Forced Marijuana Treatment Referrals From Law Enforcement Declined More Rapidly After Legalization, Study Finds

Rates of criminal legal referrals to treatment for cannabis use disorder (CUD) among young adults “declined significantly more rapidly” following adult-use legalization of marijuana, according to a new study out of Temple University, a trend authors say is “likely due to falling cannabis-related arrests” among people 18 to 24 years old.

However, among adolescents—those 12 to 17—the researchers found that “the trajectory of decline in the proportion of criminal justice referrals did not change significantly following recreational legalization.”

To arrive at those conclusions, the study analyzed state-level data from 2008 to 2019 about treatment admissions to programs that received public funding, data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA). Researchers examined the proportion of referrals to treatment for CUD that were coming from the criminal justice system, then comparing trends seen in states with legal adult-use cannabis to states without adult-use laws.

Notably, criminal justice referrals to CUD treatment are already falling nationally—both proportionally and in terms of raw numbers—even in states where marijuana isn’t legal. “Over the study period, across the entire United States,” authors wrote, “both the number of all admissions and the number of [criminal justice] referrals to CUD treatment declined for both adolescents and young adults.”

But in states that legalized marijuana for adults, the proportion of referral rates from the criminal justice system fell faster after legalization, the study says.

“Difference-in-differences model results indicate that, among young adults, the proportion of CJ referrals declined more rapidly in states that legalized recreational cannabis, following legalization, as compared with states that did not,” the authors wrote.

The proportion of adolescent cases from criminal justice sources also declined after legalization, but “the difference in the trajectory in the decline between states legalizing and not legalizing recreational cannabis did not reach statistical significance,” says the report, published last month in the Journal of Addiction Medicine.

Overall, among more than 2 million cases over the 2008–2019 study period (1,031,411 young adult admissions and 906,809 adolescent admissions) criminal justice referrals comprised 57 percent of young adult cases and 47 percent of adolescent cases.

Authors noted that “the decline in CUD treatment admissions occurred even as the prevalence of adult use cannabis rose, and risk factors for CUD associated with legalization increased.” As such, they said, the decline in criminal justice-referred cases “represents a key health concern.”

But rather than restart the drug war, the Temple team said a more health-focused approach might be warranted.

“We believe that [substance use disorder] is best treated as a public health issue rather than a criminal justice problem and that cannabis legalization may begin to address long-held social justice concerns related to cannabis criminalization,” they wrote. “Promoting CUD treatment referrals from sources other than the criminal justice system, for instance…in primary care settings…may assist in meeting CUD treatment needs for adolescents and young adults during a period of expanding cannabis legalization.”

Not everyone is reading the news as a cause for concern, however. Paul Armentano, deputy director for NORML, said in a blog post that fewer people being compelled into treatment for cannabis use disorder might actually be a good thing.

“Most people arrested for violating marijuana possession laws do not require mandatory drug treatment,” he said, “and historically, these referrals were provided primarily to divert people away from the criminal justice system.”

In other words, it’s not immediately clear that all the people admitted even needed treatment in the first place. Some were there because it was a way to avoid a criminal record for cannabis possession.

Fewer people entering the system over the illegality of cannabis, means more resources can be directed to those with a more urgent need for treatment, Armantano added.

“In addition to ending tens of thousands of needless low-level marijuana arrests cannabis legalization is also freeing up space in drug treatment centers for those people who truly need it,” he said.

In a separate study published last month, researchers found that referrals to foster care also fell after marijuana legalization—but only following the adoption of medical cannabis laws. States that legalized adult-use marijuana, that study found, saw “no corresponding change in the number of foster care entries related to parental or teenage drug abuse relative to control states.” Drug misuse is the second most common reason that a child is placed into foster care.

While that study didn’t identify a meaningful link between adult-use legalization and foster care drug misuse cases, a report published last year did. Researchers at the University of Mississippi found that recreational legalization was associated with at least a 10 percent decrease in foster care admissions on average, including reductions in placements due to physical abuse, neglect, parental incarceration and misuse of alcohol and other drugs.

Another study published earlier this year found that marijuana is “significantly” associated with reduced opioid cravings for people using them without a prescription, suggesting that expanding access to legal cannabis could provide more people with a safer substitute.

Medical Marijuana Patients See Improved Quality Of Life And Lower Pain, Anxiety And Depression After Three Months Of Use, Study Shows