Cannabis Legalization Research Articles

Pot for Profit: Cannabis Legalization, Racial Capitalism, and the Expansion of the Carceral State. By Joseph Mello. Stanford: Stanford University Press, 2024. 208p. $105.00 cloth, $26.00 paper.

Pot for Profit: Cannabis Legalization, Racial Capitalism, and the Expansion of the Carceral State. By Joseph Mello. Stanford: Stanford University Press, 2024. 208p. $105.00 cloth, $26.00 paper.

Developments in cannabis enforcement practices and patterns associated with non-medical cannabis legalization policies: a basic literature/data review

ABSTRACT Non-medical cannabis control has recently shifted to legalization policies in multiple jurisdictions, including North America. In addition to improved public health and safety, legalization aims to advance other, including ‘social justice’ outcomes, e.g. as related to cannabis law enforcement. We identified and examined (10) available studies from North American jurisdictions specifically assessing developments or changes in cannabis-related enforcement practices and patterns from pre- to post-legalization contexts. While source data-related study approaches and policy settings are heterogeneous, essential results suggest that legalization policy implementation has been associated with mostly 1) substantive reductions in enforced cannabis (e.g. possession/use) offenses involving legal-age adults; 2) mixed – ranging from decreases to increases – developments regarding enforcement targeting (under-age) youth; 3) decreases in total but persistence of relative race-related enforcement disparities involving both adult and youth populations. These data imply at least partial legalization-related successes toward improved related ‘social justice’ aims in these respects, while key questions remain, specifically concerning systemic enforcement biases involving racial minorities and the criminalization of underage youth as vulnerable groups. These enforcement-related outcomes of cannabis legalization policies warrant continued monitoring and in-depth policy-analytical examination, while jurisdictions newly implementing legalization should pay particular attention to ‘social justice’ objectives.

Abstract 4112546: Cannabis Legalization and Cardiovascular Hospitalizations: A Nationwide Difference-in-Differences Analysis

Background: Legal recreational cannabis sales (“legalization”) began earlier in the Western U.S. (January 2014) versus non-Western states (November 2018), providing a natural experiment to study its impact. Aim: To test the association between legalization and cardiovascular hospitalizations. Methods: Using the National Inpatient Sample (NIS), we performed a difference-in-differences analysis of the association between legalization and hospitalization rates for 6 cardiovascular diagnoses, a positive control (cannabis-related diagnoses), and 2 negative control diagnoses (opioid-related and urinary stones). We used survey-weighted Poisson regression modeling adjusted for age, sex, income, and race/ethnicity to estimate the relative change in hospitalization rates associated with each year of legalization. Results: Each year of legalization was associated with the following relative change in the hospitalization incidence rate ratio (cIRR) compared with regions that did not legalize: cannabis-related diagnoses [cIRR 1.138, 95% CI 1.066-1.214, p < 0.001], atrial fibrillation/flutter (AF) [cIRR 1.023, 95% CI 1.010-1.035, p<0.001], heart failure (HF) [cIRR 1.037, 95% CI 1.029-1.046, p < 0.001], myocardial infarction (MI) [cIRR 1.031, 95% CI 1.014-1.048, p < 0.001], ischemic stroke [cIRR 1.011, 95% CI 0.999-1.024, p=0.078], venous thromboembolism (VTE) [cIRR 1.009, 95% CI 0.999-1.020, p =0.066], and ventricular tachycardia (VT) [cIRR 1.019, 95% CI 0.993-1.046, p=0.161]. For falsification testing, there was no change in hospitalizations for urinary stones [cIRR 1.006, 95% CI 0.986-1.027, p = 0.535] or opioid-related diagnoses [cIRR 0.966, 95% CI 0.927-1.006, p = 0.091]. Conclusions: Recreational cannabis legalization was associated with increased hospitalizations for AF, HF, and MI. Further work is needed to replicate these findings in state-level analyses, ideally accounting for different cannabis formulations.

