Differentiating the Drug Normalization Framework: A Quantitative Assessment of Cannabis Use Patterns, Accessibility, and Acceptability Attitudes among University Undergraduates.

BACKGROUND/OBJECTIVES: The drug normalization framework investigates the social integration of substance use. This article contributes a quantitative assessment of cannabis normalization as differentiated by social location predictors.

METHODS: Logistic and zero-inflated negative binomial regression models assess three areas of cannabis normalization: accessibility, acceptability, and recent use. Peer network cannabis use prevalence, gender, nativity, campus locale and living arrangement are explored as focal predictors of variation in normalization among 1,713 cannabis using and nonusing undergraduate students in Canada.

RESULTS: Women report lower odds of positive cannabis acceptability attitudes. While women report lower rates of recent cannabis use, gender is not a significant predictor for lifetime prevalence. Being a recent immigrant significantly predicts lower recent use, lower odds of favorable attitudes to cannabis, and reduced accessibility in comparison to students born in Canada. Longer-term immigrants do not show significant differences from students born in Canada on accessibility and acceptability, suggesting a substance use acculturation effect. Lower peer cannabis use prevalence exhibits a protective effect against use. In comparison to students who report that "some" of their peer network uses cannabis, those with "all" users in their network exhibit lower acceptability attitudes. This suggests a threshold relationship between peer use prevalence and acceptability. Conclusions/Importance: This article provides a data point for assessing future shifts in cannabis normalization prior to impending changes in Canadian drug policy that will legalize recreational cannabis use. Results show that normalization components of recent use, acceptability, and accessibility are differentiated by gender, nativity, and peer network cannabis use prevalence.