Medical marijuana laws (MMLs) and dispensary provisions not associated with higher odds of adolescent marijuana or heavy marijuana use: A 46 State Analysis, 1991-2015.

Background: States are rapidly moving to reverse marijuana prohibition, most frequently through legalization of medical marijuana laws (MMLs), and there is concern that marijuana legalization may affect adolescent marijuana use. Methods: This natural-experimental study used state Youth Risk Behavior Survey (YRBS) data collected from participants in grades 9-12 from 1991 to 2015 in 46 states (N = 1,091,723). Taking advantage of heterogeneity across states in MML status and MML dispensary design, difference-in-difference estimates compared states with enacted MMLs/dispensaries to non-MML/dispensaries states. Multivariable logistic regression modeling was used to adjust for state and year effects, and student demographics. The main outcome assessed was past 30-day adolescent marijuana use ["any" and "heavy" (≥20)]. Results: In the overall sample, the adjusted odds of adolescents reporting any past 30-day marijuana use was lower in states that enacted MMLs at any time during the study period (OR 0.94, 95% CI 0.89 to 0.99; p < .05), and in states with operational dispensaries in 2015 (OR 0.93, 95% CI 0.88 to 0.99; p < .05). Among grade cohorts, only 9th graders showed a significant effect, with lower odds of use with MML enactment. We found no effects on heavy marijuana use. Conclusions: This study found no evidence between 1991 and 2015 of increases in adolescents reporting past 30-day marijuana use or heavy marijuana use associated with state MML enactment or operational MML dispensaries. In a constantly evolving marijuana policy landscape, continued monitoring of adolescent marijuana use is important for assessing policy effects.

Using the National Incident-Based Reporting System (NIBRS) to examine racial and ethnic disparities in cannabis incidents.

Background: Reducing racial and ethnic arrest disparities is one driver of cannabis legalization in the US., but outcomes of cannabis policies and equity provisions remain unknown. Early research finds legalization reduces total cannabis incidents, but disparities persist. In response, novel research approaches are emerging, but a comprehensive assessment of their strengths and limitations is needed, particularly when using data sources developed for other purposes. Objectives: This perspective assesses the National Incident-Based Reporting System (NIBRS), originally developed for crime statistics, as a means to surveil cannabis incident disparities. Methods: Massachusetts NIBRS (2000-2013) illustrates discussion points, including around sample inclusion, data integrity, and missing data. Results: We find that NIBRS is a comprehensive source for state-level monitoring if used with knowledge of its limitations. However, drawing conclusions about disparities requires careful assessment of sample inclusion and any changes to participation rates, data integrity, reporting changes, and missing variables, before analysis and reporting. Conclusion: NIBRS utility would increase with greater or required jurisdiction participation, guidance for collection of racial and ethnic data, and required ethnicity reporting. Despite limitations, cannabis disparity analyses using NIBRS can provide key insights for increasing equity in states considering and enacting cannabis legalization.

A tale of two cities: Racialized arrests following decriminalization and recreational legalization of cannabis.

BACKGROUND: In the U.S., "War on Drugs" policies have led to large and unequal increases in arrests among particularly of Black/African American men. The change in the legal status of cannabis may reduce the racial disparity in arrests. We examined the impact of changing legal status on arrest disparities. METHODS: We obtained publicly available deidentified cannabis arrest data from the District of Columbia (D.C.) Metropolitan Police Department (2012-2019) and Los Angeles (L.A.) Police Department (2010-2019). We examined the differences in average monthly cannabis arrest rates for each city and each outcome (possession, possession with intent to distribute, distribution, and public consumption) across racial groups. RESULTS: For both D.C. and L.A. following changes in the legal status of cannabis, we saw a decrease of the absolute disparity in possession-related arrests. There was also a reduction in D.C. for the relative disparity, but there was an increase in the relative disparity in L.A. In both cities, there was an emergence of public consumption-arrests. In D.C., there was an absolute increase of 4.0 (SD=2.5) more arrests per-month for Black people than white people and a relative increase of 9.1 (SD=1.5). In L.A., absolute disparity of 0.6(SD=1.3) and a relative disparity of 6.7 (SD=2.0). CONCLUSIONS: There was a reduction in the absolute arrest disparity for cannabis-related possession arrests following decriminalization and legalization in both D.C and L.A. However, we saw the emergence of arrests for public consumption. This emergence of possession arrests towards public consumptions arrests, underscores the need to examine arrests beyond possession.

Racial Equity in Cannabis Policy: Diversity in the Massachusetts Adult-Use Industry at 18-months.

Background: Cannabis criminalization disproportionately harms communities of color in the United States. In Massachusetts' legal recreational ("adult-use") cannabis industry, state regulations intend to promote diverse participation. We assessed short-term racial/ethnic and gender diversity across the industry and in senior-level positions with greater opportunities to build wealth (i.e., board members, executives, directors). Methods: We extracted race/ethnicity and gender from required registration forms submitted to state regulators for each person working in a licensed adult-use cannabis business from October 2018 to April 2020 (n=4,883). We conducted descriptive analysis and negative binomial regression to assess characteristics associated with senior positions. Results: As of April 2020, racial/ethnic and gender diversity in the Massachusetts adult-use cannabis market (n=4,883) was 75% white, 7% Latino, 6% Black/African American, similar to the state labor market, and 65% male. Diversity was more limited in senior positions. Agents in senior positions (n=403) were 84% white, 2% Latino, 5% Black/African American, and 82% male. Senior-level participation was markedly low for women of color. Conclusion: Despite legislative and regulatory commitment, diversity lacks in senior positions in this emerging cannabis market. States considering adult-use cannabis markets, and those that have already done so, should monitor participation to identify inequities and adapt initiatives to ensure Black/African American and Latino communities socially and economically benefit from state legalization.

Evaluation of Availability of Survey Data About Cannabis Use.

Importance: In response to increasing public support for cannabis legalization, understanding associations of state and federal policy changes related to cannabis legalization with patterns of cannabis use is important. A challenge for public health monitoring and research is significant variation in data availability related to cannabis use behaviors and perceptions across and within states and over time, including the availability of prelegalization vs postlegalization data. Objective: To review data available on cannabis use and related behaviors over time in Massachusetts and the US. Design, Setting, and Participants: This case series examined state and national surveys on public health and related behaviors and outcomes to review availability of cannabis-related data for Massachusetts for 8 key indicators over time. Additionally, the Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance System for all states were reviewed. The analysis was conducted between February 1, 2019, and March 18, 2020. Exposures: Surveys that enable state-level estimation of cannabis use and related behaviors. Main Outcomes and Measures: Eight key indicators related to cannabis use behaviors and perceptions: lifetime cannabis use, age of initiation, frequency of use, location of use, method of use, source of cannabis, perceptions of cannabis, and reason for use (ie, medical vs nonmedical). Results: There were 7 surveys that monitored cannabis use and related behaviors in Massachusetts for adolescents and adults. No surveys monitored all 8 indicators of interest, and availability over time was limited. In the most recent BRFSS, 24 states asked cannabis-related questions, meaning BRFSS data on cannabis use was lacking for more than half of the US adult population. In the Youth Risk Behavior Surveillance System, 36 states asked standard cannabis questions; most other states had at least 1 question related to cannabis use and frequency. Conclusions and Relevance: These findings of limitations of existing surveys, and particularly the lack of national questions in the BRFSS and Youth Risk Behavior Surveillance System, suggest that available data have substantial limitations for monitoring cannabis use. As cannabis policy changes continue, there is a need to remain focused on the availability of high-quality data sources that allow for critical public health research.