Cannabis Legalization and the Impact on Substance Use Treatment

Background/Purpose: Cannabis policy is rapidly evolving in the United States. Although cannabis is illegal at the federal level under the Controlled Substances Act, 18 states and the District of Columbia have legalized recreational cannabis use for adults 21 years and older. The increases in support for cannabis legalization have also coincided with decreases in perceived risk (Ellis & Resko, 2022). The impact of legalization on substance use treatment providers is unclear. This exploratory study utilizes a statewide sample to examine how treatment providers’ work has been affected by the legalization of cannabis in the state of Michigan.

Methods: Substance use treatment providers in Michigan (N=570) were recruited to complete a web-based survey on employment experiences. Recruitment focused on treatment staff working at publicly funded agencies and data was collected from November 2020 through July 2021. Surveys included an open-ended question that asked: “Has the legalization of marijuana impacted your work in any way? If so, how?” About 70% of respondents (n=401) answered the open-ended survey. These participants included licensed social workers (45.5%), counselors (20%), and psychologists (4.4%); and certified addictions specialists (37.1%), peer recovery coaches (11.5%), and clinical supervisors (14.8%). A two-phase process was used to code the data. Thematic analysis (Braun & Clarke, 2006) was initially utilized to identify key themes related to changes experienced following cannabis legalization. Erickson’s (1986) analytic induction framework (Patton, 2002) was then used to review the themes and corpus of data with the goal of arriving at a set of final assertions based on a thorough understanding of the data. To determine whether each assertion was warranted, we reviewed and assembled the data to assess confirming and disconfirming evidence.

Results: Most treatment providers (81%) identified changes in their work related to cannabis legalization. Six major themes were identified, including 1) changes in attitudes and perceptions of cannabis, 2) confusion around drug laws and agency policies, 3) changes in consequences for clients (e.g., less child welfare and criminal justice involvement for clients), 4) increased use of cannabis among clients in treatment (e.g., more clients showing up for counseling high, “California Sober” clients that use cannabis but no other drugs, more clients using cannabis for medical reasons), 5) more difficulty addressing cannabis clinically (e.g., harder to explain to clients, prevention is more difficult), and 6) changes in referral sources (e.g., more self-referrals, fewer criminal justice referrals).

Discussion/Implications: Findings highlight how treatment providers have varied attitudes toward cannabis legalization, with some supporting it, others viewing it as a challenge, and mixed views. Participants reported considerable confusion about cannabis laws and highlighted the need to educate treatment providers and clients on cannabis policies (e.g., differences in state/federal laws, why cannabis is not allowed by probation/parole). Many treatment providers described how legalization and shifts in attitudes, including risk perception, have made their work more challenging. Other providers, who reflected a harm reduction approach, emphasized positive changes including more honest discussions about cannabis use, reduced stigma, shame and guilt, and fewer child-welfare or criminal issues.