Furthermore, the number of dispensaries the cities in LA County have so far allowed may not have reached the threshold where their number has had an effect on the marijuana use behaviors of the adolescents who live/attend school there, but as licensing for recreational outlets proceeds the number of dispensaries in many LA County cities is increasing or is planned to increase. For example, the City of Los Angeles Department of Cannabis Regulation estimates that an additional 200 licenses for retail storefronts will be able to be given out under current regulations. When added to the 170 existing medical marijuana dispensaries currently permitted by the City there will be close to 400 licensed dispensaries operating in the City of Los Angeles. Continued research on the impact to youth and other vulnerable populations as increasing numbers of recreational marijuana use outlets are licensed in LA County cities is crucial to determine their effects compared to medical marijuana outlets. It will also be important to monitor cities’ progress in reducing the number of unlicensed dispensaries and how this may impact adolescent marijuana use and other health and safety outcomes. Although it may have raised as many questions as it has answered, it has also hopefully resulted in some useful findings about the impact of local policy implementation on adolescent marijuana use. The most important implication for policy and practice identified here is the importance of local enforcement. The example of the City of Los Angeles was first to tolerate dispensaries under state law,bud drying rack but the lack of enforcement from the state combined with what was a very underdeveloped regulatory structure instead resulted in the presence of dispensaries having unwanted impacts on youth and public health. In Los Angeles it took many attempts and a voter mandate from a ballot measure to develop and implement an adequate regulatory approach with Proposition D.
Then it took time and the dedication of staff and financial resources in enforcement to make it successful. The decline in rates of marijuana use after Proposition D was enacted show that it is possible to take an out of control marijuana market in hand and that doing so can have a preventative impact on youth use. However, the experience of the City of Los Angeles also indicates that a complete ban on dispensaries is not necessary to curb undesirable outcomes. Instead it suggests that a robust local regulatory structure may allow for adult access to marijuana while reversing trends of marijuana use among adolescents and, by extension, health harms. Cities that allow dispensaries are forced to balance the tax and potentially other economic gains that can come from hosting marijuana businesses with the potential costs of enforcing marijuana regulations and the potential harms that dispensaries could cause. Many cities may have not been willing to take on the challenge, which could be one reason why most of the cities in LA County have enacted bans on dispensaries. However, preventing youth use is also a frequently mentioned reason for banning dispensaries, if not always the primary reason . The results of this study suggest that allowing dispensaries to operate in a city may not bring about significant harm to youth as long as dispensaries are located far enough away from schools. This information should guide the cities of LA County in choosing an approach to dispensary regulation. If a city feels it has the resources to vigorously enforce a dispensary ordinance and the capacity to host dispensaries far from sensitive areas, it may make economic sense to allow a small number of marijuana outlets serve their adult residents. Furthermore, continuing to ban dispensaries does not obviate the need for enforcement, which means that cities with dispensary bans must spend resources on marijuana control without the benefit of marijuana taxes. Finally, an important finding from a forthcoming impact evaluation on medical and recreational marijuana outlets in LA County found than the numbers of unlicensed outlets has been decreasing in cities where dispensaries are allowed, while they have held steady in cities and unincorporated areas where they are banned .
Licensing a small number of dispensaries may offer cities more local control over marijuana if allowing a few marijuana outlets cuts down on the number of unlicensed outlets a city must identify and close down. It my hope that by using evidence-based policy we can create an environment where the young people of LA County will use marijuana less and later. With this research my aim was to determine the effectiveness of a common approach to dispensary regulation, dispensary bans, on preventing adolescent marijuana use. It also aimed to build on our understanding of how city policies like dispensary bans can be effective, whether it is by their association with a lower number of dispensaries in a city, with increasing perceptions of the risk of marijuana use among young people, with a greater distance between schools and dispensaries, or with a lower number of dispensaries located near schools. Although this analysis shows that enacting and enforcing strict controls on marijuana outlets can have a preventative impact on a city’s students, dispensary bans were not found to have an independent association with lower rates of marijuana use in cross sectional analyses. Given that minors ostensibly cannot access marijuana directly from storefront dispensaries, it may not be surprising that city ordinances that allow storefront dispensaries should have little substantive effect on adolescents’ marijuana use. I hypothesized that dispensary bans would make access to marijuana less convenient for adults on a city level, which in turn could impact availability for youth, but there are many alternate sources for marijuana available to adults other than a dispensary in their city. There was also substantial variation in enforcement among the cities in LA County that have enacted dispensary bans, where some do not seem to have the resources or political will to enforce them. In the absence of rigorous enforcement to prevent unlicensed outlets, city bans on storefront marijuana outlets are evidently more symbolic than effective. Although the number of dispensaries in a city was not significantly associated with student marijuana use, future research should monitor adolescent marijuana use rates as the number of dispensaries in cities increases with additional adult use/non-medical outlets. There may be a threshold effect for the ratio of dispensaries per resident that a city can host without a concomitant increase in adolescent marijuana use, but this threshold is unknown to date.
