UNASSIGNED: As the most commonly used illicit substance, cannabis is gaining global acceptance through increasing legalization efforts. This shift intensifies the need for research to guide policymakers and healthcare providers in harm reduction and treatment strategies. Nonetheless, the relationship between psychopathological symptoms and cannabis use remains inadequately understood.
UNASSIGNED: A sample of regular cannabis consumers completed self-reported assessments for depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), Attention-Deficit/Hyperactivity Disorder (ADHD; Adult ADHD Self-Report Scale V1.1), and psychosis (Early Recognition Inventory based on IRAOS) as well as previous black-market cannabis use patterns. Cannabis Use Disorder Identification Test Revised (CUDIT-R) was used to identify cannabis use disorder (CUD). To understand psychopathological symptom load related to cannabis consumption as well as cannabis use motives, multiple regression models were performed to identify psychopathological variables predicting cannabis use frequency and quantity. Linear regression and correlation analyses were conducted, adjusting for relevant covariates (age, gender, education, alcohol, other substance use).
UNASSIGNED: Three-hundred-sixty regular cannabis users interested in a study on regulated cannabis access in Basel, Switzerland were examined. In bivariate analysis, cannabis use frequency correlated with depressive (r(358) = 0.16, p = 0.003) and anxiety symptom load (r(358) = 0.11, p = 0.034). Cannabis quantity correlated with depressive (r(358) = 0.15, p = 0.005), ADHD (r(358) = 0.14, p = 0.008), and psychosis symptom load (r(358) = 0.16, p = 0.002). However, in the adjusted regression models only depressive and ADHD symptom loads were significantly associated with cannabis use frequency (p = 0.006 and p = 0.034, respectively) and quantity (p = 0.037 and p = 0.019, respectively). No significant correlations between cannabis consumption and anxiety or psychosis remained after adjustment.
UNASSIGNED: ADHD and depressive symptoms correlate with increased cannabis use in a cohort of regular users, suggesting potential self-medication in nonclinical populations. With the rising availability of cannabis worldwide, these results highlight the necessity for longitudinal studies to disentangle the complex dynamics between cannabis consumption and mental health symptoms.

BACKGROUND: Cannabis use disorder (CUD) treatment prevalence decreased in the US between 2002 and 2019, yet structural mechanisms for this decrease are poorly understood. We tested associations between cannabis laws becoming effective and self-reported CUD treatment.
METHODS: Restricted-use 2004-2019 National Surveys on Drug Use and Health included people ages 12+ classified as needing CUD treatment (i.e., past-year DSM-5-proxy CUD or last/current specialty treatment for cannabis). Time-varying indicators of medical cannabis laws (MCL) with/without cannabis dispensary provisions differentiated state-years before/after laws using effective dates. Multi-level logistic regressions with random state intercepts estimated individual- and state-adjusted CUD treatment odds by MCLs and model-based changes in specialty CUD treatment state-level prevalence. Secondary analyses tested associations between CUD treatment and MCL or recreational cannabis laws (RCL).
RESULTS: Using a broad treatment need sample definition in 2004-2014, specialty CUD treatment prevalence decreased by 1.35 (95 % CI = -2.51, -0.18) points after MCL without dispensaries and by 2.15 points (95 % CI = -3.29, -1.00) after MCL with dispensaries provisions became effective, compared to before MCL. Among people with CUD in 2004-2014, specialty treatment decreased only in MCL states with dispensary provisions (aPD = -0.91, 95 % CI = -1.68, -0.13). MCL were not associated with CUD treatment use in 2015-2019. RCL were associated with lower CUD treatment among people classified as needing CUD treatment, but not among people with past-year CUD.
CONCLUSIONS: Policy-related reductions in specialty CUD treatment were concentrated in states with cannabis dispensary provisions in 2004-2014, but not 2015-2019, and partly driven by reductions among people without past-year CUD. Other mechanisms (e.g., CUD symptom identification, criminal-legal referrals) could contribute to decreasing treatment trends.

BACKGROUND: Canada took a national approach to recreational cannabis that resulted in official legalization on October 17, 2018. In the United States (US), the approach has been more piecemeal, with individual states passing their own laws regulating adult use. The objective of this study was to compare the two jurisdictions.
METHODS: Two exploratory, quantitative surveys were administered in May of 2021 in both Canada and the US. One thousand forty-seven Canadian and 1037 US residents (age 19 and older) were surveyed on approaches to and attendant regulations of consumer cannabis. Tests of significance were performed to analyze differences between two groups.
RESULTS: No statistically significant differences exist between the two countries in terms of cannabis legalization acceptance. Usage rates among adults was similar with 45% of Canadians and 42% of Americans confirming they consume cannabis. Respondents maintain that they intend to increase their usage, with edibles attracting a rising level of interest from consumers.
CONCLUSIONS: Results suggest that public policy in both Canada and the USA needs to change to reflect rapidly evolving acceptance of cannabis products in North America to realize potential economic returns.

