Cannabis Grow

During this 13-month period, medicinal retailers continued selling cannabis to state residents with up-to-date recommendations from physicians.However, some medicinal cannabis businesses faced unusual local challenges in 2017 as some cities and counties that were opposed to the establishment of an adult-use cannabis industry restricted or banned all cannabis operations from their jurisdictions.On January 1, 2018, all cannabis businesses that had not applied for temporary licenses from state agencies became illegal from the point of view of the state.The Bureau of Cannabis Control, the California Department of Food and Agriculture, the California Department of Public Health and other state agencies propagated regulations that implemented most parts of a regulatory structure that merged AUMA with previous medicinal cannabis legislation.As of January 1, 2018, licensed distributors were required to pay a 15% state excise tax on all medicinal and adult-use cannabis sold at retail, and licensed growers were expected to pay a cultivation tax of $9.25 per ounce for any cannabis that entered legal market channels in 2018.In some counties and cities, additional local taxes were imposed.All licensees were also required to follow costly new regulations governing security, age verification, handling, labeling, child-proof packaging, inventory storage and “seed-to-sale” tracking — but not yet mandatory testing, one of the costliest elements of the new regulations.A final regulatory point worth noting is that since the launch of adult-use sales in January 2018, the California cannabis retail environment has drawn little distinction between medicinal and adult-use cannabis, and we do not distinguish between the two in our reporting of retail prices.

There are some differences between the medicinal and adult-use systems: Retailers need separate medicinal pot for growing marijuana permits to sell medicinal cannabis; the minimum age for purchasing medicinal cannabis is 18 instead of 21; the maximum quantity that may be purchased is 8 ounces instead of 1 ounce; and purchases are exempt from sales tax if the customer has a medicinal recommendation and a county-issued medicinal ID card.However, the cannabis supply for adult-use and medicinal sales is interchangeable.Medicinal and adult-use cannabis are subject to the same testing, labeling and packaging standards.In general, the only substantial cost faced by a medicinal cannabis retailer who enters the adult-use market is an additional license fee.Meanwhile, the potential market for medicinal retailers is severely limited because consumers of medicinal cannabis, if they wish their purchases to be exempt from sales tax, must obtain county identification cards for medicinal cannabis in addition to medical recommendations — at a combined cost of up to $100 per year.With adult-use cannabis now widely available, many consumers who participated in the medicinal market in 2017 chose not to renew their medicinal recommendations in 2018.From an economic perspective, the 2018 California cannabis market is thus more usefully viewed as a single market than as separate adult-use and medicinal markets.The leading source of publicly available data on U.S.cannabis retail prices is Weed maps, an internet platform that enables retailers in California and other states to publish and update their price lists, locations and other practical information on a standardized consumer-facing website and app.Weed maps has operated since 2008.Researchers have used it to study the California cannabis industry since well before the autumn of 2016, when AIC researchers first gathered information from the site.For instance, Freisthler and Gruenewald used Weed maps listings to study the industrial organization of cannabis retailers in California.Weed maps listings do not collectively represent the full California retail landscape.

We found no reliable estimates of the percentage of California retailers listed on Weed maps.But because retailers may add or remove listings from Weed maps for business or marketing reasons other than opening or closing, Weed maps provides incomplete and constantly changing coverage of California’s retail cannabis market.Bierut et al., another study that uses Weed maps data, finds that Weed maps includes about 60% of retailers in Colorado and 40% of retailers in Washington, but does not analyze California retailers on Weed maps.This uncertainty should be kept in mind when interpreting our data.We began gathering price data from Weed maps in October 2016.We recorded prices by product type and also collected information on retail sales locations and whether retailers were storefront or delivery-only operations.We collected only the minimum and maximum listed price for three of the most common cannabis products.Many retailers listed a price schedule with just two levels for each product type: entry-level and “top-shelf” prices.Some retailers maintained three to four price levels, but during the first year of data collection, we rarely encountered more than five levels.With or without intermediate prices, we had no access to information about quantities sold and could not construct quantity-weighted average prices.Moreover, cannabis strains and forms of packaging were often specific to individual retailers, and measures of specific brand or product characteristics were not consistently available on Weed maps.Considering that not all retailers list prices on Weed maps, and that some retailers who at some point listed prices on Weed maps might have removed their listings while continuing to conduct business, we supplemented our data set with prices from Leafly, a competing cannabis portal whose functionality and business model are similar to those of Weed maps.In particular, we turned to Leafly when Weed maps price information was not available for retailers whose prices we were already tracking — or, in later rounds of data collection, from retailers that had obtained licenses from the Bureau of Cannabis Control to operate in the regulated 2018 environment.Coverage provided by Weed maps and Leafly is partly overlapping: Some retailers list prices on both portals whereas others list prices only with one service or the other.To test for bias that might result from the inclusion of Leafly prices as part of our data set, we compared Weed maps and Leafly average minimum and average maximum prices in a sub-sample of non-overlapping retailers, controlling for package size, and we found no statistically significant differences between Weed maps and Leafly average minimum and average maximum prices.All retailers listed prices for one-eighth ounce of packaged flower.Not all retailers listed prices for 1 ounce of packaged flower or 500-milligram oil cartridges.

In later rounds of data collection, the share of retailers listing prices for 1 ounce of flower was smaller and the share of retailers listing prices for 500 milligrams of oil was larger.For instance, in October 2016, 90% of the 542 retailers listed prices for 1 ounce of flower and 57% listed prices for 500 milligrams of oil.In August 2017, 91% of retailers still listed prices for 1 ounce of flower and 82% listed prices for 500 milligrams of oil.By July 2018, only 49% listed prices for 1 ounce of flower and 89% listed prices for 500 milligrams of oil.The decrease in prevalence of 1-ounce packages might be associated with the introduction of regulations in January 2018 requiring that all cannabis be pre-packaged and pre-labeled, such that after January 2018, retailers might incur extra inventory risk by prepackaging cannabis in 1-ounce packages.The increase in prevalence of 500-milligram oil packages, on the other hand, might be best explained by the opening and expansion of the adult-use market.Vape pens, which are comparatively easy to use and do not require additional paraphernalia or prior experience with cannabis , may have greater appeal to “cannabis novices” than dried flower.In the interest of space, we do not list individual sample sizes for each price average in each round of data collection.During the first two weeks of October 2016, we collected prices, retailer locations and other information from each of 542 cannabis retailers on Weed maps in seven counties around California.We chose these counties to serve collectively as a reasonable approximation of the statewide market.We call this initial group of 542 retailers the “seven-county sample.” The seven counties cover a wide range of geographic and economic conditions in California.According to the U.S.Census Bureau , their basic demographics as of 2016 were in the aggregate similar to the demographics of California as a whole.The seven counties are shown in table 1.Summary statistics provided in table 1 support the notion that the demographic and economic characteristics of the sample are similar to those of California as a whole.Within the sample, the collective population is 42% Latino, 33% non-Latino white, 16% Asian and 8% black and the per capita income is about $30,600.Collectively, as of 2016, the seven counties included approximately half of the state’s population.In January 2017, March 2017 and August 2017, we collected three new rounds of prices from the seven county sample.In each of these three rounds, we collected prices from all of the retailers in the original October 2016 group that still listed price data on Weed maps or Leafly.In order to continue tracking as many of the original 542 retailers as possible, we attempted to follow businesses that moved to new locations or that temporarily closed and then re-opened.We coded retailers by county, city and phone number.When a retailer’s listing disappeared, container for growing weed we searched for other listings under the same name or phone number.When we found the same retailer or a branch of the same retail chain elsewhere in the same county, we kept the retailer in the data set.If a retailer disappeared and then reappeared in a later round of data collection, we kept it in the data set.

If a retailer removed its online price list, or moved its only location outside the original seven counties, we removed it from the data set for that data collection round.Between January 2017 and August 2017, we observed significant attrition from the initial group of 542 retailers in the October 2016 seven-county sample.By August 2017, 389 of the original 542 retailers remained in the data set.As shown in tables 2 and 3, average prices for these retailers changed little during this 11-month period.We call this “attrition” because the data collection method was consistent over this time period.In our 2018 rounds of data collection, we impose the additional condition that retailers must be licensed, thus changing the data collection method.Thus, for 2018 data collection rounds, the percentage of retailers dropping out of the data set from the original October 2016 sample of 542 retailers should not be thought of as “attrition.” Some retailers may have removed their online price lists from both Weed maps and Leafly but continued to operate.Attrition from the initial 542 retailers thus should not be interpreted solely as a measure of how many cannabis retailers left the legal cannabis segment.In January 2018, mandatory licensing laws went into effect, thus rendering illegal under state law any cannabis retailer without a temporary license from the Bureau of Cannabis Control.We verified licensing status by cross-referencing all Weed maps and Leafly listings in California with the publicly available lists of temporary licenses granted by the Bureau of Cannabis Control.If both a Weed maps and a Leafly listing were found, we used the Weed maps data and dropped the Leafly data.In computing averages for our last three data collection rounds , we calculated “legally marketed” minimum and maximum price averages at California cannabis retailers that listed prices on Weed maps and that had obtained temporary licenses to sell cannabis in compliance with state regulations at the time of each data collection round.For comparative purposes, we also collected a sample of about 90 unlicensed retailers in 20 counties from Weed maps or Leafly, distributed similarly to the licensed retailers.We chose these retailers from within a set of 20 representative counties, approximately in proportion to the relative populations of those counties.We selected retailers for this “20-county unlicensed sample” arbitrarily from the first page of search results on Weed maps for retailers in each of the 20 counties, but we did not use mathematical randomization to select the counties or the listings we chose within counties.These data may not be fully representative of legal cannabis price ranges for several reasons.First, as discussed above, not all legal retailers use Weed maps or Leafly, and prices may not be representative of all prices.The price data we collected also may not fully represent the range of products in the market, which may have varied in different rounds of data collection.As is suggested by the changing prevalence of 1-ounce flower packages and 500-milligram oil cartridge packages, product assortments may have changed within each of these categories.This problem plagues price data in many different industries, but changes in product assortments and price listings may have been especially rapid in the emerging cannabis market.

