Higher cannabis use in states that have legalized

Abra Jeffers Amy Byers and Salome Keyhani just published a large study of cannabis use patterns in 23 US states and territories from 2016 to 2019. Our national study, “Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US” published in JAMA Network Open found higher-frequency cannabis use is more common among young and racial minority populations, as well as respondents with low socioeconomic status. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to high-frequency use among underserved populations in the form of screening, risk stratification, and treatment.

Based on the distribution of use patterns, we categorized people who uses cannabis into daily and nondaily use and nonuse. To create a more granular distribution of cannabis use frequency, we divided nondaily use into infrequent and frequent nondaily use based on the median number of days of nondaily use (5 days). Thus, we categorized frequency of cannabis use into 4 categories: nonuse, infrequent (1-5 days), frequent (6-29 days), and daily cannabis use in the past 30 days.

Prevalence of cannabis use was higher in states that legalized cannabis. Specifically, prevalence of infrequent (5.3%), frequent (4.2%), and daily use (4.7%) of cannabis was higher in those states with recreational legal cannabis than other states with nonlegal use (infrequent, 2.7%; frequent, 1.9%; daily, 2.6%) or medically legal use (infrequent, 3.5%; frequent, 2.5%; daily, 3.5%)

While much of cannabis legalization has been driven by the desire to roll back inequities in criminal justice due to the failed War on Drugs, our data highlight the potential for severe inequities in the population health impact of cannabis use, and especially of frequent use. Health advocates and policymakers need to pay more attention to regulatory policies that reduce the actions of the rapidly emerging cannabis industry likely to lead to frequent and more harmful  use (including higher potency, attractiveness to youth, aggressive marketing) as well as screening, early detection and treatment of substance abuse.

Here is the abstract:

Importance: Cannabis use has increased, but there are few studies on frequent and daily cannabis use among US adults. Individuals who engage in higher frequency use may suffer more health consequences.

Objective: To examine frequency of cannabis use and associated factors among US adults.

Design, setting, and participants: This survey study included data from 21 US states and 2 US territories reported in the Behavioral Risk Factor Surveillance System surveys from 2016 to 2019. Cross-sectional data on US adults ages 18 years and older were used to estimate demographic, socioeconomic, and behavioral risk factors for cannabis use, taking into account the survey strata and sampling weights for the 4 years of combined data. Using a multivariable ordinal logistic analysis, the association of demographic, socioeconomic status, and behavioral risk factors with past month cannabis frequency were examined.

Exposures: Sociodemographic characteristic, ie, age, gender, race and ethnicity, educational attainment, employment status, and annual household income.

Main outcomes and measures: Ordinal categorization of number of days of cannabis use in the past 30 days in terms of nonuse, infrequent use (1-5 days), frequent use (6-29 days), and daily use.

Results: Among the 387 179 respondents, 58 009 (27.9%) were ages 18 to 34 years, 186 923 (50.3%) were ages 35 to 64 years, and 142 225 (21.8%) were age 65 years or older (mean [SD] age, 48.3 [0.1] years). The sample included 28 345 (9.8%) Black, 36 697 (22.6%) Hispanic, and 292 210 (57.3%) White respondents. Smoking was the most common form of cannabis use. The frequency of cannabis use varied significantly by age, gender, race, marital status, education, and employment. Higher frequency cannabis use was associated with younger age (ages 18-34 years: adjusted odds ratio [aOR],4.12; 95% CI, 3.63-4.68; ages 35-64 years: aOR,2.22; 95% CI, 1.98-2.49), Black (aOR, 1.46; 95% CI, 1.33-1.71) and Native American (aOR, 1.25; 95% CI, 1.04-1.52) race, and less educational attainment (high school or less: aOR,1.09; 95% CI, 1.02-1.17; some college: aOR,1.27; 95% CI, 1.19-1.35). Being married (aOR, 0.54; 95% CI, 0.51-0.58) or identifying as Asian (aOR, 0.60; 95% CI, 0.51-0.71) or Hispanic (aOR, 0.71; 95% CI, 0.65-0.77) was associated with lower-frequency cannabis use after accounting for other baseline factors.

Conclusions and relevance: This nationally based study found that higher-frequency cannabis use is more common among young and racial minority populations, as well as respondents with low socioeconomic status. Given the known and emerging negative health effects of cannabis use, more attention may need to be paid to high-frequency use among underserved populations in the form of screening, risk stratification, and treatment.

The full citation is: Jeffers AM, Glantz S, Byers A, Keyhani S. Sociodemographic Characteristics Associated With and Prevalence and Frequency of Cannabis Use Among Adults in the US. JAMA Netw Open. 2021 Nov 1;4(11):e2136571. doi: 10.1001/jamanetworkopen.2021.36571. PMID: 34846523. It is available for free here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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