Civic norms and etiquettes regarding marijuana use in public settings in New York City

Race, psychosocial characteristics, and treatment outcomes among individuals undergoing treatment for cannabis use disorder: A latent profile analysis based on preferred method of using cannabis

INTRODUCTION

There are a wide variety of methods for using combustible cannabis which may impact an individual's pattern of use as well as their response to cannabis use disorder (CUD) treatment. Previous research has noted racial/ethnic differences in cannabis users' preferred method of use.

METHOD

The current study examined data from a randomized placebo-controlled trial of a pharmacological intervention for adults with CUD. Latent profile analysis classified participants (N = 302) based on their primary method of combustible cannabis use.

RESULTS

A four profile solution emerged which identified participants who demonstrated 1) Primarily Joint (n = 50), 2) Primarily Blunt (n = 106), 3) Mixed MoU (n = 30), and 4) Primarily Pipe (i.e., pipe or bong; n = 116) use. Profiles were compared on socio-demographic characteristics and racial differences were found among the four latent profiles as well as differences in their level of use. Cannabis users with a preference for joints were more likely to be White as compared to other racial groups. In contrast, a greater proportion of participants with a preference for blunts were African American. The Primarily Joint profile was found to have the highest cannabis relapse rate at 1-month follow-up (94%) which was significantly greater than the Mixed MoU (74%, x² = 5.06, p < .05) and Primarily Pipe (78%, x² = 9.24, p < .01) profiles. Interestingly, there was no difference in 1-Month Follow-up cannabis relapse rates between the Primarily Joint and Blunt profiles (87%, x² = 9.24, p > .05).

CONCLUSIONS

Findings suggest that treatment-seeking individuals who primarily use joints or blunts may face unique challenges that may impact cannabis abstinence. Along with other cannabis-related characteristics, an individual's preferred method of use may represent an important factor to consider in the treatment of CUD.

A qualitative review of cannabis stigmas at the twilight of prohibition

BACKGROUND

As laws change and cannabis use increases, it is worthwhile to take a rich account of cannabis stigmas in society, and this review identifies a disjunction between quantitative investigations on cannabis users and qualitative investigations on the same population. This is also the first attempt to explicate cannabis stigmas as they manifest on multiple analytical levels. Following brief explanations of the normalization hypothesis and the concept of stigma, this review is organized between structural (macro) stigmas, social (meso) stigmas, and personal (micro) stigmas. Furthermore, since cannabis stigmas are similar to the stigmas faced by sexual minorities in that each is physically concealable, the two groups are compared here because the literature base is more extensive with the latter.

METHODS

This qualitative review synthesizes the body of empirical studies on both medical and nonmedical cannabis use with attention to stigma, stereotypes, and other social consequences. Studies considered for the review mostly come from the social sciences, particularly sociology. The information presented here is primarily drawn from peer-reviewed articles on cannabis users in the USA, though research from similar national contexts is cited as well.

RESULTS

This review suggests claims of normalization may be premature. While stigmas surrounding cannabis appear to have diminished, there is little evidence that such stigmas have entirely disappeared. It is possible that sweeping claims of cannabis normalization may be symptomatic of unchecked social privileges or social distance from cannabis users. Such claims may also be the product of valuing quantitative data over the nuanced accounts uncovered through qualitative investigations.

CONCLUSION

This substantial coverage of the literature indicates the lived experience of a post-prohibition society is not the same as a one where cannabis is normalized. Individuals working with those who use cannabis should not assume stigmas have disappeared, especially since cannabis stigmas often intersect with other sources of social inequality. While a comprehensive discussion of ways to combat lingering social stigmas is beyond the scope of this review, it concludes by highlighting some of the strategies identified through research which help users resist or mitigate these oppressive forces. Future research would be wise to prioritize the experiences of people of color, women, and adult populations if the hope is to identify ways to further normalize the plant in American society.

Cannabis use and stigma among Canadian high school students: Results from the 2015 and 2017 Cancer Risk Assessment in Youth Survey

BACKGROUND

Adolescent cannabis use is perceived as a risky behavior, has been linked with many negative health outcomes, and is increasingly being connected with stigma.

METHODS

The purpose of this study is to investigate how cannabis use is associated with potentially stigmatizing markers of identity among adolescents two waves of a repeat cross-sectional survey (2015 N = 12,110; 2017 N = 15,191) of high schools students in seven Canadian provinces. Students were asked about ever use of cannabis, as well as "stigma markers", including their current living arrangement, mother's education, and ethnicity. Multivariable logistic regression models were used to examine associations between cannabis use and stigma markers.

