Introduction
The accessibility of cannabis plays a crucial role in shaping its use. Since 2014, the rise of
retailers has made cannabis more accessible to the public, leading to increases in both cannabis
use and consumption of non-combustible cannabis in relevant areas. Heightened perceived stress
has also emerged as a risk factor for cannabis use. Evidence suggests that increased stress levels
during the COVID-19 pandemic (pandemic) correlate with a rise in overall substance use.
Additionally, the pandemic saw increased pulmonary health awareness, with some reports of
greater consideration for respiratory risks by people who smoke than before the pandemic. As
legislatures contemplate cannabis legalization and retail licensing during an escalating, national
mental health crisis, they should deliberate policy impacts on usage behaviors. For clinicians,
understanding the motivations driving change in cannabis use during the pandemic can better
illustrate strategies for both cessation and harm reduction. This repeated cross-sectional study
investigates variations in cannabis use during the pandemic between two states, New York (NY)
and Washington (WA), with similar pandemic responses, but differences in their access to retail
cannabis to help guide policymakers and clinicians in the evolving landscape of cannabis
legalization.
Methods
Data was analyzed from the NY and WA Behavioral Risk Factor Surveillance System (BRFSS)
from 2019 and 2021 to compare pre-pandemic and pandemic levels of cannabis use between a
decriminalized/legal cannabis state without retail cannabis, NY, to a state with established retail
cannabis, WA. Respondents reported on whether they used cannabis in the past 30 days, and
whether smoking was their primary method of cannabis use. Data was analyzed using weighted
prevalence and 95% CIs estimated using a bootstrap approach, with statistics performed by SPSS
statistical software.
Results
This study analyzed 75,606 responses, with a median age range of 45-54 years old, 53.8% of
responses from those who identify as female, and the following race/ethnicity profile: 74.2%
White, 6.1% Black, 8.9% Hispanic, and 10.8% Other (American Indian or Alaskan Native,
Asian, Native Hawaiian or Pacific Islander, Other, Multiracial, and Not Reported). For cannabis
use in the past 30 Days, NY and WA had a prevalence of 8.2% (7.8% to 8.7), and 14.8% (14.1%
to 15.5%) respectively in 2019, with a change of -5.1%, (-4.6% to -5.6%) and -0.7%, (.2% to -
1.7%) in 2021. For smoking as a primary method of use in those with cannabis use in the past 30
days, NY and WA had a prevalence of 73%, (70.3% to 75.4%) and 63.3 % (60.8% to 65.8%)
respectively in 2019, with a change of -1.9%, (1.8% to -5.6%) and -4.5% (-1.2% to -8.0%) in
2021.
Discussion
Our findings indicate a decrease in overall cannabis use and smoking as a primary method of use
in both NY and WA populations, despite increased stress during the pandemic. NY demonstrated
a lower initial prevalence of cannabis use, experiencing a more substantial decline during the
pandemic. WA reported a lower initial prevalence of smoking as the primary method of cannabis

use, with a more pronounced reduction during the pandemic. These variations in prevalence and
usage align with existing research highlighting access as a determinant of cannabis use.
Additionally, the respective shifts away from combustible cannabis may be from the availability
of non-combustible cannabis in the context of pulmonary health considerations. Surprisingly,
neither state exhibited significant increases in cannabis use, contradicting some prior research
regarding pandemic substance use. As policymakers contemplate cannabis legalization, they
should consider the health implications tied to increased cannabis use post-legalization and
funding pro-social alternatives amid escalating mental health burdens. Furthermore, if legalized,
policymakers must consider the impact of accessibility factors such as zoning allowances and
maximum retailer density when legislating retail cannabis. For clinicians, these findings
underscore the importance of education regarding cannabis use risks and discussions that
integrate harm reduction concepts.


References
Black JC, Amioka E, Iwanicki JL, et al. Evaluation of Cannabis Use Among US Adults During
the COVID-19 Pandemic Within Different Legal Frameworks. JAMA Netw Open.
2022;5(11):2240526.
Goodman S, Wadsworth E, Leos-Toro C, et al. Prevalence and forms of cannabis use in legal vs.
illegal recreational cannabis markets. International Journal of Drug Policy. 2020;76(1):102658.
‌Miller K, Laha-Walsh K, Albright D, et al. Cannabis use during the COVID-19 pandemic: results
from a longitudinal study of Cannabis users. Journal of Substance Use. 2022; 27(1): 38-42.
Schauer GL, Dilley JA, Roehler DR, et al. Cannabis sales increases during COVID-19: Findings
from Alaska, Colorado, Oregon, and Washington. International Journal of Drug Policy.
2021;98:103384
Vanderbruggen N, Matthys F, Van Laere S, et al. Self-Reported Alcohol, Tobacco, and Cannabis
Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey. Eur Addict Res.
2020;26(6):309-315.

