Unexpected Public Health Emergencies—A Descriptive Analysis of Trends in the Massachusetts Medical and Adult-use Cannabis Markets

In the United States (U.S.), access to legal cannabis through regulated state markets is rapidly changing, but little is known about consumer behavior when states with legal access choose to restrict access due to public health or safety concerns. This exploratory study examines the Massachusetts recreational (“adult-use”) and medical cannabis markets before and during two major public health crises that changed consumer access: (1) the e-cigarette or vaping use-associated lung injury (“EVALI”) crisis and state requirements to stop vape product sales in the adult-use and medical markets from 9/24/2019-12/12/2019, and (2) the SARS-CoV-2 (“COVID-19”) crisis and state emergency order that temporarily halted all adult-use retail sales but not medical sales from 3/24/20-5/24/20. We used the Massachusetts seed-to-sale tracking system (i.e., Metrc) to run descriptive statistics examining medical sales for patients and all adult-use sales across the largest product segments: buds, vapes and concentrate (each), edibles, and other categories (i.e., prerolls, concentrate, infused nonedible, infused beverage, kief, shake/trim, suppository) spanning May 2019-December 2020. To account for classification changes in the dataset, sales for vape products and concentrate (each) product were summed into a single category. We further examined trends in registered patients and “per patient” spending across cannabis product types (i.e., monthly sales per product category divided by monthly registered patients). Our findings showed a decline in market share for the vape and concentrate (each) product category in the adult and medical markets during the EVALI crisis when sales were halted, while buds, followed by edibles and other products increased in market share during this time. After vape products could be sold again, the market share of vape and concentrate (each) products rose but did not return to pre-EVALI levels. We did not observe an overall shift in market share by product type in the medical market during the COVID-19 adult-use store closure. Although gross medical sales trended upward, increases in the medical market did not account for the vast majority of prior spending in the adult-use market during the market’s closure. The number of registered active patients also trended upward. From December 2020 to December 2021, there was a 56% increase in patients (59,173 to 92,148 patients), and we observed a marked increase following the temporary halt of adult-use sales. During and prior to halted adult-use sales, we observed an increase in per patient monthly spending for cannabis products. This was particularly salient for buds. Per patient monthly spending for buds peaked in May 2020. Study limitations include a single state sample and that this study does not examine changes to the illicit market. We cannot make any causal claims and any long-term implications of trends observed during the EVALI and COVID-19 crises are unknown. Our exploratory findings suggest that there are a range of consumer responses in the legal market in response to temporary loss of access, including evidence of consumers changing legal markets (i.e., adult-use to medical) and changing product types. More research is needed, particularly to understand potential concurrent changes in the illicit market during these crises.