Legalization Of Recreational Cannabis Research Articles

What impact could the legalisation of recreational cannabis have on the health of the UK? Lessons from the rest of the world.

Several jurisdictions across the globe have introduced legislation to legally permit the sale and consumption of recreational cannabis. This editorial considers current evidence from the rest of the world and asks how this might inform the possible consequences of 'legalisation' models in the UK.

Cannabis Roots: Therapeutic, Biotechnological and Environmental Aspects.

Since the legalization of recreational cannabis in Canada in 2018, the number of licenses for this crop has increased significantly, resulting in an increase in waste generated. Nevertheless, cannabis roots were once used for their therapeutic properties, indicating that they could be valued today rather than dismissed. This review will focus on both traditional therapeutic aspects and potential use of roots in modern medicine while detailing the main studies on active phytomolecules found in cannabis roots. The environmental impact of cannabis cultivation and current knowledge of the root-associated microbiome are also presented as well as their potential applications in biotechnology and phytoremediation. Thus, several high added-value applications of cannabis roots resulting from scientific advances in recent years can be considered to remove them from discarded residues.

Recreational and Medical Cannabis Legalization and Opioid Prescriptions and Mortality

While some have argued that cannabis legalization has helped to reduce opioid-related morbidity and mortality in the US, evidence has been mixed. Moreover, existing studies did not account for biases that could arise when policy effects vary over time or across states or when multiple policies are assessed at the same time, as in the case of recreational and medical cannabis legalization. To quantify changes in opioid prescriptions and opioid overdose deaths associated with recreational and medical cannabis legalization in the US. This quasiexperimental, generalized difference-in-differences analysis used annual state-level data between January 2006 and December 2020 to compare states that legalized recreational or medical cannabis vs those that did not. Recreational and medical cannabis law implementation (proxied by recreational and medical cannabis dispensary openings) between 2006 and 2020 across US states. Opioid prescription rates per 100 persons and opioid overdose deaths per 100 000 population based on data from the US Centers for Disease Control and Prevention. Between 2006 and 2020, 13 states legalized recreational cannabis and 23 states legalized medical cannabis. There was no statistically significant association of recreational or medical cannabis laws with opioid prescriptions or overall opioid overdose mortality across the 15-year study period, although the results also suggested a potential reduction in synthetic opioid deaths associated with recreational cannabis laws (4.9 fewer deaths per 100 000 population; 95% CI, -9.49 to -0.30; P = .04). Sensitivity analyses excluding state economic indicators, accounting for additional opioid laws and using alternative ways to code treatment dates yielded substantively similar results, suggesting the absence of statistically significant associations between cannabis laws and the outcomes of interest during the full study period. The results of this study suggest that, after accounting for biases due to possible heterogeneous effects and simultaneous assessment of recreational and medical cannabis legalization, the implementation of recreational or medical cannabis laws was not associated with opioid prescriptions or opioid mortality, with the exception of a possible reduction in synthetic opioid deaths associated with recreational cannabis law implementation.

Is legal recreational cannabis associated with cannabis use during pregnancy, beliefs about safety, and perceived community stigma?

BackgroundAmong pregnant and recently pregnant people we investigated whether legal recreational cannabis is associated with pregnancy-related cannabis use, safety beliefs, and perceived community stigma. MethodsIn 2022, we surveyed 3571 currently and recently pregnant English- or Spanish-speaking adults in 37 states. Primary outcomes included cannabis use during pregnancy and two continuous scale measures of beliefs about safety and perceived community stigma. Using generalized linear models and mixed effects ordinal logistic regression with random effects for state, we assessed associations between legal recreational cannabis and outcomes of interest, controlling for state-level and individual-level covariates and specifying appropriate functional form. ResultsThose who reported cannabis use during pregnancy were more likely to believe it is safe and to perceive community stigma compared to those who did not report use during pregnancy. Legal recreational cannabis was not associated with cannabis use during pregnancy, continuation or increase in use, frequency of use, or safety beliefs. Legal recreational cannabis was associated with lower perceived community stigma (coefficient: −0.07, 95% CI: −0.13, −0.01), including among those who reported use during (coefficient = −0.22, 95% CI: −0.40, −0.04) and prior to but not during (coefficient = −0.19, 95% CI: −0.37, −0.01) pregnancy. ConclusionFindings do not support concerns that legal recreational cannabis is associated with cannabis use during pregnancy or beliefs about safety. Legal recreational cannabis may be associated with lower community stigma around cannabis use during pregnancy, which could have implications for pregnant people’s disclosure of use and care-seeking behavior.

