When matched for usage, women reported stronger "Good" and "Take Again" ratings than men after smoking cannabis, despite identical intoxication and heart rate responses — suggesting sex-based differences in abuse liability.
Women wondering about their personal risk profile with cannabis, clinicians advising patients on cannabis use, researchers designing sex-balanced clinical trials, and anyone interested in why substance use affects men and women differently.
Women rated cannabis as significantly more "Good" and worth "Taking Again" than men (p<=0.05), even though they reported identical levels of being "High" — the rewarding effects diverge from intoxication by sex.
The Backstory
In 2014, a study emerged from the New York State Psychiatric Institute that challenged a basic assumption in cannabis pharmacology: that the drug acts the same way in everyone. Ziva Cooper and Margaret Haney took data from four rigorous, double-blind experiments — all conducted in their own lab at Columbia University — and asked a question that surprisingly few researchers had bothered to ask directly: does cannabis feel different to men and women?
The answer upended a convenient fiction. When you match men and women on exactly how much they smoke, cannabis produces the same high in both sexes. They feel equally intoxicated. Their hearts race at the same rate. But the reward — how good it feels, whether they'd do it again — is significantly stronger in women. That disconnect between identical intoxication and divergent reward has implications that ripple from neuroscience through clinical practice to public health policy.
The Setup: Why No One Had Done This Properly
Cannabis research has a gender problem. Historically, clinical studies overenrolled men — sometimes dramatically. When women were included, the data were rarely analyzed by sex. And the few population surveys that did break down results by gender typically couldn't control for usage patterns. If men smoke more, any comparison of effects is contaminated by dose differences.
Cooper and Haney solved this by going back to their own data. They had run four separate double-blind, within-subject laboratory studies at Columbia, all following the same general protocol. Each study included both men and women. By pooling across all four and matching 35 women to 35 men on current cannabis use — same frequency (roughly 7 days/week), same daily quantity — they eliminated the dosing confounder that had hobbled every prior comparison.
How They Did It
How the Study Was Designed
All conducted at NYSPI using identical assessment instruments and smoking procedures. Original total: 146 participants.
Matched on current cannabis use frequency and quantity. Women: 6.8 days/week; Men: 6.9 days/week. No significant differences in usage.
NIDA-supplied cannabis cigarettes (~800mg). Active: 3.27-5.50% THC. Placebo: 0% THC. Protocol: 5-second inhalation, 10-second breath-hold, 40-second intervals, 3-7 puffs.
15 to 195 minutes post-smoking. Visual Analog Scales for abuse liability (Good, Liking, Take Again) and intoxication (High, Stimulated).
Heart rate and blood pressure via continuous monitoring. Sessions lasted 6-7 hours.
Cooper & Haney (2014), Drug Alcohol Depend 136:85-91
The key detail: participants fasted overnight, arrived at 9 AM, provided carbon monoxide and urine samples to confirm abstinence, then smoked under observation. This wasn't a survey or a self-report study. These were controlled drug administrations in a clinical laboratory, with placebo conditions and repeated measures.
The Results: Same High, Different Reward
Sex Differences
Cannabis Effects by Sex in Matched Daily Smokers
p<=0.05
Women rated 'Good' higher
Under active cannabis conditions only
p<=0.05
Women rated 'Take Again' higher
Under active cannabis conditions only
No difference
Intoxication ('High', 'Stimulated')
Identical between sexes
No difference
Heart rate increase
Same cardiovascular response in both sexes
Cooper & Haney (2014), Drug Alcohol Depend
This pattern is the study's most important contribution: the dissociation between intoxication and reward. Both sexes felt equally high. Both showed the same physiological arousal. But women's brains coded the experience as more pleasurable and more worth repeating. In pharmacological terms, the abuse-related subjective effects diverged while the intoxicating and cardiovascular effects did not.
Under placebo conditions, there were no sex differences at all. The divergence only appeared when active cannabis was administered. This rules out a general tendency for women to rate experiences more positively — the effect was specific to the drug.
Why This Matters: The Telescoping Effect
The finding slots into a well-documented epidemiological pattern called the telescoping effect: women progress from first cannabis use to cannabis use disorder in a shorter timeframe than men. This has been observed across multiple substances — alcohol, opioids, cocaine — but the mechanism was poorly understood for cannabis.
Process
The Telescoping Effect in Cannabis Use
Men and women begin using cannabis at similar ages, though men are slightly more likely to initiate.
