Advertisement

Short-Term Effects of Recreational Cannabis Legalization on Youth Cannabis Initiation

      Abstract

      Purpose

      As recreational cannabis is legalized, it is critical to know the impacts of legalization on youth cannabis use. Existing research generates conflicting results and does not shed light on channels of effects. This study investigates the impacts of legalization on youth cannabis initiation and overall cannabis use prevalence.

      Methods

      We used Interrupted Time Series design and data from nationally-representative repeated cross-sectional Canadian surveys spanning 16 years. The primary outcomes were cannabis initiation rates and cannabis use prevalence among youths. The secondary outcomes were self-reported age of first cannabis use, ease of cannabis access, and perception of cannabis harm among youths.

      Results

      After legalization, cannabis initiation rate among youths was 2.7 percentage points (95% confidence interval: 1.7–3.7; p < .01) or 69% higher, although there was no significant increase in the overall prevalence of cannabis use. Furthermore, there was a 4-month delay in the average age of first cannabis use among youths aged 17–18 years (95% confidence interval: 2.6–5.5 months; p < .01). The legalization was associated with greater perception of cannabis harm but also easier access to cannabis.

      Discussion

      The impacts of legalization on youth cannabis use after 1 year are mixed. Although we observed an increase in cannabis initiation among youths who had never used cannabis, there was no change in the overall prevalence of cannabis use, implying a possible offsetting increase in cannabis cessation among existing users. To achieve legalization's goal of reducing youth cannabis use, policy measures are needed to curb youth cannabis access and initiation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Forbes
        Connecticut legalizes marijuana—here are other states that could soon do the same.
        (Available at:)
        • Government of Canada
        An act respecting cannabis and to amend the controlled drugs and substances act, the criminal code and other acts.
        (Available at:)
        • Tibbo P.
        • Crocker C.E.
        • Lam R.W.
        • et al.
        Implications of cannabis legalization on youth and young adults.
        Can J Psychiatry. 2018; 63: 65-71
        • Canadian Centre on Substance Use and Addiction
        Cannabis.
        (Available at:)
        • Substance Abuse and Mental Health Services Administration
        2019 NSDUH annual national report | CBHSQ data.
        (Available at:)
        • Alcover K.C.
        • Thompson C.L.
        Patterns of mean age at drug use initiation among adolescents and emerging adults, 2004-2017.
        JAMA Pediatr. 2020; 174: 725-727
        • Canadian Centre on Substance Abuse
        The effects of cannabis use during adolescence.
        (Available at:)
        https://www.deslibris.ca/ID/247657
        Date accessed: November 22, 2020
        • Paschall M.J.
        • Grube J.W.
        Recreational marijuana availability in Oregon and use among adolescents.
        Am J Prev Med. 2020; 58: e63-e69
        • Karbakhsh M.
        • Smith J.
        • Pike I.
        “Where does the high road lead?” Potential implications of cannabis legalization for pediatric injuries in Canada.
        Can J Public Health. 2018; 109: 752-755
        • Anderson D.M.
        • Hansen B.
        • Rees D.I.
        • et al.
        Association of marijuana laws with teen marijuana use: New estimates from the youth risk behavior surveys.
        JAMA Pediatr. 2019; 173: 879-881
        • Canadian Cancer Society
        Implementation of a public health regulatory framework to reduce the impact of recreational cannabis legalization on tobacco use.
        (Available at:)
        • Hammond D.
        • Wadsworth E.
        • Reid J.L.
        • et al.
        Prevalence and modes of cannabis use among youth in Canada, England, and the US, 2017 to 2019.
