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Objective The purpose of this commentary was to briefly summarize the literature on the relationship between adolescent marijuana use and mental health and how policy changes surrounding marijuana decriminalization and legalization might impact this relationship. Methods A comprehensive literature search on adolescent marijuana use, mental health, and the impact of decriminalization and legalization was conducted. Findings are briefly summarized and discussed. Results Although there is a great deal of ambiguity regarding the causal direction of marijuana use and mental health problems, what can safely be gleaned from this body of research is that early and frequent use of marijuana during adolescence is associated with the development of more psychiatric-related problems than occasional use or nonuse. Conclusions Until there is greater clarity in this domain, clinicians should continue to screen adolescent patients for marijuana use as well as mental health difficulties, but may need to be more thoughtful about screening among early adolescents, if in fact a shift in the age of marijuana uptake occurs amidst policy changes.