Impact Of Legalization Research Articles

The Potential Impact of Legalization of Recreational Cannabis among Current Users: A Qualitative Inquiry

ABSTRACT Given legislative initiatives in Rhode Island pertaining to consideration of cannabis legalization for recreational purpose, a qualitative inquiry was conducted regarding anticipated changes in use among recreational cannabis users in Rhode Island. Five focus groups were conducted with recreational cannabis users (N = 31; 6–7 per group). Participants were queried about anticipated impact of legalization on their use patterns. Themes were identified using applied thematic analysis. Participants discussed (1) a desire to maintain the status quo due to satisfaction with local cannabis regulations and their current use behaviors, (2) how and why cannabis use may change, including pros and cons of legalization, and (3) anticipated changes in purchasing behavior given display and legitimacy of legal dispensaries. While participants anticipate use levels and prevalence may remain relatively stable following legislation changes, findings suggest possible changes related to mode of administration and location of use. Public health concerns exist related to high-risk potencies and use of cannabis in edible form; therefore, trialing of new cannabis products has important clinical implications should legalization occur in Rhode Island.

The impact of non-medical cannabis legalization and other exposures on retention in longitudinal cannabis research: a survival analysis of a prospective study of Canadian medical cannabis patients

BackgroundDespite repeated calls by medical associations to gather evidence on the harms and benefits of cannabis, there are ongoing methodological challenges to conducting observational and clinical studies on cannabis, including a high rate of patients that are lost to follow-up (LTFU). This study explores factors potentially associated with retention in a large prospective study of Canadian medical cannabis patients, with the goal of reducing the probability that patients will be lost to follow-up in future cannabis research.MethodsThe Tilray Observational Patient Study (TOPS) was a multi-site, prospective study assessing the impact of medical cannabis over 6 months in a broad population of authorized Canadian cannabis patients. The study took place from 2016 to 19, and we conducted a series of exploratory analyses including a Kaplan–Meier survival analysis and logistic regressions to assess the potential association between study retention and variables including patient characteristics, cannabis and prescription drug use, quality of life, and the legalization of non-medical cannabis.ResultsOverall, 1011 participants were included in this analysis, contributing 287 patient-years of data. Retention was 728 (72%) at 3 months, and 419 (41.4%) at 6 months. Our analyses found significantly lower adjusted odds of retention following legalization (AOR 0.28, 95% CI 0.18–0.41), and in patients that used prescription opioids at baseline (AOR 0.62, 95% CI 0.46–0.85), while increased odds of retention were found in patients with a higher baseline psychological score (AOR 1.43, 95% CI 1.08–1.90) or that used anti-seizure medications at baseline (AOR 1.91, 95% CI 1.30–2.81).DiscussionTOPS provided a unique opportunity to examine patient characteristics and other variables that may be associated with retention in prospective medical cannabis studies. Our findings highlight some of the challenges of conducting medical cannabis research at a time when patients have a multitude of cannabis access options, including legal adult dispensaries and a robust illicit market. High LTFU rates can impact the validity of studies, and potentially lead to misestimations of the harms and benefits of medical cannabis use. Despite being a multi-site prospective study, this was a convenience sample, thereby limiting the generalizability of these findings. Additionally, data regarding the use of cannabis was self-reported by patients, so is subject to potential recall bias.ConclusionWe found evidence that external policy changes that affect access to cannabis such as the legalization of non-medical adult use and patient characteristics associated with patient physical/psychological capacity can impact retention in prospective medical cannabis studies. Evidence-based strategies to reduce study burden on participants, such as minimizing in-person visits by providing digitized internet-based surveys and phone or telemedicine follow-up options as well as ensuring adequate participant compensation could improve retention. Additionally, policy-related changes aimed at improving access to medical cannabis, including increased cost-coverage and community-based distribution, could encourage patients to remain in the federal medical cannabis program and thereby reduce LTFU in associated studies.

Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review.

