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News|Articles|April 29, 2024

Recreational Cannabis Legalization Associated with Decreases in Alcohol, E-Cigarette Use

Retail sales were associated with lower e-cigarette use, although recreational legalization also increased the frequency of cannabis use among adolescents.

Recreational cannabis legalization has been associated with modest decreases in cannabis, alcohol, and e-cigarette use, according to results of a research letter published in JAMA Pediatrics. Additionally, retail sales were associated with lower e-cigarette use and a lower likelihood of usage, although the recreational legalization also increased the frequency of cannabis use among adolescents, which led to no overall changes in cannabis use.1,2

“If we look across the ocean or even to places like Brazil or Berlin, everything is sold in a pharmacy setting, and that's because there's a federal layer of legislation which activated the use of cannabis for medical purposes. So, you have to go back and think about how the [United States] will legalize,” Kyle Detwiler, CEO of Clever Leaves, said in an interview with Pharmacy Times.3

“If the Biden administration, working with Congress, set up a new approach—which is probably just a rescheduling of cannabis, moving it away from being neighbors with heroin and ecstasy and treated like a more regulated pharmaceutical product—well, we have a very fancy sophisticated pre-built system for the distribution of those substances, and they are called pharmacies. I actually think there is a strong potential, especially if federal legalization occurs focused on the medical channel, that pharmacies very well could play a big role,” Detwiler said.3

In the study, investigators gathered data from the Youth Risk Behavior Surveys from 2011 to 2021, with students in the ninth and tenth grade included from 47 states. Students reported their cannabis, alcohol, cigarette, and e-cigarette use. The investigators adjusted for youth demographic characteristics, medical cannabis and decriminalization, other state policies, and state and year fixed effects, according to the study authors.2

Investigators included 898,271 students in the analysis, finding that each additional year of recreational cannabis legalization was associated with 8% higher odds of zero cannabis use. Further, recreational cannabis retail sale was associated with 28% higher odds of zero cannabis use, but 26% higher frequency of use among users. Like recreational legalization, recreational cannabis retail sale was associated with 8% higher odds of zero use, but also 8% higher frequency of use.2

Key Takeaways

  1. Recreational cannabis legalization, while increasing cannabis use frequency among users, was associated with a slight decrease in overall cannabis, alcohol, and e-cigarette use among adolescents.
  1. The study suggests that recreational cannabis retail sales may be more effective in reducing overall use compared to legalization alone.
  1. The article explores the potential role of pharmacies in a federally legalized cannabis market, but emphasizes the need for a shift in federal policy before this can occur.

Additionally, there was a negative total effect estimate for alcohol use, and no significant results for cigarettes. Further, each additional year of recreational cannabis legalization was associated with 16% increase in odds of zero e-cigarette use and recreational cannabis retail sale was associated with 42% increased odds of zero e-cigarette use and 20% increased odds of zero use, according to the study authors.2

In an article published on Pharmacy Times, pharmacists play a role in educating patients about the use of cannabis, and they should become more familiar with cannabis from a drug information perspective. It’s possible for patients to ask pharmacists questions about cannabis, and pharmacists should be informed about the effects and contraindications for patients, including cardiovascular effects that could happen when patients smoke the drug.4

References
  1. Cannabis legalization and rising sales have not contributed to increase in substance abuse, study finds. EurekAlert. April 18, 2024. Accessed April 25, 2024. https://www.eurekalert.org/news-releases/1041776
  2. Coley RL, Carey N, Kruzik C, Hawkins SS, Baum CF. Recreational Cannabis Legalization, Retail Sales, and Adolescent Substance Use Through 2021. JAMA Pediatr. Published online April 15, 2024. doi:10.1001/jamapediatrics.2024.0555
  3. Pharmacy Times. Expert: In Brazil, Berlin, Medical Cannabis Is Sold in Pharmacies, There Is a ‘Strong Potential’ Legalization in the US Could Follow Suit. November 11, 2021. Accessed April 25, 2024. https://www.pharmacytimes.com/view/expert-in-brazil-berlin-medical-cannabis-is-sold-in-pharmacies-there-is-a-strong-potential-legalization-in-the-us-could-follow-suit
  4. Hippensteele A. Navigating Cannabis in Pharmacy Practice: State Legislation and Contradictions for Patient Use. Pharmacy Times. March 22, 2024. Accessed April 25, 2024. https://www.pharmacytimes.com/view/navigating-cannabis-in-pharmacy-practice-state-legislation-and-contraindications-for-patient-use

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