Cannabis Policy Research Articles

Bridging the gap: Exploring consumer experiences and motivations for transitioning between illicit and regulated cannabis markets

BackgroundCanada pioneered the non-medical legalization of cannabis production and sales, witnessing substantial growth in the regulated market over the last five years, post-legalization. However, persistent barriers hinder many consumers from transitioning to the legal market, necessitating a nuanced understanding of their behaviors for targeted policy interventions. This study aims to improve understanding of cannabis consumers’ unregulated purchase decisions in British Columbia (B.C.), and to explore motivational factors for transitioning to the legal market. MethodsWe conducted semi-structured interviews with cannabis consumers in B.C., who were at least 19 years old and purchased some or all of their cannabis through unregulated sources. Interviews were transcribed and an inductive thematic analysis was conducted using NVivo. Through coding iterations, we moved from descriptive to analytic codes, and finally mapped the codes to themes aligned with the Five Stages of Consumer Decision Making model. ResultsParticipants (N = 31) represented a broad range of demographic characteristics (i.e., gender, age, education, income). Four themes were identified: seeking information, evaluation of alternatives, purchase decision, and post purchase evaluation. Despite purchasing all or some of their cannabis from the unregulated market, most participants were supportive of legalization and felt that legal cannabis is safe, accessible, and of reasonable quality. However, several barriers prevent consumers from regularly accessing the regulated market, including: price, lack of sales and promotions, potency, limited product variety, and inadequate product interaction. ConclusionThis study delineates barriers that obstruct consumers' transition to the regulated market. These findings, aligned with considerations for public health and safety, offer valuable insights to inform cannabis policy and promote a more effective and consumer-oriented regulatory framework.

Association of Local Cannabis Policy and Retail Availability With Cannabis Use and Problematic Cannabis Use Among Adolescents in Northern California.

Objectives. To examine whether local cannabis policies and retail availability are associated with cannabis use and problematic cannabis use (PCU) among adolescents in Northern California. Methods. The sample comprised adolescents aged 13 to 17 years screened for past-year cannabis use during well-child visits in 2021. Exposures included local bans on cannabis storefront retailers, policy protectiveness, and retail proximity and density. Outcomes included self-reported past-year cannabis use and PCU diagnoses. Modified Poisson regression models adjusted for sociodemographics. Results. The sample (n = 103 134) was 51.1% male with a median age of 15 years (interquartile range [IQR] = 14-16 years); 5.5% self-reported cannabis use, and 0.3% had diagnosed PCU. Adolescents had a lower prevalence of cannabis use in jurisdictions that banned storefront retailers (adjusted prevalence rate [APR] = 0.857; 95% confidence interval [CI] = 0.814, 0.903 vs allowed), banned delivery (APR = 0.751; 95% CI = 0.710, 0.795 vs allowed), or had more policy protections (APR range = 0.705-0.800). Lower PCU prevalence was also found among those in jurisdictions that banned (vs allowed) storefront retailers (APR = 0.786; 95% CI = 0.629, 0.983) or delivery (APR = 0.783; 95% CI = 0.616, 0.996). Longer drive time and lower density of storefront retailers were associated with a lower cannabis use prevalence. Conclusions. More protective cannabis policies and less retail availability were associated with a lower prevalence of adolescent cannabis use and PCU. (Am J Public Health. 2024;114(S8):S654-S663. https://doi.org/10.2105/AJPH.2024.307787).

Is Delta-8-THC use associated with state-level cannabis policies? A content analysis from different jurisdictions in the United States.

The United States has seen a rapid increase in the use of Δ-8-tetrahydrocannabinol (Δ8-THC), a psychoactive compound similar to Δ-9-tetrahydrocannabinol (Δ9-THC). This study aimed to explore themes in Δ8-THC related tweets from U.S. jurisdictions with varying cannabis regulations from 2020 to 2022. Tweets mentioning Δ8-THC were collected using search terms: D8, Delta-8, and Delta8 THC. The tweets were date-restricted from January 21, 2020, to May 31, 2022, resulting in 139,843 tweets. The final dataset included 61,800 U.S. tweets with complete location data. A subset of 1,000 tweets (n = 250 for each legal jurisdiction) was selected for content analysis. Three main themes related to Δ8-THC emerged across all jurisdictions: 'Sales and Advertising', 'Policy', and 'Personal Use'. In states where cannabis was legal for adult use, sales-themed tweets were most prevalent, promoting product sales and discounts. 'Policy' tweets were more common in medical CBD-only (34.5%) and fully illegal (24.8%) jurisdictions than in those with legalized medical (20.4%) and adult use (20.2%). Tweets about personal use appeared at similar rates in fully illegal (27.7%), medical (25.0%), medical CBD-only (24.5%), and fully legal jurisdictions (22.8%). Reports of adverse effects were frequent in tweets from fully illegal (28.9%), fully legal (27.7%), and medical (27.7%) jurisdictions, with the lowest frequency in medicinal CBD-only (15.6%) jurisdictions. The current study on the public discourse on Twitter indicates that discussions about the use and marketing of Δ8-THC are present in all U.S. jurisdictions, not just those without legal recreational cannabis markets.

