Research has begun into the impact of Uruguay’s legalization and regulation of the cannabis market. Studies out of the US and Uruguay alike have begun to publish initial results, which show little significant change in consumption patterns, especially among the most vulnerable, but significant improvement in public perception, especially from initially doubtful pharmacies and neighbours.
Uruguay and Canada are the only countries where marijuana use has been legalized. Reason enough for Uruguayan and foreign academics to set their sights on the small South American country, to see the impact of the new regulations.
On Monday, the National Drug Board presented the results of the VIII National Survey on Drug Use in High School Students, which showed that cannabis use in high school students did not increase between 2016 and 2018.
Along with those promising initial results, two studies were presented that sought to measure the impact of Uruguayan cannabis policy in the short term, and what has generated the sale of cannabis in pharmacies.
Research on cannabis consumption in Uruguay
“Short-term effects of the law regulating the marijuana market in Uruguay” is the title of the paper by Magdalena Cerdá, associate professor in the Department of Population Health at NYU Langone Health and director of the Center for Epidemiology and Public Policy on Opioids and Opioids.
In presenting her work, Cerdá said that, after alcohol and tobacco, marijuana is the most widely used substance in the world (3.8% say they have used it in the last year, that is, 188 million people), and that in several countries its use and potency has been increasing. She reminded us that although it is not a drug that is associated with major public health problems, early and frequent use carries a greater risk of psychiatric disorders (such as schizophrenia) and respiratory problems. It can also have a negative impact on traffic accidents and academic and professional performance.
Cerdá set out to assess changes in perceptions of risk and availability of marijuana, and the prevalence, frequency and intensity of use. In order to know if the changes in marijuana use were due only to law enforcement, she decided to compare the evolution of consumption in Uruguay with that of two countries in the region that did not have changes in their legislation. Specifically 24 provinces in Argentina and 15 regions in Chile with which there were significant socio-demographic similarities.
Results show no significant change in cannabis consumption among Uruguayan teens
The work pointed out that in the general population (15-64 years old) the prevalence of consumption in the last year and in the last month after the law was implemented in Uruguay had “a slight increase” (4.7% and 2.7% respectively). However she maintained that “none of these changes was statistically significant, that is, it was not different from what one might expect for reasons of random variation. There is no major increase in consumption in Uruguay that could be attributed to the law”.
In relation to the population aged 15 to 25, specifically, she also identified a slight increase in Uruguay compared to what occurred in the regions of Chile and Argentina, but again “it is not a variation that is greater than what one would expect for random reasons”. Nor did they find any increase in dependency symptoms.
For the perception of risks the research focused on the school-aged population (13-17 years old) and because of the availability of data, the comparison was only made with the 15 Chilean regions. There too, she found no significant changes in risk perception due to frequent use, ease of access, or prevalence of consumption per year and per month. “The passage of the law did not lead to a greater increase in marijuana use among high school students,” she reaffirmed.
What about the impact among Uruguayan adults of Cannabis legalization?
Given that the legalization of marijuana use is for those over 18, to see the impact of the law Cerdá sought to assess how marijuana use had varied between those under and over 18. “If the law has an effect, we would see a greater increase in the older people because they have a legal path of access,” she said.
The variables she used were to compare risky marijuana use and heavy use. The former relies on a scale that takes into account multiple variables such as whether the person smoked before noon, whether they smoked alone, whether they have memory problems when smoking marijuana, whether family or friends have told them that they should reduce consumption, whether they have tried to reduce consumption without success, or whether they have had problems associated with consumption, such as fights, accidents or poor academic performance. The latter, heavy use, applies if they consumed cannabis on at least 10 days in the last month.
She shared her findings. “After 2014 there was a greater increase in risky use in those over 18 in Uruguay” and the difference between under and over 18 consumption grew in Uruguay, and increased more in comparison with Chile. Clearly “the greatest increase in risky use was focused on those over 18 in Uruguay,” she said. And something similar was observed for the heavy use variable: possibly there has been an increase in heavy use in that population that now has legal access to marijuana, she said.