RESULTS

After adjusting models for grade, gender, and province of residence, students who did not live with their mothers had higher odds of cannabis use relative to students living with their mothers [OR = 1.94, 95% CI 1.62-2.31]. Low maternal education was also significantly associated with cannabis use, as was ethnicity (students who identified as Indigenous had 3.38 (95% CI 2.29-4.99) times higher odds of using cannabis compared to students who identified as "white" in 2017). Findings related to attending school in a rural (vs. urban) area (2015 OR = 1.33 95% CI 0.99-1.78; 2017 OR = 1.44 95% CI 0.9 to -2.15) and low SES (2015 OR = 0.99, 95% 0.98-1.00; 2017 OR = 1.00, 95% CI 0.98-1.01) were more marginal.

CONCLUSIONS

Future research should explore cannabis initiation experiences among vulnerable groups to better understand potential stigma triggers.

Sexual Venue Choice and Sexual Risk-Taking Among Substance-Using Men Who have Sex with Men

Commercial sex venues (CSVs) and public sex environments (PSEs) offer men who have sex with men (MSM) sexual privacy and anonymity. Sociodemographic characteristics (e.g., race/ethnicity, sexual identity, age, HIV status) are correlated with individuals' choice of sexual venue, potentially suggesting environmental associations with both sociodemographics and sexual risk. From March 2005 through March 2012, 1298 substance-using MSM provided information on their most recent sexual encounter; iterative logit models estimated associations between sociodemographics and sexual venue, and/or whether sexual venue was associated with sexual risk-taking while controlling for sociodemographics. More than a third of participants' most recent sexual encounters took place in either a PSE (23.0%) or a CSV (11.3%); anonymous, HIV-serodiscordant, and/or sex while on methamphetamine and/or marijuana was significantly more likely to occur in CSVs/PSEs than in a private location, even when controlling for sociodemographics. Findings demonstrate that socioenvironmental factors were associated with sexual risk-taking among high-risk, urban MSM.

Responsible and controlled use: Older cannabis users and harm reduction

BACKGROUND

Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg's classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use.

METHODS

We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users' perspectives.

RESULTS

Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification.

CONCLUSION

Participants followed rituals or cultural practices, characterized by sanctions that helped define "normal" or "acceptable" cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods.

Perceptions of cannabis as a stigmatized medicine: a qualitative descriptive study

Background

Despite its increasing prevalence and acceptance among the general public, cannabis use continues to be viewed as an aberrant activity in many contexts. However, little is known about how stigma associated with cannabis use affects individuals who use cannabis for therapeutic purposes (CTP) and what strategies these individuals employ to manage associated stigma. The aim of this Canadian study was to describe users’ perceptions of and responses to the stigma attached to using CTP.

Methods

Twenty-three individuals who were using CTP for a range of health problems took part in semi-structured interviews. Transcribed data were analyzed using an inductive approach and comparative strategies to explore participants’ perceptions of CTP and identify themes.

Results

Participant experiences of stigma were related to negative views of cannabis as a recreational drug, the current criminal sanctions associated with cannabis use, and using cannabis in the context of stigmatizing vulnerability (related to existing illness and disability). Strategies for managing the resulting stigma of using CTP included: keeping CTP ‘undercover’; educating those who did not approve of or understand CTP use; and using cannabis responsibly.

Conclusions

Understanding how individuals perceive and respond to stigma can inform the development of strategies aimed at reducing stigma associated with the use of CTP and thereby address barriers faced by those using this medicine.

Individual and contextual predictors of severity of marijuana use events among young frequent users

