Changes in alcohol and cigarette consumption in response to medical and recreational cannabis legalization: Evidence from U.S. state tax receipt data

Veligati, Sirish; Howdeshell, Seth; Beeler‐Stinn, Sara; Lingam, Deepak; Allen, Phylicia C.; Chen, Li Shiun; Grucza, Richard A.

doi:10.1016/j.drugpo.2019.10.011

Cited by 30 publications

(25 citation statements)

References 39 publications

(51 reference statements)

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“…Despite the relationship between cannabis and cigarette use, the increased negative consequences associated with co‐use and the increasing use and acceptance of cannabis alongside increasing cannabis legalization, little is known about how cannabis legalization might impact upon the co‐use of cigarettes and cannabis versus the use of cigarettes without cannabis or cannabis without cigarettes. One US national study reported a higher prevalence of cigarette–cannabis co‐use in states with versus without MCL in 2013 (5.8 versus 4.8%, P < 0.01) [46], whereas another study [47] found that per capita cigarette sales did not differ overall for states with versus without MCL or RCL. Similarly, several studies showed no RCL‐related changes in cigarette use [48,49] or cannabis use [50] among young adults.…”

Section: Introductionmentioning

confidence: 99%

A difference‐in‐difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004–17

et al. 2022

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Aims To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. Design A difference‐in‐difference approach was applied to data from the 2004–17 National Survey on Drug Use and Health (NSDUH). Setting United States. Participants Nationally representative cross‐sectional survey of Americans aged 12 years and older (combined analytical sample for 2004–17, n = 783 663). Measurements Data on past‐month use of (1) cigarettes and (2) cannabis were used to classify respondents into four groups: cigarette and cannabis co‐use, cigarette‐only use, cannabis‐only use or no cigarette or cannabis use. State of residence was measured by self‐report. MCL/RCL status came from state government websites. Findings Difference‐in‐difference analyses suggest that MCL was associated with an increase in cigarette–cannabis co‐use overall [adjusted odds ratio (aOR) = 1.09; 95% confidence interval (CI) = 1.02–1.16], with the greatest increases among those aged 50 years and above (aOR = 1.60; CI = 1.39–1.84), married (aOR = 1.19; CI = 1.07–1.31), non‐Hispanic (NH) black (aOR = 1.14; CI = 1.02–1.07) and with a college degree or above (aOR = 1.15; CI = 1.06–1.24). MCL was associated with increases in cigarette‐only use among those aged 50 years and above (aOR = 1.07; CI = 1.01–1.14) and NH black (aOR = 1.16; CI = 1.06–1.27) and increases in cannabis‐only use among those aged 50 years and above (aOR = 1.24; CI = 1.07–1.44) and widowed/divorced/separated (aOR = 1.18; CI = 1.01–1.37). RCL was associated with an increase in cannabis‐only use overall (aOR = 1.21; 95% CI = 1.09–1.34), a decline in cigarette‐only use overall (aOR = 0.89; 95% CI = 0.81–0.97) and increases in co‐use among those who were married (aOR = 1.24; CI = 1.02–1.50) and aged 50 years and above (aOR = 1.37; CI = 1.03–1.84). Conclusions Recreational and medical cannabis legalization have had a varying impact on the use, and co‐use, of cannabis and cigarettes in the United States.

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Section: Introductionmentioning

confidence: 99%

A difference‐in‐difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004–17

et al. 2022

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“…Two studies included in this review focused on population aggregated sales data, either in terms of total aggregated sales of alcoholic beverages per capita 68 or in terms of Nielsen scanner data sales. 27 The findings from these two studies suggested that alcohol sales were lower in states that adopted MMLs.…”

Section: Resultsmentioning

confidence: 99%

“…However, the findings in the study by Veligati et al, which also included additional alcohol policy measures that better captured the overall alcohol environment and covered a much longer time period, suggested that this association was not statistically significant. 68 Moreover, Veligati et al suggested that states that further adopted adult-use cannabis policies subsequently had an increase in per capita alcohol sales; 68 Baggio et al did not consider these subsequent changes. 27 …”

Section: Resultsmentioning

confidence: 99%

“…It is not a trivial point to note that every state that adopted an RML policy prior to 2020 transitioned from a MML policy. It is possible that positive associations that were identified for RML policies in hospital admissions data 63 and/or aggregated sales data 68 may reflect the longer term impact of a mature market on the medical and recreational cannabis markets combined rather than an isolated impact of RML alone. Relatedly, they also might reflect a changing cannabis policy environment due to differential implementation caused by a specific federal response and/or changes in implementation that occur over time.…”

