In a 5-year longitudinal study following Canadian legalization, social acceptability of recreational cannabis use increased over time, but so did perceived health risks including addiction potential and links to anxiety, depression, and sleep disruption, with non-users showing the steepest attitude shifts.
Policymakers, public health professionals, and anyone interested in how legalization changes public attitudes toward cannabis.
Social acceptance of cannabis increased but so did perceived risks for anxiety, depression, and addiction
What the researchers found
Social acceptability of any recreational use (OR 1.06) and trying cannabis (OR 1.02) increased over time. But perceived riskiness of regular use also increased (OR 0.97), along with perceived addiction potential (OR 0.94). Perceived health benefits decreased while perceived risks increased (exacerbating stress, anxiety, depression; disrupting sleep). Non-users before legalization showed the steepest increases in social acceptability but smaller increases in risk perception.
Why it matters
A major concern about legalization is that it will normalize cannabis and reduce perceived risks, leading to greater misuse. This study shows a more nuanced picture: while social acceptance grew, Canadians simultaneously became more aware of specific health risks, suggesting that post-legalization public health education may be working.
The numbers in context
Mean 9.9 assessment waves per participant over 5 years. Social acceptability of recreational use: OR 1.06 per wave. Medical use acceptability decreased: OR 0.95. Regular use perceived as riskier: OR 0.97. Addiction risk perceived as greater: OR 0.94. 48% reported pre-legalization cannabis use.
How the study worked
Longitudinal observational cohort (60% female, median age 29, 48% pre-legalization users) assessed up to 11 times from September 2018 to October 2023. Measures included social acceptability of various use patterns, perceived risks and benefits, and moderation by pre-legalization use status.
What this study cannot tell us
Cohort may not be nationally representative (convenience sample, 60% female, median age 29). Attrition could bias results if participants with changing attitudes were more likely to drop out. Self-reported attitudes may not reflect behavior. The 5-year window may not capture longer-term shifts.
How to read the evidence
Longitudinal cohort with up to 11 assessments over 5 years providing robust within-person change data, though convenience sampling limits generalizability.
When this study was published
Published in 2025, covering September 2018 to October 2023.
The bigger picture
The simultaneous increase in acceptance and risk perception is encouraging from a public health perspective. It suggests Canadians are developing more sophisticated attitudes: accepting cannabis use as a personal choice while becoming more informed about its health risks. The decrease in perceived medical cannabis benefits may reflect growing awareness that evidence for many medical claims is limited.
Questions still open
- Will risk perceptions continue to increase, or will they plateau? Are shifting attitudes translating into changed behavior? Why did perceived medical cannabis benefits decrease? Will non-users who became more accepting eventually become users?
Common questions
Did legalization make Canadians think cannabis is safe?
Did attitudes change differently for users versus non-users?
Read the original research
Changes in cannabis attitudes and perceptions in the five years following recreational legalization in Canada: Findings from an observational cohort study of community adults.
The International journal on drug policy, 140, 104782
Citation
Doggett, Amanda; Belisario, Kyla L; McDonald, André J; De Jesus, Jane; Vandehei, Emily; Gillard, Jessica; Lee, Laura; MacKillop, James. (2025). Changes in cannabis attitudes and perceptions in the five years following recreational legalization in Canada: Findings from an observational cohort study of community adults.. The International journal on drug policy, 140, 104782. https://doi.org/10.1016/j.drugpo.2025.104782