Vira Pravosud, several UCSF colleagues and I just published Cannabis legalization and changes in cannabis and tobacco/nicotine use and co-use in a national cohort of U.S. adults during 2017-2021 in the International Journal of Drug Policy that adds to the evidence that legalizing medical and recreational cannabis is followed by increased use among adults.
In this longitudinal study, we followed 9003 people forward in time from 2017 through 2021 to see how their cannabis and tobacco use changed following legalization in the states in which they lived. As in all such studies, we lost people during follow-up and ended up with 5420 people in the 2021 sample.
Specifically, we (1) describe changes in current cannabis and tobacco/nicotine use and co-use over time; (2) examine whether living in the states with medical or recreational cannabis legal status was associated with higher odds of current cannabis and tobacco/nicotine use and co-use compared to a non-legal status; and (3) determine the independent (additional) effect of enacting recreational cannabis above legalizing medical cannabis.
Current cannabis use significantly increased +3.3 % between 2017 and 2021, while tobacco/nicotine use significantly declined (-1.9 %); co-use of cannabis and tobacco/nicotine did not change significantly (+0.2 %). Both medical and recreational cannabis legalization was associated with increased current cannabis use; the independent additional effect of recreational cannabis legalization was 1.13 times larger than medical legalization alone.
(There were no cases in which recreational legalization occurred without medical legalization either taking place first or concurrently with recreational legalization.)
There were no statistically significant differences in tobacco/nicotine use and co-use prevalence by cannabis legalization status.
While legalization benefits justice in terms of incarceration, the increasing prevalence of cannabis use following legalization also increases disease risk.
Cannabis legalization legislation should incorporate best practices from tobacco control, including licensing, restrictions on retail cannabis stores, advertising, price and tax measures and protection of nonusers by including inhaled cannabis use in smokefree laws as well as educational campaigns to increase public awareness on the health risks of cannabis.
Here is the abstract:
Background: Little is known about whether cannabis legalization impacts cannabis use uptake or has spillover effects on co-use of cannabis and tobacco/nicotine (using both in the past 30 days). We determined associations of cannabis legalization with self-reported (1) current (past 30-day) cannabis use; (2) current (“now”) tobacco/nicotine use (smoking or electronic cigarette use); and (3) current co-use of cannabis and tobacco/nicotine and how prevalence is changing over time.
Methods: In this longitudinal study, a web-based survey was administered to a nationally representative, population-based panel of US adults in 2017, 2020, and 2021. We used weighted unadjusted binomial logistic GEE models to assess changes in prevalence of cannabis, tobacco/nicotine use and co-use and weighted, adjusted binary logistic GEE models to assess associations of cannabis legalization with cannabis, tobacco/nicotine use and co-use.
Results: A total of 9003 participants (age range = 18-94, mean age = 47.9 [±17.4 SD] years; 4696 females [weighted 52.0 %]) completed the survey in 2017; 5979/8529 (70.1 %) in 2020 and 5420/7305 (74.2 %) in 2021 from the original cohort who remained available. Current cannabis use significantly increased +3.3 % between 2017 and 2021, while tobacco/nicotine use significantly declined (-1.9 %); co-use of cannabis and tobacco/nicotine did not change significantly (+0.2 %). Both medical and recreational cannabis legalization was associated with increased current cannabis use; the independent effect of recreational cannabis legalization was 1.13 times larger than medical. There were no statistically significant differences in tobacco/nicotine use and co-use prevalence by legalization status.
Conclusion: Cannabis legalization increases cannabis use but is not associated with changes in tobacco/nicotine use or co-use. Legalization should be coupled with public health efforts.
The full citation is: Pravosud V, Glantz S, Keyhani S, Ling PM, Lempert LK, Hoggatt KJ, Hasin D, Nguyen N, Graham FJL, Cohen BE. Cannabis legalization and changes in cannabis and tobacco/nicotine use and co-use in a national cohort of U.S. adults during 2017-2021. Int J Drug Policy. 2024 Nov 4;134:104618. doi: 10.1016/j.drugpo.2024.104618. Epub ahead of print. PMID: 39500225. It is available here or here (open access until Dec 24, 2024).
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