With the majority of U.S.states having adopted legislation to medically and/or recreationally legalize cannabis, the already high prevalence of cannabis use is expected to further increase nationwide, especially among existing users.States that allow the legal use of cannabis for medicinal purposes have higher rates of cannabis use and cannabis use disorder in national survey data and specifically within the Veterans Health Administration.Veteran advocacy groups have been created to further veterans’ rights to access cannabis for medical purposes and discuss its use with their VHA providers.There are also published reports that veterans perceive cannabis to be a low-risk or safe substance unlike other drugs of abuse and expect cannabis to provide relief from symptoms of combat-related trauma.However, there has been little research on the patterns and correlates of MC use specifically among veterans.Growing research indicates that rates of cannabis use and CUD are particularly elevated among veterans with post traumatic stress disorder and major depressive disorder.These individuals are particularly likely to use cannabis as a means of coping with negative affect and with sleep disturbances.Nonveter an research also identifies cannabis use as an emotion-regulatory strategy to reduce or manage perceived aversive psychological and mood states.However, although such sleep and emotion regulation motives are commonly endorsed reasons for non-MC use among veterans in general, little is known about potential differences in motives among veterans using MC relative to those using cannabis recreationally for non-medical reasons.Motivation for MC use has been examined in non-veteran populations , with the most commonly endorsed reasons for use being pain, anxiety, and sleep problems.Besides pain management, relief of anxiety, especially PTSD, appears to be a prevalent motive for MC use in community samples and among veterans.Indeed, PTSD is now recognized as a qualifying condition by the majority of states permitting legal access to medicinal cannabis.

Sleep disturbance,grow cannabis particularly in conjunction with PTSD, is associated with more frequent and more problematic use of cannabis in non-veteran samples and with frequent cannabis use and CUD among veterans.Thus, MC use may be driven by specific motives for use that are inter-related with certain comorbid conditions that are particularly prevalent in veteran populations.Medical dispensary patients also report using cannabis as a substitute for prescription medication and for alcohol , with the most common motives for using cannabis instead of alcohol or illicit or prescription drugs being fewer perceived side effects, better symptom management , and decreased severity of withdrawal with cannabis.Indeed, the vast majority of MC patients self-report at least moderate symptom relief across all conditions.Preliminary prospective research found a 42% reduction in use of prescribed opiates over 3 months following the initiation of MC treatment.Yet, cannabis used specifically for pain management among MC users is significantly associated with past history of more severe substance use patterns including use of alcohol, illicit drugs, and non-prescribed pain relievers.In contrast to the growing literature on MC use, only a few non-veteran studies explicitly compared MC and RC users on cannabis-related behaviors and motives.MC users were found to have poorer health but lower levels of alcohol and drug use disorders relative to RC users.Compared with RC users, MC users have reported lower frequency of alcohol and drug problems during a visit to the emergency department and primary care clinic.Among MC users, patients with state legal access to cannabis had lower rates of other substance use relative to cannabis users without access to MC who might have used cannabis recreationally.To date, there has been little research on MC use in veteran populations, with only one study differentiating between MC and RC use in veterans.Findings from this online survey of veterans recruited from a pro-marijuana legalization listserv showed that MC users had more PTSD symptoms and greater combat exposure than RC veterans as well as lower levels of alcohol use.Veteran research can greatly inform federal and state cannabis-related policies, which are in constant flux yet shifting toward more tolerant practices regarding MC use within the VHA.These policies are especially relevant to returning veterans from the Operation Enduring Freedom/ Operation Iraqi Freedom/Operation New Dawn conflicts, because they have endured high stress levels due to their military experiences and post deployment reintegration problems.Like non-veteran MC users, OEF/OIF/ OND soldiers, particularly those with PTSD, also report poor general health and increased somatic symptoms such as chronic pain , greater medical services utilization , and worse sleep.

Anecdotal reports indicate returning veterans also use cannabis as a substitute for other prescribed and non-prescribed substances and may perceive cannabis to be less harmful than opioids.Therefore, both actual and perceived poor health combined with increasingly favorable attitudes toward cannabis among veterans may further increase the likelihood of OIF/OEF/OND veterans seeking MC.In summary, use of MC within the VHA is a growing clinical issue.However, there is a dearth of studies differentiating MC versus RC use patterns and correlates in veterans, despite their disproportionately higher rates of PTSD, anxiety, sleep, and chronic pain diagnoses relative to the general population.The present study has two aims.First, we describe the characteristics and motives for past year MC use in a sample of returning veterans.Second, we compare past-year MC versus RC users on socio-demographic factors and diagnostic characteristics, substance use, motives for cannabis use, and physical and mental health variables.MC use was determined by veteran self-report of using cannabis for medicinal purposes, regardless of whether a veteran possessed a medical marijuana registration card.Frequency of marijuana use was covaried in these analyses because MC users typically endorse daily or almost daily patterns of use.We hypothesized that MC veteran users would endorse more salient coping and sleep cannabis use motives relative to RC users as a means of coping with psychiatric and medical conditions.These comparisons between MC and RC users can inform the development of future VHA policy as well as current screening, assessment and clinical practices with OIF/OEF/OND veterans.To our knowledge, this is the first study to compare MC and RC users in a sample of veterans enrolled in a VHA facility.Results indicated that the most frequently endorsed conditions for MC use were anxiety, stress, PTSD,pain, depression, and insomnia.Consistent with findings from non-veteran studies, this veteran study demonstrated that MC users endorsed worse physical and mental health functioning relative to RC users.MC users were three times more likely to meet criteria for PTSD than RC users, adjusting for frequency of cannabis use, which varied across the two groups.As hypothesized, the greatest difference between MC and RC users was found for sleep as the reason for cannabis use.Furthermore, this difference remained and was one of the two significantly different motives when adjusting for frequency of use.Mental health concerns were highly prevalent in this veteran sample, in contrast to previous findings identifying pain as the most prevalent qualifying condition among non-veteran MC users.Specifically, more MC users endorsed anxiety and PTSD than chronic pain and other psychological conditions.As mentioned previously, sleep emerged as one of the most important motives for MC use, along with using for relaxation reasons and to relieve PTSD.This is consistent with other studies , indicating that sleep motives are the most robust significant mediating factor underlying the relations between both PTSD with cannabis use and increased risk of CUD.

Furthermore, MC users were more likely to meet criteria for current and lifetime diagnosis of PTSD than were RC users.One prior online survey of veterans similarly demonstrated that, relative to RC users, MC users endorsed more PTSD symptoms on a PTSD screening checklist and reported greater combat exposure and greater subjective arousal to items on the PTSD screen.These findings are not surprising given the high prevalence of PTSD among veterans using indoor cannabis grow system and with increasing number of MC users endorsing PTSD symptoms and/or history of trauma.Although controlled evidence on effectiveness of MC as PTSD treatment is currently lacking, preliminary research indicates cannabinoid receptor agonists to have beneficial effects in terms of relief from PTSD symptoms.Clearly, data from clinical trials is needed to help clarify whether cannabis helps relieve PTSD symptoms or whether it iatrogenically maintains some aspects of PTSD.Evidence in support of the endocannabinoid system’s therapeutic potential in the modulation of stress response may help stimulate the sorely lacking empirical research on the use of cannabis for psychological distress and sleep problems.Additional findings regarding MC users are worth noting, especially in the context of acquiring and using cannabis.For example, although 62% of MC users reported having a medical condition that would qualify them for a medical marijuana registration card in their state, only 24% reported having obtained one.One possible explanation for this discrepancy that we can posit from our data is that nearly 26% of MC users reported that they refrained from discussing medical cannabis with their doctor out of concern that doing so may get them into trouble and/or negatively affect their benefits and services at the U.S.Department of Veterans Affairs.Veterans also indicated they can more easily access cannabis from a source that does not require a state-issued medical card or that they obtained cannabis from someone else who had a medical marijuana card.Factors contributing to this may include prohibitive costs of maintaining a medical marijuana registration or higher prices of cannabis sold legally in dispensaries than on the black market.Future qualitative research might help explicate the nature of this incongruity.As increasing numbers of mental health care providers encounter veterans who use cannabis, many may be concerned about the risk of misuse of cannabis and other substances.

