Limited Evidence on Cannabis Taxation Effects in the United States: A Rapid Review of Use, Purchasing, and Risk Perceptions

OBJECTIVE: The global cannabis policy landscape has changed dramatically in recent decades. In the United States, there is significant variation in cannabis tax structures, and there is limited consensus on how to implement cannabis tax policy to mitigate related harms. Therefore, the objective of this rapid review was to synthesize current evidence on the impact of cannabis taxation on purchasing behavior, use, and risk perceptions among U.S. adults. METHODS: We systematically searched for peer-reviewed studies published in English (2014-present) in PubMed, SCOPUS, and Google Scholar. Two reviewers conducted independent screening of all relevant articles according to eligibility criteria using Covidence software. Out of the 1342 references identified, 1337 were not eligible for inclusion. RESULTS: The 5 included studies examined excise cannabis taxes. Outcomes measured across the studies included cannabis use, cannabis demand, purchasing patterns, and perceptions. The data sources ranged from participant-level, state-level, and nationally representative data. One study found a negative association between taxes and past 30-day cannabis use, though statistically insignificant. A higher cannabis tax was linked to a decrease in cannabis demand. Another study demonstrated evidence of consumer stockpiling and increased cross-border substitution in response to higher cannabis tax rates. In terms of perceptions, policymakers rated taxes as a highly efficacious public health tool, and cannabis users viewed taxation as an important factor in their purchase decisions. CONCLUSIONS: The limited number of articles identified in this rapid review highlights the need for future studies to better understand consumer behavior and inform policy.