Excise Tax Structures for Marijuana Use

Overseen By Amy Wermert, MPH

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Non-recreational marijuana use, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 11

2500 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on marijuana use and purchasing behavior, so it's best to consult with the study team for specific guidance.

What data supports the effectiveness of the treatment in the clinical trial 'Excise Tax Structures for Marijuana Use'?

The research on excise taxes for tobacco and alcohol suggests that increasing taxes can reduce consumption and prevalence of use, which might imply similar effects for marijuana. This could mean that excise tax structures might help decrease marijuana use by making it more expensive, similar to how tobacco taxes have been used to deter smoking. ^{1 2 3 4 5}

Is marijuana generally safe for human use?

Research on marijuana use shows mixed safety outcomes. Some studies suggest increased risks, such as higher rates of fatal car crashes and potential links to increased suicide rates among young people in certain areas. However, these findings are not consistent across all studies or locations, indicating that safety may vary based on context and individual factors. ^{6 7 8 9 10}

How does the treatment of excise tax structures for marijuana use differ from other treatments?

Excise tax structures for marijuana use are unique because they focus on economic policy rather than a medical or pharmaceutical approach. This treatment aims to reduce marijuana use by increasing its cost through taxation, similar to strategies used for alcohol and tobacco, which have been shown to effectively decrease consumption and related harms. ^{5 11 12 13 14}

What is the purpose of this trial?

The investigators will follow probability-based cohorts of adult non-medical marijuana users (N=1,500; ages 21+) and susceptible adolescents and young adults (AYA) users (N=1,000; ages 15-20) over four years. The investigators will use a prospective survey to collect marijuana use information and will conduct volumetric choice experiments (VCEs) where participants choose quantities to purchase among three legal product prototypes: flower, edible, and concentrate; and one illegal flower product, under simulated retail marijuana tax structures. The presentation of edibles and concentrates will change over time to capture the range of product varieties in the market and to accommodate new products and characteristics as they evolve. Choice experiments including VCEs use a series of manipulations as a measurement device to elicit preferences for products and consumption. Therefore, the experimental design is within-subjects with repeated measures, which allow for causal identifications of the impact of design attributes (e.g., tax bases and rates) on preference and consumption outcomes. The attributes and levels are selected to reflect THC levels in the market, existing (weight, price, tiered price by forms) and novel (potency) tax bases, existing (10%-40% of retail price or equivalent in other bases) and potential (high 60% and 80% of retail prices or equivalent) tax rates, and price distribution for each product. Price distribution levels (5 to 95 percentiles) will come from our price data collection and will be updated over time and vary by participants' state and locality of residence. Before the experiment, study personnel will instruct participants 1) how to answer the choice experiment question, including considering their weekly expenditures when answering VCE questions; 2) that there is no access to other products, no stockpiling, no selling or giving away products to others, etc., to ensure that participants choose products that reflect their usual purchase patterns for self-use; 3) that there are no right or wrong responses. Study personnel will instruct participants to answer all questions honestly, thoughtfully, and to the best of their understanding as if they were actually in this situation, to reduce hypothetical bias; 4) that there may be potential costs or issues associated with purchasing illegal products, including risks of penalties, undefined potency, possible contamination, and inconsistent product quality; and 5) that participants should keep their weekly budget in mind when making purchase choices of the products. In VCEs, the investigators will manipulate THC levels, tax rates and bases, and price levels. Participants will be asked to answer the following: "Imagine these are the marijuana products that you (participants) can purchase for non-medical use, how many of each product would you (participants) most likely buy next time?" Participants can choose more than one product, and as they choose quantities, the total balance will be displayed. To make the tasks easier, study personnel will 1) set a warning to inform participants if their reported budget exceeds their weekly budget for spending; 2) provide a dropdown list for quantities or, if they would like more units than the listed, they can fill in a number; and 3) all products are described as high-quality to allow for a comparison of prices. Half of the participants will be randomized to see itemized pre-tax tag price, excise taxes, and sales taxes, as requested in some states (e.g., Illinois); the other half will be randomized to see only prices that are inclusive of excise taxes. This will allow us to whether excise taxes are more effective when applied at checkout compared to hidden in the tag prices.

Eligibility Criteria

This trial is for adults aged 21+ who use marijuana non-medically, and adolescents/young adults aged 15-20 at risk of substance use disorder. Participants must be willing to provide information about their marijuana usage and make choices in simulated purchase experiments.

Inclusion Criteria

I am 21 or older and have used marijuana recreationally in the last 30 days.

I am between 15 and 20 years old and might start using marijuana.

Exclusion Criteria

I am a teen or young adult who does not use marijuana.

I am under 15 years old.