Consistent with national sample data , our findings suggest that while cannabis-related problems and CUD were more prevalent among MC users relative to RC users, none of these differences remained significant in analyses controlling for cannabis use frequency.With respect to other substance use, MC users reported lower frequency of alcohol use, as compared with RC users.This finding is consistent with other studies reporting lower alcohol problem severity and lower frequency of drug use in MC users relative to non-medical cannabis users.Groups differed specifically in terms of the frequency of alcohol consumption but were similar in terms of quantity of alcohol used once frequency of cannabis use was controlled in the analyses.Furthermore, alcohol was the only significant cannabis-use motive more frequently endorsed by RC relative to MC users in the analyses adjusted for frequency of cannabis use.Consistent with the finding on higher frequency of alcohol use, alcohol-intoxication motives reflect greater prevalence of problem alcohol use among RC as compared with MC users.Of note, while MC users reported using cannabis at least half of the time or more as a substitute for prescription medication, they did not use it as a substitute for alcohol or other drugs as often.These findings are consistent with other studies indicating significant history of past alcohol, drug and prescription substance use and misuse among MC users , with evidence from other studies suggesting cannabis is often effectively used as a harm reduction strategy to substitute for alcohol, opiates, and other drugs.For example, among Canadian medical cannabis dispensary patients, over 36% were found to report using cannabis as a substitute for illicit drugs, 41% reported using cannabis as a substitute for alcohol, and nearly 68% reported using cannabis as a substitute for prescription drugs.The most commonly endorsed reasons for substituting cannabis for the previous substances included the belief that cannabis led to less withdrawal, produced fewer side effects, and provided better symptom management.Recommendations for substance use disorder treatment providers of veterans using MC in VHA and seeking SUD treatment are limited because of the dearth of clinical trials on the impact of MC use on the effectiveness of addiction treatment combined with equivocal findings on the effect of cannabis on alcohol and drug treatment.specifically, some studies do not find negative impact of cannabis on treatment retention or compliance with opiate maintenance therapy or smoking cessation , yet cannabis has been implicated in worse outcomes in opiate and alcohol treatments.Future longitudinal studies and controlled research specifically examining the role of MC use on treatment of other SUDs is needed to help elucidate its impact on addiction treatment.Another implication of these findings is the need for more innovative treatment solutions for veterans with PTSD and sleep disturbance who may be turning to cannabis in search of relief of their symptoms.Many of the individuals with PTSD and CUD comorbidity do not have access to evidence-based integrated trauma-focused and CUD treatment.Furthermore, although MC users cited improving sleep as a central reason to use cannabis, both MC and RC users had endorsed clinically significant poor sleep quality, as measured by the PSQI, despite their use of cannabis in efforts to address insomnia and sleep disturbances.

Cannabis prohibition laws were initially established in the late nineteenth and early twentieth centuries through disparate national drug control initiatives.Over the course of the nineteenth century, cannabis medical uses were regulated in a patchwork manner as part of wider legal frameworks governing the production and sale of pharmaceuticals. In the US, cannabis use began to be perceived as a social problem that should be a subject of criminal regulation during the Progressive Era.This criminalization campaign was inspired by the legislative inroads made by the temperance movement during that period and by awakening nativist sentiments toward incoming Mexican migrants, whose habits of marijuana smoking became major objects of media attention and public anxiety.In 1915, California introduced the nation’s first anti-marijuana criminal prohibition. Three decades later, such prohibitions appeared in the statute books of forty-six states and a series of marijuana-related federal offenses were included in the Marijuana Tax Act of 1937.The transnational legal ordering of cannabis regulations originated during the League of Nations era.An earlier international drug convention, signed at The Hague in 1912, focused on regulating opium, morphine, and cocaine and did not include implementation mechanisms. Under the League’s auspices, new requirements concerning the regulation of medical and non-medical uses of cannabis were introduced at the 1925 International Opium Convention. However, the pre-UN frameworks of international drug control did not place emphasis on the use of punitive measures to regulate cannabis or other psychoactive substances. Although the US had strongly advocated the introduction of a strict prohibitionist approach, this position was met with resistance from European colonial powers that had significant financial interests in the production of opium and coca and the manufacturing of their derivatives.

In the absence of an international consensus regarding the need to strengthen the criminal regulation of illicit drug use,vertical grow system the preUN drug control framework focused on the development of administrative measures to govern cross-border commodity flows and to encourage a more effective domestic regulation of local drug markets.Following WWII, the growing capacity of the US to shape the rules and institutions of the international drug control system facilitated the move of the prohibitionist approach from the periphery to the center of the policy agenda.To a considerable extent, the institutionalization of the cannabis prohibition TLO provides a paradigmatic example of what has been usefully conceptualized as “globalized localism”—a process by which policy models that originated in the distinctive cultural and institutional contexts of a powerful country come to be perceived as global standards due to their inclusion in treaties, diagnostic indicators, interpretive guidelines, and other instruments of transnational legal diffusion. The introduction of the Single Convention on Narcotic Drugs in 1961 served as an important milestone in this process.The Convention frames the issue of drug use as a moral problem, stating in its preamble that “addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind.” In line with this moralizing framing, the Convention requires signatory countries to criminalize a wide range of drug-related activities. Responding to the increasing production and use of synthetic drugs as part of the rise of the counter-cultural movements of the late 1960s, the 1971 Psychotropic Drug Treaty applied these policy principles to synthetic psychoactive drugs, such as opioids and amphetamine-type stimulants. The 1988 Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances further expanded the array of criminal justice enforcement measures states are required to adopt. Importantly, however, the mandatory criminalization norms established by the UN drug conventions are defined in a manner that leaves two major sources of textual ambiguity regarding their scope of application.

First, the conventions deliberately refrain from providing a definition of what constitutes medical and scientific uses of drugs. Second, they clarify that countries should implement the duty to criminalize drug-related activities in accordance with their domestic constitutional principles. As is often the case, these two provisions are products of efforts to paper over divergent policy preferences. During the negotiations of the Single Convention, several countries objected to banning certain drugs that have traditional and quasi-medical uses among indigenous populations. India, for example, expressed concerns regarding the implied need to criminalize traditional uses of bhang, which is made from cannabis leaves with a low Tetrahydrocannabinol content. Other countries emphasized the need to retain interpretive flexibility in light of the possibility that future research would reveal new medical benefits. The resulting compromise encouraged countries that would not have otherwise supported the prohibitionist principles set by the treaties to come on board. However, this compromise also sowed the seeds of later controversies regarding the ways in which cannabis prohibition norms should be applied. As the following discussion shows, these controversies will set recursive processes of transnational legal change in motion, leading to the settling and unsettling of specific interpretations of the scope and meaning of these norms.It is an irony of history that the first decade following the entry into force of the Single Convention experienced a marked increase in the prevalence of cannabis use in Western countries. When the Single Convention was signed in 1961, cannabis use was particularly prevalent in developing countries where the plant was traditionally cultivated, while it had little impact on mainstream culture in North America and Europe. By the end of the decade, the drug acquired unprecedented political salience not only in light of objective increases in the prevalence of its use but also due to its symbolic association with emerging countercultures and the perceived threat they putatively posed to public morality. These dramatic changes intensified the enforcement of cannabis offenses, but they also attracted heightened public attention to the negative consequences of such enforcement efforts.

In the late 1960s, there was an historical increase in the rates of arrests, prosecutions, and convictions of cannabis users in various Western countries. The magnitude of this change was most remarkable in the US. In California, for example, the number of people arrested for marijuana offenses increased from about 5,000 in 1960 to 37,514 in 1967.Arrests for cannabis possession became increasingly common in countries such as Germany, the Netherlands, and Canada as well.The civil rights implications of these increased levels of drug law enforcement generated vigorous public debate on the justifications of treating cannabis on par with other psychoactive substances that are widely perceived to be more dangerous and harmful.Disagreements regarding whether cannabis should be classified under the strictest schedules of the UN drug control treaties were already evident during the Plenipotentiary Conference, which drafted the Single Convention.However, it was only as a result of the increased enforcement of cannabis prohibitions that such disagreements precipitated domestic forms of political and legal resistance. Due to increasing public criticism, national governments in several countries appointed public committees to consider the effectiveness of the existing laws. These committees directed strong criticism towards the criminological and medical underpinnings of the prohibitionist approach and sided with proponents of the decriminalization of mild forms of cannabis use. President Nixon’s famous identification of drug abuse as “America’s public enemy number one” led to the nomination of the National Commission on Marihuana and Drug Abuse . To the surprise of many, the Commission’s 1972 Report, entitled Marihuana: A Signal of Misunderstanding, concurred with the liberal approach endorsed by other national investigation committees. While the Commission emphasized that cannabis was not a harmless substance, it stressed that its dangers had often been overstated. It advocated repealing the criminal prohibitions on the possession of small amounts of marijuana and establishing alternative measures to address the public health concerns associated with cannabis use. Such reforms, the Commission stated,mobile grow systems are needed to relieve “the law enforcement community of the responsibility for enforcing a law of questionable utility, and one which they cannot fully enforce.”These recommendations were repudiated by the Nixon administration, but they inspired grassroots activists to mobilize cannabis liberalization reforms at the state and local levels. In 1973, Oregon became the first state that decriminalized the possession of small amounts of marijuana. Eleven states followed suit during the next half of the decade.The failure of the US national administration to secure the compliance of state governments with the prohibitionist norms it sought to propagate internationally provided a clear indication of the decline of the cannabis prohibition TLO. However, rather than precipitating the global circulation of new models of cannabis-liberalization reform, this early crisis stimulated new cycles of recursive transnational lawmaking, leading to the entrenchment of the prohibitionist approach. In the US, calls to reintroduce tougher drug laws resonated with the wider conservative offensive against the putative “soft on crime” inclinations of liberal policymakers in the post-civil rights era.Opponents of legalization sought to challenge the public health frame that gained increasing influence in the wake of the Shafer Commission’s Report and to contextualize the issue of cannabis use as yet another symptom of a putative law and order crisis in American cities.

