Abstract
Little is known about changes in cannabis use outcomes by race and ethnicity following the enactment of recreational cannabis laws (RCLs). To 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. This 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. Self-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. A 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. Changes 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.
Highlights
Cannabis laws are changing rapidly in the US
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-recreational cannabis laws (RCLs) among individuals categorized as other overall, but no increases were found by age group
Racial and Ethnic Differences in RCL Enactment Prevalence of past-year cannabis use increased after RCL/after medical cannabis law enactment (MCL) among Hispanic (11.7% to 15.0%; adjusted odds ratios (aOR), 1.33; 95% CI, 1.15-1.52), other (14.8% to 18.5%; aOR, 1.31; 95% CI, 1.12-152), and White (16.6% to 19.4%; aOR, 1.21; 95% CI, 1.12-1.31) participants (Table 2)
Summary
Cannabis laws are changing rapidly in the US. By January 2021, 15 states and Washington, DC, had fully legalized cannabis use for adults aged 21 years or more and an additional 21 states had legalized medical cannabis.[1]. In 2018 the lifetime prevalence of cannabis use was lower for Black (45.3%) than White (53.6%) adults aged 18 years or older,[8] but Black individuals were 3.64 times more likely to be arrested for cannabis possession.[9] In states with RCLs, overall rates of cannabis arrests have decreased but Black and Hispanic individuals are still more likely to be arrested than their White counterparts.[9,10] Communities of color (Black and Hispanic populations, as well as some Asian subgroups) may be more likely than White populations to experience negative consequences of legalization, including increased frequent cannabis use and CUD.[11] Such unintended consequences could occur because of structural factors informed by the legacies of US racism, for example locating dispensaries (which have been tied to increased CUD12,13) in neighborhoods with a majority racial or ethnic minority population
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