Use of Cannabis for Medical or Recreational Purposes Among US Young Adults: Correlates and Implications for Problematic Use and Interest in Quitting.

Objective: Recreational and medical cannabis use has increased, particularly among young adults, but little is known regarding who uses for these purposes or how purpose of use is associated with problematic use. Methods: We analyzed Fall 2019 survey data among 1,083 US young adults (ages 18-34) reporting past 6-month cannabis use. Multivariable regression analyses examined: 1) characteristics of those using for only/primarily medical purposes, primarily recreationally, and only recreationally vs. equally for medical and recreational purposes (referent; multinomial logistic); and 2) reasons for use in relation to cannabis use disorder symptoms (linear) and driving under the influence of cannabis (DUIC; binary logistic). Results: 37.1% used only recreationally, 23.5% primarily recreationally, 21.5% equally for both, and 17.8% medically. Compared to those using equally for medical and recreational purposes, those using only/primarily medically had fewer friends who used cannabis; those using primarily recreationally were younger, more educated, less likely used tobacco, and reported fewer ACEs. Those using only recreationally were younger, more likely male, less likely to report an ADHD diagnosis or past-month alcohol or tobacco use, and reported fewer friends who used cannabis, ACEs, and depressive symptoms. Using equally for medical and recreational purposes (vs. all other cannabis use subgroups) correlated with greater use disorder symptoms and DUIC. Conclusions: Using cannabis equally for medical and recreational purposes may pose particularly high-risk, given the association with greater mental health concerns and problematic use. Understanding use profiles and how young adults interpret and distinguish medical and recreational use is critical.

Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities.

As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.

Assessment of Online Marketing and Sales Practices Among Recreational Cannabis Retailers in Five U.S. Cities.

Background: With more states legalizing recreational cannabis, examining cannabis retail and marketing is crucial, as it may influence consumers' perceptions and behaviors. Particularly understudied is online cannabis retail. Methods: In Spring 2022, coders collected and analyzed data regarding retailer characteristics, age verification, and marketing strategies (e.g., product availability, health-related content, promotions, website imagery) among 195 cannabis retail websites in five U.S. cities (Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California). Descriptive analyses characterized the websites overall and across cities. Results: Overall, 80.5% verified age for website entry, and 92.8% offered online purchases (92.3% of retailers in Seattle, where prohibited). Of these, 82.9% required age verification for purchases, and 30.9% offered delivery. Almost all (>92%) offered flower/bud, concentrates, edibles, vaping devices, topicals, and tinctures. Health warnings were displayed on 38.3% of websites. Although all five states required health warnings regarding use during pregnancy, only 10.3% had these warnings. In addition, 59.0% posted some unsubstantiated health claims, most often indicating physical and mental health benefits (44.6%). Although Colorado, Washington, and Oregon prohibit health claims, 51.2-53.8% of these retailers posted them. Discounts, samples, or promotions were present on 90.8% of websites; 63.6% had subscription/membership programs. Subpopulations represented in website content included the following: 27.2% teens/young adults, 26.2% veterans, 7.2% sexual/gender minorities, and 5.6% racial/ethnic minorities. Imagery also targeted young people (e.g., 29.7% party/cool/popularity, 18.5% celebrity/influencer endorsement). Conclusions: Regulatory efforts are needed to better monitor promotional strategies and regulatory compliance (e.g., health claims, youth-oriented content, underage access) among online cannabis retailers.