Furthermore, increased density of outlets can have other undesirable effects such as marijuana abuse and dependence among adults . The multivariate analyses presented here also found little evidence for an effect of dispensary bans on young people’s attitudes toward the risk of marijuana use. Instead these attitudes seem to be driven by other factors that were not measured in this study. Therefore,grow solutions greenhouse it appears that cities may be better served worrying about their capacity to enact tight regulations on dispensaries and to enforce them than being concerned whether enacting an ordinance allowing dispensaries will send a message to young people that marijuana use is safe and acceptable and thus encourage use. The most potent effects on student marijuana use were related to the proximity of unlicensed outlets. The negative association between dispensary bans and student marijuana use, was significantly dependent on dispensary bans being associated with a greater distance to the nearest dispensary in the County compared to city dispensary policies that allowed dispensaries. The continuous distance to the nearest dispensary had a powerful association with students’ marijuana use within LA County, at one mile, and at short distances such as 2,000 feet. These local effects prove the primary importance of keeping unlicensed outlets much farther away from schools than current regulations in any city in LA County require. Future policy efforts should place greater importance on preventing the localized effects of unlicensed outlets and explore different approaches, such as clustering dispensaries in industrial zones or other areas far from the business and residential neighborhoods where schools are found. Together these findings support a rigorous but nuanced approach to regulating marijuana outlets. It is evident that enforcement was key in preventing marijuana use among the youth in this study. Whether a city allowed dispensaries or not, the presence of unlicensed dispensaries seemed to drive associations with youth marijuana use, indicating that the quality of enforcement is more important than the kind a policy a city chooses. Future research should focus on minimizing the localized effects of unlicensed dispensaries and undertake to better understand why unlicensed outlets have such a disparate impact on youth marijuana compared to licensed outlets. Marijuana is the most frequently used illicit drug in America, with an estimated 18.9 million people aged 12 years or older identifying as current users in 2012. The prevalence of marijuana use has increased since 2002, and this trend can be expected to continue as states enact policies to permit medicinal or recreational use. Despite the growing movement to legalise marijuana, however, little is known about its effect on metabolic health.
Research on the association between marijuana use and various metabolic indices suggests a paradox in which greater marijuana use is associated with increased caloric consumption, but with decreases in the levels of various metabolic risk indices, including BMI, waist circumference , fasting insulin and HOMA-IR. A recent meta-analysis of eight studies suggested that current cannabis smoking is associated with 30% lower odds of diabetes. However, previous studies have been limited to cross-sectional analyses and might have lacked proper adjustment for confounding. A prospective assessment of health outcomes in relation to prior marijuana use would limit the potential bias that might result from individuals’ decisions to alter marijuana exposure based on their own health status. The purpose of this study was multifaceted. First, we aimed to assess the association between self-reported marijuana use and prediabetes and diabetes mellitus using cross-sectional and prospective analyses, considering both status and quantity used. Second, we aimed to examine the role of BMI and WC as potential confounding or mediating factors of these associations. Finally, given the varying diabetes risk profiles by race and sex, we sought to evaluate the heterogeneity of effects in the associations by race and sex.The Coronary Artery Risk Development in Young Adults study is a longitudinal observational study intended to investigate the development of coronary artery disease risk factors in four healthy metropolitan populations of black and white adults aged 18–30 years at recruitment. Participants were contacted by telephone annually and invited to participate in follow-up examinations at 2, 5, 7, 10, 15, 20 and 25 years after enrolment. Demographic information was obtained, BP and chemistries were measured, and anthropometry and structured questionnaires on manifold health characteristics were conducted, following standardised protocols that were harmonised over time. The institutional review board at each study site granted approval, and informed consent was obtained from the 5,115 participants at enrolment in 1985–1986 and at each follow-up examination. Details of the study design have been published previously. Individuals were asked to present in a fasting state on the morning of their clinical examination and to forgo tobacco use and strenuous physical activity . Appointments were generally scheduled to begin between 08:00 hours and 12:00 hours. At each clinical examination, individuals were asked to update their sociodemographic information and were questioned about their medical and family history and individual lifestyle characteristics, including educational attainment, tobacco use , regular alcohol consumption, and moderate and strenuous physical activity. A valid and reliable metric for leisure-time physical activity was developed by CARDIA researchers, as previously described. Venous blood was drawn and serum separation was performed, following which aliquots were stored at −70°C and shipped on dry ice to a central laboratory. Serum glucose was measured using the hexokinase method, and per cent HbA1c was assessed using Tosoh G7 HPLC and standardised across examinations. The 2 h serum glucose levels were measured from a standard 2 h OGTT at Y10, Y20 and Y25. Procedures for collection, storage and determination of plasma lipids and C-reactive protein have been previously described.