The Cartel Mystique: Race and the Social Construction of the Cannabis Grower

Racialization of the drug trade has been an ongoing feature of drug‐related moral panics for over a century. In the latter part of the twentieth century, public anxieties about ongoing economic changes made immigrants and Mexican drug cartels convenient scapegoats in the context of moral panics about cannabis and cannabis growers. In this research, I focus on the social construction of cannabis growers in the Emerald Triangle of Northern California, with a particular focus on the cartel grower construct. Through a content analysis of news media coverage, government and law enforcement reports, and field notes from personal communications with law enforcement officers and government officials, I identify racialized constructions of growers in the region. I also explore the relationships between local narratives and the broader cannabis discourse. In this “post‐prohibition” moment, this discourse impacts U.S. cannabis policy conversations and fuels anti‐immigrant rhetoric.

Cannabis-Derived Product Types, Flavors, and Compound Types From an E-Commerce Website

Cannabis-derived products (CDPs) are widely available and diverse. A classification of product and flavor types is necessary to establish a foundation for comparative research, although research aiming to classify cannabis in its variety of products, flavors, and cannabinoid compounds based on public online e-commerce data is lacking. To analyze data from a large cannabis e-commerce marketplace to identify and characterize cannabis product types, flavors, and compound types. This qualitative study was conducted in 2 phases: (1) data mining of the cannabis e-commerce website Weedmaps for product listings in the US between September 1 and November 30, 2023 and (2) grouping CDPs into product, flavor, and cannabinoid compound categories. Cannabis product listings. Product listings and descriptions were extracted from the platform. Coding was performed for specific product characteristics, routes of administration (ROAs), and characterization of flavors. A total of 573 854 unique US CDP sales listings from the platform were collected; after removing 72 842 nonconsumable items, 501 012 were analyzed. Product ROAs included multisystem (205 637 [41.04%]), respiratory (185 296 [36.98%]), digestive (98 941 [19.75%]), epidermal (9487 [1.89%]), and oral (1651 [0.33%]). Nearly half (210 575 [42.03%]) of all product listings included at least 1 flavor, with 247 762 instances of flavors. The 3 most common flavors were lemon (22 106 [8.92%]), cake (19 463 [7.86%]), and strawberry (13 961 [5.63%]). The most common cannabinoid compound type was Δ9-tetrahydrocannabinol (54 699 [63.30%]). This qualitative study categorized more than half a million CDPs for product and flavor types. Results are needed for comparative studies on product and market availability and can help in assessing concerns about appealing characteristics. The results can also inform future market surveillance efforts aimed at identifying new and emerging products as cannabis policy continues to move toward greater legalization.

Commentary on Pessar et al.: 'Downscaling' United States state cannabis policy to investigate environmental and social impacts on cannabis use.

Commentary on Pessar et al.: 'Downscaling' United States state cannabis policy to investigate environmental and social impacts on cannabis use.

“California on the Vistula River?” Cannabis users’ engagement with licit and illicit cannabis markets in Poland

Purpose Poland, like many other countries, is experiencing a shift in its drug policy as reflected with the decision of its government to legalise medical cannabis in 2017. This paper aims to explore the engagement of cannabis consumers with legal and illegal markets for cannabis in Poland. Design/methodology/approach Data comes from the Polish Ministry of Health and a survey of 571 cannabis users. The questionnaires were posted on Polish Facebook groups consisting of users, and other people interested in science/politics associated with cannabis. The users were asked if they currently use the illegal market to buy cannabis, and if yes then why. Findings Most respondents report that they do not engage with the illegal market for cannabis. Those who described themselves as medical users now enjoy a better access to cannabis, but even recreational users are finding ways to use the system. Some, however, continue to use the illegal market for cannabis due to reasons associated with honesty, access, price and quality of cannabis. Research limitations/implications Given a convenience sample, generalisable conclusions cannot be made on the impact of the medical cannabis policy on the illegal market for cannabis yet. However, what can be concluded is that increasingly more users are likely opting out for the regulated medical market than the traditional illegal market. This could be associated with an increasing willingness of medical practitioners to prescribe medical cannabis. Originality/value Only a handful of articles have been written on the Polish medical cannabis policy. This is the first article to show that the Polish medical cannabis policy has changed very significantly since the early enactment. Very probably contrary to the wishes of the policymakers who wanted to create a stricter model than the one in California, for example, which they named as more permissive one.

