Global patterns in small-scale cannabis growers' distribution practices: Exploring the grower-distributor nexus.

BACKGROUND: While the supply of cannabis is commonly assumed to be dominated by criminal gangs, a sizable share of the domestic cannabis supply is provided by small-scale growers. This article examines the nature and scope of small-scale growers' distribution practices, with a particular focus on cross-country differences and variations between different types of grower-distributors, i.e., "non-suppliers", "exclusive social suppliers", "sharers and sellers" and "exclusive sellers". METHODS: Based on a large convenience web survey sample of predominantly small-scale cannabis growers from 18 countries, this article draws on data from two subsamples. The first subsample includes past-year growers in all 18 countries who answered questions regarding their market participation (n = 8,812). The second subsample includes past-year growers in 13 countries, who answered additional questions about their supply practices (n = 2,296). RESULTS: The majority of the cannabis growers engaged in distribution of surplus products, making them in effect "grower-distributors". Importantly, many did so as a secondary consequence of growing, and social supply (e.g., sharing and gifting) is much more common than selling. While growers who both shared and sold ("sharers and sellers"), and especially those who only sold ("exclusive sellers"), grew a higher number of plants and were most likely to grow due to a wish to sell for profits, the majority of these are best described as small-scale sellers. That is, the profit motive for growing was often secondary to non-financial motives and most sold to a limited number of persons in their close social network. CONCLUSION: We discuss the implications of the findings on the structural process of import-substitution in low-end cannabis markets, including a growing normalization of cannabis supply.

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map.

Background: Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms. Objectives: This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps. Search Methods: We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020. Selection Criteria: The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws. Data Collection and Analysis: Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2. Main Results: The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality. Authors' Conclusions: More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

Conflict and social control among cannabis growers.

AIMS: Illegal drug markets are often assumed to be violent and predatory due to the absence of third-party enforcement. While cannabis markets are generally considered to be relatively more peaceful, there has been little investigation of the levels of conflict and victimization among small-scale cannabis growers, particularly under different cannabis policy and enforcement settings. This paper explores prevalence and predictors of conflict and social control among small-scale cannabis growers. METHODS: The data were obtained from an online convenience survey of small-scale cannabis growers from 13 countries (Austria, Canada, Denmark, Finland, France, Germany, Israel, New Zealand, Portugal, Switzerland, United Kingdom, United States, and Uruguay) from August 2020 to September 2021 (N = 5667). Key measures collected included the types of victimization due to cannabis growing, the perpetrators of these predatory actions, reasons for the conflict, and the grower's response to being victimized. Multivariate logistic regression models were used to identify predictors of different types of victimization and social control responses among cannabis cultivators. RESULTS: Most growers (76 %) never directly experienced violence or other victimization related to their cannabis cultivation. However, about one-quarter of growers had been victimized at some point, mostly involving theft, with physical violence rare. Growing outdoors, growing with others, growing more plants, and being a more seasoned grower increased the risk of victimization. Growers who were motivated by profit were more susceptible to theft. Surprisingly, growers in legal recreational jurisdictions experienced greater levels of theft and violent victimization than growers in illegal jurisdictions. Nonviolent social control responses predominated among the growers, mostly characterized by toleration but also avoidance and negotiation. CONCLUSION: While most growers reported no victimization, a substantial minority did so, largely theft rather than violence, and typically did not report employing retaliatory violence. Social control responses were mostly nonviolent. These findings varied under different cannabis policy and enforcement environments. Cannabis legalization does not eliminate opportunities for theft and violence related to cannabis cultivation.

Are cannabis use problems comparable across individuals using for recreational and medical purposes? An international cross-sectional study of individuals who use self-grown cannabis.

BACKGROUND: Little is known about cannabis use problems among individuals who use cannabis for medical purposes and whether rates and determinants of cannabis use problems in medical users differ to those observed among individuals using for recreational reasons. This study examines whether Severity of Dependence Scale (SDS) scores differ across individuals who use self-grown cannabis for the following reasons: "recreational only", "medical and recreational" and "medical only". Furthermore, the study tests whether cannabis use frequency, cannabis strain, and type of cannabis influences the strength of the association between purpose of use and cannabis use problems. METHODS: Data (n = 5,347) were collected from a subsample of the Global Cannabis Cultivation Research Consortium project, focusing on small-scale cannabis growers in 18 countries. Robust regressions analyzed differences in SDS scores across the three use motivation groups. RESULTS: Compared with respondents reporting only recreational motivations of cannabis use, those with medical (with and without recreational) motivations were associated with lower SDS scores (B: -0.190 and B: -0.459, p < 0.001 respectively). Daily use was associated with significantly higher SDS scores across all cannabis motivation groups, albeit the magnitude of the association was significantly smaller among individuals with medical motivations of use. CONCLUSION: The extent to which people experience cannabis use problems, and the determinants of these problems may differ depending on whether cannabis use is motivated by recreational or medical purposes. As such, the findings of the current study suggest that public education efforts, harm reduction approaches and policy responses should be tailored depending on whether cannabis is used for recreational or medical purposes.

