Five years after Canadian legalization, social acceptance grew but so did perceived risks of cannabis

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.

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.

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 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.

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.