Cannabis-related arrests and convictions in Canada: Differences by race/ethnicity, individual socioeconomic factors, and neighborhood deprivation

Racialized individuals were disproportionately impacted by cannabis prohibition in Canada; however, the role of socioeconomic factors and neighborhood deprivation are not well understood. The current study examined race/ethnicity, individual socioeconomic factors, and neighborhood deprivation in relation to arrests and convictions for cannabis-related offenses. Repeat cross-sectional data were analyzed from two waves of the International Cannabis Policy Study (ICPS), a web-based survey conducted in 2019 (n = 12,226) and 2020 (n = 12,815) in Canada among those aged 16 to 65. Respondents were recruited through commercial online panels. Respondents’ postal codes were linked to the INSPQ deprivation index. Multinomial regression models examined the association between race/ethnicity, individual socioeconomic factors, neighborhood deprivation, and lifetime arrests or convictions for cannabis offenses. Overall, 4.4% of respondents reported a lifetime arrest or conviction for a cannabis-related offense. Black and Indigenous individuals had more than three times the odds of conviction than White individuals (AOR = 3.90, 95% CI = 2.07–7.35, p = <0.01; AOR = 3.24, 95% CI = 1.78–5.90, p = <0.01, respectively). Differences were still statistically significant after adjusting for cannabis use and socioeconomic factors; however, after adjusting for neighborhood deprivation, only the difference for Black individuals remained. Neighborhood deprivation was associated with cannabis-related convictions: the odds of a conviction among the “most privileged” and “privileged” neighborhoods were approximately half of those in the “most deprived” neighborhoods (AOR = 0.50, 95% CI = 0.29–0.86, p = 0.01; AOR = 0.50, 95% CI = 0.27–0.92, p = 0.03, respectively). Arrests and convictions for cannabis-related offenses were disproportionately higher among racialized individuals and those living in the most marginalized neighborhoods. Future research should examine whether inequities change following the legalization of recreational cannabis in Canada.

The impact of recreational cannabis laws on cannabis use disorder during “treat and release” visits to hospital emergency departments in four U.S. states, 2017–2020

States’ legalization of cannabis influences cannabis use and may increase cannabis use disorder (CUD)—a problematic pattern of use leading to significant impairment. Few studies have examined the influence of recreational cannabis legalization on CUD in the emergency department (ED). We used four years of data from the State Emergency Department Databases (SEDD) (2017–2020) from three states (CO, MD, OR) and three years of SEDD from Rhode Island (2017–2019) to examine the relationship between the recreational legalization of cannabis and CUD among “treat and release” ED visits. During the study period, CO and OR were legal for recreational cannabis while it was illegal in MD and RI. We examined the proportion of ED visits for CUD and used multivariate logistic regression to examine the association between recreational legalization and CUD diagnosis. The sample had 17,434,655 ED visits (56.2 % female). The proportion of ED visits for CUD was 0.63 %. Annual rates ranged from 0.67 % (2017) to 0.59 % (2019) and state-level rates were 0.39 % (CO), 0.35 % (OR), 1.03 % (MD), and 0.79 % (RI). Compared to ED visits in legal states, a higher proportion of ED visits in non-legal states were from women (56.8 % versus 55.7 %) and Blacks (40.9 % versus 5.9 %). Compared to states where recreational cannabis was illegal, legalizing cannabis for recreational use was associated with nearly a 50 % decrease in the adjusted odds of CUD (AOR = 0.49, 95 % CI 0.47, 0.52). In summary, CUD rates among “treat and release” ED visits were significantly lower in legalized states than in non-legal states.

