Recreational cannabis legalization alters associations among cannabis use, perception of risk, and cannabis use disorder treatment for adolescents and young adults

Objective: Understanding how recreational cannabis legalization may impact cannabis use disorder (CUD) among adolescents and young adults is key to developing an appropriate public health response. This research in-vestigates whether associations among adolescent and young adult perception of risk of harm from cannabis use, prevalence of past-month cannabis use, and rate of CUD treatment admissions changed following recreational cannabis legalization in the US, 2008-2019.Methods: Data from the NSDUH and TEDS-A datasets are employed in difference-in-differences models of the effect of recreational legalization on perception of risk, cannabis use prevalence, and CUD treatment admissions. Moderated models test whether associations among variables changed following recreational legalization.Results: Following recreational legalization: 1) adolescent and young adult past-month cannabis use prevalence increased; 2) among both adolescents and young adults, the association of lower perception of risk of harm with higher cannabis use prevalence was strengthened; 3) among adolescents, the association of higher cannabis use prevalence with higher CUD treatment admissions was suppressed; and 4) among young adults, an association of higher cannabis use prevalence with lower CUD treatment admissions emerged. Conclusions: Recreational legalization is likely to increase cannabis use among adolescents and young adults who perceive cannabis as less harmful, while at the same time reduce rates of CUD treatment utilization. These trends portend an increase in unmet need for CUD treatment for age groups particularly vulnerable to the development and negative consequences of CUD.

Automated summary

This research shows that recreational cannabis legalization in the US has led to decreased perception of risk and increased prevalence of cannabis use among adolescents and young adults. However, it has also resulted in reduced rates of cannabis use disorder treatment. These findings highlight the potential increase in unmet need for cannabis use disorder treatment among vulnerable age groups.