Cannabis legalization in the provinces and territories: missing opportunities to effectively educate youth?
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ABSTRACT:
SUBMITTER: Watson TM
PROVIDER: S-EPMC6964574 | biostudies-literature | 2019 Aug
REPOSITORIES: biostudies-literature
Publications
Cannabis legalization in the provinces and territories: missing opportunities to effectively educate youth?
Watson Tara Marie TM Valleriani Jenna J Hyshka Elaine E Rueda Sergio S
Canadian journal of public health = Revue canadienne de sante publique 20190513 4
Cannabis is now legal in Canada, yet important questions remain regarding how the provinces and territories are approaching cannabis education and messaging aimed at youth. Although widespread education and awareness campaigns are long considered cornerstones of substance use and related harm prevention, there is limited evidence to support the effectiveness of such campaigns. We continue to see examples of cannabis-related messaging that focus on risk and harm and often adopt a narrow view of t ...[more]
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Project description:ImportanceCivil liberty advocates typically support legalization of cannabis, which targets adult use, rather than decriminalization, which can affect both adults and youths. However, it is unknown how arrests of youths for cannabis possession change when adult use of cannabis is legalized.ObjectiveTo model changes in arrest rates of adults and youths after decriminalization and legalization of cannabis.Design, setting, and participantsThis quasi-experimental study used the publicly available Uniform Crime Reporting Program Data: Arrests by Age, Sex, and Race administrative data set to examine arrest rates in 38 states from January 1, 2000, to December 31, 2016. Adult (age, ≥18 years) and youth (age, <18 years) arrests for possession of cannabis were examined. States were excluded if they did not report complete arrest data or if a policy was implemented that reduced penalties for possession of cannabis but fell short of decriminalization. Fixed-effects regression was used in an extended difference-in-differences framework. The analyses in their final form were conducted between January 17 and February 28, 2019.ExposureLiving in a state with a cannabis decriminalization policy (ie, making the penalty for cannabis possession similar to the small fine for a traffic violation) or legalization policy (ie, creating a legal supply of cannabis along with the removal of penalties for possession of a small amount of cannabis for recreational use).Main outcome and measuresState cannabis possession arrest rate per 100 000 population.ResultsData from 38 states were examined, including 4 states with cannabis legalization policies and 7 states with cannabis decriminalization policies. The adult arrest rate decreased by 131.28 (95% CI, 106.23-154.21) per 100 000 population after the implementation of decriminalization and 168.50 (95% CI, 158.64-229.65) per 100 000 population after the implementation of legalization. The arrest rate for youths decreased by 60 (95% CI, 42-75) per 100 000 population after decriminalization but did not significantly change after legalization in a state (7 per 100 000 population; 95% CI, -15 to 30).Conclusions and relevanceLegalization, as implemented through 2016, did not appear to reduce arrests for cannabis possession among youths, despite having benefited adults. The study's findings suggest that decriminalization reduces youth arrests in most cases, but these findings also suggest that any benefit for youths could be lost when adult use has also been legalized. To address this problem, it appears that state decriminalization policies should take the additional step to explicitly describe when youths can be arrested for possession of small amounts of cannabis.
| S-EPMC6580444 | biostudies-literature
Project description:Canada legalized recreational cannabis use for adults on October 17, 2018 with decision-makers emphasising the need to reduce cannabis use among youth. We sought to characterise trends of youth cannabis use before and after cannabis legalization by relying on a quasi-experimental design evaluating cannabis use among high school students in Alberta, British Columbia, Ontario, and Québec who participated in the COMPASS prospective cohort study. Overall trends in use were examined using a large repeat cross-sectional sample (n = 102,685) at two time points before legalization (16/17 and 17/18 school years) and one after (18/19 school year). Further differential changes in use among students affected by legalization were examined using three sequential four-year longitudinal cohorts (n = 5,400) of students as they progressed through high school. Youth cannabis use remains common with ever-use increasing from 30.5% in 2016/17 to 32.4% in 2018/19. In the repeat cross-sectional sample, the odds of ever use in the year following legalization were 1.05 times those of the preceding year (p = 0.0090). In the longitudinal sample, no significant differences in trends of cannabis use over time were found between cohorts for any of the three use frequency metrics. Therefore, it appears that cannabis legalization has not yet been followed by pronounced changes on youth cannabis use. High prevalence of youth cannabis use in this sample remains a concern. These data suggest that the Cannabis Act has not yet led to the reduction in youth cannabis use envisioned in its public health approach.
