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Decriminalization and legalization of marijuana in the United States

Nov. 1, 2020
States all over the country are weighing the benefits and risks of legalizing and/or decriminalizing marijuana. With many turning to cannabis for its medicinal properties, what does that mean for dental professionals?

Author’s note: Dental hygienists in clinical practice may benefit from recent research on legalization versus decriminalization of marijuana. The legalization of marijuana will open dialogue between all dental professionals and encourage the development of educational materials for patients in their care. It is imperative to consider associations between marijuana and the possibility of an increase in oral pathology, dental caries, and periodontal disease and to discover the best way to treat these conditions. In addition, legalization and decriminalization will lead to the creation of more continuing education courses on the topic and the availability of improved treatment modalities. This knowledge will benefit the dental community and may foster more honest dialogue around medical and dental histories. If patients are forthcoming with information, safer and more complete care will result, especially when local anesthesia is involved. Dental hygienists may use this knowledge to improve suggestions for oral health education and products to assist in decreasing periodontal disease, caries, and oral pathology.

The conversation surrounding marijuana has transformed drastically over the past decade. With more states legalizing and decriminalizing the use of both recreational and medicinal marijuana annually, new thoughts on the use of cannabis are arising. More states are beginning to decriminalize marijuana and others are actively working toward legalization.

Legalization vs. decriminalization

Often, the terms “legalized” and “decriminalized” are used in the wrong context. Legalization refers to the ability to purchase cannabis products as long as the customer meets age requirements, as with purchasing tobacco or alcohol. Decriminalization refers to maintaining marijuana’s status as an illegal substance in certain cases, but not prosecuting for possession under a certain amount. Instead, they might face fines or other sanctions.1 States where these laws have been passed have shown the benefits of legalization and decriminalization, but new problems have also been brought to light.

Economic impact

Decriminalization and legalization of marijuana have shown great economic impact throughout states that have adopted more liberal policies. Legalization has created jobs, and entrepreneurs have had the chance to develop their share of the business. For example, after just 12 days of legalization in Illinois, $19.7 million was generated in sales alone.2 A boost to state sales tax means more money for the local economy, while profits earned by dispensary owners fund more opportunities for them and their employees. Across the cannabis industry, profits are expected to increase each year.3

Legalization is not the only way to fuel a state’s economy. Where decriminalization is concerned, offenders are often charged a fine instead of facing jail time for possession. Fines vary by state, ranging from $100 in Delaware to $250 in Mississippi. These fines carry the benefit of bringing in revenue absent the cost of housing an inmate or crowding state facilities. In addition to a fine, one may have to complete community service hours or attend a drug counseling class.4


A question that is often asked is how legalization will affect those already punished for marijuana-related crimes. Under decriminalization laws in New York, those convicted with possession under a certain amount will have their charges expunged. This means that thousands will now have no criminal background, while others will have certain charges dropped from their background.5 This could allow for renewed opportunity for those harshly affected by marijuana crimes. However, this only applies to those who were convicted of crimes involving under a certain amount of marijuana, meaning not everyone will be eligible to have their crime expunged.

States that have legalized marijuana have used similar methods for expunging the crimes. Criminal records for marijuana-related crimes have been removed in states such as Colorado, Illinois, and California. In all of these states, expungement took place immediately on day the law went into effect.4 When planning for legalization, Illinois wanted to take a different approach. Instead of just legalizing marijuana, lawmakers wanted to seize the opportunity to spread the wealth. According to Governor J.B. Pritzker, Illinois’ plan was designed with social equity in mind. The idea of giving those in poverty-ridden neighborhoods new opportunities was one of the main goals when designing this legislation.6 Those once convicted of marijuana-related offenses are offered resources to start a business in the cannabis industry.4 Programs like this help break the cycle of poverty by giving assistance to those who may not be able to access the resources needed to start a business due to charges on their record.

Increased usage

Another question to consider is how marijuana use will affect America’s youth. Using marijuana products in adolescence has been linked to poor academic performance and future dependency issues.7 After cannabis was decriminalized in New Mexico, a study was conducted to determine if new laws would influence young adults’ choices around marijuana use. Decriminalizing may entice those who were once more fearful of being caught to start using the products. The study found that new laws did in fact produce a positive relationship between decriminalization and the use of cannabis among young adults.8

A new tool to combat the opioid crisis

Marijuana is used in many states for medicinal purposes. Users must apply for and receive a special license allowing them to purchase cannabis products to ease medical conditions. Medical marijuana can be used in place of opioids for pain. With the opioid crisis in America at an all-time high, this option may help to reduce opioid abuse that is wreaking havoc throughout the nation. In 2019, a study was conducted to investigate whether states that had decriminalized marijuana for both medicinal and recreational use had lower rates of opioid abuse. The study discovered that all states that decriminalized marijuana had fewer opioid-related deaths and hospitalizations than states that did not.9 While data was inconclusive about an overall decrease in abuse, this indicates a step in the right direction.

