Episode Transcript

Trevor: You're back.

Kirk: Hey, Trevor. How's it going?

Trevor: I'm doing well. For those of you following at home, this is the first time I've sort of talked with Kirk on a podcast since he's been back from all over Africa, Europe, the Mediterranean, around the Mediterranean.

Kirk: Don't  blow it up I went to Morocco in Spain yeah we Michelle and I were gone for.

Trevor: The whole African continent.

Kirk: Yeah the whole northeast what is it northwestern tip no we were we were gone for seven weeks I think we left it we left in August and got back in second week of October and yeah gathered a whole bunch of stories I think were just talking I think I got five to six stories about what's happening in Morocco and what's happening in Spain and fascinating stuff so we were just discussing how we're hoping to produce those in the next little while so I think it's going to be an autumn.

Trevor: Stay tuned.

Kirk: Stay tuned I think we're gonna have an autumn of travel stories road stories from Morocco and Spain can't wait

Trevor: but today we are going to talk about what can be dull but I think we both agreed ended up being really interesting. Epidemiology. So everybody loves you know statistics and let's talk about large numbers of people but this one really was cool so I think I said it in the thing but I'll repeat the the title because it's long but it kind of goes what we're talking about "gender differences in cannabis outcomes after recreational legalization: A United States repeated cross-sectional study 2008 to 2017. Okay not a short title but It was interesting.

Kirk: I found it in NORML. I think I found this story in NORML And I've found lots of stories in NORML. And I think I've told the audience this, that I get NORML push to me. I think, you know, I don't even think once a week or once a month, I didn't even know how often it comes. But I read through NORML and I find stories and I would safely say 70% of the NORML that I read, I send out requests for podcast interviews and I get back probably 10% of them. And then out of that 10%, we usually gravitate to five that usually happens and this is one of them and they got back to me as I was leaving for Spain and I punted it to you and said hey man this is an interview we should be doing and I'm so pleased we got it.

Trevor: Yeah, me too. So we have Luis and Sylvia. So, we'll let them go into the, you know, the crux of what they did, but just kind of an overview. They looked at this huge health survey that goes out all the time in the US and they focused on 2008-2017 and we'll let them do the details. But I want to, because we talked about this just before coming on air, I want to talk about. I'm going to call it a natural experiment. I'm stealing that term from the economists out there, just because I think it covers this well. So sometimes so in my world, pharmacists, we want a double blind placebo control trial, right? We want half the people to get the drug of interest and half the people get a sugar pill, knowing to know who got what and see what effect it had. That's that's our sort of goal standard. But in the real world, it can be really hard to do that. You know, it might not be possible to have a placebo control, it might be ethical. So, you know, if you want to see what effects seatbelts had on on deaths after car accidents. You know you might get lucky and lucky for deaths and car accidents where you know one province legalizes seatbelts are mandatory this year and the next province does it the year after and you can sort of see the difference they can work as their own control that's sort of a natural experiment. One of the famous ones I like talking about. It's not just because I like the book and podcast Freakonomics, but Steve Levitt, an economist and a co-author, looked at some stuff in the early 70s.  In the early 70's Roe verses Wade in the US  about abortion came on but states legalized abortion at different times so you know the supreme court thing came in and then different states in different years made abortion legal and so they used that natural experiment thing to look at about 20 years later so that happened in the early 70s so they looked in the 90s to see what was happening to crime rates and what they found is basically crime rates fell about 20 years-ish after abortion was legalized. Now this is, I'm not saying I'm pro against abortion, neither were them, that's not this podcast, save or hate mail, but it was interesting because you can't ethically or even possibly say this group of people is allowed to have abortions and this group isn't, but when you find this happening sort of quote unquote naturally, it can give you some useful information. So that's what these guys were doing in this is. Different states in this period of time, 2008 to 2017, went from medically legal to recreationally legal and that's what they were looking at.