Informing the cannabis policy debate: a cross-sectional study of current and former cannabis users in Ireland

ABSTRACT Background Cannabis is the most widely used illicit drug with considerable international discourse regarding its legal status. This study sought to examine the wellbeing, experiences, and attitudes of adults who have used cannabis to inform policy debates. Methods A national, cross-sectional survey was completed. Data related to demographics and attitudes was collected along with validated questionnaires to measure level of dependence and wellbeing. Results Respondents (n = 732) were primarily males (61%) with a median age of 21. Three-quarters (75%) consumed cannabis more than 100 days with few regretting their cannabis use. Additionally, 60% reported previous use of both cocaine and MDMA and three-quarters currently use tobacco. While strongly in favor of more liberal cannabis policies they were ambivalent about decriminalizing all drugs. Depending on the cutoff used, 14.6% to 32.2% of respondents potentially meet the criteria for cannabis dependence. Wellbeing was overall good; however, women were at significantly higher odds of poor wellbeing (OR = 2.59; 95% CI = 1.78, 3.76). Conclusion Findings suggest unanimity among cannabis users toward more liberal legal policies but have discord regarding other drugs. Harm reduction, particularly in relation to tobacco, other substances, and women is indicated.

Historical change in associations between perceived risk, disapproval, and use of cannabis among young adults ages 19–30, 2011–2022

BackgroundThe current study used U.S. young adult data to examine overall and age group-specific historical trends in (a) mean perceived risk and disapproval of cannabis use, and (b) risk/use and disapproval/use associations. MethodsData were collected from 2011 to 2022 from 16,492 respondents aged 19–30 in the national Monitoring the Future panel study. Trends in mean risk and disapproval overall and by age group (19–22, 23–26, 27–30) were modeled. Models regressing any past 30-day cannabis use on risk and disapproval controlled for sex, race/ethnicity, college education, population density, state cannabis policy, region, and year. Age group differences and historical trends in regression estimates from year-specific models were examined. ResultsFrom 2011 to 2022, overall mean perceived risk decreased from 3.08 (just over moderate) to 2.50 (between slight and moderate); mean disapproval decreased from 2.21 (between disapprove and strongly disapprove) to 1.66 (between don’t disapprove and disapprove). Higher risk and disapproval were independently associated with lower odds of past 30-day cannabis use overall (AORs 0.86 and 0.76, respectively); controlling for sociodemographics and state policy had virtually no impact on association strength. There were no significant age-related association differences. The risk/use association weakened from AOR 0.84 in 2011 to AOR 0.91 in 2022; the disapproval/use association remained stable (AORs 0.753 and 0.749). ConclusionsYoung adults now perceive cannabis as less risky and are less disapproving of using than they were a decade ago. Perceived risk has weakened as a cannabis use risk factor over time; disapproval has remained a stable risk factor.

Use of cannabis for mental health in the Canadian territories: a cross-sectional study

Background Population prevalence and patterns of cannabis use for mental health (CUMH) are underexplored. This is important to understand in the Canadian territories which has the highest prevalence of cannabis use in Canada. This study aimed to examine socio-demographic factors associated with CUMH in the territories and associations between CUMH and cannabis use outcomes. Methods This study is a cross-sectional analysis of survey data from the 2022 Cannabis Policy Study in the Territories, including 2431 respondents aged 16+. Multivariable logistic regression models were used to examine socio-demographic characteristics associated with CUMH. Among past 12-month cannabis consumers, multivariable logistic regression models were used to examine whether CUMH was associated with daily/near-daily use, cannabis product type, healthcare interactions, and self-reported impacts on mental health, controlling for socio-demographic characteristics. Results Overall, 29.6% of all participants, and 55.5% of past 12-month cannabis consumers reported ever using cannabis for mental health. Use for mental health was higher among those with lower education, lower perceived income adequacy, and younger ages. Those reporting CUMH were more likely to report daily/near-daily use (ORadj = 3.00, 95%CI: 2.01–4.49), potent product types like solid concentrates (ORadj = 2.76, 1.62–4.70), and perceived positive impacts on mental health (ORadj = 3.71, 2.49–5.52). Conclusion Due to the high prevalence of CUMH, more research is needed to examine its long-term impacts and effectiveness. Future research is also needed to understand the social context underlying socioeconomic inequalities in CUMH, including access to mental healthcare and harm reduction measures for mitigating adverse mental health impacts.

