Legalization and retail availability of recreational marijuana and adolescent use in schools

Legalization of use and retail sales of recreational marijuana in U.S. states and the associated potential increase in access to marijuana and normalization of its use by adults could lead to increased use by adolescents. Studies have found that states with legal recreational marijuana have higher rates of adolescent use and frequency of use compared to states without legal use. We examined changes in student office discipline referrals (ODRs) for substance use offenses in Oregon middle and high schools before and after the legalization of recreational marijuana relative to comparison schools in other states. We found that rates of substance use related ODRs in middle schools increased by 0.14 per 100 students (30% of the mean) with legalization relative to comparison schools. This increase was moderated by the presence of a marijuana outlet within one mile of the school. We found no statistically discernible changes in high school ODRs. Marijuana use in adolescence has been linked to negative health and social consequences, including academic problems, mental health issues, and impaired driving. Potential adverse impact on adolescents and investments in school-based prevention programs could be important considerations for policymakers and public health officials when evaluating marijuana legalization.

Young Adults' Knowledge of State Cannabis Policy: Implications for Studying the Effects of Legalization in Vermont

Objectives

Cannabis policy evaluations commonly assume equal policy exposure across a state's population using date of implementation as the key independent variable. This study aimed to explore policy knowledge as another measure of exposure and describe the sociodemographic, cognitive, and behavioral correlates of cannabis policy knowledge in young adults in Vermont.

Methods

Data are from the PACE Vermont Study (Spring 2019), an online cohort study of Vermonters (12-25). Bivariate and multivariable analyses estimated prevalence ratios (PR) for correlations between knowledge of Vermont's cannabis policy (allowed possession for adults 21 and older) and sociodemographics, cannabis use, and harm perceptions in 1,037 young adults (18-25).

Results

Overall, 60.1% of participants correctly described the state's cannabis policy. Being younger, Hispanic, non-White race, and less educated were inversely correlated with policy knowledge. Ever (PR=1.37; 95% CI 1.16-1.63) and past-30-day cannabis use (PR=1.27; 95% CI 1.12-1.45) were positively correlated with policy knowledge. Policy knowledge was more prevalent among young adults who perceived slight risk of harm from weekly cannabis use (vs. no risk; aPR=1.28; 95% CI 1.11-1.48) or agreed that regular cannabis use early in life can negatively affect attention (vs. disagree; aPR=1.55; 95% CI 1.22-1.97).

Conclusion

Findings suggest that 40% of Vermont young adults in the study were unaware of current state cannabis policy and that policy knowledge was lower in younger, less educated, Hispanic, and non-White young adults. Future research should explore using a measure of policy knowledge as an exposure or moderator variable to better quantify the effects of changes in cannabis legal status on perceptions and use in young people.

Local Laws Regulating Cannabis in California Two Years Post Legalization: Assessing Incorporation of Lessons from Tobacco Control

Introduction

As cannabis legalization continues to spread, best regulatory practice remains ill-defined and elusive, exposing the population to potential harms.

Methods

We conducted an annual, statewide, cross- sectional survey to assess cannabis-related laws in effect by January 1, 2020, in local California jurisdictions and at the state level and measured adoption of potential best practices.

Results

The current laws of all 539 jurisdictions were located; 276 jurisdictions allowed any retail sales (storefront or delivery) covering 58% of the population, an increase of 20 jurisdictions (8%) from year 1 of legalization (2018). Half allowed sales of medical cannabis, whereas slightly fewer jurisdictions (n = 225) allowed adult-use sales. Only 9 jurisdictions imposed any restrictions on products stricter than state regulations. Cannabis temporary special events were allowed in 22 jurisdictions, up from 14 in the year prior. Thirty-three jurisdictions required additional health warnings for consumers. Just over half of legalizing jurisdictions taxed cannabis locally and little revenue was captured for prevention. No new jurisdictions established a potency-linked tax. Of jurisdictions allowing storefront retailers (n = 162), 114 capped outlet licenses, and 49 increased the state-specified buffers between storefronts and schools. Thirty-six allowed on-site consumption, up from 29. As of January 2020, the state had not updated its regulations of key provisions addressed in this paper.

Conclusions

In year 2 of legalized adult-use cannabis sales in California, the state remained split between retail bans and legal sale. Local policy continued to vary widely on protective measures, and State policy remained misaligned with protection of youth and public health.

Racial Equity in Cannabis Policy: Diversity in the Massachusetts Adult-Use Industry at 18-months

Background

Cannabis criminalization disproportionately harms communities of color in the United States. In Massachusetts' legal recreational ("adult-use") cannabis industry, state regulations intend to promote diverse participation. We assessed short-term racial/ethnic and gender diversity across the industry and in senior-level positions with greater opportunities to build wealth (i.e., board members, executives, directors).

Methods

We extracted race/ethnicity and gender from required registration forms submitted to state regulators for each person working in a licensed adult-use cannabis business from October 2018 to April 2020 (n=4,883). We conducted descriptive analysis and negative binomial regression to assess characteristics associated with senior positions.

Results

As of April 2020, racial/ethnic and gender diversity in the Massachusetts adult-use cannabis market (n=4,883) was 75% white, 7% Latino, 6% Black/African American, similar to the state labor market, and 65% male. Diversity was more limited in senior positions. Agents in senior positions (n=403) were 84% white, 2% Latino, 5% Black/African American, and 82% male. Senior-level participation was markedly low for women of color.

