Perceptions of cannabis use risk to mental health among youth in Canada, England and the United States from 2017 to 2021.

BACKGROUND: There is little research examining perceptions of cannabis use risk to mental health in countries with differing cannabis regulations. This study therefore examines such perceptions among youth between 2017 and 2021 in Canada (non-medical cannabis legalized in October 2018), England (highly-restricted medical cannabis legalized November 2018), and the US (non-medical cannabis legal in some states). METHODS: Seven repeat cross-sectional online surveys were conducted between July 2017 to August 2021 among youth aged 16-19 in Canada (N=29,420), England (N=28,155), and the US (N=32,974). Logistic regression models, stratified by country, were used to examine perceptions of cannabis use risk to mental health over time, adjusting for age group, sex, race/ethnicity, cannabis use and, for the US only, state-level cannabis legalization. RESULTS: Perceptions that cannabis use posed "no risk" to mental health decreased between July 2017 and August 2021 in Canada (6.1-4.4%; AOR=0.64, 95% CI=0.52-0.78) and the US (14.0-11.3%; AOR=0.74, 0.65-0.84) but not England (3.7-4.5%; AOR=1.21, 0.97-1.52). No significant changes were observed from immediately before (August 2018) to after (August 2019) legalization of non-medical cannabis in Canada (AOR=0.99, 0.83-1.20) or highly-restricted medical cannabis in England (AOR=0.90, 0.70-1.17). In the US, perceptions of "no risk" were more likely in states where cannabis use was illegal (15.0%) compared with legal non-medical (12.2%) (AOR=0.68, 0.63-0.74). CONCLUSION: There were modest decreases in perceptions that cannabis use poses no risk to mental health in Canada and the US between 2017 and 2021 but no clear association with cannabis legalization status.

Proximity to Legal Cannabis Stores in Canada and Use of Cannabis Sources in the First Three Years of Legalization, 2019-2021.

OBJECTIVE: The accessibility of legal cannabis in Canada may influence how consumers source their cannabis. The aims of this study were to examine (a) the distance between respondents' homes and legal retail stores, (b) the cannabis sources used in the past 12 months, and (c) the association between cannabis sources used and distance to legal retail stores. METHOD: Data were analyzed from Canadian respondents participating in the International Cannabis Policy Study from 2019 to 2021. Respondents were 15,311 past-12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models examined cannabis sources used and their association with the Euclidean distance to the nearest legal store, province of residence, and year (n = 12,928). RESULTS: Respondents lived closer to a legal retail store in 2021 (1.5 km) versus 2019 (6.8 km) as the number of retail stores increased. Respondents in 2020 and 2021 had higher odds of obtaining cannabis from legal sources (e.g., legal stores: 47.9% and 60.0% vs. 38.6%, respectively, adjusted odds ratio [AOR] range: 1.41-2.42) and lower odds of obtaining cannabis from illegal sources versus 2019 (e.g., dealers: 22.6% and 19.9% vs. 29.1%, respectively, AOR range: 0.65-0.54). Respondents who lived closest to legal stores had higher odds of sourcing from legal stores and lower odds of sourcing from legal websites or growing their own cannabis. CONCLUSIONS: Legal cannabis stores are increasingly accessible to people living in Canada 3 years after legalization. Household proximity to a legal cannabis store was associated with sourcing cannabis from legal retail stores, but only among those who live very close (<3 km). Findings suggest that proximity to legal cannabis stores may aid uptake of the legal market, yet there may be diminishing returns after a certain point.

Self-reported THC content and associations with perceptions of feeling high among cannabis consumers.

INTRODUCTION: Few studies have examined consumer knowledge and communication of tetrahydrocannabinol (THC) content among cannabis consumers, including potential differences by cannabis legislation. The study sought to: (i) examine self-reported knowledge of THC content across 10 cannabis products; (ii) examine self-reported intoxication levels; and (iii) examine association between self-reported THC levels and intoxication levels. METHODS: Repeat cross-sectional surveys were conducted in Canada and the United States in September-November 2020 as part of the International Cannabis Policy Study. Respondents were past 12-month cannabis consumers, aged 16-65 (n = 13,689). A weighted logistic regression model examined the association between expected intoxication of dried flower, jurisdiction and frequency of cannabis use. RESULTS: Across all 10 cannabis products, approximately two-thirds of consumers did not know the quantitative THC level of the cannabis product they last used. Qualitative levels of THC (e.g., 'low' or 'high' THC) showed moderate correspondence with quantitative self-reported THC levels for most products. Approximately half of consumers across all products reported achieving their desired intoxication level at last use, with higher levels among more frequent consumers and Canadian consumers of dried flower (F = 2.54, p = 0.019). DISCUSSION AND CONCLUSIONS: Overall, comprehension of THC levels in cannabis products is low among consumers in both illegal and legal markets.

