R E V I E W

Drug and Alcohol Review (April 2018), 37 (Suppl. 1), S429–S434

DOI: 10.1111/dar.12642

The status of support for cannabis regulation in Uruguay 4 years after

reform: Evidence from public opinion surveys

JOSÉ MIGUEL CRUZ1 , MARIA FERNANDA BOIDI2 & ROSARIO QUEIROLO3

1
Kimberly Green Latin American and Caribbean Center, Florida International University, Miami, USA, 2Insights Research
and Consulting, Montevideo, Uruguay, and 3Universidad Católica del Uruguay, Montevideo, Uruguay

Abstract
Introduction and Aims. The objective of this study was to measure the public support for marijuana legalisation in Uru-
guay, both overall and in its provisions, in nearly 4 years after its implementation. Design and Methods. Three separate
cross-national surveys were conducted in early 2014, late 2015 and mid-2017 with national representative samples of adults.
The first study was carried out during the initial months of implementation of the law and used face-to-face interviews
(N = 1490); the second survey was conducted using a computer-assisted telephone interviewing system (N = 703); and the
third study (N = 1515), using face-to-face interviews, was completed just before the implementation of pharmacy sales.
Results. About 60.7% of respondents in 2014 were against marijuana legalisation; in 2017, 54.1% remained opposed to the
marijuana law. In 2015, half of the people interviewed (49.9%) supported access to marijuana through self-cultivation, while
38.6% favoured the provision of cannabis clubs and 33.1% agreed with the pharmacy retail provision. Support for medical
cannabis was high in 2015, with 74.5% favouring it. Discussion and Conclusions. This study shows a change in the
public opinion toward legalisation of marijuana although most people still remain opposed to the law. However, the data do
not provide indication of a significant change in its use. Results suggest that opposition to legalisation may be focused on the
pharmacy retail provision. [Cruz JM, Boidi MF, Queirolo R. The status of support for cannabis regulation in Uru-
guay 4 years after reform: Evidence from public opinion surveys. Drug Alcohol Rev 2018;37:S429–S434]

Key words: cannabis, marijuana legalisation, Uruguay, public opinion.

and regulation of cannabis: the Institute for Regulation

Introduction
In December 2013, the Uruguayan government passed
a law regulating the growth, sale, and distribution of
recreational cannabis. This legislation is considered a
milestone in drug policy reform in the world [1]. The
use of marijuana for any reason has been legal in Uru-
guay since the mid-1970s, but production and sale were
fully banned, creating a gap in the legal framework.
The 2013 legislation not only upheld the use of recrea-
tional marijuana, but also regulated the cultivation of
cannabis at home, the formation of social clubs for
growth and use, and the retail of cannabis through
pharmacies across the country [2]. The new law estab-
lished that to obtain recreational marijuana, users must
first register with the government’s office for the control
and Control of Cannabis. However, citizens aged
18 years or older can enrol for only one way of acces-
sing cannabis and, in any case, are allowed only a maxi-
mum of 40 g of marijuana per month [3].
Still, the new legislation was not popular. Public
opinion surveys showed that in early 2014, more than
60% of the population were against the new law [4].
Although the debate about marijuana in Uruguay was
not new, the law was not in response to popular move-
ments or referenda, as has been the case in the USA or
other countries [1]. Rather, the law was a reaction to
growing concerns about organised crime and insecurity
associated with the distribution of cannabis and other
illicit drugs [5,6]. The government reassured the popu-
lation that the new legislation was designed to exert a

José Miguel Cruz PhD, Director of Research, Maria Fernanda Boidi PhD, Consultant, Rosario Queirolo PhD, Associate Professor.
Correspondence to: Dr José Miguel Cruz, Kimberly Green Latin American and Caribbean Center, Florida International University, 11200 SW
8th St. DM 353, Miami, FL 33199, USA. Tel.: +(305) 348-4898; Fax: +(305) 348-3593; E-mail: jomcruz@fiu.edu

Received 22 August 2016; accepted for publication 9 November 2017.

