Reports Of Increases In Problematic Cannabis Use Don’t Mean We Should Return To Prohibition (Op-Ed)

“A free society should be capable of learning to live with potentially risky substances without the government banning them.”

By Jeffrey A. Singer, Cato Institute

As a physician, I don’t dismiss recent reports of increases in problematic cannabis use. But we should avoid letting them trigger another drug-war moral panic.

Cannabis use has increased as more states have legalized it for adults. That should surprise no one. When a widely used substance moves from an illicit market to a legal one, some who previously abstained will try it, some occasional users will use it more often and people will be more willing to admit they use it.

Yet these recent patterns don’t tell us what cannabis use will look like going forward.

History should make us cautious about extrapolating from the early years of legalization. When Americans repealed Prohibition in 1933, alcohol consumption did not immediately settle into the pattern we recognize today. Consumption rose substantially over the following decades, eventually peaked around 1981 and then declined for more than a decade. Today, the share of Americans who report drinking alcohol is at its lowest level since Gallup began tracking it in 1939.

Along the way, Americans learned to live with legal alcohol. Knowledge, customs, and social norms evolved around its responsible use. We learned to distinguish drinking from drunkenness. We came to strongly disapprove of drinking and driving and of drinking on the job. People learned to recognize their own limits, and friends and families learned to recognize when someone’s drinking was becoming a problem.

None of those norms required us to conclude that, because alcohol can cause addiction, disease, accidents and death, we should prohibit adults from drinking it.

Cannabis may be undergoing a similar period of adjustment.

As cannabis use becomes normalized, consumers can learn more about dosing, potency, frequency, impairment and their individual responses to the drug. Social norms around responsible use can develop as people gain experience with a substance that, for most of the past century, public policy treated simply as something no one should use.

There is already some evidence supporting that possibility.

Canada legalized cannabis nationwide in 2018, providing researchers with an unusually useful natural experiment. A prospective study followed 1,428 Ontario adults from immediately before legalization through five years afterward. Overall, cannabis use frequency increased slightly, yet measures of cannabis misuse decreased slightly. Even more interesting, people who used cannabis frequently before legalization showed the largest decreases in both cannabis use and misuse.

That doesn’t prove legalization caused those reductions. The researchers themselves caution that factors such as people aging out of problematic patterns of use may partly explain the findings. But the Canadian experience should at least caution us against assuming that an initial increase in use inevitably leads to ever-increasing problematic use.

Cannabis is not harmless. Frequent use can be problematic for some people. High-potency products warrant particular attention, as do the risks to adolescents and to people predisposed to psychotic disorders. We should educate people honestly about those risks and discourage them from driving or operating dangerous machinery while impaired by cannabis.

But acknowledging those risks does not justify banning adults from using cannabis.

Prohibition carries risks of its own. It pushes consumers toward illicit markets, where products may have uncertain potency and contents. It exposes otherwise peaceful people to arrest and criminal penalties. And by reducing an enormously complicated subject to “don’t use drugs,” prohibition can impede the development of the knowledge and social norms that help people make safer choices.

We should judge legalization against the real-world alternative of prohibition, with its illicit markets, criminal penalties and unreliable product information.

The latest findings about cannabis use should inform consumers, physicians and policymakers. Researchers should continue monitoring cannabis use patterns and identify which patterns of use and which products carry the greatest risks. Public health officials can provide adults with accurate information without exaggerating risks in hopes of frightening them away from using cannabis. Laws should prohibit sales to minors and driving while impaired.

Adults routinely make choices that involve risk. Some drink alcohol, some smoke tobacco and some participate in dangerous sports. Respecting their autonomy doesn’t require pretending those choices are harmless. It requires providing them with good information and allowing them to weigh the risks and benefits for themselves.

We should treat cannabis the same way.

A free society should be capable of learning to live with potentially risky substances without the government banning them.

Jeffrey A. Singer, MD practices surgery in Phoenix, Arizona and is a senior fellow at the Cato Institute. His latest book is Your Body, Your Health Care (Cato Institute, 2025).