A Spatiotemporal Analysis of the Association of California City and County Cannabis Policies with Cannabis Outlet Densities

Exploring the association between neighborhood disadvantage and cannabis retail density: A multi-measure analysis

INTRODUCTION

There is growing interest in the relationship between neighborhood disadvantage and increased cannabis retail density, driven by evidence suggesting higher density is associated with increased cannabis use. Yet little is known on how this relationship varies across different measures of cannabis retail density. This study explores how measures of neighborhood advantage and disadvantage relate to four cannabis retail density measures in the US.

METHODS

Data on licensed recreational cannabis retailers (n = 5586) were obtained from 18 state agency websites, geocoded, and spatially joined to 3369 census tracts to calculate four retail density measures: count per tract, cannabis retailers per 1000 population, per square mile, and per 10 miles of roadway. Multilevel regression models assessed the association between three Index of Concentration at the Extremes (ICE) measures-capturing tract concentration of racial and economic advantage/disadvantage-and the four cannabis retail density measures.

RESULTS

Census tracts with the highest concentrations of economic and racialized/economic disadvantage exhibited greater odds of increased cannabis retail density across all measures, compared to tracts with the highest concentration of advantage. Tracts with the greatest concentration of racialized populations did not show a higher count or density per population but did exhibit higher density per square mile and per roadway.

CONCLUSION

On average, cannabis retail density is higher in neighborhoods with the greatest structural disadvantage. Researchers, public health agencies, and policymakers should use multiple measures of cannabis retailer density in surveillance and evaluation efforts to identify policy strategies that would most effectively reduce the clustering of cannabis retailers in areas primarily occupied by low-income or racialized populations.

Geographic clustering of cannabis stores in Canadian cities: A spatial analysis of the legal cannabis market 4 years post-legalisation

INTRODUCTION

Following the legalisation of non-medical cannabis in 2018, the number of cannabis stores in Canada has rapidly expanded with limited regulation on their geographic placement. This study characterised the clustering of cannabis stores in Canadian cities and evaluated the association of clustering with provincial policy and sociodemographic variables.

METHODS

Cross-sectional spatial analysis of cannabis store density in dissemination areas ('neighbourhoods', n = 39,226) in Canadian cities in September 2022. Cannabis store density was defined as the count of stores within 1000 m of a neighbourhood centre. Clusters of high-density cannabis retail were identified using Local Indicators of Spatial Autocorrelation. Associations between provincial policy (privatised vs. public market), sociodemographic variables and cannabis store density were evaluated using multivariable regression.

RESULTS

Clusters of high-density cannabis retail were identified in 86% of Canadian cities, and neighbourhoods in clusters had a median of 5 stores within 1000 m. Toronto, Canada's most populous city, had the most extreme clustering where neighbourhoods in clusters had a median of 10 stores (and a maximum of 25 stores) within 1000 m. Neighbourhoods in private versus public retail markets had a significantly higher neighbourhood-level density of cannabis stores (adjusted rate ratio [aRR] 63.37, 95% confidence interval [CI] 25.66-156.33). Lower neighbourhood income quintile was also associated with a higher neighbourhood-level density of cannabis stores (Q5 vs. Q1, aRR 1.28, 95% CI 1.17-1.40).

DISCUSSION AND CONCLUSIONS

Since cannabis was legalised, clusters of high-density cannabis retail have emerged in most Canadian cities and were more likely to form lower income neighbourhoods and in private retail markets.

Racial, ethnic, and neighborhood socioeconomic disparities in local cannabis retail policy in California

BACKGROUND

Policies governing legal cannabis commerce can vary widely within a U.S. state when local control exists. Disproportionate distribution of policies allowing retail sale, protecting public health, or promoting equity in licensing may contribute to differences in health and economic outcomes between sociodemographic subgroups. This cross-sectional study jointly examined racial, ethnic, and neighborhood socioeconomic characteristics of Californians subject to specific local cannabis policies to identify such disparities.

METHODS

Local laws in effect January 1, 2020, governing retail cannabis sales (bans, expanding buffers from youth-serving sites, restricting advertising, promoting equity in licensing, and capping outlets) were determined for California's 539 jurisdictions. The number of Asian, Black, Latinx, and white residents in socioeconomic advantaged versus disadvantaged neighborhoods (Census block groups) was determined using 2015-2019 American Community Survey data. We estimated proportions of the sociodemographic subpopulations covered by specific policies based on the block group's jurisdiction. To ascertain disparities in coverage proportions were compared across subgroups using Z-tests with the Bonferroni correction.

RESULTS

Residents of socioeconomically advantaged neighborhoods were more likely to live in jurisdictions allowing retail cannabis commerce than those in disadvantaged neighborhoods (61.7 % versus 54.8 %). Black residents in advantaged neighborhoods were most likely to live where retailing was allowed (69 %), and white residents in disadvantaged neighborhoods least likely (49 %). Latinx and Black populations from disadvantaged neighborhoods were most likely to live in jurisdictions with stronger advertising restrictions (66 %). Equity in licensing policy was more prevalent for Black residents living in advantaged neighborhoods (57 %) than disadvantaged neighborhoods (49 %).