Both sexes transition to regular use. Men are more likely to become daily users, but women who do use regularly escalate faster.
Cooper & Haney's finding: at the same dose and frequency, women experience greater reinforcement. Each session may be slightly more rewarding, accelerating the cycle.
Women meet criteria for cannabis use disorder sooner after initiation. The time from first use to disorder is compressed.
Women who develop CUD tend to present for treatment sooner, but with more severe psychiatric comorbidity.
Synthesis of Cooper & Haney (2014), telescoping literature
Cooper and Haney's study doesn't prove the entire telescoping chain — it illuminates one specific link. If every cannabis session is slightly more rewarding for women, the cumulative reinforcement history builds faster. Over months and years, that differential compounding could explain the accelerated trajectory from use to disorder.
The Biology Underneath
Why would cannabis be more rewarding for women? The answer likely lies in the sexual dimorphism of the endocannabinoid system itself.
Biological Mechanism
How Sex Hormones Modulate Cannabis Effects
Estradiol fluctuates
CB1 receptor density differs
Endocannabinoid tone varies
Reward signaling amplified
Craft et al. (2013), Life Sciences; Cooper & Haney (2017), Neuropsychopharmacology
Rebecca Craft's landmark 2013 review in Life Sciences laid the preclinical foundation for these findings. In animal models, female rodents consistently show greater sensitivity to THC's effects — they self-administer more, develop conditioned place preference faster, and show greater analgesic responses. Ovariectomy reduces these differences; estradiol replacement restores them. The hormonal connection is not speculative — it's been demonstrated through systematic manipulation.
Cooper and Haney couldn't control for menstrual cycle phase in their pooled analysis (the original studies ran 4-8 weeks each without cycle tracking). This is simultaneously one of the study's biggest limitations and one of its most important implications: if the sex difference in reward is detectable even without controlling for cycle phase — averaged across whatever hormonal state participants happened to be in — the effect during peak estradiol periods could be substantially larger.
What People Get Wrong
Myth vs. Reality
Women get higher from cannabis than men.
Women did not feel more intoxicated in this study. The 'High' and 'Stimulated' ratings were identical between sexes. What differed was the reward value — how good it felt and whether they'd choose to use again. Being equally high but finding it more rewarding is a fundamentally different (and more concerning) pattern than simply being more intoxicated.
The Evidence
Cooper & Haney (2014): no sex differences in VAS 'High' or 'Stimulated' ratings; significant sex differences only in 'Good' (p<=0.05) and 'Take Again' (p<=0.05).
Cooper & Haney (2014), Drug Alcohol Depend
The distinction matters clinically. If women simply got higher, the solution would be straightforward: use less. But the finding is subtler and more challenging. At the same level of intoxication, women's reward circuits respond more strongly. Dose reduction might help — a lower dose could reduce the reward signal — but the underlying sensitivity difference would persist.
The Researchers
Ziva Cooper earned her PhD in biopsychology at the University of Michigan, studying abuse liability of opioids and cocaine in animal models, before completing a postdoctoral fellowship in Margaret Haney's Cannabis Research Laboratory at Columbia University. The shift from animal to human behavioral pharmacology — and from opioids to cannabinoids — positioned her uniquely to bridge preclinical sex-differences research with controlled human studies.
Cooper and Haney's 2014 paper was funded by NIDA grants DA19239, DA09236, and DA02775 — standard addiction-research funding. But the study's existence reveals an institutional bias: four separate laboratory studies had been conducted, each including women, without sex being a primary analysis variable. The data sat there for years before anyone systematically asked the question. Cooper later noted that this gap was not unique to their lab — it reflected a field-wide failure to treat sex as a fundamental variable in cannabis pharmacology.
Cooper went on to become Research Director of the UCLA Cannabis Research Initiative, where she has continued to investigate sex-dependent effects across therapeutic and recreational contexts. Her 2017 review with Haney in Neuropsychopharmacology — "Sex-Dependent Effects of Cannabis and Cannabinoids: A Translational Perspective" — became the definitive synthesis of the field, integrating preclinical, clinical, and epidemiological evidence into a framework that argues sex must be a standard variable in every cannabis study.
The Limitations That Matter
- Low THC potency (3.27-5.50%) high
Modern cannabis products typically contain 15-30%+ THC. The sex differences found at low potency might be larger, smaller, or absent at higher doses. We simply don't know.
- No menstrual cycle tracking high
Estradiol modulates CB1 receptor sensitivity. Without cycle data, the results average across hormonal states. Peak-estradiol effects could be much stronger.