Kirk: Yeah, I'm really excited about this. So, basically some numbers here. As of November 2023, 38 American states, including Washington DC, had legalized cannabis for medical use. And then, by that time, 24 of those states and Washington DC legalized for recreational use. So they, what they were able to do was to look at how people consumed cannabis between those states. So they got down to, I think they got down to nine states that they actually focused on. And then

Trevor: That change during that time period.

Kirk: That's right, yeah, during that time period. And they looked at what? 838,600 surveys were done with experienced survey interviewers who interviewed people about this and they were able to do a cross-sectional study on how people change their use in cannabis compared to the medical states and the recreational states, right? And so so I think and I mean I'm hypothesizing on this I think they got their funding because they're both they weren't let them introduce themselves, but they're focused on addictions, right? They're both health health professionals, academic.

Trevor: Substance use, yeah,.

Kirk: But academic use and how people use substances, which is usually come on, usually, it's usually misuse is involved in that, right? They're usually looking at misuse. So I think I think that they did this study, got the funding with an expectation that they didn't necessarily find. So I think they asked a question.

Trevor: I think that's fair.

Kirk: So as an academic, when I was doing my master's, you ask a question when you do it. And that's the biggest thing about PhD students and any master graduate student is people always say, so what's your question? What's your questions? What are you researching? And I think the asked the question, and they got a different result. And so you want to just go right into it, and we can come out and discuss the results.

Trevor: Absolutely. Let's listen to Luis and Sylvia and we'll talk a little more on the way up.

Kirk: Fantastic.

Trevor: On the line today we have Luis and Sylvia from New York and they are part of an interesting study on cannabis use and gender. I'm going to get them to introduce themselves. Luis, I'm gonna start with you.

Luis Segura: Hi, I am Luis Segura. I am a postdoctoral research scientist at the Department of Epidemiology working at the Substance Use Epidemiology Unit. I got my PhD from Columbia University. I'm also an MD by training from Mexico. And mainly the work that I do focuses on the impact of cannabis and other drug use policies on substance use and substance use disorders.

Trevor: Thank you very much and Sylvia.

Silvia Martins: Hello, I'm Silvia Martins. I'm a professor of epidemiology, director of the substance use epidemiology unit at the Department of Epidemiology at Columbia University. I'm also the vice Dean for faculty at the school and I lead the team that does work on cannabis and opioid policies and other substance use policies and social policies on multiple substance use outcomes.

Trevor: Thank you very much. So it said at least once, I'll read the title. So "Gender differences in cannabis outcomes after recreational legalization: United States repeated cross-sectional study, 2008 to 2017." Okay. And whoever wants to jump in. So the first is, is this fair to call this a natural experiment? An experiment where we're sort of... Where it'd be unethical or impractical to, you know, put people in, you study groups and placebo groups, but we could just kind of watch something happen. Like, you famous example would be, you watch to see what happens to deaths after seatbelt laws come into place. That's the kind of study we're looking at here, right? Yeah.

Luis Segura: Yes, I think this can be classified as a quasi-experimental design and we use a design similar to difference-in-difference, which is pretty common to use when you have your outcome, you don't have a time without the outcome, so the outcome is present when the policy happens. And then you need to see how that outcome changes after the policy is implemented.

Trevor: Sounds good. Okay, so either one of you, so what were you looking for and then we'll sort of get into how you set this up. So what were what were your interests in finding out at the beginning of this?

Silvia Martins: So at the beginning of this, we were interested in looking at whether there were changes in the prevalence of cannabis use, so past year, past month, past year past month daily use and cannabis use disorder across time after the enactment of recreational cannabis laws. And specifically, this is part of a larger body of research and specifically in this paper, we were interesting in seeing like if there were and if the changes were different across genders.

Trevor: Okay, maybe Luis, you on this one. So what sort of body of data were you looking at to try to figure this out?

Luis Segura: Yes, of course. So we use restricted access data from the National Survey on Drug Use and Health from 2018 to 2017. So these are panels of cross-sectionals that happened throughout that time period and allowed us to identify respondents, whether they reside in a recreational cannabis laws state. And their cannabis use in the past month, past year, whether they were daily users and if they had a cannabis use disorder according to the DSM.