CONCLUSIONS

Local cannabis policies potentially protecting public health and social equity are unequally distributed across race, ethnicity, and socioeconomic characteristics in California. Research examining whether differential policy exposure reduces, creates, or perpetuates cannabis-related health and socioeconomic disparities is needed.

Associations of Local Cannabis Control Policies With Harmful Cannabis Exposures Reported to the California Poison Control System

BACKGROUND

Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures.

METHODS

Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements).

RESULTS

Localities that ultimately banned storefront recreational retail cannabis businesses had fewer harmful cannabis exposures for children aged <13 years (rate ratio = 0.82; 95% confidence interval = 0.65, 1.02), but not for people aged >13 years (rate ratio = 0.97; 95% confidence interval = 0.85, 1.11). Of 167 localities ultimately permitting recreational cannabis sales, overall restrictiveness was not associated with harmful cannabis exposures among children aged <13 years, but for people aged >13 years, a 1-standard deviation increase in ultimate restrictiveness was associated with fewer harmful cannabis exposures (rate ratio = 0.93; 95% confidence interval = 0.86, 1.01). For recommended provisions, estimates were generally too imprecise to detect associations with harmful cannabis exposures.

CONCLUSION

Bans on storefront retail and other restrictive approaches to regulating recreational cannabis may be associated with fewer harmful cannabis exposures for some age groups following statewide commercialization.

State licenses for medical marijuana dispensaries: neighborhood-level determinants of applicant quality in Missouri

BACKGROUND

When state governments impose quotas on commercial marijuana licenses, regulatory commissions use an application process to assess the feasibility of prospective businesses. Decisions on license applications are often met with formal appeals and legal challenges from rejected applicants. Although prior research has examined substate disparities in the availability of marijuana dispensaries, less attention has been given to the quality of license applications. The present study analyzed the relationship between neighborhood-level characteristics and the quality of prospective dispensary businesses.

METHODS

During Missouri's first applicant pool for medical marijuana dispensaries in 2019, a total of 606 census tracts contained the location site of at least one dispensary applicant. Using data from the Missouri Department of Health and Senior Services and the American Community Survey, fractional and binary logistic regression models were used to estimate the relationship between census-tract characteristics and application outcomes.

RESULTS

License applications received higher evaluation scores when proposed dispensary sites were in census tracts with greater population densities and no majority in racial/ethnic composition. Census tracts with poorer socioeconomic conditions attracted a disproportionate share of low-scoring applicants from the bottom quartile of scores. These effects were stronger for certain application subsections, particularly those assessing the quality of an applicant's business plan and on-site security.

CONCLUSIONS

Some communities tend to attract prospective license holders who possess better quality resources, business practices, and industry experience. State disparities in commercial licensing requirements and application processes may lead to the inequities in legal product access found in some prior studies.

Toward reducing racialized pain care disparities: Approaching cannabis research and access through the lens of equity and inclusion

There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long-racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis' deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term "cannabis" here rather than "marijuana.: In the early 1900s, the lay press and government popularized the use of the word "marijuana" instead of the more common "cannabis" to tie the drug to anti-Mexican prejudice.

Alignment in local approaches to alcohol and cannabis control policy: A case study of California cities and counties

BACKGROUND

Public health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches.

METHODS

Using standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification in relation to local demographic, socioeconomic, political, and retail market characteristics.

RESULTS

All 241 localities permitted alcohol sales, while 71% banned cannabis sales. Among those that did not ban cannabis sales, more stringent alcohol policy scores were associated with more stringent cannabis policy scores (linear regression coefficient: 0.16 [95% CI: 0.07, 0.25]). Local governments rarely adopted the same provisions for alcohol and cannabis (e.g., limits on hours of sale, advertising restrictions), and only two regulated the co-location of cannabis and alcohol outlets. Localities that were restrictive on alcohol yet permissive on cannabis (12%) were more urban, politically progressive, and had more low-income and racial/ethnic minority residents. Localities that were more permissive on alcohol and restrictive on cannabis (51%) were more socioeconomically advantaged.

CONCLUSION

We found few similarities between local alcohol and cannabis control policies. California's experience suggests that, as governments around the world legalize cannabis, lessons learned from regulating alcohol are not routinely applied to cannabis, particularly in communities distinguished by high social and economic advantages.

A contextualized reinforcer pathology approach to addiction

Behavioural economic accounts of addiction conceptualize harmful drug use as an operant reinforcer pathology, emphasizing that a drug is consumed because of overvaluation of smaller immediate rewards relative to larger delayed rewards (delay discounting) and high drug reinforcing value (drug demand). These motivational processes are within-individual determinants of behaviour. A third element of learning theory posits that harmful drug use depends on the relative constraints on access to other available activities and commodities in the choice context (alternative reinforcers), reflecting the substantial influence of environmental factors. In this Perspective, we integrate alternative reinforcers into the contemporary behavioural economic account of harmful drug use - the contextualized reinforcer pathology model - and review empirical literature across the translational spectrum in support of this model. Furthermore, we consider how increases in drug-related mortality and health disparities in addiction can be understood and potentially ameliorated via a contextualized reinforcer pathology model in which lack of alternative reinforcement is a major risk factor for addiction.