Quantity of delta-9-tetrahydrocannabinol consumption and cannabis use disorder among daily cannabis consumers.

Amid escalating cannabis legalization and daily consumption in the United States (US), determining the risk of cannabis use disorder (CUD) and relevant consequences among daily consumers has become a public health priority. Understanding these risks requires valid assessment of the daily quantity of delta-9-tetrahydrocannabinol (THC) consumed and its relation to consequences. This study characterized daily cannabis consumption using a new method for estimating milligrams of THC (mgTHC), and examined the relationship between daily mgTHC and CUD severity in a large national sample of daily consumers. US adult (aged 18+ years) daily cannabis consumers (n = 4134) completed a comprehensive online survey of cannabis consumption patterns (e.g. frequency, quantity, product types, potencies, administration methods) and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) CUD criteria. The primary exposure was past-week daily mgTHC consumption, calculated from survey responses to queries about product type, amount and potency consumed and including adjustments for puff size and loss of THC from specific methods of administration. The primary outcomes were (1) number of CUD criteria (range = 0-11) and (2) CUD severity categories: none, mild, moderate, severe. Median daily consumption was ~130 mgTHC, with substantial variability (25% ≤ 50 mg and 25% ≥ 290 mg). On average, participants endorsed 2.5 CUD criteria, and 65% met criteria for CUD (39% mild, 18% moderate, 8% severe). Greater daily mgTHC predicted higher CUD criteria count [betalog(mgTHC) = 0.50, 95% confidence interval (CI) = 0.267-0.734] and higher odds of mild [log odds ratio (logOR) = 0.238, 95% CI = 0.184-0.292], moderate (logOR = 0.303, 95% CI = 0.232-0.374) or severe (logOR = 0.335, 95% CI = 0.236-0.435) CUD. Among daily consumers of cannabis, there appears to be a positive relationship between the daily quantity of cannabis consumed (measured in milligrams of delta-9-tetrahydrocannabinol) and both the risk and severity of cannabis use disorder.

Cannabis legalization and changes in cannabis and tobacco/nicotine use and co-use in a national cohort of U.S. adults during 2017–2021

BackgroundLittle is known about whether cannabis legalization impacts cannabis use uptake or has spillover effects on co-use of cannabis and tobacco/nicotine (using both in the past 30 days). We determined associations of cannabis legalization with self-reported (1) current (past 30-day) cannabis use; (2) current (“now”) tobacco/nicotine use (smoking or electronic cigarette use); and (3) current co-use of cannabis and tobacco/nicotine and how prevalence is changing over time. MethodsIn this longitudinal study, a web-based survey was administered to a nationally representative, population-based panel of US adults in 2017, 2020, and 2021. We used weighted unadjusted binomial logistic GEE models to assess changes in prevalence of cannabis, tobacco/nicotine use and co-use and weighted, adjusted binary logistic GEE models to assess associations of cannabis legalization with cannabis, tobacco/nicotine use and co-use. ResultsA total of 9003 participants (age range = 18–94, mean age = 47.9 [±17.4 SD] years; 4696 females [weighted 52.0 %]) completed the survey in 2017; 5979/8529 (70.1 %) in 2020 and 5420/7305 (74.2 %) in 2021 from the original cohort who remained available. Current cannabis use significantly increased +3.3 % between 2017 and 2021, while tobacco/nicotine use significantly declined (−1.9 %); co-use of cannabis and tobacco/nicotine did not change significantly (+0.2 %). Both medical and recreational cannabis legalization was associated with increased current cannabis use; the independent effect of recreational cannabis legalization was 1.13 times larger than medical. There were no statistically significant differences in tobacco/nicotine use and co-use prevalence by legalization status. ConclusionCannabis legalization increases cannabis use but is not associated with changes in tobacco/nicotine use or co-use. Legalization should be coupled with public health efforts.

The addition of cannabis to prescription drug monitoring programs and medication fills in Medicaid.