Cannabis and Pregnancy.

We review recent evidence describing the effects of prenatal exposure to cannabis in pregnant individuals. In the context of changing cannabis policy, more pregnant individuals are using cannabis, despite profound risks. Recent studies show possible perinatal and longitudinal neurodevelopment risks associated with cannabis use during pregnancy and lactation. Healthcare providers are reluctant to discuss this topic with patients for a variety of reasons. With increased access to cannabis comes the possibility of increased adverse effects of cannabis upon pregnant individuals and their children. A concerted effort to educate pregnant individuals about the potential risks of cannabis might mitigate those potential effects.

Cannabis Legalization in Canada and Combatting the Illicit Cannabis Market

Despite the elimination of the illegal cannabis market being a fundamental element to cannabis legalization, as outlined in the Cannabis Act (S.C. 2018, c. 16), the Canadian federal government's efforts have had a mild impact in mitigating its influence. In analyzing possible contributions to the illicit sector's sustainability, these factors are in large part due to the federal government failing to understand consumer behaviours in recreational cannabis usage, as evidenced by lack of accommodation for frequent users, pricing and quality of legal cannabis compared to illegal cannabis, alongside faulty enforcement of cannabis law due to issues of conciseness and discretionary powers between the police and federal government. However, there are some suggestions that could better help the federal government in achieving its goal of combatting the illegal cannabis market. The potential amendments to cannabis policy include lowering tax on legal cannabis to better compete with illegal cannabis at the market level while refocusing on addressing public health concerns through promoting the safety of legal cannabis, controlling accessibility of legal cannabis, and providing public education regarding cannabis consumption. If done correctly, each amendment made would address the flaws within cannabis policy, allowing the Canadian federal government to combat the illegal cannabis market more efficiently.

Changes in self-reported cannabis use in the United States from 1979 to 2022.

Multiple countries are considering revising cannabis policies. This study aimed to measure long-term trends in cannabis use in the United States and compare them with alcohol use. Secondary analysis of United States general population survey data. The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan-Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non-interference with state-level legalizations) and 2022 (most recent data available). Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past-year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15-fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high-frequency drinking is less common. In 2022, the median drinker reported drinking on 4-5days in the past month, versus 15-16 days in the past month for cannabis. In 2022, past-month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Long-term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers.

“Please Wait, Your Policy is Important to Us” issue prioritization, the ACF, and Canada’s failed attempts at cannabis decriminalization, 2003–2005

In Canada, in the early 2000s, the decriminalization of cannabis for recreational use seemed imminent. Between 2003 and 2005, three government decriminalization bills were introduced in the Canadian House of Commons, but none were adopted, and decriminalization efforts were abandoned. Subsequently, Canada went beyond decriminalization and legalized recreational cannabis in 2018. This paper examines why the Canadian decriminalization efforts failed, using the Advocacy Coalition Framework (ACF) and ACF policy change theory. Three ACF-based hypotheses to explain the failed reform attempts are developed and investigated, but none are empirically supported. A fourth hypothesis is developed using information processing insights from Punctuated Equilibrium Theory (PET) but adapted to the ACF. This hypothesis is empirically supported showing that Canada’s decriminalization efforts failed, despite a supportive advocacy coalition, favourable conditions in the cannabis policy subsystem and favourable conditions in the Canadian political system, because its systemic advocates did not give it priority relative to other issues from other subsystems. This finding has implications for ACF policy change theory, identifying a necessary condition for major policy change that has been potentially overlooked, and illustrates the potential for cross-fertilization between PET and ACF theories of policy change.