BACKGROUND: Cannabis legalization in some U.S.A. states has catapulted the mass production of concentrates, with tetrahydrocannabinol (THC) concentrations ranging from 50-90%. A major public health concern is that these products will increase cannabis-related harms such as use disorders, psychotic symptoms, and accidental poisonings. This paper describes and contextualizes the results of a study requested by the WA State Legislature to understand perspectives of WA stakeholders on the topic.
METHODS: Concept Mapping (CM), a mixed-methods research approach that supports people-centered policy decisions was utilized. The goal of the study was to explore stakeholders\' concern levels and support of policies to address the availability of high THC cannabis products. For analysis purposes, stakeholders were categorized into three groups: community, professionals, and cannabis advocates.
RESULTS: CM generated an inventory of policy ideas for regulating high-potency cannabis from a variety of stakeholders. Notably, stakeholders from community and professional groups supported environmental policy changes such as such as taxation, increasing minimum age for high concentration cannabis products, and advertising prohibition. Meanwhile, cannabis advocates (mostly industry actors) opposed taxation per THC content, proposed lowering taxes, and supported policies with low population impact such as educating parents, teachers, and youth.
CONCLUSIONS: Support for regulating high concentration THC products varied by stakeholder group. Consistent with how other health compromising industries have historically acted, cannabis industry stakeholders rejected regulation of their products. Future studies should explore non-cannabis industry stakeholders\' willingness to work towards minimizing the influence of the cannabis industry in policy development processes to assure public health regulations prevail.

Since October 2022, a total of 21 states have enacted both medical-use and adult-use cannabis legalization, each with their own unique set of laws, regulations, implementation, structures, and enforcement (\"policies\"). Unlike adult-use programs, medical-use programs often represent a safer and affordable option for patients with diverse needs; however, current evidence suggests that medical-use program activity decreases after implementation of adult-use retail. The current study compares medical patient registration data and medical- and adult-use retail data from 3 distinct medical- and adult-use states (Colorado, Massachusetts, and Oregon) in the time after adult-use retail implementation in each state.
To investigate changes in medical cannabis programs with simultaneous adult-use legalization, correlation and linear regression analyses were used to assess outcome measures: (1) medical-use retail sales; (2) adult-use retail sales; and (3) number of registered medical patients in all fiscal quarters after adult-use retail sales were implemented in each state to September 2022.
Adult-use cannabis sales increased significantly over time in all 3 states. However, both medical-use sales and number of medical patients registered in the states increased only in Massachusetts.
Results indicate that states\' preexisting medical-use programs may undergo critical changes after adult-use cannabis legalization is enacted and implemented. Key policy and program differences, such as regulatory differences in the implementation of adult-use retail sales, may have differential impacts on medical-use programs. For continued patient access, it is critical that future research assess the differences within and between states\' medical-use and adult-use programs that permit sustainability of medical-use programs alongside adult-use legalization and implementation.

The cannabis legalization movement in the United States has experienced unprecedented success in the past decade due to a wave of grassroots reforms in states across the country. The current legalization movement began in 2012, when Colorado and Washington became the first two states to legalize the use and sale of cannabis for adults aged ≥ 21 years. Since then, the use of cannabis has been legalized in 21 states, Guam, the Northern Mariana Islands, and Washington, DC. Many of these states have explicitly framed the law change as a rejection of the War on Drugs and its harms, felt disproportionately in Black and Brown communities. However, racial inequities in cannabis arrests have increased in states that have legalized cannabis for adult use. Moreover, states working to implement social equity and community reinvestment programs have made little progress toward their goals. This commentary describes how US drug policy, racist in intention, gave way to drug policy that perpetuates racism, even when its ostensible or stated goal is equity. As the United States prepares for national legalization of cannabis, it is critical that we break away from past legislation and mandate equity in cannabis policy. Developing meaningful mandates will require us to acknowledge our history of using drug policy for the racist goals of social control and extortion, study the experience of states that are trying to implement social equity programs, listen to Black leaders and other leaders of color who have developed guidance for equity-focused cannabis policy, and commit to a new paradigm. If we are willing to do these things, we may be able to legalize cannabis in an anti-racist way that will stop causing harm and enable us to effectively implement reparative practices.

UNASSIGNED: Cannabis policy evaluations commonly assume equal policy exposure across a state\'s population using date of implementation as the key independent variable. This study aimed to explore policy knowledge as another measure of exposure and describe the sociodemographic, cognitive, and behavioral correlates of cannabis policy knowledge in young adults in Vermont.
UNASSIGNED: Data are from the PACE Vermont Study (Spring 2019), an online cohort study of Vermonters (12-25). Bivariate and multivariable analyses estimated prevalence ratios (PR) for correlations between knowledge of Vermont\'s cannabis policy (allowed possession for adults 21 and older) and sociodemographics, cannabis use, and harm perceptions in 1,037 young adults (18-25).
UNASSIGNED: Overall, 60.1% of participants correctly described the state\'s cannabis policy. Being younger, Hispanic, non-White race, and less educated were inversely correlated with policy knowledge. Ever (PR=1.37; 95% CI 1.16-1.63) and past-30-day cannabis use (PR=1.27; 95% CI 1.12-1.45) were positively correlated with policy knowledge. Policy knowledge was more prevalent among young adults who perceived slight risk of harm from weekly cannabis use (vs. no risk; aPR=1.28; 95% CI 1.11-1.48) or agreed that regular cannabis use early in life can negatively affect attention (vs. disagree; aPR=1.55; 95% CI 1.22-1.97).
UNASSIGNED: Findings suggest that 40% of Vermont young adults in the study were unaware of current state cannabis policy and that policy knowledge was lower in younger, less educated, Hispanic, and non-White young adults. Future research should explore using a measure of policy knowledge as an exposure or moderator variable to better quantify the effects of changes in cannabis legal status on perceptions and use in young people.

