The Link Between Teen Cannabis Use and Psychological Distress Strengthened From 2013 to 2023
Among 35,000 Ontario teens, the cannabis-distress association grew stronger over a decade, especially for frequent female users, possibly reflecting rising THC potency.
Quick Facts
What This Study Found
Distress rose from 10.7% to 27.4% while cannabis use declined from 23.1% to 17.6%. Heavy use (40+ times) vs abstinence: adjusted prevalence difference went from 0% (2013) to 18% (2023). Dose-response in females but not males. Each later grade of initiation: 5% lower distress.
Key Numbers
35,007 students. Distress: 10.7% to 27.4%. Cannabis use: 23.1% to 17.6%. Heavy use-distress difference: 0% (2013) to 18% (2023). 5% lower distress per later grade of initiation.
How They Did This
Representative biennial surveys 2013-2023 in Ontario. 35,007 students grades 7-12. Modified Poisson regression with Kessler-6.
Why This Research Matters
The strengthening association despite declining use rates is consistent with rising potency driving more harm per user. The female dose-response is a new prevention-relevant finding.
The Bigger Picture
Cannabis potency has increased substantially. The parallel strengthening of the cannabis-distress link despite declining use supports the potency hypothesis.
What This Study Doesn't Tell Us
Cross-sectional at each wave. Cannot determine causation direction. Rising distress has many causes. Self-reported.
Questions This Raises
- ?Is rising potency driving this?
- ?Are females more biologically vulnerable?
- ?Would potency limits help?
Trust & Context
- Key Stat:
- Heavy use-distress gap: 0% in 2013, 18% in 2023
- Evidence Grade:
- Large representative survey spanning 10 years with 35,000+ students.
- Study Age:
- 2026 study
- Original Title:
- Adolescent cannabis use and psychological distress from 2013 to 2023: A population-based study in Ontario, Canada.
- Published In:
- Addiction (Abingdon, England) (2026)
- Authors:
- McDonald, André J(8), Doggett, Amanda(7), Bondy, Susan J(2), Colman, Ian, Cook, Steven, Hamilton, Hayley A, Kurdyak, Paul, Leatherdale, Scott T, Myran, Daniel T, Rehm, Jürgen, Wickens, Christine M, MacKillop, James, Halladay, Jillian
- Database ID:
- RTHC-08477
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Why is the association strengthening if fewer teens use?
Rising THC potency may mean each use has greater impact. Fewer teens using more potent cannabis could result in more harm per user.
Why does age of initiation matter?
Each later grade of starting was associated with 5% lower distress prevalence.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08477APA
McDonald, André J; Doggett, Amanda; Bondy, Susan J; Colman, Ian; Cook, Steven; Hamilton, Hayley A; Kurdyak, Paul; Leatherdale, Scott T; Myran, Daniel T; Rehm, Jürgen; Wickens, Christine M; MacKillop, James; Halladay, Jillian. (2026). Adolescent cannabis use and psychological distress from 2013 to 2023: A population-based study in Ontario, Canada.. Addiction (Abingdon, England). https://doi.org/10.1111/add.70333
MLA
McDonald, André J, et al. "Adolescent cannabis use and psychological distress from 2013 to 2023: A population-based study in Ontario, Canada.." Addiction (Abingdon, 2026. https://doi.org/10.1111/add.70333
RethinkTHC
RethinkTHC Research Database. "Adolescent cannabis use and psychological distress from 2013..." RTHC-08477. Retrieved from https://rethinkthc.com/research/mcdonald-2026-adolescent-cannabis-use-and
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.