Planalp, Colin
Research Fellow

p 612-624-4850
e cplanalp@umn.edu

Measuring Perceptions and Opinions on Cannabis Use and Access in Minnesota

Even before legalization, most Minnesotans reported that cannabis was easy to obtain; only one-third disapproved of use by adults

During the past decade, the United States’ cannabis policy landscape has changed dramatically. By the end of 2023, 24 states had legalized cannabis for non-medical use by adults — meaning the majority of the U.S. population lives in a state with legalized recreational cannabis.

These changes in the landscape of U.S. cannabis policy have coincided with evolving public opinion and perceptions about cannabis and cannabis legalization. Researchers have documented changing public attitudes about cannabis policy. For example, according to the polling firm Gallup, the share of people in the U.S. who support legalization of marijuana has grown from 50% in 2012 to 70% in 2023, just over a decade later¹. But the complexities of cannabis and the attitudes surrounding it are much more nuanced than simply whether people support or oppose cannabis legalization.

In 2023, Minnesota became the 23^rd state to legalize cannabis for non-medical use by adults. To help policymakers and Minnesotans understand the potential public health implications of that policy change, researchers from the University of Minnesota School of Public Health’s State Health Access Data Assistance Center (SHADAC) and the newly formed Cannabis Research Center (CRC) have analyzed data on people’s perceptions and opinions relating to cannabis, both for Minnesota and the U.S. as a whole.

SHADAC and the CRC used data from the federal government’s National Survey on Drug Use and Health (NSDUH). This research so far has included a focus on pre-legalization data, to better understand the people’s perspectives, opinions, and experiences with cannabis before Minnesota’s policy shift. Using the NSDUH, we report pre-legalization baseline data on several issues and commonly cited concerns associated with cannabis legalization:

• Ease or difficulty of obtaining cannabis under a policy of prohibition
• Perceived risk of smoking cannabis on a weekly basis
• Disapproval, or lack of disapproval, of cannabis use by adults (age 18 and older) and youth (age 12-17)

These particular measures are important because they may offer hints about the potential public health effects of cannabis legalization. Much of the concern about legalization hinges on the assumption that it will increase cannabis use, in turn resulting in possible consequences such as increases in prevalence of cannabis use disorder. But is it not clear whether legalization will increase cannabis use in the Minnesota context, or whether increased cannabis use will result in subsequent harms. 

Data on Minnesotans’ perceptions and opinions of cannabis can offer us clues as to how legalization might affect the state. In our analysis, we found that most Minnesotans age 12 and older reported that cannabis was very or fairly easy to obtain, even before it was legalized. That could mean that increased availability of cannabis through legalization might not have a substantial impact on use, as people already reported easy availability when cannabis was prohibited.

We also found that roughly half of Minnesotans believed that smoking cannabis once or twice a week carried no risk or only slight risk of harm. And, while our analysis found that only one in three Minnesota adults (age 18 and older) reported disapproving of adults using cannabis, four in five Minnesota youth (age 12 to 17) said they disapproved of peers using cannabis. That suggests that adults may be less inhibited to try cannabis than youth under legalization — though those attitudes could change.

Our plan is to continue monitoring the cannabis landscape in Minnesota, measuring the impacts of legalization and the consequences — positive or negative — for public health. The findings of this study offer us early hints, but it will be crucial to continue to research these issues once commercial sales of cannabis begin and as new data become available.

Find more details and data analysis in the full version of this brief by clicking on the image to the right, or at the link here.

Interested in Minnesota cannabis policy and research? Check out the following resources to learn more about this growing field:

• Companion Brief: Public Health Implications of Cannabis Policy in Minnesota
• Cannabis Research Center Website

Public Health Implications of Cannabis Policy in Minnesota

This brief uses data from the National Survey on Drug Use and Health (NSDUH) to understand issues related to public health implications of Minnesota cannabis use prior to its 2023 legalization. Along with providing key background information and context on cannabis policy in the United States, this brief specifically examines three oft cited concerns with cannabis legalization:

1. The prevalence of cannabis use
2. Cannabis abuse and dependence (i.e., addiction)
3. Driving under the influence of cannabis

Researchers from the University of Minnesota School of Public Health’s State Health Access Data Assistance Center (SHADAC) and Cannabis Research Center (CRC) present data related to these commonly cited concerns from Minnesota, from other states, and from the United States as a whole. Where available and appropriate, estimates for alcohol are also presented for comparison as it is a legal and commonly used psychoactive substance that, like cannabis, entails a range of risks to public health.

The data in this brief are intended to serve as starting points for discussions on the public health impacts of Minnesota cannabis policy. Ultimately, there will be a great need for research into the rapidly evolving cannabis policy landscape and potentially refinements in policy to maximize benefits and minimize harms.

“The implications of cannabis legalization on public health also depend on the risks and benefits asso­ciated with cannabis use, which remain areas of uncertainty that warrant further study,” says SHADAC and CRC Researcher Colin Planalp. “It will be crucial for researchers and policymakers to monitor these and other issues into the future.”