© 2017 Australasian Professional Society on Alcohol and other Drugs

S430 J. M. Cruz et al.
tighter regulation over the already common circulation
of cannabis [5]. Also, medical marijuana was belatedly
included in the legislation in early 2015, more than a
year after the recreational marijuana bill passed.
According to the most recent study of the Uruguayan
Drug Observatory, as of 2014, approximately 9% of the
Uruguayan population between 15 and 65 years old
reported using cannabis during the last 12 months,
which represents roughly 161 000 people. These fig-
ures point to a non-significant increase in the use of
marijuana in comparison with the last measure con-
ducted by the Uruguayan government in 2011 (8.3%)
[7]. The same study indicates, however, that by the
time the new regulations were implemented, 66% of
users were still obtaining cannabis from illegal retailers.
By October 2017, there were more than 7424 registered
cannabis home growers, 68 cannabis clubs across the
country with a license to operate and 14 999 users reg-
istered to buy at pharmacies [8]. However, the phar-
macy retail, which just started to be implemented in
July 2017, experienced problems ranging from opposi-
tion of the banking system to work with retailers to
issues with cannabis supply [8]. Interestingly, govern-
ment statistics from 2014 to 2016 showed a substantial
increase in seizures of illicit marijuana being smuggled
into Uruguay from neighbouring Paraguay, and local
authorities detected a shift in the routes of illegal canna-
bis trafficking [9]. It is hard to establish whether this
upsurge in illegal cannabis interdiction is a signal that
more illicit marijuana is circulating in Uruguay, but it
does show that illegal trafficking has remained a chal-
lenge after the enactment of the law.
The Uruguayan policy experience provides an oppor-
tunity to assess the public views toward marijuana lega-
lisation in a country that is already putting it into effect.
This study aims to examine the public opinion toward
the cannabis legalisation process after nearly 4 years of
implementation. Given the public debate spurred by
the law and experiences in other countries indicating
changes in public opinion once reforms are implemen-
ted [10], we would expect favourable changes in the
public attitudes toward the law.
Table 1. Characteristics of the surveys used
Characteristics Survey 1
Fieldwork dates March–April 2014
Institutional frame LAPOP’s AmericasBarometer
Sample size 1490
Sample design Multi-stage probability design
Margin of error 0.025
Interview method Face-to-face at household
Response rate 0.168
LAPOP, Latin American Public Opinion Project.
© 2017 Australasian Professional Society on Alcohol and other Drugs
Methods
This study is based on three separate cross-sectional
surveys. The first survey was conducted in early 2014,
while the second was carried out in late 2015. The third
and most recent survey was completed in May 2017
before the implementation of the pharmacy retail. Van-
derbilt University’s Latin American Public Opinion
Project conducted the 2014 and 2017 surveys under its
AmericasBarometer project, using household-based
samples of approximately 1500 interviews at the
national level. The survey of 2015, on the other hand,
was commissioned by the authors to the polling firm
CIFRA, using a computer-assisted telephone interview-
ing system, also at the national level. Table 1 shows the
specifics for each survey used in this article.
The AmericasBarometer surveys (AB) of 2014 and
2017 used the same data collection methodology and
sampling design, a similar base questionnaire, and the
same question wording regarding cannabis. They
included general questions about opinions on the mari-
juana law in Uruguay and on cannabis use. The 2015
survey, hereinafter called the CIFRA 2015 survey, repli-
cated the items on marijuana legalisation and added
more specific questions about the implementation of
the legalisation process and opinions about medical
marijuana in the country. Details about the sample
designs and specific questions are presented in Appen-
dix S1 (Supporting information). To have a comprehen-
sive picture of the public support for cannabis
legalisation in Uruguay, this article compares the results
of the AB 2014 and 2017 on the general attitudes
toward the law and then presents the results of specific
aspects of the law based on the CIFRA 2015 survey.
All statistical analyses were conducted using Stata
14.2, accounting for each survey’s sampling design.
Since the CIFRA 2015 survey used a different method-
ology, we only compare the AB 2014 and 2017 results
regarding the general opinions on legalisation and can-
nabis use. The results of 2015 on the specific provisions
of the law and medical marijuana are presented sepa-
rately. χ2 analyses were used to compare the 2014 and
2017 results, as well as the associations between
Survey 2 Survey 3
October–November 2015 March–May 2017
CIFRA poll LAPOP’s AmericasBarometer
703 1515
Stratified telephone sampling Multi-stage probability design
0.037 0.025
Telephone interview Face-to-face at household
0.065 0.14
 Support for cannabis regulation S431

