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Background and aims: Multiple countries are considering revising cannabis policies. This study aimed to measure long‐term trends in cannabis use in the United States and compare them with alcohol use. Design and setting: Secondary analysis of United States general population survey data. Participants: The national surveys had a total of 1 641 041 participants across 27 surveys from 1979 to 2022. Measurements: Rates of use reported to the US National Survey on Drug Use and Health and its predecessors are described, as are trends in days of use reported. Four milepost years are contrasted: 1979 (first available data and end of relatively liberal policies of the 1970s), 1992 (end of 12 years of conservative Reagan‐Bush era policies), 2008 (last year before the Justice Department signaled explicit federal non‐interference with state‐level legalizations) and 2022 (most recent data available). Findings Reported cannabis use declined to a nadir in 1992, with partial recovery through 2008, and substantial increases since then, particularly for measures of more intensive use. Between 2008 and 2022, the per capita rate of reporting past‐year use increased by 120%, and days of use reported per capita increased by 218% (in absolute terms from the annual equivalent of 2.3 to 8.1 billion days per year). From 1992 to 2022, there was a 15‐fold increase in the per capita rate of reporting daily or near daily use. Whereas the 1992 survey recorded 10 times as many daily or near daily alcohol as cannabis users (8.9 vs. 0.9 M), the 2022 survey, for the first time, recorded more daily and near daily users of cannabis than alcohol (17.7 vs. 14.7 M). Far more people drink, but high‐frequency drinking is less common. In 2022, the median drinker reported drinking on 4–5 days in the past month, versus 15–16 days in the past month for cannabis. In 2022, past‐month cannabis consumers were almost four times as likely to report daily or near daily use (42.3% vs. 10.9%) and 7.4 times more likely to report daily use (28.2% vs. 3.8%). Conclusions: Long‐term trends in cannabis use in the United States parallel corresponding changes in cannabis policy, with declines during periods of greater restriction and growth during periods of policy liberalization. A growing share of cannabis consumers report daily or near daily use, and their numbers now exceed the number of daily and near daily drinkers. [ABSTRACT FROM AUTHOR]

Background: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. Methods: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. Results: The expert‐based consensus agreed upon a three‐layered hierarchical framework. Each layer—universal measures, detailed self‐report and biological measures—reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. Conclusions: Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation. [ABSTRACT FROM AUTHOR]

The iCannToolkit is a first important step to systematically gather evidence regarding the health effects of contemporary medical and non-medical cannabis use—over time, among licit and illicit settings, cultures and age groups—in order to inform policy development and to raise awareness concerning cannabis use-related risks and benefits. [ABSTRACT FROM AUTHOR]

The author discusses a study by W. Hall and colleagues about bans on high-tetrahydrocannabinol (THC) content cannabis products. Topics include the researchers' observation that many who supported legalization failed to anticipate the trend towards higher-THC products, the complex issue of taxing cannabis, and comments on the viability of banning specific products within a broader class.

