Cannabis Freedom Alliance  One-Pager Sources

i. Eric L. Sevigny, Cannabis and driving ability, 38 Current Opinion Psychology 75 (2021); Godfrey D. Pearlson, et al., Cannabis and Driving, 12 Frontiers Psychiatry 1 (2021).

ii. Michael W. DeGregorio, et al., A comprehensive breath test that confirms recent use of inhaled cannabis within the impairment window, 11 Sci. Reports 1 (2021).

iii. Thomas R. Arkell, et al., The failings of per se limits to detect cannabis-induced driving impairment: Results from a simulated driving study, 22 Traffic Inj. Prevention 102 (2021); Brett C. Ginsburg, Strengths and limitations of two cannabis-impaired driving detection methods: a review of the literature, 45 Amer. J. Drug Alcohol Abuse 610 (2019).

iv. Care Evelyn Vingilis, et al., Systematic review of the effects of cannabis retail outlets on traffic collisions, fatalities and other traffic-related outcomes, 22 J. Transport Health 1 (2021) (reviewing current research to find nine relevant studies, six of which showed an increase in adverse traffic outcomes post-legalization); Jayson D. Aydelotte, et al., Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington, 132 Accident Anal. Prevent. 1 (2019) (finding that legalization was associated with a slight increase in fatal crashes in both Colorado and Washington after both the laws passed and dispensaries opened); Tyler J. Lane & Wayne Hall, Traffic fatalities within US states that have legalized recreational cannabis sales and their neighbours, 114 Addiction 847 (2019) (finding that traffic fatalities increase by 1 for each 1 million residents in Colorado, Washington, Oregon, and their neighboring states following their implementation of adult-use cannabis sales); Jaeyoung Lee, et al., Investigation of associations between marijuana law changes and marijuana-involved fatal traffic crashes: A state-level analysis, 10 J. Transp. Health 194 (2018) (finding substantial increases in fatal traffic crashes following legalization); Johanna Marie Borst, et al., Driving under the influence: a multi-center evaluation of vehicular crashes in the era of cannabis legalization, Trauma Surgery Acute Care (2021), (finding that the number of adult motor vehicle crash patients with THC in their blood increased post-legalization of cannabis in San Diego County); Sarah B. Windle, et al., Association between legalization of recreational cannabis and fatal motor vehicle collisions in the United States: an ecologic study, CMAJ OPEN (2021), (finding that fatal motor vehicle accidents increased by 15% following the legalization of adult-use cannabis based on data from first 10 states and D.C.); Julian Santaella-Tenorio, et al., Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017, JAMA Intern. Med. (2020), (finding that legalization in Colorado was associated with an increase in traffic fatalities but not in Washington); Russell S. Kamer, et al., Change in Traffic Fatality Rates in the First 4 States to Legalize Recreational Marijuana, JAMA Internal Medicine (2020), (finding a slight increase of 2.1 traffic fatalities per billion vehicle miles traveled in Colorado, Washington, Oregon, and Alaska following adult-use legalization); Jacob Vogler, State Marijuana Policies and Vehicle Fatalities, SSRN (2017), (finding that legalizing recreational cannabis increased quarterly vehicle fatalities by 8%): But see Marco H. Benedetti, et al., Self-reported driving after marijuana use in association with medical and recreational marijuana policies, 92 Int’l J. Drug Pol’y 1 (2021) (finding no evidence that drivers in states with recreational marijuana were more likely to drive after use); Jim Dewey, et al., State Marijuana Laws and Traffic Fatalities, 51 Rev. Region. Stud. 246 (2021) (finding no statistically significant association between traffic fatalities and adoption of adult-use cannabis laws); Taylor Lensch, et al., Cannabis use and driving under the influence: Behaviors and attitudes by state-level legal sale of recreational cannabis, 141 Prevent. Med. 1 (2020) (finding that cannabis users from states with recreational cannabis were less likely to drive after use when controlling for frequency of use); Collin Calvert & Darin Erickson, An examination of relationships between cannabis legalization and fatal motor vehicle and pedestrian-involved crashes, 21 Traffic Injury Prev. 521 (2020) (finding no impact on pedestrian-involved vehicle accidents or fatal crashed generally from Washington and Oregon legalizing recreational cannabis but a slight increase in fatal accidents overall in Colorado); Gregory Leung & Jessica Dutra, Legal Access to Marijuana and Motor Vehicle Fatalities in the United States, 1990—2019, SSRN (2021), (finding no change in traffic  fatality rate following the legalization of adult-use cannabis in states before 2019); Benjamin Hansen, et al., Early Evidence on Recreational Marijuana Legalization and Traffic Fatalities, National Bureau of Economic Research (2018), (finding that both states legalizing adult-use cannabis and those that did not saw similar increases in traffic fatalities); See also Brian C Tefft & Lindsay S Arnold, Estimating Cannabis Involvement in Fatal Crashes in Washington State Before and After the Legalization of Recreational Cannabis Consumption Using Multiple Imputation of Missing Values Get access Arrow, 190 Amer. J. Epidemiology 2582 (2021) (finding that the number of drivers testing positive for THC after legalization in Washington state increased from 9.3% to 19.1% with those with high THC also increasing at a lower but substantial rate).