Co-use of cannabis and alcohol before and after Canada legalized nonmedical cannabis: A repeat cross-sectional study.

BACKGROUND: This study examined changes in population-level co-use of cannabis and alcohol before and 12 months after nonmedical cannabis legalization in Canada, relative to the United States that had previously legalized and not legalized (US legal and illegal states, respectively). METHODS: Data are from waves 1 and 2 of the International Cannabis Policy Study, collected in 2018 (before) and 2019 (12 months after legalization in Canada). Respondents aged 16-65 years from Canada (n = 25,313) and US legal (n = 25,189) and US illegal (n = 19,626) states completed an online survey. Changes in co-use between 2018 and 2019 in US legal and illegal states compared to those in Canada were assessed using multinomial logistic regression. RESULTS: Descriptive analyses show increases in cannabis use and monthly or more frequent (MMF) co-use between 2018 and 2019 in all jurisdictions. Compared to no MMF use of cannabis or alcohol, there was no evidence suggesting differences in changes in MMF co-use in US legal or illegal states relative to Canada. However, respondents in US legal states had 33% higher odds of MMF alcohol-only use (OR = 1.33, 99% CI: 1.12, 1.57) compared to no MMF use relative to Canada. CONCLUSIONS: Increases in co-use were observed between 2018 and 2019 in all jurisdictions regardless of the legal status of cannabis. These shifts were largely due to increases in cannabis use across the population, including those that use alcohol, and may indicate changing societal norms toward cannabis generally. As the cannabis legalization transition in Canada matures, evaluation over the longer term will improve understanding of the influence of cannabis liberalization on co-use.

Legal sourcing of ten cannabis products in the Canadian cannabis market, 2019-2021: a repeat cross-sectional study.

BACKGROUND: One of the objectives of cannabis legalization in Canada is to transition consumers from the illegal to the legal market. Little is known about how legal sourcing varies across different cannabis product types, provinces, and frequency of cannabis use. METHODS: Data were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted annually from 2019 to 2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models estimated the association between legal sourcing ("all"/ "some"/ "none") of ten cannabis product types, province, and frequency of cannabis use over time. RESULTS: The percentage of consumers who sourced "all" their cannabis products from legal sources in the past 12 months varied by product type, ranging from 49% of solid concentrate consumers to 82% of cannabis drink consumers in 2021. The percentage of consumers sourcing "all" their respective products legally was greater in 2021 than 2020 across all products. Legal sourcing varied by frequency of use: weekly or more frequent consumers were more likely to source "some" (versus "none") of their products legally versus less frequent consumers. Legal sourcing also varied by province, with a lower likelihood of legal sourcing in Québec of products whose legal sale was restricted (e.g., edibles). CONCLUSION: Legal sourcing increased over time, demonstrating progress in the transition to the legal market for all products in the first three years of legalization in Canada. Legal sourcing was highest for drinks and oils and lowest for solid concentrates and hash.

Prices and Purchase Sources for Dried Cannabis Flower in the United States, 2019-2020.

Introduction: The price of cannabis has major implications for public health, public safety, social equity, and government revenues. This article examines prices and sources of purchased dried cannabis flower among consumers facing different state laws in the United States. Methods: Repeat cross-sectional survey data were collected from the International Cannabis Policy Study in 2019 and 2020. U.S. respondents were recruited through online commercial panels, ages 16-65, and purchased dried flower in the past year (n=9766). Weighted binary logistic regression models examined legal purchasing in states that had legalized recreational cannabis. Results: Compared with respondents in states with recreational stores, respondents living in "illegal," "medical," and "recreational" states without stores were associated with paying a higher unit price of dried flower (+20.5%, +23.6%, +27.4%, respectively; all p<0.05). The majority of respondents in states with recreational stores last purchased from stores/dispensaries (2019: 66.6%; 2020: 62.0%) and the odds of purchasing legally was greater with each additional year after stores opened (adjusted odds ratio=1.48, 95% confidence interval: 1.37, 1.60). Conclusions: Cannabis prices and purchase behaviors are strongly influenced by its legal status and presence of stores. After states legalize for recreational purposes, it takes multiple years for the legal market to become established as the number of retail stores increase and prices decrease. The findings demonstrate that consumers use sources that they are legally allowed to access, suggesting an increased number of physical retail stores and online delivery services could expand uptake of legal sources in states with recreational cannabis laws.