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Project description:BackgroundIn 2013, Uruguay became the first country in the world to legalize recreational cannabis, instituting a non-commercial state regulatory model of production and supply. This study provides the first empirical evidence on its impacts on adolescent use of cannabis and related risks.MethodsWe use a generalization of the synthetic control method (SCM) to estimate the impact of legalization in Uruguay on adolescent past year and month cannabis use, perceived availability of cannabis and perceived risk of cannabis use. We compare biennial high school student self-reported survey data from Montevideo and regions in the interior of Uruguay post-legalization (2014-2018) and post initial implementation (2015-2018) to a synthetic counterfactual constructed using a weighted combination of 15 control regions in Chile.ResultsWe find no evidence of an impact on cannabis use or the perceived risk of use. We find an increase in student perception of cannabis availability (58% observed vs. 51% synthetic control) following legalization.ConclusionOur findings provide some support for the thesis that Uruguay's state regulatory approach to cannabis supply may minimize the impact of legalization on adolescent cannabis use. At the same time, our study period represents a period of transition: pharmacy access, by far the most popular means of access, was not available until the summer of 2017. Additional study will be important to assess the longer-term impacts of the fully implemented legalization regime on substance use outcomes.
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Project description: Not available
| S-EPMC8742190 | biostudies-literature
Project description:ImportanceThe impact of nonmedical cannabis legalization on traffic injuries and cannabis involvement in traffic injuries is unclear.ObjectiveTo examine changes in the number and characteristics of cannabis-involved traffic injury emergency department (ED) visits from before to after legalization and subsequent commercialization (ie, increased retail store and product availability) of cannabis in Ontario, Canada.Design, setting, and participantsThis repeated cross-sectional study examined changes in cannabis- and alcohol-involved traffic injury ED visits in Ontario, Canada, during 3 time periods: prelegalization (January 2010-September 2018), legalization with product and retail store restrictions (October 2018-February 2020), and commercialization with new products and expanded number of stores, which coincided with the COVID-19 pandemic (March 2020-December 2021). All individuals aged 16 years and older eligible for Ontario's Universal Health Coverage were included. Season- and time-adjusted quasi-Poisson models were used to generate rate ratios with 95% CIs. Data were analyzed from March to April 2023.Main outcomes and measuresQuarterly counts of cannabis-involved ED visits for traffic injury.ResultsThere were 947 604 traffic injury ED visits, of which 426 (0.04%) had documented cannabis involvement and 7564 (0.8%) had documented alcohol involvement. Of the 418 individuals with documented cannabis involvement, 330 (78.9%) were male, 109 (25.6%) were aged 16 to 21 years (mean [SD] age at visit, 30.6 [12.0] years), and 113 (27.0%) had an ED visit or hospitalization for substance use in the 2 years before their traffic injury ED visit. Annual rates of cannabis-involved traffic injury ED visits increased 475.3% over the study period (0.18 visits per 1000 total motor vehicle collisions in 2010 to 1.01 in 2021). Over the same period, alcohol-involved traffic injury ED visits increased by 9.4% (8.03 in 2010 to 8.79 per 1000 traffic injury ED visits in 2021). Legalization with restrictions was associated with a 94% increase in the quarterly rate of cannabis involvement in traffic injury ED visits relative to prelegalization (adjusted rate ratio [aRR], 1.94; 95% CI, 1.37-2.75). Commercialization/COVID-19 was associated with a greater increase of 223% in rates (aRR, 3.23; 95% CI, 2.42-4.33). After adjusting for time trends before legalization, only commercialization/COVID-19 was associated with increased rates. Male sex (adjusted odds ratio [aOR], 3.38; 95% CI, 2.66-4.29), living in the lowest-income neighborhood (aOR, 1.92; 95% CI, 1.39-2.67), being aged 19 to 21 years (aOR, 4.67; 95% CI, 3.27-6.67), and having a prior cannabis-related ED visit (aOR, 8.03; 95% CI, 5.85-11.02) were all positively associated with cannabis involvement during a traffic injury ED visit.Conclusions and relevanceThis cross-sectional study found large increases in cannabis involvement in ED visits for traffic injury over time, which may have accelerated following nonmedical cannabis commercialization. Although the frequency of visits was rare, they may reflect broader changes in cannabis-impaired driving. Greater prevention efforts, including targeted education and policy measures, in regions with legal cannabis are indicated.
