The effects of commercialized legal cannabis on criminal legal involvement and hospitalizations in first episode psychosis
Michael W Flores (CHA/HMS)
Danta Bien-Aime (CHA/HMS)
Alice Gelman (CHA/HMS)
Julie Johnson (Massachusetts Cannabis Control Commission)
A. Eden Evins (MGH/HMS)
Dost Ongur (McLean/HMS)
Benjamin Le Cook (CHA/HMS)
Background/Objectives: Individuals with first episode psychosis (FEP) are disproportionately likely to experience adverse effects from cannabis use, and cannabis legalization and commercialization has been associated with a rise in both cannabis use and emergency department visits among individuals with established psychosis. The present study sought to ascertain cannabis policy effects on young people with first episode of psychosis by examining the impact of the opening of cannabis dispensaries on clinical and criminal-legal outcomes.
Methods: We utilized longitudinal data from the Early Psychosis Intervention Network, a network of early psychosis clinics from states with a variety of cannabis policy regimes. 3,607 individuals contributing 7,409 responses were included. The exposure was the opening of cannabis dispensaries in a state. Outcomes included 30-day use of cannabis, recent psychiatric hospitalization, and recent legal issues. Panel fixed effect logistic regression models were utilized to ascertain associations between exposure to dispensaries and outcomes, with both year and individual fixed effects included.
Results: After adjusting for individual and year fixed effects, there was a no significant change in 30-day cannabis use after exposure to dispensaries (OR=2.4, 95% CI 0.86-6.53, p=0.09). Exposure to dispensaries was associated with both an increase in psychiatric hospitalization (OR=1.8, 95% CI 1.2-2.8, p=0.005) and increased criminal-legal involvement (OR=8.6, 95% CI 2.3-32.4, p=0.001).
Implications: Young people with first episode psychosis had increased rates of both psychiatric hospitalization and criminal legal involvement after cannabis dispensaries opened. Increased availability of cannabis and wider availability of high-potency cannabis products may be partially responsible for these adverse consequences. FEP clinicians should engage in systematic assessment and treatment of problematic cannabis use as well as encourage harm reduction practices such as the reduction in use of high potency products, while programs diverting individuals with psychosis from jails and prisons into treatment may need to be strengthened after cannabis legalization.