Health and social consequences of national marijuana legalization

摘要 大麻政策正在发生巨大的历史性变化。科罗拉多、华盛顿、阿拉斯加和俄勒冈州 已经合法化商业生产和拥有娱乐大麻，其他州正在 类似的政策。关于相关的社会和健康后果存在着大量的争论 这些政策变化。尽管随着时间的推移对这些状态的评估是必要的步骤，但这样的评估是必要的。 评估只会告诉我们大麻合法化的完全商业模式对大麻合法化的影响。 大麻使用和相关的社会问题。我们缺少关于受监管的、非- 控制大麻市场的商业模式，这些模式可能是大麻使用的关键驱动因素，包括 广告、个人购买限制和销售点对大麻的使用和相关的社会影响 问题乌拉圭大麻的全国合法化为我们提供了一个评估这种模式的机会。 2013年12月，乌拉圭成为世界上第一个取消禁令并规范 大麻的销售、种植和分销。乌拉圭模式与美国州模式有独特的不同 可以为美国未来在这一主题上的政策提供信息的方法。这是一种非商业性的合法化模式， 大麻的生产和销售由国家而不是市场控制。该产品的广告是 严禁使用者在国家登记处登记，只允许通过3种方式之一获得大麻。 每年最多分配480格拉尔的机制。(i.e.药房;家庭种植;大麻 俱乐部）。相比之下，美国各州允许广告，没有用户注册，购买限制仅为 放置在销售点上。我们提出了一个前/后法，干预/对照组比较，与 乌拉圭首都蒙得维的亚市作为干预地点。我们将比较 大麻使用，其他类型的物质使用和交通伤害，前（2001-2014）和后（2015-2019） 合法化，在蒙得维的亚的8个城市，并在一个合成的控制组校准的类似数据， 智利和阿根廷16个可比城市的167个自治市。本研究的目的是：（1）评估是否 大麻合法化与乌拉圭蒙得维的亚与控制城市的大麻使用变化有关; 以及大麻的风险和可获得性以及大麻价格的变化是否可以解释 大麻使用的变化;（2）评估大麻合法化是否与大麻使用的变化有关。 使用其他药物（即酒精、烟草、非医疗处方药使用、可卡因及其衍生物（“pasta 基地”））在蒙得维的亚与对照城市;（3）评估大麻合法化是否与 蒙得维的亚与对照城市交通死亡率的变化。随着美国越来越多的州 大麻合法化，他们将能够使用我们的研究证据，结合美国研究的证据， 就最不可能导致以下后果的合法化方法类型做出经验性决定： 药物使用的增加和相关的社会问题。

Abstract Immense historical shifts are taking place in marijuana policy. Colorado, Washington, Alaska, and Oregon have legalized commercial production and possession of recreational marijuana, and other states are considering similar policies. There is substantial debate about the social and health consequences associated with these policy changes. Even though the evaluation of these states over time is a necessary step, such an evaluation will only tell us about the impact that fully commercial models of marijuana legalization have on marijuana use and associated social problems. We are missing information on the impact that regulated, non- commercial models that control aspects of the marijuana market that could be critical drivers of use, including advertising, individual purchasing limits, and points of sale, have on marijuana use and associated social problems. The national legalization of marijuana in Uruguay offers us an opportunity to evaluate such a model. In December 2013, Uruguay became the first country in the world to remove the prohibition and regulate the sale, cultivation, and distribution of marijuana. The Uruguayan model differs from U.S. state models in unique ways that can inform future U.S. policies in this topic. It is a non-commercial model of legalization, whereby the state, rather than the market, controls production and sales of marijuana. Advertising of the product is prohibited. Users are registered in a national registry and are only allowed to obtain marijuana through one of 3 mechanisms with a maximum annual dispensation of 480 grs. (i.e. pharmacies; home cultivation; cannabis clubs). In contrast, U.S. states allow for advertising, there is no registry of users, and purchase limits are only placed on the point of sale. We propose a pre/post law, intervention/control group comparison, with municipalities in Montevideo, the capital of Uruguay, as the intervention sites. We will compare the prevalence of marijuana use, other types of substance use and traffic injuries, pre- (2001-2014) and post- (2015-2019) legalization, in 8 municipalities in Montevideo, and in a synthetic control group calibrated by similar data from 167 municipalities in 16 comparable cities in Chile and Argentina. This study aims: (1) To evaluate whether marijuana legalization is associated with changes in marijuana use in Montevideo, Uruguay, vs. control cities; and whether changes in perceived riskiness and availability of marijuana, and in marijuana price, explain changes in marijuana use; (2) To evaluate whether marijuana legalization is associated with changes in the use of other drugs (i.e. alcohol, tobacco, nonmedical prescription drug use, cocaine and derivatives (“pasta base”)) in Montevideo vs. control cities; and (3) to evaluate whether marijuana legalization is associated with changes in the prevalence of traffic fatalities in Montevideo vs. control cities. As more states in the U.S. legalize marijuana, they will be able to use evidence from our study, jointly with evidence from U.S. studies, to make an empirical decision about the types of legalization approaches that will be least likely to lead to increases in substance use and associated social problems.