Self-reported Impact of the COVID-19 Pandemic on Cannabis Use in Canada and the United States.

The current study examined the self-reported impact of the COVID-19 pandemic on cannabis consumption and behaviors among past 12-month cannabis consumers in Canada and the U.S. across different cannabis laws. Cross-sectional survey data were collected in 2020 from respondents recruited through online commercial panels, aged 16-65, who consumed cannabis in the past 12 months (n = 13,689). Weighted multinomial logistic regression models examined differences between jurisdictions for five outcomes: 1) cannabis consumption; 2) use of product types; 3) use of sources to obtain cannabis; 4) legality of source used; and 5) access to cannabis. Approximately one third of cannabis consumers reported changes to their consumption during the pandemic. Edibles (23% - 31%) and dried flower (21% - 30%) were the two most common products that respondents reported they were "more likely" to use during the pandemic. Most consumers reported "no difference" to changes in sourcing cannabis. Compared to consumers in U.S. recreational states, consumers in U.S. medical (AOR = 1.27, 95% CI: 1.07, 1.50) and illegal states (AOR = 1.22, CI: 1.00,1.48) had higher odds of reporting it was "harder" to access cannabis, and consumers in Canada had lower odds (AOR = 0.73, CI: 0.63,0.84). Future research should examine whether these changes remain after public health restrictions due to the pandemic are removed.

Trends and Socio-Demographic Differences of Cannabis Vaping in the USA and Canada.

Given the rise in cannabis vaping, it is important to highlight the heterogeneity in vaping different cannabis product because of the potential differences in their health risks. This study aims to estimate the trends and socio-demographic correlates of the use of various cannabis vaping products across jurisdiction with different legal status. Data from the 2018 (n = 27,169) and 2019 (n = 47,747) waves of the International Cannabis Policy Study (ICPS) were used. Respondents aged 16-65 completed web-based surveys. In 2019, proportions of past year vaping of cannabis oil, dried flower and concentrates in the overall sample were highest in U.S. jurisdictions where cannabis was legalized for non-medical use (17.4%, 6.0%, 4.9%), followed by U.S. jurisdiction where non-medical cannabis use is illegal (13.7%, 5.8%, 2.9%), and lowest in Canada (8.1%, 4.4%, 2.1%). Vaping dried flower decreased from 2019 to 2018 in U.S. legal jurisdictions and Canada, while vaping cannabis oil and concentrates increased in all jurisdictions (p < 0.001). The odds of vaping all forms of products were higher among younger respondents (16-55 years), males, respondents with some college education, and persons with low-risk perceptions on daily cannabis vaping. In both ICPS surveys (2018 and 2019), cannabis oil was the most frequently vaped products, followed by dried flower, and concentrates. Detailed measures of product forms for cannabis vaping should be considered in future surveys.

Consumer perceptions of legal cannabis products in Canada, 2019-2021: a repeat cross-sectional study.

BACKGROUND: Consumer perceptions of legal cannabis products may drive willingness to purchase from the illegal or legal market; however, little is known on this topic. The current study examined perceptions of legal products among Canadian cannabis consumers over a 3-year period following federal legalization of non-medical cannabis in 2018. METHODS: Data were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted in 2019-2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models examined the association between perceptions of legal cannabis and province of residence, and frequency of cannabis use over time. RESULTS: In 2021, cannabis consumers perceived legal cannabis to be safer to buy (54.0%), more convenient to buy (47.8%), more expensive (47.2%), safer to use (46.8%) and higher quality (29.3%) than illegal cannabis. Except for safety of purchasing, consumers had more favourable perceptions of legal cannabis in 2021 than 2019 across all outcomes. For example, consumers had higher odds of perceiving legal cannabis as more convenient to buy in 2021 than 2019 (AOR = 3.09, 95%CI: 2.65,3.60). More frequent consumers had less favourable perceptions of legal cannabis than less frequent consumers. CONCLUSIONS: Three years since legalization, Canadian cannabis consumers generally had increasingly favourable perceptions of legal vs. illegal products - except for price - with variation across the provinces and frequency of cannabis use. To achieve public health objectives of legalization, federal and provincial governments must ensure that legal cannabis products are preferred to illegal, without appealing to non-consumers.