• There are interesting parallels between fireworks policy and drug policy. • Injury rates are similar in the U.S. per dollar spent on fireworks and cannabis. • Fireworks have alternately been prohibited or legalized in different places and times. • Fireworks prohibitions have been less strenuously enforced than drug prohibitions. • Use is highly concentrated in time for fireworks but by person for drugs. Nations wrestle with whether to prohibit products that can harm consumers and third parties but whose prohibition creates illegal markets. For example, cannabis is banned in most of the world, but supply for non-medical use has been legalized in Uruguay, Canada, and much of the United States and possession restrictions have been liberalized in other countries. Likewise, supply and possession of fireworks have been subject to varying degrees of prohibition in multiple countries, with those bans prompting significant evasion. Current and past history of fireworks regulations, sales, and harms are reviewed and contrasted with those for cannabis. The focus is on the United States, but literature from other countries is incorporated when possible and appropriate. This extends the insightful literature comparing drugs to other vices (such as gambling and prostitution) by comparing a drug to a risky pleasure that is not seen as a vice but which has been subject to prohibition. There are many parallels between fireworks and cannabis in legal approaches, harms to "users", harms to others, and other externalities. In the U.S. the timing of prohibitions were similar, with prohibitions on fireworks being imposed a little later and repealed a little sooner. Internationally, the countries that are strictest with fireworks are not always those that are strictest with drugs. By some measures, harms are of roughly similar magnitude. During the last years of U.S. cannabis prohibition, there were about 10 emergency department (ED) events per million dollars spent on both fireworks and illegal cannabis, but fireworks generated very roughly three times as many ED events per hour of use/enjoyment. There are also differences, e.g., punishments were less harsh for violating fireworks prohibitions, fireworks consumption is heavily concentrated in just a few days or weeks per year, and illegal distribution is primarily of diverted legal products, not of illegally produced materials. The absence of hysteria over fireworks problems and policies suggests that societies can address complex tradeoffs involving risky pleasures without excessive acrimony or divisiveness when that product or activity is not construed as a vice. However, the conflicted and time-varying history of fireworks bans also show that difficulty balancing freedoms and pleasure with harms to users and others is not restricted to drugs or other vices. Use-related harms fell when fireworks were banned and rose when those bans were repealed, so fireworks prohibitions can be seen as "working" from a public health perspective, but not well enough for bans to be employed in all times or places. [ABSTRACT FROM AUTHOR]

Aims To (1) assess trends and variation in the market share of product types and potency sold in a legal cannabis retail market and (2) estimate how potency and purchase quantity influence price variation for cannabis flower. Design Secondary analysis of publicly available data from Washington State's cannabis traceability system spanning 7 July 2014 to 30 September 2016. Descriptive statistics and linear regressions assessed variation and trends in cannabis product variety and potency. Hedonic regressions estimated how purchase quantity and potency influence cannabis flower price variation. Setting Washington State, USA. Participants (1) A total of 44 482 176 million cannabis purchases, including (2) 31 052 123 cannabis flower purchases after trimming price and quantity outliers. Measurements Primary outcome measures were (1) monthly expenditures on cannabis, total delta-9-tetrahydrocannabinol (THC) concentration and cannabidiol (CBD) concentration by product type and (2) excise tax-inclusive price per gram of cannabis flower. Key covariates for the hedonic price regressions included quantity purchased, THC and CBD. Findings Traditional cannabis flowers still account for the majority of spending (66.6%), but the market share of extracts for inhalation increased by 145.8% between October 2014 and September 2016, now comprising 21.2% of sales. The average THC-level for cannabis extracts is more than triple that for cannabis flowers (68.7% compared to 20.6%). For flower products, there is a statistically significant relationship between price per gram and both THC [coefficient = 0.012; 95% confidence interval (CI) = 0.011-0.013] and CBD (coefficient = 0.017; CI = 0.015-0.019). The estimated discount elasticity is −0.06 (CI = −0.07 to −0.05). Conclusions In the state of Washington, USA, the legal cannabis market is currently dominated by high-THC cannabis flower, and features growing expenditures on extracts. For cannabis flower, both THC and CBD are associated with higher per-gram prices, and there are small but significant quantity discounts. [ABSTRACT FROM AUTHOR]

The U.S. appears to be on a path toward legalizing cannabis on the alcohol model, which is to say allowing for-profit corporations to produce, sell, and promote its use. Even after national legalization, it will take decades to observe the full effects on industry structure and behavior, or on use and misuse. However, we should not be surprised if after markets have matured and consumption patterns stabilized, legalization increases acute cannabis intoxication in the U.S. by 40 billion hours per year. This increase in use will be the most important cannabis-specific effect of legalization. The bulk of it will be consumption by daily and near-daily users, and it is possible that roughly half will be by people who meet the medical criteria for substance use disorder. Much resulting harms will be borne by the users, and their families, and the harms are not primarily "medical", at least not in the narrow sense. Hence, legalization replaces the current problems of crime and black markets not so much with a medical or public health problem, but rather with a problem of potentially excessive consumption of a "temptation good" whose acute effects are performance degrading, not performance-enhancing. As legalization removes formal social controls, it might be prudent for society to develop stronger informal social norms - akin to "friends don't let friends drive drunk" - to protect the public and more importantly the users themselves from the performance degradation of bouts of nearly perpetual intoxication. [ABSTRACT FROM AUTHOR]