demographic variables and opinions toward the legali- Table 2. Support for legalisation of recreational marijuana by
sation process in 2015. The Institutional Review sex, age and previous use, 2014 and 2017
Boards of Vanderbilt University (AmericasBarometer
surveys) and the Catholic University of Uruguay 2014 2017
(CIFRA 2015 survey) reviewed the subject protection
n = 1490 n = 1515
provisions and ethics procedures utilised in the surveys. % (95% CI) % (95% CI)
All 34% (31.6, 36.5) 41.8% (39.2, 44.3)
Sex
Results Male 37% (33.5, 40.6) 47.2% (43.6, 50.9)
Female 31.2% (28.2, 34.7) 36.7% (33.3, 40.1)
Participants χ2 (P) 5.35 (0.021) 21.04 (0.000)
Age, years
Demographic results were similar in all inquiries, with 18–35 42.4% (38, 46.8) 53.8% (49.3, 58.2)
confidence intervals showing non-significant differences 36–55 32.3% (28.3, 36.5) 39.3% (35.1, 43.7)
between the distributions of gender, age, and region in 56 and older 27.5% (23.8, 31.6) 32.3% (28.3, 36.6)
χ2 (P) 25.2 (0.000) 53.72 (0.000)
the country in 2014, 2015, and 2017. In the three sur- Region of the
veys, respondents represented all 19 geographic depart- country
ments of Uruguay, with 39.8% (95% confidence Montevideo 42.5% (38.5, 46.6) 50.1% (46.1, 54.1)
interval [CI] 37.4–42.3) residing in the metropolitan Rest of the 28.8% (26, 31.8) 36.1% (33, 39.4)
country
area of Montevideo. The demographic composition of
χ2 (P) 29.3 (0.000) 28.6 (0.000)
the three survey samples is shown in Appendix S1. Have ever tried
marijuana?
Yes 62.9% (57.5, 68) 72.2% (67.2, 76.6)
No 25.7% (23.3, 28.3) 32.4% (29.7, 35.2)
Who reports using cannabis? χ2 (P) 157.95 (0.000) 180.54 (0.000)

Asked whether they have ever used marijuana (Have

you ever tried marijuana?), 77.9% respondents reported
never using marijuana in 2014 (95% CI 75.7–79.9). In
May 2017, 77% reported not using marijuana (95% CI
74.8–79), well within the margin of significance. On the
question of whether the respondent has close friends
and relatives who use marijuana, the results returned
significant differences. In 2014, 48.8% said that they
had close people who consume marijuana; in 2017,
53.5% stated they did, a nearly 5-point increase.
Opinions toward cannabis legalisation in comparative
perspective
In 2014, 60.7% (95% CI 58.2–63.2%) were against the
law regulating recreational cannabis; in 2017, respondents
who disagreed with the law went down to 54.1% (95% CI
51.6–56.6%) (χ2 = 19.33, P < 0.01). The views toward
legalisation showed significant differences regarding gen-
der in 2014 when more males (37%) supported the new
cannabis policy than females (31.2%) (P < 0.05). These
differences became bigger in 2017 as support for cannabis
legalisation increased to 47.2% among males and nearly
37% among females (see Table 2).
Approval toward legalisation was more common
among the youth than the rest of the population in
both measurements (P < 0.01). In 2017, for instance,
53.8% between 18 and 35 years old agreed with legali-
sation; while 39.3% aged between 36 and 55 years and
Source: AmericasBarometer 2014 and 2017. CI, confidence
interval.
32.3% with 56 years or older showed support to the
cannabis initiative.
Compared with respondents living in the metropoli-
tan area of the capital Montevideo, participants in the
surveys residing in the rest of the country were less
likely to approve marijuana legalisation, and such dif-
ferences have remained the same despite the general
increase in approval toward legalisation.
The results of both surveys showed significant statis-
tical differences in the opinions toward legalisation
between respondents with previous use of cannabis and
those who have never tried the substance (P < 0.001).
In 2014 and 2017, more than 62% who had used can-
nabis before supported the marijuana policy; in con-
trast, fewer than 33% of people who never consumed
marijuana supported the policy in both surveys.
Opinions toward the provisions of the law in 2015
The CIFRA 2015 survey included several questions
about the specific provisions of the law that were not
included in the 2014 and 2017 AB measurements.
About the three modes of obtaining recreational can-
nabis established in the law, 49.9% said they agreed
with allowing people to grow their marijuana plants.
About 38.6% of interviewees favoured the measure of
© 2017 Australasian Professional Society on Alcohol and other Drugs
S432 J. M. Cruz et al.