To date, there is considerable evidence of the medical applications of cannabis, however concerns regarding the safety of cannabis are also mounting. To improve the safety of cannabis, nine states have added medical cannabis to their state PDMPs, helping providers to take patient cannabis use into consideration when making prescribing decisions. Across a variety of models using Medicaid State Drug Utilization claims data, I find statistically significant reductions in severely and moderately contraindicated medication fills across two outcomes. In my main specification, adding cannabis to a state PDMP is associated with a 14.4% (p<0.01) and 7.74% (p<0.001) decrease in the units per prescription, for severely and moderately contraindicated medications, respectively, as compared to states with legal medical cannabis dispensaries open. An interesting spillover effect of adding cannabis to PDMPs is an apparent decrease in the prescribing of scheduled narcotics, with Schedule II medications seeing a moderately significant decrease and Schedule IV medications seeing a 11.4% decrease (p<0.01) in the prescribing rate and a 16.2% decrease (p<0.001) in the units per prescription. The main analysis was conducted using the Borusyak etal. (2023) Imputation Estimator with a robustness check using the Callaway and Sant'Anna (2021) difference-in-difference. This work presents evidence that adding cannabis to a state PDMP impacts provider prescribing decisions involving medications that are contraindicated for use with cannabis as well as controlled substances. This paper demonstrates that adding cannabis to PDMPs influences prescribing and thus has the potential to make medical cannabis use safer. Conversely, this work indicates providers may have bias against patients who use cannabis and deny them life-improving medications (like controlled ADHD medication or opioids) on the basis of medical cannabis use. This paper also contributes to the literature comparing DD outcomes estimated using Borusyak, Jaravel, and Spiess' (2023) Imputation Estimator and Callaway and Sant'Anna's (2021) DD Estimator.

Self-Medication Paths: A Descriptive Study Unveiling the Interplay Between Medical and Nonmedical Cannabis in Chronic Pain Management.

Cannabis is used by one-third of people living with chronic pain to alleviate their symptoms despite warnings from several organizations regarding its efficacy and safety. We currently know little about self-medication practices (use of cannabis for therapeutic purposes without guidance), mainly since the legalization of recreational cannabis in countries such as Canada has expanded the scope of this phenomenon. This study aimed to describe legal cannabis self-medication for pain relief in people living with chronic pain and to explore perceptions of the effectiveness and safety of cannabis. A cross-sectional descriptive study was performed among 73 individuals living with chronic pain and using cannabis (Quebec, Canada). Data collection using telephone interviews occurred in early 2023. Results indicated that 61.6% of participants reported using cannabis without the guidance of a health care professional (self-medication). Surprisingly, among those, 40.0% held a medical authorization. Overall, 20.6% of study participants were using both medical and legal nonmedical cannabis. Different pathways to self-medication were revealed. Proportion of women versus men participants self-medicating were 58.2% versus 70.6% ( P =0.284). In terms of perceptions, 90.4% of the sample perceived cannabis to be effective for pain management; 72.6% estimated that it posed no or minimal health risk. Cannabis research is often organized around medical versus nonmedical cannabis but in the real-world, those 2 vessels are connected. Interested parties, including researchers, health care professionals, and funding agencies, need to consider this. Patients using cannabis feel confident in the safety of cannabis, and many of them self-medicate, which calls for action.

Medical Misinformation and Quality of Public Video Content on Cannabis for Chronic Pain Management: A Cross-Sectional Analysis of the YouTube Platform.