Background and Aims In 2014 the legislature of Vermont, USA passed a law requiring the Secretary of Administration to report on the consequences of legalizing marijuana. The RAND Corporation was commissioned to write that report. This paper summarizes insights from that analysis that are germane to other jurisdictions. Method Translation of key findings from the RAND Corporation report to the broader policy debate. Results Marijuana legalization encompasses a wide range of possible regimes, distinguished along at least four dimensions: which organizations are allowed to produce and supply the drug, the regulations under which they operate, the nature of the products that can be distributed and taxes and prices. Vermont's decriminalization had already cut its costs of enforcing marijuana prohibition against adults to about $1 per resident per year. That is probably less than the cost of regulating a legal market. Revenues from taxing residents' purchases after legalization could be many times that amount, so the main fiscal cost of prohibition after decriminalization relative to outright legalization may be foregone tax revenues, not enforcement costs. Approximately 40 times as many users live within 200 miles of Vermont's borders as live within the state; drug tourism and associated tax revenues will be important considerations, as will be the response of other states. Indeed, if another state legalized with lower taxes, that could undermine the ability to collect taxes on even Vermont residents' purchases. Conclusions Analysis of possible outcomes if Vermont, USA, legalized marijuana reveal that choices about how, and not just whether, to legalize a drug can have profound consequences for the effects on health and social wellbeing, and the choices of one jurisdiction can affect the options and incentives available to other jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Understanding of substitution patterns in drug using careers is limited. Between 2009 and mid-2013, the purity-adjusted price of methamphetamine declined sharply in Melbourne in absolute terms and relative to the purity-adjusted price of heroin. We determine whether there were associated increases among people who inject drugs (PWID) in (1) use of methamphetamine and (2) citing methamphetamine as the drug of choice.Method: Responses to “drug of choice” and “most used drug” were obtained from baseline and follow-up interviews of the 688 PWID enrolled in the Melbourne Injecting Drug User Cohort Study between April 2008 and August 2013, categorised as heroin, methamphetamine, cannabis or other. Previous month heroin and methamphetamine use was reported at baseline by 82% and 41% of participants, respectively, and 51% had completed four or more interviews in this period. A Markov model that included marginal effects for methamphetamine purity-adjusted price was used to calculate (1) transitions between drug of choice and (2) conditional probabilities for most used drug. Parameters were determined by fitting multinomial logistic models to appropriate data subsets.Results: At baseline, the majority of participants reported heroin as both their preferred drug and the drug they used most. There were no significant increases in reports of methamphetamine as drug of choice, or as the most used drug.Conclusion: In a cohort of PWID who reported a range of drug behaviours, there was little evidence of drug substitution into methamphetamine, despite substantial declines in its purity-adjusted price. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the author's views about advertising restrictions on cannabis products that are used for nonmedical purposes, and it mentions another article which appears in the same issue of the journal and deals with the legal aspects of cannabis and advertising in the U.S. America's Food and Drug Administration (FDA), the nation's Controlled Substances Act (CSA), and marijuana laws in places such as Oregon are assessed.

