Belackova Vendula, Petruzelka Benjamin, Cihak Jakub, Michailidu Jana, Mravcik Viktor
Social Policy Research Centre, Arts, Design & Architecture, University of New South Wales, Sydney, Australia.
Department of Addictology, General University Hospital in Prague, Prague, Czech Republic; Department of Addictologsy, First Faculty of Medicine, Charles University, Prague, Czech Republic.
Int J Drug Policy. 2025 Aug;142:104796. doi: 10.1016/j.drugpo.2025.104796. Epub 2025 May 19.
Several jurisdictions have pursued reforms that regulate cannabis production and/or sale for adult (non-medical) use. Looking at outcomes of such reforms across multiple jurisdictions may help to identify outcomes that are inherent to non-criminal cannabis supply, as well as provide insight into the outcomes of specific regulation models.
We identified nine indicators of cannabis policy outcomes and aggregated them into three domains (social outcomes, outcomes in cannabis use, health-related outcomes). We assessed these outcomes across five jurisdictions with different models of regulating cannabis supply (Netherlands, Spain, U.S. states that legalized cannabis, Uruguay, and Canada). We used a three-level systematic literature review, prioritising studies with quasi-experimental design (i.e. comparative and longitudinal). We categorised the studies according to their design and the type of outcome (increase, decrease, or no outcome).
Across long-standing as well as recent cannabis supply regimes, and across different models of cannabis supply, our review identified common outcomes: a decrease in cannabis-related arrests, an increase in adult (but not adolescent) cannabis use, and increase in healthcare utilization (not traffic-related). Negative health-related outcomes were most consistently found for the U.S. states that legalised cannabis for adult non-medicinal use (there were limitations to nuancing cannabis supply models across U.S. states). In the remaining jurisdictions (the Netherlands, Spain, Canada, Uruguay), the design or time-frame of the identified studies was limited, and studies on certain outcomes were lacking.
Regulating cannabis supply may be associated with benefits in the social area and with potential harms regarding public health; there may though be trade-offs depending on the choice of a cannabis regulation model. Jurisdictions may attempt to mix and match the present models of cannabis regulation to achieve the best ratio of benefits and harms. More research into the specific parameters influencing cannabis policy outcomes is needed.
多个司法管辖区已推行改革，对大麻生产和/或销售进行监管，以供成年人（非医疗用途）使用。审视多个司法管辖区此类改革的结果，可能有助于识别非刑事大麻供应所固有的结果，并深入了解特定监管模式的结果。
我们确定了大麻政策结果的九个指标，并将其汇总为三个领域（社会结果、大麻使用结果、健康相关结果）。我们在五个采用不同大麻供应监管模式的司法管辖区（荷兰、西班牙、大麻合法化的美国各州、乌拉圭和加拿大）评估了这些结果。我们进行了三级系统文献综述，优先考虑采用准实验设计（即比较性和纵向性）的研究。我们根据研究设计和结果类型（增加、减少或无结果）对研究进行分类。
在长期以及近期的大麻供应制度中，以及在不同大麻供应模式中，我们的综述确定了常见结果：与大麻相关的逮捕减少、成年人（而非青少年）大麻使用增加、医疗保健利用率提高（与交通无关）。对于将成人非医疗用途大麻合法化的美国各州，最一致地发现了与健康相关的负面结果（在美国各州细微区分大麻供应模式存在局限性）。在其余司法管辖区（荷兰、西班牙、加拿大、乌拉圭），已确定研究的设计或时间框架有限，并且缺乏关于某些结果的研究。
监管大麻供应可能在社会领域带来益处，但在公共卫生方面可能存在潜在危害；不过，根据大麻监管模式的选择，可能需要进行权衡。司法管辖区可能会尝试混合搭配当前的大麻监管模式，以实现最佳的利弊比例。需要对影响大麻政策结果的具体参数进行更多研究。
