Among nearly 1.9 million adolescent hospitalizations across 18 states from 2008-2019, cannabis-related admissions increased after both medical and recreational legalization, with the steepest increases in recreational states and among younger teens.
Pediatricians, policy makers, parents, and public health researchers studying legalization effects on youth.
Greatest increase in 13-year-olds in recreational legalization states
What the researchers found
Cannabis-related hospitalization odds increased after both medical cannabis laws (OR 1.05) and recreational cannabis laws (OR 1.03). The greatest increases post-legalization were in adolescents without underlying mental health or substance use disorders and in younger adolescents (age 13) in recreational states.
Why it matters
Legalization policies for adults (21+) may have downstream effects on adolescent health. The finding that younger teens and those without pre-existing mental health conditions showed the greatest post-legalization increases suggests legalization may be expanding cannabis-related hospitalizations beyond traditional high-risk groups.
The numbers in context
1,898,432 hospitalizations; 37,562 (2%) cannabis-related; MCL states OR 1.05; NMCL states OR 1.03; greatest increases in adolescents without mental health disorders and age 13 in NMCL states
How the study worked
Retrospective cohort study of 1,898,432 adolescent (11-17 years) hospitalizations at children's hospitals from 2008-2019 using the Inpatient Essentials database across 18 states and Washington, DC. Logistic regression compared cannabis-related diagnoses by state legalization status.
What this study cannot tell us
Hospital-based data may miss cases managed in outpatient settings. Cannabis-related diagnosis coding may vary across institutions and time. Cannot determine whether increases reflect more use or more screening/documentation. Administrative data lacks use pattern details.
How to read the evidence
Large multi-state hospital database with longitudinal tracking across policy changes, though administrative data limitations apply.
When this study was published
Published in 2021 using data from 2008-2019.
The bigger picture
While the absolute odds ratios are small, the shift toward younger adolescents and those without pre-existing conditions after recreational legalization suggests these policies may be normalizing cannabis use in ways that reach vulnerable populations not previously at risk.
Questions still open
- Are the increases driven by actual increased use or improved detection? What specific harms are driving these hospitalizations? Would targeted prevention in recreational states reduce these trends? How do these patterns evolve as legalization matures?
Common questions
Did legalization increase teen hospitalizations for cannabis?
Which teens were most affected?
Read the original research
Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 69(6), 999-1005
Citation
Masonbrink, Abbey R; Richardson, Troy; Hall, Matt; Catley, Delwyn; Wilson, Karen. (2021). Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019.. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 69(6), 999-1005. https://doi.org/10.1016/j.jadohealth.2021.07.028
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