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Posts in Rule of Law
The Impact of State-level U.S. Legalization Initiatives on Illegal Drug Flows 

By Vivian Mateos Zúñiga and David A. Shirk

Scholars and legalization advocates have argued that the legalization of cannabis would help curb drug flows from Mexico and weaken criminal organizations south of the border. However, there is little empirical research examining how the legalization of cannabis for medical and recreational purposes at the state-level in the United States has affected production levels and flows of cannabis from Mexico. To examine the theory that drug legalization reduces the incentives and profits for international drug trafficking organizations (DTOs), the authors draw on a mixed methodological approach that includes descriptive and inferential statistical analysis of data from the U.S. State Department, archival research using primary and open-source documents from U.S. and Mexican government and media sources, and interviews with U.S. officials and security experts to analyze trends in seizures and legalization. Drawing on this information, we employ a series of statistical tests to examine the relationship of greater legal access to cannabis in U.S. states—measured by the percentage of the population living in states with access to legalized medical or recreational marijuana over time—to illegal eradication and seizures of drugs by Mexican government and U.S. border authorities. We use this measurable outcome as a proxy for illicit drug production and transshipment in Mexico. We find a substantial and statistically significant decrease in the amounts of cannabis apprehended by Mexican and U.S. border authorities in relation to the rate of legalization in the United States using our measurements of drug legalization. At the same time, the authors find additional statistically significant evidence that, as legal access to cannabis has increased, flows of other illicit drugs increased simultaneously, suggesting that criminal organizations have diversified into other drugs to remain profitable, particularly heroin and methamphetamine. Our findings do not find any evidence that cocaine has been significantly affected, for reasons we discuss.   

Volume 19, Number 1 January 2022 San Diego: Justice in Mexico, University of San Diego, 2022.

Understanding The EU's Response to Organised Crime

By Katrien Luyten with Alessia Rossi

The EU has made substantial progress in terms of protecting its citizens since the early 1990s. This has often been in response to dramatic incidents, such as murders committed by the mafia or other organised crime groups or big money-laundering scandals, or to negative trends, such as the steep increase in migrant smuggling and trafficking in human beings following the 2015 migration crisis. More recently, it was necessary to respond to the sharp rise in cybercrime, fraud and counterfeiting during the coronavirus pandemic. Criminal organisations continue to pose big risks to the EU's internal security. A rising number of organised crime groups are active in EU territory, often with cross-border reach. Organised crime is furthermore an increasingly dynamic and complex phenomenon, with new criminal markets and modi operandi emerging under the influence of globalisation and new technologies in particular. While the impact of serious and organised crime on the EU economy is considerable, there are also significant political and social costs, as well as negative effects on the wellbeing of EU citizens. As organised crime has become more interconnected, international and digital, Member States – which remain responsible for operational activities in the area of police and judicial cooperation –rely increasingly on cross-border and EU-level cooperation to support their law enforcement authorities on the ground. Recognising the severity of the problem and the need for coordinated action, the EU has initiated several measures to encourage closer cooperation between Member States; it has furthermore adopted common legal, judicial and investigative frameworks to address organised crime. The European Parliament has made fighting organised crime a political priority and helped shape the relevant EU legislation. Future EU action will focus on implementing existing rules, improving operational cooperation – even beyond the EU's boundaries – and information-sharing, while also addressing some of the main criminal activities of organised crime groups. Furthermore, the EU aims to make sure that crime does not pay. This is an updated version of a briefing from September 2020

Brussels: EPRS | European Parliamentary Research Service,  2022. 12p.

Integrity and Independence of Criminal Justice Institutions in the Western Balkans: Police and Prosecution

Edited by Uglejesa Ugi Zvekic and Ioannis Vlassis

Despite reforms, political influence continues to affect prosecutorial and police services across Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia, and Serbia (collectively, WB6), hindering effective action against organized corruption. The report provides a detailed examination of police and prosecution services in the region and evaluates the integrity, operational independence, and oversight of these institutions, especially in their role against organized crime and corruption. WB6 countries face challenges like ineffective internal oversight, low conviction rates for high-ranking officials, and limited resources within dedicated anti-corruption divisions within police and prosecution services. This study emphasizes the need for reinforced accountability, resilience, and operational independence to dismantle corruption networks. Among key recommendations, the report advocates for regional cooperation, stronger educational and training programs, and enhanced civil society engagement.

