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Now more than ever before, marijuana divides the nation. Nearly half of Americans still believe it should be illegal,1 but nearly half of states have medical marijuana laws.2
This split in public opinion and government legislation has created a unique situation in which one million Americans per year receive substance abuse treatment for their use of marijuana,3 while at the same time, 1.2 million use marijuana as their medical “treatment.”4
With opinions and laws constantly shifting, we decided to explore the who, what, where, and why of marijuana abuse treatment using the most recent nationally representative survey data.
Our data come from the Treatment Episode Data Set (TEDS), which is a national census of annual admissions to substance abuse treatment facilities carried out by the Substance Abuse and Mental Health Services Administration (SAMHSA). All states that receive public funds for their treatment programs are required to provide figures to SAMHSA on who is treated, the substances involved, and supplementary demographic and geographic facts.
The breakdown above includes our first significant finding. Of the 281,991 people who received treatment primarily for marijuana in 2013 (the most recent year full TEDS data are available), the majority (51.9%) were referred through the criminal justice system. Specifically, 44.1% entered treatment as a component of their probation or parole, 16.2% through state or federal court, 11.5% as part of a formal adjudication, and 2.8% because of a DWI/DUI case.
This suggests that the majority of people who enter treatment for marijuana abuse are not there because they have personally decided they need and want treatment. This is true for other substances as well, but to a far lesser extent than marijuana. For example, 32.2% of alcohol admissions are self/individual referrals. This means that the client entered rehab voluntarily or because of a family member or friend. Comparatively, 27.2% of methamphetamine admissions and 29.9% of admissions for hallucinogens are voluntary. Heroin is the only drug for which the majority (58%) of treatment admissions are self/individual referrals.
By charting the two most common types of marijuana treatment referrals, we can see that, while there have been fluctuations, the story overall hasn’t changed much in the past 20 years. The criminal justice system has often accounted for three times more marijuana treatment admissions than those made by individuals.
The number of current marijuana users across the United States has been dramatically increasing for years. In 2004, 14.7 million people had used the substance within the past month, compared with 16.9 million people in 2009, and 22.2 million in 2014.5 There is also strong evidence, based on the THC levels of seized drugs, that the potency of marijuana has been increasing in recent years.6 Despite these facts, the TEDS data show that the percentage of primary substance abuse treatment admissions for marijuana, while marginally increasing from 2007 to 2010, did not significantly change between 2003 and 2013. There were 291,000 in the former year and 282,000 in the latter, with a peak of 372,000 in 2009.
However, there have been some major differences among states.
To compare the percentage of primary substance abuse treatment admissions involving marijuana at the state level, we averaged TEDS data from 2012 to 2014. The results show a significant gap between states. Massachusetts has the lowest proportion (3.1%) of marijuana admissions and Kansas has the highest proportion (29.8%) of marijuana admissions. Interestingly, the three states with the lowest rates also have some of the most relaxed marijuana laws in the country.
In Massachusetts, marijuana is a class D drug. Possession of small amounts has been decriminalized since 2008, and medical marijuana was added to its law books in 2012. Medical marijuana has been legal in Maine, the state with the second-lowest proportion of marijuana treatment admissions, since 1999. Possession of amounts under 2.5 ounces was decriminalized 10 years later. Ranking third for the lowest proportion of treatment admissions, Colorado has in recent years become the nation’s marijuana hub, with recreational laws relaxed enough to have even encouraged “marijuana tourism.”7
It’s a very different story in Kansas, Colorado’s neighboring state, which had the highest proportion of marijuana abuse treatment admissions in the country. Almost one in three admissions were primarily for marijuana. Current laws in Kansas have been considered severe by some,8 as possession of even small amounts is punishable by up to one year in jail plus a $1,000 fine. It was only in February 2016 that a limited medical marijuana bill moved forward in the state Senate. Another bill is being considered that would reduce the penalties for recreational possession.
Now that we have some idea of how many admissions for marijuana treatment there are and where they occur at the highest rates, let’s look at the people they involve.
There are two main ways to assess how race and marijuana treatment admissions intersect. The first is to look at what proportion of admissions involve individuals of various races. On this measure, the TEDS data show that, of every 100 people who were admitted for substance abuse therapy for marijuana in 2013, about 43 were non-hispanic white, 32 were non-hispanic black/African-American, 18 were Hispanic, and seven were “other” (including American Indian, Asian, and Alaska Native). Here’s how that looks on a chart, with “other” split into two subcategories.
Black/African-American and American Indian/Alaska Natives are the most over-represented race categories in marijuana abuse treatment. In 2013, both were admitted at roughly 2- 2.5 times the nationally proportional rate.
The other way to assess race and marijuana abuse treatment is to examine what percentage of each race’s substance abuse admissions were primarily for marijuana, as opposed to any other substance.