Impact of Recreational Cannabis Legalization on Adolescent Cannabis Use in Washington State

An important public concern about the impact of recreational cannabis legalization is how it may affect adolescent cannabis use. Prior research on this issue has primarily focused on the implications of medical cannabis legalization for adolescents and used data that cover a relatively short post-legalization period. This study extends this line of research by examining the relationship between recreational cannabis legalization and adolescent cannabis use in Washington State, using the National Survey of Drug Use and Health (NSDHU) data from 2005 to 2019. Based on a quasi-experimental research design, this study found some evidence suggesting a positive effect of recreational legalization on the prevalence of adolescent cannabis use and cannabis initiation. Findings suggest the need to create a cannabis regulatory environment that minimizes adolescent access to this drug.

Young Adult Depression and Cannabis Use: Associations Before and After Recreational Legalization

The co-occurrence of depression with cannabis use worsens both mood and substance use disorder outcomes, with young adults particularly at risk of co-occurrence. This research investigates whether the association of state-level prevalence rates of young adult (age 18-25) depression and cannabis use in the U.S. changed following enactment of recreational (adult use) cannabis legalization between 2008 and 2019. Annual, state prevalence data on past-year major depressive episode (hereafter, depression) and past-month cannabis use were extracted from the National Survey on Drug Use and Health (N=600 state-year observations). Moderated regression models tested whether the association of depression with cannabis use differed before versus after recreational legalization by comparing prevalence rates of depression and cannabis use in states that enacted recreational legalization to those that did not, while fixing state, year, and medical legalization effects. Data were accessed and analyzed in 2023. Prevalence rates of both depression and cannabis use increased throughout the study period. The positive statistical effect of depression on cannabis use more than doubled in magnitude after legalization (β=0.564, 95% CI=0.291, 0.838) as compared to before (β=0.229, 95% CI=0.049, 0.409), representing a significant change (β=0.335, 95% CI=0.093, 0.577). These results suggest that the association between prevalence rates of young adult depression and cannabis use strengthened following recreational legalization in the U.S. This is potentially due to increases in cannabis accessibility and the acceptance of the health benefits of cannabis, which may enhance the use of cannabis as a coping mechanism among young adults with depression.

Recreational Cannabis Legalization and Adolescent Sexual Risk Behaviors

Little is known about the implications of cannabis legalization on adolescent health behaviors. This study sought to examine the relationship between recreational cannabis legalization and adolescent sexual risk behaviors. Data on 371,487 respondents who have ever had sexual intercourse from 41 states in the 2005 to 2019 Youth Risk Behavior Survey was linked with data on state-level cannabis policies. Difference-in-differences logistic regression models were conducted. Recreational cannabis legalization was associated with a reduced likelihood of respondents having 2+ sexual partners (adjusted OR [aOR] 0.63, 95% CI [0.47, 0.84]), but had no association with condom use (aOR 0.94, 95% CI [0.80, 1.11]). Changing social norms around cannabis is a potential pathway linking cannabis legalization to a reduction in sexual risk behaviors.

