Pregnant Women in Legal Cannabis States Are Less Likely to Complete Treatment

Retrospective cross-sectional analysis of the Treatment Episode Data Set-Discharge (TEDS-D), 2020–2022. N = 13,088 pregnant women aged 12+ admitted for cannabis use. States categorized by legalization status (fully legal, medical only, illegal). Multivariable logistic regression for treatment completion. Subgroup analyses by treatment setting and referral source.

Cannabis use during pregnancy is the most commonly used illicit substance in pregnancy (RTHC-00209), and the evidence for fetal harm is growing. If legalization reduces treatment completion among pregnant users, that's a public health consequence that legalization advocates and regulators need to address—perhaps through pregnancy-specific outreach, incentive programs, or alternative intervention models.

This adds a concerning dimension to the legalization evidence. RTHC-00181 found mostly neutral mental health effects from legalization at the population level, and RTHC-00175 mapped monitoring recommendations. But this study identifies a specific subgroup—pregnant women needing cannabis treatment—where legalization may be actively harmful by reducing treatment engagement. It connects to the prenatal evidence cluster (RTHC-00209, 00191, 00217, 00216, 00226) by showing that legalization may increase the exposed population.

TEDS-D captures treatment facility data, not all cannabis users—many pregnant users never enter treatment. The definition of 'treatment completion' varies by setting and program. Confounders at the state level (treatment availability, cultural attitudes, referral mandates) may explain the association more than legalization itself. Cross-sectional by state design can't control for all between-state differences. The 2020–2022 period overlaps with COVID, which disrupted treatment services differently by state.