Substance Abuse Timeline

Substance Abuse

Focus on Marijuana

Substance Abuse Timeline

Cannabis

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2000-2010

2020-2025

1960

1971

2010-2020

1980-1990

Present

1970

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References

America Civil Liberties Union. (2020). A Tale of Two Countries Racially Targeted Arrests in the Era of Marijuana Reform. https://www.aclu.org/wp-content/uploads/publications/marijuanareport_03232021.pdfDEA. (2025). Adams, Z. W., Marriott, B. R., Hulvershorn, L. A., & Hinckley, J. D. (2023). Treatment of Adolescent Cannabis Use Disorders. The Psychiatric clinics of North America, 46(4), 775–788. https://doi.org/10.1016/j.psc.2023.03.004 Bourgois, P. (2008). The Mystery of Marijuana: Science and the U.S. War on Drugs. Substance Use & Misuse, 43(3–4), 581–583. https://doi.org/10.1080/10826080701884853 Crocq, M. (2020b). History of cannabis and the endocannabinoid system. Dialogues in Clinical Neuroscience, 22(3), 223–228. https://doi.org/10.31887/dcns.2020.22.3/mcrocq Drug Scheduling. Www.dea.gov; United States Drug Enforcement Administration. https://www.dea.gov/drug-information/drug-scheduling Gabay, M. (2013). The Federal Controlled Substances Act: Schedules and pharmacy registration. Hospital Pharmacy, 48(6), 473–474. https://doi.org/10.1310/hpj4806-473 Hossain, M. K., & Chae, H. J. (2024). Medical Cannabis: From Research Breakthroughs to Shifting Public Perceptions and Ensuring Safe Use. Integrative Medicine Research, 13(4), 101094. https://doi.org/10.1016/j.imr.2024.101094 King, D. D., Gill, C. J., Cadieux, C. S., & Singh, N. (2024). The role of stigma in cannabis use disclosure: an exploratory study. Harm Reduction Journal, 21(1). https://doi.org/10.1186/s12954-024-00929-8 Kurtzman, E. T., Greene, J., Begley, R., & Drenkard, K. N. (2022). "We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study. International journal of nursing studies advances, 4, 100065. https://doi.org/10.1016/j.ijnsa.2022.100065 National Academies of Sciences, Engineering, and Medicine. (2017). The Health Effects of Cannabis and Cannabinoids. National Academies Press. https://doi.org/10.17226/24625Satterlund, T. D., Lee, J. P., & Moore, R. S. (2015). Stigma Among California’s Medical Marijuana Patients. Journal of Psychoactive Drugs, 47(1), 10–17. https://doi.org/10.1080/02791072.2014.991858Turner, K., Nguyen, O. T., Islam, J. Y., Sahana Rajasekhara, Martinez, Y. C., Amir Alishahi Tabriz, Gonzalez, B. D., Jim, H. S. L., & Egan, K. M. (2024). Patient-provider communication about the use of medical cannabis for cancer symptoms: a cross-sectional study. JNCI Monographs, 2024(66), 298–304. https://doi.org/10.1093/jncimonographs/lgad026 Montgomery, L., Dixon, S., & Mantey, D. S. (2022). Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers. Current addiction reports, 9(1), 14–22. https://doi.org/10.1007/s40429-021-00404-5

Legalization Expansion and COVID:

- Marijuana legalization expanded across many U.S. states, increasing public acceptance, accessibility, and normalization of both medical and recreational cannabis use (Hossain et al., 2024).- During COVID-19, cannabis dispensaries were designated as essential businesses in many states, reflecting growing policy legitimacy and contributing to increased accessibility. - Criminal stigma surrounding marijuana decreased as legalization spread, but healthcare-related stigma persisted, particularly in patient-provider interactions (King et al., 2024). - Provider knowledge gaps, inconsistent cannabis education, and structural inequities continued to negatively impact care quality and patient outcomes (Turner et al., 2024). - Social equity initiatives and federal cannabis policy reform discussions highlighted ongoing racial, economic, and healthcare disparities despite broader legalization.

1970's :Controlled Substances Act

• In 1970, the Controlled Substances Act classified cannabis as a Schedule I drug, meaning it was seen as having a high potential for abuse and no accepted medical use (Gabay, 2013). This placed it under strict federal control.
• This classification increased stigma, as users were viewed as criminals rather than patients, leading to marginalization. As a result, healthcare access was limited because cannabis could not be used as a treatment. The quality of care was also affected, as providers avoided it due to legal risks, and research restrictions slowed medical progress.
• Overall, this policy limited treatment options and negatively impacted patient outcomes (Gabay, 2013).

