43.4 Cannabis Legalization and Adolescent Other Substance Use

Abstract

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 aims to evaluate relationships between cannabis legalization and the 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. Data are from the CDC’s 2019 Youth Risk Behavior Surveillance Survey (n = 182,491), a nationally representative sample of US high school students. Students were categorized by the cannabis legalization status of the state in which they lived during survey completion, and associations with use of each substance (yes/no) were evaluated with logistic regressions, adjusting for demographic characteristics to provide adjusted ORs (aORs) and 95% CI (α = 0.05). Students in states in which recreational cannabis was legal (RCL states) were significantly more likely than students in states in which only medical cannabis was legal (MCL states) to report methamphetamine, cocaine, or ecstasy use (aORs 1.31-2.64). Compared to students in which neither recreational nor medical cannabis was legal (NL states), students in MCL states were significantly more likely to report cannabis use (aOR 1.15; 95% CI, 1.07-1.24; p = 0.0002) but significantly less likely to report cocaine, inhalant, ecstasy, or opioid use (aORs 0.72-0.88). Students in both RCL and MCL states were significantly less likely to report cigarette use compared to students in NL states (aORs 0.54 [95% CI, 0.44-0.67] and 0.74 [95% CI, 0.68-0.81], respectively; p < 0.0001). This mixed landscape of adolescent substance use indicates interesting potential adolescent substance use patterns depending on the cannabis policies enacted in their state that deserve further study.