As marijuana legalization expands, emergency room visits and poison-control calls are declining in legal markets, challenging predictions of a public health crisis
The cannabis industry is filled with small mom and pop businesses who are constantly fighting misinformation. Â Remember when opponents of marijuana legalization warned making cannabis legal would send more people to hospital emergency rooms? It was a major talking point to not only not legalize, bu to increase restrictions. Years after a change in policy, legal cannabis is not sending everyone to the ER. Visits involving marijuana are declining in legal states like Maryland and Colorado, and poison-control calls have also dropped in Maryland. This isn’t the story many legalization opponents expected and shared.
Maryland has some particularly interesting numbers. According to the state’s 2025 Cannabis Use Biannual Study, cannabis-related emergency room visits fell 17% between 2023 and 2024. Calls to poison control involving cannabis also dropped about 10%, from 820 to 741.
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It is encouraging for a state who launched recreational marijuana sales in July 2023. But the numbers also show why looking at the details matters. When researchers counted only emergency visits where cannabis was the primary reason for the visit, those numbers fell 5% in 2024, following a 17% increase the previous year.
In other words, the broader category of hospital visits involving cannabis is moving down, but the numbers depend on exactly what is being measured.
Colorado has been living with legal recreational marijuana since 2014, giving researchers a longer window to examine what happens after dispensaries become part of everyday life.
The state’s December 2025 legalization report found marijuana-related emergency department visits peaked in 2018 at 1,171 per 100,000 emergency visits. By 2021, the rate had fallen to 672.
That’s a substantial decline, although there are some important caveats. The report notes  hospital coding changed during the period and emergency visits also declined during the COVID-19 pandemic, when people were less likely to seek hospital care for some conditions.
Still, Colorado’s experience challenges the idea a legal cannabis marketplace automatically produces an ever-growing number of emergency room visits.
A 2023 study published in Preventive Medicine Reports looked at more than 17 million emergency department visits across Colorado, Oregon, Maryland and Rhode Island.
Researchers examined cannabis use disorder diagnoses in emergency visits where patients were treated and released. They found the adjusted odds of a cannabis use disorder diagnosis were nearly 50% lower in the states with recreational legalization than in states where recreational marijuana remained illegal during the study period.
One of the arguments for legalization has always been a regulated marketplace gives consumers more information about what they are buying. Product testing, THC labeling, serving-size information and child-resistant packaging are intended to make cannabis use more predictable and reduce accidental exposure.
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This doesn’t mean every consumer reads the label or every product is risk-free. But it does give states tools not used with a 100% black market.
For consumers, understanding THC potency and keeping edibles away from children remain important. For states, tracking hospital visits, poison-control calls and patterns of problematic use is part of making legalization work.
For a country and a newish congress still debating marijuana policy, it a development worth paying attention to.