Cannabis Use Frequency and Cannabis-Related Consequences in High-Risk Young Adults Across Cannabis Legalization

A key concern about recreational cannabis legalization is increases in use and adverse consequences, particularly among young adults (aged 18-29 years) who have the highest prevalence of cannabis use, and especially in higher-risk, more vulnerable young adults. However, few longitudinal studies have examined patterns of cannabis consumption in high-risk young adults over the course of legalization. To examine changes in cannabis use frequency and cannabis-related consequences over recreational cannabis legalization in Canada in a longitudinal sample of high-risk young adults. Longitudinal observational cohort study following young adults in Ontario, Canada, aged 19.5 to 23.0 years who reported regular heavy episodic drinking (65% past-month cannabis use) at enrollment. Participants were surveyed every 4 months for 3 years between February 2017 and February 2020 (3 prelegalization waves, 4 postlegalization waves). Data were analyzed from March to May 2023. Recreational cannabis legalization in Canada and 4 potential moderators of change: sex, income, education, and prelegalization cannabis use frequency. Cannabis use frequency and cannabis-related adverse consequences. In a cohort of 619 high-risk young adults (baseline mean [SD] age, 21.0 [1.2] years; 346 female participants [55.9%]), omnibus model testing revealed significant overall decreases in both cannabis use frequency (F = 2.276, 3000.96; P = .03) and cannabis-related consequences (F = 10.436, 3002.21; P < .001) over time, but these changes were substantially moderated by prelegalization frequency (frequency: F = 7.5224, 3021.88; P < .001; consequences: F = 7.2424, 2986.98; P < .001). Follow-up tests showed individuals who used cannabis more frequently prelegalization significantly decreased their use and cannabis-related consequences postlegalization. In contrast, individuals who did not use cannabis prelegalization exhibited a small magnitude increase in frequency over time but nonsignificant changes in cannabis-related consequences. Sex, income, and education did not moderate changes over time. In this cohort study of high-risk young adults, individuals using cannabis frequently prelegalization showed significant reductions in use and consequences over time, reflecting an aging out pattern. Small increases in use among participants with no prelegalization use were observed over time, but without parallel changes in cannabis-related consequences. The results did not reveal substantive adverse near-term outcomes across the legalization period, although a within-participants design cannot rule out the possibility of alternative trajectories in the absence of legalization.

Addendum to “Evaluating substance use outcomes of recreational cannabis legalization using a unique co-twin control design”

ABSTRACT An earlier version of this article was published in error. Our prior publication was missing reference to a prior study on this topic. Our prior research has not found an association between recreational cannabis legalization (RCL) and negative psychosocial and psychiatric outcomes. We reported significant associations between RCL with greater cannabis frequency and fewer alcohol use disorder symptoms. The current study expands on our previous research by using a cross-sectional design and different measures of problems from cannabis and alcohol use and including additional substance use variables. The current study found similar results to our previous research.

Criminal Justice Referrals to Cannabis Use Disorder Treatment among Adolescents and Young Adults following Recreational Cannabis Legalization in the United States.

This study investigates whether the proportion of referrals to cannabis use disorder (CUD) treatment from the criminal justice system declined among adolescents (aged 12-17 years) and young adults (aged 18-24 years) following state recreational (adult use) cannabis legalization in the United States between 2008 and 2019. Cannabis use disorder treatment referral data were extracted from the Treatment Episode Dataset-Admissions and used to calculate trends in the number and proportion of criminal justice referrals. Difference-in-differences analysis was used to estimate the effect of recreational legalization on the state-level proportion of criminal justice referrals as a share of all admissions. Nationwide, the number and proportion of adolescent and young adult criminal justice referrals to CUD treatment declined over the study period. The proportion of young adult criminal justice referrals declined significantly more rapidly after recreational legalization as compared with before ( β = -0.045; 95% confidence interval, -0.079 to -0.010; P = 0.01). Among adolescents, the trajectory of decline in the proportion of criminal justice referrals did not change significantly following recreational legalization ( β = -0.033; 95% confidence interval, -0.073 to 0.008; P = 0.11). The decline in the proportion of young adult criminal justice referrals to CUD treatment following recreational legalization is likely due to falling cannabis-related arrests. Although cannabis criminalization may result in court-mandated CUD treatment for some young adults without CUD, the decline in CUD treatment admissions during a period of increasing CUD risk factors associated with recreational legalization represents a key health concern. Promoting screening and other CUD treatment referral sources, such as through primary care, may be warranted.

Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal.

Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use. To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use. This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study. Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons. Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use. Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01). In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

Evaluation of Field Sobriety Tests for Identifying Drivers Under the Influence of Cannabis

With increasing medicinal and recreational cannabis legalization, there is a public health need for effective and unbiased evaluations for determining whether a driver is impaired due to Δ9-tetrahydrocannabinol (THC) exposure. Field sobriety tests (FSTs) are a key component of the gold standard law enforcement officer-based evaluations, yet controlled studies are inconclusive regarding their efficacy in detecting whether a person is under the influence of THC. To examine the classification accuracy of FSTs with respect to cannabis exposure and driving impairment (as determined via a driving simulation). This double-blind, placebo-controlled parallel randomized clinical trial was conducted from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California, San Diego. Participants were aged 21 to 55 years and had used cannabis in the past month. Data were analyzed from August 2021 to April 2023. Participants were randomized 1:1:1 to placebo (0.02% THC), 5.9% THC cannabis, or 13.4% THC cannabis smoked ad libitum. The primary end point was law enforcement officer determination of FST impairment at 4 time points after smoking. Additional measures included officer estimation as to whether participants were in the THC or placebo group as well as driving simulator data. Officers did not observe driving performance. The study included 184 participants (117 [63.6%] male; mean [SD] age, 30 [8.3] years) who had used cannabis a mean (SD) of 16.7 (9.8) days in the past 30 days; 121 received THC and 63, placebo. Officers classified 98 participants (81.0%) in the THC group and 31 (49.2%) in the placebo group as FST impaired (difference, 31.8 percentage points; 95% CI, 16.4-47.2 percentage points; P < .001) at 70 minutes after smoking. The THC group performed significantly worse than the placebo group on 8 of 27 individual FST components (29.6%) and all FST summary scores. However, the placebo group did not complete a median of 8 (IQR, 5-11) FST components as instructed. Of 128 participants classified as FST impaired, officers suspected 127 (99.2%) as having received THC. Driving simulator performance was significantly associated with results of select FSTs (eg, ≥2 clues on One Leg Stand was associated with impairment on the simulator: odds ratio, 3.09; 95% CI, 1.63-5.88; P < .001). This randomized clinical trial found that when administered by highly trained officers, FSTs differentiated between individuals receiving THC vs placebo and driving abilities were associated with results of some FSTs. However, the high rate at which the participants receiving placebo failed to adequately perform FSTs and the high frequency that poor FST performance was suspected to be due to THC-related impairment suggest that FSTs, absent other indicators, may be insufficient to denote THC-specific impairment in drivers. ClinicalTrials.gov Identifier: NCT02849587.

The impact of cannabis legalization and decriminalization on acute poisoning: A systematic review.

Many countries have recently legalized medicinal and recreational cannabis. With increasing use and access come the potential for harms. We aimed to examine the effect of cannabis legalization/decriminalization on acute poisoning. A systematic review and meta-analysis registered with PROSPERO (CRD42022323437). We searched Embase, Medline, Scopus and Cochrane Central Register of Controlled Trials from inception to March 2022. No restrictions on language, age or geography were applied. Abstracts from three main clinical toxicology conferences were hand-searched. Included studies had to report on poisonings before and after changes in cannabis legislation, including legalization and decriminalization of medicinal and recreational cannabis. Where possible, relative risk (RR) of poisoning after legalization (versus before) was calculated and pooled. Risk of bias was assessed with ROBINS-I. Of the 1065 articles retrieved, 30 met inclusion criteria (including 10 conference abstracts). Studies used data from the United States, Canada and Thailand. Studies examined legalization of medicinal cannabis (n = 14) and decriminalization or legalization of recreational cannabis (n = 21). Common data sources included poisons centre records (n = 18) and hospital presentations/admissions (n = 15, individual studies could report multiple intervention types and multiple data sources). Most studies (n = 19) investigated paediatric poisoning. Most (n = 24) reported an increase in poisonings; however, the magnitude varied greatly. Twenty studies were included in quantitative analysis, with RRs ranging from 0.81 to 29.00. Our pooled estimate indicated an increase in poisoning after legalization [RR = 3.56, 95% confidence interval (CI) = 2.43-5.20], which was greater in studies that focused on paediatric patients (RR = 4.31, 95% CI = 2.30-8.07). Most studies on the effect of medicinal or recreational cannabis legalization/decriminalization on acute poisoning reported a rise in cannabis poisoning after legalization/decriminalization. Most evidence is from US legalization, despite legalization and decriminalization in many countries.