v.  Impaired Driving Task Force, Report to the Legislature: Senate Bill No. 94, California Highway Patrol (2021),

vi. International Association of Chiefs of Police, Drug Recognition Experts (DREs), International Association of Chiefs of Police (2022),

vii. Eve Paquette & Joanie Prince, The effectiveness of simulation in drug recognition expert training: Quebec hybrid training model, 22 Police Prac. Res. 510 (2021) (finding between 90-92% accuracy based on training method); Rebecca L. Hartman, et al., Drug Recognition Expert (DRE) examination characteristics of cannabis impairment, 92 Accident Anal. Prevent 219 (2016); Edna Schechtman & David Shinar, Modeling drug detection and diagnosis with the ‘drug evaluation and classification program’, 37 Accident Anal. Prevent. 852 (2005); Stephen J. Heishman, et al., Laboratory Validation Study of Drug Evaluation and Classification Program: Ethanol, Cocaine, and Marijuana, 20 J. Analytical Toxicology 468 (1996); National Highway Traffic Safety Administration, Field Evaluation of the Los Angeles Police Department Drug Detection Procedure, U.S. Department of Transportation (1986), (finding 94% accuracy); See also International Association of Chiefs of Police, Drug Recognition Experts (DREs): 12 Step Process, International Association of Chiefs of Police (2022),

i. Richard A. Miech, et al., National Survey Results on Drug Use, 1975-2021: Secondary School Students, The University of Michigan Institute for Social Research (2022),; Schulenberg, supra note i.

ii. Janet E. Joy, et al., National Academy of Sciences, MARIJUANA AND MEDICINE: ASSESSING THE SCIENCE BASE (1998); Erich Labouvie, et al., Age of first use: Its reliability and predictive utility, 58 J. Studies Alcohol 638 (1997).

iii. Joy, supra note ii (“There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs... There is no evidence that marijuana serves as a stepping stone on the basis of its particular physiological effect.”); Cody Jorgensen & Jessica Wells, Is marijuana really a gateway drug? A nationally representative test of the marijuana gateway hypothesis using a propensity score matching design, J. Exp. Criminology (2021); Louisa Degenhardt, Evaluating the drug use “gateway” theory using cross-national data: Consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys, 108 Drug Alcohol Depend. 845 (2010); Andrew R Morral, et al., Reassessing the marijuana gateway effect, 97 Addiction 1493 (2002); Joseph J. Sabia, et al., Is Recreational Marijuana a Gateway to Harder Drug Use and Crime?, National Bureau of Economic Research (2021), (“Across analyses of four national datasets (the NSDUH, the UCR, the NVSS Mortality Files, and the TEDS) we find little consistent evidence, at least thus far, of important gateway effects of RMLs.   While RMLs are associated with increases in adult marijuana use and a reduction in marijuana-related arrests, we find little compelling evidence to suggest that RMLs result in increases in illicit drug use, arrests for part I offenses, drug-involved overdoses, or drug-related treatment admissions for addiction.”).

