At the time of this writing, 47 jurisdictions in the United States have enacted legislation authorizing the use of marijuana (aka, cannabis sativa) or its active ingredient, tetrahydrocannabinol (THC), for medical purposes, and 9 states and Washington, DC allow recreational use of the drug. The federal government regulates marijuana under the Controlled Substances Act (CSA; 21 U.S.C. § 811), which does not recognize a distinction between medical and recreational use, treating the product as a controlled, dangerous, illegal drug with no acceptable medicinal value. Amid the conflicting laws, mental health practitioners (MHPs) must give careful attention to the ethical and risk management issues involved as we strive to provide optimal care to our clients and adhere to legal obligations. We review the current status of legalized marijuana in the United States and offer practice recommendations to MHPs in that context. (PsycINFO Database Record (c) 2018 APA, all rights reserved)