The proliferation of grassroots parents’ movements lobbying for the stricter regulation of marijuana provided considerable political momentum for the introduction of tougher penalties for trafficking and possession offenses.The process by which cannabis prohibition norms again became settled at the national level in the US provided facilitative conditions for the increasing involvement of the federal government in exporting its drug policies to other countries. This effort became increasingly consequential in an historical moment in which the US came to perceive itself “not just as a powerful state operating in a world of anarchy” but as “a producer of world order.”With the end of the Cold War, new discourses of “securitization” emerged as part of the search for a new way of grounding America’s internationalist engagement.Drug policy became increasingly aligned with national security issues pertaining to the activities of insurgent and terrorist groups in Latin American countries and to the risks posed by these groups to the democratic stability and peace in the region.This new frame of diagnosing the implications of the illegal drug trade led to the development of new modes of defining the goals of US counternarcotic policies as well as the strategies through which such goals should be pursued. These new strategies have sought to reduce drug production at the source, to combat drug trafficking en route to US borders, to dismantle international illicit drug networks, to reduce drug demand at home and abroad, and to incentivize foreign governments to cooperate with US counternarcotic goals. The institutionalization of these strategies necessitated strengthening the capacity of the US government to influence the drug policies of other countries and to dominate the transnational agenda of cannabis control. From the mid-1980s onwards, the US government institutionalized an array of multilateral, bilateral, and unilateral measures intended to coerce, induce, and socialize other countries to cooperate with its counternarcotic strategies.Its multilateral efforts have largely been based on the extensive funding and support of international and regional organizations that are committed to the prohibitionist approach. In this context, the US has consistently pushed for an expansion of the International Narcotic Control Board’s monitoring authority and has served as a staunchest defender of its prohibitionist policies.Building on and expanding the scope of the international obligations enshrined in the Vienna Convention and the INCB recommendations, the US has made extensive use of bilateral treaties to create an issue-linkage between states’ willingness to adopt zero-tolerance models of drug policy and their eligibility for foreign aid. Over the next decades, such bilateral agreements provided a basis for the operation of extensive cooperation and capacity-building projects in countries as diverse as Afghanistan, Colombia, Mexico, Nigeria, Peru, Ghana, Thailand, and many others. Along with these multilateral and bilateral instruments used to influence the drug policies of other countries, the US government has had an extensive reliance on unilateral tools of imposing economic and reputational sanctions on non-compliant states. In 1986, Congress introduced the Omnibus Drug Enforcement, Education, and Control Act, which created a certification process for drug-producing and drug-transit countries.The certification process requires the president to withdraw financial assistance and support in multilateral lending institutions from countries that fail to comply with requisite benchmarks of anti-drug policy. To enable congressional deliberations over such sanctions, the US Department of State submits an annual International Narcotic Control Strategy Report that identifies the major illicit drug-producing and drug-transit countries and evaluates the extent to which their domestic policies are in compliance with the US counternarcotic agenda.

According to the NASEM report, there is a moderate level of evidence of a statistical association between cannabis use and the development of substance dependence and/or substance abuse disorder for alcohol, tobacco, and illicit drugs.Multiple cohort studies have demonstrated these results.Four separate discordant twin studies have found that the twin who used marijuana was more likely to use other substances even after controlling for environmental and genetic influences.Although some studies reported that medical cannabis has resulted in improvements in opiate-related deaths,Colorado has had an increase in poisoning and deaths from opiates and methamphetamines since 2010, with the highest in 2017. These rates have increased nationwide as well and the influence of cannabis in Colorado is difficult to discern. Nevertheless, the increase in overdose deaths in Colorado is alarming. These data are shown in Figure 6.25 Although animal studies do not consistently translate to human effects, rat studies can provide some mechanistic clues. After exposure to tetrahydrocannabinol , rats have an increased behavioral sensitization response to not only THC but also opiates and nicotine.Studies also demonstrate that these behavioral changes in rats correspond to neuronal activity changes in mesolimbic dopamine neurons in the ventral tegmental area and nucleus accumbens and that cross tolerance results with exposure to morphine, amphetamines, and cocaine.Repeat morphine self-administration has been shown to be significantly lower in CB1 knockout mice and opiate withdrawal symptoms significantly less when the knockout mice are administered naloxone.The effect of cannabinoids on the cardiovascular system is complex and an area of ongoing research.

Of concern to practicing emergency physicians is ST-segment elevation myocardial infarctions and acute stroke presentations with a close temporal relationship with cannabis grow racks use, which have been documented in multiple case reports in otherwise young, healthy, male patients.The NASEM summary found there was a limited level of evidence of a statistical association between acute cannabis use and triggering an acute myocardial infarction , ischemic stroke, or subarachnoid hemorrhage.The WHO review states: “There is evidence that cannabis use can trigger coronary events. Recent case reports and case series suggest that cannabis smoking may increase cardiovascular disease risk in younger cannabis smokers who are otherwise at relatively low risk.”6 CDPHE found moderate evidence that marijuana use increases risk of ischemic stroke in individuals younger than 55 years of age and limited evidence that acute marijuana use increases risk of myocardial infarction.The main case crossover study cited for the AMI findings demonstrated that the risk for AMI associated with cannabis use during the hour preceding symptoms of AMI was elevated 4.8 times over baseline . This risk was substantially reduced following that hour.A review of nationwide inpatient sample data from 2010 to 2014 demonstrated a 32% increase in inpatient admissions for primary diagnosis of myocardial infarction and secondary diagnosis of cannabis use disorder . The overall mean age of patients was 41 years old. These patients also had longer lengths of stay, higher hospitalization costs, and higher levels of morbidity due to AMI following hospitalization than non-cannabis users.84 In a study reviewing secondhand marijuana smoke exposure, the authors found that one minute of exposure substantially impaired endothelial function in rats for at least 90 minutes, considerably longer than comparable impairment by tobacco secondhand smoke.The pathophysiological basis of these events is not fully understood and a full discussion is beyond the scope of this review. In short summary, it may encompass a complex interaction between exogenous cannabinoids and the endocannabinoid system, autonomic nervous system, oxidative stress, direct cellular effects on the endothelium, and pro-coagulant effects.Exposure to THC causes activation of the sympathetic nervous system and inhibition of the parasympathetic nervous system.These effects include elevated heart rate, serum norepinephrine levels, elevated supine blood pressure, and increases in left ventricular systolic function.Smoking results in decreasing oxygen delivery to the heart and other vital organs and may be further compromised by increasing carboxyhemoglobin levels.

The impaired myocardial oxygen demand-to-supply ratio following cannabis smoking has been shown to reduce the time to onset of symptoms during exercise in patients with stable angina.Direct effects of cannabis on blood vessels are complex due to the differing compounds in cannabis and the functional properties of the blood vessels examined.Studies are inconsistent regarding the effects on vasoconstriction and dilation. Cannabis has been consistently shown to produce vasodilation with resultant orthostatic hypotension,but it has also been implicated in vasoconstrictive arteritis mechanisms.A large review article suggested that there are three phases in cardiovascular parameters affected by the endocannabinoid system and that different chemical constituents of the cannabis plant have varying effects at different target organs, which may account for the differences.Transient vasospasm and reduction in cerebral blood flow are well described and may underlie changes in coronary, cerebral, and peripheral arterial systems leading to end organ ischemia.Myocardial blood flow has been shown to correlate inversely with circulating plasma levels of endocannabinoids.Cannabis has also been shown to be a potent source of cellular oxidative stress through formation of reactive oxygen species, and this may contribute to endothelial dysfunction and promote regional arterial vasospasm.THC has also recently shown a dose-dependent procoagulant effect.This ex vivo observation has been supported by reports of thrombotic coronary artery occlusion in young individuals without underlying atherosclerosis.There are also cannabinoid receptors on the surface of platelets and THC has been shown to increase the surface expression of glycoprotein IIb–IIIa and P select in in a concentration-dependent manner resulting in platelet activation.Figure 7 summarizes these effects.Varying cultivation techniques and end-product alterations further complicate the understanding of the physiological effects of cannabis. Cannabis plants can be altered to achieve higher growth rates, changes in potency, and increased bud production. These techniques can include use of varying soil types, fertilizers, and pesticides that can result in physiological effects. These changes may also result in exposures to possible fungal agents such as powdery mildew and botrytis; budworm or mite infestations have been reported in the literature. Historically, there have been reports of bacterial contamination with salmonella, enterobacter, streptococcus, and klebsiella, as well as case reports of fungal spore contaminants, including mycotoxin‐ producing strains of aspergillus.There are three pathways through which cannabis may be contaminated with heavy metal substances.

