Adolescent cannabis hospitalizations increased after legalization, especially in recreational states
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Greatest increase in 13-year-olds in recreational legalization states
- Evidence Grade:
- Large multi-state hospital database with longitudinal tracking across policy changes, though administrative data limitations apply.
- Study Age:
- Published in 2021 using data from 2008-2019.
- Original Title:
- Trends in Adolescent Cannabis-Related Hospitalizations by State Legalization Laws, 2008-2019.
- Published In:
- The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 69(6), 999-1005 (2021)
- Authors:
- Masonbrink, Abbey R, Richardson, Troy, Hall, Matt(2), Catley, Delwyn, Wilson, Karen
- Database ID:
- RTHC-03328
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Did legalization increase teen hospitalizations for cannabis?
Yes, modestly. Both medical and recreational legalization were associated with small but significant increases in cannabis-related adolescent hospitalizations, with recreational states showing a disproportionate increase.
Which teens were most affected?
The greatest post-legalization increases were in younger adolescents (age 13) and those without pre-existing mental health or substance use disorders, suggesting legalization may be reaching new populations.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-03328APA
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
MLA
Masonbrink, Abbey R, et al. "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, 2021. https://doi.org/10.1016/j.jadohealth.2021.07.028
RethinkTHC
RethinkTHC Research Database. "Trends in Adolescent Cannabis-Related Hospitalizations by St..." RTHC-03328. Retrieved from https://rethinkthc.com/research/masonbrink-2021-trends-in-adolescent-cannabisrelated
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.