Computational Approaches to Detect Illicit Drug Ads and Find Vendor Communities Within Social Media Platforms.

The opioid abuse epidemic represents a major public health threat to global populations. The role social media may play in facilitating illicit drug trade is largely unknown due to limited research. However, it is known that social media use among adults in the US is widespread, there is vast capability for online promotion of illegal drugs with delayed or limited deterrence of such messaging, and further, general commercial sale applications provide safeguards for transactions; however, they do not discriminate between legal and illegal sale transactions. These characteristics of the social media environment present challenges to surveillance which is needed for advancing knowledge of online drug markets and the role they play in the drug abuse and overdose deaths. In this paper, we present a computational framework developed to automatically detect illicit drug ads and communities of vendors. The SVM- and CNN- based methods for detecting illicit drug ads, and a matrix factorization based method for discovering overlapping communities have been extensively validated on the large dataset collected from Google+, Flickr and Tumblr. Pilot test results demonstrate that our computational methods can effectively identify illicit drug ads and detect vendor-community with accuracy. These methods hold promise to advance scientific knowledge surrounding the role social media may play in perpetuating the drug abuse epidemic.

Cannabis and driving ability.

The aim of this review is to discuss recent evidence on cannabis and driving ability. In particular, the review examines experimental research on the acute effects of tetrahydrocannabinol (THC) on driving-related neurobehavioral skills and driving performance based on simulator and road course studies. The evidence indicates that certain driving abilities are significantly, albeit modestly, impaired in individuals experiencing the acute effects of THC. Treatment effects are moderated by dose, delivery method, recency of use, and tolerance development, with inconclusive evidence concerning the moderating influence of cannabidiol. Emerging research priorities include linking neurobehavioral deficits to specific decrements in driving performance, estimating the real-world implications of experimental impaired driving research, understanding how tolerance differentially affects driving impairment across subgroups, and developing more evidence on cannabidiol's potential role in mitigating THC-induced impairment.

Development of a global index measuring national policy commitments to HIV prevention and treatment among people who inject drugs.

BACKGROUND: People who inject drugs (PWID) around the world are disproportionately affected by the HIV epidemic. National policy responses to the epidemic heavily influence risk factors for HIV acquisition among this key group. Prior efforts to monitor national policy responses to HIV/AIDS among PWID were limited both in scope and coverage. In this paper we develop and validate the HIV-PWID Policy Index (HPPI) to benchmark and monitor national commitments to HIV prevention and treatment among PWID. METHODS: Composite indicator was constructed employing fuzzy multilayer data envelopment analysis (FMLDEA). Model inputs based on data from 105 countries included 27 variables measured across six conceptual domains, including needle and syringe programs, opioid substitution treatment, testing and counseling, information and education, monitoring and evaluation, and legal and policy climate. RESULTS: According to the HPPI, which ranges from 0 to 1, the top performing countries in policy commitments to HIV prevention and treatment among PWID were Spain (0.988), Switzerland (0.982), Luxembourg (0.970), Moldova (0.970), and Kyrgyzstan (0.945), whereas the poorest performing included Nicaragua (0.094), Japan, (0.094), Cape Verde (0.097), Syria (0.174), and Benin (0.185). Regionally, commitment to HIV services targeting PWID was highest among European countries (0.81) and lowest among African countries (0.50), with Oceania (0.76), Asia (0.66), and the Americas (0.56) in the mid-range. Subregional differences were even more prominent, with West and Central European nations (0.84) and Central American nations (0.22) earning the highest and lowest HPPI scores, respectively. CONCLUSIONS: The HPPI documented substantial national and regional variation in policy responses to the HIV epidemic among PWID. Our analysis also revealed that many countries have limited HIV/AIDS data collection and monitoring capabilities. Continued enhancement and standardization of global HIV/AIDS monitoring efforts are therefore vital to articulated national and international benchmarking and performance assessment goals.