As cannabis legalization expands nationally and globally, its use for chronic pain increases, prompting people to seek information on social media platforms like YouTube. This study evaluates the accuracy and quality of information of popular YouTube videos on cannabis for chronic pain. Using search terms related to cannabis for pain, the top 66 videos by view count were selected. Each video was classified as useful, misleading, or neither. The quality and reliability of each video were assessed using the modified DISCERN, mDISCERN, score and the Global Quality Scale, GQS. The video characteristics, usefulness classification, mDISCERN scores, and GQS scores were summarized. Continuous and categorical outcomes were compared using t-test and chi-square, respectively. Of the 66 videos, 22.73% (n=15) were classified as useful, and 77.27% (n=51) were classified as neither. Of useful videos, 40.00% (n=6) were uploaded by physicians, 40.00% (n=6) were uploaded by corporations, and 6.67% (n=1) were uploaded by an independent user. Of videos classified as neither useful nor misleading, news sources uploaded 27.45% (n=14) of these videos (P=0.02). Physicians uploaded 37.50% (n = 18) of videos with a GQS score ≥3 (P=0.04), while independent users uploaded significantly more videos with a mDISCERN score <3 (22.20%, P=0.02). Useful videos had a mean GQS of 4.00 ± 0.65 compared to a mean GQS of 2.76 ± 0.86 for videos deemed neither (P<0.0001). This study suggests a moderate quality of YouTube content on cannabis use for chronic pain. Given cannabis's growing popularity and potential for misinformation on popular social media platforms, healthcare professionals and organizations should consider uploading educational videos on this topic on YouTube.

Key insights into cannabis-cancer pathobiology and genotoxicity.

Whilst mitochondrial inhibition and micronuclear fragmentation are well established features of the cannabis literature mitochondrial stress and dysfunction has recently been shown to be a powerful and direct driver of micronucleus formation and chromosomal breakage by multiple mechanisms. In turn genotoxic damage can be expected to be expressed as increased rates of cancer, congenital anomalies and aging; pathologies which are increasingly observed in modern continent-wide studies. Whilst cannabinoid genotoxicity has long been essentially overlooked it may in fact be all around us through the rapid induction of aging of eggs, sperm, zygotes, foetus and adult organisms with many lines of evidence demonstrating transgenerational impacts. Indeed this multigenerational dimension of cannabinoid genotoxicity reframes the discussion of cannabis legalization within the absolute imperative to protect the genomic and epigenomic integrity of multiple generations to come.

Cannabis Use During Early Pregnancy Following Recreational Cannabis Legalization

It is unknown whether state recreational cannabis legalization (RCL) is related to increased rates of prenatal cannabis use or whether RCL-related changes vary with cannabis screening methods or the local policy environment. To test whether RCL in California was associated with changes in prenatal cannabis use rates, whether changes were evident in both self-report and urine toxicology testing, and whether rates varied by local policies banning vs allowing adult-use retailers post-RCL. This population-based time-series study used data from pregnancies in Kaiser Permanente Northern California universally screened for cannabis use during early pregnancy by self-report and toxicology testing from January 1, 2012, to December 31, 2019. Analyses were conducted from September 2022 to August 2024. California state RCL passage (November 9, 2016) and implementation of legal sales (January 1, 2018) were examined with a 1-month lag. Local policies allowing vs banning medical retailers pre-RCL and adult-use retailers post-RCL were also examined. Any prenatal cannabis use was based on screening at entrance to prenatal care (typically at 8-10 weeks' gestation) and defined as (1) a positive urine toxicology test result or self-report, (2) a positive urine toxicology test result, or (3) self-report. Interrupted time series models were fit using Poisson regression, adjusting for age, race and ethnicity, and neighborhood deprivation index. The sample of 300 993 pregnancies (236 327 unique individuals) comprised 25.9% Asian individuals, 6.4% Black individuals, 26.0% Hispanic individuals, 37.7% White individuals, and 4.1% individuals of other, multiple, or unknown race, with a mean (SD) age of 30.3 (5.4) years. Before RCL implementation, rates of prenatal cannabis use rose steadily from 4.5% in January 2012 to 7.1% in January 2018. There was no change in use rates at the time of RCL passage (level change rate ratio [RR], 1.03; 95% CI, 0.96-1.11) and a statistically significant increase in rates in the first month after RCL implementation, increasing to 8.6% in February 2018 (level change RR, 1.10; 95% CI, 1.04-1.16). Results were similar when defining prenatal cannabis use by (1) a toxicology test or (2) self-report. In local policy analyses, the post-RCL implementation increase in use was only found among those in jurisdictions allowing adult-use cannabis retailers (allowed RR, 1.21; 95% CI, 1.10-1.33; banned RR, 1.01; 95% CI, 0.93-1.10). In this time-series study, RCL implementation in California was associated with an increase in rates of cannabis use during early pregnancy, defined by both self-report and toxicology testing, driven by individuals living in jurisdictions that allowed adult-use retailers.

