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.
Policy researchers, public health officials, parents, anyone following cannabis legalization debates
Recreational-legalization states had overdose death rates up to 479% higher among adolescents than non-legalizing states
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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
How to read the evidence
Large national dataset but ecological design cannot prove causation; major confounders (fentanyl, COVID-19) not fully controlled
When this study was published
Published 2025
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.
Questions still open
- 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?
Common questions
Did cannabis legalization cause more adolescent overdose deaths?
How much higher were overdose deaths in legalization states?
Read the original research
Cannabis and the overdose crisis among US adolescents.
The American journal on addictions, 34(3), 327-333
Citation
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