Young Adult Cannabis Use Kept Rising Through COVID in Washington State
Cannabis use among young adults in Washington State continued its pre-pandemic upward trend through 2021, while alcohol, cigarette, and e-cigarette use declined.
Quick Facts
What This Study Found
Past-month cannabis use among 18-25 year olds increased by 1.6 percentage points per year from 2016-2019, with no pandemic-related disruption. Meanwhile, alcohol, cigarette, and e-cigarette use all declined.
Key Numbers
Cannabis: +1.6 pp/year (95% CI 0.6-2.6), no pandemic deflection. Cigarettes: -3.8 pp deflection. E-cigarettes: -2.9 pp deflection in 2020. Under-21 cannabis: -7.5 pp deflection in 2020. N=12,516.
How They Did This
Population-based survey of 12,516 young adults aged 18-25 across 6 annual waves (2016-2021) of the Washington State Young Adult Health Survey.
Why This Research Matters
Washington legalized recreational cannabis in 2012, making this a mature legal market. Cannabis use trends were resilient to pandemic disruption while other substance use declined.
The Bigger Picture
The diverging trends suggest cannabis has established a different user base and supply chain in legal states, one less disrupted by pandemic-related social changes.
What This Study Doesn't Tell Us
Single state with established legal market. Survey-based self-report. Cannot isolate pandemic effects from other policy changes.
Questions This Raises
- ?Why did under-21 cannabis use dip in 2020 while legal-age use didn't?
- ?How much of the e-cigarette decline was pandemic vs policy-driven?
Trust & Context
- Key Stat:
- Cannabis use rose 1.6 percentage points per year with no pandemic disruption
- Evidence Grade:
- Large population-based survey across 6 years, though limited to one state.
- Study Age:
- 2025 study
- Original Title:
- Young Adult Cannabis, Alcohol, Nicotine, and Nonprescribed Pain Reliever Use in Washington State Before and During COVID-19 Pandemic.
- Published In:
- AJPM focus, 4(4), 100342 (2025)
- Authors:
- Fleming, Charles B(7), Martinez, Griselda(4), Rhew, Isaac C(11), Kilmer, Jason R, Larimer, Mary E, Guttmannova, Katarina
- Database ID:
- RTHC-06467
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Did the pandemic change cannabis use among young adults?
Not significantly. Cannabis use continued its pre-pandemic upward trend. The only exception was a temporary dip among under-21 users in 2020.
Why did e-cigarette use decline during the pandemic?
The decline likely reflects both pandemic disruption and Washington State's 2020 restrictions on flavored vaping products.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-06467APA
Fleming, Charles B; Martinez, Griselda; Rhew, Isaac C; Kilmer, Jason R; Larimer, Mary E; Guttmannova, Katarina. (2025). Young Adult Cannabis, Alcohol, Nicotine, and Nonprescribed Pain Reliever Use in Washington State Before and During COVID-19 Pandemic.. AJPM focus, 4(4), 100342. https://doi.org/10.1016/j.focus.2025.100342
MLA
Fleming, Charles B, et al. "Young Adult Cannabis, Alcohol, Nicotine, and Nonprescribed Pain Reliever Use in Washington State Before and During COVID-19 Pandemic.." AJPM focus, 2025. https://doi.org/10.1016/j.focus.2025.100342
RethinkTHC
RethinkTHC Research Database. "Young Adult Cannabis, Alcohol, Nicotine, and Nonprescribed P..." RTHC-06467. Retrieved from https://rethinkthc.com/research/fleming-2025-young-adult-cannabis-alcohol
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.