Home cannabis cultivation in the United States and differences by state-level policy, 2019-2020.

Background: As of 2022, all but two U.S. states with adult-use cannabis laws also allow home cultivation. Home cultivation has the potential to support or oppose public health measures, and research in U.S. states is nascent.Objectives: 1) estimate the percentage of respondents who reported growing cannabis plants; 2) estimate the average number of plants grown; 3) examine the association between home cultivation, jurisdiction, and individual-level factors; and 4) examine the association between home cultivation and state-level policies in adult-use states.Methods: Repeat cross-sectional survey data come from U.S. respondents aged 21-65 in 2019 and 2020. Respondents were recruited through online commercial panels. Home cultivation rates were estimated among all U.S. respondents (n = 51,503; 46-52% male). Additional analyses were conducted on a sub-sample of respondents in states that allowed adult-use home cultivation (n = 29,100; 50% male).Results: A total of 6.8% and 7.3% of U.S. respondents reported home cultivation in 2019 and 2020, respectively. Respondents in states that allowed adult-use home cultivation had higher odds of reporting home cultivation than respondents in states without medical or adult-use cannabis laws (AOR = 1.48, 95% 1.26, 1.75). Among respondents in states that allowed adult-use home cultivation, the median number of plants that respondents reported growing was below state cultivation limits.Conclusion: Home cultivation rates in the U.S. were higher in states that allowed adult-use home cultivation; however, other evidence suggests these same states had higher rates predating adult-use legalization. Further work is needed to examine how home cultivation relates to public health measures in adult-use states.

An analysis of cannabis home cultivation and associated risks in Canada, before and after legalization.

Background: In 2018, Canada legalized the use and sale of non-medical cannabis, with most provinces also permitting home cultivation. To advance the knowledge of home cultivation patterns in Canada within the context of legalization, this study examines (1) the demographics and use patterns of cannabis home growers before and after legalization and (2) the relationship between home cultivation and cannabis-related risks, including workplace use and driving after cannabis use(DACU). Data and methods: The study is based on seven waves of the National Cannabis Survey, dating from 2018 to 2019. Descriptive statistics were used to analyze home cultivation across several individual and sociodemographic characteristics pre- and post-legalization. Logistic regression was used to examine whether home cultivation is correlated to selected cannabis-related risks. Results: The rate and demographics of home cultivation remained relatively unchanged post-legalization. Those most likely to cultivate cannabis post-legalization were male; 35 years and older; not single; married, common law, divorced, separated or widowed; lived in the Atlantic provinces; consumed cannabis medically or medically and non-medically on a daily or almost daily basis; had more than a high school diploma; and reported "smoking" as their primary consumption method. Home cultivation was correlated to workplace use but not to DACU. Interpretation: The research provides early insights into home cultivation within a legalized framework. It also shows a relationship between home cultivation and certain cannabis-related risks (e.g., workplace use), suggesting a need for future research to determine whether tailored education and policy interventions are needed to target cannabis home growers.

Trends in the use of cannabis products in Canada and the USA, 2018 - 2020: Findings from the International Cannabis Policy Study.

BACKGROUND AND AIMS: There is little information on consumption patterns across the diverse range of cannabis product types. This paper examines trends in consumption patterns in Canada and the United States (US) between 2018-2020. DESIGN: Repeat cross-sectional surveys were conducted as part of the International Cannabis Policy Study online survey in 2018 (n=27,024), 2019 (n=45,426), and 2020 (n=45,180). SETTING: Respondents were recruited from commercial panels in Canada and US states that had and had not legalized non-medical cannabis (US 'legal' and 'illegal' states, respectively). PARTICIPANTS: Respondents were male and female participants aged 16-65 years. MEASUREMENTS: Data on frequency and consumption amounts were collected for nine types of cannabis products, including dried flower and processed products (e.g., oils and concentrates). Consumers were also asked about mixing cannabis with tobacco. Socio-demographic information was collected. FINDINGS: Dried flower was the most commonly used product, although use in the past 12 months declined between 2018 and 2020 in Canada (81% to 73%), US legal (78% to 72%) and illegal states (81% to 76%; p<0.05 for all). Prevalence of past 12-month use increased for virtually all other product forms, although prevalence of daily use remained stable across years. In 2020, edibles and vape oils were the most commonly used products after flower. Use of non-flower products was highest in US legal states, although similar trends were observed in all jurisdictions. Males were more likely to report using processed products, and vape oils were the most commonly processed product among 16-20-year-olds. Daily use of cannabis flower increased in US legal and illegal states, and average joint size increased across all jurisdictions over time. CONCLUSIONS: Dried flower remains the dominant product in Canada and the US; however, use of processed cannabis products has increased, with the largest increases observed in legal cannabis markets.