Conclusion

Despite legislative and regulatory commitment, diversity lacks in senior positions in this emerging cannabis market. States considering adult-use cannabis markets, and those that have already done so, should monitor participation to identify inequities and adapt initiatives to ensure Black/African American and Latino communities socially and economically benefit from state legalization.

Parents' Perceptions of Adolescent Exposure to Marijuana Following Legalization in Washington State

OBJECTIVE

Parents in Washington State face new challenges related to the non-medical marijuana legislation that was passed in 2012. We asked parent focus group participants about changes they have observed in their environment, how their children are exposed to marijuana, and how this exposure might affect youth marijuana use.

METHOD

We conducted 6 focus groups with parents of youth ages 8 to 15 (N = 54). Parents were recruited from the Seattle Social Development Project, a multi-ethnic, longitudinal panel study that originated in Seattle in 1985. Thematic content analysis was used to analyze qualitative data.

RESULTS

Parents agreed that they did not want their children using marijuana, and were concerned that their children were exposed to marijuana more often and in many different contexts. Parents said they now need to monitor their children's environment more carefully, especially the other adults that spend time around their children. Edible marijuana products were particularly concerning for parents, as they offer a new set of challenges for parents in monitoring their children's exposure to and use of marijuana. Parents were concerned that marijuana exposure would increase risk of marijuana use in adolescents.

CONCLUSIONS

Parents' experiences in Washington State provide valuable lessons for social work practitioners, policymakers and those developing preventive interventions. Prevention efforts and public health messaging should begin before legalization takes effect to support parents in preparing for changes in their social and physical environments, and should seek to incorporate parenting strategies to monitor and intervene when children are exposed to marijuana.

Social and Political Factors Associated With State-Level Legalization of Cannabis in the United States

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This paper analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.

Age of First Marijuana Use and Its Impact on Education Attainment and Employment Status

With the increased prevalence of marijuana use among youth, the increase in state legalization, and changing social norms in the United States, it is important to understand the long-term impact of marijuana use initiation. This study examined whether age of first marijuana use is associated with educational attainment and employment status. Data from 5,988 adults aged 26 to 49 years who participated in the 2015 National Survey on Drug Use and Health were used in the current study. Logistic regression analyses were used to examine the odds of graduating from high school and being employed. Controlling for demographics, persons with late-early first use had significantly higher odds of graduating from high school and being employed compared with persons with early first use. Results underscore the importance of early prevention for youth aged 15 and younger and have implications for intervention and policy development.

Marijuana as a Substitute for Prescription Medications: A Qualitative Study

Background: Over the past few decades in the United States, marijuana for medical purposes has become increasingly prevalent. Initial qualitative and epidemiological research suggests that marijuana may be a promising substitute for traditional pharmacotherapies. Objectives: This qualitative study examined perceptions relating to (1) using medical marijuana in comparison to other prescription medications and (2) user perception of policy issues that limit adoption of medical marijuana use. Methods: Qualitative interviews were conducted with Rhode Island medical marijuana card holders (N = 25). The interviews followed a semi-structured agenda designed to collect information from participants about their reasons for, and perceptions of, medical marijuana use. All interviews were audio recorded, transcribed verbatim, and de-identified. Qualitative codes were developed from the agenda and emergent topics raised by the participants. Results: Three themes emerged related to medical marijuana use, including (1) comparison of medical marijuana to other medications (i.e., better and/or fewer side effects than prescription medications, improves quality of life), (2) substitution of marijuana for other medications (i.e., in addition to or instead of), and (3) how perception of medical marijuana policy impacts use (i.e., stigma, travel, cost, and lack of instruction regarding use). Conclusions: Several factors prevent pervasive medical marijuana use, including stigma, cost, and the inability for healthcare providers to relay instructions regarding dosing, strain, and method of use. Findings suggest that medical patients consider marijuana to be a viable alternative for opioids and other prescription medications, though certain policy barriers inhibit widespread implementation of marijuana as a treatment option.

Trends and age, period and cohort effects for marijuana use prevalence in the 1984-2015 US National Alcohol Surveys

BACKGROUND AND AIMS

Epidemiological trends show marijuana use in the United States to have increased in recent years. Previous research has identified cohort effects as contributing to the rising prevalence, in particular birth cohorts born after 1945. However, given recent policy efforts to regulate marijuana use at the state level, period effects could also play a contributory role. This study aimed to examine whether cohort or period effects play a larger role in explaining trends in marijuana use.

DESIGN

Using data from seven National Alcohol Surveys, we estimated age-period-cohort decomposition models for marijuana use, controlling for socio-demographic measures.

SETTING

United States.

PARTICIPANTS

US general population aged 18 and older from 1984 to 2015.

MEASUREMENTS

Any past-year marijuana use.

FINDINGS

Results indicated that period effects were the main driver of rising marijuana use prevalence. Models including indicators of medical and recreational marijuana policies did not find any significant positive impacts.

CONCLUSIONS

The steep rise in marijuana use in the United States since 2005 occurred across the population and is attributable to general period effects not linked specifically to the liberalization of marijuana policies in some states.