Hippie Era: Cannabis linked to antiwar counterculture, increasing backlash and stigma. Controlled Substances Act (1970): Cannabis classified as Schedule I, restricting research and medical use. War on Drugs (1971): Nixon intensified criminalization, shifting substance use from public health to law enforcement; burdened Black and Brown communities disproportionately. (Montgomery et. al., 2022) Marginalized communities were disproportionately targeted through arrests, surveillance, and incarceration. Black Americans historically 3-4x more likely to be arrested for marijuana offenses. (Montgomery et. al., 2022) Long-term impact: Criminalization fueled stigma, barriers to care, distrust in institutions, and persistent health inequities.

1971: Counterculture, Criminalization & Health Inequities Hippie Era: Cannabis linked to antiwar counterculture, increasing backlash and stigma. Controlled Substances Act (1970): Cannabis classified as Schedule I, restricting research and medical use. War on Drugs (1971): Nixon intensified criminalization, shifting substance use from public health to law enforcement. Marginalized communities were disproportionately targeted through arrests, surveillance, and incarceration. Long-term impact: Criminalization fueled stigma, barriers to care, distrust in institutions, and persistent health inequities.

1970-1980's

HIV/AIDS Crisis and the re-emergence of medical cannabis

• During epidemic, cannabis began to be used as therapeutic option for symptom management
• Anti-Inflammatory effects, could help manage complications.
• Improved quality of life and helped reduce morbidity
• Stigma discouraged open communication with healthcare providers, and reduced access to safe, supervised care

Early Medical Marijuana Use

-- Medical marijuana legalization expanded across several U.S. states for conditions like chronic pain, cancer, and HIV/AIDS (National Academies of Sciences, Engineering, & Medicine, 2017). - Marijuana remained federally classified as a Schedule I substance, reinforcing legal restrictions and persistent social stigma (Drug Enforcement Administration [DEA], 2020). - Cannabis users were still widely associated with criminality, deviance, and irresponsible behavior due to ongoing societal and policy-driven stigma (Satterlund et al., 2015). - Patients often faced judgment from healthcare providers, causing many to avoid disclosure of cannabis use (Satterlund et al., 2015). - Limited provider knowledge and legal uncertainty reduced safe, evidence-based patient guidance (Satterlund et al., 2015). - Black and Brown communities continued to face disproportionate criminalization despite increasing medical access, reflecting ongoing racial disparities in cannabis enforcement (ACLU, 2020).

• Cannabis is now legal for recreational use in 24 states + D.C. and widely legal for medical use, showing a major shift from criminalization to regulation.
• Youth use remains a public health concern: ~40% of U.S. youth report lifetime cannabis use, and ~4% of adolescents meet criteria for cannabis use disorder (Adams et al., 2023).
• Health disparities persist: Communities such as the Latino/African American ethnicity disproportionately criminalized in the past may still face unequal access to care and benefits of legalization. (Temourian et al., 2025)
• Stigma still exists in healthcare, affecting disclosure and trust due to SUD and incarceration associated with marijuana (King et. al., 2024)
• Patients benefit from evidence-based cannabis education and harm reduction, not stigma. (Kurtzman et al, 2022)

2010-2020s Legalization & Rising use

• Medical cannabis use increased significantly from 2013 to 2020 in the U.S.
• State legalization was the main driver of increased medical cannabis use and access.
• People living in states with medical cannabis laws were much more likely to use cannabis for medical purposes.
• Despite growth, federal restrictions limited research and created unequal access to care across states.

1960's :Shift Away from Medical Use and Increased Regulation

• In the 1960s, cannabis began to decline in medical use, even though it had previously been used to treat conditions like migraines and menstrual pain. According to Crocq (2020), one reason was the lack of standardization, meaning doses were not consistent. This made cannabis less reliable compared to newer medications like aspirin.
• During this time, social attitudes also changed. Cannabis became associated with recreational drug use and was viewed negatively. This created stigma, where users were seen as drug users rather than patients, leading to marginalization.
• As a result, cannabis was removed from mainstream medical practice. This limited healthcare access by reducing treatment options, affected quality of care by discouraging providers from considering cannabis medically, and may have worsened outcomes for patients who could have benefited from its use (Crocq, 2020).