Reasons for Purchasing Cannabis From Illegal Sources in Legal Markets: Findings Among Cannabis Consumers in Canada and U.S. States, 2019-2020.

OBJECTIVE: Nonmedical cannabis is legal in Canada and several U.S. states. Displacing the illegal market is a primary goal of legalization; however, there are little data on factors that predict consumers' transition from the illegal to the legal market. The current study aimed to examine reasons for purchasing illegal cannabis and, thus, potential barriers to purchasing legal cannabis among consumers in Canada and U.S. states. METHOD: Data are from the 2019 and 2020 International Cannabis Policy Study, a repeat cross-sectional survey conducted among 16- to 65-year-olds. Reasons for purchasing illegally in the past 12 months were asked of male and female cannabis consumers in Canada and U.S. legal states (n = 11,659). Changes over time in reasons for illegal purchasing were tested. Analyses among Canadians also examined associations between reasons for illegal purchasing and objective data on cannabis prices and retail density. RESULTS: In both years, the most commonly reported barriers to legal purchasing were price (Canada: 35%-36%; United States: 27%) and inconvenience (Canada: 17%-20%; U.S.: 16%-18%). In 2020 versus 2019, several factors were less commonly reported as barriers in Canada, including inconvenience (17% vs. 20%, p = .011) and location of legal sources (11% vs. 18%, p < .001). Certain barriers increased in the United States, including slow delivery (5% vs. 8%, p = .002) and requiring a credit card (4% vs. 6%, p = .008). In Canada, consumers in provinces with more expensive legal cannabis were more likely to report price as a barrier, and those in provinces with fewer legal retail stores were more likely to report inconvenience as a barrier (p < .001). CONCLUSIONS: Higher prices and inconvenience of legal sources were common barriers to purchasing legal cannabis. Future research should examine how perceived barriers to legal purchasing change as legal markets mature.

Home cultivation across Canadian provinces after cannabis legalization.

Aims: Little research exists on home cultivation in Canada after non-medical cannabis legalization in 2018. The aims of the study were to: (1) estimate the percentage of home cultivation before and after legalization; (2) estimate the quantity and expenditure of cannabis plants; and (3) examine the association between provincial policies and home cultivation after legalization. Methods: Repeat cross-sectional survey data come from Canadian respondents in the International Cannabis Policy Study in 2018, 2019, and 2020. Respondents aged 16-65 were recruited through online commercial panels. Home cultivation rates were estimated among all respondents in 2019 and 2020 (n = 26,304) and among a sub-sample of past 12-month cannabis consumers in 2018-2020 (n = 12,493). Weighted multivariable logistic regression models examined the association between home cultivation and provincial policies among all respondents, 2019-2020. Results: Cannabis consumers in 2019 (7.9%; AOR = 1.47, 95% CI: 1.07,2.01) and 2020 (8.8%; AOR = 1.62, 95 %CI: 1.18,2.23) had higher odds of reporting home cultivation in the past 12 months than pre-legalization (5.8%). Post-legalization, past 12-month home cultivation was lower in Quebec and Manitoba, the two provinces that prohibited home cultivation (3.2%), than in provinces where home cultivation was permitted (6.8%; AOR = 0.48, 95 %CI: 0.39, 0.59). The median number of plants grown across all provinces was between 3.1 and 3.5 in all years. Conclusions: Almost one in ten Canadian cannabis consumers reported home cultivation of cannabis in 2020, with modest increases following legalization and most growing within the non-medical limit of four plants. Home cultivation was less common in provinces where home cultivation was prohibited.

Legal status of recreational cannabis and self-reported substitution of cannabis for opioids or prescription pain medication in Canada and the United States.