Geneva: Global Initiative Against Transnational Organized Crime, 2024. 91p.

Opium Poppy Cultivation (Volume 1): Afghanistan Drug Insights

By The United Nations Office on Drugs and Crime (UNODC)

Now entering its second year of enforcement, the ban continues to hold. In 2024, the area under cultivation was estimated at 12,800 ha, or 19% more than in 2023 (10,800 ha)1 . Despite the increase, opium poppy cultivation is still far below the priorban levels. In 2022 an estimated 232,000 ha were cultivated.2 The increase in cultivation came with a geographical shift. The South-western provinces of the country were long the center of cultivation up to and including 2023. In 2024, this changed and now 59% of all cultivation took place in the North-east, particularly in Badakhshan. The rapid and currently sustained decline in poppy cultivation and opium production has important and wide-ranging implications for the country and opiate markets long supplied by product from Afghanistan. Questions remain as to how the country will cope with the continued reduction in opiate income and how opiate markets downstream will react. Farmers that lack sustainable alternatives face a more precarious financial and economic situation and need alternative economic opportunities to become resilient against picking up poppy cultivation in the future. Distributors and dealers closer to destination markets, as well as consumers, are likely to experience supply constraints in the coming years, should the ban remain in place. Following a major hike in 2022 and 2023, dry opium prices stabilized slightly in the first half of 2024 to around US$730. These prices are several times higher than the long-running pre-ban average of US$100 per kilogram. Extremely high farmgate prices and questions about dwindling opium stocks may encourage a resumption in poppy cultivation, especially in places outside of traditional cultivation centers, including neighboring countries.  

Vienna: United Nations Office on Drugs and Crime; 2024. 20p.

Mandated Drug Treatment In the Aftermath of Recreational Cannabis Legalization

By Katharine Neill Harris, Christopher F. Kulesza

Roughly half of the U.S. population now lives in a state that permits recreational cannabis use and sales. Still, the criminal legal system continues to play a primary role in determining who receives treatment for cannabis use. It remains the single largest treatment referral source, and in 2019 more than 100,000 people who were admitted to treatment for cannabis use were referred by a legal entity. This raises questions regarding the extent to which individuals who interact with the legal system are monitored and punished for cannabis use in the post-legalization era. Moreover, the issue has not been addressed by state legalization measures. We examined trends in legal system referrals to treatment for cannabis use in legal and nonlegal states from 2007 to 2019. We also tested the relationship between recreational cannabis legalization and legal system treatment referrals for Black, Hispanic, and white adults and juveniles. The legal system’s practice of requiring individuals to participate in drug treatment warrants scrutiny because of its potentially negative and long-lasting consequences. While mandated treatment may be appropriate in some cases, the legal system often requires treatment participation from individuals who do not meet the criteria for a substance use disorder, and it does a poor job of connecting those who do have substance use disorders with appropriate care. The legal system’s limited efficacy in this arena is problematic because mandated treatment carries the possibility of additional legal consequences if program expectations are not met. The harmful effects of legal involvement include fewer education and employment prospects, reduced earning potential, destabilized family structures, negative mental and physical health outcomes, and diminished quality of life. Communities of color are disproportionately targeted by drug enforcement and disproportionately impacted by its collateral consequences. Recreational cannabis legalization (RCL) is intended to remedy, in part, the harmful and racially disparate effects of cannabis prohibition. However, the continuation of compulsory treatment for cannabis use, and the legal involvement it entails, is a potential pathway through which the systemic harms and inequities of cannabis prohibition can persist. The problematic nature of this arrangement is enhanced when it occurs alongside a commercial cannabis industry that profits from greater levels of cannabis use 

Houston, TX: The Baker Institute, 2023. 44p.   

Illicit Drug Policy: Developments Since The 2020 Ice Inquiry Report

By Lenny Roth, Tom Gotsis, Christine Lamerton, Ali Rabbani

Government policy to address the use of illicit drugs is a topic of ongoing debate. 

