The lack of a clear federal public health response to the growing legalization of marijuana and proliferation of promarijuana marketing has left a vacuum that is filled by commercial interests . Unlike the tobacco industry, the marijuana industry has remained largely unchallenged by a coordinated regulatory response, and is aggressively advertising its product in states with rapidly expanding commercial markets . Over half of adults living in states with recreational marijuana are frequently exposed to pro-marijuana advertising in numerous forms , and research indicates that greater exposure to promarijuana advertising is associated with heavier marijuana use among adolescents and heavier use among adult persons who use . More stringent regulations of marijuana product marketing, and also a cohesive public health messaging campaign, are necessary to combat misinformation and communicate the potential risks associated with marijuana use so consumers can make informed choices about use. With the exception of smoking rates, which were roughly equivalent among residents in recreationally legal and medically legal states, prevalence of use among all forms of marijuana and use of multiple forms of marijuana was higher among residents in recreationally legal states. This is not surprising, given that novel forms of marijuana are more accessible in states with robust recreational markets. For example,rolling benches in the first year with an active recreational marijuana market, Colorado dispensaries sold 4.81 million units of edible cannabis product .
The popularity of marijuana products in forms other than smoking is a cause for some concern as such products are increasingly available with THC content at high levels not yet studied. Previous research suggests that some edible products exceed state-mandated THC thresholds and can reach as high as 7000 mg per package . Given the growing popularity of marijuana in forms like edibles or extracts, increased focus should be directed towards understanding the health effects of THC at such concentrated levels. In the absence of evidence of harms, states may be reluctant to more stringently regulate the form and content of edible products. There are several limitations to this study. The generalizability of our results may have been limited by the use of an internet survey as the population who choose to join an ongoing internet panel may be different from individuals who choose not to participate. However, GfK’s KnowledgePanel has demonstrated no evidence of non-response bias in the panel on core demographic and socioeconomic variables . We did not conduct reliability testing of the survey items. As a result, it is possible the interpretation of our questions might differ between participants. For example, though pain management was endorsed as the most important benefit across residents of all states, we did not distinguish between types of chronic pain, and this may have been interpreted differently between participants. Additionally, we did assess the extent of individual marijuana use among participants, medical reasons for use among marijuana users, and sources of information regarding beliefs about marijuana. However, the data were not sufficiently relevant when stratified by state legalization status.
Furthermore, it is important to note that we did not differentiate between state legal status beyond the designation of ‘‘recreationally legal, medically legal, or nonlegal,’’ and marijuana accessibility can vary greatly within states with the same legal status due to differences in state-based implementation. Nonetheless, we found clear differences in opinions of residents of recreationally legal states compared with other states. Finally, the study was cross-sectional. Therefore, it is unknown if people in states where marijuana was legalized for recreational use developed their beliefs before legalization, which then led to legalization in their state, or if the opinions assessed in this survey were a result of recreational legalization of marijuana.Substance-use disorders afflict marginalized communities of color, specifically the African American and Latinx communities at alarming rates. The attention towards the deleterious impacts of substance-use disorders stemmed from the opioid epidemic in which 10.3 million people within the United States misused prescription opioids and heroin in 2018. Out of 10.3 million individuals affected by the opioid epidemic, 2 million individuals in the U.S. had developed a form of opioid use disorders. According to Substance Abuse and Mental Health Services Administration, focus on epidemic hones in on “White and suburban rural communities,” while less attention was given to “African American communities” that experienced increased drug overdose rates. In 2015-2016, around opioid misuse rates of 40% were attributed to the population which traversed the opioid misuse rates of White ethnic groups nationally . Additionally, according to the Substance Abuse and Mental Health Services Administration, in the year 2019, 6.5 million African Americans suffered from a mental illness or substance use disorder with an increase of 10.1% in cases for both SUD and mental illness.
Kids who were 12 years old or older faced consistently high rates of opioid misuse: around 3.4% out of 7% of the African American population within the United States. During the same time period, African Americans misused synthetic versions of opioids and crack cocaine which called for a national outcry towards restoring these communities’ mental health outcomes and developing drug-use prevention services to prompt drug detoxification. However, an opposite phenomenon incurred in which African American drug users were incarcerated unjustly which shattered many families livelihoods and fueled their mistrust towards reforming power structures. Behind this phenomenon, a substantial healthcare disparity can be observed in that not only was the label of “drug user” pinned on African American populations leading to elevated incarcerated rates within this population, but also physicians implicit disbelief of pain felt by African American communities prompting them to deny legal opioid prescription provision to African American patients. As healthcare providers denied legal opioid prescription to these communities, this treatment by these providers upended these communities’ illicit procurement of these opioids and subsequent mis-use. During this opioid crisis, implicit bias and patterns of discrimination exuded by these healthcare institutions and individual healthcare providers may have not only contributed to their pattern of labelling which further promulgated distress within these communities, but also served as a proxy for these communities to procure as well as mis-use manifolds of lethal substances. A source states that 40.0% of Latinx women and 45.1% of Latinx men were engaged in the use of illicit drugs for 12 months. Currently, one substance that has been mis-used upon its legalization in the United States is marijuana. Connecting to this,grow tray racial disparities are a leading factor in marijuana possession arrests in which African American individuals are 3.64 times more likely to be incarcerated for marijuana nationally and individual states in comparison to white individuals .” Not only does this community experience higher rates of drug use, but also they are more likely to be incarcerated due to a powerful bias that attaches the label of “drug user” on the African American community in comparison to white communities. Additionally, previous studies have demonstrated that the frequency of marijuana mis-use was the highest among marginalized African American and Latinx youth aged 4-14 . With this, Latinx men and women are more likely to be over-criminalized due to their increased percentage of marijuana use and labels delineating them as drug users which causes racial profiling/subsequent discrimination. Although African American communities and Latinx communities have distinctions in community drug rate use as well as types of drugs being used, a similarity is seen in the form of a trend: both communities are over-criminalized and discriminated against by power structures as their implicit bias demarcates them as formidable drug users and overlooks drug misuse as being perpetrated by racist power structure beliefs. The presence of discrimination and lack of awareness to over-criminalization of Latinx individuals are a few factors that constitute social disorganization within communities.