Most proposals for legalizing cannabis production and sale ban sales to minors. But such bans are not self-executing. There is at least the risk--if not the overwhelming probability--that legal availability for adults will change price and availability for minors in a way that will increase the prevalence of underage use. This is especially problematic with respect to use by younger adolescents and to heavy use. It might be possible, with vigorous enforcement, to reduce the impact of legalization on use by minors, but the costs and unwanted side effects of such efforts may make them, on balance, inadvisable. The example of alcohol shows that it is possible to make it difficult for minors to buy directly from licensed stores and that doing so reduces alcohol consumption and alcohol-related harms in the target population. But strong efforts to prevent minors from buying cannabis illegally from adults, who in turn buy it from licensed stores, may not be advisable. With minors now accounting for approximately 25 percent of the volume in the cannabis markets, giving strictly illicit producers and vendors a firmer grip on the underage market would undermine the goal of reducing illicit-market harms, including violence, the need for enforcement, and the supply of products of uncertain potency, perhaps containing harmful contaminants. If this is so, then the harms associated with increased juvenile use are not entirely separable from the decision to make cannabis lawfully available to adults. [ABSTRACT FROM AUTHOR]

Aims Drug policy strategies and discussions often use prevalence of drug use as a primary performance indicator. However, three other indicators are at least as relevant: the number of heavy users, total expenditures and total amount consumed. This paper stems from our efforts to develop annual estimates of these three measures for cocaine (including crack), heroin, marijuana and methamphetamine in the United States. Methods The estimates exploit complementary strengths of a general population survey ( National Survey on Drug Use and Health) and both survey and urinalysis test result data for arrestees ( Arrestee Drug Abuse Monitoring Program), supplemented by many other data sources. Results Throughout the 2000s US drug users spent in the order of $100 billion annually on these drugs, although the spending distribution and use patterns changed dramatically. From 2006 to 2010, the amount of marijuana consumed in the United States probably increased by more than 30%, while the amount of cocaine consumed in the United States fell by approximately 50%. These figures are consistent with supply-side indicators, such as seizures and production estimates. For all the drugs, total consumption and expenditures are driven by the minority of users who consume on 21 or more days each month. Conclusions Even for established drugs, consumption can change rapidly. The halving of the cocaine market in five years and the parallel (but independent) large rise in daily/near-daily marijuana use are major events that were not anticipated by the expert community and raise important theoretical, research, and policy issues. [ABSTRACT FROM AUTHOR]

Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes—not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, and other states and countries may follow. Our goal is not to address whether marijuana legalization is a good or bad idea but, rather, to help policymakers understand the decisions they face and some lessons learned from research on public health approaches to regulating alcohol and tobacco over the past century. [ABSTRACT FROM AUTHOR]

The article discusses the potential decriminalization of marijuana use and possession in the U.S. in relation to tax revenues, black and gray markets, and marijuana legalization efforts and laws in American states such as Colorado and Washington as of June 2013. The U.S. Controlled Substances Act is addressed, along with excise taxes, ad valorem taxation, and various types of cannabis. Sales taxes and government monopolies are also mentioned.