This study used momentary sampling to characterize marijuana events among young frequent users and determine contextual and individual predictors of use severity. Medical clinic outpatients aged 15-24 who used marijuana at least twice a week completed a baseline assessment, then used a handheld computer to report marijuana use at 4-6 signal-prompted times per day and before/after use for 2 weeks. Reports assessed event characteristics (when, with whom, where, how, why, how much, how high). Timestamps identified time, weekend, and duration for each event. Generalized estimating equations tested associations of individual and event-specific contextual characteristics with hits/event, duration, and high. Forty-one youth completed 3868 momentary reports; 40 (98%) reported at least one marijuana use event (N=432 events; M=10.5/participant) and thus provided data for these analyses. Marijuana was most commonly used with other people (74% of events), at home (58%), via blunt (66%), and for social or enhancement reasons (86%). Most events (62%) occurred on weekdays; use was least likely in the morning (8%). Most events involved 6 or more hits (81%). Mean high was 5.2 (out of 8). Of events with start and end times (n=250), mean duration was 46.8 min. Poor mental health and use with a blunt or a bong, in the morning or evening, and on the weekend were associated with 6 or more hits/event. Female gender was associated with greater event duration. Poor mental health predicted higher high. Among youth who used it frequently, marijuana was used in a variety of contexts, with diversity in method, dose, and duration. Contextual factors appeared to predict marijuana dose for a given event, while individual characteristics were more predictive of high and duration.

Creating nurturing environments: a science-based framework for promoting child health and development within high-poverty neighborhoods

Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities.

The role of marijuana use etiquette in avoiding targeted police enforcement

Internationally, where marijuana is illegal, users follow etiquette rules that prevent negative consequences of use. In this study, adherence to etiquette is hypothesized to reduce likelihood of marijuana-related police stop/search and arrest. Ethnographers administered group surveys to a diverse, purposive sample of 462 marijuana-using peer groups in several areas of New York City. Findings indicated that lack of etiquette was associated with dramatically higher likelihood of police stop/search or arrest only for users who were Black, male, and/or recruited from Harlem/South Bronx. If these users followed a few identified etiquette rules, their risk of police stop/search or arrest was comparable to that of other users. Implications are that etiquette represents an intentional conscientiousness about marijuana use. Groups that are specially targeted for anti-marijuana enforcement can remediate that heightened risk by following marijuana etiquette.

An Analysis of Alternatives to New York City's Current Marijuana Arrest and Detention Policy

During the 1990s, the New York Police Department (NYPD) instituted a policy of arresting and detaining people for minor offenses that occur in public as part of their quality-of-life (hereafter QOL) policing initiative. The number of NYPD arrests for smoking marijuana in public view (MPV) increased from 3,000 in 1994 to over 50,000 in 2000, and have been about 30,000 in the mid 2000s. Most of these arrestees (84%) have been minority; blacks have been 2.7 more likely and Hispanics 1.8 times more likely to be detained than whites for an MPV arrest. Minorities have been most likely to receive more severe dispositions, even controlling for demographics and prior arrest histories.This paper examines the pros and cons of the current policy; this is compared with possible alternatives including the following: arrest and issue a desk appearance ticket (DAT); issue a non-criminal citation (violation); street warnings; and tolerate public marijuana smoking. The authors recommend that the NYPD change to issuing DATs on a routine basis. Drug policy reformers might wish to further pursue changing statutes regarding smoking marijuana in public view into a violation (noncriminal) or encourage the wider use of street warnings. Any of these policy changes would help reduce the disproportionate burden on minorities associated with the current arrest and detention policy. These policies could help maintain civic norms against smoking marijuana in public.

THE RACE/ETHNICITY DISPARITY IN MISDEMEANOR MARIJUANA ARRESTS IN NEW YORK CITY

RESEARCH SUMMARY: This article examines the growth in marijuana misdemeanor arrests in New York City (NYC) from 1980 to 2003 and its differential impact on blacks and Hispanics. Since 1980, the New York City Police Department (NYPD) expanded its use of arrest and detention for minor offenses under its quality-of-life (QOL) policing initiative. Arrest data indicate that during the 1990s the primary focus of QOL policing became smoking marijuana in public view (MPV). By 2000, MPV had become the most common misdemeanor arrest, accounting for 15% of all NYC adult arrests and rivaling controlled substance arrests as the primary focus of drug abuse control. Of note, most MPV arrestees have been black or Hispanic. Furthermore, black and Hispanic MPV arrestees have been more likely to be detained prior to arraignment, convicted, and sentenced to jail than their white counterparts. POLICY IMPLICATIONS: In light of the disparities, we recommend that the NYPD consider scaling back on MPV enforcement and reducing the harshness of treatment by routinely issuing Desk Appearance Tickets when the person is not wanted on other charges, so that most MPV arrestees would not be detained. Furthermore, we recommend that legislators should consider making smoking marijuana in public a violation and not a misdemeanor. Lastly, we suggest ways that NYC could monitor the effectiveness of these policy modifications to assure that the city continues to meet its goals for order maintenance.