Differentiating the Drug Normalization Framework: A Quantitative Assessment of Cannabis Use Patterns, Accessibility, and Acceptability Attitudes among University Undergraduates

ABSTRACT

Background/Objectives: The drug normalization framework investigates the social integration of substance use. This article contributes a quantitative assessment of cannabis normalization as differentiated by social location predictors. Methods: Logistic and zero-inflated negative binomial regression models assess three areas of cannabis normalization: accessibility, acceptability, and recent use. Peer network cannabis use prevalence, gender, nativity, campus locale and living arrangement are explored as focal predictors of variation in normalization among 1,713 cannabis using and nonusing undergraduate students in Canada. Results: Women report lower odds of positive cannabis acceptability attitudes. While women report lower rates of recent cannabis use, gender is not a significant predictor for lifetime prevalence. Being a recent immigrant significantly predicts lower recent use, lower odds of favorable attitudes to cannabis, and reduced accessibility in comparison to students born in Canada. Longer-term immigrants do not show significant differences from students born in Canada on accessibility and acceptability, suggesting a substance use acculturation effect. Lower peer cannabis use prevalence exhibits a protective effect against use. In comparison to students who report that “some” of their peer network uses cannabis, those with “all” users in their network exhibit lower acceptability attitudes. This suggests a threshold relationship between peer use prevalence and acceptability. Conclusions/Importance: This article provides a data point for assessing future shifts in cannabis normalization prior to impending changes in Canadian drug policy that will legalize recreational cannabis use. Results show that normalization components of recent use, acceptability, and accessibility are differentiated by gender, nativity, and peer network cannabis use prevalence.

KEYWORDS:

• Drug normalization
• cannabis
• recreational substance use
• marijuana
• university students

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Acknowledgments

The authors would like to thank the anonymous reviewers for their helpful comments, and Amir Mostaghim for his assistance in implementing the survey.

Notes

1 Social location structures individual access to particular opportunities and groups, and exposes individuals to specific risks at an aggregate level. Examples of social location factors include gender, race/ethnicity, and income.

2 Regulations allowing access to cannabis for medical reasons were introduced in Canada in 2001 (Health Canada, 2016). Cannabis possession without a medical document provided by an authorized health care practitioner remained illegal.

3 This survey item may face limitations because it could be interpreted by students as referring to the location where they are completing the survey, rather than reflect ability to access cannabis generally. This survey has been successfully piloted at the University of Guelph prior to full implementation. We have found that the accessibility item accurately reflects student ability to access cannabis, as most students report accessing cannabis by contacting friends or dealers using phone calls, email or text messaging, which is not limiting to immediate location.

4 The study team ran statistical diagnostic tests on all models to ensure that they are appropriately specified, including tests for multicollinearity. The authors are confident that the results on the relationship of cannabis acceptability to perceived peer network cannabis use prevalence are not an outcome of collinearity issues between independent variables.

Additional information

Funding

Social Sciences and Humanities Research Council of Canada, 410-2011-0070.