Post-Legalization Opening of Retail Cannabis Stores and Adult Cannabis Use in Washington State, 2009-2016.

To assess the relationship between adult cannabis use and time-varying local measures of retail cannabis market presence before and after legalization (2012) and market opening (2014) in Washington State. We used 2009 to 2016 data on 85 135 adults' current (any) and frequent (20 or more days) past-month cannabis use from the Washington Behavioral Risk Factor Surveillance System linked to local retailer proximity and density. Multilevel models predicted use over time, accounting for nesting within communities. Current and frequent cannabis use grew significantly between 2009 and 2016; use did not significantly change immediately after legalization but increased subsequently with greater access to cannabis retailers. Specifically, current use increased among adults living in areas within 18 miles of a retailer and, especially, within 0.8 miles (odds ratio [OR] = 1.45; 95% confidence interval [CI] = 1.24, 1.69). Frequent use increased among adults living within 0.8 miles of a retailer (OR = 1.43; 95% CI = 1.15, 1.77). Results related to geospatial retailer density were consistent. Increasing cannabis retail access was associated with increased current and frequent use. Policymakers might consider density limits as a strategy for preventing heavy cannabis use among adults.