Changes in Cannabis Use Patterns in Psychiatric Populations Pre- and Post-Legalization of Recreational Cannabis Use in Canada: A Repeated Cross-Sectional Survey

Objective: Since the federal Canadian government legalized cannabis in 2018, cannabis use in the general population has slightly increased. However, little is known about the impact of cannabis legalization on pattens of cannabis use in psychiatric populations. Method: We studied changes in daily/almost daily and average 30-day cannabis use amongst individuals currently using cannabis who reported past 12-month experiences of specific mental health disorders and among those without past 12-month experiences of any mental health disorder before and after Canadian legalization of recreational cannabis use (N = 13,527). Data came from Canadian respondents in Wave 1 (August–October 2018), Wave 2 (September–October 2019), and Wave 3 (September–November 2020) of the International Cannabis Policy Study (ICPS). Results: After adjustment for covariates, among individuals currently using cannabis, the odds of using cannabis daily/almost daily increased only in individuals with schizophrenia between Wave 1 and Waves 3 (aOR = 9.19, 95% CI: 2.46 – 34.37). Similarly, significant increases in average 30-day cannabis use between Wave 1 (M = 12.80, SE = 1.65) and Wave 3 (M = 18.07, SE = 1.03) were observed only among individuals with schizophrenia [F (1,2) = 4.58, p < .05). No significant changes in daily/almost daily or average past 30-day cannabis use were observed in those without mental health problems or those reporting anxiety, depression, PTSD, bipolar disorder, or substance use disorders. Conclusions: Since legalization, cannabis use has significantly increased only among people with schizophrenia, highlighting the need for targeted public health prevention programs.

Cannabis policy bundles and traffic fatalities in the American States over time.

Since 1996, 38 US states have legalized access to cannabis (medical and/or adult-use recreational). We aimed to estimate the effect of three dimensions of state cannabis policy design - pharmaceutical, permissive and fiscal - on levels of overall, alcohol-impaired, occupant, light truck and pedestrian fatality rates. Observational study of US states' overall, alcohol-impaired, occupant, light truck and pedestrian fatalities between 1994 and 2020. The unit of analysis was at the state level, consisting of 50 states and 27 years of time series data, resulting in a total of 1350 state-year observations. Fatality rates associated with alcohol-impaired, pedestrian, total occupant, passenger car and light truck fatality rates were obtained from the Fatality Analysis Reporting System of the National Highway Traffic Safety Administration and normalized per 10 billion vehicle miles traveled. State cannabis policies are measured in three bundles (scales): pharmaceutical, permissive and fiscal. The pharmaceutical bundle was associated with increases in all fatality rates [β = 0.145; 95% confidence interval (CI) = 0.116-0.173; P < 0.000]. The permissive bundle was associated with lower overall fatality rates (β = -0.319; 95% CI = -0.361 to -0.277; P < 0.000). The fiscal bundle was generally associated with higher fatality rates (β = 0.062; 95% CI = 0.043-0.081; P < 0.000), occupant (β = 0.070; 95% CI = 0.042-0.098; P < 0.000), light trucks (β = 0.049; 95% CI = 0.026-0.072; P < 0.000). US state cannabis regulations influence traffic safety. Greater permissiveness in US state cannabis regulations does not appear to correlate with traffic fatality rate increases, but greater medicalization and fiscal operation does.

Trends in cannabis and tobacco co-use in the United States, 2002–2021

BackgroundCo-use of cannabis and tobacco poses greater risks than use of either substance individually and may be becoming more prevalent with increasing cannabis medicalization and legalization. We aimed to assess trends in the prevalence of cannabis and tobacco co-use between 2002–2019 and identify the updated prevalence and correlates of co-use in 2021 among US adults. MethodsThis study used data from the 2002–2021 National Survey on Drug Use and Health, a nationally-representative, cross-sectional survey in the US. We assessed prevalence trends in past 30-day cannabis and tobacco co-use, exclusive cannabis use, and exclusive tobacco use overall and by sociodemographic group using joinpoint regression. Additionally, multinomial models identified correlates of co-use in 2021. ResultsIn 2021, the weighted prevalence of cannabis and tobacco co-use was 6.38 %, the weighted prevalence of exclusive cannabis use was 7.28 %, and the weighted prevalence of exclusive tobacco use was 15.01 %. From 2002 to 2019, the prevalence of past 30-day co-use of cannabis and tobacco increased significantly (annual percentage change [APC]: 1.9 [1.4–2.4], P<0.05) among the overall US population. All subgroups of sex, race/ethnicity, and age also saw significant increases in co-use, other than young adults ages 18–25, for whom co-use was stagnant between 2002–2014 and then decreased significantly between 2014–2019. ConclusionThis study identified increasing cannabis and tobacco co-use overall and among most sociodemographic strata in the US. As cannabis policy changes rapidly, co-use requires closer surveillance, clinical screening, and dedicated research.

