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

• Published in: Addictive behaviors Vol. 138; p. 107552
• Main Authors: Mennis, Jeremy, McKeon, Thomas P., Stahler, Gerald J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2023
• Subjects: Adolescent; Cannabis; Cannabis use disorder; Difference-in-differences; Humans; Legalization; Legislation, Drug; Marijuana Abuse - epidemiology; Marijuana Abuse - therapy; Moderation; Perception; Substance-Related Disorders; Young Adult; Legalization; Cannabis; Cannabis use disorder; Difference-in-differences; Moderation
• ISSN: 0306-4603; 1873-6327
• DOI: 10.1016/j.addbeh.2022.107552

•Adolescent and young adult cannabis use increased after recreational legalization.•The negative association of risk perception and cannabis use strengthened.•The positive association of cannabis use and CUD admissions weakened.•Recreational cannabis legalization may increase unmet need for CUD treatment. 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 investigates 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. 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. 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. 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.