PMID- 37414510
OWN - NLM
STAT- MEDLINE
DCOM- 20230710
LR  - 20240416
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 45
IP  - 6
DP  - 2023 Jun
TI  - Exploring the Impact of Adult-use Cannabis Legalization on Legal System Referrals 
      to Treatment for Cannabis Use: Do Age and Race Have a Moderating Effect?
PG  - 599-615
LID - S0149-2918(23)00105-4 [pii]
LID - 10.1016/j.clinthera.2023.03.006 [doi]
AB  - PURPOSE: Despite the progression of recreational cannabis legalization, the legal 
      system remains the largest source of referral to treatment for cannabis use. The 
      legal system's continued practice of requiring participation in cannabis 
      treatment programs raises questions regarding the extent to which individuals who 
      interact with the legal system are monitored for cannabis use post-legalization. 
      This article presents trends in justice-system referrals to treatment for 
      cannabis use in legal and nonlegal states for 2007-2019. The relationship between 
      legalization and justice system treatment referrals for black, Hispanic/Latino, 
      and white adults and juveniles was explored. Given that minority and youth 
      populations are subject to disproportionate levels of cannabis enforcement, 
      legalization is expected to have a weaker relationship with justice-system 
      referral rates in white juveniles and black and Hispanic/Latino adults and 
      juveniles compared to white adults. METHODS: Using 2007-2019 data from the 
      Treatment Episode Data Set-Admissions (TEDS-A), variables were created for 
      state-level rates of legal system-referred treatment admissions for cannabis use 
      in black, Hispanic/Latino, and white adults and juveniles. Rate trends were 
      compared across populations and staggered difference-in-difference and event 
      analyses were conducted to determine whether legalization is associated with a 
      decline in justice-system referrals to treatment for cannabis use . FINDINGS: For 
      the study period, the mean rate of legal system-referred admissions in the total 
      population was 2.75 per 10,000 residents. Black juveniles had the highest mean 
      rate (20.16), followed by Hispanic/Latino juveniles (12.35), black adults (9.18), 
      white juveniles (7.58), Hispanic/Latino adults (3.42), and white adults (1.66). 
      Legalization did not have a significant impact on treatment-referral rates in any 
      population of study. Events analyses indicated significant rate increases in 
      black juveniles in legalized states compared to controls at 2 and 6 years after 
      policy change, and in black and Hispanic/Latino adults at 6 years after policy 
      change (all, P < 0.05). While racial/ethnic disparities in referral rates 
      declined in absolute terms, the relative size of these disparities increased in 
      legalized states. IMPLICATIONS: TEDS-A captures only publicly funded treatment 
      admissions and relies on the quality of individual-state reporting. 
      Individual-level factors that may impact decisions regarding treatment referrals 
      for cannabis use could not be controlled for. Despite limitations, the present 
      findings suggest that for individuals who interact with the criminal legal 
      system, cannabis use may still result in legal monitoring after reform. The 
      upward trend in legal system referrals for black (but not white) adults and 
      juveniles several years after states legalize cannabis warrants further 
      examination and may reflect continued disparate treatment of these populations at 
      multiple points along the legal-system continuum.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - Harris, Katharine Neill
AU  - Harris KN
AD  - Baker Institute for Public Policy, Rice University, Houston, Texas. Electronic 
      address: kan1@rice.edu.
FAU - Kulesza, Christopher
AU  - Kulesza C
AD  - Baker Institute for Public Policy, Rice University, Houston, Texas.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Medical Marijuana)
SB  - IM
MH  - Adolescent
MH  - Humans
MH  - Adult
MH  - United States
MH  - *Cannabis
MH  - *Marijuana Smoking
MH  - Legislation, Drug
MH  - *Medical Marijuana/therapeutic use
MH  - Hospitalization
OTO - NOTNLM
OT  - cannabis
OT  - criminal justice system
OT  - legalization
OT  - marijuana
OT  - racial disparities
COIS- Declaration of Interest The authors have indicated that they have no conflicts of 
      interest with regard to the content of this article.
EDAT- 2023/07/07 01:05
MHDA- 2023/07/10 06:42
CRDT- 2023/07/06 20:57
PHST- 2022/10/31 00:00 [received]
PHST- 2023/02/23 00:00 [revised]
PHST- 2023/03/09 00:00 [accepted]
PHST- 2023/07/10 06:42 [medline]
PHST- 2023/07/07 01:05 [pubmed]
PHST- 2023/07/06 20:57 [entrez]
AID - S0149-2918(23)00105-4 [pii]
AID - 10.1016/j.clinthera.2023.03.006 [doi]
PST - ppublish
SO  - Clin Ther. 2023 Jun;45(6):599-615. doi: 10.1016/j.clinthera.2023.03.006.