| S-EPMC10483310 | biostudies-literature
Project description:AimsTo estimate the effect of recreational legalization on cannabis use frequency and sources of variance across legal environments.DesignLongitudinal discordant twin and gene-environment interaction models in twins recruited from birth records and assessed prospectively.SettingThe United States, including states with different recreational cannabis policies before and after 2014, when recreational cannabis was first legalized.ParticipantsTwo longitudinal, prospectively assessed samples of American twins aged 24-47 (n = 1425 in legal states, n = 1996 in illegal states), including 111 monozygotic pairs discordant for residence.MeasurementsCurrent cannabis use frequency (measured continuously and ordinally) was the primary outcome, and the predictor was recreational status of cannabis (legal/illegal) in the participant's state of residence at the time of assessment. Covariates include age, sex and cannabis use frequency prior to 2014.FindingsAccounting for pre-2014 use, residents of legal states used cannabis more frequently than residents of illegal states (b = 0.21, P = 8.08 × 10-5 ). Comparing 111 pairs of monozygotic twins discordant for residence confirmed the effect (b = 0.18, P = 0.014). There was inconclusive evidence for genetic influences on cannabis use frequency that were specific to the legal environment [χ2 = 2.9 × 10-9 , degrees of freedom (d.f.) = 1, P > 0.999]. Existing genetic influences were moderated by the legal environment, as the genetic correlation between marijuana use before and after legalization was lower in states that legalized (rgenetic = 0.24) compared with states that did not (rgenetic = 0.78, Pdifference = 0.016).ConclusionsIn the United States, there appears to be a ~ 20% average increase in cannabis use frequency attributable to recreational legalization, consistent across increasingly rigorous designs. In addition, the heritability of cannabis use frequency appears to be moderated by legalization.
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Project description:The relationship between cannabis legalization and traffic safety remains unclear. Physiological measures of cannabis impairment remain imperfect. This analysis used self-report data to examine the relationship between cannabis legalization and driving under the influence of cannabis (DUIC). Using a cross-sectional national sample (2016-2017) of 1,249 past-30-day cannabis users, we regressed self-reported DUIC (driving within three hours of "getting high") on cannabis legalization (recreational and medical (recreational), medical only (medical), or no legal cannabis), adjusting for demographics, days of use (past 30 days), days of use*legal status, calibration weights, and geographic clustering. The risk of DUIC in recreational (risk ratio [RR] = 0.41, 95% confidence interval (CI):0.23-0.72) and medical (RR = 0.39, 95% CI:0.20-0.79) states was lower than in states without legal cannabis, with one exception. Among frequent cannabis users (≥20 days per month), there was a significantly lower risk of DUIC for those living in recreational states (RR = 0.70, 95% CI: 0.49-0.99), but not for those living in medical states (RR = 0.87, 95% CI: 0.60-1.24), compared to users living in states without legal cannabis. The risk of self-reported DUIC was lower in recreational and medical cannabis states compared to states without legal cannabis. The only exception was for frequent users in medical states, for whom there was no difference in risk compared to frequent users living in states without legal cannabis.
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Project description:Cannabis is widely used in the U.S. and internationally despite its illicit status, but that illicit status is changing. In the U.S., 33 states and the District of Columbia have legalized medical cannabis, and 11 states and D.C. have legalized adult use cannabis. A majority of state medical cannabis laws and all but two state adult use laws are the result of citizen ballot initiatives, but state legislatures are beginning to seriously consider adult use legislation. From a public health perspective, cannabis legalization presents a mix of potential risks and benefits, but a legislative approach offers an opportunity to improve on existing legalization models passed using the initiative process that strongly favor business interests over public health. To assess whether state legislatures are acting on this opportunity, this article examines provisions of proposed adult use cannabis legalization bills active in state legislatures as of February 2019 to evaluate the inclusion of key public health best practices based on successful tobacco and alcohol control public health policy frameworks. Given public support for legalization, further adoption of state adult use cannabis laws is likely, but legalization should not be viewed as a binary choice between total prohibition and laissez faire commercialization. The extent to which adult use cannabis laws incorporate or reject public health best practices will strongly affect their impact, and health advocates should work to influence the construction of such laws to prioritize public health and learn from past successes and failures in regulating other substances.
