Youth and Adult Arrests for Cannabis Possession After Decriminalization and Legalization of Cannabis.

IMPORTANCE: Civil liberty advocates typically support legalization of cannabis, which targets adult use, rather than decriminalization, which can affect both adults and youths. However, it is unknown how arrests of youths for cannabis possession change when adult use of cannabis is legalized. OBJECTIVE: To model changes in arrest rates of adults and youths after decriminalization and legalization of cannabis. DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental study used the publicly available Uniform Crime Reporting Program Data: Arrests by Age, Sex, and Race administrative data set to examine arrest rates in 38 states from January 1, 2000, to December 31, 2016. Adult (age, ≥18 years) and youth (age, <18 years) arrests for possession of cannabis were examined. States were excluded if they did not report complete arrest data or if a policy was implemented that reduced penalties for possession of cannabis but fell short of decriminalization. Fixed-effects regression was used in an extended difference-in-differences framework. The analyses in their final form were conducted between January 17 and February 28, 2019. EXPOSURE: Living in a state with a cannabis decriminalization policy (ie, making the penalty for cannabis possession similar to the small fine for a traffic violation) or legalization policy (ie, creating a legal supply of cannabis along with the removal of penalties for possession of a small amount of cannabis for recreational use). MAIN OUTCOME AND MEASURES: State cannabis possession arrest rate per 100 000 population. RESULTS: Data from 38 states were examined, including 4 states with cannabis legalization policies and 7 states with cannabis decriminalization policies. The adult arrest rate decreased by 131.28 (95% CI, 106.23-154.21) per 100 000 population after the implementation of decriminalization and 168.50 (95% CI, 158.64-229.65) per 100 000 population after the implementation of legalization. The arrest rate for youths decreased by 60 (95% CI, 42-75) per 100 000 population after decriminalization but did not significantly change after legalization in a state (7 per 100 000 population; 95% CI, -15 to 30). CONCLUSIONS AND RELEVANCE: Legalization, as implemented through 2016, did not appear to reduce arrests for cannabis possession among youths, despite having benefited adults. The study's findings suggest that decriminalization reduces youth arrests in most cases, but these findings also suggest that any benefit for youths could be lost when adult use has also been legalized. To address this problem, it appears that state decriminalization policies should take the additional step to explicitly describe when youths can be arrested for possession of small amounts of cannabis.

Long-Term Outcomes After Residential Substance Use Treatment: Relapse, Morbidity, and Mortality.

A cohort of 207 veterans admitted to a residential substance use treatment program was followed for 5 years following discharge to determine factors associated with reduced relapse or mortality following discharge. Subsequent utilization of medical and psychiatric hospitalization and emergency room utilization was also examined. Retrospective chart review was conducted using demographic, diagnostic, and prior treatment as independent variables. Dependent variables included aftercare compliance and subsequent morbidity as measured by relapse, emergency room visits, subsequent hospitalizations, and mortality. Cox proportional hazards models were used to examine factors associated with relapse and mortality. Aftercare attendance was higher in those who completed treatment (p < 0.01). Factors associated with higher risk of relapse included comorbid disorders, failure to complete the index residential substance use treatment program, and psychiatric rehospitalization. Factors associated with higher mortality included failure to complete residential substance use treatment, longer medical rehospitalization, and nicotine dependence. Longer psychiatric rehospitalization was associated with a lower risk of mortality. Comorbid psychiatric conditions and failure to complete residential substance use treatment were associated with higher relapse. Limitations include that this population has severe substance use disorder, that subjective report of symptom severity was not assessed and that attendance at Alcoholics Anonymous aftercare was not surveyed.

Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study.

BACKGROUND: A person-centered substance use treatment component, the Natural Recovery Program, was developed. The Natural Recovery Program is comprised of small group therapy combined with pursuit of hobbies. METHODS: This was a pilot study of the program and was not randomized. A retrospective record review of 643 veterans in an inpatient mental health recovery and rehabilitation program was analyzed to determine if participants of Natural Recovery had a different rate of treatment completion than those who elected to participate in the core program alone. Univariate and multivariate analyses were conducted on: participation in the Natural Recovery Program; co-morbid psychiatric disorders; and legal, medical, and psychiatric issues. RESULTS: Participation in Natural Recovery was significantly associated with successful treatment completion when analyzed by univariate analysis (p = 0.01). Other significant variables associated with successful completion included: no co-morbid psychiatric diagnosis, fewer prior suicide attempts, and no homelessness prior to admission. Binary logistic regression demonstrated that participation in Natural Recovery was associated with improved treatment completion, even when other variables were considered (p = 0.01). Treatment retention was longer for patients who participated in Natural Recovery, even if they did not complete treatment. CONCLUSIONS: The Natural Recovery Program was associated with improved outcomes, as measured by treatment retention in the first 60 days and by treatment completion. Participants of Natural Recovery with co-morbid psychiatric disorders completed treatment at a higher rate than those with co-morbid psychiatric disorders who participated in the core program. Patients reported high satisfaction with the program. This program may be a valuable adjunct to residential treatment.