Read the brief in full here. Additionally, if you’d like to learn more about cannabis and other substance use in Minnesota and beyond, check out the following resources:

• SHADAC blog accompanying this brief - “SHADAC and CRC brief provides pre-legalization data on Minnesota’s cannabis landscape”  
• Brief on the United States Opioid Crisis – “Opioid Crisis in the Pandemic Era”
• Explore data on the topic of substance use, alcohol-involved deaths, and more on State Health Compare 

Planalp, Colin
Research Fellow

p 612-624-4850
e cplanalp@umn.edu

UMN Opioid Advisory Task Force

On Thursday, September 21, SHADAC Senior Research Fellow Colin Planalp presented a data-focused look at the national opioid crisis during a University of Minnesota Opioid Advisory Task Force forum. Colin presented his recent findings about overdoses related to four different drug categories - fentanyl, methamphetamine, prescription opioids, and cocaine - to the Opioid Advisory Task Force's board of directors, as well as other stakeholders. The research shows that much of the increase in deaths across all four drug categories can be attributed to the involvement of fentanyl, which he refers to as the "hidden tentacles of fentanyl."

Across the states, the opioid crisis varies widely—both in the range of opioid death rates and in the type of narcotic used. For example, deaths from fentanyl alone ranged from a low of 3.7 per 100,000 people in Hawaii in 2021 to a high of 73.5 per 100,000 people in West Virginia. 

The presentation also includes information by demographic sub-populations, including age, race/ethnicity, and urbanization, as well as a discussion of the opioid crisis in the wake of the COVID-19 pandemic.

Click the image to see the full presentation, and for more resources on opioid-related data visit "The Opioid Epidemic in the United States" SHADAC resource page. 

Disparities in Minnesota’s COVID-19 Vaccination Rates

August 2023:

A new SHADAC issue brief found stark disparities not only in the share of subpopulations that have been immunized against COVID-19 in Minnesota, but also in the length of time it took vaccines to reach most people in these different groups.

For instance, by the end of 2022, 80 percent of Asian and Native Hawaiian and Pacific Islander people in Minnesota were vaccinated against COVID-19, but only 53 percent of American Indian and Alaska Native people in the state were vaccinated.

Similarly, while Minnesota successfully vaccinated half of the state’s Asian and Native Hawaiian and Pacific Islander population and White population within six months of the first COVID-19 vaccine authorization, the state took fifteen months to reach vaccination for half of the American Indian and Alaska Native population.

The study also found wider and more obvious disparities among younger segments of Minnesota’s population. For instance, half of the elderly population (age 65+) in all racial and ethnic groups were vaccinated within similar time frames of just three or four months. However, among young adults age 19-24, Minnesota was able to vaccinate half of Asian and Native Hawaiian and Pacific Islander young adults within five months but took roughly twice as long to reach half of Latino young adults (nine months), White young adults (ten months), and Black young adults (eleven months). And, shockingly, Minnesota had failed to reach half of American Indian and Alaska Native young adults by the end of 2022—almost two years after vaccines were first authorized.

The analysis also looked at vaccination data by categories of geography and sex, and for children separately, as vaccines for their age group were developed and authorized later than for adults. All data used in SHADAC’s analysis were provided through a collaboration with the Minnesota Electronic Health Record Consortium, a partnership of state health systems and public health agencies aimed at providing comprehensive and timely data to better inform policy.

Click on the image above to read the full brief.

Blewett, Lynn A.
Natalie Mac Arthur

SHADAC Researchers Co-Author Maternal and Child Health Journal Article on Medical Home Contributions to Child Health Outcomes

SHADAC researchers Natalie Mac Arthur and Lynn Blewett recently published a journal article in Maternal and Child Health Journal that examines the medical home model—a widely accepted model of team-based primary care—and its unique contributions to child health outcomes.  

Their analysis drew on data from the 2016-2017 National Survey of Children’s Health (NSCH) to assess five key medical home components–usual source of care, personal doctor/nurse, family-centered care, referral access, and coordinated care–and their associations with child outcomes. Health outcomes included emergency department (ED) visits, unmet health care needs, preventive medical visits, preventive dental visits, health status, and oral health status.

Key Findings

• Results showed that children who were not white, living in non-English households, with less family income or education, or who were uninsured had lower rates of access to a medical home and its components.
   
• A medical home was associated with beneficial child outcomes for all six of the outcomes and the family-centered care component was associated with better results in five outcomes.
   
• ED visits were less likely for children who received care coordination.

These findings highlight the role of key components of the medical home model and the importance of access to family-centered health care that provides needed coordination for children of all backgrounds. Health care reforms should consider disparities in access to a medical home and specific components and the contributions of each component to provide quality primary care for all children. Understanding the role of medical home components contributes to the refinement of the model and can inform health care policy efforts to improve health equity for all children.    

Read the full article in the Maternal and Child Health journal.