First, state-level community norms more supportive of marijuana use may contribute to the legalization of medical marijuana and to higher rates of marijuana use. Prior studies on drinking and smoking suggest a direct link between community approval of use and policy change (Lipperman-Kreda and Grube, 2009; Lipperman-Kreda et al., 2010). Regarding marijuana, passage of state medical marijuana laws may reflect underlying state-level community norms, especially when such legislation is passed by voter referenda. In addition, the medical marijuana laws that passed in state legislatures by wide margins of votes appear to reflect an underlying high level of support for such legislation prior to their enactment, as well as the absence of a strong and vocal minority opposition (Mikos, 2009; Scott, 2000).
