However, despite several years passing since cannabis legalization first started rolling out, judging the full impact is still difficult. Differences in implementation along with ongoing debate are muddying the waters.
Eighteen American states, as well as Canada and Uruguay, have legalized cannabis in recent years and established regulated markets for this substance. As shown by a review of the scientific literature carried out by Addiction Switzerland on behalf of the Federal Office of Public Health (FOPH), it is generally still too early to draw robust conclusions about the effects of the different regulatory models. However, the analysis provides some initial results in the short term, particularly for the United States.
The regulatory models adopted in the countries and regions where cannabis has been legalized are different from each other and are the subject of intense debate. On behalf of the FOPH, Addiction Switzerland has reviewed the scientific literature on the impact of the legalization of non-medical cannabis in the USA, Canada and Uruguay. The topics covered are cannabis markets and consumption, health, road safety and crime. Studies published through early 2021, seven years after the first legal cannabis market opened in Colorado and two years after legalization in Canada, were considered.
The scientific work published to date allows few conclusions to be drawn about the impact of cannabis legalization. There are still too many unknowns and it will take a few more years and more solid data before the consequences of cannabis legalization, for example on the health of the population, can be scientifically assessed. This is also the conclusion reached by other researchers.
United States: a regulatory model with a commercial vocation
However, the literature review of Addiction Switzerland allows for some initial observations in the short term, particularly for the United States, the country where most of the studies have been carried out. At the beginning of 2021, about one third of the American population lived in a state which had legalized cannabis and surveys show that almost two thirds of the population now support this legalization. Of the eighteen states where cannabis is legal, ten have established regulated 21+ markets. These are generally commercial models with relatively modest health protections.
Most research indicates that, to date, there has been no increase in underage cannabis use in states that have legalized cannabis. However, several studies have found increases in adult use compared to states where cannabis remains illegal, particularly in the younger age groups (18-25 years).
The available data also highlight a diversification of products (edibles, concentrates) in the United States and, in many cases, an increase in their THC content. These developments pose various challenges, particularly in terms of quality control and marketing (quantity, packaging, information) of cannabinoid products. For example, the number of emergency room admissions, hospitalizations and calls to poison control centers following cannabis use increased after legalization – a phenomenon closely linked to the use of the new products.
The number of outlets and the quantities being sold are still increasing in most US states. Prices initially rose after the markets opened and then gradually fell. There are also various indications that the black market is increasingly being supplanted by the legal market. As expected, there has been a sharp decline in the number of reports of cannabis possession.
Data available to date indicate an increase in cannabis-related traffic fatalities in some states where cannabis has been legalized, as well as an increase in motorists testing positive for cannabis.
Canada: too early to tell
In Canada, the federal government regulates cannabis production, as well as some health and safety aspects, and the provinces are responsible for regulating distribution and sales. As of October 2018, they began allowing private or public outlets. The data available so far suggest that the legal cannabis market is gradually replacing the illegal market as more outlets are established. Cannabis use among the Canadian population has also increased in the months following legalization, particularly among adults. However, it is not yet possible to investigate the precise causes of this increase.
Uruguay: state-controlled model with very little research
This Latin American state was the first to legalize cannabis in 2013. Production, trade and consumption are largely under state control. Access to cannabis is through individual cultivation or consumer associations, or through purchase in pharmacies. Here again, the few studies available do not allow for many conclusions about the effects of legalization, and the slowness with which this regulatory model is being implemented does not simplify matters. In 2018, less than a third of consumers obtained cannabis through the regulated market. Overall, the number of users has increased in Uruguay since legalization, particularly among minors and among 26- to 35-year-olds, but studies point to similar developments in neighboring countries where cannabis is not legal.
What about Switzerland?
More studies in the next few years will help to better understand the effects of cannabis legalization internationally and to compare different regulatory models. In Switzerland, a revision of the drug law now allows for local pilot trials of cannabis sales to adults. These trials are subject to strict rules. In order to protect health, sales personnel must be trained and made aware of risk reduction. The quality of the products, which have a limited THC content, will also be controlled. There will be a general ban on advertising and packaging that cannot be opened by children. The first projects are expected to start in 2022 and will allow a better understanding of the effects of different models of cannabis sales in Switzerland.
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