ABSTRACT Aims No modern jurisdiction has ever legalized commercial production, distribution and possession of cannabis for recreational purposes. This paper presents insights about the effect of legalization on production costs and consumption and highlights important design choices. Methods Insights were uncovered through our analysis of recent legalization proposals in California. The effect on the cost of producing cannabis is largely based on existing estimates of current wholesale prices, current costs of producing cannabis and other legal agricultural goods, and the type(s) of production that will be permitted. The effect on consumption is based on production costs, regulatory regime, tax rate, price elasticity of demand, shape of the demand curve and non-price effects (e.g. change in stigma). Results Removing prohibitions on producing and distributing cannabis will dramatically reduce wholesale prices. The effect on consumption and tax revenues will depend on many design choices, including: the tax level, whether there is an incentive for a continued black market, whether to tax and/or regulate cannabinoid levels, whether there are allowances for home cultivation, whether advertising is restricted, and how the regulatory system is designed and adjusted. Conclusions The legal production costs of cannabis will be dramatically below current wholesale prices, enough so that taxes and regulation will be insufficient to raise retail price to prohibition levels. We expect legalization will increase consumption substantially, but the size of the increase is uncertain since it depends on design choices and the unknown shape of the cannabis demand curve. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Decisions on whether and how to 'schedule' drugs (i.e. to determine their legal status and penalties to be applied for sale or possession) are often heavily criticized. We sought to assess more comprehensively the results of such decisions for newly emerging drugs. Methods Through analysis of legislation and secondary sources, we identified 63 substances that have emerged since 1971, including all that have been added to the most restrictive schedule by the United Nations, United States, United Kingdom, Canada, Australia and/or New Zealand. Measurements For each jurisdiction we recorded whether, when, and how the substance was scheduled and note what decisions engendered substantial criticism or controversy within the international treaties' framework of balancing medical benefits with risk of abuse. Findings (i) The rate of emergence of new drugs has been fairly steady. (ii) There is broad cross-national agreement on what should be scheduled. (iii) The United States often acts first. (iv) Temporary bans that delay final decisions by 12-18 months can sometimes allow final decisions to be grounded on a substantially expanded research base. (v) It appears that no more than seven of the decisions reached by the United States with respect to the 63 substances are candidates for being considered errors, and arguably the United States has committed at most one serious Type I and one serious Type II error. Results for other countries are broadly similar. Conclusions The process for determining the legal status of new psychoactive substances appears to function reasonably well, within the framework of international treaty obligations. Most criticisms relate to one or a few substances (e.g. 3,4-methylenedioxymethamphetamine) and/or complaints that the decisions discount benefits that are not recognized by the treaties (e.g. recreational or religious use). [ABSTRACT FROM AUTHOR]

Background: Cannabis legalization and the arrival of nonmedical fentanyl are fundamentally altering North American drug markets. An essential part of that change is the ability to produce large quantities of these drugs at low costs, which is like a technological breakthrough in their production technology. This essay explores possible future consequences of these trends.Methods: Descriptive statistics, historical analogy and economic reasoning.Results: In North America, wholesale prices for cannabis and opioids - in the form of illegally manufactured fentanyl and other new synthetic opioids - are radically lower than they were a decade ago. Retail prices for cannabis have fallen commensurately, but not yet for opioids. Historical analogies suggest that very large declines in price can have effects on use that go beyond just an expansion of traditional patterns of consumption.Conclusion: For cannabis and opioids in North America, conditions are ripe for significant changes in not only quantities consumed, and associated harms, but also in the roles these drugs and their control play in society. The overall situation with these drugs may look more different in 2040 compared to today, than today looks different from 2000. There are no obvious reasons why these trends will not spread to other continents. [ABSTRACT FROM AUTHOR]

This article explores quantity discounts and quality (purity) premia in the prices of illicit drugs. It examines several models of how drug prices might depend on transaction size. A simple relation implied by a tree model of the domestic distribution network fits data provided by the Western States Information Network for 1984-1991 quite well for various effect drugs. Quality premia are less well explained. It is observed that price is not a function of pure quantity alone, customers pay more for 2 grams at a given purity than they do for 1 gram at double that purity. Nevertheless, some purity premia are observed for white heroin, brown heroin, and powder cocaine, although not for methamphetamines, crack, or heroin tar. The estimated coefficients reflect known phenomena such as the collapses in the prices of cocaine and black tar heroin, intuitively reasonable but undocumented phenomena, such as discounts for brown heroin near the Mexican border, and some unexpected results, such as an apparent difference between the distribution of sinsemilla and that of other cannabis products. [ABSTRACT FROM AUTHOR]

Cannabis legalization is often falsely depicted as a binary choice between status quo prohibition and legalizing production and distribution by (regulated) for-profit industry. There are, however, many more prudent architectures for legalization, such as restricting production and distribution licenses to not-for-profit entities. Wilkins describes how New Zealand applied that concept to gambling machines and proposes a parallel for cannabis legalization. Greater investment in proposing good designs along these lines, including attending to governance structures, would be valuable. [ABSTRACT FROM AUTHOR]

A response is provided to articles in the same issue of the journal which address additional data sources for cannabis markets, the legalization of the cannabis industry, and changes in cannabis policies as of 2017. The economic profitability of marijuana as a commodity is examined, along with the structure, performance, and conduct of an industrial organization. Company loyalty and frequent buyer programs are assessed, along with data mining and smart vaporizer pens.