        Drug Alcohol Depend. 2021; 219108505
        • Zuckermann A.M.
        • Battista K.V.
        • Bélanger R.E.
        • et al.
        Trends in youth cannabis use across cannabis legalization: Data from the COMPASS prospective cohort study.
        Prev Med Rep. 2021; 22101351
        • Laqueur H.
        • Rivera-Aguirre A.
        • Shev A.
        • et al.
        The impact of cannabis legalization in Uruguay on adolescent cannabis use.
        Int J Drug Policy. 2020; 80102748
        • Cerdá M.
        • Wall M.
        • Feng T.
        • et al.
        Association of state recreational marijuana laws with adolescent marijuana use.
        JAMA Pediatr. 2017; 171: 142-149
        • Dilley J.A.
        • Richardson S.M.
        • Kilmer B.
        • et al.
        Prevalence of cannabis use in youths after legalization in Washington state.
        JAMA Pediatr. 2019; 173: 192-193
        • Anderson D.M.
        • Rees D.I.
        • Sabia J.J.
        • et al.
        Association of marijuana legalization with marijuana use among US high school students, 1993-2019.
        JAMA Netw Open. 2021; 4e2124638
        • Coley R.L.
        • Kruzik C.
        • Ghiani M.
        • et al.
        Recreational marijuana legalization and adolescent use of marijuana, tobacco, and alcohol.
        J Adolesc Health. 2021; 69: 41-49
        • Cerdá M.
        • Mauro C.
        • Hamilton A.
        • et al.
        Association between recreational marijuana legalization in the United States and changes in marijuana use and cannabis use disorder from 2008 to 2016.
        JAMA Psychiatry. 2020; 77: 165-171
        • Sarvet A.L.
        • Wall M.M.
        • Keyes K.M.
        • et al.
        Recent rapid decrease in adolescents’ perception that marijuana is harmful, but no concurrent increase in use.
        Drug Alcohol Depend. 2018; 186: 68-74
        • Roffman R.
        Legalization of cannabis in Washington State: How is it going?.
        Addiction. 2016; 111: 1139-1140
        • Levy N.S.
        • Mauro P.M.
        • Mauro C.M.
        • et al.
        Joint perceptions of the risk and availability of Cannabis in the United States, 2002-2018.
        Drug Alcohol Depend. 2021; 226108873
        • Blevins C.E.
        • Marsh E.
        • Banes K.E.
        • et al.
        The implications of cannabis policy changes in Washington on adolescent perception of risk, norms, attitudes, and substance use.
        Subst Abuse. 2018; 12 (:1178221818815491)
        • Wadsworth E.
        • Driezen P.
        • Chan G.
        • et al.
        Perceived access to cannabis and ease of purchasing cannabis in retail stores in Canada immediately before and one year after legalization.
        Am J Drug Alcohol Abuse. 2022; 48: 195-205
        • Alley Z.M.
        • Kerr D.C.
        • Bae H.
        Trends in college students’ alcohol, nicotine, prescription opioid and other drug use after recreational marijuana legalization: 2008–2018.
        Addict Behav. 2020; 102106212
        • Bailey J.A.
        • Epstein M.
        • Roscoe J.N.
        • et al.
        Marijuana legalization and youth marijuana, alcohol, and cigarette use and norms.
        Am J Prev Med. 2020; 59: 309-316
        • Government of Canada
        Canadian tobacco and nicotine survey (CTNS).
        (Available at:)
        • Statistics Canada
        Canadian tobacco alcohol and drugs (CTADS).
        (Available at:)
        • East K.A.
        • Reid J.L.
        • Hammond D.
        Smoking and vaping among Canadian youth and adults in 2017 and 2019.
        Tob Control. 2021; https://doi.org/10.1136/tobaccocontrol-2021-056605
        • Patten S.B.
        • Williams J.V.
        • Wiens K.
        • et al.
        Emerging patterns of e-cigarette use in the general population.
        Can J Psychiatry. 2021; 66: 503-505
        • Pham T.T.
        • Williams J.V.
        • Bulloch A.G.
        • et al.
        Patterns of cannabis use before and after legalization in Canada.
        Can J Addict. 2022; 13: 27-35
        • Sampasa-Kanyinga H.
        • Hamilton H.A.