| S-EPMC8351589 | biostudies-literature
Project description:ImportanceLittle is known about changes in cannabis use outcomes by race and ethnicity following the enactment of recreational cannabis laws (RCLs).ObjectivesTo examine the association between enactment of state RCLs and changes in cannabis outcomes by race and ethnicity overall and by age groups in the US.Design, setting, and participantsThis cross-sectional study used restricted use file data from the National Surveys of Drug Use and Health between 2008 and 2017, which were analyzed between September 2019 and March 2020. National survey data included the entire US population older than 12 years.Main outcomes and measuresSelf-reported past-year and past-month cannabis use and, among people that used cannabis, daily past-month cannabis use and past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) cannabis use disorder. Multi-level logistic regressions were fit to estimates changes in cannabis use outcomes by race and ethnicity overall and by age between respondents in states with and without enacted RCLs, controlling for trends in states with medical cannabis laws or no cannabis laws.ResultsA total of 838 600 participants were included for analysis (mean age, 43 years [range, 12-105 years]; 434 900 women [weighted percentage, 51.5%]; 511 900 participants (weighted percentage, 64.6%) identified as non-Hispanic White, 99 000 (11.9%) as non-Hispanic Black, 78 400 (15.8%) as Hispanic, and 149 200 (7.6%) as other (including either Native American, Pacific Islander, Asian, or more than 1 race or ethnicity). Compared with the period before RCL enactment, the odds of past-year cannabis use after RCL enactment increased among Hispanic (adjusted odds ratio [aOR], 1.33; 95% CI, 1.15-1.52), other (aOR, 1.31; 95% CI, 1.12-1.52), and non-Hispanic White (aOR, 1.21; 95% CI, 1.12-1.31) populations, particularly among those aged 21 years or more. Similarly, the odds of past-month cannabis use increased among Hispanic (aOR, 1.43; 95% CI, 1.22-1.69), other (aOR, 1.43; 95% CI, 1.20-1.70), and non-Hispanic White (aOR, 1.24; 95% CI, 1.13-1.35) populations after RCL enactment. No increases were found in the odds of past-year or past-month cannabis use post-RCL enactment among non-Hispanic Black individuals or among individuals aged 12 to 20 years for all race and ethnicity groups. In addition, among people who used cannabis, while no increases were found in past-month daily cannabis in any racial or ethnic group, the odds of cannabis use disorder increased post-RCL among individuals categorized as other overall (aOR, 1.45; 95% CI, 1.07-1.95), but no increases were found by age group.Conclusions and relevanceChanges in cannabis use by race and ethnicity that may be attributable to policy enactment and variations in recreational policy provisions should be monitored. To ensure that the enactment of recreational cannabis laws truly contributes to greater equity in outcomes and adheres to antiracist policies, monitoring unintended and intended consequences that may be attributable to recreational cannabis use and similar policies by race and ethnicity is needed.
| S-EPMC8477268 | biostudies-literature
Project description:ImportanceCannabis use disorder (CUD) is increasing among US adults. Few national studies have addressed the role of medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) in these increases, particularly in patient populations with high rates of CUD risk factors.ObjectiveTo quantify the role of MCL and RCL enactment in the increases in diagnosed CUD prevalence among Veterans Health Administration (VHA) patients from 2005 to 2019.Design, setting, and participantsStaggered-adoption difference-in-difference analyses were used to estimate the role of MCL and RCL in the increases in prevalence of CUD diagnoses, fitting a linear binomial regression model with fixed effects for state, categorical year, time-varying cannabis law status, state-level sociodemographic covariates, and patient age group, sex, and race and ethnicity. Patients aged 18 to 75 years with 1 or more VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given calendar year were included. Time-varying yearly state control covariates were state/year rates from American Community Survey data: percentage male, Black, Hispanic, White, 18 years or older, unemployed, income below poverty threshold, and yearly median household income. Analysis took place between February to December 2022.Main outcomes and measuresAs preplanned, International Classification of Diseases, Clinical Modification, ninth and tenth revisions, CUD diagnoses from electronic health records were analyzed.ResultsThe number of individuals analyzed ranged from 3 234 382 in 2005 to 4 579 994 in 2019. Patients were largely male (94.1% in 2005 and 89.0% in 2019) and White (75.0% in 2005 and 66.6% in 2019), with a mean (SD) age of 57.0 [14.4] years. From 2005 to 2019, adjusted CUD prevalences increased from 1.38% to 2.25% in states with no cannabis laws (no CLs), 1.38% to 2.54% in MCL-only enacting states, and 1.39% to 2.56% in RCL-enacting states. Difference-in-difference results indicated that MCL-only enactment was associated with a 0.05% (0.05-0.06) absolute increase in CUD prevalence, ie, that 4.7% of the total increase in CUD prevalence in MCL-only enacting states could be attributed to MCLs, while RCL enactment was associated with a 1.12% (95% CI, 0.10-0.13) absolute increase in CUD prevalence, ie, that 9.8% of the total increase in CUD prevalence in RCL-enacting states could be attributed to RCLs. The role of RCL in the increases in CUD prevalence was greatest in patients aged 65 to 75 years, with an absolute increase of 0.15% (95% CI, 0.13-0.17) in CUD prevalence associated with RCLs, ie, 18.6% of the total increase in CUD prevalence in that age group.Conclusions and relevanceIn this study of VHA patients, MCL and RCL enactment played a significant role in the overall increases in CUD prevalence, particularly in older patients. However, consistent with general population studies, effect sizes were relatively small, suggesting that cumulatively, laws affected cannabis attitudes diffusely across the country or that other factors played a larger role in the overall increases in adult CUD. Results underscore the need to screen for cannabis use and CUD and to treat CUD when it is present.
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