Socially disorganized communities are characterized as communities that indulge in maladaptive social and organizational behaviors such as substance use encouragement, construction of alcohol outlets, lack of control over suppressing the presence of crimes, and over-criminalization of communities as “drug mis-users.” These factors fostered increases in marijuana mis-use rates amongst adolescents as these factors perpetrated increased access to these substances as well as discrimination/racial profiling that fuels their marijuana mis-use . Additionally, the pattern of increased alcohol outlet development in South Central LA is now expanding to include the rise in marijuana outlet and dispensary development near middle/school schools in South Central LA. Although marijuana consumption is legal with the legal age to purchase marijuana being 21, this is problematic because outlet increases near youth/adolescent concentrated areas/institutions confers them with easy access to purchase marijuana through others who have attained the legal age as well as mis-use of marijuana at a young age. With the development of marijuana outlets being labeled as an adverse social community organization indicator according to Goldstick, youth aged 8-12 have not only been inclined to obtain marijuana but also this age bracket has been statistically shown to consume/smoke marijuana more than other age groups. Therefore, investigating South CentralLA resident’s perception behind the contributing causes to increased marijuana mis-use rates by adolescent communities of color can not only prompt an advocacy platform for decreasing the prevalence of marijuana outlet construction in urban/school areas, but can also instigate a call for stable social community organization through the introduction of educational programming and “Drug Take Back” day-like events for communities in promoting marijuana disposal/mis-use prevention practices.” With this, community structures and indicators of stability have been shown to understand the prevalence of substance mis-use rates amongst marginalized African American and Latinx youth. However, previous studies have not unearthed the correlation between the community stability indicator of marijuana mis-use education/prevention program awareness development and the effectiveness of these programs in expelling substantial information about the adverse impact of marijuana-misuse to observe reductions in rates of marijuana mis-use amongst marginalized youth, presenting a gap in existing research. To mend this gap, exploration of this topic is necessary: how marginalized communities of color such as African American and Latinx communities are more prone to drug misuse due to the presence of unstable community indicators such as implicit bias presence or community labellings such as “drug misusers.” Additionally, the question of whether educational programming can spur awareness of this topic and whether this tool can be used to dismantle the effects of unstable community indicators as well as increase marijuana mis-use prevention must be addressed. I hope to bridge these gaps by using a community-engaged research approach, which will prompt me to implement community education initiatives and safe medication disposal programs which emphasize substance misuse prevention to determine whether these programs are effective in steering marginalized individuals towards substance misuse prevention or recovery programs.Mending these gaps will not only clearly define the “mis-use term,” but will also unveil whether the increased presence of marijuana outlets is perceived as pernicious for the health/education related to adolescents of color. One study conducted by Damon evaluated perspectives of participants who use drugs excessively through a community-based participatory research lens. Fourteen participants with persistent substance mis-use were interviewed about their experiences using a community-based participatory research framework, however participants had negative afterthoughts after these CBPR principles were employed due to the superficial implementation of research methods. Results further elucidated that CBPR was implemented inconclusively within marginalized communities . The use of CBPR in order to investigate participant experiences of implicit bias exuded by healthcare institutions as well as societal stigmas, wasn’t deemed as effective as CBPR didn’t include marginalized participants from non-urban settings as well as low income neighborhoods. Additionally, community based participatory research centralized on sampling marginalized participants as well as evaluating their experiences with substance mis-use, posed ethical challenges in which there is an absence of an identifiable community and research about their particular drug use patterns in terms of community engagement. CBPR on the topic of substance mis-use doesn’t account for mobilizing communities of marginalized individuals who harness historical engagements in substance mis-use, therefore it is recommended that community engaged research framework be utilized within this topic to mobilize marginalized communities into becoming attuned to substance misuse patterns as well as actively preventing these patterns through researcher’s collaboration with substance mis-use community organizations.