Legalization and innovation in the cannabis market

Systematic Review and Meta-Analysis: Medical and Recreational Cannabis Legalization and Cannabis Use Among Youth in the United States

Association of recreational cannabis legalization with changes in medical, illegal, and total cannabis expenditures in Canada.

Changes in alcohol and cigarette consumption in response to medical and recreational cannabis legalization: Evidence from U.S. state tax receipt data

Changes in Alcohol and Tobacco Consumption in Response to Medical and Recreational Cannabis Legalization: Evidence from U.S. State Tax Receipt Data

ObjectiveThe purpose of this study is to examine how cannabis legalization and corresponding taxation would affect the supply-side of the cannabis market. Specifically, the study considers various scenarios in which Oklahoma legalizes recreational cannabis for adult use and simulates changes in state-level market sales for other legal states and the average grower profits in Oklahoma. We assume that legalizing recreational cannabis in medical-only states would significantly increase the demand quantity in the legalized states and the local government would levy a significant level of tax on recreational cannabis. These assumptions are based on the post-legalization phenomena in other legalized US states.MethodWe simulate outcomes in the cannabis industry under the assumption of representative consumers with constant elasticity of substitution demand behavior and profit-maximizing firms with a Cobb-Douglas profit function. All agents are assumed to take exogenous prices as given. We calibrate the model using state-level sales data from 2020 and explore potential policies in Oklahoma and at the federal level.ResultsWe find that, under the scenarios we consider, legalization of recreational cannabis in Oklahoma would lead to a decrease in the quantity of cannabis sold in Oklahoma’s medical cannabis market as well as decreases in the quantity of cannabis sold in other states on average. Furthermore, we find that as the excise tax rate on recreational cannabis in Oklahoma is increased, the demand quantity in recreational cannabis market would decrease while the other markets’ demand quantity would increase on average. As the elasticity of substitution between state-level products increases, the overall demand quantity would increase and the market quantity across states become more sensitive to Oklahoma’s tax policies. This pattern could become starker as the elasticity of substitution between recreational and medical cannabis increases. In terms of profit, heavy taxation and price decrease due to legalization would significantly decrease cannabis producers’ production and profit levels unless the cost reduction strategies complement legalization.ConclusionBased on our results, the legalization of recreational cannabis has the potential to generate tax revenue to fund critical government projects and services. However, such legalization would have to be done carefully because heavy excise taxes would decrease the legal cannabis market demand and growers’ profit, which would incentivize producers and consumers to move to the illicit cannabis market. Policymakers would have to compromise between the levels of interstate transportation and taxation to ensure that cannabis suppliers also realize some profit within the cannabis supply chain.

Pediatric Cannabis Single-Substance Exposures Reported to the Michigan Poison Center From 2008-2019 After Medical Marijuana Legalization.

Background The past two decades have seen significant debate around cannabis legalization globally, including in India. Since there is no data on professionals’ attitudes toward cannabis legalization; we aimed to assess early-career psychiatrists (ECP) views on cannabis legalization. Methods An online survey consisting of questions regarding personal and socio-demographic details, attitudes toward legalization of medicinal cannabis and recreational cannabis, and potential indications of medicinal cannabis use was distributed to ECPs. Data from 105 respondents were analyzed using descriptive statistics, chi-square test, and t-test. Results More respondents agreed with the legalization of medical cannabis (55%) as compared to recreational cannabis (23%). More than 80% ECPs considered cannabis to be associated with psychosis and adverse mental health outcomes; however, those in favor of legalization considered cannabis to be less harmful. ECP with past cannabis use was more likely to have a permissive attitude toward the legalization of recreational cannabis (χ2 =6.79, p < .05) but not for medicinal cannabis use (χ2 =1.96, p > .05). Conclusion ECP in India are open to the idea of legalizing cannabis for medicinal purposes but not for recreational purposes.

While some have argued that cannabis legalization has helped to reduce opioid-related morbidity and mortality in the US, evidence has been mixed. Moreover, existing studies did not account for biases that could arise when policy effects vary over time or across states or when multiple policies are assessed at the same time, as in the case of recreational and medical cannabis legalization. To quantify changes in opioid prescriptions and opioid overdose deaths associated with recreational and medical cannabis legalization in the US. This quasiexperimental, generalized difference-in-differences analysis used annual state-level data between January 2006 and December 2020 to compare states that legalized recreational or medical cannabis vs those that did not. Recreational and medical cannabis law implementation (proxied by recreational and medical cannabis dispensary openings) between 2006 and 2020 across US states. Opioid prescription rates per 100 persons and opioid overdose deaths per 100 000 population based on data from the US Centers for Disease Control and Prevention. Between 2006 and 2020, 13 states legalized recreational cannabis and 23 states legalized medical cannabis. There was no statistically significant association of recreational or medical cannabis laws with opioid prescriptions or overall opioid overdose mortality across the 15-year study period, although the results also suggested a potential reduction in synthetic opioid deaths associated with recreational cannabis laws (4.9 fewer deaths per 100 000 population; 95% CI, -9.49 to -0.30; P = .04). Sensitivity analyses excluding state economic indicators, accounting for additional opioid laws and using alternative ways to code treatment dates yielded substantively similar results, suggesting the absence of statistically significant associations between cannabis laws and the outcomes of interest during the full study period. The results of this study suggest that, after accounting for biases due to possible heterogeneous effects and simultaneous assessment of recreational and medical cannabis legalization, the implementation of recreational or medical cannabis laws was not associated with opioid prescriptions or opioid mortality, with the exception of a possible reduction in synthetic opioid deaths associated with recreational cannabis law implementation.

