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      Six policy lessons relevant to cannabis legalization

      1 , 2
      The American Journal of Drug and Alcohol Abuse
      Informa UK Limited

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          Abstract

          Cannabis (marijuana) has been legalized for recreational and/or medicinal use in many U.S. states, despite remaining a Schedule-I drug at the federal level. As legalization regimes are established in multiple countries, public health professionals should leverage decades of knowledge from other policy areas (e.g., alcohol and tobacco regulation) to inform cannabis policy. Identify policy lessons from other more established policy areas that can inform cannabis policy in the U.S., Canada, and any other nations that legalize recreational cannabis. Narrative review of policy and public health literature. We identified six key lessons to guide cannabis policy. To avoid the harms of “a medical system only in name”, medical cannabis programs should either be regulated like medicine or combined with the recreational market. Capping potency of cannabis products can reduce the harms of the drug, including addiction. Pricing policies that promote public health may include minimum unit pricing or taxation by weight. Protecting science and public health from corporate interest can prevent the scenarios we have seen with soda and tobacco lobbies funding studies to report favorable results about their products. Legalizing states can go beyond reducing possession arrests (which can be accomplished without legalization) by expunging prior criminal records of cannabis-related convictions. Finally, facilitating rigorous research can differentiate truth from positive and negative hype about cannabis’ effects. Scientists and policymakers can learn from the successes and failures of alcohol and tobacco policy to regulate cannabis products, thereby mitigating old harms of cannabis prohibition while reducing new harms from legalization.

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          Most cited references31

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          Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013.

          Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century.
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            Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

            Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding.
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              Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state

              Aims To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market, and (2) estimate how potency and purchase quantity influence price variation for cannabis flower. Design Secondary analysis of publicly available data from Washington State’s cannabis traceability system spanning July 7, 2014 to September 30, 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation. Setting Washington State, USA. Participants (1) 44,482,176 million cannabis purchases, including (2) 31,052,123 cannabis flower purchases after trimming price and quantity outliers. Measurements Primary outcome measures were (1) monthly expenditures on cannabis, total delta-9-tetrahydrocannabinol (THC) concentration, and cannabidiol (CBD) concentration by product type; and (2) excise-tax-inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC, and CBD. Findings Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now composing 21.2% of sales. The average THC-level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC [coefficient = 0.012; 95% confidence interval (CI) = 0.011 to 0.013] and CBD [coefficient = 0.017; CI = 0.015 to 0.019]. The estimated discount elasticity is −0.06 [CI = −0.07 to −0.05]. Conclusions In the state of Washington, USA, the legal cannabis market is currently dominated by high-THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per-gram prices, and there are small but significant quantity discounts.
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                Author and article information

                Journal
                The American Journal of Drug and Alcohol Abuse
                The American Journal of Drug and Alcohol Abuse
                Informa UK Limited
                0095-2990
                1097-9891
                March 14 2019
                March 14 2019
                : 1-9
                Affiliations
                [1 ] Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
                [2 ] Department of Psychiatry and Behavioral Sciences, Veterans Affairs Health Care System and Stanford University, Palo Alto, CA, USA
                Article
                10.1080/00952990.2019.1569669
                6745015
                30870053
                44ca617f-8592-452c-908e-5523a2dad247
                © 2019
                History

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