Commentary on Han & Shi: The presence of recreational cannabis dispensaries and storefront marketing activities in residential neighborhoods—recent evidence for associations with individual cannabis use

Abstract

Investigation into the effects of recreational cannabis dispensaries’ locations as well as point-of-sale marketing activities on cannabis use outcomes is critical for the development of effective surveillance measures and regulations.

In the United States, as of April 2023, 22 states and the District of Columbia have enacted recreational cannabis laws (RCLs) [1]. Emerging evidence suggests that RCL implementation may increase cannabis use and related harms, such as cannabis use disorders (CUD) [2] and simultaneous use with other substances [3]. In states with RCL, retail sales occur at recreational cannabis dispensaries (RCDs), which have rapidly increased in number following commercialization. Preliminary research suggests a positive association between the presence of RCDs in residential areas and cannabis use and related problems, which may be attributed to increased product availability, accessibility and social acceptance [4, 5]. While the extent of these effects remains under debate, additional methodologically rigorous investigations are necessary to understand underlying mechanisms and to address public health concerns.

Han & Shi [6] provide valuable contributions to the limited literature on the relationship between RCD presence, point-of-sale marketing activities and cannabis use. Their study overcomes previous limitations using individual-level analysis with accurate dispensary–home distances and a probability-based sample that is representative of adult Californians. The authors emphasize the importance of identifying cannabis users by their reasons for use. However, recent studies [7, 8] suggest a more extensive range of reasons for recreational use, beyond use to experience the euphoric effects of cannabis, which were not considered in this study. Examples of such reasons include using cannabis for experimental purposes, to alleviate boredom, to fit in and for social reasons. Collecting data on medical cannabis cardholder status could have further enhanced the understanding of the medical-only group and impacted the study’s findings.

Previous research indicates that youth and adult exposure to points-of-sale of tobacco products is associated with increased susceptibility to smoking, smoking in a dose-dependent manner and other negative smoking-related outcomes [9, 10]. Studies on alcohol generally yield similar results [11]. Research on the negative effects of marketing activities in tobacco and alcohol retail outlets can provide insights for cannabis research and policymaking. Han & Shi found positive associations between proximity and density of storefront signs promoting cannabis and its health benefits and cannabis use. However, findings varied based on RCD location and cannabis use measures. For example, positive associations were found between the count of RCDs with signs promoting health benefits within a 2–4-mile radius of individuals’ homes and recreational-only cannabis use, but not within a ≤ 2-mile radius. Future studies should include samples from other jurisdictions and RCL states to account for socio-demographic differences.

Future research should identify user profiles that are more responsive to RCD presence and marketing activities to develop effective harm reduction strategies and public health policies. In addition to reasons for cannabis use, investigating frequency and quantity of cannabis use is important to understanding how and to what extent RCDs promote problematic use. This knowledge can assist in preventing initiation of cannabis use among new users and mitigating problematic use and CUD among frequent users. Panel studies and social media-delivered surveys are particularly effective in gathering detailed information on cannabis use practices compared to national studies.

Future studies should also consider several important factors. First, the impact of RCD characteristics on the use of different cannabis product types, particularly highly concentrated products that are among the top-selling items [12] and pose increased risks of dependence, requires investigation. Secondly, research should prioritize assessing the effects of RCDs on children and adolescents, who may be more susceptible to normative messaging conveyed by their presence and marketing activities [13]. Thirdly, some states have implemented regulations for overseeing RCDs’ marketing activities [14], but licensed cannabis retailers on the internet present new regulatory challenges. Their websites often lack age restrictions, promote medical benefits without acknowledging adverse effects and offer on-line sale and home delivery [15]. To effectively address the continually changing landscape of cannabis retail, research is necessary to promote adaptation and refinement of regulatory efforts. Finally, while tools to audit RCDs for research purposes are being developed [16, 17], accounting for a thriving unlicensed RCD grey market remains a critical challenge [18]. Unlicensed RCDs are more likely to sell high-potency products, allow on-site consumption and fail to restrict underage access [19].