iv. The entirety of the current research shows a strong substitution effect for binge drinking and overall alcohol consumption, a mixed result for tobacco, and a possible substitution of cannabis for other illegal substances. See Charles B.Fleming, et al., Trends in Alcohol, Cigarette, E-Cigarette, and Nonprescribed Pain Reliever Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis, 1 J. Adolescent Health 1 (2022) (finding that alcohol and cigarette use, heavy drinking, and opioid use all declined among 18-25 year olds between 2014 and 2019 after Washington legalized adult use cannabis); Hollis C. Karoly, et al., Effects of cannabis use on alcohol consumption in a sample of treatment-engaged heavy drinkers in Colorado, 116 Addiction 2529 (2021) (finding that use of cannabis among those being treated for alcohol consumption resulted in them having 29% fewer drinks and reduced their likelihood of binge-drinking by more than 2 times); Keaton Miller & Boyoung Seo, The Effect of Cannabis Legalization on Substance Demand and Tax Revenues, 75 Nat’l Tax J. 107 (2021) (finding that legalization of adult-use cannabis in Washington resulted in a 15% decrease in alcohol demand and a 5% decrease in tobacco demand); Collin M. Calvert & Darin Erickson, Recreational cannabis legalization and alcohol purchasing: a diference-in-diferences analysis, 3 J. Cannabis Res. 1 (2021) (finding that legalization of adult-use cannabis was associated with a 16% decline in overall monthly alcohol purchases in Colorado, a 12% decrease in wine and 25% increase in spirits purchases each month in Washington, and a small decline in monthly spirits demand in Oregon); Jeremy Mennis, et al., Treatment admissions for opioids, cocaine, and methamphetamines among adolescents and emerging adults after legalization of recreational marijuana, 122 J. Substance Abuse Treatment 1 (2021) (finding that adult-use legalization in Colorado and Washington did not impact treatment admissions for addiction to cocaine, opioids, or meth);  Davide Dragone, et al., Crime and the legalization of recreational marijuana, 159 J. Econ Behav. Org. 488 (2019) (finding a decrease in the use of other drugs and binge drinking following legalization); Meenakshi S. Subbaraman & William C. Kerr, Subgroup trends in alcohol and cannabis co-use and related harms during the rollout of recreational cannabis legalization in Washington state, 75 Int’l J. Drug. Pol’y 1 (2020) (finding that the amount of alcohol consumed by men declined after the legalization of cannabis in Washington and that both the number of alcohol-related and financial harms experienced by women also declined); Sabia, supra note iii (finding that the legalization of adult-use marijuana is associated with declines in overdose deaths from other illicit substances); But see Thanh Lu, Marijuana legalization and household spending on food and alcohol, 30 Health Econ. 1684 (2021) (finding that adoption of recreational marijuana resulted in a 9% increase in quarterly spending on alcohol); Seong-min Park, et al., The Effect of Marijuana Legalization on the Trajectories of Hard Drug–Related Hospitalizations: A Growth Curve Analysis of the County-Level State Inpatient Database in Washington, 2009–2015, 50 J. Drug Issues 273 (2020) (finding that adult-use cannabis legalization in Washington shifted the state from declining hard-drug hospitalizations to increasing hard-drug hospitalizations); Ashutosh Bhave & B. P. S. Murthi, A Study of the Effects of Legalization of Recreational Marijuana on Sales of Cigarettes, SSRN (2021), (finding that legalization of adult-use cannabis in Colorado was associated with a 7% increase in cigarette consumption); See also Constanza Risso, et al., Does cannabis complement or substitute alcohol consumption? A systematic review of human and animal studies, 34 J. Psychopharmacology 938 (2020) (reviewing 64 studies examining whether cannabis and alcohol are substitutes or compliment; finding that 30 studies found substitution, 17 found compliments, 14 found neither, and 4 found evidence for both).

v. Brendan Saloner, et al., A Public Health Strategy for the Opioid Crisis, 133 Pub. Health Rep. 24S (2018); Eric P. Baron, Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science, 58 Headache 1139 (2018); National Academies of Sciences, Engineering, and Medicine, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, National Academies of Sciences, Engineering, and Medicine (2017),; See also Lauren Hersch Nicholas & Johanna Catherine Maclean, The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study, 38 Pol’y Anal. Mgmt. 445 (2019) (Finding that adoption of medical marijuana law resulted in 2.1% reduction in reported pain among older Americans.)