Background:Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD.Objectives:To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD.Methods:This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period.Results:4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD.Conclusion:We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

Impact of recreational cannabis legalization on patient self-reporting of cannabis use at a pharmacist-led primary care clinic

BackgroundThe Cannabis Act, introduced in Canada in 2018, legalized the use of recreational cannabis. The impact of the announcement and implementation of this act on patient self-reporting of cannabis use has not been explored. ObjectiveThe study objective was to determine if patient self-reported cannabis use increased after the announcement and implementation of legislative changes to legalize recreational cannabis. MethodsA repeated cross-sectional design was used for a retrospective chart review of patients seen at a pharmacist-led primary care clinic. A convenience sample of patient records was divided into 3 panels, corresponding with the preannouncement (November 1, 2013-October 4, 2015), postannouncement (October 5, 2015-October 16, 2018), and postimplementation (October 17, 2018-October 17, 2019) stages of the legalization of recreational cannabis. Search terms used included cannabis, marijuana, marihuana, recreational drugs, natur∗, medicinal, pot, joint, oil, butter, brownies, edibles, cannabin∗, THC, tetrahydro∗, sativa, and indica (∗ = string wild card). The frequency of reporting use and the number of queries related to cannabis were assessed. The analysis of variance test and Pearson correlation (chi-square) were used to compare the 3 panels. ResultsA total of 298 patient charts were included in the analysis. One hundred, 99, and 99 patient charts corresponded with panels 1, 2, and 3, respectively. At each time point, 6%, 8%, and 14% of the patients reported cannabis use (P = 0.03). A statistically significant increase in topical oil use and a decrease in prescription tablet or capsule use between panels 1 and 3 (P = 0.036) were identified. ConclusionThis study found an increase in self-reporting of cannabis use across the 3 consecutive panels. The change in the product formulations used may reflect the various products available. Frontline pharmacists are encouraged to initiate conversations regarding cannabis use as part of routine practice.

Increasing Cannabis Use Is Associated With Poorer Cigarette Smoking Cessation Outcomes: Findings From the ITC Four Country Smoking and Vaping Surveys, 2016-2018.

Concurrent use of tobacco and cannabis may impede successful cigarette smoking cessation. This study examined whether changes in cannabis use frequency were associated with smoking cessation. Nationally representative samples of adult cigarette smokers from Canada (n = 1455), the United States (n = 892), England (n = 1416), and Australia (n = 717) were surveyed in 2016 and 2018. In each year, smokers reported how often they used cannabis in the previous 12 months. Reports were compared to determine whether cannabis use increased, remained unchanged, or decreased. Smoking cessation outcomes, measured in 2018, were (1) any attempt to quit in the previous year, (2) currently quit, and (3) currently quit for at least 6 months. Weighted multivariable logistic regression estimated the association between changes in cannabis use and cessation outcomes. Cigarette smokers who increased their frequency of cannabis use were significantly less likely to be currently quit than noncannabis-using smokers (adjusted odds ratio (aOR) = 0.52, 95% CI = 0.31% to 0.86%); they were also less likely to have quit for at least 6 months (aOR = 0.30; 95% CI = 0.15% to 0.62%). Smokers who increase their frequency of cannabis use have poorer smoking cessation outcomes compared to noncannabis-using smokers. It will be important to monitor the impact of cannabis legalization on patterns of cannabis use, and whether this influences cigarette smoking cessation rates. Cigarette smokers who start using cannabis may be less likely to quit cigarettes compared with smokers who do not use cannabis at all. If smokers who also use cannabis are more likely to continue smoking, it is important to monitor these trends and understand the impact, if any, on smoking cessation in jurisdictions that have legalized cannabis for nonmedical use.

Implications of Adult Use Cannabis Legalization for Adolescent Use, Perceptions, Health, and Consequences

Background: Adult-use cannabis legalization is being increasingly embraced by various jurisdictions in the United States (US) and internationally. As adolescents are particularly vulnerable to the negative consequences of cannabis, it is essential to ensure that the effects of adult-use legalization are minimized. Objectives: This review aimed to synthesize the extant literature exploring the impact of adult-use legalization on adolescents and provide recommendations for future action. We focused on the following domains: 1) prevalence of use, 2) high-frequency use, 3) perceived harm, 4) perceived availability, 5) modes of use, 6) potency, 7) mental health and medical outcomes, and 8) legal consequences. Methods: Narrative review is focused on adult-use legalization in the US. Results: Adolescent cannabis use prevalence in US legal (as well as illegal) states has remained essentially stable since the advent of adult-use legalization. Criminal penalties for adolescents have not decreased in legal states and maybe increasing; out-of-school suspensions for cannabis use may also be increasing. It is uncertain whether reported decreases in national rates of perceived harm and availability and increases in cannabis frequency and potency of use in adolescents differ between legal and illegal states. The impact of legalization on adolescent health outcomes remains uncertain. Conclusion: At this early stage of adult-use legalization, we recommend that jurisdictions implement real-time, detailed monitoring to assess adolescent outcomes. In addition, both criminal penalties and out-of-school suspensions for cannabis infractions should be minimized.