Table 3. Support for medicinal marijuana and modes of access to recreational marijuana by sex, age, region of the country
and previous use, 2015 (N = 703)

Support for modes of access to recreational marijuana Support for medical

marijuana
Self-cultivation, % Cannabis clubs, % Pharmacies, %
(95% CI) (95% CI) (95% CI) % (95% CI)

All 49.9% (46.2, 53.7) 38.6% (34.9, 42.3) 33.1% (29.7, 36.7) 76.5% (73.2, 79.5)
Sex
Male 55.3% (49.8, 60.7) 43.6% (38.2, 49.2) 37.8% (32.6, 43.2) 79.9% (75.2, 84)
Female 45.2% (40.2, 50.3) 34.2% (29.4, 39.2) 29.1% (24.7, 33.9) 73.5% (68.7, 77.8)
χ2 (P) 7.34 (0.025) 6.37 (0.041) 5.91 (0.052) 4.89 (0.087)
Age, years
18–35 66.5% (59.6, 72.8) 47.7% (40.7, 54.7) 39.6% (33, 46.6) 78.2% (71.9, 83.5)
36–55 49.6% (43.6, 55.6) 39.1% (33.3, 45.1) 31.2% (25.9, 37) 76.2% (70.6, 81.1)
56 and older 35.7% (29.7, 42.2) 29.8% (24.1, 36.2) 29.9% (24.2, 36.1) 75.2% (69.2, 80.4)
χ2 (P) 43.56 (0.000) 16.14 (0.003) 5.80 (0.214) 2.17 (0.703)
Region of the country
Montevideo 55.1% (49.2, 61) 45.6% (39.7, 51.5) 38% (32.5, 43.9) 79.1% (73.9, 83.5)
Rest of the country 46.5% (41.7, 51.3) 33.8% (29.3, 38.6) 29.9% (25.7, 34.5) 74.7% (70.2, 78.7)
χ2 (P) 4.94 (0.084) 9.60 (0.008) 5.64 (0.060) 2.56 (0.277)
Have ever tried
marijuana?
Yes 80.8% (73.7, 86.3) 68.7% (60.8, 75.6) 51% (43, 59) 92.7% (87.3, 95.9)
No 41.2% (37.1, 45.4) 30% (26.2, 34) 28.3% (24.6, 32.2) 71.9% (67.9, 75.6)
χ2 (P) 78.3 (0.000) 74.5 (0.000) 30.2 (0.000) 28.6 (0.000)

Source: CIFRA 2015 poll. CI, confidence interval.

permitting cannabis clubs, and only 33.1% agreed with
the provision of distributing recreational marijuana in
pharmacies (see Table 3).
The results of the CIFRA 2015 survey reveal that
males tend to support accessing marijuana through
self-cultivation and cannabis clubs more than females
(P < 0.05), but they do not significantly differ when it
comes to obtaining marijuana through pharmacies
(P = 0.052). Similarly, interviewees under 25 years old
approved the access to marijuana through self-
cultivation and clubs in higher percentages than the
rest of the population, especially than people over
55 years old (P < 0.01). However, support for the pro-
vision of pharmacy retail was not statistically different
regarding age (P = 0.214). Residents of Montevideo
showed more approval with all provisions of the law
than inhabitants of the rest of the country, but the dif-
ferences were statistically significant only in the case of
cannabis clubs (P < 0.01). Finally, respondents who
have tried marijuana before were significantly more
likely to approve all three forms of getting cannabis
established by the law than people who have never
used the substance (P < 0.001).
About the commercial availability of medical canna-
bis, 76.5% of respondents favoured the distribution of
medical marijuana, and only 22.2% (95% CI
19.2–25.5) disagreed with it. The results revealed no sta-
tistical differences in these opinions by sex (P = 0.087),
© 2017 Australasian Professional Society on Alcohol and other Drugs
age (P = 0.70), and region of the country (P = 0.27),
but they found more support among those with previous
use of cannabis (P < 0.001) (see Table 3).
When given different policy alternatives regarding
marijuana, 64.6% (95% CI 60.8–68.1) said the best
alternative is that the state tightly regulates the market.
The remaining interviewees were divided between
those who rejected any regulation (15.2%; 95% CI
12.7–18.1), those who wanted the private sector to con-
trol the cannabis market (13.3%; 95% CI 10.9–16.1),
and a minority who believed that complete prohibition
is the best alternative (6.9%; 95% CI 5.2–9.1).
Discussion
The law regulating the production, distribution, and
use of recreational marijuana in Uruguay has trans-
formed the way in which people in this country—and
in Latin America overall— are discussing drug policy
[11]. The wave of positive attitudes toward legalisation
that is stirring legislatures in the US, Canada and
Australia has not, however, taken hold in Uruguay to
the same extent. As several public opinion polls and
media outlets have indicated, although more citizens
are now approving legalisation, public opinion remains
mostly split on the cannabis legalisation initiative. On
the other hand, by 2015, there seemed to be very little