vi. Coleman Drake, et al., Recreational cannabis laws and opioid-related emergency department visit rates, 30 Health Econ. 2595 (2021) (finding that adoption of adult-use cannabis decreases opioid-related emergency room visits by 7.6% for six months after implementation); Kayla N. Tormohlen, et al., The State of the Evidence on the Association Between State Cannabis Laws and Opioid‑Related Outcomes: A Review, 8 Current Addiction Reports 538 (2021) (reviewing the conclusions of 21 past studies and finding that all looking at medical cannabis found a reduction in opioid prescriptions and mixed results for adult-use legalization); Jiebing Wen, et al., The impact of medical and recreational marijuana laws on opioid prescribing in employer-sponsored health insurance, 30 Health Econ. 989 (2021) (finding that medical cannabis laws [7%] and adult-use cannabis laws [13%] were associated with a reduction in the prescription of morphine among patients in employer-sponsored health insurance programs); .J. Alcocer, Exploring the effect of Colorado's recreational marijuana policy on opioid overdose rates, 185 Public Health 8 (2020) (finding that legalization of adult-use cannabis in Colorado caused a 5% reduction in opioid overdose deaths); Nathan W. Chan, et al., The Effects of Recreational Marijuana Legalization and Dispensing on Opioid Mortality, 58 Econ. Inquiry 589 (2020) (finding adoption of adult-use cannabis is associated with a 20-35% reduction in annual opioid mortality); Benjamin J. McMichael, et al., The impact of cannabis access laws on opioid prescribing, 69 J. Health Econ. 1 (2020) (finding that adult-use and medical cannabis laws reduced prescriptions of morphine by almost 62% and reduced the prescription of all opioids in general); Amalie K. Kropp Lopez, et al., Prescription Opioid Distribution after the Legalization of Recreational Marijuana in Colorado, 17 Int’l j. Environ. Res. Public Health 1 (2020) (finding significantly higher reductions in pain reliever prescriptions in Colorado [31.5%] when compared to Maryland [12.2%] and Utah [23.5%] following the legalization of adult-use cannabis); Stanford Chihuri & Guohua Li, State marijuana laws and opioid overdose mortality, 6 Injury Epidemiology 1 (2019) (finding that medical cannabis legalization was associated with a 7% reduction in opioid prescriptions when combining the findings of 16  past studies); Yuyan Shi, et al., Recreational marijuana legalization and prescription opioids received by Medicaid enrollees, 194 Drug Alcohol Dependence 13 (2019) (finding that prescriptions, total doses, and spending on Schedule III opioids were all reduced by more than 30% in states having adult-use cannabis among Medicaid enrollees); Anuj Shah, et al., Impact of Medical Marijuana Legalization on Opioid Use, Chronic Opioid Use, and High-risk Opioid Use, 34 J. Gen. Internal Med. 1419 (2019) (finding that medical marijuana legalization is associated with a reduction in both opioid prescriptions and high-risk opioid prescriptions); Hefei Wen & Jason M. Hockenberry, Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees, 178 JAMA Intern. Med. 673 (2018); Di Liang, et al., Medical cannabis legalization and opioid prescriptions: evidence on US Medicaid enrollees during 1993–2014, 113 Addiction 2060 (2018); Yuyan Shi, Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever, 173 Drug Alcohol Dependence 144 (2017) (finding that medical marijuana legalization is associated with a 23% reduction in hospitalizations related to opioid dependence or abuse and a 13% reduction in hospitalizations for opioid overdoses); Maria Eugenia Socias, et al., High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis, 113 Addiction 2250 (2018); Michelle N. Anyaehie, et al., Opioid distribution trends in California post recreational marijuana legalization, medRxiv (2021), (comparing California and Texas to find reductions in cumulative opioid distribution and a significantly slower increase in heroin overdoses); Hayoung Cheon, et al., The Impact of Medical Marijuana Legalization on Opioid Prescriptions, SSRN (2021), (finding that adoption of medical