Trevor: Okay. And the other thing I noticed is it ended up being nine states, just that's sort of what happened in your time frame. So you were sort of looking at, did they have a recreational cannabis law? Did they have a medical cannabis law and sort of when it switched from one one to the other sort of during this this this time period?

Silvia Martins: Yes, and just to clarify, like we used all US states in the analysis, but there were only nine states that switched from like medical cannabis to recreational cannabis. So that was our contrast of interest, looking specifically at those that switched, but we included all the other states, all the states in analysis. And I think it's important to say that in the US, all states that have enacted past recreational cannabis laws where states were already medical cannabis what had been already legalized in the past. I don't know Louise do you want to add anything to that?

Luis Segura: Yeah, I think that it is important also to know that medical cannabis laws had already showed some effect on cannabis use. So the idea of focusing on the switching between enacting recreational cannabis loss in states that had already passed medical cannabis laws, which were all states that passed recreational, was to hold constant the effect on the trend in cannabis use. So it was important to include the states that only had medical cannabis laws to adjust for that trend in the use of cannabis and the other cannabis outcomes that we looked at. And also for states that were very different but also where cannabis use has a certain trend, which are states that did not pass anything.

Trevor: Okay and just because it's right there in the title were you interested in gender from the beginning or was it just something that sort of popped out as you were doing the study?

Silvia Martins: I think we were we were interested on gender from the beginning so from the beginning because we had seen that was based upon like research done with medical cannabis laws and studies done like looking at treads over time in cannabis use that showed like gender differences so that's why like we've been interested not just like in the in looking at changes in the general population but also by gender and by age groups because we know that we thought there would be, we would see different changes.

Trevor: Okay and just because you know math is hard to do over a podcast we're not going to get too deep into the the stats here but either one of you do want to give us just sort of the the high level of how you how you did this and what you were looking at then then we'll finally get around to the results of what came out the other end.

Luis Segura: Yeah, of course. Yeah, so I think at the time, this was also a very interesting analysis to do because at the the way of doing these difference-in-differences, when you have policies that are enacted at different time points represented a challenge, right? So usually in a normal in a normal experiment what most people are used to. You have people without the outcome, right? You assign an intervention or an exposure. And then after a certain period of time, you evaluate whether or not they have the outcome. However, in this kind of quasi-experimental designs, you have, people that already have the outcomes, right, and then an intervention happened. And what you want to see is whether the outcome shifted from the trajectory that they had before the policy intervention. However, at the time, methods for evaluating these were based on a fixed time of when the intervention happened. So when you have an intervention that happens at one time point for some individuals and then at a later time period happens for other individuals and so on. Then the analysis in the math becomes a little bit more challenging, right? So what our study did was that we implemented a time-varying exposure of when the recreational laws is enacted. So at every time point we have an indicator of these recreational cannabis laws that change for some individuals, so change or gets activated. So we know that they were actually exposed. And what we did then was to compare their cannabis outcome when these laws were inactive compared to those that were not residing in the state that the recreational cannabis sauce were enacted. And we adjusted for the previous trend in the outcome, right? So we can see just the bump above and beyond the trajectory that they had on their cannabis use.

Trevor: Okay, all right. So I think we've got this set up nicely. So we've done this. Like Sylvia was saying, we looked at the whole US and we were kind of using, jump in if I am saying this wrong, the States that didn't have recreational cannabis laws, almost as controls for the ones that did. And we got some results based on gender and age. So what sort of popped out the other end of this?

Silvia Martins: So, interestingly, what we saw is that overall, we saw increases in past year cannabis use among both men and women. We also saw some increases in pass month cannabis use, but we didn't see increases in pass month daily cannabis use or DSM-5 cannabis use disorder. And Luis, do you want to add the results by age and by gender?

Trevor: Before you do that, because I probably should have asked, so just for the audience, just real quick, what do we mean by past month use, past daily use, and you don't have to go through all the criteria about what sort of things we're looking at to indicate someone had cannabis use disorder.