The purpose of this paper is to provide an update on key policy developments since the report of the NSW Special Commission of Inquiry into the Drug Ice in January 2020. The paper summarises the former government's response to the inquiry recommendations and notes progress that has been made since then. Significant reforms in other states and territories are outlined and the decriminalisation of personal drug use in three overseas jurisdictions is also discussed.

Key points

  • The NSW Special Commission of Inquiry into the Drug Ice was established in 2018 to investigate and advise on how best to tackle use of amphetamine-type stimulants. Its report was released in January 2020 and made 109 recommendations.

  • The former government’s response to the inquiry supported 86 of these recommendations. The government announced a $500 million funding package over 4 years including $358 million for health-related programs and $140 million to expand justice initiatives. 

  • Recommendations that the government rejected included decriminalising the personal use of illicit drugs, introducing pill testing, and expanding supervised drug consumption facilities.

  • In February 2024 NSW Health provided an update on progress in implementing the recommendations that the government had supported. 

  • A new police diversion program for possessing small quantities of illicit drugs commenced in February 2024 (the Early Drug Diversion Initiative). Critics have argued that police are diverting only a small proportion of those who are eligible for the program. 

  • In 2023 the ACT enacted laws to decriminalise personal use of small amounts of various illicit drugs. Pill testing services have continued in the ACT, were introduced in 2024 in Queensland, and will commence in Victoria in the summer of 2024–25. 

  • Oregon decriminalised the personal use of illicit drugs in 2021 and British Columbia also did so in 2023. In 2024 Oregon reinstated criminal penalties while recent changes in British Columbia have restricted the public places where personal drug use is legal. 

  • In 2022–23 most respondents to Australia’s Drug Strategy Household Survey did not support legalising the personal use of illicit drugs but most respondents did support pill testing and regulated injecting centres.

NSW Parliamentary Research Service, 2024

The Varieties of Money Laundering and the Determinants of Offender Choices

By Michele Riccardi & Peter Reuter

Two images dominate the discussion of money laundering. Investigative journalists and politicians stress the variety and sophistication of methods that have been used to launder the money of corrupt officials and white-collar offenders. The research literature, largely dependent on criminal cases, emphasizes how unsophisticated and routine are the laundering methods used by drug dealers and other illegal market participants. The discrepancy may reflect the incapacity of police to detect sophisticated money laundering but it may also represent the reality; that different groups of offenders choose different methods. This paper presents a theoretical framework to explain how offenders choose to launder their criminal earnings. Specifically, it asks: what determines the sophistication of the method chosen? Among the variables that we suggest influence the choice are: (a) the type of predicate crime and of crime proceeds, (b) the type of offender (age, education, social status), (c) his/her motivations, (d) the AML environment and the level of AML controls. The paper provides arguments from criminological and economic theory for how these variables might play a role. Without claiming that individual cases can test the theory, we offer some case narratives to suggest the plausibility of the factors that we propose.

European Journal on Criminal Policy and Research, Volume 30, pages 333–358, (2024)

How Criminal Is It to Rape a Partner According to the Justice System? Analysis of Sentences in Spain (2015–2022)

By J.M. Tamarit Sumalla, P. Romero Seseña, L. Arantegui Arràez, A. Aizpitarte

Sexual violence in an intimate relationship is a less studied phenomenon than other forms of intimate partner violence, despite data pointing to a high prevalence. Studies on how the cases are sentenced are scarce. Until recently, many laws did not allow marital rape to be punished as a crime of rape, and some studies showed a tendency for the courts to punish these cases less severely. The present study is based on an analysis of 964 rape cases of adult women in Spain. All the information was extracted from sentences of the Provincial Courts issued between 2015 and 2022. Results showed that significantly lower conviction rates and less severe penalties were imposed when the rape was committed by the intimate partner compared to other rape cases where the offenders were not partners (family members, acquaintances, or unknown strangers). The practical implications of these results in several areas are discussed. 

