Decrease In Cannabis Treatment Tied To Policy Changes
Legalization of Cannabis Associated with Decrease in Cannabis Use Disorders.
A new study has found that the legalization of cannabis is not associated with an increase in cannabis use disorders. Instead, it has decreased since 2004.
Contrary to the common belief that states legalizing cannabis for both medical and recreational purposes experience an increase in cannabis use disorder (CUD) cases, a recent study indicates the opposite, suggesting that CUD has actually decreased following legalization.
In a study published in the journal Drug and Alcohol Dependence, Researchers from Columbia University Mailman School of Public Health and other institutions discovered that from 2004 to 2014, the decline in CUD treatment was primarily seen in states with cannabis dispensary provisions. However, from 2015 to 2019, while a similar pattern was noted, no significant associations were found.
CUD is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a problematic pattern of cannabis consumption resulting in significant impairment or distress.
With rising rates of CUD among adults, particularly in states with earlier medical cannabis laws, one might expect shifts in CUD treatment following the implementation of cannabis laws. However, this study reveals that CUD treatment rates are lower following the legalization of medical cannabis, particularly in areas where cannabis dispensaries are present.
This study used data from the National Survey on Drug Use and Health (NSDUH), an annual survey covering non-institutionalized civilians aged 12 and above from all 50 states and the District of Columbia. Approximately 68,000 individuals were sampled each year through face-to-face interviews using computer-assisted techniques. The researchers accessed NSDUH data from 2004 to 2019, including state-level indicators, through the Research Data Center in New York.
The study looked at data from a national survey between 2004 and 2019 to understand how many people needed treatment for CUD and how many actually received treatment. They found that about 2.4–2.5% of people aged 12 and older needed treatment for CUD, but only 7.3–10.4% of them received any treatment, and even fewer got specialty treatment.
Researchers also analyzed how medical cannabis laws affected treatment rates. They found that in states where MCLs were in place, especially with dispensaries, fewer people received specialty treatment for CUD compared to before those laws were enacted. Similar patterns were seen between 2015 and 2019, but the relationship wasn't as clear.
Among those who met the criteria for CUD, the proportion receiving specialty treatment was lower in states with MCL, especially those with dispensaries. This pattern was consistent from 2004 to 2019.
Overall, states with both medical and recreational cannabis laws had the lowest rates of specialty treatment for CUD. Only about 2.5% of people with CUD received specialty treatment between 2004 and 2014, and this decreased to 1.8% between 2015 and 2019.
By analyzing the impact of cannabis policy changes on treatment in two study groups, one made of individuals requiring treatment for CUD and the other focused specifically on individuals diagnosed with CUD, researchers discovered that only MCLs with dispensaries were linked to reduced specialty treatment for CUD among individuals with recent CUD diagnoses. However, both MCLs and RCLs were associated with decreased specialty treatment for CUD when considering a broader definition of individuals in need of CUD treatment.
"Together, findings indicate cannabis policy-related reductions in CUD treatment among people with CUD were concentrated in states with cannabis dispensary provisions; reductions were observed in both in MCL regardless of dispensaries and in RCL states when including people who did not meet past-year CUD criteria. Importantly, CUD treatment use remained very low across years and policy exposures, indicating unmet CUD treatment need throughout the US," the study reads.
Reductions in treatment for people with CUD were mainly seen in states MCLs that had dispensaries, highlighting, according to the study, how cannabis laws can affect the use of treatment for CUD.
The findings of this study support the idea that cannabis dispensaries play a significant role in shaping outcomes related to cannabis. They could influence treatment by impacting how likely it is for someone to recognize symptoms of CUD and feel they need treatment.
In fact, researchers suggest that cannabis dispensaries can affect people's awareness of cannabis laws, their perceptions of the risks associated with cannabis, and their actual cannabis use. Additionally, signs promoting the health benefits of cannabis near dispensaries may increase cannabis use nearby.
The study says that MCLs have also been linked to higher rates of using cannabis as a form of self-medication among people with mood or anxiety disorders, likely making it harder for these individuals to recognize symptoms of CUD, leading to a lower perceived need for treatment.
When researchers investigate the reasons behind how cannabis policies might lead to a reduction in CUD treatment, they suggest that there could be an increasing number of individuals with mild CUD, resulting in reduced perceived risk and a lower sense of needing treatment for CUD. Although higher severity of CUD is typically linked with a greater likelihood of seeking treatment, the prevalence of CUD among individuals who report daily cannabis use has decreased.
"Low treatment use among people with CUD could be related to difficulties identifying CUD symptoms, especially among people with mild CUD. Findings suggest the need for public education about the likelihood and symptoms of CUD, as well as need for treatment when clinically indicated, in the context of changing cannabis legal status," the study reads.
Researchers acknowledge that this study has limitations. Data restrictions prevented access to pre-MCL data for states, potentially leading to underreporting. Also, the policy exposure assessment didn't account for the simultaneous implementation of various policies in states, introducing variability and measurement errors.