Silvia Martins: Oh, yes, sure. So, past year use is people reporting, self-reporting, whether they used cannabis at least once in the past year. So, it could have been like used, let's say, at a party, used at friends, but at least ones. Past month is people self-reporting that they used cannibals at least one in the last month. Daily use, we use a classification where people reported that they used cannabis at least 20 days in the past month, so almost every day, and that is consistent with what others have done in other studies. And cannabis use disorder is whether people, in this survey, people are asked several questions that match on to like the DSM-4 criteria, the DSM4 criteria. So whether they are having problems with their cannabis use, reporting withdrawal, withdrawal tolerance, or problems with their family, problems in work, spending a lot of time looking for cannabis. So they meet criteria for a certain number of those questions and they could in theory potentially have a cannabis use disorder.

Trevor: Yes, and thank you Luis. So what were we finding out when some of these age stratification, gender stratification came out? Right.

Luis Segura: So, in general, we found that men and women aged 21 to 30 years old, their past year In the past month, cannabis use increased. More than the other age groups. They were the age bracket that showed a higher increase in past month and past year cannabis use. However, their daily cannabis use or how frequent they were using and their cannabis use disorder did not increase in any of the different age brackets that we which were 12 to 20, 21 to 30, 31 to 40, and 40 and plus. Either for men and women. So those show no significant increases. One of the main concerns about these policies is whether or not they affect the use of adolescents and young adults. Right. So people age 12 to 20, which we did evaluate whether their cannabis use increased, we found that it did not increase for men or for women. In fact, past-year cannabis use decreased a little among men aged 12 to 20, and their past-month cannabis use did not change.

Trevor: Okay, no, that's interesting. Now to just probably restate what you're saying, but just again, jump if I'm getting something wrong. So the first thing you said, anecdotally doesn't surprise me, after cannabis becomes recreational in a state, people aged 20 to 30 ish, male or female, are more likely to have a joint at a party than they were before legalization. Not that anecdotally, but like you said... Something everybody's concerned about is after we get recreational legalization do teenagers use cannabis more and you're finding a no and even decreases in teenage boys and in cannabis use did i do i have that right?

Luis Segura: correct, small decreases. However, the concern is always that these policies will increase, right? That's the main concern that all these and like you said is not surprising, right, because cannabis policies they are mainly they are making these products legal for adults, right. So the concern is whether there's spillovers to other age groups that they are not meant to be impacted by this policy. So for example, adolescents and young boys, right. The other thing that was also that we evaluated and we were very interested is this concept of the cannabis gender gap. Historically, and it's very well known, that men use more cannabis than women because of their perception or maybe their risk-taking behavior, or we are not entirely but it seems that on every other or research has shown that in general, women tend to have more liberal views about most things like gun control and other policies. They are more supportive or like government regulation than men. However, in the case of cannabis, they tend to be more more conservative or they tend to engage less with use of cannabis historically. So there's a gap between the use of men and women. So we were interested in evaluating whether this, because making cannabis more accessible, right, with legalization, whether that changed that gap between men and woman in cannabis use. So even though men start at a higher level of use than women. We saw that. The increase for both men and women after legalization was higher for women than men, decreasing that gender gap.

Trevor: And that is interesting. Yeah, again, anecdotally, you guys have done the research, but anecdotally, yes, cannabis has sort of been seen as a male-dominated space, something that young boys and men were interested in and women not. So it is interesting to see that legalization, maybe I'm reading too much into this, but seems to make it more acceptable. Women find it less less inaccessible, less stigmatizing, less something that there is now something they're more interested in trying or using.

Silvia Martins: Yes, I think it's exactly that. Like once it's less stigmatizing, more acceptable, like we see like this greater increase in women. Yeah.

Trevor: Okay and something else and you touched on but I think it's just worth spending a little bit of time with. When we have recreational cannabis laws come into effect, you know we talked about teenagers already, but the other big thing is is everybody now going to have a problem with cannabis? Is everyone now going have cannabis use disorder? And that is not what you found, correct?