UNASSIGNED: As cannabis legalization continues to spread, best regulatory practice remains ill-defined and elusive, exposing the population to potential harms.
UNASSIGNED: We conducted an annual, statewide, cross- sectional survey to assess cannabis-related laws in effect by January 1, 2020, in local California jurisdictions and at the state level and measured adoption of potential best practices.
UNASSIGNED: The current laws of all 539 jurisdictions were located; 276 jurisdictions allowed any retail sales (storefront or delivery) covering 58% of the population, an increase of 20 jurisdictions (8%) from year 1 of legalization (2018). Half allowed sales of medical cannabis, whereas slightly fewer jurisdictions (n = 225) allowed adult-use sales. Only 9 jurisdictions imposed any restrictions on products stricter than state regulations. Cannabis temporary special events were allowed in 22 jurisdictions, up from 14 in the year prior. Thirty-three jurisdictions required additional health warnings for consumers. Just over half of legalizing jurisdictions taxed cannabis locally and little revenue was captured for prevention. No new jurisdictions established a potency-linked tax. Of jurisdictions allowing storefront retailers (n = 162), 114 capped outlet licenses, and 49 increased the state-specified buffers between storefronts and schools. Thirty-six allowed on-site consumption, up from 29. As of January 2020, the state had not updated its regulations of key provisions addressed in this paper.
UNASSIGNED: In year 2 of legalized adult-use cannabis sales in California, the state remained split between retail bans and legal sale. Local policy continued to vary widely on protective measures, and State policy remained misaligned with protection of youth and public health.

Wide variation exists in the possession limits of cannabis products sold for medical use in the U.S. as well as the tetrahydrocannabinol (THC) content of cannabis products. Prior work has found that legal limits on recreational cannabis sold per transaction may promote moderate use and diversion. This paper finds similar results for monthly medical cannabis limits. In the present analyses, state limits on medical cannabis were aggregated and converted into 30-day limits and 5 milligram (mg) THC doses. Grams of pure THC were calculated using plant weight limits and medical cannabis median THC potency aggregated from Colorado and Washington state medical cannabis retail sales data. Weight in pure THC was then broken down into 5 mg doses. Weight-based possession limits of cannabis for medical use varied widely across states (range: 1.5-762.05 grams pure THC per 30 days), with three states lacking a quantifiable weight limit (in which limits are not by weight but by physician\'s recommendation). States generally do not impose limits on the potency of cannabis products, therefore small differences in weight limits can result in large differences in the amount of total THC allowed to be sold. Assuming a typical medical dose of 5 mg and the median THC potency of 21%, current laws allow for sales of 300 (Iowa) to 152,410 (Maine) doses per month. Current state statutes and methods of cannabis recommendation allow patients to increase therapeutic THC doses independently, and perhaps unknowingly. High THC content products combined with the higher purchase or possession limits allowed by medical cannabis laws may lead to an increased potential for overconsumption or diversion.

UNASSIGNED: Cannabis criminalization disproportionately harms communities of color in the United States. In Massachusetts\' legal recreational (\"adult-use\") cannabis industry, state regulations intend to promote diverse participation. We assessed short-term racial/ethnic and gender diversity across the industry and in senior-level positions with greater opportunities to build wealth (i.e., board members, executives, directors).
UNASSIGNED: We extracted race/ethnicity and gender from required registration forms submitted to state regulators for each person working in a licensed adult-use cannabis business from October 2018 to April 2020 (n=4,883). We conducted descriptive analysis and negative binomial regression to assess characteristics associated with senior positions.
UNASSIGNED: As of April 2020, racial/ethnic and gender diversity in the Massachusetts adult-use cannabis market (n=4,883) was 75% white, 7% Latino, 6% Black/African American, similar to the state labor market, and 65% male. Diversity was more limited in senior positions. Agents in senior positions (n=403) were 84% white, 2% Latino, 5% Black/African American, and 82% male. Senior-level participation was markedly low for women of color.
UNASSIGNED: Despite legislative and regulatory commitment, diversity lacks in senior positions in this emerging cannabis market. States considering adult-use cannabis markets, and those that have already done so, should monitor participation to identify inequities and adapt initiatives to ensure Black/African American and Latino communities socially and economically benefit from state legalization.