The proportion of counties in Colorado with prohibitions was also greater than that found in a policy surveillance study from California.Our results add to existing reports that numerous counties are opting to prohibit recreational marijuana facilities in states where recreational marijuana can be legally purchased and consumed . We found local stakeholders were publicly engaged in county policy decisions. We did not identify stakeholders who represented industry groups or external entities, which appear to play a limited public role in local debates. It is feasible that industry groups or other external advocates were involved in private lobbying efforts as opposed to public facing advocacy strategies. Our findings about the predominance of local stakeholders in policy debates are similar to research examining a local medical marijuana policy debate in California involving internal actors, and the arguments namely reflected a struggle between identity and social order within the region.The involvement of local stakeholders also suggests marijuana commercialization is currently a cottage industry. In the absence of targeted regulatory policy to retain small-scale growers and retailers, a large marijuana industry could emerge, prioritizing lobbying and aggressive advertising strategies.Tobacco companies may potentially enter marijuana policy debates given their long-standing interest in entering into legalized marijuana markets based on the sales potential.Based on our qualitative data, whereas some stakeholders were likely to support allowing marijuana facilities as a way of attracting outside tourism, other stakeholders used concerns about legal liability or additional crime from outsiders as rationale to prohibit these facilities. Future work should further explore how county policymakers balance local-level politics and perspectives with state policy directives and policies over time. Additional research could examine factors influencing enactment of local recreational marijuana policies and closely examine the effect of population density and county-state borders on local marijuana policy decisions.

Arguments in favor of permissive cannabis dry rack county ordinances included economic benefits 60 and increased access to medicinal and therapeutic treatment. Early evidence on cannabis markets in Washington suggests increased cannabis retail access is associated with more frequent use among adults in the state.Sales data from Washington indicate a large and growing marijuana market, yielding a substantial source of state revenue allocated to the general fund, basic health, local municipalities, prevention and education, research, and other issues. In fiscal year 2019, Washington collected $395.5 million in legal marijuana taxes and license fees.62 During the COVID-19 pandemic, monthly recreational marijuana sales in Colorado were $183 million in July 2020 alone.As state and local governments continue to be impacted by the economic losses associated with COVID-19, economic gain arguments might become increasingly attractive to offset diminishing revenues from other sources. The gradient of local marijuana policy is more nuanced than these three categories because some counties allowing all types of marijuana facilities also have restrictive zoning conditions, limit the maximum number of facilities, or limit acreage for cultivation or processing facilities. Additionally, our study did not closely examine other local marijuana policy elements such as minimum buffer distances, business hour limits, public health messaging, or advertising restrictions.Another study limitation is the exclusion of cities and towns from the sample. It is important to note that counties are limited in their regional authority and can include cities with marijuana policies that differ from the county policy. Prior studies on similar topics and geographies have examined marijuana policy in Washington cities with more than 3,000 residents3 and all cities in California.6 Given our additional focus on policy stakeholders, arguments, and advocacy efforts, we elected to solely concentrate on county-level policies. A key strength of our study is that it is the first to consider local policy variation across two states that legalized recreational marijuana use at the same time. The typology we created and employed can serve as the basis for future legal epidemiology work to examine the effects of policy on public health, health, and social outcomes.

Other strengths are the inclusion of qualitative research and newspaper article data for the purpose of providing rich descriptions of the county policy environments and change. Prior cross-sectional policy surveillance studies lacked these elements. Further, our findings convey the value of ongoing local policy surveillance data because four counties identified as having moratoriums/bans in place as of July 2014 allowed recreational marijuana facilities by mid-2019, indicating considerable local policy change processes occurred within these jurisdictions in the span of a few years.Since 2012, several other states have legalized recreational marijuana for adults and have permitted local-level jurisdictions to regulate local markets. States may benefit from the results of our findings as they create their own frameworks to regulate marijuana and take into consideration similar fundamental local government concerns, such as public safety, health, and environmental impact issues. Opponents of permissive marijuana policies point to perceived public health, safety, and welfare issues related to marijuana facilities and use, including addiction, increased crime, and detrimental health effects for minors. Early results from Colorado suggest legalization has led to increased marijuana-related hospitalizations, an initial surge in poison control center calls mentioning marijuana, and increased DUIs for which marijuana was identified as the primary impairing substance.In Colorado and Washington, commercial marijuana legalization is significantly associated with increased rates of fatal motor vehicle accidents.There is also evidence on the harms of marijuana secondhand smoke on cardiovascular health.Use of high-potency cannabis concentrate products has also been associated with negative consequences like psychosis and emergency department visits.These public health outcomes should be considered and used to inform policy decisions. Research about associations between crime and legal recreational marijuana facilities and local markets can also help address perceived concerns about increased crime. Findings from existing studies are mixed, likely due in part to challenges in interpreting law enforcement data.