Black/African-American men and women had the highest proportion of marijuana abuse treatment admissions among the races shown above. Of substance abuse admissions for black males in 2013, 30.1% were for marijuana, which was more than double the proportion of white and Asian/Pacific Islander males. Overall, men were far more likely than women to enter substance abuse treatment, accounting for two-thirds of all admissions in 2013. At 18.3%, men are also slightly more likely to receive treatment primarily for marijuana use, versus 13.6% of women. Again, there were substantial differences at the state level.
Arizona was the state with the most gender parity in its marijuana abuse treatment admissions between 2012 and 2014, in which 58.2% of treatment episodes involved men. In Pennsylvania, the proportion of men was much higher, at 80.5% – the highest in the country. Nationally, 73 of every 100 people who entered marijuana abuse treatment were men, which may be partly due to the fact that men have an illicit drug abuse/dependence rate (3.4%) approaching twice that of women (1.8%).9
What is harder to explain is why black/African-American men represent one in three of the male marijuana abuse treatment admissions nationwide because – according to the 2014 National Survey on Drug Use and Health – black individuals only have a marginally higher rate of past-year marijuana use than white individuals (19.2% versus 16.9%). To explore this question further, we mapped just marijuana admissions involving black/African-Americans by state.
To create the map and ranking above, we averaged substance abuse treatment admission data from 2012 to 2014, but this time calculated the admission rate of black/African-American persons per 10,000 black/African-American state residents. West Virginia is the state with the lowest admission rate, at 1.5 persons per 10,000, and Iowa is the highest, at 118.5 persons per 10,000.
It’s possible that some of this difference is due to how states categorize and report treatment admissions. However, given that we know that more than half of marijuana treatment admissions across the country are criminal justice referrals, it’s also possible that the rate at which states arrest black/African-American individuals for low-level drug offenses (many of which end up in treatment referrals) could be a major contributing factor.
Iowa, which had the highest rate of marijuana treatment admissions for black individuals in the country (1.2% of the state’s black population), has a history of racially disproportionate arrest rates. In 2013, a national American Civil Liberties Union study found that a black person in Iowa was more than eight times more likely to be arrested for marijuana possession than a white person. Similarly, in Vermont, black individuals were 4.4 times more likely to be arrested.<sup10
In 2013, the average age of a person who received treatment for marijuana abuse was 25, compared with 42 for alcohol, 38 for cocaine, and 34 for heroin. This is largely because marijuana is used by young people at a far higher rate than harder drugs. On average, it’s used for the first time at a younger age as well. Approximately 55% of the people who received treatment for marijuana as their primary substance of abuse had first used the drug before the age of 14. For other substances, the equivalent figures were much lower: heroin at 6.8%, cocaine at 9.9%, and alcohol at 29.9%.
Among adolescents aged 12 to 17, nearly 90% of treatment admissions involved marijuana as a primary or secondary substance. As with all marijuana admissions, many (44%) were also referred through the criminal justice system. This is compared with 51.9% of criminal justice referrals across all types of substance use admissions. The proportion of marijuana treatment admissions involving 12- to 17-year-olds has also varied a lot by state.
Across the country, 27.6% of marijuana treatment admissions between 2012 and 2014 involved 12- to 17-year-olds. At the state-level, Hawaii had the largest percentage of marijuana admissions (75%) involving 12- to 17-year-olds. This is almost three times higher than the national average. Florida had the second largest percentage of 12- to 17-year-old youths admitted for marijuana use, which was nearly double that of the national average.
It’s important to note that states with high rates of adolescent treatment admissions aren’t necessarily bad. Treatment referrals that juvenile drug courts give to non-violent, low-level offenders are often a preferred alternative to criminal prosecutions. The data show that criminal justice referrals among adolescent marijuana treatment admissions fell by 3.5% between 2003 and 2013, despite adolescent marijuana-involved admissions increasing by 6.7%.
When it comes to discussions around marijuana use, a big part of the debate is whether or not the drug is more harmful or helpful. One review of the evidence, which looked at data spanning 20 years, pointed out certain key facts about the potential harms associated with the regular use of marijuana.11 A few among them:
There is also more evidence than ever that points to the potential benefits of marijuana, especially when used to treat chronic medical conditions. Since 1990, at least 41 studies have found that marijuana may help patients suffering from over a dozen serious ailments, including Multiple Sclerosis and cancer.12
What’s certain is that the data show marijuana use is climbing year-over-year as more cities and states consider revisions to their laws concerning its recreational and medical use. This means that the number of people who are dependent on the drug (around 9% of users) is likely to increase as well. The New England Journal of Medicine puts it like this: “As policy shifts toward [the] legalization of marijuana, it is reasonable and probably prudent to hypothesize that [marijuana] use will increase and that, by extension, so will the number of persons for whom there will be negative health consequences.”13
It is therefore more important than ever that those with the most pressing need for treatment are able to receive it.
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