Marijuana policy and tribal communities in the United States

In the United States (US), the policy landscape surrounding marijuana is complex, multijurisdictional, and often messy, if not contradictory-particularly for tribal communities. Currently, tribes may choose to criminalize or legalize marijuana but may be located within a state or adjacent to a city that has opposing policies. With patterns of substance use that are notably different from the US population as a whole, including higher rates of marijuana use and dependence among Native American youth, tribal communities have important policy decisions to make that will directly impact public health. This paper reviews the history and policy background related to marijuana in the United States, associated health concerns for American Indian and Alaska Native communities, and considerations for tribal communities seeking how to best move forward. A community-led public health response that is culturally grounded can more effectively promote Indigenous health and sovereignty worldwide.