We found that advocates of allowing local marijuana facilities claimed legalization could reduce local marijuana black market activities; however, opponents were concerned about additional enforcement or implementation costs, as well as crime. Cost-effectiveness studies comparing the cost of additional enforcement or implementation mechanisms to local revenues are needed. Potential associations between local marijuana policy and health effects and crime have gone largely unexplored due to restrictions and limitations on federal funding for marijuana research. Studies on the implementation and management of marijuana prevention and control programs have also been constrained by a lack of federal funding. However, interest in the public health and safety impact of local marijuana businesses expressed by local stakeholders in our study indicates a critical demand for policy effectiveness research to inform local decisions. Youth access to and use of marijuana, driving under the influence of marijuana, marijuana dependence and addiction,botanicare rolling benches unwanted contaminants in marijuana products, uncertain potency of marijuana products, and concurrent use of marijuana and alcohol have previously been identified as important topics for public health research and evaluation to inform policy.Public concern about noxious odors was a frequent argument against permitting marijuana cultivation and processing facilities in local jurisdictions, as well as a reason to overturn permissive marijuana ordinances. This is an issue that policymakers and marijuana producers need to address and mitigate with regulatory policy and practice. As the legal market continues to grow, more research is needed on the impact of operating marijuana cultivation and processing facilities on the environment,including studies of the use of pesticides and cannabis cultivation and regulation standards.Concerns have been raised regarding the concentration of cultivation licenses in agricultural areas and environmental health concerns for vulnerable populations,who often disproportionately face environmental injustices. Research is also needed to explore the role of state and local public health departments in regulating marijuana in states where recreational marijuana is legal, since a public health framework would designate them as the lead regulatory agency.Studying the impact of marijuana legalization on public health departments’ scope of work and health education and promotion efforts in marijuana prevention and control programs is also important. States such as Washington that have earmarked revenue for prevention, control, and research may have made further progress than counterparts in this area for developing educational campaigns .Co-occurring marijuana and tobacco use have been associated with increased rates of psychiatric disorders and psychosocial problems . Further, co-use has been linked to more days of past month marijuana use and higher rates of marijuana dependence relative to marijuana only smokers . Despite the negative health related consequences of tobacco and marijuana co-use, a recent review found only three studies focusing on co-use prevention and two studies on treatment . Since that review, a few treatment studies for marijuana and tobacco co-use have been published . However, additional research is needed to inform the effective development of prevention and treatment interventions for tobacco and marijuana co-users. Identifying interaction expectancies might help identify barriers and strategies that should be used in the development of prevention and treatment interventions for co-users .

High expectations may pose barriers to cessation of either substance, therefore underlying low motivation to quit. The Nicotine and Other Substance Use Interaction Expectancies Questionnaire was developed by Rohsenow et al. to investigate expectations regarding the relationship between smoking and other substance use held by treatment seeking substance users. Participants reported that substance use almost always increased their smoking or urges to smoke, but smoking only increased their substance use or urges about half of the time . More recently, Ramo et al. adapted the NOSIE to examine cigarette and marijuana interaction expectancies . In a non-treatment seeking sample of young adult marijuana and tobacco co-users, Ramo et al. found that young adults who used more tobacco and marijuana held higher expectancies regarding the interaction of the two substances. In addition, days of past month marijuana use and thoughts about abstinence, significantly predicted responses to the NAMIE scales. The current study examines presence and predictors of tobacco and marijuana interaction expectancies among African American young adults participating in an anonymous online survey. African Americans were chosen as the population of interest, as co-use is considerably high among this population of young adults and they experience higher rates of negative drug-related consequences of substance use comparable to other racial/ethnic groups . Further, African Americans are more likely to smoke blunts than other racial/ethnic groups , and little is known about whether this form of co-use may be associated with unique patterns of interaction expectancies compared to other forms of co-use. The purpose of the current study was to determine if there are differences in tobacco and marijuana co-use expectations among blunt and cigarette co-users [hereafter referred to as blunt co-users] and non-blunt and cigarette co-users [non-blunt co-users] and determine if expectancies among blunt co-users and non-blunt co-users were associated with variables that have been linked with expectations about drug use in previous studies , including age at first tobacco use, age at first marijuana use, days of past month marijuana use, and days of past month tobacco use.Participants were African American young adults who completed an anonymous online survey. The survey was designed to assess patterns of and factors associated with marijuana and tobacco co-use among non-treatment seeking young adults. Participants were recruited via flyers distributed in predominately African American communities , word of mouth, and a free campaign on Craigslist in a Midwestern city in the United States. The survey link, along with a Quick Response code, was included on the flyer, which directed participants to the consent form, screening questions, and a secure survey within Qualtrics. Participants who met the following criteria were eligible to participate in the survey: were between the ages of 18–29, self-reported as being a non-Hispanic African American or Black woman or man, self-reported smoking marijuana at least four times in the past month, self-reported smoking tobacco at least 20 of the past 30 days, were not enrolled in outpatient or residential substance abuse treatment for marijuana or not engaged in formal smoking cessation treatment in the past year and had a personal email account to receive an electronic gift card. Eligible participants were invited to complete a brief survey, and received a $20 online gift card for their time and effort. Of the 185 participants who completed the survey screener, 162 participants met eligibility criteria to complete the survey. Of those, 144 completed the survey. For the current study, we used data from participants who reported past month marijuana and cigarette use .