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.

Examining the Potential Impact of Recreational Cannabis Legalization on Individuals Receiving Treatment for Substance Use Disorder: An Interrupted Time Series Study in Guelph, Ontario, Canada

Objective: The present research evaluated the impact of legalizing recreational cannabis among individuals with substance use disorders (SUDs) who may already use cannabis at high rates. Method: Using an interrupted time series study design, we evaluated the potential impact of legalizing recreational cannabis among individuals seeking treatment for SUD within a hospital-based treatment setting in Guelph, Ontario. We examined 2,925 individuals who entered an inpatient SUD treatment program between April 2017 and December 2021. We performed segmented regression analyses using both the date of cannabis legalization and the date of edibles legalization as the interruption time point. We also performed stratified analyses to examine potential sex differences. Results: We found no significant changes in the frequency of cannabis use using either of the interruption time points. However, among the subsample who had used cannabis, there was evidence of increasing CUD severity post-legalization of edibles, as well as an overall decreasing trend in readiness to quit over time. Stratified analyses also suggested possible sex differences in frequency of cannabis use, CUD severity, and readiness to quit. Conclusions: Results point to some small but potentially important impacts of recreational cannabis legalization that may only continue with time. Nevertheless, there is a need to continue to monitor cannabis use trends over time to understand any potential lagged effects.

South Africa’s crowded cannabis market: identifying new market opportunities for Ilco Farming’s “green gold”

Learning outcomes Following a discussion of the case, students should be able to analyse competitive dynamics: provide an in-depth critical analysis of Ilco Farming’s microenvironment, using the structure–conduct–performance framework; evaluate strategic positioning: conduct a SWOT analysis of Ilco Farming’s medicinal cannabis business; and develop strategic approaches: propose actionable strategies that would provide effective solutions to the problem of constrained market conditions currently faced by Ilco Farming. Case overview/synopsis Coenie and Ilse Venter established Ilco Farming, a cannabis farm located in the Viljoenskroon district in the Free State province in South Africa, in 2021. From the beginning, they poured their hearts and souls into their new venture, which soon paid off. A few short months after Ilco Farming began operating, despite the presence of other large competitors, Ilco Farming supplied a large share of the domestic medicinal market with flower heads. But then an unexpected challenge presented itself. In March 2023, Ilco Farming was operating at only 23% (600 m2) of its production capacity of 2600 m2 and had considerable room for growth, the local market – at least the local legal market – for cannabis began to show signs of saturation. Coenie and Ilsa found themselves at the proverbial crossroads, grappling with the crucial decision of how to secure their farm’s future in the face of a fast-saturating local (legal) cannabis market and a thriving (illegal) black market. Coenie and Ilse refused to entertain the idea of going the black market route, as they were unwilling to risk losing their operating licence. They calculated that the farm would reach breakeven point within the next two years, with profits unlikely during this period. Should they persist with their current strategy of producing high-quality products and delivering a superior service in the hopes of growing their market share? Or should they consider other strategic options? Coenie and Ilse were sitting at their boardroom table having a cup of coffee and looking out of the window at Ilco Farming’s impressive SAHPRA- and GAP-approved warehouse and tunnels. “What should we do?” they both wondered. Complexity academic level The case study can be used in postgraduate courses in microeconomics (PGDIP/MBA) and agricultural economics (PGDIP/MBA). Supplementary materials Teaching notes are available for educators only. Subject code CSS 5: International business.

