Adolescent Drug Overdose Deaths Rose More in States That Legalized Cannabis
After a decade of similar trends, US states that legalized cannabis saw significantly greater increases in adolescent drug overdose deaths compared to non-legalizing states, especially those with recreational legalization.
Quick Facts
What This Study Found
States with recreational cannabis legalization had overdose death rates 88% higher (2019), 479% higher (2020), and 115% higher (2021) among 14-18 year-olds compared to non-legalizing states. The correlation appeared across sexes and White, Black, and Hispanic populations.
Key Numbers
Recreational legalization states: 88% higher overdose death rate in 2019, 479% higher in 2020, 115% higher in 2021 vs. non-legalizing states; correlations present in both sexes and across White, Black, and Hispanic populations; adolescent overdose death rate more than doubled nationally since 2019
How They Did This
Retrospective analysis of unintentional drug overdose deaths among 14-18 year-olds from CDC WONDER data, comparing states by cannabis legalization status (recreational, medical-only, and non-legalization) across multiple years.
Why This Research Matters
The adolescent overdose crisis has been devastating, with death rates more than doubling since 2019. This study raises the question of whether cannabis legalization contributed by examining state-level correlations, though it cannot prove causation.
The Bigger Picture
Whether cannabis legalization contributes to harder drug use and overdose deaths among adolescents is one of the most consequential questions in drug policy. This study reports a troubling correlation, but the massive spike in 2020 overlapping with COVID-19 and fentanyl proliferation complicates interpretation.
What This Study Doesn't Tell Us
Ecological study cannot prove causation, does not control for fentanyl availability which varied by state, COVID-19 disruptions overlapped with the study period, states that legalize cannabis may differ from non-legalizing states in other ways that affect overdose risk, does not examine whether the adolescents who died actually used cannabis
Questions This Raises
- ?Is the correlation driven by cannabis itself, or by other factors that differ between legalizing and non-legalizing states?
- ?How much of the 2020 spike reflects fentanyl contamination rather than cannabis-related pathways?
- ?Would individual-level data show the same association?
Trust & Context
- Key Stat:
- Recreational-legalization states had overdose death rates up to 479% higher among adolescents than non-legalizing states
- Evidence Grade:
- Large national dataset but ecological design cannot prove causation; major confounders (fentanyl, COVID-19) not fully controlled
- Study Age:
- Published 2025
- Original Title:
- Cannabis and the overdose crisis among US adolescents.
- Published In:
- The American journal on addictions, 34(3), 327-333 (2025)
- Authors:
- Bleyer, Archie, Barnes, Brian, Stuyt, Elizabeth, Voth, Eric A, Finn, Kenneth
- Database ID:
- RTHC-06081
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Did cannabis legalization cause more adolescent overdose deaths?
This study found a correlation between state-level cannabis legalization and higher adolescent overdose death rates, but it cannot prove causation. States that legalized cannabis may differ in other ways that affect overdose risk, and fentanyl proliferation was not fully controlled for.
How much higher were overdose deaths in legalization states?
States with recreational cannabis legalization had adolescent overdose death rates 88% to 479% higher than non-legalizing states between 2019 and 2021, with the largest gap in 2020.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06081APA
Bleyer, Archie; Barnes, Brian; Stuyt, Elizabeth; Voth, Eric A; Finn, Kenneth. (2025). Cannabis and the overdose crisis among US adolescents.. The American journal on addictions, 34(3), 327-333. https://doi.org/10.1111/ajad.13669
MLA
Bleyer, Archie, et al. "Cannabis and the overdose crisis among US adolescents.." The American journal on addictions, 2025. https://doi.org/10.1111/ajad.13669
RethinkTHC
RethinkTHC Research Database. "Cannabis and the overdose crisis among US adolescents." RTHC-06081. Retrieved from https://rethinkthc.com/research/bleyer-2025-cannabis-and-the-overdose
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.