Firstly, cannabis is able to remove heavy metals from substrate soils and deposit these in its tissues by virtue of its bio-accumulative capacity. Secondly, cross‐contamination may occur during processing . Thirdly, post‐processing adulteration may occur, whereby metals may be added to the preparation to increase weight and thereby appreciate its street value. There are case reports of lead and arsenic poisoning from cannabis.Pesticides are also commonly used in cannabis cultivation. In a report from Washington State, laboratory analysis revealed that 84.6% of legalized cannabis products contained significant quantities of pesticides including insecticides, fungicides, miticides, and herbicides. These comprised a wide array of different substances and encompassed proven carcinogens , endocrine disruptors, as well as a variety of developmental, reproductive, and neurological toxins.There are also changes in end-product concentrations through post-processing of the plant. These changes include creation of oils, waxes/shatter, and dabs. Oils are created by removing the hydrophobic components such as THC with a heated butane solvent. THC concentrations may reach up to 55.7%.Waxes and shatter are concentrated and solidified oil with THC concentration reaching up to 90% THC.Dabs are composed of heated wax and are inhaled off of an object such as a nail, which even further concentrates THC content over 90%.Preparation of these concentrated products has also led to fires and explosion injuries in amateur production attempts in garages, tool sheds, and vacant homes.In Colorado 29 patients with butane hash-oil burns were admitted to the University of Colorado Burn Center from 2008-2014. Zero cases presented prior to medical liberalization, 19 during medical liberalization , and 12 from January–June 2014 at the study’s conclusion. The median total body surface area burn size was 10% . Median length of hospital admission was 10 days. Six required intubation for airway protection while 19 required skin grafting.Marijuana shop employees not trained in medicine or pharmacology are giving medical advice that may be harmful to patients. A recent study in Colorado found that employees are giving medical advice 70% of the time to use cannabis for treatment of nausea and vomiting in pregnancy and few dispensaries encouraged discussion with a healthcare provider without prompting.The author has personally had patients bring in products recommended by dispensary workers with a recommended potency and frequency of use and report being advised to stop their usual medications and use the cannabis product instead.

Cannabis dispensaries provide medical advice and offer treatment without medical training even when this may harm the patient.There are potential therapeutic intervention targets for cannabinoids. In general, these therapeutic targets require a high ratio of cannabidiol compounds , and are from products that significantly differ from those found in commercial dispensaries. The NASEM report found substantial evidence that cannabis grow system or cannabinoids are effective for the treatment of chronic pain in adults, as an antiemetic for chemotherapy-induced nausea and vomiting, and for improving patient-reported multiple sclerosis spasticity symptoms. They also found moderate evidence that cannabis or cannabinoids are effective for improving short-term sleep outcomes associated with obstructive sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis.Studies have also demonstrated that cannabinoids may improve cardiovascular outcomes.92,117 Likely the most significant treatment implication has been in patients with refractory epilepsy, most commonly in patients with Dravet’s syndrome and Lennox-Gestault syndrome, but also in other patients. This has led to the U.S. Food and Drug Administration approving Epidiolex in June 2018 for the treatment of Dravet’s syndrome and Lennox-Gestault syndrome.Despite these potential medicinal uses, current Colorado legal distribution of cannabis products goes through an intermediary bud tender before making it to the patient which may not consistently promote therapeutic benefit; there is insufficient training of dispensary staff to serve this purpose.The potential positive health effects of cannabis rest on which of the multiple species and hybrids are studied and their specific chemical composition. One of the difficulties in determining the physiological effects of cannabis is that “marijuana,” or “cannabis,” can refer to multiple species of plants with widely varying chemical compounds and corresponding variable physiological effects. The cannabis genus includes multiple species, most commonly Cannabis sativa and Cannabis indica, and within those are hybrids specifically developed by growers to achieve a specific effect. For example, the commonly used term, hemp, refers to a variety of Cannabis sativa that is fast growing and can be spun into usable fiber for paper, textiles, clothing, bio-fuel, animal feed, and other industrial uses. Hemp has low concentrations of THC and higher concentrations of CBD. The differences in composition offer different potential treatment effects. For example, the effect for pain control cited in the NASEM review was primarily found with nabiximols , a cannabis extract mouth spray that delivers a dose of 2.7 mg of THC and 2.5 mg of CBD.For comparison, a typical marijuana cigarette or joint contains 0.5 g of marijuana and THC content ranges from 12-23%; therefore, a typical joint contains 60-115 mg of THC, 20-40 times the medicinal dose. The NASEM cautioned that many of the cannabis products sold in state regulated markets bear little resemblance to those available for research at the federal level in the U.S.This is further complicated in that commonly sold cannabis products are often mislabeled for CBD and THC content. One study showed only 17% of dispensary products were accurately labeled.Scientific studies, particularly for treatment of pain, have been limited by a substantial bias, and results have varied.Some demonstrate improvement in pain10 with coinciding decreases in opiate abuse,while others show the opposite.The conflict between federal and state laws on the medical use of cannabis products, the lack of consistency among state laws, and the availability of artisanal products in dispensaries, with high variability between composition of products, have caused significant confusion for researchers and limited the ability to fully and accurately research the true effects of commonly available dispensary cannabis products.This was not a systematic review of the literature but rather a summary of selected research including several large reviews from the NASEM, the WHO, and the CDPHE. There is undoubtedly much literature, some of it conflicting, not cited here. However, as other states and countries wrestle with decriminalization and legalization of cannabis for personal use and sale, it is crucial to report the Colorado experience as a cautionary tale. This review summarizes a large body of research for practicing emergency physicians who are increasingly confronted with questions and patients who use cannabis.

The cannabis industry has historically resisted widespread farm consolidation, perhaps due to its status as an unregulated, and illicit or semi-licit, activity. While the amount of cannabis produced in California is substantial , evidence from 2016 suggests that most outdoor cannabis was then produced on farms smaller than one acre . When Proposition 64 legalized non-medicinal cannabis in 2016, its size provisions explicitly acknowledged the state’s desire to see cannabis farms remain small . Initial regulations limited each permit to an area no greater than one acre and limited each entity to only one permit. Federal laws against cannabis have also encouraged small farms: Farmers with more than 99 plants potentially face federal minimum sentences of five years in prison . Local permitting may also favor smaller producers. Each jurisdiction in California can create its own permitting system, and possessing a local permit is a condition for obtaining a state permit. Most local jurisdictions place limitations on field sizes, and these limitations can encourage small-scale farming. While local permits may provide an avenue for local governments to protect small farmers , they also add another layer of regulation, potentially increasing entry costs. Beginning with California’s first attempt to implement a comprehensive regulatory system for the cultivation and distribution of legal cannabis, through the 2015 passage of the Medical Marijuana Regulation and Safety Act, stakeholders have expressed concerns that the permitting process privileges large farms over small. MacEwan et al. calculate that, due to the nature of regulatory costs, the type of small cannabis farmer prevalent in Northern California is the “least likely to participate in the regulated market.” Yet to date, empirical evidence on cannabis producers’ engagement with the formal market under the new regulatory framework has been lacking. In particular,hydroponic drain table there is a large evidence gap about the types of farms that participate in the regulated market and those that do not.

The gap exists partly because of a lack of public data about growers who have not applied for permits. We remedy that gap by combining information about farmers who have started the permit application process with a unique dataset of cannabis farms in Humboldt County in 2012 and 2016. Humboldt County is one of the largest cannabis producing regions in California and perhaps the world. Cannabis farming began there in the early 1960s, with rapid expansion following in the 1970s, and cannabis has been among the most valuable crops in the county at least since a proposition legalizing medical cannabis was approved by voters in 1996 . Recent studies suggest that at least 5,000 cannabis farms operate in Humboldt County . In the lead-up to the enactment of regulated cultivation of cannabis — which began for the medicinal market in 2016 and for the adult-use market in 2018 — the region experienced a cannabis boom, with the number of plants under cultivation increasing by 150% between 2012 and 2016 . This time of massive cannabis expansion is often referred to locally as the “green rush.” To track both permitted and unpermitted cannabis growers, we used data created by Butsic et al. . In their study, Butsic et al. hand-digitized cannabis farms using very high resolution satellite imagery. Cannabis production was measured in both 2012 and in 2016. Outdoor plants were counted and the number of plants inside greenhouses was estimated based on greenhouse size. Of the 1,724 farms in the dataset, 942 started producing cannabis between 2012 and 2016 and 782 produced at least some positive amount in both 2012 and 2016 . For permit data, we used publicly available data from the Humboldt County Planning Department, compiled from applications for commercial cannabis cultivation permits . We were able to combine the farm location data with the permit data based on the unique parcel identification that existed in both datasets. In total, applications were received for cultivation on 1,945 unique parcels. Of these, 533 were located within our study area .