Aims: With increased liberalization of cannabis policies in North America, there is growing interest in the use of cannabis to manage pain instead of opioids. The objectives of the study were to (1) examine the use of cannabis for pain relief in Canada and the United States (US) in 2018 and 2019; (2) examine the association between recreational cannabis laws and changes in the use of cannabis for pain relief, instead of opioids or prescription pain medication. Methods: Repeat cross-sectional survey data were used from Wave 1 and Wave 2 of the International Cannabis Policy Study conducted in 2018 and 2019 in Canada and the US. Respondents were recruited through commercial panels, aged 16-65, and had ever tried cannabis (N = 44,119). Weighted binary logistic regression models examined the association between the legal status of recreational cannabis and cannabis use for pain relief instead of opioids or prescription pain medication (n = 15,092). Results: Between 14-33% of cannabis consumers in Canada and the US reported using cannabis to manage headaches or pain. Of these consumers, 79% and 78% respondents in Canada; 80% and 83% in US illegal states; and 83% and 84% in US legal states, in 2018 and 2019, respectively, reported cannabis use for pain relief instead of opioids or prescription pain medication. There was little evidence of an association between the legal status of recreational cannabis and cannabis use for pain relief instead of opioids or prescription pain medication, among Canadian (AOR = 0.98, 95% CI: 0.78, 1.22) and US respondents (AOR = 1.11, 95% CI: 0.96, 1.28). Conclusions: Although substitution of cannabis for opioids or prescription pain medication is common among those who use cannabis for pain, there does not seem to be a significant difference according to cannabis legality. Future research should examine cannabis and opioid substitution using different research designs and time frames.

Prevalence and use of cannabis products and routes of administration among youth and young adults in Canada and the United States: A systematic review.

BACKGROUND: The current systematic review aimed to summarize the literature on the prevalence of routes of administration and cannabis products used among youth and young adults in Canada and the United States (US). METHODS: Five academic databases were searched in April 2020 and February 2021. Peer-reviewed articles were included if they were a population-based quantitative observational study describing the prevalence of a cannabis product or route of administration among youth and young adults in Canada or the US. Risk of bias was assessed using Hoy and colleagues' risk of bias assessment tool. A narrative review was conducted. RESULTS: Twenty-six studies were identified for the following routes of administration: smoking (n = 16), vaping (n = 21), dabbing (n = 3), oral (n = 13), topical (n = 1); and products: dried flower (n = 2), and concentrates (n = 8). Smoking had the highest prevalence rates among youth and young adults; however, rates of use appeared to reduce over time. Conversely, prevalence of vaping appeared to increase over time. Fewer studies focused on oral or dabbed cannabis but those that did reported prevalence estimates of approximately a third among recent cannabis consumers. DISCUSSION: The heterogeneity of cannabis routes of administration restricted our ability to collate average prevalence estimates. In jurisdictions where non-medical cannabis is legal, policymakers should provide guidance and education to youth on each type of product and routes of administration. OTHER: Funding for this study was provided by a Canadian Institutes of Health Research (PJT-153342). The current review was registered with PROSPERO (CRD42020169275).

Perceived access to cannabis and ease of purchasing cannabis in retail stores in Canada immediately before and one year after legalization.

Background: Canada legalized non-medical cannabis in October 2018. Little research has examined the change in perceived access to cannabis after legalization in Canada, including the perceived ease of purchasing cannabis in a legal market.Objectives: To: 1) describe changes in perceived ease of access to cannabis before and one year after legalization; 2) examine associations between perceived ease of cannabis access and cannabis use; and 3) examine associations between perceived ease of purchasing from cannabis stores and cannabis use.Methods: Repeat cross-sectional data come from Canadian respondents aged 16-65 (50% male) in August-October 2018 (n = 10,057) and September-October 2019 (n = 15,256). Respondents were recruited through commercial online panels. Multivariable logistic regression models examined correlates of perceived proximity to retail stores, ease of access, and ease of purchasing from retail stores.Results: Canadians who do not consume cannabis were more likely to report "easy" access to cannabis in 2019 than in 2018 (55% vs. 42%; AOR = 1.80:1.66,1.96). All cannabis consumer groups were more likely to report living 15 minutes or less from a retail store in 2019 than 2018, but the association was strongest among non-consumers in 2019 vs 2018 (AOR = 2.01:183,2.21 vs. AOR = 1.33:1.03,1.73 for daily consumers). Non-daily and daily cannabis consumers were more likely to report it was easy to purchase from an illegal (AOR ranged 1.58-2.22) or legal (AOR ranged 1.31-1.39) store than non-consumers in 2019.Conclusion: Most cannabis consumers and non-consumers perceived access to cannabis as 'easy' before legalization and the percentage increased one year after legalization.