Hemp-based psychoactive use and risk among young adults: Trend theory, policy, and regulation beyond legality

BackgroundHemp-based psychoactives comprise a burgeoning legal substance market with rising trends in use across the U.S. and Canada as well as parts of Europe. Currently, scant empirical research on the use of these Novel Psychoactive Substances (NPS) exists. By examining policy, market conditions, consumer uptake, and related risks, this research extends theory on drug trends by describing the regulatory environments that shape the emergence and popularity of psychoactive hemp-based products among young adults. MethodsRelying on ethnographic fieldwork of hemp-based markets across 3 U.S. state hemp and cannabis policy contexts as well as in-depth interviews with 40 young adult cannabis consumers recruited across 10 U.S. states, we examined how regulatory conditions shape hemp-based psychoactive markets, trends in their use, and associated risks. ResultsYoung adults are motivated to consume hemp-based psychoactives due to the regulatory and market environments that facilitate the production of highly potent products that are inexpensive and easily accessible. States that regulate hemp-based psychoactives as cannabis, do not provide hemp markets with a competitive advantage and as such see minimal uptake. In the absence of hemp specific policies, substantial variations in product potencies, insufficient dosing information, and unscrupulous product packaging practices may increase related risks. ConclusionTrend theory provides insight into the complex relationships that exist between drug policy, markets, and the proliferation of legal highs. Understanding the contextual significance that both market and regulatory conditions have on legal drug production, distribution, and consumption may better inform approaches to reduce the risks commonly associated with novel psychoactive substances like hemp-based psychoactives.

Cannabis policy liberalization is only associated with increased blunt use if states lack strong tobacco control

IntroductionCo-use of tobacco and cannabis has long been an issue for prevention and intervention efforts targeting these substances. Blunt use—cannabis inside a cigar wrapper—has been a consistent mode of cannabis consumption since the 1990s. Since then, both tobacco control and cannabis policies have changed considerably. This paper examines the influence of tobacco taxes and smoke-free policies as well as medical and recreational cannabis policies on blunt use among young people. MethodsCombining state-level tobacco control and cannabis policy data with the restricted-access youth cohort of the Population Assessment of Tobacco and Health (PATH) study, we use multilevel logistic regression models to examine the impact of these policies on past-year blunt use. ResultsWhile we found a main effect whereby both legal medical and recreational cannabis policies are associated with higher odds of blunt use among youth, interaction effects demonstrate that this association only emerges in states lacking a comprehensive tobacco smoke-free policy. In states with smoke-free policies, we found no significant associations between cannabis policy and odds of blunt use. ConclusionsDenormalization through smoke-free policies may mitigate the effects of recreational and medical cannabis policies on blunt use. Smoke-free policies represent a possible cost-effective mechanism to curb the co-use of tobacco and cannabis in the form of blunts. States with medical and recreational cannabis policies may benefit from greater prevention efforts for young people specifically focused on blunt use, especially in states that do not have strong tobacco control.

Road hazard: a systematic review of traffic injuries following recreational cannabis legalization.

Acute cannabis use is associated with impaired driving performance and increased risk of motor vehicle crashes. Following the Canadian Cannabis Act's implementation, it is essential to understand how recreational cannabis legalization impacts traffic injuries, with a particular emphasis on Canadian emergency departments. This study aims to assess the impact of recreational cannabis legalization on traffic-related emergency department visits and hospitalizations in the broader context of North America. A systematic review was conducted according to best practices and reported using PRISMA 2020 guidelines. The protocol was registered on July 5, 2022 (PROSPERO CRD42022342126). MEDLINE(R) ALL (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), and Scopus were searched without language or date restrictions up to October 12, 2023. Studies were included if they examined cannabis-related traffic-injury emergency department visits and hospitalizations before and after recreational cannabis legalization. The risk of bias was assessed. Meta-analysis was not possible due to heterogeneity. Seven studies were eligible for the analysis. All studies were conducted between 2019 and 2023 in Canada and the United States. We found mixed results regarding the impact of recreational cannabis legalization on emergency department visits for traffic injuries. Four of the studies included reported increases in traffic injuries after legalization, while the remaining three studies found no significant change. There was a moderate overall risk of bias among the studies included. This systematic review highlights the complexity of assessing the impact of recreational cannabis legalization on traffic injuries. Our findings show a varied impact on emergency department visits and hospitalizations across North America. This underlines the importance of Canadian emergency physicians staying informed about regional cannabis policies. Training on identifying and treating cannabis-related impairments should be incorporated into standard protocols to enhance response effectiveness and patient safety in light of evolving cannabis legislation.