Cannabis use among young adults in Washington State continued its pre-pandemic upward trend through 2021, while alcohol, cigarette, and e-cigarette use declined.
Substance use epidemiologists; public health officials; cannabis policy researchers.
Cannabis use rose 1.6 percentage points per year with no pandemic disruption
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot tell us
Single state with established legal market. Survey-based self-report. Cannot isolate pandemic effects from other policy changes.
How to read the evidence
Large population-based survey across 6 years, though limited to one state.
When this study was published
2025 study
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.
Questions still open
- 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?
Common questions
Did the pandemic change cannabis use among young adults?
Why did e-cigarette use decline during the pandemic?
Read the original research
Young Adult Cannabis, Alcohol, Nicotine, and Nonprescribed Pain Reliever Use in Washington State Before and During COVID-19 Pandemic.
AJPM focus, 4(4), 100342
Citation
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
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