More research is needed to determine full impact of Uruguayan cannabis legalization
In conclusion, Cerdá reminded us that this is just preliminary data, since pharmacies began selling marijuana in 2017 and the measurement she made are from 2018. It will be necessary to see the impact with greater distance. Still, she said that “the regulation of the marijuana market seems to have limited effects on marijuana consumption, so at the population level we haven’t seen an increase in consumption.” She did identify that “there may be a possible increase in risky and heavy use in adolescents 18 and older, but that should be contrasted with the good news that among those students who do not have legal access there has been no increase in problematic use.
Research on the impact of legalization on public perception
Rosario Queirolo, professor of the Department of Social Sciences at the Catholic University of Uruguay has also been actively researching the topic. Dedicated herself to studying the impact of the law through the sale of marijuana in pharmacies. Which remains the most visible route (in part because of the queues formed by the low supply), since cannabis clubs do not advertise, and neither does the route of self-cultivation.
She reported that in January 2020 there were 17 pharmacies selling marijuana, located in ten departments (seven in Montevideo, two in Maldonado and one in Artigas, Flores, Lavalleja, Paysandú, Salto, San José, Soriano and Treinta y Tres). Territorial coverage is low, she said; yet the number of people registered to buy in pharmacies rose from 9,221 when they started selling to 39,423 in January 2020.
Queirolo’s team surveyed neighbors and interviewed owners or managers of pharmacies that would sell and not sell marijuana in June 2017 – a month before pharmacy sales began – and again in August 2018. In total, they contacted 1,298 neighbors and 119 pharmacy managers.
Queirolo said that before the sale began, the pharmacists used very different arguments; some said they would not sell because they were afraid there would be problems with security, or they did not see the profitability (some preferred not to sell because they did not know if it would be well received by the people) or because of prejudice. “In some cases, these prejudices about users were also linked to safety issues, like saying ‘Go figure, when there’s no marijuana, they’ll set my pharmacy on fire,'” he said.
How has public perception changed with regards to cannabis sales in Uruguay?
In August 2017, following the banking system’s threat to isolate pharmacies selling marijuana, some stopped selling, but then others joined in. In total, the researchers interviewed managers of 20 pharmacies that sold marijuana. In 2018, 16 of them said they had no problems with dispensing, 14 said they had not received complaints from neighbors or customers about selling marijuana, and some who did were for “selling a ‘drug,'” Queirolo said.
For most of the pharmacy managers, not only were the fears of insecurity quickly abandoned, but also some of the stereotypes. 12 responded that they considered marijuana users to be “very much or somewhat like themselves, who are ordinary people,” the researcher said. “None of those fears about what could happen with the sale of marijuana in pharmacies turned out to be founded, at least in the people who are in charge of the pharmacy,” she said.
As for the perception of insecurity, the study found that both neighbors of pharmacies that sell marijuana and those that do not live near one identified an increase in social disorder between 2017 and 2018. Yet points out that “neighbors of pharmacies that sell find there is less social disorder than neighbors of pharmacies that don’t sell. In addition, they have found that the neighbors of pharmacies that sell marijuana “perceive that the law has a greater impact in reducing drug trafficking” because they line up to buy it. The assumption being that “in some sense it will have taken a piece of the market away from drug trafficking.”
Like Cerdá, Queirolo stressed the importance of continuing to monitor the impact of this policy.
Comparison with U.S. Regulation
Prohibiting and increasing sanctions or absolute liberalization are the two extremes of a range of options when thinking about regulating marijuana use. In between are the different strategies adopted by many countries, which involve more or less state and commercial influence.
Cerdá compared Uruguayan regulation to the commercial model adopted by several states in the United States, which legalizes the production, sale and consumption of marijuana for recreational purposes with the private sector deciding the quality and potency of the product, with a minimal state role in regulation. She said that in the United States there has been a small increase in abuse and dependence of this substance among adolescents and those over 25, as well as an increase in alcohol consumption among those over 25 as well as in traffic accidents, but clarified that this occurs with the U.S. business model.
Instead, she said that in Uruguay, in contrast to the United States, limits were placed on the amount of product that can be produced and sold, on the potency and type of product that can be sold. In short on the entire production process. Cerdá concluded that “this type of model of legalization of marijuana where the market is highly regulated [by the state] can have much more positive effects in terms of public health and social issues.” Certainly a strong endorsement of the Uruguayan model of cannabis regulation and legalization.
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