Cannabis and Alcohol Use by U.S. Young Adults, 2008–2019: Changes in Prevalence After Recreational Cannabis Legalization

Young adults' cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18-20 vs 21-23 years). Repeated cross-sectional data (2008-2019) were collected from college-eligible participants aged 18-23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022. Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08-1.32) and 1.14 (1.003-1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21-23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes. Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years.

Collisions and cannabis: Measuring the effect of recreational marijuana legalization on traffic crashes in Washington State

Objective Washington State was among the first states in the US to legalize recreational consumption and retail sales of marijuana. Recreational use of cannabis was legalized December 6, 2012, following the passage of Initiative 502 30 days prior. Roughly 19 months later the first retail cannabis stores opened their doors for public sales (“commercialization”). I measure the impact of cannabis legalization and commercialization on traffic collisions in Washington State. Methods With county-level vehicle crash data from the Washington State Department of Transportation collected monthly, I utilize an interrupted time-series framework with Poisson estimation to compare traffic collisions with recreational retail cannabis sales revenue from 2011 (three years pre-commercialization) through 2017 (three years post-commercialization). First, I measure the shift in collisions brought about by Washington’s 2012 cannabis legalization. Then, I compare retail cannabis sales—a measure of commercialization—to traffic collisions based on severity of injury (fatal, severe injury, minor injury, non-injury, and all). Results After controlling for confounding factors, evidence suggests that recreational cannabis legalization led to fewer fatal and serious injury collisions. Retail cannabis sales generally correlate with more traffic collisions, particularly for less severe (minor injury) crashes. These findings are robust to the inclusion of additional control variables pertaining to county-level cannabis usage and driving behavior while intoxicated. Conclusions Cannabis legalization led to fewer fatal, serious, and minor injury collisions. Commercialization (cannabis sales) correlated with an increase in less severe crashes. Although cannabis use generally increased in Washington State following legalization/commercialization, survey data suggest that driving behavior while under the influence of cannabis did not change significantly over the post-commercialization period. Future research should focus on measuring the dose-dependent impact of cannabis consumption on traffic collisions. This should include recognition of the importance of cannabis dosing, timing, and route of consumption. Lastly, the dangers of poly-drug driving—particularly cannabis and alcohol—are well established and should be high priority for further research.

Cannabis use for menopause in women aged 35 and over: a cross-sectional survey on usage patterns and perceptions in Alberta, Canada

ObjectiveUse of cannabis for medical reasons has increased in Canada since legalisation of recreational cannabis in 2018. The objective of this study was to examine the pattern of use and...

