Remarkably, Irvine has 9.7% of the Hispanic population, and Santa Ana—77.3%. In Outsiders, Howard Becker defines three types of social control of cannabis use: limiting supply and access to the drug; keeping nonusers from discovering that one is a user; defining the act as immoral. Since Becker published his book, cannabis has been depenalized, decriminalized, and finally legalized in California. Although the situation has significantly improved in terms of supply and access to cannabis, the stigmatization of cannabis use is still a pressing issue in the legal cannabis market. The war on drugs generated various misconceptions about cannabis, which detrimentally affected public perceptions. First, despite scientific research showing that cannabis is no more harmful than nicotine or alcohol, some people still believe that cannabis is a gateway drug to heavier substances that induces criminal activity and violence. Second, although most people recognize the medicinal benefits of cannabis , they continue to disfavor the recreational use of cannabis, perceiving it as a non-conforming and risky behavior and its users as weak and non-productive members of society. Finally, people who tolerate the recreational use of cannabis in private spaces do not always accept its public display and consumption. Agreeing with legalization as a concept, Californians are not ready to embrace it entirely and allow dispensaries in their own neighborhoods—this occasionally leads to their obtaining court rulings against cannabis-growing operations. The drug problem cannot be adequately understood without examining the underpinning issues of poverty and disadvantage . There is nothing inherently criminogenic about drugs, nor drugs necessarily relate to poverty. Stigmatization of drug use is a product of a culture in which the consumption of pleasurable intoxicants is deemed intolerable and punishable. Drug use is a heavily moralized territory, indoor grow shelves and the lower social strata suffer worse outcomes than more affluent people for the same drug-related behavior .
The literature on the history of drugs portrays drug regulation as a moral tale, in which the “blurry lines between us and them, privileged and repressed, strong and weak, keep getting rewritten as the boundaries between good and evil” . Existing at all social levels, drug use is recognized as a problem in specific social contexts—namely, it is clustered in the communities suffering already from multiple socio-economic difficulties . Even if the number of cannabis arrests is declining every year, Hispanics and African Americans continue to be disproportionately arrested. In California, in 2019, Hispanics accounted for 41.7% of cannabis felony arrests, African Americans for 22.3%, and whites for 21.3%. Despite the fact that cannabis consumption rates are higher among whites, they are less likely to be arrested for cannabis-related offenses . The idea behind socio-spatial control is that deviance should be contained within designated territories, i.e., if objects, practices, and behaviors do not fit the existing social order, they are to be spatially excluded. In this chapter, I tested the reverse hypothesis, i.e., if things are geographically put out of place, it means that they are viewed as socially undesirable and inappropriate. The statistical analysis shows that city governments act as moral entrepreneurs when deciding whether they want to forbid or allow legal cannabis businesses. The prohibition era stereotypes continue to influence the development of the legal cannabis market: most jurisdictions decide to keep aloof from spoiled identities and tainted places associated with cannabis use, even at the cost of not reaping financial rewards. On the contrary, economically disadvantaged communities with a larger Hispanic population are more likely to permit cannabis dispensaries because: they have higher financial incentives, and they have lower reputational risks. Since these communities are already marginalized and associated with crime, disadvantage, and social exclusion, having legal cannabis dispensaries will not exacerbate their stigmatization.As of May 2022, 38 states permit medical cannabis and 19 states permit recreational cannabis.
These policies have numerous potential implications for public health, including changes in the epidemiology of cannabis consumption and associated health outcomes. States regulate cannabis in varied ways, but many cede substantial powers to local governments. Within the bounds of state law, local authorities may determine the number and type of commercial cannabis businesses allowed, if any. They can also regulate locations of retail cannabis outlets, hours and days of sale, types of products sold, packaging, advertising, tax rates, and clean air requirements. Guidelines for state and local cannabis control policies regulating cannabis are based on alcohol and tobacco research. Recommended policies may protect public health by limiting cannabis availability and potency and by encouraging safer modes of use. In states with legal cannabis and local control, city and county governments can advance health equity by adopting health-promoting cannabis control policies and ensuring that they are fairly applied across the population. Little is known about local variation in cannabis control policies or to whom these policies apply. Previous studies surveyed local cannabis control policies following recreational cannabis legalization in Colorado, Washington, and California. All found wide variation, primarily between jurisdictions that banned commercial cannabis businesses and those that allowed all or most commercial activities. However, none of these studies characterized the populations affected by distinct policy approaches. Variation in local laws is important, because if policies that protect public health are adopted in socially advantaged communities but not in disadvantaged communities, health disparities may be exacerbated. For example, uneven application of smoke-free tobacco laws across localities was linked to racial/ethnic and socioeconomic disparities in tobacco related disease. Anticipating such disparities can inform appropriate public health responses.