cannabis laws are associated with a reduction in quarterly prescriptions of opioids, the days of supply for opioid prescriptions dosage strength of opioid prescriptions); Isabella Kathleen MacMillan & Kevin M. Gorey, Cannabis- Based Reduction in Opioid-Related Harms: Population-Based Observational Meta Analysis, Research Square (2020), (finding that opioid prescriptions declined by 8% after medical marijuana legalization and reduced even more by adult-use legalization); Pelin Ozluk, The Effects of Medical Marijuana Laws on Utilization of Prescribed Opioids and Other Prescription Drugs, SSRN (2017), (finding that adoption of a medical cannabis law is associated with a $2.47 decrease in the value of opioids prescribed per individual aged 18-39); Jacob M. Vigil, et al., Associations between medical cannabis and prescription opioid use in chronic pain patients: A preliminary cohort study, PLOS One (2017),; But see June H.Kim, et al., Association between fatal opioid overdose and state medical cannabis laws in US national survey data, 2000-2011, 99 Int’l J. Drug Policy 1 (2022) (finding that medical cannabis laws did not reduce the rate of opioid overdoses between 2000-2005 and 2006-2011); Lynn M. Neilson, et al., Impact of Marijuana Legalization on Opioid Utilization in Patients Diagnosed with Pain, 36 j. Gen. Internal Med. 3417 (2021) (finding that patients living in a medical cannabis or adult-use cannabis were more likely to receive an initial opioid prescription, a follow-up prescription, and a greater than 90 days follow-up supply); Luis E. Segura, Association of US Medical Marijuana Laws With Nonmedical Prescription Opioid Use and Prescription Opioid Use Disorder, 2 JAMA Netw. Open 1 (2019) (finding no association between the adoption of medical cannabis and a change in opioid prescriptions); See also William C. Goedel, et al., Association of medical cannabis licensure with prescription opioid receipt: A population-based, individual-level retrospective cohort study, 100 Int’l J. Drug Pol’y 1 (2022) (finding that a doctor holding a medical cannabis license does not reduce the likelihood of filling an opioid prescription); Sunday Azagba, et al., Trends in Opioid Misuse among Marijuana Users and Non-Users in the U.S. from 2007–2017, 16 Int’l J. Environ. Res. Public Health 1 (2019) (finding that opioid prescriptions declined faster among cannabis users over non-users); Ashley Bradford & David Bradford, The Impact of Medical Cannabis Legalization on Prescription Medication Use and Costs under Medicare Part D, 61 J. Law Econ. 461 (2018) (Finding $638.8 million in Medicare Part D savings from patients substituting medical marijuana for other prescription drugs.); Greta Hsu & Balázs Kovács, Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study, BMJ (2021), (finding that the number of medical or adult-use dispensaries in a county is associated with a reduction in opioid mortality; an increase from one to two dispensaries is associated with a 17% reduction in opioid-related mortality); Sabia, supra note iii (NBER 2021).

i  Lemstra M, Bennett NR, Neudorf, C. et al. A Meta-analysis of Marijuana and Alcohol Use by Socio-economic Status in Adolescents Aged 10–15 Years, Can J Public Health 99, 172–177 (2008).

ii Ibid.

iii. DiNardo J, Lemieux T. Alcohol, marijuana, and American youth: the unintended consequences of government regulation, Journal of Health Economics, 20; 6: 991-1010 (2001). ​​;  Miech et al. ICPSR 38156 ICPSR Codebook. Inter-university Consortium for Political and Social Research. Ann Arbor, MI. (2021)

iv. Miron J, Basov S, Jacobson M. Prohibition and the Market for Illegal Drugs: An Overview of Recent History. World Economics, 2; 4:133-158 (2001).

v. Rich JJ, et al. Effect of cannabis liberalization on suicide and mental illness following recreational access: a state-level longitudinal analysis in the USA. medRxiv, 2020.09.25.20201848 (2022); Anderson DM, Rees DI, Sabia JJ, Safford S. Association of Marijuana Legalization With Marijuana Use Among US High School Students, 1993-2019. JAMA Netw Open. 4; 9: e2124638 (2021). doi:10.1001/jamanetworkopen.2021.24638