INTRODUCTION: The criminal legal system (CLS) is the most common treatment referral source for adolescent cannabis-related problems. Understanding trends in racial/ethnic disparities of CLS-referred treatment could help identify groups in need of additional supports.
METHODS: This observational study used repeated cross-sectional data from the Treatment Episode Dataset-Admissions 2010-2022 and Census population denominators to calculate annual specialty CLS-referred cannabis-related treatment admission rates per 10,000 adolescents ages 12-17 by race and ethnicity. Joinpoint models examined trends in CLS-referred treatment rates by race and ethnicity, and group differences in the percent of cannabis admissions referred through the CLS were described.
RESULTS: Adolescent cannabis CLS-referred treatment rates decreased overall by 81.6% from 2010 (16.93/10,000) to 2022 (3.11/10,000). Joinpoint models identified different turning points when significant reductions started by race and ethnicity. Compared to non-Hispanic White adolescents across all years, CLS-referred treatment admission rates were higher for American Indian/Alaska Native non-Hispanic adolescents (rate difference [RD]=19.53 95% CI=7.91-31.15) and Black non-Hispanic adolescents (RD=10.14, 95% CI=0.19, 20.08), but not other groups. American Indian/Alaska Native and Black adolescents had higher CLS-referred treatment than white adolescents in 2010 in both absolute and relative terms; differences with wider confidence intervals in 2022 were no longer statistically significant.
CONCLUSIONS: CLS-referred cannabis-related treatment admissions decreased substantially across groups over time. High CLS-referral rates among American Indian/Alaska Native and Black non-Hispanic adolescents highlight the importance of distinguishing heterogeneous racial/ethnic groups. Targeted structural interventions are needed to increase non-CLS-related referrals and address cannabis-related treatment gaps in a changing cannabis policy environment.
Decreasing criminal legal system referrals to cannabis treatment in the US: Adolescent trends by race and ethnicity between 2010-2022
American Journal of Preventive Medicine [Epub 2026 Mar 27]. doi: 10.1016/j.amepre.2026.108351.