support (6.9%) toward complete prohibition, and most
preferred to have the State behind the regulation. In
light of the decline in the opinions rejecting legalisa-
tion, it is likely that approval for complete prohibition
will continue to be low.
Although the process of marijuana regulation in
Uruguay has been gradually implemented, the persis-
tence of illegal trafficking and the problems with phar-
macy retail [9,12] have raised concerns about the
helpfulness of cannabis legislation. Some domestic
observers have criticised the slow pace of the reforms
by the government administration that took office after
the law was enacted. The government of Tabaré Vas-
quez has taken a more restrained approach to the
implementation of the reforms and has focused more
on issues regarding alcohol and tobacco abuse [9].
The provision for access to recreational marijuana
through pharmacies was repeatedly postponed, and it
has suffered setbacks after being finally implemented
in July 2017.
It is not surprising that, as this study shows, con-
cerns still linger about the law, even after nearly 4 years
of its passing. Domestic and international observers of
the Uruguayan experiment have interpreted these
unfavourable opinions as an indication of the public’s
rejection toward recreational marijuana legalisation
[12]. The data of these surveys, however, provide a
more nuanced view. First, they show that acceptance
of the cannabis law has increased in Uruguay, and that
approval of the legislation is consistently higher among
young people, residents of the capital, Montevideo,
and especially among individuals with previous use of
marijuana. These results complement what other stud-
ies have found in the early stages of the implementa-
tion of the law in Uruguay [13,14], and follow similar
patterns found in other countries undergoing legalisa-
tion initiatives [15]. They also suggest that changes in
public opinion are occurring slowly. Second, the
results reveal that most opposition toward the law is
concentrated on the provision of retail pharmacies as a
way to access marijuana for leisure purposes. Even in
May 2017, the AB survey indicated that 60.4% (95%
CI 57.9–62.8) disapproved pharmacy retail. Such
opposition may explain, in part, the difficulties that the
Uruguayan government had implementing such provi-
sions. Third, and related to the former, many Uru-
guayan citizens seem willing to accept the provision of
self-supply through home-grown plants more than any
other way, which may reinforce the argument that
opposition to the cannabis reform might especially
concentrate on the availability in public markets.
Fourth, these public opinion studies provide no evi-
dence of a significant change in the lifetime prevalence
of cannabis use in Uruguay. Notwithstanding surveys
analysed here were not specifically designed to
Support for cannabis regulation S433
measure the substance’s use, the data do not provide
any substantiation to claims that legalisation is signifi-
cantly expanding cannabis consumption among the
adult population. As the Uruguayan Drug Observatory
has indicated, the increase in marijuana use seems to
have slowed down in the last 5 years [9]; however, as
of 2017, it is still early to assess the impact of legalisa-
tion on the consumption behaviour.
Fifth, when asked about different alternatives for the
regulation of cannabis after nearly 2 years of enact-
ment, a majority of the respondents backed the role of
the state in controlling the cannabis market. Very few
respondents signed up for full prohibition, while nearly
a third endorsed more lenient measures to access mari-
juana. In other words, while most people are in dis-
agreement with the provision of distribution through
pharmacies, a majority of Uruguayans back the strong
state intervention in the cannabis market and seem to
endorse the idea of liberalisation of recreational mari-
juana use in the country. Furthermore, most respon-
dents approved the access to medicinal marijuana,
something that was belatedly incorporated in to the
law. Again, opposition to the cannabis law in Uruguay
may not be resistance toward marijuana liberalisation
reform, but toward the specific ways of accessing can-
nabis. Even some of those with previous history of can-
nabis use seem not to be convinced about accessing
marijuana through commercial pharmacies.
These findings may suggest that the new regulations
could have had more support from the public if the
administration had conceived the law without the
pharmacy provisions and had started with the medici-
nal uses of cannabis as happened in the US [16]. In
any case, the study suggests public opinion in Uruguay
remains sceptical and divided. The lack of support for
the access to cannabis through pharmacy retail may
compound an already problematic process of law
implementation.
Acknowledgements
This paper is part of a research funded by the Open
Society Foundations (Grant ID: OR2014–18322). The
authors wish to express their gratitude to David Holiday
for the support to this research initiative. The final
responsibility for the content is, of course, solely of the
authors.
Conflict of Interest
There are no conflicts of interest posed by the authors
and the submission of this manuscript.
© 2017 Australasian Professional Society on Alcohol and other Drugs
S434 J. M. Cruz et al.
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Supporting information
Additional Supporting Information may be found
in the online version of this article at the publisher’s
web-site:
Appendix S1. Information on sample design, ques-
tion wording, and demographic results.