A young man once sat across from me in the psychiatric emergency room — hollow-eyed, trembling, and confused. He’d tapered off his antidepressants and started using cannabis to sleep. “It helped,” he whispered, “until it didn’t. Now I can’t tell what’s real anymore.”

I see versions of him every week. Some come in hearing voices. Others are gripped by paranoia. Most are young — and many are using high-potency cannabis.

That’s why, as Ohio lawmakers revisit the marijuana law voters approved in 2023, we must move forward with both justice and prevention in mind.

After voters passed Issue 2 in November 2023 by more than 57%, Ohio became the 24th state to legalize recreational marijuana. But now, lawmakers are advancing Senate Bill 56 and House Bill 160 — proposals that would cap dispensaries, limit THC potency and restrict sharing of homegrown cannabis.

Some call this a rollback of democracy. Others say it’s needed to protect public health. As a psychiatrist, I believe we need balance — and better data-driven regulation.

First, cannabis is not harmless.A 2023 Danish study found cannabis use disorder was linked to nearly 30% of new schizophrenia cases in young men. In Ontario, a Canadian study reported rising psychosis rates following legalization. In the United States, the federal Centers for Disease Control and Prevention warns that adolescent cannabis use can affect brain development, memory, and emotional regulation.

A 2021 study suggested that as many as one in three daily users may develop cannabis use disorder. Today’s high-potency THC products can disrupt dopamine function in the brain, mimicking the chemical storm of psychosis.

While some turn to cannabis for anxiety or depression, a 2020 Lancet Psychiatry review found no strong evidence supporting its use for these conditions. Often, short-term calm hides long-term risk.

In considering reforms, Ohio lawmakers must weigh the voter’s 57% marijuana mandate against legislative caution.

Ohioans voted for access, but lawmakers are right to flag public health concerns. Delta-8 loopholes, marketing to youth, and lack of potency standards are valid issues. We should regulate cannabis as we do tobacco or alcohol.

However, parts of SB 56 and HB 160 — like banning home sharing and slashing cultivation rights — undermine voter trust. Reintroducing criminal penalties contradicts the will of Ohioans, who sought decriminalization, not substitution.

Instead of shrinking what voters passed, lawmakers should refine it: tighten labeling; protect youth; and promote public health campaigns — not gut core provisions through the back door.

To lead with integrity, Ohio must:

• Cap THC levels in youth-facing products.
• Require clear, evidence-based warnings.
• Fund mental health research and addiction prevention.
• License equitably, including those harmed by past cannabis enforcement.

We’ve seen what happens when states legalize without protections — and when others ignore public consensus.

This is Ohio’s chance to do both: Build a responsible, regulated market while honoring democracy.

Because, while cannabis may be legal, it is not benign. And smart, compassionate regulation should serve both public health and public will.

Dr. Fawad Taj is a psychiatrist based in Cleveland. He serves in leadership roles at the intersection of mental health, community advocacy, and public policy.

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