Teasing out the impact of adult attitudes on adolescent marijuana use is difficult in the context of rapidly changing marijuana policy and is further complicated by the fact that there is seldom data available to account for whether a law that granted easier access to marijuana for adults increased the supply of marijuana available to adolescents. Marijuana laws may also have an influence on youth attitudes toward marijuana and marijuana use behavior that is independent of any increase in availability. For example, Miech and colleagues found that passage of a 2010 California law decriminalizing possession of personal use quantities of marijuana for adults was followed by a 25% increase in 12th graders’ likelihood of using marijuana, a 20% decrease in their likelihood to perceive regular marijuana use as dangerous, and a 20% decrease in the likelihood of strong disapproval of marijuana use . That these trends were in evidence when the law had been approved but not yet enacted suggests that the policy change may have enhanced impressions among adolescents that marijuana use is socially acceptable and/or decreased perceptions of harm without having made any change in the accessibly of marijuana use . When California voters approved the Compassionate Use Act of 1996, California became the first state to decriminalize possession of small quantities of marijuana for medical use. Under the Compassionate Use Act medical marijuana patients and their primary caregivers were permitted to possess and cultivate marijuana for personal use with a recommendation from a licensed physician. The purpose of the Compassionate Use Act was to ensure that seriously ill Californians could use marijuana to treat serious medical conditions such as cancer, AIDS, and seizure disorders without being vulnerable to criminal prosecution. The phrase “any other illness for which marijuana provides relief” is a broad definition of illness and symptoms compared to the medical marijuana laws that have followed in other states,indoor cannabis grow system and in practice it allows physicians in California to recommend marijuana for any condition they think it might it help with.

The language of the Compassionate Use Act directly addressed the rights of the marijuana patient and their primary caregiver but did not provide guidelines for how a person could obtain medical marijuana without growing it themselves or buying it on the illicit market. Nor did it address details of enforcement such as how law enforcement officers could distinguish qualified patients from recreational users. A regulatory structure was intended to be decided with subsequent legislation and the Act explicitly encouraged the State government to implement “a plan for the safe and affordable distribution of marijuana to all patients in medical need of marijuana”. Unfortunately, although multiple state and assembly bills were proposed over the years following the enactment of the Companionate Use Act in 1996, legislation to develop a truly comprehensive regulatory structure for medical marijuana in California was not successfully passed until twenty years later, with the Medical Marijuana Regulation and Safety Act of 2016. State-level estimates for marijuana use in California are not reliably available prior to 2002, but in response to the passage of the Compassionate Care Act in 1996, the National Household Survey of Drug Abuse , the precursor to the NSDUH, supplemented the survey sample in California during the 1997 and 1998 survey years to measure the impact of legalizing medical marijuana. In addition, the NHSDA sample in California was large enough in 1995 and 1996 to allow examination of longer-term trends. A 1999 supplemental report issued by the Substance Abuse and Mental Health Services Administration indicates that there was no significant change in marijuana use between 1997 and 1998 in California among adults or among adolescents between 12-17 years old. Instead, the NHSDA survey results indicated that rates of both adolescent and adult marijuana use had been stable since 1995 and that perceptions of the health risk associated with using marijuana also remained fairly constant . The Medical Marijuana Protection Act became effective on January 1, 2004. It created a voluntary identification card system for purchasing medical marijuana, the California Department of Public Health Medical Marijuana Program , that was administered by county health departments.

The MMP created a state-licensed medical marijuana identification card program and a registry database for verification of qualified patients and their primary caregivers . The identification cards were issued to people with physician recommendations to use marijuana to treat medical conditions, as well as to their designated primary caregiver. The action of the law that was most relevant to this dissertation, however, was that SB 420 allowed for the establishment of storefront dispensaries. Whereas previously caregivers could only supply medical marijuana privately to 5 patients, with the enactment of SB 420 a collective of caregivers could provide for hundreds of patients and sell marijuana at retail storefronts as long as they operated as a non-profit business . State-level estimates of NSDUH data for California show a small and gradual increase in rates of current use among adolescents aged 12-17 not long after SB 420 was enacted in 2004 and storefront medical marijuana dispensaries became a reality . The trend was minimal, however, until there an expansion in the medical marijuana industry after 2009 that is explained in further detail in the next section. The Federal policy environment may likewise be an important influence on marijuana use behaviors and perceptions of risk among LA County youth. Changes in state laws may have played an influential role in the rapid changes in teenagers’ attitudes toward marijuana that have been noted at a national level. Following California’s precedent of legalizing medical marijuana use in 1996, an increasing number of U.S. states have enacted policies legalizing some degree of access to marijuana. By 2009, over half of the population of the United States lived in a state sanctioning some level of marijuana use , although marijuana remains an illegal substance under Federal law today. A total of 34 states, the District of Columbia, Guam, Puerto Rico and the US Virgin Islands have now approved comprehensive, publicly available medical marijuana programs and an additional 12 states allow use of “low THC, high cannabidiol ” products for medical reasons in limited situations or as a legal defense . The increasingly liberal state marijuana laws being passed in the U.S. have coincided with declining perceptions of the risk of marijuana among American teenagers, but not with increased use . Thus, it seems that to date the primary impact of state medical marijuana laws has been increasingly liberal social norms and attitudes toward marijuana use rather than a change in marijuana use behaviors. Alternatively, cannabis grow equipment the increasingly liberal state laws governing marijuana may instead reflect a secular change in social norms and attitudes toward marijuana that precedes the passage of laws allowing greater access to marijuana.

