Cannabis legalization linked to cannabis use disorder

Takeaway

• Despite recreational marijuana legalization (RML), there have been slight increases in both cannabis use disorder (CUD) among adolescents and past-month use/frequent use, past-year CUD among adults aged ≥26 years.
• Related editorial.

Why this matters

• While there is no demonstrable association between RML and significantly increased cannabis use, especially among young adults, proactive conversations about potential risks and benefits are important.
• Consider incorporating cannabis use questions into yearly physicals, routine visits.

Key results

• 505,796 respondents.
• Adolescents (age, 12-17 years): no change in overall sample, users, in past-month use/frequent use after state RML.
• Past-year CUD prevalence: slight increase from 2.18% to 2.72% (OR, 1.25; 95% CI, 1.01-1.55).
• Adults aged 18-25 years: no differences in overall sample, current users in past-month use/frequent use, past-year CUD after state RML.
• Adults aged ≥26 years in general population: past-month use increased, 5.65% to 7.10% (OR, 1.28; 95% CI, 1.16-1.40); past-month use frequency increased, 2.13% to 2.62% (OR, 1.24; 95% CI, 1.08-1.41); past-year CUD increased, 0.90% to 1.23% (OR, 1.36; 95% CI, 1.08-1.71); no changes seen in current users.

Study design

• Cross-sectional, multilevel, difference-in-difference survey analysis of changes in frequent cannabis use, CUD after RML enactment, 2008-2016.
• Funding: National Institute on Drug Abuse.

Limitations

• Self-report bias.
• Limited dimensions explored.
• DSM-IV vs DSM-V CUD definition used.
• Underestimated prevalence.