Understanding the Dynamics between Vaping and Cannabis Legalization Using Twitter Opinions

Cannabis legalization has been welcomed by many U.S. states but its role in escalation from tobacco e-cigarette use to cannabis vaping is unclear. Meanwhile, cannabis vaping has been associated with new lung diseases and rising adolescent use. To understand the impact of cannabis legalization on escalation, we design an observational study to estimate the causal effect of recreational cannabis legalization on the development of pro-cannabis attitude for e-cigarette users. We collect and analyze Twitter data which contains opinions about cannabis and JUUL, a very popular e-cigarette brand. We use weakly supervised learning for personal tweet filtering and classification for stance detection. We discover that recreational cannabis legalization policy has an effect on increased development of pro-cannabis attitudes for users already in favor of e-cigarettes.

The Association Between Same-Sex Marriage Legalization and Youth Deaths by Suicide: A Multimethod Counterfactual Analysis

PurposeTo estimate the association between same-sex marriage legalization and deaths by suicide among youth. MethodsThe study used country-level suicide data sourced from the Global Burden of Disease Study for all 36 Organisation for Economic Co-operation and Development countries for the period 1991–2017. We analyzed the suicide rates of all youth, male youth, and female youth aged 10–24 years using multiple policy-evaluation methods—difference-in-differences, matrix completion, and generalized synthetic control via expectation-maximization—to estimate the impact of same-sex marriage legalization at the country level. Secondary analysis considered several covariate specifications, evaluated the immediacy and persistence of the estimated associations, and assessed whether any observed association was limited to early adopters of same-sex marriage. ResultsThe state-of-the-art matrix completion analysis indicated that same-sex marriage legalization was associated with a decline in the youth suicide rate of 1.191 deaths per 100,000 individuals (95% CI = −1.66, −.64; p < .001), corresponding to a reduction of 17.90% compared to the youth suicide rate at the time of legalization. This decline was most pronounced in males for whom the suicide rate fell by 1.993 (CI = −2.76, −1.12; p < .001) compared to a decrease of .348 for female youth (CI = −.60, −.06; p = .02), corresponding to decreases of 19.98% and 10.90%, respectively. These associations persisted after legalization, but to differing degrees depending on model specification. ConclusionsDeveloped countries that are yet to legalize same-sex marriage have an opportunity to put downward pressure on youth suicide.

Cannabis Use During the Pre-Conception Period and Pregnancy After Legalization

There is limited evidence of the impact of cannabis legalization on the prevalence of cannabis use and use of other substances. The aim of this exploratory observational study was to compare rates of cannabis use, cigarette smoking, alcohol consumption, and the use of any street drugs during the preconception period and in pregnancy in two convenience samples of pregnant persons in British Columbia, Canada, before and after the legalization of cannabis. Any pregnant person residing in British Columbia, aged >19 years, at any gestational age was eligible to participate. Pre- and post-legalization study participants were recruited between May and October 2018 and July 2019 and May 2020, respectively. Multivariate models were constructed to examine the effect of legalization on cigarette smoking and the use of cannabis, alcohol, and street drugs, adjusting for demographic, pre-pregnancy, and pregnancy confounders. From pre- to post-legalization, the prevalence of self-reported cannabis use during the preconception period increased significantly, from 11.74% (95% CI 9.19%-14.88%) to 19.38% (95% CI 15.45%-24.03%). Rates of cannabis use during pregnancy also increased from 3.64% (95% CI 2.32%-5.69%) before legalization to 4.62% (95% CI 2.82%-7.47%) after; however, this difference was not statistically significant. Adjusting for potential confounders, the post-legalization group had significantly higher odds of cannabis use during the preconception period (adjusted odds ratio 1.71; 95% CI 1.14-2.58) but not during pregnancy (adjusted odds ratio 1.66; 95% CI 0.75-3.65). Legalization was also not associated with significant changes in cigarette smoking, alcohol consumption, or the use of street drugs during the preconception period and pregnancy, after adjusting for potential confounders. The preliminary evidence presented in this study shows that the legalization of cannabis was associated with 71% higher odds of cannabis use during the preconception period. Studies examining the effects of cannabis use on perinatal outcomes, as well as public health interventions and educational programs related to cannabis use, should include the preconception period as an area of focus.