Silvia Martins: Correct, correct, that is not what we found. Of course, like we should, there is a caveat that we analyze data up until 2017 and during that time period, like only nine states switched to having recreational cannabis laws, but I think it is also at the same time, like encouraging to see that even though more people are reporting cannabis use, we weren't seeing like increases in cannabis use disorder. But, of course, that could take time and we need like to continue following up, especially now that more U.S. States have legalized to see if there is or if this trend continues or there is a shift also in this outcome.

Luis Segura: If I may add also, and that is a very important limitation, that cannabis use disorder takes time to develop, but the other also strength of what we did and that supports the notion that these laws are not increasing people's cannabis use disorders is that other studies have shown that cannabis use disorder has increased in the overall population. After enactment of cannabis laws, but there's a caveat to analyzing the data that way, right? Because cannabis use, recreational and cannabis policies are increasing the number of users. So they're increasing the pool of people that use cannabis. So yes, of course, you're going to have a bigger proportion of people who endorse cannabis use disorder eventually. However, when you look at people that are users of cannabis, whether or not they are having higher proportion of cannabis use disorder, we found that that is not the case after enactment of recreational cannabis laws. So those are people that are at risk of developing cannabis use disorder, which suggests that these laws are increasing the pool of people that are using cannabis. Yes, of course, but they don't seem to be increasing the frequency or the intensity by which cannabis users are using cannabis. So that is, I think, in support of these laws not increasing cannabis Use disorder.

Trevor: Well that's great and just again to restate and jump in if I'm not getting this right but so as the number of people who use cannabis go up not surprising the absolute number of people with cannabis use disorder it's going to go up but the recreational use laws the increase does not seem to increase the rate or the proportion or the percentage of of people that a cannabis use disorder.

Luis Segura: Correct yes.

Trevor: That that good to know. Obviously we're a pro-pass podcast and other people may be much more upset by the fact that the absolute number is going up and it's not and we're not trying to dismiss that. Was there anything else or surprising that came out of the numbers that you really went, wow I didn't expect that or I better recheck my math or that was weird and anything else sort of pop up out at you from from the study?

Luis Segura: I think that we were very surprised by the narrowing of the cannabis gender gap. I think we were, I mean, our prior was that or our prior belief was that, you know, the cannabis gender gap was going to stay the same. But it does seem that there is some, there is effect on individuals. Particularly women, perception of how risky it is to engage with cannabis use after an enactment of this laws, or maybe what is changing is their perception of availability or both. There are studies that look at both perception of availability and perception of risk of using cannabis and how this has changed over time, probably due to the enactment of this laws and making cannabis less stigmatizing. And there's also these... Belief or idea that cannabis legalization can also help more social equity outcomes to advance them because it changes how people perceive the risk associated with cannabis use, for example, whether or not that is a criminal offense that needs to be approach in a more harder way, right, or how it changes how society engage in these gender norms. So we thought that was very interesting. I personally had a prior that I didn't think it was going to change much, but we were very surprised by seeing this gender gap narrow.

Trevor: Well, that's the good part.

Silvia Martins: Yeah, I think another thing that we were surprised is that even though we weren't surprised that there weren't increases like in the adolescent population, so the population ages 12 to 20, we were somewhat surprised that they were decreases in the prevalence of past year cannabis use among boys. So we were expecting that there might not be increases, but we weren't expecting also like to see a decrease. Yeah, so I think all of that is part of the same larger picture.

Trevor: That's very cool. And you know, the whole the whole point of research is to be surprised. So I'm glad we got some surprising things. So this is my usual time of saying, did I miss anything? Or was there anything else you were expecting? Anything else you think our listeners need to know about cannabis use, gender gaps, age stratification, the study in general, where you're going in the future, anything else that we need to know about this one? 

Luis Segura: uh sure well, I mean, I think that one of the limitations that Dr. Martin's already talked about, which is to see at future time points if Cannabis Use Disorder have had time to develop and if these actually increase is an important thing to replicate in the future. That's a future direction. And also to clarify for the listeners, all these hypothetical mechanisms by which cannabis use increase more among women than men are just that our hypothesis based on what other people have found in the literature we just found that the cannabis gender gap narrow. So future studies should look at these mechanisms, right? These mediating mechanisms by which use increase, whether it is changing in gender norms or increased perception of or increased perception of, sorry, decreased perception of risk of using cannabis. So I think that's another interesting avenue for future research. Yeah, I don't know if you want to add something, Silvia.

