What Happens After Legalization?: The Role of Cannabis Policy in Markets, Policing, Youth, and Patient Health

Session Submission Type: Panel

Abstract

As cannabis legalization continues to expand across U.S. states, policymakers face mounting questions about the downstream consequences of these reforms for public health, public safety, and regulatory design. This panel brings together four empirical studies that collectively examine how cannabis policy changes reshape medical marijuana markets, law enforcement practices, youth access and consumption, and patient health outcomes. Each paper leverages distinct data sources and rigorous empirical methods to evaluate effects across different policy dimensions, offering a comprehensive assessment of the intended and unintended consequences of cannabis reform.

The first paper examines whether the introduction of recreational marijuana retail in Colorado crowds out participation in the state's medical marijuana registry. Using county-level panel data and exploiting staggered variation in the timing and density of recreational retailer entry, the study compares two-way fixed effects estimates with newer heterogeneity-robust difference-in-differences estimators. Findings suggest limited substitution from medical to recreational markets, underscoring the importance of estimator choice in staggered policy evaluations.

The second paper investigates the impact of adult-use cannabis legalization on law enforcement stops and searches. Because cannabis possession and odor have historically provided officers with reasonable suspicion to detain and search individuals, legalization may reduce a key tool of proactive policing. Using originally collected administrative data on stop activity in large U.S. cities and quasi-experimental methods, this study analyzes how legalization and explicit statutory protections against cannabis-based searches affect stop patterns and arrest rates.

The third paper addresses an underexplored source of mixed findings on cannabis legalization and youth use: variation in enforcement of the minimum legal purchase age. Combining youth survey data with administrative records on retailer compliance checks in Washington state, the study applies staggered difference-in-differences methods and finds that compliance checks meaningfully reduce youth cannabis use, suggesting that inconsistent enforcement may bias prior estimates downward.

The fourth paper leverages Florida's sequential policy changes permitting smoked flower and then edibles within the state's medical marijuana program to examine how route-of-administration utilization patterns relate to patient health outcomes. Linking patient-level registry data with Medicaid, Medicare, and controlled substance records, the study uses individual fixed effects and event-study designs to assess associations between specific routes of administration and prescription medication use, potentially risky co-use, and acute clinical events.

Together, these papers advance the evidence base on cannabis policy reform by illuminating consequences that span market structure, civil liberties, adolescent health, and clinical safety. The panel offers policy-relevant findings for legislators designing cannabis regulatory frameworks, law enforcement agencies adapting to legalization, regulators overseeing youth access protections, and clinicians counseling patients in medical marijuana programs.

Policy Area

• Health Policy

Chair

• Ashley Bradford, Georgia Institute of Technology

Discussants

• Jayani Jayawardhana, University of Kentucky

• Peter H. Reuter, University of Maryland, College Park

Organizer

• Danielle Atkins, Florida State University

Individual Presentations

• The Impact of Marijuana Legalization on Medical Marijuana Enrollment: The Case of Colorado - Presenting Author: Thao P Pham, University of Illinois at Chicago

• Cannabis Legalization and Crime: Cannabis as a Basis for Law Enforcement Stops and Searches - Presenting Author: Anne Elizabeth Boustead, University of Arizona

• Cannabis Legalization and Youth Cannabis Use: Evidence on the Importance of Enforcing Retailer Compliance - Presenting Author: Rosalie Liccardo Pacula, University of Southern California

• Policy-Driven Changes in Medical Marijuana Routes of Administration and Patient Health Outcomes: Evidence from Florida - Presenting Author: Danielle Atkins, Florida State University