Admissions to substance use treatment facilities for cannabis use disorder, 2000–2017: Does legalization matter?

Abstract

Background and Objectives: A growing number of US states have legalized marijuana use in the past decade. We examined if marijuana legalization is associated with increased marijuana-related admissions to substance use treatment facilities between 2000 and 2017.Methods: Data from the Treatment Episode Data Set-Admissions were used to examine the relationship between marijuana-related admissions among adults aged ≥18 by year and legalization status (i.e., fully legalized, medical use only [partially legalized], and illegal) (N = 35,457,854). Using interaction analyses, we further examined whether certain patient characteristics were associated with residence in states that legalized marijuana use as compared to those in which marijuana remained illegal.Results: Overall, the proportion of marijuana-related admissions in states with legalization decreased by 2.3% from 31.7% in 2000-2005 to 29.4% in 2012-2017 (odds ratio [OR], 0.90; 95% confidence intervals [CI], 0.89-0.90) with little difference from states where marijuana use remained illegal, in which marijuana use as any reason for admissions decreased by 0.3% from 39.8% in 2000-2005 to 39.5% in 2012-2017 (OR, 0.99; 95% CI, 0.98-0.99). We did not find any striking patient characteristics (e.g., referral by the police) associated with admissions in states that legalized compared to those that had not.Discussion and Conclusions: While earlier studies suggested that marijuana legalization is associated with increased levels of use, emergency department visits, and traffic fatalities, our findings suggest that marijuana legalization did not increase marijuana-related treatment use in the United States.Scientific Significance: This is the first study to examine the association of marijuana legalization with marijuana-related treatment use.

Assessing the Impact of Recreational Cannabis Legalization on Cannabis Use Disorder and Admissions to Treatment in the United States

“…Four research articles examining cannabis policy and CUD treatment admissions were published within our review window [ 48 – 51 ]. The study years ranged from 1992 to 2017.…”

“…All four studies utilized the national Treatment Episode Data Set (TEDS). One study focused on adolescents [ 49 ], one used a sample of young adults aged 18—24 [ 50 ], and two examined treatment admissions for adults aged 18 or older [ 48 , 51 ]. The outcome measure was treatment admission with cannabis listed as the primary reason for admission, although one study [ 48 ] also considered a second measure for cannabis as either the primary, secondary, or tertiary substance.…”

“…One study focused on adolescents [ 49 ], one used a sample of young adults aged 18—24 [ 50 ], and two examined treatment admissions for adults aged 18 or older [ 48 , 51 ]. The outcome measure was treatment admission with cannabis listed as the primary reason for admission, although one study [ 48 ] also considered a second measure for cannabis as either the primary, secondary, or tertiary substance. One study looked at discharge rather than admission data and measured treatment completion and length of stay for those with cannabis as the primary reason for admission [ 51 ].…”

“…No studies found a significant relationship between RCL status and cannabis-related treatment admissions. Using the TEDS from 2000 to 2017 on adult treatment admissions, Rhee & Rosenheck [ 48 ] found no significant association between RCLs and cannabis-related treatment admissions. Throughout the 2000—2017 study period though, individuals in states that eventually legalized were less likely to be admitted to treatment.…”

“…Further analysis limited to RCL states found that the number of years since legalization was also not associated with increased treatment admissions. Adult cannabis admissions nationwide showed a small increase from 2000–2005 to 2006–2011, followed by a small decrease in 2012–2017 [ 48 ].…”