- Smoked route only moderate
Edibles, vapes, and concentrates produce different pharmacokinetic profiles. Sex differences in first-pass metabolism (relevant for edibles) remain untested.
- Secondary analysis, not pre-registered moderate
The sex comparison was not the primary aim of any of the four original studies. This introduces the possibility of post-hoc bias, though the direction aligns with preclinical predictions.
- Acute effects only moderate
The study measured immediate subjective response, not progression to disorder. The link between enhanced reward and accelerated dependence is plausible but unproven in this dataset.
Cooper & Haney (2014), study limitations
The potency issue deserves emphasis. Cannabis in 2014 was already far stronger than the 3-5% THC cigarettes NIDA provides for research. The average dispensary flower now exceeds 20% THC, and concentrates can reach 80-90%. Whether sex differences in abuse-related effects scale with dose, plateau, or reverse at higher potencies is one of the most clinically urgent unanswered questions in cannabis pharmacology.
The Bigger Picture: Why We're Still Flying Blind
In 2025, the FDA issued updated draft guidance on studying sex differences in clinical evaluation of medical products. The agency has required sex-specific analysis since 1993. Yet in cannabis research, this mandate has been largely ignored. A review of over 40 randomized controlled trials on medical cannabis found that very few evaluated sex-dependent efficacy, and even fewer examined sex-specific adverse effects.
This isn't just an academic oversight. As of 2024, over 50% of patients receiving medical cannabis licenses in many jurisdictions are women. If cannabis is more reinforcing for women at therapeutic doses, treatment protocols designed around male-dominated trial data may be systematically miscalibrated for half the patient population.
Cooper and Haney's study — modest in sample size, limited by NIDA's low-potency research supply — opened a door that the field has been slow to walk through. The data suggest we need sex-specific dosing guidelines, cycle-aware treatment protocols, and clinical trials that don't just include women but analyze their outcomes separately.
Related Research
The Sex Differences Research Network
Sex Differences in Cannabinoid Pharmacology
Craft, Marusich & Wiley (2013)
Evaluation of Sex Differences in Cannabinoid Dependence
Marusich et al. (2014)
Sex Differences in THC Withdrawal During Adolescence
Harte-Hargrove et al. (2012)
Sex Differences in Cannabis-Related Neuropsychological Effects
Crane et al. (2015)
Do women get higher from cannabis than men?
Not exactly. In Cooper and Haney's study, women did not feel more "High" or "Stimulated" than men. What differed was how rewarding the experience felt — women rated it as more "Good" and were more willing to "Take Again." The intoxication was the same; the enjoyment was different. This dissociation between intoxication and reward is actually more concerning from an addiction perspective than a simple dose-response difference would be.
Does this mean women are more likely to become addicted to cannabis?
This study provides one possible mechanism for why women progress to cannabis use disorder faster (the telescoping effect), but it doesn't prove causation. Enhanced rewarding effects could contribute to faster dependence development, but many factors — hormonal, social, psychological, genetic — also play roles. What the data do suggest is that sex should be considered a risk factor in CUD screening, not that every woman who uses cannabis will develop problems.
Should women use lower doses of cannabis?
The research suggests women may benefit from starting at lower doses, particularly for therapeutic use. Greater sensitivity to rewarding effects at the same dose implies that less may be needed to achieve desired outcomes — and that higher doses may accelerate tolerance and dependence pathways. This applies to microdosing approaches as well.
Did the study account for the menstrual cycle?
No, and this is one of its key limitations. Preclinical research shows that estradiol levels, which fluctuate across the menstrual cycle, modulate CB1 receptor sensitivity. The follicular phase (when estrogen is rising) may amplify cannabis's rewarding effects. Future studies need to track cycle phase to understand the full range of sex differences.
Does this study apply to edibles, vapes, or concentrates?
The study only tested smoked cannabis at low THC potencies (3.27-5.50%). Whether sex differences in reward hold for other routes, higher potencies, or CBD-containing products is unknown. Given that edibles undergo first-pass metabolism (producing the more potent 11-OH-THC), and that sex differences in liver enzyme activity are well-documented, the pharmacology could diverge further with oral administration.
What the researchers found
Women gave higher "Good" (p<=0.05) and "Take Again" (p<=0.05) ratings than men under active cannabis conditions in a pooled analysis of four double-blind studies, despite no sex differences in intoxication ratings ("High," "Stimulated") or cardiovascular response. This selective enhancement of abuse-related — but not intoxication — effects in women provides a potential mechanistic explanation for the telescoping effect in cannabis use disorder.