Commentary to: Considering marijuana legalization carefully: insights for other jurisdictions from analysis for Vermont [ABSTRACT FROM AUTHOR]

In this article Jonathan P. Caulkins, Beau Kilmer, Peter H. Reuter and Gregory Midgette respond to commentaries within the issue which focus on their article "Cocaine’s Fall and Marijuana’s Rise: Questions and Insights Based on New Estimates on Consumption and Expenditures in US Drug Markets". In the article they offer opinions on several points which are raised within the commentaries and on several aspects of their own article which are discussed in the commentaries.

In this article, researcher Johnathan P. Caulkins responses to the commentatries made on his study related to the issue of legalizating cannabis. He mentions that his study focused on design choices for implementing legalization of cannabis. He also mentions that the production costs after legalization process can drop below the current wholesale prices. Further he mentions the Kettil Bruun Society has reveals the difficuties in regulation right for drugs as they have been conforting the nuances of alcohol control for 25 years.

Purpose: This study applies the concept of restrictive deterrence to a sample of drug market offenders. In particular, we assess the influence of behavioral changes post-arrest on time to rearrest. Methods: The sample consists of arrest data on all drug offences in South Australia from the start of 2000 to the end of 2007 (n=26819). Cox proportional hazard models are used to conduct survival analyses. Supplementary models focus on those repeatedly arrested for cannabis cultivation to assess the influence of adjusting amounts of drugs on time to rearrest. Results: Changing behaviors is related to more rapid rearrest. Switching offense location, drug seriousness, and charge seriousness are all risk factors. However, among offenders repeatedly arrested for cannabis cultivation, changing location and increasing the number of plants they grow is related to a longer period before rearrest. Conclusions: Offenders that change their drug market behavior after being arrested appear to be placing themselves in situations in which they are more likely to fail due to the dangers of breaking into an unfamiliar market or offense pattern. Offenders with the longest post-arrest survival seem to be those that maintain their overall pattern of behavior while implementing subtle arrest avoidance techniques. [Copyright &y& Elsevier]

Background: Cannabis policy is developing faster than empirical evidence about policy effects. With a panel of experts in substance use policy development and research, we identified key cannabis policies and their provisions enacted by U.S. states; rated their theoretical efficacy in a restrictive form for reducing problematic use and impaired driving in the context of a recreational cannabis market as judged by experts; and rated the strength of evidence for each policy.Methods: Using a modified Delphi approach, 9 panelists rated the comparative efficacy of 18 state cannabis policies for reducing youth use of cannabis, excessive cannabis use among the general population, and cannabis-impaired driving. Each outcome was rated separately using a Likert scale, and panelists also rated the strength of evidence supporting each efficacy rating. Investigators provided descriptions of each policy so that the nine panelists had similar conceptions of each policy.Results: State monopoly (state owns all production, manufacturing, wholesale, and retail operations) was rated as the most effective policy for all three outcome areas. Restrictions on retail physical availability, taxes, retail price restrictions, and retail operations restrictions were also highly rated for all three outcomes. Policies regulating cannabis businesses and products were judged more effective than policies targeting consumer use and behavior. Panelists reported there was little or no direct evidence from the cannabis policy literature for most of the included policies.Conclusion: These ratings can facilitate research as well as policy-making decisions. A relatively small number of policies were judged to be highly effective across all three domains, indicating that for the most part adult excessive use, youth use, and impaired driving can all be reduced with the same set of policies; these policies tended to target the behaviors of businesses rather than consumers. The low levels of direct evidence available to inform policy ratings, as reported by the policy panelists, makes clear the need for ongoing and sustained cannabis policy research. [ABSTRACT FROM AUTHOR]