European Journal on Criminal Policy and Research,  Volume 30, pages 567–587,

Getting Cannabis Legalization Right in Hawaii

By Michelle Minton and Geoffrey Lawrence

Hawaii may be poised to become the 25th state to legalize the recreational use of cannabis for adults aged 21 and over. Nearly 90 percent of Hawaii residents supported full legalization of cannabis for adult use in a January 2023 poll conducted by the Hawaii Cannabis Industry Association. Gov. Josh Green has said he would sign a legalization bill if one is delivered to his desk—marking a significant departure from former Gov. Dave Ige, who left office in 2023. During the 2023 legislative session, lawmakers considered proposals to legalize adult-use cannabis. One of these bills was passed by the state Senate but was not heard in the state House of Representatives. Between the conclusion of the 2023 legislative session and the convening of the 2024 session, Attorney General Anne Lopez met with key lawmakers to develop proposed language for a legalization bill that could gain the support of the administration and the legislature. This working group produced a 315-page draft bill, introduced in each chamber of the legislature as House Bill 2600 and Senate Bill 3335, respectively. Despite having played a key role in drafting the legislation, however, the attorney general’s office testified in early hearings that it “does not support the legalization of adult-use cannabis,” although the current legislation is a “good faith effort toward protecting the public welfare and is an improvement on previous bills that have been heard by the legislature.” Reason Foundation has offered recommendations for improvement to successive cannabis legalization proposals in Hawaii. Several of these recommendations were adopted by Senate committees during the 2023 legislative session. Reason Foundation has also reviewed the provisions of Senate Bill 3335, as amended, and submitted recommendations for improvement. This brief goes beyond those recommendations and provides key background on the Hawaiian marijuana market and considerations for market structure and tax policy. Cannabis consumers are price-sensitive and have many options for purchasing cannabis. Prices and availability within the licensed cannabis industry can strongly influence the decisions of both producers and consumers to either participate in this industry or engage in illicit cannabis activity. In California, high taxes and a lack of legal sellers resulted in roughly two-thirds of cannabis demand being satisfied by the illicit market six years after legalization. The prevalence of illicit sales also negatively affects state tax collections, as only a minority of cannabis transactions are legal and subject to taxation. California has recently begun to take corrective action to lower the tax-induced price disparity between licensed and illicit goods, but Hawaiian lawmakers can circumvent the rise of large illicit markets with an appropriate market design. 

Los Angeles: The Reason Foundation, 2024. 18p.

A Framework for Federal and State Hemp-Derived Cannabinoid: A Framework for Federal and State Hemp-Derived Cannabinoid Regulation