        • LeBlanc A.G.
        • et al.
        Cannabis use among middle and high school students in Ontario: A school-based cross-sectional study.
        CMAJ Open. 2018; 6: E50-E56
        • Imtiaz S.
        • Wells S.
        • Rehm J.
        • et al.
        Cannabis use during the COVID-19 pandemic in Canada: A repeated cross-sectional study.
        J Addict Med. 2021; 15: 484-490
        • Zajacova A.
        • Jehn A.
        • Stackhouse M.
        • et al.
        Changes in health behaviours during early COVID-19 and socio-demographic disparities: A cross-sectional analysis.
        Can J Public Health. 2020; 111: 953-962
        • Kontopantelis E.
        • Doran T.
        • Springate D.A.
        • et al.
        Regression based quasi-experimental approach when randomisation is not an option: Interrupted Time Series analysis.
        BMJ. 2015; 350h2750
        • Saeed S.
        • Moodie E.E.M.
        • Strumpf E.C.
        • et al.
        Segmented generalized mixed effect models to evaluate health outcomes.
        Int J Public Health. 2018; 63: 547-551
        • StataCorp
        Stata Statistical Software: Release 17.
        StataCorp LLC, College Station2021
        • Pacula R.L.
        Does increasing the beer tax reduce marijuana consumption?.
        J Health Econ. 1998; 17: 557-585
        • Crost B.
        • Guerrero S.
        The effect of alcohol availability on marijuana use: Evidence from the minimum legal drinking age.
        J Health Econ. 2012; 31: 112-121
        • Miech R.
        • Patrick M.E.
        • Keyes K.
        • et al.
        Adolescent drug use before and during U.S. national COVID-19 social distancing policies.
        Drug Alcohol Depend. 2021; 226108822
        • Hawke L.D.
        • Henderson J.
        Legalization of cannabis use in Canada: Impacts on the cannabis use profiles of youth seeking services for substance use.
        J Subst Abuse Treat. 2021; 126108340
        • Anyanwu P.E.
        • Craig P.
        • Katikireddi S.V.
        • et al.
        Impact of UK tobacco control policies on inequalities in youth smoking uptake: A natural experiment study.
        Nicotine Tob Res. 2020; 22: 1973-1980
        • Norberg K.E.
        • Bierut L.J.
        • Grucza R.A.
        Long term effects of minimum drinking age laws on past-year alcohol and drug use disorders.
        Alcohol Clin Exp Res. 2009; 33: 2180-2190
        • Song A.V.
        • Dutra L.M.
        • Neilands T.B.
        • et al.
        Association of smoke-free laws with lower percentages of new and current smokers among adolescents and young adults: An 11-year longitudinal study.
        JAMA Pediatr. 2015; 169e152285
        • Hyland A.
        • Barnoya J.
        • Corral J.E.
        Smoke-free air policies: Past, present and future.
        Tob Control. 2012; 21: 154-161
        • Friese B.
        “Is marijuana even a drug?” A qualitative study of how teens view marijuana use and why they use it.
        J Psychoactive Drugs. 2017; 49: 209-216
        • Price Wolf J.
        • Lipperman-Kreda S.
        • Bersamin M.
        “It just depends on the environment”: Patterns and decisions of substance use and co-use by adolescents.
        J Child Adolesc Subst Abuse. 2019; 28: 143-149
        • Popova L.
        • McDonald E.A.
        • Sidhu S.
        • et al.
        Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: Implications for health education and research.
        Addiction. 2017; 112: 1821-1829
        • McGinty E.E.
        • Samples H.
        • Bandara S.N.
        • et al.
        The emerging public discourse on state legalization of marijuana for recreational use in the US: Analysis of news media coverage, 2010-2014.
        Prev Med. 2016; 90: 114-120
        • CBC News
        Health Canada spending $100M on cannabis education over 6 years.
        (Available at:)
        • Goodman S.
        • Hammond D.
        Noticing of cannabis health warning labels in Canada and the US.
        Health Promot Chronic Dis Prev Can. 2021; 41: 201-210