Summaries of Articles

Summaries of Articles

Impact of Marijuana Legalization on Opioid Utilization in Patients Diagnosed with Pain.

Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes. Assess the impact of recreational and medical marijuana legalization on opioid utilization among patients receiving pharmacotherapy for pain. Retrospective claims-based study of commercially insured patients continuously eligible for pharmacy and medical benefits from July 8, 2014 to June 30, 2017. Index pain prescription period was defined between January 8, 2015 and June 30, 2015, and longer-term opioid use examined during 2-year follow-up. Marijuana state policy on July 1, 2015, was assigned: none; medical only; or medical and recreational. Patients aged 18-62 without cancer diagnosis. Patient receiving (1) opioid at index; (2) > 7 days' supply of index opioid; (3) opioid during follow-up; and (4) ≥ 90 days' opioid supply during follow-up. Multivariable regression assessed associations between opioid utilization and state marijuana policy, adjusting for age, gender, overall disease burden, mental health treatment, concomitant use of benzodiazepine or muscle relaxant, and previous pain prescription. Of 141,711 patients, 80,955 (57.1%) resided in states with no policy; 56,494 (39.9%) with medical-only; and 4262 (3.0%) with medical and recreational. Patients in states with both policies were more likely to receive an index opioid (aOR = 1.72, 95% CI = 1.61-1.85; aOR = 1.90, 95% CI = 1.77-2.03; P < 0.001) but less likely to receive > 7 days' index supply (aOR = 0.84, 95% CI = 0.77-0.91; aOR = 0.76, 95% CI = 0.70-0.83; P < 0.001) than patients in states with no policy or medical-only, respectively. Those in states with both policies were more likely to receive a follow-up opioid (aOR = 1.87, 95% CI = 1.71-2.05; aOR = 2.20, 95% CI = 2.01-2.42; P < 0.001) than those in states with no policy or medical-only, respectively, and more likely to receive ≥ 90 cumulative follow-up opioid days' supply (aOR = 1.18, 95% CI = 1.07-1.29; P < 0.001) than those in states with no policy. Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.

The Potential Impact of Recreational Cannabis Legalization on the Prevalence of Cannabis Use Disorder and Psychotic Disorders: A Retrospective Observational Study

The principal objective of our study was to document the short-term impact of the legalization of recreational cannabis on active cannabis use, cannabis use disorder, and various psychotic disorders. We carried out a retrospective observational study of patients who were at least 12 years old and who had visited a psychiatrist in the emergency unit of the Centre hospitalier universitaire de Sherbrooke (CHUS). We included all the consultations of this type over a 5-month period, immediately following the legalization of recreational cannabis in Canada. We then divided our population into an adult (over 18) and teenager group (12 to 17) compared the data to the data from consultations made 2 years earlier, using a generalized linear mixed model. We examined consultations in patients over 18 years old in prelegalization (n = 1,247) and postlegalization (n = 1,368) groups. We observed a statistically significant increase in the use of cannabis (28.0% to 37.1%; odds ratio [OR] = 1.81 [1.34 to 2.44], P = 0.00011) as well as an increase in diagnoses of active cannabis use disorder (17.7% to 24.3%; OR = 1.53 [1.13 to 2.08], P = 0.0064). The increase in cannabis use disorder was more prominent among patients between 18 and 24 years old (17.3% to 25.9%; OR = 2.27 [1.17 to 4.40], P = 0.015). We observed no statistically significant difference in terms of psychotic disorder diagnoses (27.4% to 29.2%; OR = 1.17 [0.84 to 1.63], P = 0.35)]. Conversely, we identified a greater proportion of patients who had a personality disorder diagnosis in the postlegalization period (39.6% to 44.9%; OR = 1.35 [1.02 to 1.80], P = 0.038). Examination of pediatric (under 18 years old) consultations revealed no statistically significant differences. Although an affirmative conclusion is tentative, the current findings suggest a first link between the legalization of cannabis in Canada and increased diagnoses of cannabis use disorder, as well as cannabis use in general among patients in a university hospital psychiatric emergency department.

