Graduate Thesis Or Dissertation
 

Current Drug Policies in the United States : Using Research to Inform Policy

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  • Drug policies in the United States are rapidly changing at the state and national level paralleling a shift in drug culture from a societal perspective. This dissertation addresses current public health policy topics with a focus on three recent drug policies. As of 2015, medical cannabis is legal in 23 states and recreational cannabis in four, while others are proposing similar ballot measures. The effect of dynamic cannabis policies on public health outcomes is critical to understand. Study 1 analyzed the 2012 population survey of behavioral risk factors on eleventh graders in Oregon to test whether, and to what extent, increased medical cannabis supply - measured by county-level per-capita medical cannabis cardholders - may elevate the likelihood of using cannabis and diverted medical cannabis among adolescents. The population-based analysis revealed that approximately 3% (N=505) of Oregon eleventh graders obtained medical cannabis from a registered cardholder or grower. This study also empirically tested mechanisms through which supply of medical cannabis may affect adolescents' cannabis use including perceived risk of using cannabis, approval, and perceived availability, and found that an increase in supply of medical cannabis decreases adolescents' approval of cannabis usage. Drug testing public assistance recipients is another drug policy receiving national attention. Ten states in the past three years have implemented a drug testing policy for welfare recipients with little empirical evidence supporting implementation. Study 2 analyzed data from the 2013 National Survey of Drug Use and Health (NSDUH), and provided current data on substance use, abuse, and dependence among welfare receipts. The study also tested the relationship between SUAD and welfare receipt, and identified TANF recipients at a greater risk of using substances. Seven percent of NSDUH respondents received TANF in the previous 12 months (n = 2,595). Of these 17% used cannabis only in the previous year, 14% used a substance excluding cannabis in the previous year, 2% satisfied substance abuse criteria, and 6% satisfied substance dependence criteria. Substance use including only cannabis, substance use excluding cannabis, and substance dependence are positively significantly associated with receipt of TANF, however, other problems such as mental health and alcohol are more prevalent among TANF recipients and remain undetected by drug testing. Of the TANF recipient population, 22% received mental health treatment within the previous year. In 2012, Washington voters approved legalizing cannabis recreationally, and concurrently Washington became one of 16 states with a driving under the influence of cannabis policy, i.e., a per se or zero tolerance per se law. Study 3 examined the relationship between Washington’s historic cannabis policy and traffic fatalities as well as driving under the influence of drugs using 2006-2013 data from the Washington State Department of Transportation and Oregon Department of Transportation. This study also provided four extension models adjusting for group-specific time trends, and age, sex, and sobriety level of drivers. Washington's cannabis policy is positively significantly associated with fatal collisions and significantly negatively associated with driving under the influence of drugs.
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