The association between state cannabis legalization and non-fatal opioid poisonings among adults with employer-sponsored insurance in the United States

Objective While attention has been given to how legalization of recreational cannabis affects traffic crash rates, there was been limited research on how cannabis affects pedestrians involved in traffic crashes. This study examined the association between cannabis legalization (medical, recreational use, and recreational sales) and fatal motor vehicle crash rates (both pedestrian-involved and total fatal crashes). Methods We used crash data from the Fatality Analysis Reporting System (FARS) to calculate monthly rates of fatal motor vehicle crashes and fatal pedestrian-involved crashes per 100,000 people from 1991 to 2018. Changes in monthly crash rates in three states that had legalized cannabis (Colorado, Washington, and Oregon) were compared to matched control states using segmented regression with autoregressive terms. Results We found no significant differences in pedestrian-involved fatal motor vehicle crashes between legalized cannabis states and control states following medical or recreational cannabis legalization. Washington and Oregon saw immediate decreases in all fatal crashes (-4.15 and −6.60) following medical cannabis legalization. Colorado showed an increase in trend for all fatal crashes after recreational cannabis legalization and the beginning of sales (0.15 and 0.18 monthly fatal crashes per 100,000 people). Conclusions Overall findings do not suggest an elevated risk of total or pedestrian-involved fatal motor vehicle crashes associated with cannabis legalization.

The legalization and depenalization of recreational cannabis is increasingly debated in Europe, including in Poland, where medical cannabis was legalized in 2017. Despite ongoing public discourse, up-to-date data on public attitudes toward recreational cannabis legalization remain limited. This study aimed to characterize public attitudes toward the legalization and depenalization of recreational cannabis in Poland. This retrospective, cross-sectional, computer-assisted web interviewing-based nationwide survey was conducted between July 11 and 13, 2025, using an online questionnaire completed by a representative sample of 1113 Polish adults. The survey assessed support for recreational cannabis depenalization, perceived accessibility, attitudes toward personal possession laws, and views on the impact of medical cannabis legalization. Multivariable logistic regression identified factors associated with public attitudes. Results showed 29.6% respondents supported full legalization of recreational cannabis, 39.6% favored depenalization (eg, legal possession of up to 100 g or 3 plants), and 18.7% perceived cannabis as easily accessible; 32.4% expressed concern that medical cannabis legalization may lead to increased recreational use. Support for legalization and depenalization was significantly associated with male sex, younger age (18-29 years), urban residence, active occupational status, and good household economic status. Eight years after medical cannabis legalization, public opinion in Poland shows limited support for full recreational legalization but substantially greater acceptance of depenalization, revealing a clear policy gradient. Demographic factors of sex, age, and place of residence strongly shape public attitudes. These findings provide evidence to inform drug policy discussions in Poland and other Central and Eastern European countries.

ABSTRACTThere are some indices in which legalization of medical cannabis in the Republic of Serbia might be considered. The purpose of this research was to assess knowledge and attitudes towards medical cannabis in an urban adult population. This cross-sectional study was conducted in December 2015 and January 2016. A convenience sample of study participants comprised users of the Community Health Center. A total of 360 adults were invited to participate. Data were collected through an anonymous questionnaire. Most participants (77.1%) answered correctly that cancer was indicative of medical cannabis treatment, while the remaining conditions were less frequently recognized. A total of 42% answered correctly that adverse effects of cannabis were hallucinations and dizziness. Persons who previously used cannabis were more knowledgeable on conditions for medical cannabis treatment (ρ = 0.155; p = 0.006). Study respondents expressed positive attitude towards legalization of medical cannabis (median 5 out of 5) and negative towards legalization of recreational cannabis (median 2 out of 5). In conclusion, the adult population in Belgrade had some knowledge of medical cannabis. The overall attitude of our population regarding legalization of medical cannabis was positive, while the attitude towards legalization of cannabis for recreational purposes was negative.

