Over the past 25 years, the US prevalence of adolescent and adult depression indicators has increased.^1,2 However, national epidemiologic information on major depressive disorder (MDD) is limited to pre–DSM-5 studies conducted more than 15 years ago. The DSM-IV diagnosis of MDD was associated with impairment,^3,4 psychiatric and substance use disorders (SUDs),^5-9 poor health,^10,11 mortality,¹² disease and economic burden,¹² and disability-years.^13-16 Updated knowledge is needed on the prevalence of MDD and its association with sociodemographic and clinical characteristics, including other psychiatric disorders, suicidality, impairment, and treatment use.

This review provides an overview of the changing US epidemiology of cannabis use and associated problems. Adults and adolescents increasingly view cannabis as harmless, and some can use cannabis without harm. However, potential problems include harms from prenatal exposure and unintentional childhood exposure; decline in educational or occupational functioning after early adolescent use, and in adulthood, impaired driving and vehicle crashes; cannabis use disorders (CUD), cannabis withdrawal, and psychiatric comorbidity. Evidence suggests national increases in cannabis potency, prenatal and unintentional childhood exposure; and in adults, increased use, CUD, cannabis-related emergency room visits, and fatal vehicle crashes. Twenty-nine states have medical marijuana laws (MMLs) and of these, 8 have recreational marijuana laws (RMLs). Many studies indicate that MMLs or their specific provisions did not increase adolescent cannabis use. However, the more limited literature suggests that MMLs have led to increased cannabis potency, unintentional childhood exposures, adult cannabis use, and adult CUD. Ecological-level studies suggest that MMLs have led to substitution of cannabis for opioids, and also possibly for psychiatric medications. Much remains to be determined about cannabis trends and the role of MMLs and RMLs in these trends. The public, health professionals, and policy makers would benefit from education about the risks of cannabis use, the increases in such risks, and the role of marijuana laws in these increases.