A study of 4.8 million US adults found that recreational cannabis laws had limited overall effects on alcohol and tobacco use, but when dispensaries were operational, small decreases in current drinking and smoking emerged, with effects varying by age, sex, race, and income.
People interested in how cannabis legalization affects other substance use patterns and public health.
Operational dispensaries associated with 0.95 percentage point drop in current drinking
What the researchers found
Using law passage as the measure, recreational cannabis laws showed no association with alcohol or tobacco use. But using operational dispensary opening, these laws were associated with a 0.95 percentage point decrease in current drinking and 0.48 percentage point decrease in current smoking. Subgroup analysis revealed heterogeneous effects across demographics.
Why it matters
Whether cannabis legalization increases or decreases use of other substances has major public health implications. This study suggests the answer depends on how you measure legalization and which population groups you examine, adding important nuance to a polarized debate.
The numbers in context
Sample: 4.8 million adults, 2012-2022. With operational dispensaries: current drinking decreased 0.95 percentage points (95% CI 0.09-1.80), current smoking decreased 0.48 percentage points (95% CI 0.10-0.85). Some subgroups showed increased smokeless tobacco use.
How the study worked
Researchers analyzed cross-sectional data from 4.8 million adults in the 2012-2022 Behavioral Risk Factor Surveillance System using a difference-in-differences approach, adjusting for individual characteristics and state-level factors. Two definitions of cannabis law implementation were tested: law passage and operational dispensary opening.
What this study cannot tell us
Cross-sectional survey data with self-reported substance use. The difference-in-differences approach relies on parallel trends assumptions that may not hold for all states. The small effect sizes, while statistically significant, may have limited clinical or public health significance. Cannot distinguish between substitution and complementary use.
How to read the evidence
Large population study with 4.8 million adults using a rigorous difference-in-differences design, but limited by self-reported cross-sectional data.
When this study was published
Published in 2025, using data from 2012 to 2022.
The bigger picture
The distinction between law passage and dispensary operations is key. Laws on the books may have little effect until people can actually purchase cannabis legally. The heterogeneous effects across demographics suggest that cannabis substitution for alcohol and tobacco is not universal but depends on factors like age, sex, race, and socioeconomic status.
Questions still open
- Why do effects differ by demographic groups? Is the decrease in drinking and smoking driven by substitution with cannabis, or by other policy changes that correlate with legalization? What explains the increase in smokeless tobacco use in some groups?
Common questions
Does cannabis legalization reduce alcohol use?
Did legalization affect tobacco use?
Why does it matter whether dispensaries are open?
Read the original research
The Effects of Recreational Cannabis Laws on Alcohol and Tobacco Use Among U.S. Adults, 2012-2022.
American journal of preventive medicine, 68(5), 1032-1040
Citation
De, Prabal K; Sun, Ruoyan. (2025). The Effects of Recreational Cannabis Laws on Alcohol and Tobacco Use Among U.S. Adults, 2012-2022.. American journal of preventive medicine, 68(5), 1032-1040. https://doi.org/10.1016/j.amepre.2025.01.024