IMPACT OF RECREATIONAL CANNABIS LEGALIZATION IN MICHIGAN: A BASELINE REPORT May 2020 Prepared by the University of Michigan Injury Prevention Center A CDC-Funded Injury Control Research Center Project Leadership Kipling M. Bohnert, Ph.D., University of Michigan, Injury Prevention Center, Addiction Center, and Department of Psychiatry; VA Center for Clinical Management Research Erin E. Bonar, Ph.D., University of Michigan, Injury Prevention Center, Addiction Center, and Department of Psychiatry Additional Report Authors (listed in alphabetical order) Patrick M. Carter, M.D., University of Michigan, Injury Prevention Center, Department of Emergency Medicine, and Department of Health Behavior & Health Education, School of Public Health Lara N. Coughlin, Ph.D., University of Michigan, Addiction Center and Department of Psychiatry Rebecca M. Cunningham, M.D., University of Michigan, Injury Prevention Center, Department of Emergency Medicine, and Department of Health Behavior & Health Education, School of Public Health Jason E. Goldstick, Ph.D., University of Michigan, Injury Prevention Center and Department of Emergency Medicine Pete Haak, B.S., Michigan Department of Health and Human Services, Maternal and Child Health Epidemiology Section Sonia V. Kamat, M.S., University of Michigan, Injury Prevention Center and Department of Emergency Medicine Michael Mueller-Smith, Ph.D., University of Michigan, Department of Economics and Population Studies Center, Institute for Social Research Jordan Papp, Ph.D., University of Michigan, Population Studies Center, Institute for Social Research Jessica S. Roche, M.P.H., University of Michigan, Injury Prevention Center and Department of Emergency Medicine Maureen A. Walton, M.P.H., Ph.D., University of Michigan, Injury Prevention Center, Addiction Center, and Department of Psychiatry List of Contributors (listed in alphabetical order) Carol Flannagan, Ph.D., University of Michigan, Transportation Research Institute and Injury Prevention Center Amanda Kogowski, M.P.H., University of Michigan, Injury Prevention Center and Department of Emergency Medicine Sarah Rockhill, M.P.H., Michigan Department of Health and Human Services, Environmental Health Surveillance Section Abby Schwartz, M.P.H., Michigan Department of Health and Human Services, Environmental Health Surveillance Section 2 Acknowledgements This report was prepared by members of the University of Michigan Injury Prevention Center, in collaboration with a variety of agencies and institutions that provided relevant data. In particular, we offer special thanks to the organizations listed below: • Michigan High Intensity Drug Trafficking Area (HIDTA) • Michigan Department of Health and Human Services (MDHHS) • Michigan Department of Licensing and Regulatory Affairs (LARA) Funding Information reported herein was supported by a grant to the University of Michigan Injury Prevention Center by the Centers for Disease Control & Prevention, Award Number R49-CE-002099. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control & Prevention or the Michigan Department of Health and Human Services. For more information, contact the University of Michigan Injury Prevention Center: [email protected] Please cite this publication as follows: University of Michigan Injury Prevention Center. Impact of Recreational Cannabis Legalization in Michigan: A Baseline Report. University of Michigan. Ann Arbor, MI. May 2020. IMPACT OF RECREATIONAL CANNABIS LEGALIZATION IN MICHIGAN • 3 TABLE OF CONTENTS LIST OF ABBREVIATIONS .........................................................6 BACKGROUND AND PURPOSE OF THIS REPORT ......................................7 EXECUTIVE SUMMARY ...........................................................8 LONG-TERM TRENDS IN CANNABIS USE ............................................ 16 Trends in the Percentage of People Reporting Past-Year Cannabis Use ................... 16 Past-Year Cannabis Use in Michigan ............................................. 17 Comparing Trends in Michigan to the Midwest and other U.S. States ...................18 Past-Year Cannabis Use in Michigan by Age Group ................................. 