Silvia Martins: I think one thing to point out like are also like some of the limitations of the study like so this is a national survey and we only have information on self-report so we don't have like any information like a Now the survey is collecting data on modes of cannabis use, but at the time, we didn't have information on modes on cannabis use and we also don't have the information like on the THC content of the cannabis products that the people are using. So that's also an avenue for future research.

Trevor: Right. And I think another. Fascinating. Keep going, Luis, go ahead. Sorry.

Luis Segura: Of course, I think that also another important component of any policy is how they vary under different provisions. So future studies should look at how different provisions or different stipulations of these policies have differential effects or can affect differently cannabis use. Whether the policy increases the number of legal dispensaries or allows cultivation or are there different consumption restrictions in different states, right? Those are things that definitely should be explored and see how they affect cannabis use and whether or not that affects also the cannabis gender gap. And, of course, like I said before at the time, the evaluation of an intervention that has a stagger adoption approach was limited now. Because we do a lot of policy evaluation, we know that there are more developed methods that it will be interesting to replicate these findings and see if they hold.

Trevor: Was really good. I really appreciate your time and this was great. We learned a lot and for me, especially the whole cannabis legalization doesn't seem to affect teenagers I think is a huge takeaway that I think everybody should know about.

Silvia Martins: Thank you. Thank you for inviting us.

Trevor: So Kirk, uh, let's hit some highlights. I'm going to talk about my favorite highlight, significant, not important or not. Uh, teenage boys were using less cannabis post legalization than pre-legalization. Thoughts? Yeah.

Kirk: Yeah, that's astounding. And I think, I mean, looking at what happened in Canada, Canada legalized October 18th, seven years ago, and the big, you know, the sky's going to fall, kids are going to consume cannabis. Well, Cannabis is not being consumed by a lot of people like kids, the kids aren't doing it. They're not drinking alcohol and they're not consuming cannabis as the thought was going to happen. I mean, sure, kids are using cannabis. Kids have been using cannabis since the 30s for crying out loud. But however, the big numbers didn't jump. So yeah, I thought that was an interesting number that, you know, boys are using it less. So I guess because it's legal, it's less cool, I don't know. But I was thinking that we should talk a little bit about what the DSM says about cannabis disorder because a lot of this...

Trevor: That's good before you do because they did mention it but i think it's worth highlighting remember they can't actually diagnose anybody with uh cannabis use disorder in a survey so this was people who answered the question as if they might have cannabis use disorder but it's different from you physically going and seeing a doctor nurse practitioner getting diagnosis but yeah so no one got diagnosed but showed tendencies towards so okay Go ahead. Tell us what the DSM-4 is saying.

Kirk: Yeah, so when we look at the DSM, which is DSM stands for.

Trevor: Diagnostic and Statistical Manual.

Kirk: Yes, and this is where we diagnose psychological issues. This was a revelation for me a few years ago when I was managing a psych floor and I had to look through the DSM and learn about what the DSM was because I was never a psych nurse so I was more of an emergency paramedic type guy. But I had to learn about DSMs because I managing a floor. Anyways, that's a different story too. So people were interviewed and what they're looking at here now, again these are These are behaviors. One of them is cannabis is taken in large amounts or used over a long period of time more than intended. Persistent desire to cut down with unsuccessful attempts. Excessive time spent acquiring cannabis, using cannabis or recovering from its effect. Craving for Cannabis. Recurrent use resulting in neglect of social obligations. Continued use despite social or interpersonal problems. Important social occupational or recreational activities for gone so that you can use your cannabis. Continued use despite physical harm. Continued used despite physical or psychological problems associated with the cannabis use. Your tolerance level goes up, and you get withdrawal symptoms from using cannabis. Essentially, I think you can plug in any behavior and come up with this a disorder. You know just plug in cannabis. If you were using any substance that basically takes you away from your social or your occupational responsibilities then you might have a problem. And I guess the terminology I like to use is, as opposed to blaming the individual, you just talk about behaviors and behaviors is you're misusing cannabis and you're using cannabis in such a way that it harms you to progress in life, if that's a better way of saying it. And again, define progressing in life. I mean, individuals are individuals. So that's how the DSM diagnoses you or gives you a label that you misuse cannabis. So in this study, they were able to look at those behaviors and see if... By by by um by legalizing a state do those behaviors materialize so they were actually talking to people that had cannabis experience and now that you live in a recreational state has your cannabis experience changed and what did they discover trevor