Introduction
The accessibility of cannabis plays a crucial role in shaping its use. Since 2014, the rise of
retailers has made cannabis more accessible to the public, leading to increases in both cannabis
use and consumption of non-combustible cannabis in relevant areas. Heightened perceived stress
has also emerged as a risk factor for cannabis use. Evidence suggests that increased stress levels
during the COVID-19 pandemic (pandemic) correlate with a rise in overall substance use.
Additionally, the pandemic saw increased pulmonary health awareness, with some reports of
greater consideration for respiratory risks by people who smoke than before the pandemic. As
legislatures contemplate cannabis legalization and retail licensing during an escalating, national
mental health crisis, they should deliberate policy impacts on usage behaviors. For clinicians,
understanding the motivations driving change in cannabis use during the pandemic can better
illustrate strategies for both cessation and harm reduction. This repeated cross-sectional study
investigates variations in cannabis use during the pandemic between two states, New York (NY)
and Washington (WA), with similar pandemic responses, but differences in their access to retail
cannabis to help guide policymakers and clinicians in the evolving landscape of cannabis
legalization.
Methods
Data was analyzed from the NY and WA Behavioral Risk Factor Surveillance System (BRFSS)
from 2019 and 2021 to compare pre-pandemic and pandemic levels of cannabis use between a
decriminalized/legal cannabis state without retail cannabis, NY, to a state with established retail
cannabis, WA. Respondents reported on whether they used cannabis in the past 30 days, and
whether smoking was their primary method of cannabis use. Data was analyzed using weighted
prevalence and 95% CIs estimated using a bootstrap approach, with statistics performed by SPSS
statistical software.
Results
This study analyzed 75,606 responses, with a median age range of 45-54 years old, 53.8% of
responses from those who identify as female, and the following race/ethnicity profile: 74.2%
White, 6.1% Black, 8.9% Hispanic, and 10.8% Other (American Indian or Alaskan Native,
Asian, Native Hawaiian or Pacific Islander, Other, Multiracial, and Not Reported). For cannabis
use in the past 30 Days, NY and WA had a prevalence of 8.2% (7.8% to 8.7), and 14.8% (14.1%
to 15.5%) respectively in 2019, with a change of -5.1%, (-4.6% to -5.6%) and -0.7%, (.2% to -
1.7%) in 2021. For smoking as a primary method of use in those with cannabis use in the past 30
days, NY and WA had a prevalence of 73%, (70.3% to 75.4%) and 63.3 % (60.8% to 65.8%)
respectively in 2019, with a change of -1.9%, (1.8% to -5.6%) and -4.5% (-1.2% to -8.0%) in
2021.
Discussion
Our findings indicate a decrease in overall cannabis use and smoking as a primary method of use
in both NY and WA populations, despite increased stress during the pandemic. NY demonstrated
a lower initial prevalence of cannabis use, experiencing a more substantial decline during the
pandemic. WA reported a lower initial prevalence of smoking as the primary method of cannabis

use, with a more pronounced reduction during the pandemic. These variations in prevalence and
usage align with existing research highlighting access as a determinant of cannabis use.
Additionally, the respective shifts away from combustible cannabis may be from the availability
of non-combustible cannabis in the context of pulmonary health considerations. Surprisingly,
neither state exhibited significant increases in cannabis use, contradicting some prior research
regarding pandemic substance use. As policymakers contemplate cannabis legalization, they
should consider the health implications tied to increased cannabis use post-legalization and
funding pro-social alternatives amid escalating mental health burdens. Furthermore, if legalized,
policymakers must consider the impact of accessibility factors such as zoning allowances and
maximum retailer density when legislating retail cannabis. For clinicians, these findings
underscore the importance of education regarding cannabis use risks and discussions that
integrate harm reduction concepts.


**References**
Black JC, Amioka E, Iwanicki JL, et al. Evaluation of Cannabis Use Among US Adults During
the COVID-19 Pandemic Within Different Legal Frameworks. JAMA Netw Open.
2022;5(11):2240526.
Goodman S, Wadsworth E, Leos-Toro C, et al. Prevalence and forms of cannabis use in legal vs.
illegal recreational cannabis markets. International Journal of Drug Policy. 2020;76(1):102658.
‌Miller K, Laha-Walsh K, Albright D, et al. Cannabis use during the COVID-19 pandemic: results
from a longitudinal study of Cannabis users. Journal of Substance Use. 2022; 27(1): 38-42.
Schauer GL, Dilley JA, Roehler DR, et al. Cannabis sales increases during COVID-19: Findings
from Alaska, Colorado, Oregon, and Washington. International Journal of Drug Policy.
2021;98:103384
Vanderbruggen N, Matthys F, Van Laere S, et al. Self-Reported Alcohol, Tobacco, and Cannabis
Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey. Eur Addict Res.
2020;26(6):309-315.

Retail Access to Cannabis and Cannabis Use During the COVID-19 Pandemic