Decriminalizing and Legalizing Cannabis for Clinical Benefits in Malaysia: Perspective Among Pharmacists (A Qualitative Study)

ABSTRACT Cannabis, often criticized, has active compounds that indicate multiple medical benefits. However, before the potential decriminalization and legalization of medical cannabis, pharmacists play a crucial role in the decision-making for personalized therapy and evidence-based medicine. This study investigates pharmacists’ perspectives on medical cannabis, covering medical use, societal impact, research, legality, and regulation. This study was conducted through semi-structured interviews with pharmacists from different sectors. Interviews were conducted with 16 pharmacists, with 4 from each sector: industry, academia, community, and hospital. There was a consensus on the need for streamlined research before potential decriminalization and legalization of cannabis, highlighting concerns about abuse and misuse despite its benefits. With that in mind, all participants agree that there is a need to update the current legislation and regulations to better control the use and distribution of medical cannabis. Several participants also called to attention that education plays an important role in the potential decriminalization of medical cannabis, with cannabis-related stigma being a potential deterrent for not only the public but also healthcare professionals. As medical cannabis is a new subject in Malaysia, this study could ignite further multidisciplinary human-related research with strict regulations which will ultimately result in evidence-based medicine.

Clinical Evaluation of the Cannabis-UsingPatient: A Moving Target.

The prevalence of cannabis use has been increasing among both adolescents and adults worldwide. New trends in cannabis legalization and enhanced social media marketing have led to the availability of multiple high-potency cannabis products with hundreds of new and powerful delivery systems. Over the last decade, there have been drastic changes in cannabis formulations, potency, routes of consumption, and device technology, with increased complexity and sophistication among growers, suppliers, and consumers. Patterns of cannabis use among patients can have important clinical implications, including acute neurocognitive effects, chronic multiorgan toxicity, psychiatric, behavioral, social, and economic impact. However, assessment of medical or surgical patients who use cannabis either recreationally or problematically has become challenging for the clinician due to the changing patterns of cannabis consumption. This review provides information on the clinical evaluation of patients who use cannabis in a problematic fashion, with the focus on tetrahydrocannabinol. It provides the clinician with knowledge regarding cannabis terminology, sources, pharmacology, routes of administration, formulations, dosing, and toxicities. Using these components, an assessment approach for diagnosing cannabis use disorder is synthesized at the conclusion of the article.

Cultivating Choice: Determinants of Home Cannabis Growing Among Legal Users in the United States

As cannabis legalization evolves in the United States, policies regarding home cultivation vary significantly across states. This study examines factors influencing the decision to grow cannabis at home by cannabis‐consuming residents in legal states. Using data from a large online survey (n = 4,823) of recent cannabis users in cannabis‐legal states, we explore four potential explanations for home cultivation: legal access, needs‐based motivations, resource‐based factors, and identity‐based reasons. Our analysis reveals that home growers differ significantly from non‐growers across multiple dimensions. The stance of state policies on home cultivation plays a role in determining who will grow their own. Notably, a strong sense of cannabis identity is the most powerful predictor for home cultivation. While some aspects of needs‐based and resource‐based motivations play a role, multivariate analyses demonstrate that the most compelling explanation includes a mix of variables, demonstrating the complexity of cannabis consumption and choices to cultivate.

Nonmedical cannabis legalization policy in Canada: Has commercialization been a pivotal mistake for public health?