Patterns of substance involvement and criminal behavior: a gender-based cluster analysis of Pennsylvania arrestees.

Recent drug-crime scholarship has underscored the importance of conducting disaggregated research that focuses on the consistencies and variations between subcategories of drug misuse and criminal activity and, further, how these associations may vary across sociodemographic and cultural boundaries. The research presented in this article used cluster analysis to independently classify male and female arrestees based on their arrest charges and substance-specific indicators of initiation, use, dependence, and treatment need. The data come from Pennsylvania's Substance Abuse and Need for Treatment Among Arrestees study conducted as part of the State Treatment Needs Assessment Program. Five groups were identified in both the male and female cluster analyses. The results reveal both important differences and strong similarities in the drug-crime typologies of male and female arrestees. Given these findings, implications are discussed for developing and targeting responsive treatment services that match the particular risks and needs of drug-involved offenders.

The effects of medical marijuana laws on cannabis-involved driving.

This study uses data from the Fatality Analysis Reporting System and a differences-in-differences model to examine the effect of state medical marijuana laws (MMLs) on cannabis-involved driving among U.S. drivers involved in a fatal crash between 1993-2014. Findings indicate that MMLs in general have a null effect on cannabis-positive driving, as do state laws with specific supply provisions including home cultivation and unlicensed or quasi-legal dispensaries. Only in jurisdictions with state-licensed medical marijuana dispensaries did the odds of marijuana-involved driving increase significantly by 14 percent, translating into an additional 87 to 113 drivers testing positive for marijuana per year. Sensitivity analyses reveal these findings to be generally robust to alternate specifications, although an observed spillover effect consistent with elevated drugged driving enforcement in bordering states weakens a causal interpretation. Still, reasonable policy implications are drawn regarding drugged driving prevention/enforcement and regulations governing dispensary delivery services and business siting decisions.

When DAWN went dark: Can the Nationwide Emergency Department Sample (NEDS) fill the surveillance gap left by the discontinued Drug Abuse Warning Network (DAWN)?

BACKGROUND: This study assessed whether the Nationwide Emergency Department Sample (NEDS) could reliably fill the national drug surveillance gap caused by the discontinuation of the Drug Abuse Warning Network (DAWN). METHODS: Estimates of the drug-related emergency department (ED) visits derived from DAWN (2004-2011) and NEDS (2006-2013). Estimates of the underlying reason for the drug-related ED visit, patient characteristics, and the specific drugs involved were compared for 2011, the most recent overlapping data year in DAWN and NEDS. Trends in ED visits for major drugs of abuse were then compared over the period 2004-2013. RESULTS: In 2011, DAWN and NEDS produced statistically similar estimates of the overall number of drug-related ED visits (5.1 vs. 4.9 million) and those involving drug misuse or abuse (2.65 vs. 2.77 million). Among the latter, estimates by gender, age group, and patient disposition were generally consistent across data systems, suggesting that NEDS and DAWN samples draw from a similar population. Main analyses reveal statistically similar estimates across data systems in both levels and trends for cocaine, amphetamines, and narcotic pain relievers. In contrast, the number of ED visits for sedatives and heroin was significantly undercounted in NEDS, whereas marijuana-related ED visits were undercounted in DAWN. CONCLUSIONS: This study demonstrates the utility of NEDS for conducting post-DAWN drug surveillance. Because NEDS cannot provide targeted surveillance of certain established (e.g., heroin) and emerging (e.g., fentanyl) drugs, however, it is critical that a data system that employs medical record-based reviews be implemented to augment the known weaknesses of NEDS.

Assessing the effects of medical marijuana laws on marijuana use: the devil is in the details.

This paper sheds light on previous inconsistencies identified in the literature regarding the relationship between medical marijuana laws (MMLs) and recreational marijuana use by closely examining the importance of policy dimensions (registration requirements, home cultivation, dispensaries) and the timing of when particular policy dimensions are enacted. Using data from our own legal analysis of state MMLs, we evaluate which features are associated with adult and youth recreational and heavy use by linking these policy variables to data from the Treatment Episode Data Set (TEDS) and National Longitudinal Survey of Youth (NLSY97). We employ differences-in-differences techniques, controlling for state and year fixed effects, allowing us to exploit within-state policy changes. We find that while simple dichotomous indicators of MML laws are not positively associated with marijuana use or abuse, such measures hide the positive influence legal dispensaries have on adult and youth use, particularly heavy use. Sensitivity analyses that help address issues of policy endogeneity and actual implementation of dispensaries support our main conclusion that not all MML laws are the same. Dimensions of these policies, in particular legal protection of dispensaries, can lead to greater recreational marijuana use and abuse among adults and those under the legal age of 21 relative to MMLs without this supply source.

