Medical Marijuana, Emerging Adults, and Community: Connecting Health and Policy

PROJECT SUMMARY/ABSTRACT Access to greater varieties, amounts, and potencies of cannabis has increased dramatically in the U.S. over the past decade as more states legalize cannabis for medical and adult use. Research on cannabis users who consume in a controlled manner, that is, in a way that does not compromise responsibilities to family and work or minimizes risk to self, is limited despite the fact that most cannabis users do not become dependent or develop a disorder. Significantly, models of controlled cannabis use have been inhibited from developing historically due to factors related to stigma and illegality, but are urgently needed as states continue to legalize cannabis for medical and adult use, which increases availability and access to potent cannabis products. Our long-term goal in this renewal of a currently funded R01 is to advance the scientific understanding of safer and controlled use of cannabis in policy environments where access to cannabis and potent products is high or increasing. Our objective here is to advance the conceptualization and assessment of controlled cannabis use across different policy environments for clinical and community-wide dissemination to fill research and practical gaps in knowledge. We will achieve this objective by sampling from two ongoing longitudinal cohorts of cannabis users -- 23-37-year-old adult users in CA (n=200) and 23-37-year-old medical users in PA (n=200) -- utilizing a measurement burst design that incorporates 21 days of ecological momentary assessment (EMA) and quantitative surveys over two time points plus qualitative interviews. Our central hypothesis is that persons who exhibit greater control over their cannabis use (via greater adherence to rituals and rules, e.g., “don’t use cannabis before work or driving” or “only use on the weekends”, defined as controlled users) will report lower cannabis use and better psychosocial functioning across the study period compared to uncontrolled users. This renewal study is guided by findings from our current studies of young adult cannabis users as well as theoretical insights into controlled use of cannabis described in Zinberg’s classic book Drug, Set, and Setting – specifically the application of rules and rituals derived from social “setting.” Our central hypothesis will be tested by pursuing three specific aims: 1) Develop and test a new scale assessing the rules of controlled cannabis use to be utilized during the subsequent EMA study; 2) Determine daily cannabis use practices and psychosocial functioning among controlled and uncontrolled users in contrasting policy environments using EMA and a baseline survey (n=400); 3) Identify longitudinal patterns of daily cannabis use practices and psychosocial functioning among controlled and uncontrolled users using EMA and surveys from two time points (n=400), and qualitative interviews (n=100). Deliverables from this project include: (1) a theoretically derived instrument assessing the rules of controlled cannabis use; (2) a fine-grained, process-level understanding of controlled use of cannabis over time via EMA, annual surveys, and qualitative interviews; (3) key factors/mechanisms identified via Aims 1- 3 that can inform the development of policies and interventions to support controlled and safer use of cannabis.