Neighborhoods inside 1000 meters of cannabis retailers showed rising cannabis-related emergency visits, while unexposed neighborhoods saw declines.
The pattern suggests that commercialization and dense store clustering may elevate public health risks.
Cannabis Store Exposure Linked to Higher Rates of Harm
A population-based natural experiment explored how living near cannabis retail stores relates to cannabis-related harms. The analysis showed that neighborhoods with more retail access experienced higher rates of harm, and the increase was most pronounced in areas with a greater concentration of stores. According to the authors, limiting the total number of cannabis outlets, reducing clusters of stores, or restricting where they can open may provide meaningful public health protections. The study appears today (November 24) in Annals of Internal Medicine.
Large Ontario Dataset Used to Track Emergency Department Trends
Researchers from North York General Hospital and collaborating institutions examined health and demographic information from 6,140,595 Ontario residents aged 15 to 105 years who lived in 10,574 neighborhoods between April 2017 and December 2022. Their goal was to determine whether living near a cannabis retail store after legalization in October 2018 influenced neighborhood-level rates of cannabis-related emergency department (ED) visits.
Using provincial data on cannabis store locations, the team categorized neighborhoods as exposed (within 1000m of a cannabis retail store) or unexposed (more than 1000m from a cannabis retail store). The main health measure was the rate of cannabis-attributable ED visits per 100,000 people aged 15 years or older.
Urban, Low-Income Areas More Likely to Be Exposed
The researchers observed that exposed neighborhoods were more commonly found in large urban regions and in the lowest income quintile when compared with unexposed neighborhoods. Despite these differences, exposed neighborhoods did not show a rise in monthly cannabis-attributable ED visits after gaining access to a cannabis store. In contrast, unexposed neighborhoods experienced a decline in monthly ED visit rates over the same period.
Higher Store Density Connected to Rising ED Visits
When comparing the two groups, exposed neighborhoods had a 12% increase (CI, 6% to 19%) in the absolute rate of cannabis-attributable ED visits relative to unexposed neighborhoods. The analysis also indicated that neighborhoods with multiple cannabis stores located within 1000m saw larger increases in cannabis-related ED visits. These results suggest that legalization combined with widespread retail commercialization may carry different public health implications than legalization on its own.
Reference: “Effect of Nonmedical Cannabis Legalization and Exposure to Retail Stores on Cannabis Harms: A Quasi-experimental Study” 24 November 2025, Annals of Internal Medicine.
DOI: 10.7326/ANNALS-25-01960
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