Risk Factors for Adolescent Cannabis Use in a State With Legal Recreational Cannabis: The Role of Parents, Siblings, and Friends

PurposeCannabis use during adolescence can have harmful consequences, including poor educational outcomes, neurocognitive defects, and an increased risk of addiction to other drugs, such as tobacco, alcohol, and opioids. Perceived family and social network cannabis use is a risk factor for use among adolescents. It is not currently known whether there is an association between perceived family/social network cannabis use and adolescent cannabis use in the context of legalization. The purpose of this study was to examine associations between adolescent perceptions of parent, sibling, and best friend medical and/or recreational cannabis use and adolescents’ own use and whether the association changed pre-legalization and post-legalization in Massachusetts. MethodsWe analyzed responses from surveys administered to students at 2 high schools in Massachusetts before legalization in 2016 (wave 1) and after legalization but before the start of regulated retail cannabis sales in 2018 (wave 2). We used χ2 tests and multiple logistic regression to examine associations between adolescent perception of parent, sibling, and best friend use and adolescent past 30-day cannabis use before and after legalization. FindingsIn this sample, no statistically significant differences were found in the prevalence of past 30-day cannabis use before and after legalization among adolescents. There was an increase in the proportion of adolescents who reported any perceived parent cannabis use from before to after legalization (18% before legalization to 24% after legalization; P = 0.018). Perceived parent, sibling, and best friend medical and recreational cannabis use were all associated with an increased odds of adolescent use, with the highest increase in odds found for perceived best friend use (adjusted odds ratio, 17.2; 95% CI, 12.4–24.0). ImplicationsAdolescent perceptions of their parents as cannabis users increased after legalization, even before state-regulated retails sales began. Parent, sibling, and best friend cannabis use is each independently associated with increased odds of adolescent's own use. These findings from 1 Massachusetts district should be explored in larger and more representative populations and motivate additional attention to interventions that consider family and friend influences when seeking to address adolescent cannabis use.

Exploring the Impact of Adult‐use Cannabis Legalization on Legal System Referrals to Treatment for Cannabis Use: Do Age and Race Have a Moderating Effect?

PurposeDespite the progression of recreational cannabis legalization, the legal system remains the largest source of referral to treatment for cannabis use. The legal system's continued practice of requiring participation in cannabis treatment programs raises questions regarding the extent to which individuals who interact with the legal system are monitored for cannabis use post-legalization. This article presents trends in justice-system referrals to treatment for cannabis use in legal and nonlegal states for 2007–2019. The relationship between legalization and justice system treatment referrals for black, Hispanic/Latino, and white adults and juveniles was explored. Given that minority and youth populations are subject to disproportionate levels of cannabis enforcement, legalization is expected to have a weaker relationship with justice-system referral rates in white juveniles and black and Hispanic/Latino adults and juveniles compared to white adults. MethodsUsing 2007–2019 data from the Treatment Episode Data Set—Admissions (TEDS-A), variables were created for state-level rates of legal system–referred treatment admissions for cannabis use in black, Hispanic/Latino, and white adults and juveniles. Rate trends were compared across populations and staggered difference-in-difference and event analyses were conducted to determine whether legalization is associated with a decline in justice-system referrals to treatment for cannabis use . FindingsFor the study period, the mean rate of legal system–referred admissions in the total population was 2.75 per 10,000 residents. Black juveniles had the highest mean rate (20.16), followed by Hispanic/Latino juveniles (12.35), black adults (9.18), white juveniles (7.58), Hispanic/Latino adults (3.42), and white adults (1.66). Legalization did not have a significant impact on treatment-referral rates in any population of study. Events analyses indicated significant rate increases in black juveniles in legalized states compared to controls at 2 and 6 years after policy change, and in black and Hispanic/Latino adults at 6 years after policy change (all, P < 0.05). While racial/ethnic disparities in referral rates declined in absolute terms, the relative size of these disparities increased in legalized states. ImplicationsTEDS-A captures only publicly funded treatment admissions and relies on the quality of individual-state reporting. Individual-level factors that may impact decisions regarding treatment referrals for cannabis use could not be controlled for. Despite limitations, the present findings suggest that for individuals who interact with the criminal legal system, cannabis use may still result in legal monitoring after reform. The upward trend in legal system referrals for black (but not white) adults and juveniles several years after states legalize cannabis warrants further examination and may reflect continued disparate treatment of these populations at multiple points along the legal-system continuum.