19 Trends in How Individuals Obtain Cannabis in Michigan ...............................20 Mode of Obtaining Cannabis ..................................................20 Trends in the Percentage of People in Michigan Reporting Past-Month Cannabis Use .......21 Past-Month Cannabis Use in Michigan ............................................21 Comparing Trends in Michigan to the Midwest and other U.S. States ...................22 Past-Month Cannabis Use in Michigan by Age Group ................................23 Cannabis Use among Sociodemographic Subgroups in Michigan ......................23 Initiation of Cannabis Use among Michigan Residents .................................24 LONG TERM TRENDS IN CANNABIS USE DISORDER ...................................26 Trends in Self-Reported Past-Year Cannabis Use Disorder in Michigan ....................27 Percentage of Individuals with Cannabis Use Disorder in Michigan Over Time ............27 Cannabis Use Disorder among Individuals Reporting Past-Year Cannabis Use in Michigan by Age Group .........................................28 BELIEFS ABOUT CANNABIS USE ..................................................30 Michigan Trends in Perceptions of Risk and Legal Penalties Associated with Cannabis Use ...30 Cannabis Risk Perceptions ..................................................... 31 Perceptions of Legal Penalties for Cannabis .......................................32 Perceived Ease of Availability for Cannabis ........................................32 Michigan Youth’s Beliefs about the Social Acceptability of Cannabis Use .................33 Perceived Parental Approval ...................................................33 Disapproval of Peer Cannabis Use ...............................................33 CANNABIS USE AND PREGNANCY .................................................35 Cannabis Use among Mothers Giving Birth in 2016 and 2017 ...........................36 Cannabis Use Before Pregnancy ................................................37 Cannabis Use During Pregnancy ................................................37 Cannabis Use Following Pregnancy .............................................38 CANNABIS USE IN THE MICHIGAN WORKFORCE .....................................39 Comparing Michigan to the U.S. ..................................................40 4 LIST OF ABBREVIATIONS .........................................................6 MEDICAL CANNABIS ............................................................ 41 BACKGROUND AND PURPOSE OF THIS REPORT ......................................7 Patients, Caregivers, and Physicians ............................................... 41 Qualifying Conditions .........................................................43 EXECUTIVE SUMMARY ...........................................................8 Costs Associated with Medical Cannabis Program Administration .......................44 LONG-TERM TRENDS IN CANNABIS USE ............................................ 16 New Regulations for Medical Cannabis Facilities .....................................44 Trends in the Percentage of People Reporting Past-Year Cannabis Use ................... 16 Licenses and Revenue of the MMFLA ...............................................45 Past-Year Cannabis Use in Michigan ............................................. 17 CANNABIS AND THE OPIOID EPIDEMIC ............................................47 Comparing Trends in Michigan to the Midwest and other U.S. States ...................18 Past-Year Cannabis Use in Michigan by Age Group ................................. 19 MOTOR VEHICLE CRASHES AND IMPAIRED DRIVING ..................................49 Trends in How Individuals Obtain Cannabis in Michigan ...............................20 Fatal Motor Vehicle Crashes in Michigan ............................................50 Mode of Obtaining Cannabis ..................................................20 Driving Under the Influence among Michigan Medical Cannabis Patients .................51 Trends in the Percentage of People in Michigan Reporting Past-Month Cannabis Use .......21 CANNABIS-RELATED MORTALITY .................................................53 Past-Month Cannabis Use in Michigan ............................................21 Comparing Trends in Michigan to the Midwest and other U.S. States ...................22 SUICIDES AND HOMICIDES ......................................................54 Past-Month Cannabis Use in Michigan by Age Group ................................23 Cannabis Testing Results for Michigan Suicide Deaths in 2016 ..........................54 Cannabis Use among Sociodemographic Subgroups in Michigan ......................23 Cannabis Testing Results for Michigan Homicide Deaths in 2016 ........................55 Initiation of Cannabis Use among Michigan Residents .................................24 HEALTHCARE UTILIZATION ......................................................56 LONG TERM TRENDS IN CANNABIS USE DISORDER ...................................26 Emergency Department Visits ....................................................56 Trends in Self-Reported Past-Year Cannabis Use Disorder in Michigan ....................27 Adverse Effects of Cannabis Use ................................................57 Percentage of