescent
outcomes. In addition, both criminal penalties and out-of-school suspensions for
cannabis infractions should be minimized.