Impact of Cannabis Legalization on Substance Use Disorders in the United States Public

Abstract

Background: Substance use disorders (SUDs) are a growing public health issue in the United States, affecting millions annually. The recent legalization of cannabis in various states raises concerns about its impact on SUD prevalence. This study investigates the relationship between the legal status of recreational cannabis and the prevalence of various SUDs.

Methods: A cross-sectional design analyzed data from the 2022 National Survey on Drug Use and Health (NSDUH). The study assessed the presence of SUDs, including any SUD, multiple SUDs (defined as two or more), alcohol use disorder, cannabis use disorder, methamphetamine use disorder, stimulant use disorder, and opioid use disorder, based on DSM-5 criteria. The primary independent variable was the legal status of recreational cannabis in participants' states. Data analysis used univariate and multivariate approaches, controlling for demographic and behavioral variables, such as age, sex, race/ethnicity, marital status, education level, family income, binge alcohol use, major depressive episode, and medical marijuana legality. Logistic regression assessed associations between cannabis legalization and SUDs, with odds ratios and 95% confidence intervals reported.

Results: The study included 48,612 participants; adolescents made up 18.46%, and adults 81.54%. SUDs were identified in 18.38% of participants, with 3.87% having multiple SUDs, 9.38% with cannabis use disorder, 11.38% with alcohol use disorder, 0.65% with methamphetamine use disorder, 0.39% with stimulant use disorder, and 0.96% with opioid use disorder. Recreational cannabis legalization was associated with higher odds of any SUD (adjusted odds ratio [aOR]: 1.147, 95% CI: 1.079-1.218) and cannabis use disorder (aOR: 1.313, 95% CI: 1.218-1.415). Conversely, legalization was linked to lower odds of methamphetamine use disorder (aOR: 0.557, 95% CI: 0.410-0.755). No significant associations were found between legalization and multiple SUDs, alcohol use disorder, stimulant use disorder, or opioid use disorder after adjustment.

Conclusion: This study found significant associations between recreational cannabis legalization and SUDs. States with legal recreational cannabis had higher odds of any SUD and cannabis use disorder, but lower odds of methamphetamine use disorder. These results highlight the need for targeted public health interventions in states with legal cannabis to address SUDs and mitigate potential adverse outcomes.

Table of Contents

Table of Contents

Introduction..…………………….……………………………………………………………………………………………….…..…………… 1

Literature Review………………...………………………………………...……………………………….……………………………………. 3 Methods..…………………………………………………………………………………………………………………………………………… 11 Results…………..…………………………………………………………………………….………………………………………..………..… 13 Discussion.………..…………………………………………………………………………………………………………………..………...… 15 Reference...…………………………………………………………………………………………….………………………..……………...... 20 Appendix…..………………………………………………………………………………………………..……………………………………... 24 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Substance Use Disorder
Committee Chair / Thesis Advisor	Anne Spaulding, Emory University
Committee Members	Tara Ayala, Bureau of Prisons

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