We also include data describing farm/parcel characteristics. Locational variables such as distance to public roads and cities are used to proxy for transportation cost, while distances to endangered and threatened fish species habitat proxy for the environmental sensitivity of a site. Biophysical characteristics such as slope and presence of prime agricultural soils are used to describe the growing conditions of a site, while zoning designations are used to identify areas where growing cannabis is allowed . We also determined if a timber harvest plan had been associated with a parcel at any point since 1997. We include the quadratic term on farm size to increase the goodness of fit in our model and allow a more flexible relationship between farm size and permit application. The other covariates included in our regression are useful predictors of permit application, as they explain site-specific characteristics as well as proxy for potential land-use opportunities. They have been found to be significant predictors of farm location or farm abandonment . Importantly, these other covariates are primarily time-invariant or predetermined at the time growers decide whether to apply for permits. Specifically, we include variables of environmental sensitivity as proxies for potential challenges in obtaining approval from the Regional Water Quality Control Board. We include zoning information to help describe the other potential uses of the parcel if it were not being used for cannabis. Finally, we include a variable indicating if the area had ever had a timber harvest plan since 1997. We include this variable to see if past land use influences the likelihood of permit application. The average farm size in 2016 was 432 plants, with a median of 263 plants, a minimum of 14 and a maximum of 12,901 . Over 90% of farms produced fewer than 1,000 plants and fewer than 2% produced more than 2,000. Examining permit application rates by farm size reveals a distinct size gradient , as application rates increase substantially over farm-size categories. This pattern holds for both existing and new farms, but the rise is much sharper for the latter. Approximately 10% of small new farms apply for a permit, but rates jump to 61% and 50%, respectively, for the largest farm size groupings. We found a significant difference in size between farms that applied for a cannabis permit in 2016 relative to those that did not apply . The trend according to which larger farms applied for permits at higher rates held true regardless of production type .

The size differences are proportionally similar for both greenhouse and outdoor plants, so we do not find evidence that the relationship between farm size and permit application is solely driven by production method. Our regression models confirm that this result is robust to controlling for other covariates. In all our regression specifications, the coefficient on the total number of plants in 2016 is positive and statistically significant at the 1% level. The effect size of the number of plants indicates that, controlling for parcel characteristics, an increase of 100 plants increases the probability of applying for a permit by 2.4% , with the slope of the relationship declining for extremely large farms . The overall marginal effect is similar for existing and new farms, , though the declining marginal effect for very large farms is driven by new farms , and is robust to the inclusion of watershed fixed effects . The pattern also holds for size in 2012. Restricting the sample to existing farms, an increase of 100 plants in 2012 increases the probability of application by 3.1%.We first categorize growth of existing farms according to the proportionate change in plants produced between 2012 and 2016. The “declining production” group consists of farms that shrank by more than 5% ; “minimal change” farms experienced between −5% and 5% growth ; “moderate growth” farms grew between 5% and 50% and “high growth” farms grew by more than 50% . Within the sample of existing farms, there is a clear gradient of application rates with respect to growth between 2012 and 2016 . The farms least likely to apply are those that declined in size, followed by those with minimal growth. Application rates for existing farms that grew moderately jump to over 40%,rolling benches hydroponics with high growth farms the most likely to apply. Note that across all expansion rates for existing farms, application rates are significantly higher than the average rate for new farms. Statistical tests confirm this trend. Existing farms that applied for permits displayed a mean expansion of 212 plants between 2012 and 2016, while the mean expansion for farms that did not apply was 130 plants . This difference of 82 plants is significant at the 1% level. Our regression results also find expansion associated with permit application . In column 6, an increase of 100 plants among existing growers is associated with a 1.5% higher probability of applying for a permit, with the result positive and statistically significant at the 1% level. farms than existing farms . However, new farms are far less likely to apply for permits than existing farms. The univariate comparison shows that, on average, a new farm was 22% less likely to apply for a permit than a farm that already existed in 2012. Our regression results indicate that this relationship is robust to controlling for associated covariates, including farm size. The coefficient on new farms is statistically significant and negative in all regression specifications.

Controlling for other factors, new farms are approximately 7.3% less likely than existing farms to apply for a permit, with the magnitude of the effect slightly reduced when relying only on within-watershed variation . Small new farms are very unlikely to apply for a permit, even in comparison with existing farms of similar size . Regression results indicate that farms which have not applied for permits tend to be located further north, closer to both cities and the coast and further away from roads . They are also more likely to be located on prime agricultural soils, which is a listed requirement for obtaining a permit. However, there seems to be no effect associated with flat terrain or agricultural zones, which are also requirements for permits. These results suggest that siting criteria in the permit ordinance do not appear to be positive independent drivers of application decisions. In contrast, farms that did apply for permits tend to be located closer to streams and chinook salmon habitat, even as permit eligibility requires the use of non-diversionary water sources . Applying farms are also more likely to be located in forest recreation or timber production zones and to have been transacted at least once since 2015. They also tend be located on larger parcels. However, from comparing the results in columns and , it is clear that a number of regression outcomes between permit applications and parcel characteristics are not robust to the inclusion of watershed fixed effects. This suggests the existence of underlying geographic drivers which might influence these relationships.Cannabis has been profitably produced in California, primarily on small farms, for decades . As cannabis becomes increasingly legal, production practices have become more standardized, and many small farms fear that the increased regulatory costs associated with formalization will force them to either shut down or remain on the black market . Here, we use empirical data on farm location and permit status to investigate differences between cannabis farms that applied for permits to produce in the legal market and those that did not. We find strong evidence that farms with more plants are more likely to apply for permits than farms that grow fewer plants. This is consistent with the argument that increased formalization disfavors small-scale farms . A potential implication of this trend is that continued cannabis expansion in California may disproportionately favor the establishment of large farms, despite measures seemingly designed to prevent this outcome. Small cannabis farms may face challenges similar to those faced by small farms producing other crops — and if small farms are valued, additional policy solutions are required. While our results point toward a robust positive relationship between size and permit application , we cannot definitively attribute the cause to either the fixed cost of initial application or ongoing costs associated with regulatory compliance.

Similar to findings by Lopez-Larson discussed above, the concept of deleterious effects related to early initiation of cannabis has been explored in the neuroimaging literature as well. According to Wilson and colleagues , individuals reporting marijuana use prior to age 17 demonstrated decreased whole brain and cortical gray matter in addition to increased percent white matter volume. Findings also included higher cerebral blood flow in males reporting early initiation of marijuana use. While findings do not necessarily support a clear and consistent pattern of changes in cortical/sub-cortical volume and thickness measurements, as emphasized by Lopez-Larson and colleagues, we can conclude that marijuana may influence the trajectories of appreciable gray matter changes in several ways. The compound may illicit premature tissue development, impose a marijuana-related effect on regressive changes , and alter ongoing myelination of fiber tracts that are impacting gray matter estimates. Functional changes likely affect the mechanics that underlie structural brain changes, and interactions between these processes cannot be ruled out.White matter tissue integrity is believed to be important for efficient cortical connectivity in the developing brain. The literature has shown linear increases in white matter over early development. As the brain becomes increasingly myelinated and fiber bundles mature from infancy to late adolescence, restriction of diffusing water molecules along the principal axis of an axon is commonly observed due to increasingly compact fibers and with more limited intracellular space. Diffusion tensor imaging commonly utilizes two indices of white matter tract coherence to reflect water diffusion in white matter, fractional anisotropy and mean diffusivity , which are thought to help to identify alterations in the health of white matter fibers. Increases in FA and decreases in MD are typically seen in healthy white matter development from young children to early adulthood. In 2006, DeLisi and colleagues published one of the earlier studies to explore the potential for deleterious effects of cannabis on developing white matter.

The authors found higher FA and lower in MD in several tracts in MJ users compared to matched controls; they conclude no evidence of pathological white matter changes despite finding differences between groups. Since this study,greenhouse growing racks findings do suggest some evidence of alterations in white matter integrity in adolescent cannabis users. While DeLisi and colleagues suggest no evidence of pathology per se, subsequent studies have since shown changes in unanticipated directions. While this may not represent a typical pathological process, group differences in either direction may still be reflective of a neural alterations. For instance, increased MD in the prefrontal fiber bundles of the corpus callosum in heavy cannabis using adults who initiated use during adolescence suggest changes in white matter development associated with cannabis use. Ashtari and colleagues found that adolescents with heavy cannabis use enrolled in residential drug treatment had reduced FA and increased MD in cortical association areas such as the temporal-parietal fiber tracts. Recently, in a small sample of adolescents approximately 18 years of age, WM alterations were found in cannabis users compared to controls. Decreased FA in cortical and sub-cortical areas was found in cannabis users compared to controls with no history of substance abuse. In our laboratory, we have found white matter alterations in our abstinent teen marijuana users compared to controls. In two studies published in 2008 and 2009, we found poorer white matter integrity in several association and projection fiber tracts in adolescent cannabis users with concomitant alcohol use. Areas showing between group differences included tracts linked to fronto-parietal circuitry. White matter integrity in several of these regions was linked to neurocognitive performance on measures of attention, working memory, and processing speed; we have also seen white matter linked to emotional functioning and prospective risk taking in our substance users.