Working toward racial equality

Historically, there have been racially charged arguments about how marijuana laws are not enforced equally across races. A report created by the American Civil Liberties Union analyzed the rate at which Black people and White people were being convicted of marijuana-related crimes between 2001 and 2010. On average, they found that Black people are 3.73 times more likely to be arrested for a marijuana-related offense than White people, despite both races having similar usage rates.10 Decriminalization and legalization of marijuana could help with this problem. With more lenient laws for marijuana-related offenses, we may be able to achieve more equality.

In summary

Overall, decriminalization and legalization of marijuana have already had a substantial impact in the United States, despite recent legislation. As more states continue to work toward total legalization, the steps they are taking to decriminalize cannabis are making a difference both locally and nationally. While the laws may be imperfect, we can hope to see more progress and justice for those affected by past marijuana offenses. 


  1. Svrakic DM, Lustman PJ, Mallya A, Lynn TA, Finney R, Svrakic NM. Legalization, decriminalization & medicinal use of cannabis: a scientific and public health perspective. Mo Med. 2012;109(2):90-98.
  2. Marotti A. Illinois dispensaries sold more than $19.7 million in recreational marijuana the first 12 days of sales. Chicago Tribune. January 13, 2020. Accessed January 17, 2020. https://www.chicagotribune.com/marijuana/illinois/ct-biz-legal-weed-sales-figures-20200113-ooby3fleyjgvfebbaldwdctfce-story.html
  3. Parker KA, Di Mattia A, Shaik F, Ortega JCC, Whittle R. Risk management within the cannabis industry: Building a framework for the cannabis industry. Financ Mark Inst Instrum. 2019;28: 3-55. doi:10.1111/fmii.12104
  4. Illinois. Marijuana Policy Project. Accessed January 16, 2020. http://www.mpp.org/states/illinois/
  5. Paybarah A. Marijuana convictions to be erased for thousands in New York state. New York Times. August 29, 2019: A21.
  6. Pletz J. High stakes: With recreational marijuana, Illinois promises to share the wealth and repair past harms. Can it succeed where all others stumbled? Crain’s Chicago Business. November 28, 2019. Accessed January 21, 2020. https://www.chicagobusiness.com/crains-forum-cannabis/no-easy-path-sharing-marijuana-wealth
  7. D’Amico EJ, Miles JNV, Tucker JS. Gateway to curiosity: Medical marijuana ads and intention and use during middle school. Psychol Addict Behav. 2015;29(3):613-619. doi:10.1037/adb0000094
  8. Cook, AC, Leung, G, Smith, RA. Marijuana decriminalization, medical marijuana laws, and fatal traffic crashes in US cities, 2010-2017. Am J Public Health. 2020;110(3):363-369. doi:10.2105/AJPH. 2019.305484
  9. Wendelboe AM, Mathew R, Chongsuwat T, et al. Is there less opioid abuse in states where marijuana has been decriminalized, either for medicinal or recreational use? A Clin-IQ. J Patient Cent Res Rev. 2019;6(4):267-273. doi:10.17294/2330-0698.1704
  10. Report: The war on marijuana in black and white. American Civil Liberties Union. June 2013. Accessed January 17, 2020. http://www.aclu.org/report/report-war-marijuana-black-and-white

RYKI DAYMON, BSDH, RDH, CDHC, is a 2020 graduate of the dental hygiene program at Southern Illinois University in Carbondale, Illinois. She enjoys being part of such a growing and rewarding profession and looks forward to beginning her journey in dental hygiene clinical practice. For more information, contact Daymon at [email protected].

JENNIFER S. SHERRY, MSEd, RDH, is an associate professor in the dental hygiene program at Southern Illinois University in Carbondale, Illinois. She has been very involved with research in public health, patient case studies, and organizing and developing community programs to help the underserved in the southern Illinois area. For more information, contact Sherry at [email protected].