By Michelle Minton and Geoffrey Lawrence

In the wake of the 2018 Farm Bill, which legalized hemp and its derivatives across the country, an unexpected flood of hemp-derived cannabinoid products hit the market and has sparked a whirlwind of interest—and concern—among state lawmakers. Unlike marijuana, which for now remains a Schedule I controlled substance under federal law, hemp-derived cannabinoids, such as cannabidiol (CBD) and delta-8 THC, occupy a murkier legal and regulatory landscape. This ambiguity, along with a lack of guidance from federal authorities, has left states grappling with how to ensure consumer safety, prevent underage access, facilitate interstate commerce, and support existing marijuana markets. The growing popularity of hemp-derived products has stimulated significant legislative attention in recent years, with over 90 regulatory proposals introduced in state legislatures in 2024 alone and 14 states adopting restrictions or prohibitions to some degree. A small but growing number of states have sought to legalize and regulate intoxicating hemp derivatives as general consumer goods, similar to alcoholic beverages or tobacco, or by incorporating them into their existing regulations governing medical or recreational marijuana. Yet, the continued proliferation and evolution of hemp-derived cannabinoid products has exposed significant gaps in existing regulatory paradigms. State regulations governing hemp products vary widely and are unevenly enforced, creating a patchwork of rules that can change dramatically from one state to the next. Unlike the market for marijuana, which has remained largely intrastate due to federal prohibition, federally-legal hemp products can cross state lines more freely. This has resulted in a marketplace where consumers face an increasingly confusing array of products of uncertain quality while businesses must navigate a shifting and uncertain regulatory environment. Additionally, lawmakers and regulators must continually update or amend rules in response to the emergence of new products, consumer behaviors, and industry dynamics. This piecemeal approach leaves consumers at risk, strains state resources, and hampers the ability for even willing actors to comply with state rules. This paper advocates for a cohesive approach to regulating hemp cannabinoid products that includes action by both federal and state policymakers. Our paper presents a series of recommendations for both federal and state authorities aimed at harmonizing standards across testing, labeling, packaging, and taxation for all cannabis products. By implementing these measures, states can enhance compliance and market competitiveness, reduce costs, and ensure consumer safety as both marijuana and hemp markets evolve. Ensuring consumer safety and minimizing youth access to potentially intoxicating products can also be achieved through state regulations that differentiate between high-THC and low-THC hemp products. We recommend states adopt labeling standards by which high THC product labels must provide detailed potency disclosures and risk warnings, while low THC products may adhere to general consumer goods standards. Consistent advertising restrictions across all cannabis products will also avoid bias based on the source of cannabinoids. The disparity in tax and regulatory burdens between marijuana and hemp products also fosters an uncompetitive landscape between the two product categories. High costs in state-regulated marijuana markets, such as those in California, push consumers toward cheaper alternatives, including both illicit marijuana or less-regulated hemp. To level the playing field, states should reduce the tax and compliance costs imposed on legal marijuana businesses, aligning them more closely with those for hemp producers. Imposing a single, uniform excise tax on all intoxicating cannabis products would simplify the tax system and reduce incentives for consumers to seek cheaper, illicit options. Restrictive licensing frameworks for marijuana businesses also contribute to its competitive disadvantage compared to hemp, limiting market entry, innovation, and consumer access, with the artificial scarcity raising prices and pushing consumers toward alternatives. In contrast, intoxicating hemp products can be produced in any state, shipped to a variety of retailers, and sold directly to consumers even in states without legal marijuana sales. This dynamic distorts the market in favor of hemp products, sometimes sold under transient branding and lacking clear originating information for the producer, which consumers might not choose if legal marijuana were more affordable or available. Regulators ought to be aware of who is selling intoxicating cannabis products, but regulatory schemes should not push market participants toward the hemp market merely because marijuana licensing is too costly or unavailable. We recommend states adopt a middle ground approach between overly-restrictive marijuana licensing regimes and the lack of any such framework for hemp. In particular, we suggest state law at least require hemp producers to register with state regulatory authorities while also drastically reducing both financial and non-financial barriers to entry into the marijuana market. This may include allowing any retailer who can demonstrate competence over inventory management for age-gated products to become eligible to retail both hemp cannabinoid and marijuana products. Finally, to fully realize the potential of a national cannabis market, particularly in light of the emerging hemp derivatives sector, states must also permit the interstate sale of marijuana products. As these authors argued in a prior paper, existing bans on out-of-state marijuana products are unconstitutional under the Commerce Clause and exacerbate the competitive advantage hemp currently enjoys. State lawmakers should agree to remove bans on the import of marijuana and allow state-licensed producers to export to purchasers in other states. In addition, lawmakers should take steps to align packaging, labeling, and testing protocols to facilitate a robust and legal interstate market. The rapidly evolving cannabis industry presents both opportunities and challenges for state regulators. By adopting a more unified and flexible approach to both hemp and marijuana regulation, states can enhance market competitiveness, reduce costs, and protect consumers. Embracing these recommendations will position states to lead in the burgeoning cannabis sector while ensuring consumer safety and market integrity

Los Angeles: The Reason Foundation, 2024. 85p.

