Decreasing Criminal Legal System Referrals to Cannabis Treatment in the U.S.: Adolescent Trends by Race and Ethnicity Between 2010 and 2022

INTRODUCTION: The criminal legal system is the most common treatment referral source for adolescent cannabis-related problems. Understanding trends in racial/ethnic disparities of criminal legal system-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 criminal legal system-referred cannabis-related treatment admission rates per 10,000 adolescents aged 12-17 years by race and ethnicity. Joinpoint models examined trends in criminal legal system-referred treatment rates by race and ethnicity, and group differences in the percentage of cannabis admissions referred through the criminal legal system were described. RESULTS: Adolescent cannabis criminal legal system-referred treatment rates decreased overall by 81.6% from 2010 (16.93 per 10,000) to 2022 (3.11 per 10,000). Joinpoint models identified different turning points when significant reductions started by race and ethnicity. Criminal legal system-referred treatment admission rates were higher for American Indian/Alaska Native non-Hispanic adolescents (rate difference=19.53, 95% CI=7.91, 31.15) and Black non-Hispanic adolescents (rate difference=10.14, 95% CI=0.19, 20.08) than among non-Hispanic White adolescents across all years but not among other groups. American Indian/Alaska Native and Black adolescents had higher criminal legal system-referred treatment than White adolescents in 2010 in both absolute and relative terms; differences with wider CIs in 2022 were no longer statistically significant. CONCLUSIONS: Criminal legal system-referred cannabis-related treatment admissions decreased substantially across groups over time. High criminal legal system-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 noncriminal legal system-related referrals and address cannabis-related treatment gaps in a changing cannabis policy environment.