Abstract

BackgroundWhether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key question as cannabis policy evolves, particularly given the adverse health and social effects of alcohol use. Relatively little research has explored this question.MethodsThis study examined the association between recreational cannabis legalization and alcohol purchasing in the USA using an interrupted time series design. We used data from the Nielsen Consumer Panel (2004–2017) from 69,761 households in all 50 states to calculate monthly milliliters of pure ethanol purchased for four beverage categories (beer, wine, spirits, and all alcohol products). We used difference-in-differences models and robust cluster standard errors to compare changes in milliliters of pure ethanol purchased. We fit models for each beverage category, comparing three “policy” states that have legalized recreational cannabis (Colorado, Oregon, and Washington) to states that had not legalized recreational cannabis. In one set of models, a single control state was selected that matched pre-policy purchasing trends in the policy states. In another set, policy states were compared to all states that had not legalized recreational cannabis.ResultsCompared to all other states that did not legalize recreational cannabis, Colorado households showed a 13% average monthly decrease in purchases of all alcoholic products combined (estimate, 0.87; CI, 0.77, 0.98) and a 6% decrease in wine (0.94; CI, 0.89, 0.99). Estimates in Washington were suggestive of an increase in spirits purchased in both the unrestricted (1.24; CI, 1.12, 1.37) and restricted sample (1.18; CI, 1.02, 1.36). Oregon showed a significant decrease in monthly spirits purchased when compared to its selected comparator state (0.87; CI, 0.77, 0.99) and to all other states without legalized recreational cannabis (0.85; CI, 0.77, 0.95).ConclusionsResults suggest that alcohol and cannabis are not clearly substitutes nor complements to one-another. Future studies should examine additional states as more time passes and more post-legalization data becomes available, use cannabis purchase data and consider additional methods for control selection in quasi-experimental studies.

Highlights

  • Whether recreational cannabis legalization is associated with changes in alcohol consumption is a key question as cannabis policy evolves, given the adverse health and social effects of alcohol use

  • In the unrestricted sample of households, alcohol purchased was higher in Washington compared to its matched control, but similar in Colorado and Oregon compared to their respective controls

  • The present study builds on prior literature by measuring the association between recreational cannabis legalization and alcohol purchasing among a longitudinal, nationally representative sample of households

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Summary

Introduction

Whether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key question as cannabis policy evolves, given the adverse health and social effects of alcohol use. A recent meta-analysis found annual increases in both alcohol use (0.30% per year [95% CI, 0.22%, 0.38%]) and binge drinking (0.72% per year [95% CI, 0.46%, 0.98%]) from 2000 to 2016 (Grucza et al 2018). Martinez and colleagues found increases of per-capita alcohol sold for beer, spirits, and wine products from 2003 to 2016 in the USA nationally and across the majority of states (Martinez et al 2019). This trend in increased alcohol consumption raises concerns for alcohol-related morbidity and mortality

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