To better understand micro-structural differences in tissue integrity among adolescent marijuana users as compared to binge drinkers, we looked at white matter differences between adolescent binge drinkers compared to binge drinkers with histories of heavy marijuana use . While between group differences persisted between marijuana users and controls, surprisingly, teens engaging in binge drinking only looked significantly worse on indices of white matter integrity in several areas as compared to marijuana users, highlighting the need for further research to disentangle the effects of marijuana and alcohol on the developing brain. In general, research points to poorer white matter integrity in adolescent marijuana users compared to non-substance using controls. While white matter findings are subtle in nature, we have observed poorer white matter integrity correlated with poorer neurocognitive functioning in our studies, which underscores the impact that slight alterations in white matter health during this time could have on optimal cognitive functioning. Interestingly, some preliminary evidence supports that marijuana-related toxicity on white matter integrity may be more modest compared to the impact adolescent alcohol use has on the developing brain, although more research in needed in this area.Changes in cognitive performance after acute and longer-term cannabis use are fairly well documented, even if residual effects are suspected to largely resolve. However, less is known on how brain functioning, or neural activation/signaling, may be changed by marijuana use and thereby reflected in declines in neuropsychological performance. Comparisons between blood oxygen dependent signal in adolescent marijuana users and controls in response to cognitive tasks have revealed subtle differences in brain activation patters in marijuana users. Jacobsen and colleagues were the first to pilot an auditory working memory fMRI study comparing marijuana users compared to a tobacco using group and control group. The authors found cannabis users performed the task less accurately and failed to deactivate the right hippocampus across conditions. In another study by the same authors, nicotine withdrawal elicited increased activation across brain regions in the marijuana group, including parietal cortex, superior temporal gyrus, posterior cingulate gyrus, and the right hippocampus. The same effect was not found in the tobacco-only control group suggesting marijuana use may lead to developmental changes masked by nicotine use.We have conducted several BOLD fMRI studies evaluating differences in activation patters between our sample of abstinent marijuana users and matched controls.

In 2007, we found marijuana users to have substantially more activation than non-using peers in response to an inhibitory processing task, particularly in parietal and dorsolateral prefrontal cortices, suggesting additional neural resources required to maintain adequate executive control during response inhibition. In evaluating response patterns to a spatial working memory task, adolescent marijuana users exhibited increased activation in the right parietal lobe along with diminished activation in the right dorsolateral prefrontal cortex to achieve good task performance, which was not observed in controls. In a follow-up investigation using the same spatial working memory task, we evaluated teens with more recent abstinence compared to prolonged abstinence from marijuana, as well as matched controls. Recent users showed greater brain activation in prefrontal cortices, regions needed for working memory processes, and bilateral insula. In response to a third task assessing verbal encoding, marijuana users demonstrated increased encoding-related activation in anterior brain regions as compared to decreased activation in posterior regions, despite no differences in task performance; findings may suggest increased recruitment of neural resources in brain areas sub-serving task-related processing in marijuana using teens. Several recent studies outside of our laboratory have shown similar findings. For example, Jager and colleagues evaluated boys with frequent cannabis use compared to matched controls and found that cannabis users showed excessive activity in prefrontal regions in response to a working memory task, studies from this same research group with young adults have yielded similar, although modest, aberrant findings of the working memory system. In 2010, an investigation comprising chronic marijuana users and matched controls , suggest increased activity in the prefrontal cortex in response to a task requiring executive aspects of attention. Cousijn and colleauges recently found increased activation in heavy cannabis users in response to the Iowa Gambling task during win evaluations in brain areas such as the insula, caudate, and temporal gyrus, which was also positively related to weekly cannabis use; win-related increase in brain activity also predicted increased cannabis use six months later.Lopez-Larson and colleagues found differences in cortico-cerebellar activity in older adolescents with heavy marijuana use. The authors describe decreased activation in response to a bilateral finger-tapping task,vertical hydroponic garden and motor function activation was negatively correlated with total lifetime marijuana use.

Age of onset also continues to play an important role, as early-onset cannabis users demonstrated increased activation in the left superior parietal lobe in response to a verbal working memory challenge , and earlier initiation of use was associated with increased BOLD activity. The majority of findings suggest increased recruitment of neural resources in brain areas sub-serving task-related processing in marijuana using teens. There has been limited research on brain functioning using EEG among adolescent cannabis users. The strength in using EEG is the degree of temporal resolution that is not possible with BOLD imaging. Information on the degree of attentional bias to marijuana cues may provide some indication of brain-based differences in cue-reactivity resulting in heavier use of marijuana among certain teenagers. For instance, one lab based paradigm of cue reactivity found increased skin conductivity among teens diagnosed with cannabis use disorde. Nickerson and colleagues found that among adolescents ages 14–17, P300 response was larger among cannabis users, and response increased in the user group after handling marijuana paraphernalia; findings suggest attentional bias, increased arousal, and possible neural differences that may elucidate discrepancies among teen substance use engagement. The neurovascular effect of marijuana use in adolescence has not been studied extensively. Understanding vascular changes in cerebral blood flow can help us better understand neural signaling and vascular alterations that may be related to changes in neurocognitive functioning and/or changes in neural signaling related to the BOLD signal. Adult studies typically report increased CBF after acute exposure and lower or stabilized CBF after a period of abstinence in heavy users, although this has varied to some degree. To our knowledge, there has only been one study in adolescent blood perfusion in heavy cannabis users. In a recent study in our laboratory utilizing arterial spin labeling , we found that heavy marijuana users assessed pre-and post 28 days of monitored abstinence showed reduced CBF in 4 cortical regions, including the left superior and middle temporal gyri, left insula, left and right medial frontal gyrus, and left supramarginal gyrus at baseline; users showed increased CBF in the right precuneus at baseline, as compared to controls. We did not observe group differences in neurovascular functioning after four weeks of abstinence, suggesting marijuana may influence cerebral blood flow acutely with a possible return to baseline with prolonged abstinence. A study evaluating young adults found that acute THC administration increased blood perfusion in areas important for emotional and cognitive processing, such as the anterior cingulate, frontal cortex, and insula, and reduced perfusion in posterior brain regions. Resting state activity was also altered, as THC increased baseline activity. Very few studies have looked at neurochemical brain changes related to marijuana use in adolescence. Prescott and colleagues found decreases in metabolite concentrations in the anterior cingulate, suggesting poorer underlying neuronal health in adolescent marijuana users, While the exact mechanisms by which cannabis would affect neuronal health is unclear, it is possible that modulation of neurotransmitters such as glutamate and GABAhave adverse consequences on cellular development and neuron integrity; changes in neuronal health is one suggested mechanism which may underlie neuroimaging and neurocognitive findings discussed above.A detailed analysis of the preclinical studies is beyond the scope of this review, however briefly discussing the existing literature is important for translation to human models. Studies also focus on various cannabinoids beside Δ9 -tetrahydrocannabinol , the principal psychoactive component of marijuana; for example increasing attention is being given to cannabidiol, a nonpsychoactive cannabinoid that may have promising therapeutic effects independent of THC. However, this brief summary will focus on models of exposure to the natural compound or cannabinoid agonists, which mimic the structure Δ9 -THC. A great benefit of animal studies is lack of heterogeneity that corresponds with human consumption and substance use reporting. In animals, postnatal days 28–49 correspond with human adolescent development. Studies during this postnatal time period in rats have evaluated both emotional behavior as well as cognitive/behavioral functioning.

There are many rare social facts, but some become pathological based due to their infrequency, and others do not. Why is that so? To tailor the Durkheimian theory and make it more suitable for my empirical analysis, I incorporate Mary Douglas’s idea of pollution and power. Rather than speaking about pathological forms, Douglas focuses on marginal conditions. Her basic premise is that objects, practices, behaviors, and ideas that do not fit the existing social classifications are considered polluting, impure, and even dangerous and thus should be separated . Managing spatiality is a technique of power that allows the legitimate authority to reject “inappropriate” elements and protect what it deems normal, natural, and right. In this paradigm, space is not value-free but constructed through politics and power relations. Take, for example, racial segregation, building the wall to isolate immigrants, hot spot policing, skid rows, mental hospitals, jails and prisons—in all these cases, devaluation of individuals involves their spatial separation. Socio-spatial stigmatization is a mutually constitutive process, in which places inherit the stigma of persons, but persons also can be stigmatized through their interaction with places . For instance, concentrating homeless shelters into specific areas of a town tends to reinforce the stigmatized understanding of such areas. In similar ways, the stigma attached to a homeless shelter extends to individuals using it.Those who live in areas with a high concentration of “disordered” facilities, practices, and individuals tend to oppose them physically, ideologically, and discursively . For example, in his research of addiction treatment clinics in Toronto, Christopher Smith shows that residents perceive these facilities as a threat to the productive places and try to enforce certain socio-spatial borders .