Predicting Diversion Program Outcomes Using Drug Testing Information

By Yanwen Wang, Jacquelyn Gilbreath , Lynne Mock

While drug crime-related criminal legal system and victim costs reached $113 billion across the United States in 2007, just $14.6 billion was spent on treating substance use disorder (National Institute on Drug Abuse, 2014). Due, in part, to drug crimes, many U.S. citizens are under correctional supervision, with 1 in 66 adults being on probation or parole in 2020 (Bureau of Justice Statistics, 2021). In Illinois, 67,587 individuals were on probation in 2020 (Administrative Offices of the Illinois Courts, 2021) and 26,426 were on parole (Illinois Department of Corrections, 2020). The supervision population rate of substance use is estimated to be two to three times higher than that of the general population, with nearly half of the people under community supervision having a substance use disorder (PEW Charitable Trusts, 2018). The Illinois Criminal Justice Information Authority’s Adult Redeploy Illinois (ARI) program was established by the Crime Reduction Act of 2009 to provide financial incentives to local jurisdictions for programs that divert justice-involved individuals from state prisons by providing community-based supervision and individualized services. While researchers have evaluated ARI, models used in some jurisdictions (DeLong & Reichert, 2016; Kroner, et al., 2021; Mock et al., 2017; Reichert et al., 2016), research on ARI client outcomes related to the impact of drug testing is limited. The research goals for this study included: • Quantitatively examining all local ARI program drug test data, including tested drugs, drug test frequencies, and drug test results. • Systematically examining how ARI drug testing contributes to the possibility of revocation including other factors such as age, sex, and race. • Proposing recommendations for better program practice to reduce the rate of revocation. This study sought to answer the following research questions: 1. How is drug testing being practiced and observed in ARI in terms of its frequency, pass rates, and tested drugs? 2. Does drug testing have a significant impact on ARI participant outcomes when controlling for demographic variables? The study included 53,159 records of 1,055 individuals collected from October 3, 2011, to June 20, 2019. The median number of drug tests per individual was 19, and the median of the average days between drug tests was 10 days. The most frequently tested drugs also had the highest positive results: heroin (32%), marijuana/THC (30%), cocaine/crack (14%), alcohol (10%), and other opiates (8%). Logistic regression analyses were used to determine what demographic, drug testing, and criminal justice variables predicted program outcomes of completion or revocation. Among the demographic variables, only age predicted program outcomes. Neither sex nor race emerged as significant program outcome predictors. Drug test positivity rates predicted revocation, as well as drug test frequency (number of times an individual was tested) and average number of days between the drug tests. i Overall, the average drug positivity rate was 29% and most tests were passed with no drug found. Most successful clients who were older women at medium to medium-high recidivism risk and whom tested monthly with lower test positivity rates. Those most likely to experience program revocation were younger men who tested several times per month with higher test positivity rates during their program tenure. Graphing the programs by test positivity, number of tests, and frequency of tests suggests that individuals enrolled in some programs had higher test positivity rates (>50%) and were subject to less frequent drug tests than other programs. This study focuses on drug test outcomes, however, it also would be worth exploring data on drug testing rewards, sanctions, and requirements for program completion and their impacts on program outcomes.   

Chicago:  Illinois Criminal Justice Information Authority., 2022. 33p 

Oregon’s Ongoing Fentanyl Crisis

By Mark McMullen

Although it is particularly pronounced in Oregon, there is no question that the fentanyl epidemic is imposing severe economic costs across the nation. The current report quantifies some of these costs and describes the state policy environment. Public policy regarding drug use is evolving rapidly in Oregon as we speak. As with all CSI does, the primary goal of this report is to educate and inform Oregonians on policy issues such as this that impact their lives. Key Findings • The economic cost of Oregon’s fentanyl crisis is more than $31 billion annually, up from $5.88 billion in 2017. • Enough fentanyl was seized last year to kill every Oregonian more than 20 times over. • Most western states have seen above-average growth in fentanyl use during recent years. Even so, Oregon’s experience stands out relative to its neighbors. Since the pandemic began, fentanyl-related overdose deaths in Oregon have increased by over 1,000%, more than in any other state. Alaska’s experience is the only one that even comes close. • Although Oregon’s decriminalization experiment cannot be blamed for all the disproportionate local impact of the fentanyl epidemic, it is clearly playing a role. When decriminalization went into effect in February 2021, Oregon ranked 38th out of 48 states with available data in the rate of fentanyl related overdose deaths. By January 2024, Oregon’s rank rose to 13th. • Many voters and policymakers quickly experienced regrets associated with the decriminalization effort and are making some efforts to improve the law. During the 2023 legislative session, legislators enacted House Bill 4002, which created a new misdemeanor for simple drug possession. The new law gives leeway to counties on how to implement it locally, and we are likely to learn much as the different programs evolve.

Greenwood Village, CO: Common  Sense Institute 2024. 

Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon

By Michael J. Zoorob, Ju Nyeong Park, Alex H. Kral,  et alBarrot H. Lambdin, PhD3Brandon del Pozo, PhD, MPA, MA1,2

IMPORTANCE-  With the implementation of Measure 110 (M110) in 2021, Oregon became the first US state to decriminalize small amounts of any drug for personal use. To date, no analysis of the association of this law with overdose mortality has fully accounted for the introduction of fentanyl—a substance that is known to drive fatal overdose—to Oregon’s unregulated drug market. OBJECTIVE -  To evaluate whether the decriminalization of drug possession in Oregon was associated with changes in fatal drug overdose rates after accounting for the rapid spread of fentanyl in Oregon’s unregulated drug market. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, the association between fatal overdose and enactment of M110 was analyzed using a matrix completion synthetic control method. The control group consisted of the 48 US states and Washington, DC, all of which did not decriminalize drugs. The rapid spread of fentanyl in unregulated drug markets was determined using the state-level percentage of all samples reported to the National Forensic Laboratory Information System that were identified as fentanyl or its analogues. Mortality data were obtained from the Centers for Disease Control and Prevention for January 1, 2008, to December 31, 2022. Data analysis was performed from fall 2023 through spring 2024. EXPOSURES Measure 110 took effect in Oregon on February 1, 2021. MAIN OUTCOMES AND MEASURES The primary outcome assessed was fatal drug overdose rates per half-year. A changepoint analysis also determined when each state experienced a rapid escalation of fentanyl in its unregulated drug market. RESULTS In this analysis, rapid spread of fentanyl in Oregon’s unregulated drug supply occurred in the first half of 2021, contemporaneous with enactment of M110. A positive crude association was found between drug decriminalization and fatal overdose rate per 100 000 per half year (estimate [SE], 1.83 [0.47]; P < .001). After adjusting for the spread of fentanyl as a confounder, the effect size changed signs (estimate [SE], −0.51 [0.61]; P = .41) and there was no longer an association between decriminalization and overdose mortality in Oregon. Sensitivity analyses were consistent with this result. CONCLUSIONS AND RELEVANCE In this cohort study of fatal drug overdose and the spread of fentanyl through Oregon’s unregulated drug market, no association between M110 and fatal overdose rates was observed. Future evaluations of the health effects of drug policies should account for changes in the composition of unregulated drug markets.

  JAMA Netw Open. 2024;7(9):e2431612. doi:10.1001/jamanetworkopen.2024.3161

Prevalence of and Trends in Current Cannabis use Among US Youth and Adults, 2013-2022

By Delvon T. Mattingly a b, Maggie K. Richardson c, Joy L. Hart 

Cannabis use is increasing due to several factors including the adoption of laws legalizing its use across the United States (US). We examined changes in current cannabis use among US youth and adults and by key sociodemographic groups. Methods: Using data from the 2013-2022 National Survey on Drug Use and Health (n=543,195), we estimated the prevalence of (2013-2019, 2020, 2021-2022) and trends in (2013 2019, 2021-2022) current (i.e., past 30-day) cannabis use among US youth (aged 12-17) and adults (aged 18+) overall and by age, gender, race and ethnicity, educational attainment, and total annual family income. We also examined sociodemographic factors associated with use from 2013-2019, in 2020, and from 2021-2022. Results: Cannabis use increased from 7.59% to 11.48% in 2013-2019, was 11.54% in 2020, and increased again from 13.13% to 15.11% in 2021-2022. Among youth, cannabis use remained constant from 2013-2019 and 2021-2022. In 2022, use was highest among aged adults 18-34, male, non-Hispanic multiracial, and generally lower SES adults. From 2021-2022, cannabis use increased among several groups such as adults who were aged 35-49 (14.25% to 17.23%), female (11.21% to 13.00%), and Hispanic (10.42% to 13.50%). Adults who were aged 18-25, male, non-Hispanic multiracial, some college educated, and of lower annual family income had consistently higher odds of current cannabis use from 2013-2019, in 2020, and from 2021-2022. Conclusions: Cannabis use is increasing overall and among certain sociodemographic groups. Our findings inform prevention and harm reduction efforts aimed at mitigating the burden of cannabis use in the US. 

Drug and Alcohol Dependence Reports