Previous studies show that cannabis outlets, particularly illegal ones, are disproportionately located in less advantaged communities. Studies from alcohol control show that local governments can play a role in both creating and mitigating undue burden of alcohol outlets in vulnerable communities through local planning, zoning, and public health regulations. Similar provisions could be needed to protect communities from uneven distributions of legal or illegal cannabis outlets. In this study, we characterized the demographic and socioeconomic characteristics of communities subject to different types of local cannabis control policies. We considered 3 levels of policy measures: overall bans on cannabis businesses, restrictions on cannabis availability, and individual cannabis control policies. We hypothesized that policies designed to protect public health would be less common in socially disadvantaged communities. We focused on 12 counties in California, where adult use of recreational cannabis was legalized on November 9, 2016, and retail sales were implemented on January 1, 2018.We assessed local cannabis control polices for 12 of California’s 58 counties and all the incorporated cities within them. These counties were selected to capture a range of sizes, sociodemographic compositions, political orientations, and cannabis policy approaches. City policies apply within incorporated city borders, indoor garden table and county policies apply to areas outside of incorporated cities . We defined “jurisdictions” as the set of incorporated cities and unincorporated county areas because these are mutually exclusive and collectively exhaustive geographic areas to which distinct policies apply. The 12 counties included 230 distinct cities and 11 unincorporated county areas , covering 59% of the California population . Using a legal epidemiological approach, we systematically coded characteristics of cannabis policies in all 241 jurisdictions and then linked these policies to data on demographic and socioeconomic factors to characterize the affected populations. For each jurisdiction, we identified the corresponding local government’s online searchable database of currently applicable laws. All code and ordinances are publicly available under the California Public Records Act. We downloaded all legal text pertaining to cannabis by using the search term “cannabis OR marijuana OR marihuana.” Across jurisdictions, relevant legal text ranged in length from 1 paragraph to thousands of pages. Five authors reviewed the text using a structured data collection instrument to capture the presence or absence and content of prespecified provisions in each jurisdiction’s cannabis law. Policy data were collected and managed using REDCap electronic data capture tools hosted at the University of California San Francisco. The data collection instrument was iteratively piloted and refined as new policy approaches were uncovered. To ensure accuracy, all jurisdictions were double coded by 2 analysts until achieving greater than 95% agreement. Policy data collection and coding were conducted from November 2020 to January 2021. The complete protocol and data collection instrument are provided in Appendices B and C .California state law specifies a minimum set of policies that apply to medical and recreational cannabis statewide. However, localities retain considerable discretion. We collected cannabis policy measures, guided by an established taxonomy of all possible cannabis policies developed by affiliates of the Alcohol Policy Information System. From this comprehensive taxonomy, we measured all policies that could be applied at the local level in California given state law, varied across jurisdictions within California, were more restrictive than state law, and were plausibly related to public health according to previous evidence, recommended public health best practices, and expert opinion. We captured the greatest detail on restrictions related to cannabis availability and retail sales, because these are major levers for modifying population-level consumption, and existing evidence suggests that policies regulating retail sales are the key component of state laws linking legalization to consumption and problems. Appendix A, Table A describes these local policies, relative to state law.To characterize the populations exposed to different policy approaches, we included a range of demographic and socioeconomic characteristics from sources including the US Census Bureau and Geolytics.
We considered sociodemographic characteristics related to health disparities, including age, race/ethnicity, gender, educational attainment, poverty, unemployment, median income, household composition, urbanicity , home ownership, and population change. We also assessed the density of social organizations as a measure of social capital and density of general retail businesses as a measure of economic development. Appendix A, Table B provides additional detail on each covariate. In addition to considering each sociodemographic characteristic individually, to help synthesize the overall pattern of results, we created a binary measure of social advantage by entering all of the jurisdiction-level sociodemographic measures into a principal components analysis and dichotomizing the resulting first component at the median. In sensitivity analyses, we considered measures of social advantage dichotomized at the 75th and 90th percentiles.We found substantial local variation in cannabis control policies. Of 241 jurisdictions, 83 permitted at least 1 form of commercial medical or recreational cannabis business . The largest distinction in regulatory approaches across jurisdictions was between those that banned all forms of medical and recreational cannabis businesses and those that permitted them all . Between these extremes, 5 jurisdictions permitted all types of medical businesses but not recreational businesses; 14 permitted cultivation, distribution, manufacture, and testing but not retail; and 5 permitted retail only. Jurisdictions with nonzero residential populations permitting at least one form of medical or recreational retail cannabis enacted a range of cannabis control policies . Most jurisdictions required local permits for retail sales , limited hours of sale , taxed retail purchases , restricted the density of outlets permitted per land area or population , and adopted operating standards for upkeep and safety . Bans on on-site consumption, which protect workers and visitors from health hazards such as secondhand smoke exposure, were present in 74% of jurisdictions. Less common were public health tools such as restrictions on marketing or advertising , server training requirements , limits on product types or potency , or social host liability .For the 238 jurisdictions with nonzero residential populations, Table 1 compares the population characteristics of jurisdictions banning all cannabis businesses versus those that permitted 1 or more. All-out bans on all cannabis businesses were more common in areas with higher socioeconomic status. Populations in jurisdictions permitting commercial cannabis, by contrast, were on average less educated, with lower median income, more poverty, higher unemployment, and more crowded housing. Cities and unincorporated areas allowing cannabis businesses were also slightly older and had greater proportions of Black and Latinx residents, and fewer Asian and White residents. Population density, population growth, renters, non-family households, and densities of general retail and social organizations were also greater in jurisdictions permitting cannabis businesses.For the 68 jurisdictions with nonzero residential populations that permitted at least 1 form of cannabis retail, Table 2 shows the characteristics of populations residing in jurisdictions with varying numbers of public health restrictions on retail sales and cannabis availability.