Global health. The current scenario and future perspectives

217 informal market. However, this market has different faces, not just drug trafficking. In fact, 35.7% declared that their most frequent access to cannabis was what is known as “national illegal access”, which includes “unregistered self-cultivators”, or those who “bought from someone who self- cultivates or is a member of a club” or “someone who bought for me from a self-cultivator or club member” and mainly those who reported having “shared unregistered homegrown buds”. The study conducted in 2014 demonstrated that classic drug trafficking (direct or indirect contact with drug trafficking) was the main source of access, estimated at 58.2% of users utilizing this source, which decreased to 11.6% in 2018 (Junta Nacional de Drogas & Observatorio Uruguayo de Drogas, 2019). The field work for this study was conducted between September and December 2018 and by then, according to the Institute for Regulation and Control of Cannabis (IRCCA, 2022), there were 43,694 people registered to legally access cannabis through any of the three alternatives provided by law. This figure increased to 67,998 by December 2021. This represented an increase of 56% over a three-year period. This would imply that there is a dynamic process with still room for an increase in Uruguay’s regulated cannabis market. Finally, trends on marijuana consumption are presented below for both national level and states where it has been legalized for recreational use in the United States. In the case of studies in school-aged population (eighth, tenth and twelfth grades), Figure 5 presents the trends in past-year marijuana use at national level and by grade from 1991 to 2021, based on information from the Monitoring The Future report. Both globally and for each grade, 2001 shows a statistically significant decrease in prevalence compared to 2020. Figure 5. Past-year prevalence of marijuana use by grade and total. School- aged population, United States, 1991-2021.