From the Temple University, Philadelphia, PA.
J Addict Med. 2023;17(6):725-728. doi: 10.1097/ADM.0000000000001219. Epub 2023 Aug 29.
This study investigates whether the proportion of referrals to cannabis use disorder (CUD) treatment from the criminal justice system declined among adolescents (aged 12-17 years) and young adults (aged 18-24 years) following state recreational (adult use) cannabis legalization in the United States between 2008 and 2019.
Cannabis use disorder treatment referral data were extracted from the Treatment Episode Dataset-Admissions and used to calculate trends in the number and proportion of criminal justice referrals. Difference-in-differences analysis was used to estimate the effect of recreational legalization on the state-level proportion of criminal justice referrals as a share of all admissions.
Nationwide, the number and proportion of adolescent and young adult criminal justice referrals to CUD treatment declined over the study period. The proportion of young adult criminal justice referrals declined significantly more rapidly after recreational legalization as compared with before ( β = -0.045; 95% confidence interval, -0.079 to -0.010; P = 0.01). Among adolescents, the trajectory of decline in the proportion of criminal justice referrals did not change significantly following recreational legalization ( β = -0.033; 95% confidence interval, -0.073 to 0.008; P = 0.11).
The decline in the proportion of young adult criminal justice referrals to CUD treatment following recreational legalization is likely due to falling cannabis-related arrests. Although cannabis criminalization may result in court-mandated CUD treatment for some young adults without CUD, the decline in CUD treatment admissions during a period of increasing CUD risk factors associated with recreational legalization represents a key health concern. Promoting screening and other CUD treatment referral sources, such as through primary care, may be warranted.
本研究旨在调查自 2008 年至 2019 年美国各州休闲（成人使用）大麻合法化后，青少年（12-17 岁）和年轻成年人（18-24 岁）因刑事司法系统转介大麻使用障碍（CUD）治疗的比例是否有所下降。
从治疗发作数据集-入院中提取大麻使用障碍治疗转介数据，用于计算刑事司法转介数量和比例的趋势。差异中的差异分析用于估计休闲合法化对州一级刑事司法转介比例作为所有入院人数的比例的影响。
在全国范围内，青少年和年轻成年人因刑事司法系统转介 CUD 治疗的人数和比例在研究期间呈下降趋势。与休闲合法化之前相比，年轻成年人因刑事司法转介的比例下降速度明显更快（β=-0.045；95%置信区间，-0.079 至-0.010；P=0.01）。在青少年中，休闲合法化后刑事司法转介比例的下降轨迹没有明显变化（β=-0.033；95%置信区间，-0.073 至 0.008；P=0.11）。
休闲合法化后年轻成年人因刑事司法系统转介 CUD 治疗的比例下降可能是由于与大麻相关的逮捕人数下降所致。尽管大麻刑事定罪可能导致一些没有 CUD 的年轻成年人因法院命令接受 CUD 治疗，但在与休闲合法化相关的与 CUD 风险因素增加的时期，CUD 治疗入院人数下降代表了一个关键的健康问题。通过初级保健等途径，促进 CUD 筛查和其他 CUD 治疗转介来源可能是必要的。