Introduction and Aims: Increasingly more Australians are in favor of legalizing medical and recreational cannabis use. This paper explored the personal characteristics of those who supported each of these policies in Australia.Design: Cross-sectional national survey.Methods: This study included 21,729 participants aged 18 years and above who responded to the 2016 National Drug Strategy Household Survey. Participants were provided the assurance of confidentiality for their participations. Logistic regression models were used to examine the relationships between personal characteristics and support for the legalization of medical and recreational cannabis.Results: Overall, 77 and 40% of participants supported the legalization of medical and recreational cannabis respectively. People of older age were more likely to support medical cannabis legalization while those who supported legalization of recreational cannabis use were more likely to be younger. Medical cannabis supporters were more likely to report chronic pain (OR = 1.44, 95% CI: 1.04, 2.00) while recreational cannabis supporters were more likely to suffer high level of psychological distress (OR = 1.28, 95% CI: 1.14, 1.43). Experience with cannabis use was strongly associated with supportive attitudes, with recent cannabis users almost 14 times (OR = 14.13, 95% CI: 5.37, 37.20) and 34 times (OR = 33.74, 95% CI: 24.22, 47.01) more likely to support the legalization of medical and recreational cannabis use, respectively.Discussion and Conclusions: The majority of Australians approve the legalization of cannabis for medicinal purposes but most remain cautious about legalizing recreational cannabis use. The sociodemographic and clinical profile of supporters of medical and recreational legalization suggests a potential interaction of self-interests and beliefs about the harms of cannabis use.

Engagement with medical cannabis information from online and mass media sources: Is it related to medical cannabis attitudes and support for legalization?

We thank Smyth & McCarron [1] for taking the time to comment on our recent publication [2]. We agree that our paper did not fully discuss the process towards non-medical legalization in Canada for an international audience. To clarify: in the pre-legalization period, there was widespread access to an illicit cannabis market, including retail dispensaries and on-line delivery services [3]. In addition, there was access to medical cannabis, which began in 2001 for individuals with a limited list of health conditions, and was expanded in 2014 for individuals who received authorization from a physician that they would therapeutically benefit from medical cannabis [4]. There are several comments made by Smyth & McCarron that we would like to address. First, they question whether the rapid increase in emergency department (ED) visits during the 2.75-year pre-legalization period used in our study is representative of the longer pre-legalization period in Canada. In Fig. 1, we present visit rates over a longer pre-legalization period beginning in January 2010, which shows that ED visits due to cannabis have indeed been rapidly increasing over time for at least 8.5 years prior to legalization. There is a modest monthly slope increase (incident rate ratio = 1.008; 95% confidence interval = 1.005–1.011 for adults aged 15+ years) following the public commitment in December 2015 by the federal government to legalize non-medical cannabis. Sustained increases pre-legalization are consistent with prior work where we found that hospitalizations due to cannabis in Ontario began increasing in 2008 [5]. We speculated that this strong pre-legalization trend was multi-factorial, including increasing access to medical and illicit sources, changing stigma towards cannabis use (e.g. individuals become both more likely to use cannabis and more likely to report use of cannabis) and increasing cannabis potency [e.g. tetrahydrocannabinol (THC) concentration] over time [4-6] (Figure 1). Secondly, to clarify, we observed that the first phase of legalization—with strict controls on retail stores and product types (e.g. no legal vapes, edibles or concentrates) was associated with a statistically significant attenuation of the pre-legalization slope of increasing rates of ED visits due to cannabis over time, not a decrease in visits. While this is indicated throughout our paper, we agree that our concluding paragraph could make this clearer and should have the following italicized words added: ‘We found that the trend in cannabis-attributable ED visits decreased relative to the pre-legalization trend following recreational cannabis legalization with strict retail controls’. Thirdly, Smyth & McCarron suggest that the presence of an illicit or gray cannabis market in Canada and changing social norms in the lead-up to legalization reduces the generalizability of these findings to other countries considering legalization. Importantly, illicit cannabis is available in every region of the world, and we believe that a transition period from an illicit to legal market is part of the legalization process [7]. Cannabis use has also become less stigmatized and more socially acceptable around the world, regardless of legal status [8]. The recent experience of other countries proceeding with non-medical legalization, such as Germany, also suggests that policy shifts towards legalization are likely to have similar lead-in periods as in Canada, with potential changes in cannabis-related stigma and drug enforcement [9]. Importantly, while we believe that the Canadian experience regarding legalization will generalize to other countries, we highlight that legalization itself can take multiple forms. Our ongoing research suggests that regulatory decisions such as allowing or restricting cannabis marketing and promotion, retail access, product types and cannabis potency can all influence cannabis use and related health outcomes post-legalization [10-13]. Consequently, as other countries proceed towards legalization, we caution that policies that allow higher levels of commercial access risk important population-level changes in cannabis use and consequent harms. Daniel Myran: Conceptualization; funding acquisition; methodology; formal analysis; investigation; visualization. Michael Pugliese: Data curation; formal analysis; investigation; methodology; software; visualization. Peter Tanuseputro: Conceptualization; funding acquisition; methodology; supervision. Monica Taljaard: Conceptualization; formal analysis; investigation; methodology; supervision; visualization. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MoH) and the Ministry of Long-Term Care (MLTC). This study was also supported by a project grant (452360) from the Canadian Institute for Health Research (CIHR). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. None.