I am over 21 and do not use marijuana recreationally.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Initial data collection and instruction on choice experiments

1 week

1 visit (in-person or virtual)

Volumetric Choice Experiments (VCEs)

Participants engage in choice experiments to simulate marijuana purchases under different tax structures

4 years

Repeated measures over 4 years

Follow-up

Participants are monitored for changes in purchasing behavior and preferences

18 months

Follow-up at 6, 12, and 18 months

Treatment Details

Interventions

• Arm 1 Intervention
• Arm 2 Intervention

Trial Overview The study tests how different tax structures on retail marijuana affect consumption patterns. It uses surveys and choice experiments with legal (flower, edible, concentrate) and illegal products under varying tax scenarios to see what participants would buy.

Participant Groups

Group I: Tax structure weight arm 2 Experimental Treatment 1 Intervention

Participants are randomized into seeing PRICE based taxes for recreational cannabis, then they make hypothetical purchases in responses to products with different THC levels, prices, and taxes.

Group II: Tax structure weight arm 1 Experimental Treatment 1 Intervention

Participants are randomized into seeing WEIGHT based taxes for recreational cannabis, then they make hypothetical purchases in responses to products with different THC levels, prices, and taxes.

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Findings from Research

Medical marijuana laws (MMLs) in ten states from 2004 to 2012 were associated with increased marijuana use among adults aged 21 and older, including higher rates of regular use and dependence.

MMLs also led to an increase in binge drinking among adults aged 21 and older, but did not significantly affect alcohol use or other psychoactive substances among adolescents aged 12-20.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances. Wen, H., Hockenberry, JM., Cummings, JR.[2022]

In the Czech Republic, public healthcare costs for treating smoking-related diseases significantly exceeded tax revenues from tobacco products for most of the years analyzed (1998-2017), indicating a financial burden on the healthcare system.

Similarly, expenditures for alcohol-related diseases also surpassed tax revenues from alcohol, suggesting that the excise taxes on these products do not adequately cover the healthcare costs associated with their consumption.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of estimated direct health expenses on tobacco- and alcohol-related diseases in context of excise taxes revenues in the Czech Republic. Kukalová, G., Moravec, L., Bína Filipová, D., et al.[2023]

A study involving 27 low-income smokers in Dunedin, New Zealand, revealed that while tobacco excise taxes aim to reduce smoking, they create significant financial hardship for those who struggle to quit, leading to feelings of victimization and desperation.

Participants reported resorting to extreme measures, such as recycling waste tobacco, to cope with increased costs, highlighting the need for more supportive cessation programs to help low-income smokers rather than punitive policies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A qualitative analysis of low income smokers' responses to tobacco excise tax increases. Hoek, J., Smith, K.[2018]

The clinical trial sample for cannabis cessation was significantly different from national datasets, showing higher representation of older adults, African Americans, Hispanic/Latinos, and individuals with more education, which may affect the generalizability of the trial results.

This study highlights the importance of ensuring representative samples in cannabis treatment trials to better reflect the diverse population affected by cannabis use disorder, similar to findings in other substance use disorder research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing adult cannabis treatment-seekers enrolled in a clinical trial with national samples of cannabis users in the United States. McClure, EA., King, JS., Wahle, A., et al.[2022]

Raising tobacco taxes is widely supported by lawmakers and the public, and it has proven effective in reducing tobacco use among price-sensitive groups, particularly adolescents.

Since 2001, 44 states have increased their tobacco taxes, generating significant revenue (approximately $10.2 billion), which can be used to fund health programs like Medicaid, while also being a politically favorable option for increasing state revenue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Public health: tobacco taxes and Internet sales--2005. End of Year Issue Brief. McKinley, A.[2023]

State medical marijuana laws (MMLs) generally do not have a significant effect on cannabis-positive driving among U.S. drivers involved in fatal crashes from 1993 to 2014, indicating that the legalization of medical marijuana may not directly correlate with increased drugged driving incidents.

However, in states with licensed medical marijuana dispensaries, there was a notable 14% increase in the odds of marijuana-involved driving, suggesting that the presence of dispensaries may contribute to more drivers testing positive for marijuana, with an estimated additional 87 to 113 cases per year.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of medical marijuana laws on cannabis-involved driving. Sevigny, EL.[2018]

In Washington State, the legalization of cannabis was associated with a significant 17.9% increase in suicide rates among 15-24-year-olds, translating to an additional 2.13 deaths per 100,000 population, indicating a concerning trend in this age group.

In contrast, Colorado did not show a similar increase in suicide rates following cannabis legalization, suggesting that the impact of legalization on suicide rates may vary by state and demographic factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Washington State and Colorado's cannabis legalization on death by suicides. Doucette, ML., Borrup, KT., Lapidus, G., et al.[2021]

A study of 711 adult cannabis and alcohol users found that these substances often complement each other, meaning that as the price of one increases, the consumption of both tends to decrease.

