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The State of Mental Health in America (2018) ranks the 50 states and the District of Columbia according to the prevalence of mental illness and access to care. Oregon ranks first—the highest in the nation—for mental health and substance use issues. Alcohol is the most commonly used drug among Oregon youth. The consequences are great as 44 percent of fatal car crashes in Oregon involve alcohol. Statistics from the Centers for Disease Control and Prevention (CDC) reveal:

• 12- to 20-year-olds consume 11 percent of all alcohol sold in the U.S.
• 90 percent of that alcohol is consumed during “binge drinking” (five or more drinks at one time)
• Underage drinking results in more than 4,300 youth deaths per year in the U.S.

A study by the National Institute on Drug Abuse revealed that adolescent drug use is decreasing with the exception of marijuana. Although marijuana is an illegal substance under U.S. Federal Law, it is legal for recreational use in the state of Oregon; however, any underage use of marijuana is illegal. The rate of marijuana use was already high in Oregon before the state legalized recreational use. The legalization of recreational and medical marijuana is associated with a higher prevalence of marijuana use among youth due to perceived norms that favor marijuana use, including lower levels of parental disapproval. Another possible factor is that marijuana has become more visible and accessible to youth due to the growth of dispensaries and advertising. Marijuana use during adolescence is associated with negative consequences including increased risk of accidental injury, fatal car crashes, respiratory illness, mental health issues, impaired cognitive functioning, impaired brain development, and a greater risk of drug dependence into adulthood.