The effects of medical marijuana laws on potency.

BACKGROUND: Marijuana potency has risen dramatically over the past two decades. In the United States, it is unclear whether state medical marijuana policies have contributed to this increase. METHODS: Employing a differences-in-differences model within a mediation framework, we analyzed data on n=39,157 marijuana samples seized by law enforcement in 51 U.S. jurisdictions between 1990 and 2010, producing estimates of the direct and indirect effects of state medical marijuana laws on potency, as measured by Δ(9)-tetrahydrocannabinol content. RESULTS: We found evidence that potency increased by a half percentage point on average after legalization of medical marijuana, although this result was not significant. When we examined specific medical marijuana supply provisions, results suggest that legal allowances for retail dispensaries had the strongest influence, significantly increasing potency by about one percentage point on average. Our mediation analyses examining the mechanisms through which medical marijuana laws influence potency found no evidence of direct regulatory impact. Rather, the results suggest that the impact of these laws occurs predominantly through a compositional shift in the share of the market captured by high-potency sinsemilla. CONCLUSION: Our findings have important implications for policymakers and those in the scientific community trying to understand the extent to which greater availability of higher potency marijuana increases the risk of negative public health outcomes, such as drugged driving and drug-induced psychoses. Future work should reconsider the impact of medical marijuana laws on health outcomes in light of dramatic and ongoing shifts in both marijuana potency and the medical marijuana policy environment.

Are movies with tobacco, alcohol, drugs, sex, and violence rated for youth? A comparison of rating systems in Argentina, Brazil, Mexico, and the United States.

BACKGROUND: This study aimed to determine between-country differences and changes over time in the portrayal of youth risk behaviors in films rated for youth in Argentina, Brazil, Mexico and the United States. METHODS: Content and ratings were analyzed for 362 films that were popular across all four countries from 2002 to 2009. Country-specific ratings were classified as either youth or adult, and Generalized Estimating Equations were used to determine between-country differences in the presence of tobacco, alcohol, drugs, sexual content, and violence in youth-rated films. Within-country differences in this content over time were also assessed, comparing films released from 2002 to 2005 with those released from 2006 to 2009. RESULTS: In the US, films rated for youth were less likely to contain all five risk behaviors than in youth-rated films in Argentina, Brazil, and, when the "15 and older" rating was considered a youth rating, in Mexico. All three Latin American countries "downrated" films that received an adult rating in the US. Nevertheless, tobacco and drug use in youth-rated films declined over time in all countries, whereas moderate to extreme alcohol use and violence involving children or youth increased in all countries. CONCLUSIONS: Tobacco and drug use have declined in popular US films, but these behaviors are still prevalent in films rated for youth across the Americas. The apparent success of advocacy efforts to reduce tobacco and other drugs in films suggests that similar efforts be directed to reduce alcohol portrayals.

Is today's marijuana more potent simply because it's fresher?

The average potency of illicit marijuana in the USA has increased substantially over the past four decades, and observers have suggested a number of likely reasons for this. One set of hypotheses points to a market that has evolved from foreign to domestic sources of supply, and to continuing advances in sophisticated cultivation techniques. Another set of hypotheses points to testing artifacts related to changes in the sampling, handling, and testing of illicit marijuana. The current study uses data from the federally sponsored Potency Monitoring Program, which performs ongoing forensic analysis of seized marijuana samples, to assess the extent to which the observed increase in cannabis potency in the USA between 1970 and 2010 is a function of genuine shifts in illicit marijuana markets or testing artifacts related to changes in the quality of seized marijuana. The study finds, after adjusting for marijuana quality, that the apparent 10.5 factor increase in mean reported THC% between the 1970s and the 2000s is instead on the order of a six- to seven-fold increase. By this accounting, then, the reported long-term rise in potency is roughly 57-67% as great when the quality of the tested marijuana is taken into account. This study's findings, therefore, caution against the uncritical use of potency monitoring data and highlight the importance of assessing potency measurement reliability and addressing data quality issues in future policy analytic research.