Racial and Ethnic Differences in Cannabis Use Following Legalization in US States With Medical Cannabis Laws

Abstract

IMPORTANCE Little is known about changes in cannabis use outcomes by race and ethnicity following the enactment of recreational cannabis laws (RCLs). OBJECTIVES To examine the association between enactment of state RCLs and changes in cannabis outcomes by race and ethnicity overall and by age groups in the US. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used restricted use file data from the National Surveys of Drug Use and Health between 2008 and 2017, which were analyzed between September 2019 and March 2020. National survey data included the entire US population older than 12 years. MAIN OUTCOMES AND MEASURES Self-reported past-year and past-month cannabis use and, among people that used cannabis, daily past-month cannabis use and past-year Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) cannabis use disorder. Multi-level logistic regressions were fit to estimates changes in cannabis use outcomes by race and ethnicity overall and by age between respondents in states with and without enacted RCLs, controlling for trends in states with medical cannabis laws or no cannabis laws. RESULTS A total of 838 600 participants were included for analysis (mean age, 43 years [range, 12-105 years]; 434 900 women [weighted percentage, 51.5%]; 511 900 participants (weighted percentage, 64.6%) identified as non-Hispanic White, 99 000 (11.9%) as non-Hispanic Black, 78 400 (15.8%) as Hispanic, and 149 200 (7.6%) as other (including either Native American, PacificIslander, Asian, or more than 1 race or ethnicity). Compared with the period before RCL enactment, the odds of past-year cannabis use after RCL enactment increased among Hispanic (adjusted odds

Marijuana Policy Bundles in the American States Over Time and Their Impact on the Use of Marijuana and Other Drugs

“…Different policy approaches may influence usage of marijuana, and there may be spillover effects from legal adult use to abuse by adolescents and to illicit use of other drugs by any age group. Measuring the impact of medical marijuana laws with only a binary variable representing the passage of a law ignores important variation in policy characteristics that could shape the behavioral effects of policy (Chapman et al, 2016;Martins et al, 2021;Pacula et al, 2015;Williams et al, 2016). As marijuana legalization has increased, the policies have also become more complex and robust as states consider a mix of policies for implementation.…”

“…As policymakers consider marijuana policies, they may be concerned about cannabis and other drug use rates in the state population. The National Survey on Drug Use and Health (NSDUH) is a common source of data on monthly usage rates for marijuana and for other illicit drugs (Harper et al, 2012;Wen et al, 2015;Martins et al, 2016, Mauro et al, 2019Martins et al, 2021). Our dependent variables are the age group usage rates (ages 12-17, 18-25, 18 and older, and 26 and older) per 100,000 residents for those who report use of the respective substances, and we use data from 2000 to 2019 for state rates (U.S. Department of Health and Human Services, 2020).…”

“…Within the cannabis legalization policy arena, states have adopted policy components in the initial approval of legal marijuana, but they have also added many policy components in the implementation phase (Pacula et al, 2016(Pacula et al, , 2015Wilkinson et al, 2016). This policy adaptation provides an opportunity for researchers to consider how specific policy characteristics that continue to change over time influence cannabis usage rates (Chapman et al, 2016;Martins et al, 2021;Pacula et al, 2015;Williams et al, 2016).…”

Estimating the Effects of Legalizing Recreational Cannabis on Newly Incident Cannabis Use

“…The published literature to this point has evaluated prevalence of recent use, prevalence of cannabis use disorder (CUD), and frequency of use. Concerning associations between cannabis liberalization and cannabis use prevalence among youth, most published evidence indicates that prevalence did not change after legalization, and perhaps may have dropped in some sub-populations (Gruber et al, 2016; Dilley et al, 2019; Reed, 2021; Martins et al, 2021; Coley et al, 2021). Yet, a minority of studies provide firm evidence of appreciable cannabis use prevalence increases among adolescents (Cerdá et al ., 2017; Melchior et al ., 2019; Smart and Pacula, 2019; Paschall, García-Ramírez, & Grube, 2021).…”

Error in Tables

“…In the Original Investigation titled “Racial and Ethnic Differences in Cannabis Use Following Legalization in US States With Medical Cannabis Laws,” 1 published September 27, 2021, there were errors in the column headings in Tables 2 and 3. Subheadings have been added to clarify these results.…”