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. 2017 Nov;112(11):1985-1991.
doi: 10.1111/add.13904. Epub 2017 Jul 17.

Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder

Arthur Robin Williams  1 , Julian Santaella-Tenorio  1 , Christine M Mauro  1 , Frances R Levin  1 , Silvia S Martins  1
Affiliations

Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder

Arthur Robin Williams et al. Addiction. 2017 Nov.

Abstract

Background and aims: Most US states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use and cannabis use disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical mml programs.

Design: Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized versus non-medical). Multi-level linear regression models adjusted for state-level random effects and covariates as well as historical trends in use.

Setting: Nation-wide cross-sectional survey data from the US National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level.

Participants: Participants comprised 2004-13 NSDUH respondents (n ~ 67 500/year); age groups 12-17, 18-25 and 26+ years. States had implemented eight medicalized and 15 non-medical MML programs.

Measurements: Primary outcome measures included (1) active (past-month) marijuana use; (2) heavy use (> 300 days/year); and (3) cannabis use disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group and state-level characteristics throughout the study period.

Findings: Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13 to 6.59%, P = 0.01), skewing towards greater heavy marijuana by 2.36% (from 14.94 to 17.30, P = 0.09) after MMLs were enacted. However, no associated increase in the prevalence of cannabis use disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type.

Conclusions: Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults aged 26+ years. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes.

Keywords: Adolescent drug use; cannabis use disorder; epidemiology; marijuana; medical marijuana laws; public health; state policy.

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Conflict of interest statement

Declaration of interests

None.

Figures

Figure 1
Figure 1
Trends in past-month marijuana use, heavy marijuana use (> 300 days/year) and marijuana use disorder among individuals aged 12–17 years. MML = medical marijuana law
Figure 2
Figure 2
Trends in past-month marijuana use, heavy marijuana use (> 300 days/year) and marijuana use disorder among individuals aged 18–25 years. MML = medical marijuana law
Figure 3
Figure 3
Trends in past-month marijuana use, heavy marijuana use (> 300 days/year) and marijuana use disorder among individuals aged > 26 years. MML = medical marijuana law
See this image and copyright information in PMC

References

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