Individuals who view cannabis and alcohol as complements are more likely to report higher levels of use and potential substance use disorders, suggesting that adjusting prices or implementing sales restrictions could be effective public health strategies to reduce consumption of both substances.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral economic interactions between cannabis and alcohol purchasing: Associations with disordered use. Dolan, SB., Spindle, TR., Vandrey, R., et al.[2023]

After the legalization of recreational marijuana in Colorado and Washington, fatal crash rates increased more than expected compared to control states, indicating a potential safety concern.

The increase in fatal crashes became statistically significant after the opening of commercial marijuana dispensaries, suggesting that the availability of marijuana may be linked to higher crash risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington. Aydelotte, JD., Mardock, AL., Mancheski, CA., et al.[2020]

Since the legalization of cannabis in Hawaii, the proportion of motor vehicle crash fatalities involving THC-positive drivers has tripled, indicating a significant increase in cannabis-related driving incidents.

THC-positive patients involved in crashes are less likely to use protective devices like seatbelts or helmets and are more likely to rely on public insurance, highlighting potential public health concerns associated with cannabis legalization.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor vehicle crash fatalaties and undercompensated care associated with legalization of marijuana. Steinemann, S., Galanis, D., Nguyen, T., et al.[2019]

Increasing the Federal excise tax on beer to match inflation could reduce alcohol-related motor vehicle fatalities among 18 to 20-year-olds by approximately 15%, potentially saving over 1,000 lives annually.

Restoring the Federal excise tax on cigarettes to its real value from 1951 could prevent over 800,000 premature deaths among Americans aged 12 and older, highlighting the significant public health impact of tobacco taxation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health benefits of increases in alcohol and cigarette taxes. Grossman, M.[2023]

A study of alcohol excise tax policies across 33 countries in the Americas found significant variation in tax levels and designs, with spirits being taxed at a higher percentage of retail price (21.4%) compared to wine (11.0%).

To enhance public health outcomes, the study suggests that increasing tax rates and improving tax designs could better target high-strength alcoholic beverages, as current tax levels per standard drink are generally lower for spirits than for other types of alcohol.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing taxes on alcoholic beverages in the Region of the Americas. Roche, M., Sandoval, RC., Monteiro, MG.[2023]

A systematic review of 72 studies found strong evidence that increasing alcohol taxes effectively reduces excessive drinking and related health issues, such as binge drinking and alcohol-related accidents.

The effectiveness of alcohol tax increases is proportional to the amount of the tax and is influenced by factors like disposable income and how sensitive different groups are to changes in alcohol prices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Elder, RW., Lawrence, B., Ferguson, A., et al.[2023]

Cigarette smoking is a major cause of death in the U.S., with over 440,000 deaths annually from 1995-1999, and current trends suggest that more than 5 million young people will die prematurely from tobacco-related diseases if smoking rates continue.

Increasing excise taxes on tobacco products has been shown to effectively reduce smoking rates among youth, but challenges such as legislative hurdles and tobacco smuggling threaten the success of these tax increases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tobacco use: the impact of prices. Leverett, M., Ashe, M., Gerard, S., et al.[2017]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances. [2022]

2. Czech Republic pubmed.ncbi.nlm.nih.gov

Evaluation of estimated direct health expenses on tobacco- and alcohol-related diseases in context of excise taxes revenues in the Czech Republic. [2023]

3. Netherlands pubmed.ncbi.nlm.nih.gov

A qualitative analysis of low income smokers' responses to tobacco excise tax increases. [2018]

4. Ireland pubmed.ncbi.nlm.nih.gov

Comparing adult cannabis treatment-seekers enrolled in a clinical trial with national samples of cannabis users in the United States. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Public health: tobacco taxes and Internet sales--2005. End of Year Issue Brief. [2023]

6. England pubmed.ncbi.nlm.nih.gov

The effects of medical marijuana laws on cannabis-involved driving. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Effect of Washington State and Colorado's cannabis legalization on death by suicides. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Behavioral economic interactions between cannabis and alcohol purchasing: Associations with disordered use. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington. [2020]

10. United States pubmed.ncbi.nlm.nih.gov

Motor vehicle crash fatalaties and undercompensated care associated with legalization of marijuana. [2019]

11. England pubmed.ncbi.nlm.nih.gov

Health benefits of increases in alcohol and cigarette taxes. [2023]

12. England pubmed.ncbi.nlm.nih.gov

Comparing taxes on alcoholic beverages in the Region of the Americas. [2023]

13. Netherlands pubmed.ncbi.nlm.nih.gov

The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. [2023]

14. England pubmed.ncbi.nlm.nih.gov

Tobacco use: the impact of prices. [2017]