Indeed, both processes may occur simultaneously in a self-reinforcing cycle of increasingly liberal marijuana laws and attitudes. In contrast with the change in secular attitudes toward marijuana use that has been noted on a national level, there are several Federal policies and enforcement efforts that have had a direct effect on the availability of marijuana in LA County. Marijuana is regulated under the Controlled Substances Act of 1970 and with the exception of two FDA-approved medications derived from cannabinoids that are available by prescription it remains classified as a Schedule I drug. Schedule I drugs are defined as having a high potential for abuse, as having no currently accepted medical use for treatment in the U.S., and as unsafe for use without medical supervision . Possession and sale of Schedule 1 drugs are subject to severe criminal penalties, which has important implications for law enforcement. The inconsistency between Federal and state laws governing marijuana raises legal questions that are in active debate by the nation’s highest courts. In the meantime, the Department of Justice has been obliged to issue a series of memoranda defining the Federal position on medical marijuana and the extent of their judicial and law enforcement authority. These memoranda, while directed to state legislatures and law enforcement agencies, also had a significant impact on the medical marijuana market in California and by extension the availability and visibility of marijuana outlets in LA County. The first, the “Ogden Memorandum” of 2009, stated that Federal resources should not be directed toward prosecuting “individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medicinal use of marijuana” . The development of a commercial marijuana industry in California occurred largely after this memo signaled that the Federal government would not prosecute dispensaries that were operating in compliance with state laws. Increases in the number of dispensaries were noted throughout the state , but the exact number of dispensaries that were established soon after the Ogden Memo was released is unknown . Data from the City of Los Angeles, however, documents that in 2007 the City reported 186 dispensaries, whereas by 2010 they reported 545, an increase of nearly 200% . In 2011, a new Department of Justice memorandum had an opposite, dampening effect on the marijuana marketplace. The “Cole Memorandum” narrowed the policies set forth in Ogden and drew a clear distinction between individual patients and commercial dispensaries, extending protection from Federal prosecution to registered patients but not to dispensaries . This memorandum was followed by a series raids by Federal prosecutors conducted throughout California in October of 2011. Hundreds of dispensaries across the state had their inventory confiscated and more than 200 dispensaries were shut down in Los Angeles County and surrounding counties . Although the Cole Memorandum and the subsequent raids targeted businesses and were not widely publicized, they had a significant impact on the number of dispensaries operating in LA County that reduced the accessibility of marijuana for adults and is likely to have resulted in reduced exposure to marijuana outlets among youth. According to Drug Use Social Norm theory, this reduced exposure to active dispensaries would be expected to result in LA County adolescents having less favorable perceptions of the acceptability of marijuana use. To date, however, this effect has not been investigated. The growth of the number of dispensaries in communities throughout California after the Ogden Memo of 2009 was correlated with a temporary increase in youth and adult use that reversed after the Cole Memo signaled a stricter federal stance toward marijuana businesses in 2011. Although the changes in youth use were not drastic any point over these years, the degree to which they correspond with these policy decisions is striking. That an increase in youth use was not noted following enactment of the Compassionate Use Act and there was a minimal trend of increase after SB 420 was enacted is important. It suggests that the impact of making marijuana available as a legal product and in retail settings has much to do with the number of marijuana outlets in our communities and how tightly they are regulated . The Adult Use Marijuana Act legalized marijuana possession, cultivation and use for adults over the age of 21 without requiring a recommendation from a California-licensed physician. As stated in the ballot measure text, the purpose of the AUMA is to “establish a comprehensive system to legalize, control and regulate the cultivation, processing, manufacture, distribution, testing, and sale of non-medical marijuana, including marijuana products, for use by adults 21 years and older, and to tax the commercial growth and retail sale of marijuana.” The act employed a dual license structure similar to the MCRSA that allows local jurisdictions to define polices that are more restrictive than state law. A notable exception to the dual license law is that cities and counties cannot ban personal use cultivation of less than 6 plants if cultivated indoors.The Bureau of Marijuana Control, housed in the Department of Consumer Affairs, oversees the marijuana legal market, and began issuing licenses to marijuana retailers and distributors in January of 2018. The Department of Food and Agriculture licenses and oversees marijuana cultivation and enforces environmental regulations on cultivation and food safety regulations on edibles.