Previous research showed that medical cannabis drying trays dispensaries were more likely to be located in less desirable parts of a neighborhood, characterized by high poverty level, unemployment, and homelessness . However, we know very little about the recreational cannabis facilities: Are they perceived as a “matter out of place”? Do they blur, contradict, and otherwise confuse the moral and social order of the communities? This study investigates the extent to which cannabis is normalized in California. Normalization is a barometer of changes in social behavior and cultural perspectives . Drawing from the Thomas theorem—stating that if men define situations as real, they are real in their consequences—I suggest that if cannabis is conceived as legitimate, it will not be pushed to the geographical and/or social margins. By the same token, if it is viewed as dangerous and illegitimate, then cannabis dispensaries will be regarded as sites of contagion, which are to be marginalized and isolated. I conduct a regression analysis to identify factors that explain variations in cannabis practices at the city level. In particular, I examine the relationship between the support of cannabis legalization in California cities and the number of cannabis licenses issued by local governments. Following the normalization theory, I expect that cities whose residents supported cannabis legalization are more likely to permit legal cannabis dispensaries within their borders. If residents view cannabis as legitimate and socially acceptable, local governments will favor cannabis-related activities on their territories. I also expect homogeneity in the characteristics of cities whose citizens supported cannabis legalization and those that permitted cannabis businesses. For example, if cities whose residents voted for cannabis legalization have a higher percentage of the middle and upper class, then cities that de facto legalized cannabis would also have a higher percentage of the middle and upper class. Since cannabis businesses create jobs and bring tax revenues to city budgets, local governments have strong incentives to permit cannabis-related activities, especially when most citizens favor legalization. But imagine situations in which citizens voted for cannabis legalization, but governments forbade any cannabis businesses, or, on the contrary, citizens did not support the legalization, but governments adopted pro-cannabis policies. These examples demonstrate the dissociation between the public’s wishes and the government’s deeds and cast doubts on the legitimacy of cannabis in a given jurisdiction. As I discussed earlier, cannabis users and distributors bear a stigma that can potentially extend to other people and places.

Prosperous communities may decide to distance themselves from the possible harm of cannabis stigma and forbid any cannabis related activities . In contrast, for economically disadvantaged communities, financial benefits may outweigh the harm of stigma and reinforce the marginalization of places with already limited resources. I look at the adoption of pro-cannabis regulation as an example of morality policies, through which local governments draw a boundary between “pure” and “polluted”, “ordered” and “disordered”, “safe” and “dangerous.” To get a more nuanced picture of the legalization and normalization processes, it is important to understand the moral-economic rationale behind decision making at the city level. The question is not only whether cannabis is legal, but where, how, and to what degree it is legal. The goal of the quantitative analysis is to reveal variations in local regulation practices and define factors impeding or fostering the adoption of permissive cannabis policies at the city level. By exploring which cities are more likely to allow cannabis businesses, this research contributes to understanding the relationship between legitimacy and legality and helps determine the current status of cannabis in California. Moreover, the focus on city-level data provides an insight into how boundaries of normality vary across local contexts. Acting as moral entrepreneurs, local governments rely on principles of the politics of pollution and create a cognitive map of acceptable and non-acceptable places . Previous studies have highlighted the importance of religiosity, economic development, political competition, community composition, organizational perviousness, and historical legacies in explaining moral policy outcomes . This research takes a different path and sets out to clarify the relationship between changes in public attitudes and the adoption of morality policies . I posit that greater social and cultural accommodation of cannabis can explain permissive cannabis policies only to a certain degree. Socio-economic characteristics of communities and their racial composition also matter. Licensing agencies collect information at the individual level.For the current project, I aggregate the number of issued licenses at the city level, which excludes any personal identification from the dataset . The reasoning behind aggregating data at the city level is that according to the Medical and Adult Use Cannabis Regulation and Safety Act , cities have the full power and authority to enforce cannabis regulation and complete responsibility for any regulatory function relating to the licensees within the city limits.Local jurisdictions decide whether cannabis businesses will be legal on their territories or not, define which types of cannabis activity to allow , and establish regulatory schemes for activities involving growing or selling cannabis.Before applying for a cannabis license, an applicant has to obtain a permit from the city administration that would enable him/her to conduct commercial cannabis activity. The permit does not guarantee each applicant a cannabis license, but it gives him/her the green light to advance to the final stage and submit the application to a licensing agency.

The dependent variable has three different measures: the total number of cannabis licenses, the number of cultivation cannabis licenses , and the number of sale and distribution cannabis licenses . I suggest that factors explaining the permissiveness of local governments towards cannabis cultivation and cannabis distribution are not exactly the same. Cultivation primarily occurs in private spaces and thus is hidden from the public eye. On the contrary, retail is associated with public display: shop-windows, street signs, and advertising boards make cannabis dispensaries visible and accessible. I expect that the public display of cannabis will be more stigmatized than its private cultivation. The normalization of cannabis is a gradual process, and we cannot expect it to progress at the same pace in different localities. But we can assume that cities whose residents supported cannabis legalization will be more likely to pass pro-cannabis laws. As seen in Tab. 2, 72% of California cities supported the legalization of cannabis in 2016, but only 45% of them legalized cannabis-related economic activities within their borders. Moreover,of those cities whose residents did not support Proposition 64, 22% eventually permitted cannabis companies,what is need to grow marijuana despite the lack of public support . There is an obvious gap between people’s preferences and governments’ actions, which should be explained. Before turning to the description of other independent variables, I should address the issue of moral hypocrisy. Greater cultural acceptance of cannabis does not necessarily translate into moral acceptance of its sale and use. In particular, we do not know whether people who supported legalization are amenable to cannabis dispensaries in their neighborhoods—i.e., we cannot exclude the NIMBY phenomenon.The willingness to legalize cannabis may follow a pragmatic logic: decriminalizing cannabis generates tax revenues, creates jobs, and diminishes law enforcement costs. People may also support legalization because it gives an opportunity to begin repairing the damages caused by the criminal justice system in the past. Moreover, it may be perceived as a progressive move that fits general liberalizing trends, including same-sex marriage, abortion, pre-marital sex, drinking, gambling, and so on. And yet, people may be moral hypocrites: they may support the idea of cannabis legalization and act in discord with it by opposing the location of cannabis dispensaries in their backyards. The statistical analysis cannot account for these nuances and, thus, simplifications are inevitable.For the purposes of this analysis, “legitimacy” means tolerance of cannabis use rather than its total acceptance; it is what people are ready to declare publicly rather than act upon. Legitimacy is a necessary but not sufficient condition for legality.

What other factors can explain the responsiveness of local governments to morally controversial issues? Since only 38% of California cities allowed cannabis companies, the dependent variable has many zeros. To account for excessive zeros and overdispersion, I use a negative-binomial regression, which allows the variance to exceed the mean and is appropriate for analyses with a count outcome variable.87 Table 4 reports the estimated coefficients of the negative binomial regression models. Model 1 contains all cannabis licenses issued in California cities in 2018 and 2019. Model 2 tests hypotheses only for licenses issued by the California Department of Food and Agriculture. Model 3 tests hypotheses only for licenses issued by the Bureau of Cannabis Control . The analysis demonstrates that cities whose residents supported cannabis legalization are more likely to permit cannabis-related activities within their borders . It is not surprising since, as I mentioned above, 45% of cities supporting cannabis legalization allow legal cannabis companies. The main question is: What other city properties are associated with the adoption of pro-cannabis legislation? Opinion polls show that the middle- and upper-class representatives, young adults, and non-Hispanic citizens support cannabis legalization at higher rates than other social groups. I ran a separate model regressing the percent of support for Proposition 64 on the index of economic prosperity, percent of people aged 20 to 29, and percent of the Hispanic population . The results confirm that the support of cannabis legalization is associated with a higher index of economic prosperity, a larger percentage of young adults, and a lower percentage of the Hispanic population. This association is significant at the 0.01 level. However, as we see in Table 4, cities that eventually allowed legal cannabis companies, on the contrary, are more likely have a lower index of economic prosperity , a lower percentage of young population , and a higher percentage of the Hispanic population . The disparity between the demand and supply offers an intriguing puzzle. Economically prosperous cities, on average, express higher support of cannabis legalization, but it does not mean that they are more likely to permit legal cannabis companies within their borders. Moreover, there are significant differences between licenses issued for sale and cultivation. Cultivation licenses are more likely to be issued in cities with a lower percentage of the young population, which can be explained by the fact that these are mostly rural remote areas, and young adults live in more urbanized places. Sale licenses are associated with three other factors: a higher percentage of the Hispanic population, a lower city’s fiscal score, and higher violent crime rates. There is substantial evidence in the findings that socio-spatial stigmatization of cannabis persists despite its legalization.