States with recreational cannabis sales did not see a more pronounced rise in Schedule II stimulant prescriptions compared to states without legal cannabis, despite overall national increases.
Policy researchers, people interested in legalization effects, ADHD medication stakeholders
No significant interaction (p=0.406)
What the researchers found
While total stimulant distribution rates were higher in states with recreational cannabis sales after implementation (p=0.049), there was no significant interaction between time and cannabis sales status (p=0.406), meaning legalization did not contribute to a more pronounced rise in stimulant distribution.
Why it matters
Because ADHD-like cognitive deficits can resemble effects of chronic cannabis use, some hypothesized that cannabis legalization might drive increased stimulant prescriptions. This study found no evidence supporting that concern.
The numbers in context
States with RC had higher post-implementation stimulant rates (p=0.049) but not pre-implementation (p=0.221). Time effect was significant (p<0.05), state effect significant (p=0.045), but time x RC interaction was not (p=0.406).
How the study worked
Researchers compared three-year population-corrected slopes of Schedule II stimulant (amphetamine, lisdexamfetamine, methylphenidate) distribution from the DEA ARCOS database before and after recreational cannabis sales in states with and without legal sales.
What this study cannot tell us
Ecological study design cannot track individual-level associations. ARCOS data measures distribution, not individual prescriptions. Cannot account for illicit cannabis use in non-legal states. Limited follow-up period after legalization.
How to read the evidence
Ecological analysis of national DEA data with appropriate statistical modeling, but cannot track individual-level effects.
When this study was published
2024 analysis of DEA ARCOS distribution data
The bigger picture
Rising stimulant prescriptions are a national trend driven by factors unrelated to cannabis policy. This study adds to evidence that recreational cannabis legalization has not produced many of the feared downstream effects on other substance use or prescribing patterns.
Questions still open
- What is driving the national increase in stimulant prescriptions? Could cannabis legalization affect non-stimulant ADHD medication use or ADHD diagnosis rates?
Common questions
Why would cannabis legalization affect ADHD medication?
Are stimulant prescriptions rising nationally?
Read the original research
Recreational Cannabis Legalization: No Contribution to Rising Prescription Stimulants in the USA.
Pharmacopsychiatry, 57(5), 249-254
Citation
Alexander, Garrett D; Cavanah, Luke R; Goldhirsh, Jessica L; Huey, Leighton Y; Piper, Brian J. (2024). Recreational Cannabis Legalization: No Contribution to Rising Prescription Stimulants in the USA.. Pharmacopsychiatry, 57(5), 249-254. https://doi.org/10.1055/a-2334-6253