Impact of Recreational Cannabis Legalization on Hospitalizations for Hyperemesis.

Chronic cannabis use had been associated with hyperemesis. We sought to determine whether cannabis liberalization contributed to increased hospitalizations for hyperemesis. Cannabis use and admissions for hyperemesis in legalized states were compared with those of nonlegalized states, before and after cannabis legalization, using state inpatient databases. From 2011 to 2015, cannabis use increased 2.2 times in legalized states and 1.8 times in nonlegalized states. The odds of presentation with hyperemesis were higher in 2015 compared with those of 2011 in all states. Recreational legalization may be contributing to rising cannabis use. Hospitalizations for hyperemesis have also increased but did not seem to be solely due to cannabis legalization.

The Impact of Medical Marijuana Legalization on Opioid Prescriptions

Since the late 1990s, opioids have been increasingly prescribed for pain treatment in the U.S as a result of aggressive marketing by pharmaceutical companies. This has resulted in more than 450,000 opioid overdose deaths since then. In the same time period, several U.S. states have legalized medical marijuana, a drug that can also be used for pain relief. As a result, medical marijuana can be used as a substitute for opioids, leading to a reduction in opioid prescriptions. On the other hand, marijuana use can lead to increased substance abuse, leading to a potential increase in opioid prescriptions. The lack of scientific and medical knowledge along with the uncertain regulatory environment vis-a-vis medical marijuana use also makes it possible that its legalization has no impact on opioid prescriptions. With claims data from a large health insurance company in the U.S. between 2006 and 2016, we study the effect of medical marijuana legalization on opioid prescriptions, leveraging the temporal variation in state-wise legalization. We find that, on average, opioid prescriptions decreased after medical marijuana legalization for all three outcome metrics that we consider (number of prescriptions, total days of supply, and total dosage in MME). We also find that the role of physicians in reducing opioid prescriptions after legalization is more prominent than their corresponding role in increasing opioid prescriptions.

Cannabis use prior to legalisation among alcohol consumers in the Canadian Yukon and Northwest territories

ABSTRACT Although rates of substance use are higher in the Canadian territories than the provinces, there is little research on cannabis use. This exploratory study describes cannabis use and related risk behaviours among alcohol consumers in Whitehorse (Yukon) and Yellowknife (Northwest Territories), with comparisons to data from the provinces. Prior to non-medical cannabis legalisation, respondents (n = 387) aged ≥19 were recruited from a study on alcohol labelling to complete an online cannabis survey. Logistic regression was used to compare territorial and provincial data, and correlates of cannabis use in the territories. Forty-seven percent of respondents were past 12-month cannabis consumers, and 15.5% were daily/almost daily consumers, significantly higher than in the provinces (p < 0.001 for both). Dried herb (85.7%) and edibles (58.2%) were most commonly used among consumers. Use of dried herb, edibles, solid concentrates and tinctures was significantly higher than in the provinces (all p ≤ 0.01). Twenty-four percent of respondents had ridden with a driver who had used cannabis, while 31.9% of cannabis consumers had driven within 2h of cannabis use, significantly higher than the provinces (both p < 0.001). Further research should examine the impact of legalisation on cannabis use in the territories, including rural communities.

International Judicial Performance and the Law of the Sea

In “Judicialization of the Sea: Bargaining under the UNCLOS Regime,” Sara McLaughlin Mitchell and Andrew P. Owsiak examine the extent to which legalization and judicialization of the law of the sea has changed how states manage conflicts. They argue that legalization and judicialization have diminished maritime conflict because disputing parties are able to predict how a court would rule and, therefore, they will be more likely to bargain out-of-court to achieve more favorable outcomes. Their analysis suggests that how adjudicators perform as dispute resolution bodies is basically irrelevant. Drawing on the literature on the performance of international courts, this essay identifies numerous ways that the contribution of international courts to the resolution of disputes is contingent on key performance criteria, including legal clarification and compliance. When international courts perform at their best, judicialization enhances the impact of legalization. If performance is a contingent feature of international adjudication, then the generalizability of Mitchell and Owsiak's argument might be limited by the extent to which adjudicators achieve certain key performance criteria.

Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries

BackgroundUpwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown. MethodsWe investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities. ResultsFindings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis. ConclusionsOur findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.

It’s complicated: The impact of marriage legalization among sexual minority women and gender diverse individuals in the United States.

This mixed-methods study explored perceptions of the impact of marriage legalization in all U.S. states among sexual minority women and gender diverse individuals. Survey data were collected from a nonprobability sample of individuals 18 years or older who identified as lesbian, bisexual, queer, same-sex attracted or something other than exclusively heterosexual-as well as individuals who identified as transgender or gender nonbinary (for example, genderqueer, trans woman, trans man, nonbinary, or gender non-conforming). The analytic sample included 418 participants in an online survey who responded to open-ended questions about the perceived impact of marriage legalization. Qualitative analyses revealed perceptions of marriage legalization that situated individual meanings in the context of broader political and social factors. Four themes represented the complex perceptions of participants about marriage legalization: 1) establishing a victory in civil rights, social inclusion, and acceptance; 2) creating a paradox between positives of legalization and limitations of marriage as an institution; 3) amplifying concerns for unaddressed safety and rights issues; and 4) contributing to the erosion of queer identity and community. Quantitative analyses revealed several differences by demographic characteristics, such as greater concern about the erosion of community among unmarried participants compared to participants who were married. Findings underscore the importance of policies that advance equality for sexual and gender minorities (SGMs), as well as the importance of research exploring how policies are perceived by and impact SGM subpopulations.

The Impact of Legalization of Sports Gambling: How Motivation, Fandom, and Gender Influence Sport-Related Consumption

This study examined how the legalization of sports wagering, in association with several factors (i.e., gender, motivations, and fandom), has impacted gambling behavior, interests in sport, and sport-related consumption (e.g., media, ticket sales) using a sample of active gamblers above the age of 21 (N = 58). The findings showed that economic motivation significantly predicted gambling behavior, interests in sports, and sport-related consumption, while fandom did not. People who are motivated by money are more likely to wager on sport and consume sport. However, being a sport fan or not does not impact those variables. Based on the results of the current study, it could be suggested that, since sports wagering was recently legalized, sport organizations should move quickly to attract new and potential market segments (e.g., gamblers).

The impact of legalization of access to recreational Cannabis on Canadian medical users with Cancer

BackgroundCanada legalized cannabis use for medical purposes in 1999. Legalization of cannabis for recreational purposes in October 2018 offered the opportunity to assess the impact of recreational legalization on cancer patients’ patterns of use to identify learning points that could be helpful to other countries considering similar legislation.MethodTwo identical anonymous cross-sectional surveys were administered to cancer patients in British Columbia 2 months before and 3 months following legalization, with the same eligibility criteria.The prevalence of medical cannabis use, the distribution of symptoms leading to use, the most common types of cannabis products and sources, reasons for stopping using cannabis, and barriers to access were assessed.ResultsThe overall response rate was 27%. Both cohorts were similar regarding age (median = 66 yrs), gender (53% female), and education (approximately 85% of participants had an education level of high school graduation and higher). Respondents had multiple motives for taking cannabis, including to manage multiple symptoms, to treat cancer, and for recreational reasons. The majority of patients in both surveys did not use the legal medical access system.Comparison of the two cohorts showed that after legalization the prevalence of current cannabis use increased by 26% (23·1% to 29·1%, p-value 0·01), including an increased disclosure of recreational motive for use, from 32 to 40%. However, in the post-legalization cohort more Current Users reported problems getting cannabis (18%) than the pre-legalization cohort (8%), (p-value < 0·01). The most common barrier cited was lack of available preferred products, including edibles, as these were only available from illegal dispensaries.ConclusionsResults showed that legalization of cannabis for recreational purposes may have an impact on those who use medical cannabis. Impacts include an increase in prevalence of use; problems accessing preferred products legally; higher cost, and difficulties using a legal access system. The desired goal of regulation in reducing harms from use of illegal cannabis products are unlikely to be achieved if the legal process is less attractive to patients than use of illegal sources.