(33) Cannabis Legalization and Adolescent Substance Use

Introduction: Opinions regarding cannabis legalization have shifted over the past decade with nearly one third of US states legalizing recreational cannabis use. Such policy changes may have unintended consequences for adolescents, including changes in other substance use patterns. Our study evaluates relationships between cannabis legalization and use of a broad range of substances by adolescents. We hypothesize that state cannabis legalization status will be significantly associated with differences in adolescent substance use.

Methods: Data are from the Center for Disease Control and Prevention’s 2019 Youth Risk Behavior Surveillance Survey (n=182,491), a nationally representative sample of US high school students. Students were categorized by cannabis legalization status of the state in which they lived during survey completion and associations with each use of each substance (yes/no) were evaluated with logistic regressions, adjusting for demographic characteristics to provide adjusted odds ratios (aOR) and 95% confidence intervals (CI) (α=0.05).

Results: Students living in states in which recreational cannabis was legal at time of survey (RCL states) were more likely than students in states in which only medical cannabis was legal (MCL states) to report methamphetamine, cocaine, or ecstasy use (aOR’s from 1.31-2.64). Compared to students in which neither recreational nor medical cannabis was legal (NL states), students in MCL states were more likely to report cannabis use (aOR 1.15, 95% CI 1.07-1.24, p=0.0002) and less likely to report cocaine, inhalant, ecstasy, or opioid use (aOR’s from 0.72-0.88). Students in RCL and MCL states were significantly less likely to report cigarette use compared to students in NL states (aOR 0.54 [95% CI 0.44-0.67] and 0.74 [95% CI 0.68-0.81] respectively, p<0.0001).

Conclusions: This mixed landscape of adolescent substance use indicates interesting potential patterns depending on the cannabis policies enacted in their state that deserve further study.

References: 1. Smart, R. & Pacula, R.L. Early evidence of the impact of cannabis legalization on cannabis use, cannabis use disorder, and the use of other substances: Findings from state policy evaluations. Am J Drug Alcohol Abuse 45, 644-663 (2019).
2. Garcia, A., Hanson, K. State Medical Marijuana Laws. Vol. 2021 (National Conference of State Legislatures, 2021).
3. CDC. Combining YRBS data across years and sites. Available at: https://
www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/2019_YRBS_combining_
data.pdf

Diversity, Equity, and Inclusion: Using a nationally representative sample, we are assessing trends experienced by most youth in the United States, allowing for more generalizability to the US population. By assessing how policy shifts are associated with adolescent substance use patterns will bring to light potential disparities in risk factors for substance use, especially as we are interested in differences in outcomes based on race/ethnicity and sex.