The Unequal Geography of Recreational Cannabis Retailers in the U.S.

Introduction: Although more U.S. states continue to legalize the sale of cannabis for recreational adult-use, little is known about the spatial distribution of cannabis retailers in relation to neighborhood characteristics. The objective of this study is to examine the presence or absence of cannabis retailers in census tracts in relation to measures of neighborhood advantage and disadvantage.

Methods: Using 2023 U.S. state agency lists, we identified 5586 recreational cannabis retailers and geocoded address data in 18 states with recreational cannabis legalization laws. Multilevel logistic and negative binomial regression was used to model the association between quintiles of the neighborhood deprivation index (NDI) and index of concentration at the extremes (ICE) with census tract cannabis retailer presence.

Results: Across the study states, 11% of census tracts had at least 1 recreational cannabis retailer. Census tracts with higher levels of socioeconomic deprivation, or racialized and economic disadvantage, had a significantly higher odds and rate of having cannabis retailers. In the adjusted analysis, tracts with the greatest concentration of low-income Black or Hispanic residents had 2.0 to 2.5 times the odds of cannabis retailer presence compared to more advantaged tracts.

Conclusion: In states with legalized nonmedical cannabis, there is a pattern of greater cannabis retailer presence in areas with the greatest neighborhood disadvantage. Public health agencies and policymakers should support the implementation of policies that reduce cannabis retailer clustering and enhance targeted prevention efforts in historically disadvantaged areas.