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Alcohol Use Rises When States Legalize Cannabis, Study Finds

By Alexander Beadle

Published: Nov 25, 2022   
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The implementation of recreational cannabis laws may be associated with increased alcohol use, according to a new study published in JAMA Health Forum.

The researchers, from the University of Pittsburgh and William Patterson University Departments of Economics, studied annual data from a nationwide behavioral survey over the past decade. They found a small, but significant, increase in alcohol use following the passage of state-level recreational cannabis laws. However, binge drinking and heavy drinking rates were unaffected.

Based on their findings, which indicate that increased alcohol use may be an unintended consequence of cannabis legalization, the researchers suggest that policymakers may wish to consider this knock-on effect when implementing further legalization or reform policy.

Rising alcohol use driven by younger demographic

This new cross-sectional study examined data recorded by more than 4.2 million individuals who responded to Behavioral Risk Factor Surveillance System (BRFSS) telephone surveys between 2010 and 2019.

Past-month alcohol use is measured in the BRFSS using three different questions. Firstly, any alcohol use in the past month is recorded, with additional questions intended to assess binge drinking behaviors and heavy drinking, which, for men, is defined as having more than 14 drinks per week and, for women, more than seven drinks per week.

Using a difference-in-difference approach – which compares the changes in outcomes seen in a “treatment” group against the changes seen in a control group over time – the researchers tested if there were any associations between the passing of state-level recreational cannabis laws (RCLs) and subsequent changes to alcohol use in the general population.

They found that RCLs were associated with a 0.9% increase in any reported drinking among adults. Further examinations revealed that this increase was primarily driven by increased alcohol use among adults aged between 18 and 24 years, as well as non-Hispanic White people, men, and individuals without a college education.

While there were no associations seen between RCLs and binge drinking at the overall population level, the researchers did find an increase in binge drinking among men immediately following RCL implementation, though this relationship dissipated over time.

Altogether, the researchers say that their findings suggest that increased alcohol use, specifically among young adults and men, may be an unintended consequence of recreational cannabis legalization.

Studying cannabis and alcohol use

The risks of both cannabis and alcohol have been studied individually, at length. However, it is much less common for academic study to focus on the co-use of both substances. Studies that have examined this relationship to date have found that co-use may increase the probability of unsafe driving, as well as impulsivity leading to other possible dangerous behaviors.

Studies investigating the association between cannabis policy and alcohol use have so far not led to any concrete conclusions.

This latest work would imply that cannabis and alcohol are economic complements, if just to a small extent. This means that as demand for one substance increases, so does the other. This trend has been seen in other studies, notably a cross-sectional study on college-age students, which found that making alcohol more expensive to access (thus decreasing demand) also decreased participation in cannabis use.

However, other studies have found the opposite: that cannabis and alcohol act as substitutes. For example, one study that used a regression discontinuity design found a significant increase in alcohol use and a decline in illicit cannabis use as young people reached the legal drinking age.

The researchers behind this latest JAMA Health Forum study view the debate around cannabis legalization and alcohol use as a balancing act. On one hand, frequent and excessive cannabis use may present its own set of health-related costs, such as developing a cannabis use disorder. But on the other hand, it may also have benefits, such as the treatment of intractable epilepsy.

“An expanding literature suggests, albeit not conclusively, that cannabis legalization may reduce opioid use and associated risks,” the researchers wrote. “However, our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men.”

“As more data from the postlegalization period becomes available, cost-benefit analyses would be immensely informative to the debate surrounding cannabis legalization, as would additional studies on the relationship between RCLs and alcohol use,” the study authors conclude.

The consequences of legalization

In addition to studying how cannabis legalization affects the use of other substances, researchers are also tackling the more general, yet equally complex, question of identifying how cannabis legalization itself is affecting the general population.

In late 2021, researchers from Montana State University published a paper claiming that cannabis legalization does not seem to encourage adolescent cannabis use. However, at least two readers of the paper noticed that there were flaws in how the data used in the study had been pooled.

The researchers accepted the errors and apologized in a letter published earlier this year. Their paper was also subsequently retracted and replaced with a corrected version. Despite the change to the study methods, the researcher’s original key conclusion remained unchanged; they did not find any evidence to suggest that legalization increased adolescent cannabis use.

While researchers continue to examine how legalization affects the general population, cannabis legalization may have a significant impact on man’s best friend, according to researchers at the University of Guelph, Ontario.

After surveying more than 200 practicing veterinarians in Canada and the United States, and examining reports of cannabis-related poisonings in pets, the researchers found that there was a significant increase in poisoning events following the nationwide legalization of cannabis in Canada in 2018. However, most of these events were deemed to be non-serious and were easily treated as outpatient cases.


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