Trevor: the rate didn't go up so yeah so the see if i get this right and jump in if i'm getting this a little back saying a little backwards. During legalization more people are using cannabis so there will now be more people who have cannabis use disorder but it's not like so I'm going to completely make up some percentages but just let's say 10 percent of the population has cannabis use. But after legalization, even though the number of people who use cannabis goes up, it's not like it goes from 10% to 50%. The percentage doesn't go up.

Kirk: What they have here, and I sort of cut and pasted out of the study, they were looking at within the last month. So their questions that they had on their Likert score was within the past month have. So the past-month daily consumption use and past-year DSM-5 among people that used cannabis did not increase after recreational cannabis laws. Legislation for women or men of any age, nothing went up for any age. So recognized cannabis use disorder takes time. So they recognized one of the flaws of the study is that to diagnose somebody with recreational cannabis use disorder, it takes some time. But legalization did not increase the number of cannabis use disorders anywhere. The limitation of the studies was short timelines. Laws increased the pool of users. So the more of the laws, there for more users to talk to about, because there was a small increase. Men and women did increase their use from the ages of what 21 to 30 there was a small increase

Trevor: Right and in my mind anyway that's not unexpected you know people I think drink more. Use cannabis more probably use other illicit drugs more kind of between the age of 20 and 30 that when they become more available honestly that that's not surprising to me and that's kind of what they found there but um yeah the one and it's right in their uh their title the gender differences. I did think it was interesting that more women relative to men they didn't catch up or anything there's still a gap between the number of men and women who use cannabis but more women relatively to men were using cannabis post legalization than pre-legalization The why, we of course don't know, but they were speculating and I thought it would make sense to me. The speculation was because there is now less stigma after it's legalized then women feel more acceptable for them to try cannabis.

Kirk: That was a cool thing. I'm trying to think here. Gosh, I guess I should have fact-checked myself here. But I think there's a study I read about women. First of all, women are more in touch with medical issues about themselves than men are. Women go to more medical assessments, more see doctors more regularly, obviously. But also, I think women use medical cannabis more than men do. I think this is going back a few years. Remember when we first started this podcast, we did a thing with SheCann and they were talking about this. So women tend to report more about medical issues than men do. So, maybe that was part of the factors involved with this. Some other things about this study, increase, past year cannabis use increased after recreational cannabis law and acted in women and men aged 21 and over with higher increases among those aged 21 to 30. The decrease was in boys and men between 12 and 20. That was amazing. And what else was there, an experience of decrease in the past year from 24? Like it wasn't significant, but it was enough to say that legalization, the legalization of cannabis has not sent our culture into a tailspin, essentially. And now this is an American study. There are some limitations to this study. Although they looked at America at a whole, they only really did focus on nine states, but then those nine states fell in within their parameters.

Trevor: Yeah, they looked at all 50, but those are the nine states that changed from that were medically legal became recreational legal during that time.

Kirk: Yeah, yeah, so some could argue it's a small study, but really it's not. It's a large study. It's also one of the other concerns about this study, again, quantitative versus qualitative. Because it was a self-reported study, some academics will say that the study is flawed because people self-report. However, it depends on how you're looking at social science versus hard science. And it's made, made of the using, oh, and what other things they didn't discuss was what type of cannabis are you using versus flower versus concentrates. But essentially... Essentially, for me as a cannabis advocate, this study, I'm so pleased to have it in our library because this study once again says, guys, there's no evidence that suggests cannabis is harming society. And here's a study that suggests that cannabis legalization isn't harming us.