AbstractCanada implemented the legalization of nonmedical cannabis use and supply in 2018. Initial blueprints for the legalization policy framework emphasized public health protection as a priority principle and objective, including related policy design parameters and regulatory restrictions (e.g., strict access and distribution control, advertisement/promotion ban, etc.) also as informed by adverse experiences from alcohol/tobacco control. Conversely, Canada's present legalization ecology is characterized by increasingly far‐reaching commercialization; this includes an extensive for‐profit cannabis production and retail industry producing large sales volumes that centrally include high‐risk cannabis products, with many public health‐oriented provisions hollowed out or circumvented in practice. While key cannabis‐related health problem indicators have increased through legalization, mounting evidence suggests that these adverse outcome dynamics, to a crucial extent, have been accelerated by commercialization aspects of legalization. Meanwhile, since legalization the cannabis industry has pushed for further rollbacks of public health‐oriented restrictions for benefits of increased competitiveness. Using the Canadian case study, we focus on the possible pitfalls and adverse effects of commercialization dynamics for public health‐oriented cannabis legalization. Also since commercialization‐related developments and outcomes are hard to reverse, we urge jurisdictions planning cannabis legalization reforms to carefully take consider related evidence and dynamics when assembling their legalization policy frameworks.

Impacts and Implications of Cannabis Legalization on Key Outcomes Among Adolescents in Canada.

Impacts and Implications of Cannabis Legalization on Key Outcomes Among Adolescents in Canada.

Cannabis and Cannabinoid Signaling: Research Gaps and Opportunities.

Cannabis and its products have been used for centuries for both medicinal and recreational purposes. The recent widespread legalization of cannabis has vastly expanded its use in the United States across all demographics except for adolescents. Meanwhile, decades of research have advanced our knowledge of cannabis pharmacology and particularly of the endocannabinoid system with which the components of cannabis interact. This research has revealed multiple targets and approaches for manipulating the system for therapeutic use and to ameliorate cannabis toxicity or cannabis use disorder. Research has also led to new questions that underscore the potential risks of its widespread use, particularly the enduring consequences of exposure during critical windows of brain development or for consumption of large daily doses of cannabis with high content Δ 9-tetrahydrocannabinol. This article highlights current neuroscience research on cannabis that has shed light on therapeutic opportunities and potential adverse consequences of misuse and points to gaps in knowledge that can guide future research. SIGNIFICANCE STATEMENT: Cannabis use has escalated with its increased availability. Here, the authors highlight the challenges of cannabis research and the gaps in our knowledge of cannabis pharmacology and of the endocannabinoid system that it targets. Future research that addresses these gaps is needed so that the endocannabinoid system can be leveraged for safe and effective use.

Cannabis

Objective: Almost half of U.S. states have passed recreational cannabis laws as of May 2024. While considerable evidence to date indicates cannabis may be a substitute for prescription opioids in the treatment of pain, it remains unclear if patients are treating pain with cannabis alone or concomitantly with other medications. Method: Using data from a national sample of commercially insured adults, we examine the effect of recreational cannabis legalization (through two sequential policies) on prescribing of opioids, NSAIDS, and other pain medications by implementing synthetic control estimations and constructing case-study level counterfactuals for the years 2007-2020. Results: Overall, we find recreational cannabis legalization is associated with a decrease in opioid fills among commercially insured adults in the U.S., and we find evidence of a compositional change in prescriptions of pain medications more broadly. Specifically, we find marginally significant increases in prescribing of non-opioid pain medications after recreational cannabis becomes legal in some states. Once recreational cannabis dispensaries open, we find statistically significant decreases in the rate of opioid prescriptions (13% reduction from baseline, p &lt; .05) and marginally significant decreases in the average daily supply of opioids (6.3% decrease, p &lt; .10) and number of opioid prescriptions per patient (3.5% decrease, p &lt; .10). Conclusions: These results suggest that substitution of cannabis for traditional pain medications increases as the availability of recreational cannabis increases. There appears to be a small shift once recreational cannabis becomes legal, but we see stronger results once users can purchase cannabis at recreational dispensaries. The decrease in opioids and marginal increase in non-opioid pain medication may reflect patients substituting opioids with cannabis and non-opioid pain medications, either separately or concomitantly. Reductions in opioid prescription fills stemming from recreational cannabis legalization may prevent exposure to opioids in patients with pain and lead to decreases in the number of new opioid users, rates of opioid use disorder, and related harms.