Section: Discussionmentioning

confidence: 99%

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Relationships of Cannabis Policy Liberalization With Alcohol Use and Co-Use With Cannabis: A Narrative Review

Pacula¹

2022

ARCR

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PURPOSE The liberalization of cannabis policies has the potential to affect the use of other substances and the harms from using them, particularly alcohol. Although a previous review of this literature found conflicting results regarding the relationship between cannabis policy and alcohol-related outcomes, cannabis policies have continued to evolve rapidly in the years since that review. SEARCH METHODS The authors conducted a narrative review of studies published between January 1, 2015, and December 31, 2020, that assessed the effects of cannabis policies on the use of alcohol in the United States or Canada. SEARCH RESULTS The initial search identified 3,446 unique monographs. Of these, 23 met all inclusion criteria and were included in the review, and five captured simultaneous or concurrent use of alcohol and cannabis. DISCUSSION AND CONCLUSIONS Associations between cannabis policy liberalization and alcohol use, alcohol-related outcomes, and the co-use of alcohol and cannabis were inconclusive, with studies finding positive associations, no associations, and negative associations. Although several studies found that cannabis policy liberalization was associated with decreases in alcohol use measures, these same studies showed no impact of the cannabis policy on cannabis use itself. The lack of a consistent association was robust to subject age, outcome measure (e.g., use, medical utilization, driving), and type of cannabis policy; however, this may be due to the small number of studies for each type of outcome. This paper discusses several notable limitations of the evidence base and offers suggestions for improving consistency and comparability of research going forward, including a stronger classification of cannabis policy, inclusion of measures of the alcohol policy environment, verification of the impact of cannabis policy on cannabis use, and consideration of mediation effects.

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“…In terms of other substance use and its association with the loosening of state-level restrictions on cannabis, the evidence is also mixed (for review see, e.g., Darnell, 2020;Guttmannova et al, 2016;Risso et al, 2020;Smart & Pacula, 2019). Most recently, Veligati et al (2020) demonstrated that neither alcohol nor cigarette consumption (as measured by state tax receipt data) has increased or decreased as a result of "recreational" and medical cannabis legalization. Evidence regarding substitution versus complementarity in the association between cannabis and other substances likely remains mixed because these populationlevel studies do not allow examination of whether intraindividual change over time in use of one substance is associated with intraindividual change in use of another (for a brief review of design and dataset recommendations, see, e.g., Guttmannova et al, 2016Guttmannova et al, , 2019.…”

Section: Introductionmentioning

confidence: 99%

Dual trajectories of cannabis and alcohol use among young adults in a state with legal nonmedical cannabis

Guttmannova

Fleming

Rhew

et al. 2021

Alcoholism Clin & Exp Res

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Background: Understanding the nature of the association between cannabis and alcohol use within individuals over time in the era of legalized cannabis is of crucial importance for assessing the public health consequences of increasing cannabis use. An important unanswered question is whether cannabis and alcohol use substitute for one another. Specifically, is greater use of one substance associated with less use of the other substance (i.e., a negative association) or are the substances complementary and their association positive? Methods: We used 24 consecutive months of data on a young adult sample (n = 774; 56% female, age 18-25 during the study) who drank alcohol in the year prior to enrollment. The sample was recruited in Washington State in 2015/2016 (after legalization of nonmedical cannabis) using media advertisements and community flyers and outreach. Using parallel process latent growth curve models, we assessed three types of association between cannabis and alcohol use across the 24-month period:(1) an association between average levels of cannabis and alcohol use; (2) an association between rates of change in cannabis and alcohol use; and (3) correlations between shorter-term deviations/fluctuations off of longer-term trajectories of level and change in cannabis and alcohol use. Results:We found a positive association between the average frequency of cannabis and alcohol use; individuals who used cannabis more frequently on average also drank alcohol more frequently on average. Change over time in cannabis use was positively associated with change in alcohol use. There was also a contemporaneous positive association between fluctuations in cannabis and alcohol use. Conclusions:Overall, we found no evidence of substitution. Rather, the results suggest a complementary relationship between cannabis and alcohol use, such that the use of cannabis and alcohol rises and falls together.

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Changes in alcohol and cigarette consumption in response to medical and recreational cannabis legalization: Evidence from U.S. state tax receipt data

Cited by 30 publications

References 39 publications

A difference‐in‐difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004–17

A difference‐in‐difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004–17

Relationships of Cannabis Policy Liberalization With Alcohol Use and Co-Use With Cannabis: A Narrative Review

Dual trajectories of cannabis and alcohol use among young adults in a state with legal nonmedical cannabis

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