Cannabis retail environment and treatment for cannabis use disorder.

Purpose: This research investigates whether the efficacy of a digital cannabis use disorder (CUD) treatment for young adults (age 18-25) differs by exposure to cannabis retailers in the residential neighborhood and activity space (significant places visited throughout daily life). Methods: This is a secondary analysis of data from a randomized clinical trial of the digital substance use disorder treatment Peer Network Counseling-txt (PNC-txt) for reducing cannabis use among young adults with CUD (n = 425). We hypothesize that the indirect effect of treatment on reducing cannabis use via the mediating mechanism readiness-to-change is moderated by exposure to cannabis retailers, due to the stronger effect of readiness-to-change on reducing cannabis use at lower levels of exposure. Results: The indirect effect of PNC-txt on reducing cannabis use is significantly moderated by activity space exposure to cannabis retailers (beta=0.104, 95 % CI: 0.010, 0.197), where the treatment effect is more than three times as strong at low, as compared to high, levels of exposure. We did not find significant moderating effects by residential exposure (beta=0.059, 95 % CI: -0.020, 0.137). Conclusions: Findings indicate that greater exposure to cannabis retailers in a young adult's activity space is associated with reduced CUD treatment efficacy. This is likely due to easier access to cannabis, more tolerant cannabis attitudes, and environmental cues which can trigger craving among those with CUD. Regulations regarding locations and density of cannabis retailers may contribute to better CUD treatment outcomes.