Mandated Drug Treatment In the Aftermath of Recreational Cannabis Legalization

By Katharine Neill Harris, Christopher F. Kulesza

Roughly half of the U.S. population now lives in a state that permits recreational cannabis use and sales. Still, the criminal legal system continues to play a primary role in determining who receives treatment for cannabis use. It remains the single largest treatment referral source, and in 2019 more than 100,000 people who were admitted to treatment for cannabis use were referred by a legal entity. This raises questions regarding the extent to which individuals who interact with the legal system are monitored and punished for cannabis use in the post-legalization era. Moreover, the issue has not been addressed by state legalization measures. We examined trends in legal system referrals to treatment for cannabis use in legal and nonlegal states from 2007 to 2019. We also tested the relationship between recreational cannabis legalization and legal system treatment referrals for Black, Hispanic, and white adults and juveniles. The legal system’s practice of requiring individuals to participate in drug treatment warrants scrutiny because of its potentially negative and long-lasting consequences. While mandated treatment may be appropriate in some cases, the legal system often requires treatment participation from individuals who do not meet the criteria for a substance use disorder, and it does a poor job of connecting those who do have substance use disorders with appropriate care. The legal system’s limited efficacy in this arena is problematic because mandated treatment carries the possibility of additional legal consequences if program expectations are not met. The harmful effects of legal involvement include fewer education and employment prospects, reduced earning potential, destabilized family structures, negative mental and physical health outcomes, and diminished quality of life. Communities of color are disproportionately targeted by drug enforcement and disproportionately impacted by its collateral consequences. Recreational cannabis legalization (RCL) is intended to remedy, in part, the harmful and racially disparate effects of cannabis prohibition. However, the continuation of compulsory treatment for cannabis use, and the legal involvement it entails, is a potential pathway through which the systemic harms and inequities of cannabis prohibition can persist. The problematic nature of this arrangement is enhanced when it occurs alongside a commercial cannabis industry that profits from greater levels of cannabis use 

Houston, TX: The Baker Institute, 2023. 44p.