Trevor: No, I agree. That was my big takeaway, too, is, you know, the sky didn't fall. I said on a previous interview with a local radio station around the anniversary of cannabis legalization. In a way, cannabis legalization in Canada was a bit of a nothing burger. Like, you, know, nothing too exciting happened post-legalization. There weren't suddenly a bunch of car crashes, there weren't a bunch kids high all day in math class. The sky did not fall, cannabis legalization happened, and nothing happened, nothing untoward happened.

Kirk: Yeah, I mean, if anything, we've added to our coffers like 20 billion dollars annually to the coffers and in a restricted industry. So I think this is another tool in the toolbox to say to people, relax, alcohol still does more harm to our culture than cannabis.

Trevor: No, I agree. Anything else interesting from we need to talk about on this one?

Kirk: No, I'm just very pleased we got this in our library. Like I said, when I read this study on NORML, I said I got to get these guys. I still have, I got go back in my, I got a go back on my sent file on my emails and review some of the, over the last three years, how many requests for interviews I've sent out because I've read NORML articles. So yeah, this is a good one, another good one.

Trevor: Another good one. Or you know, or you know NORML to just you know, pay us a royalty fee for keep promoting them on our podcast. But you know that's that's another discussion for another day. I'm Trevor Shewfelt, I'm the pharmacist, this has been ReeferMedness the podcast. Find everything Reefer Medness related on our website reefermed.ca or on all your podcasting platforms and on most of the social medias we are at Reefer Medness.

Kirk: Yes, Reefer medness the Podcast. I'm Kirk Nyquist. I am the registered nurse. I spend a lot of time on our webpage and I want to just let people know I push you to our webpage because on our web page you can link to Spotify. You can link it to iTunes or you can just listen to our podcast on our website because the YouTube channel is there. We subscribe to Blubrry so when you click on our podcast, on the webpage, you are actually listening to it and giving us statistics. So if you go to Spotify, it still goes back to Blubrry. I mean, so just go to our webpage. The other reason why I suggest you go to our web page, I'm meeting people on the streets, actually, I've been home for about a week now and wander around and people stop me saying, hey, I heard you away, I hear you away. Couple people actually came up to me, and these are nurses, actually came up to hey, hey, started listening to your podcast. And I started at number one and I got to number 10 and I need to go back to it and I keep saying to them, you know what, don't go to number one unless number one interests you. Go to our webpage. Our webpage is completely searchable. You can search by who we've interviewed, the affiliation of that individual, what university, what association they have, or by topic. So I would recommend go to our web page, reefermed.ca, find a topic that you're interested in, Hit the topic and you'll see that we may have four episodes on that topic. Then you can then go to Spotify if you want to take it for a walk and go to that individual episode So I recommend you go to our web page find us there. You can watch us and listen to us there and when you listen to one of these episodes Rate us tell people about us, because Meta, Facebook, Instagram, these social medias are not pushing us. Except they keep asking me to boost stuff. You notice that, Trevor? I make a post that says, boost this for $100. And I'm thinking

Trevor: Well, I'm just going to completely disagree with Kirk there. I think everybody really should go back to episode one and listen to every single one of them. Hey, put a five-star rating on every one, because, you know, you don't have anything better to do than go listen to an entire back catalog of Reefer Medness. Okay.

Kirk: There's a 157 episodes my friend.

Trevor: People have nothing else to do but listen to Reefer Medness but yeah in all seriousness I think Kirk's done a great job on our website sort of breaking it down by guest, breaking down by topic, making it easy to find for the stuff you're interested in.

Kirk: And all the research is there like this paper will be attached to the website for that particular for that Particular episode so if you don't trust us read the paper like um so yeah guys reefermed.ca Enjoy our podcast tell a friend. We've been doing this for seven years eight years now We started this before legalization, and we have something to say so spread the word help us help us spread the words

Trevor: good one guys, we'll talk to everybody later. Cheers!