Why it matters
Epidemiological data consistently show that women progress from first cannabis use to cannabis use disorder faster than men — the telescoping effect. This study provides the first controlled human laboratory evidence for a potential mechanism: women experience stronger reinforcing effects from the same dose of cannabis. This has direct implications for sex-specific approaches to prevention, treatment, and clinical trial design.
The numbers in context
- Sample: 70 daily cannabis smokers, 35 women and 35 men, matched for current use
- THC potency tested: 3.27 to 5.50% in active cannabis; 0% in inactive placebo
- Active cannabis vs placebo: stronger abuse-related and intoxication ratings (p≤0.0001)
- Sex difference under active cannabis: higher 'Good' and 'Take Again' ratings in women (p≤0.05)
How the study worked
Pooled secondary analysis of four double-blind, within-subject laboratory studies conducted at the New York State Psychiatric Institute. Seventy daily cannabis smokers (35 women, 35 men) were matched on current usage. Each participant completed 5–10 outpatient sessions over 2–8 weeks. Active cannabis (NIDA-supplied, 3.27–5.50% THC, ~800mg cigarettes) was compared to inactive placebo (0% THC) using a standardized smoking procedure (5-second inhalation, 10-second breath-hold, 40-second intervals). Subjective effects were assessed via VAS at 6 timepoints (15–195 minutes post-smoking). Cardiovascular monitoring at 7 timepoints.
Who was studied
N=70 adults, 35 men and 35 women, matched for current cannabis use, Country not specified.
What this study cannot tell us
Small sample (n=70) with limited statistical power for interaction effects. THC potency (3.27–5.50%) far below modern market products (15–30%+ THC). Pooled four studies with potentially different procedures. Did not control for menstrual cycle phase, hormonal contraception, or body composition — all known modulators of cannabinoid pharmacokinetics. Measured acute subjective response, not actual progression to cannabis use disorder. The link from enhanced "Good" ratings to increased CUD risk remains a plausible hypothesis, not a demonstrated causal pathway.
How to read the evidence
Preliminary evidence from a pooled secondary analysis. The double-blind, placebo-controlled design is rigorous, but this was not a pre-registered primary study — it combined data from four earlier experiments. Sample size limits statistical power for interaction effects. Findings align with preclinical animal data and epidemiological patterns but require replication with modern-potency products.
When this study was published
Published in 2014, using data from studies conducted in the late 2000s to early 2010s. The THC potencies tested (3.27–5.50%) are now well below typical market products, which may affect the magnitude but likely not the direction of sex differences.
The bigger picture
This study sits at the intersection of two major gaps in cannabis science: the underrepresentation of women in clinical trials and the lack of sex-specific pharmacological data. Cooper and Haney's finding that abuse-related effects diverge by sex while intoxication does not challenges the assumption that cannabis acts uniformly across populations. Their 2017 follow-up review in Neuropsychopharmacology expanded these findings into a translational framework, and subsequent research has confirmed sex differences in cannabis-related analgesia, adverse effects, and treatment outcomes.
Replication
Not stated in abstract.
Funding
Not reported in abstract.
Conflicts of interest
Not reported in abstract.
Questions still open
- Do sex differences in abuse-related effects persist with higher-potency modern cannabis products?
- How does menstrual cycle phase modulate the magnitude of these sex differences?
- Would sex-specific dosing improve therapeutic outcomes in medical cannabis programs?
- Do these findings extend to other routes of administration (edibles, vaping, concentrates)?
- Can the enhanced rewarding effects in women be attenuated by CBD co-administration?
Common questions
Do women get higher from cannabis than men?
Does this mean women are more likely to get addicted to cannabis?
Should women use lower doses of cannabis?
Did the study account for hormonal differences like the menstrual cycle?
Read the original research
Investigation of sex-dependent effects of cannabis in daily cannabis smokers
Drug and Alcohol Dependence, 136, 85-91
Drug and Alcohol Dependence is a reputable journal focusing on the biomedical and psychosocial aspects of substance abuse.
Citation
Cooper, Ziva D.; Haney, Margaret. (2014). Investigation of sex-dependent effects of cannabis in daily cannabis smokers. Drug and Alcohol Dependence, 136, 85-91. https://doi.org/10.1016/j.drugalcdep.2013.12.013
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