"Liberal states had higher past-year cannabis use, but lower cannabis use disorder prevalence among users, compared to conservative states."

Int J Drug Policy. 2019 Jan 16. pii: S0955-3959(18)30272-X. doi: 10.1016/j.drugpo.2018.10.010. [Epub ahead of print]

Associations between state-level policy liberalism, cannabis use, and cannabis use disorder from 2004 to 2012: Looking beyond medical cannabis law status.

Philbin MM1, Mauro PM2, Santaella-Tenorio J3, Mauro CM4, Kinnard EN5, Cerdá M6, Martins SS7.

Author information

1

Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: mp3243@columbia.edu.

2

Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: pm2838@columbia.edu.

3

Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: js4222@columbia.edu.

4

Department of Biostatistics, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: cmm2212@columbia.edu.

5

Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: ek3003@columbia.edu.

6

Department of Emergency Medicine, University of California Davis, 4150V Street Patient Support Services Bldg, Sacramento, CA, 95817, USA. Electronic address: cerda@ucdavis.edu.

7

Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY, 10032, USA. Electronic address: ssm2183@columbia.edu.

Abstract

BACKGROUND:

Medical cannabis laws (MCL) have received increased attention as potential drivers of cannabis use (CU), but little work has explored how the broader policy climate, independent of MCL, may impact CU outcomes. We explored the association between state-level policy liberalism and past-year cannabis use (CU) and cannabis use disorder (CUD).

METHODS:

We obtained state-level prevalence of past-year CU and CUD among past year cannabis users for ages 12-17, 18-25, and 26+ from the 2004-2006 and 2010-2012 National Surveys on Drug Use and Health. States were categorized as liberal, moderate, or conservative based on state-level policy liberalism rankings in 2005 and 2011. Linear models with random state effects examined the association between policy liberalism and past-year CU and CUD, adjusting for state-level social and economic covariates and medical cannabis laws.

RESULTS:

In adjusted models, liberal states had higher average past-year CU than conservative states for ages 12-17 (+1.58 percentage points; p = 0.03) and 18-25 (+2.96 percentage points; p = 0.01) but not for 26+ (p = 0.19). CUD prevalence among past year users was significantly lower in liberal compared to conservative states for ages 12-17 (-2.87 percentage points; p = 0.045) and marginally lower for ages 26+ (-2.45 percentage points; p = 0.05).

CONCLUSION:

Liberal states had higher past-year CU, but lower CUD prevalence among users, compared to conservative states. Researchers and policy makers should consider how the broader policy environment, independent of MCL, may contribute to CU outcomes.