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Association Between Marijuana Laws and Suicide Among 12- to 25-Year-Olds in the
United States From 2000 to 2019
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ASSOCIATION BETWEEN MARIJUANA LAWS AND SUICIDE AMONG 12- TO 25-YEAR-OLDS IN THE
UNITED STATES FROM 2000 TO 2019

 * Christopher J. Hammond, MD, PhD
   Christopher J. Hammond
   Correspondence
   Correspondence to Christopher Hammond, MD, PhD, Johns Hopkins Bayview, 5500
   Lombard Street, Baltimore, MD 21224
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   Johns Hopkins University School of Medicine, Baltimore, Maryland
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   J. Madison Hyer
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   The Ohio State University Wexner Medical Center, Columbus, Ohio
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   Anne E. Boustead
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   University of Arizona, Tucson, Arizona
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   Nationwide Children's Hospital, Columbus, Ohio
   
   
   
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Published:June 26, 2023DOI:https://doi.org/10.1016/j.jaac.2023.06.014
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OBJECTIVE

Cannabis use is associated with suicide-related outcomes in both adolescents and
adults, and may be increasing amid shifting cannabis policies. However, little
is known about the impact of medical marijuana legalization (MML) and
recreational marijuana legalization (RML) policies on youth suicide. Using 20
years of national data, we examined associations between MML, RML, and
suicide-related mortality among US individuals aged 12 to 25 years, and assessed
whether they varied based on age and sex.


METHOD

Suicide deaths (N = 113,512) from the 2000-2019 National Vital Statistics System
Multiple Cause of Death files for age groups 12 to 13, 14 to 16, 17 to 19, 20 to
22, and 23 to 25 years were examined in relation to time-varying cannabis law
status using a staggered adoption difference-in-difference (DiD) approach with a
negative binomial regression to determine associations between MML, RML, and
suicide rates, controlling for individual- and state-level covariates and
accounting for the varying effective dates of MML and RML by state.


RESULTS

The overall unadjusted annual suicide rate was 10.93/100,000, varying from 9.76
(states without marijuana laws (ML)) to 12.78 (MML states) to 16.68 (RML
states). In multivariable analysis, both MML (incidence rate ratio [IRR] = 1.10,
95% CI: 1.05-1.15) and RML (IRR = 1.16, 95% CI: 1.06-1.27) were associated with
higher suicide rates among female youth compared to those in states without ML.
Youth aged 14 to 16 years had higher rates of suicide in states with RML
compared to states with MML (IRR = 1.14, 95% CI: 1.00-1.30) and states without
ML (IRR = 1.09, 95% CI: 1.00-1.20). Findings were consistent across sensitivity
analyses.


CONCLUSION

MML and RML were associated with increased suicide-related mortality in female
youth and 14- to- 16-year-old individuals of both sexes. Mechanisms through
which cannabis policies are related to increased youth suicide warrant further
study and should inform legislative reform.


KEY WORDS

 * recreational marijuana legislation
 * medical marijuana legislation
 * suicide
 * adolescents
 * sex differences


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ARTICLE INFO


PUBLICATION HISTORY

Published online: June 26, 2023
Accepted: June 20, 2023


PUBLICATION STAGE

In Press Journal Pre-Proof


FOOTNOTES

Support for this study came from an American Academy of Child & Adolescent
Psychiatry (AACAP; Physician Scientist Career Development Award, K12DA000357 to
CJH), the Doris Duke Charitable Foundation (Grant # 2020147 to CJH), the Johns
Hopkins University School of Medicine (COVID Bridge Grant to CJH), and from the
National Institutes of Health (NIH) grants including R01MH117594 (CAF) and
UL1TR002733 (CAF, MH, GB). Funders of the study had no role in study design,
data collection, analysis, interpretation, or writing of the report. The
mortality data from this study is a restricted dataset from the National Center
of Health Statistics and therefore is not publicly available. Data on state
covariates are available from the corresponding author upon request.

The research was performed with permission from The Ohio State University’s
Institutional Review Board.

This study was presented as an abstract at the National Network of Depression
Centers 13th Annual Scientific Meeting; September 21, 2021; Virtual.

Dr. Brock served as the statistical expert for this research.

Author Contributions

All authors conceptualized and designed this study. MH, DLS, GB, and CAF
acquired, analyzed, and interpreted the data. CJH, MH, MAF, DLS, and CAF drafted
the manuscript. All authors critically reviewed the manuscript for important
intellectual content. MH and GB performed statistical analysis. CAF provided
project administration and resources. CJH and CAF supervised the study. MH and
DLS accessed and verified the data.

Disclosure: Dr. Hammond has received grant support from the National Institute
on Drug Abuse (NIDA; Bench to Bedside Award and K12DA000357), AACAP, the
Substance Abuse and Mental Health Services Administration (SAMHSA; H79
SP082126-01), the Doris Duke Charitable Foundation (Grant# 2020147), the
National Network of Depression Centers (NNDC), the Johns Hopkins Consortium for
School-based Health Solutions, and the Johns Hopkins University School of
Medicine, has served as a subject matter expert and consultant for SAMHSA, has
served on the Scientific Advisory Board for Forbes & Manhattan, and has received
honoraria in the past 24-months for meeting participation from NIDA, AACAP,
NNDC, and Psychiatric Times. Dr. Fristad has received royalties from American
Psychiatric Press and Guilford Press, an editorial stipend from the Society of
Clinical Child and Adolescent Psychology, and research support from Janssen.
Dr. Hasin has received funds for an unrelated study from Syneos Health, Inc.
Drs. Boustead, Steelesmith, Brock, and Fontanella and Mr. Hyer have reported no
biomedical financial interests or potential conflicts of interest.


IDENTIFICATION

DOI: https://doi.org/10.1016/j.jaac.2023.06.014


COPYRIGHT

©2023 American Academy of Child and Adolescent Psychiatry


SCIENCEDIRECT

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LINKED ARTICLE

 * Editorial: Marijuana Legalization and Suicide in Adolescents and
   Transitional-Age Youth: Important Future Directions for This Line of Research
   Journal of the American Academy of Child & Adolescent Psychiatry
   * Preview
     Marijuana legalization (ML) processes for medical and recreational use in
     the United States have been prompted by the potential for positive
     downstream legal effects of decriminalization, including fewer
     cannabis-related arrests and prosecutions, which have historically
     disproportionately impacted minoritized communities. However, ML evolved
     through primarily political processes, with minimal scientific guidance to
     inform policies. Commercialization has increased youth cannabis access,
     diversion of parental cannabis, and proliferation of high-potency products,
     which, along with early use, are associated with poor mental health
     outcomes.1 Taken together, these findings raise concerns about the impact
     of medical (MML) and recreational marijuana legalization (RML) on youth
     mental health.
   * Full-Text
   * PDF


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