People of Color Are Severely Underrepresented in Cannabis Use Disorder Treatment Research | Research

The takeaway

White participants were included at 49 times their share of cannabis use disorder cases in behavioral health trials, while no studies were culturally adapted for people of color.

Addiction researchers, clinical trial designers, health equity advocates, and anyone interested in racial disparities in cannabis research.

49x overrepresentation of White participants in CUD trials

What the researchers found

Of 14 cannabis use disorder behavioral health RCTs (1994-2025), White people comprised 64% of participants despite having a smaller share of CUD cases, overrepresented at 49 times their proportional rate. Black participants were 19%, Latino 5%, Asian 0.6%, and Indigenous 0.4%. Zero studies were culturally adapted or designed to address challenges specific to people of color. Diversity has not improved over time.

Why it matters

People of color have higher CUD prevalence and severity, face unique challenges like racial discrimination, and experience more severe legal consequences of cannabis use. Yet the treatments being developed are overwhelmingly tested on White populations with no cultural adaptation.

The numbers in context

966 studies screened, 14 met criteria. White: 64% of participants (49x overrepresentation). Black: 19%. Latino: 5%. Multiracial/other: 0.8%. Asian: 0.6%. Indigenous: 0.4%. Zero culturally adapted studies.

How the study worked

Systematic review of PubMed, PsycINFO, and ClinicalTrials.gov for US-based adult cannabis use disorder behavioral health RCTs, identifying 14 of 966 studies for review.

What this study cannot tell us

Only US-based behavioral health RCTs were included. The small number of eligible studies (14) reflects the limited CUD treatment research overall. Self-identified race categories may not capture nuanced identities.

How to read the evidence

Systematic review of all eligible US-based CUD behavioral health RCTs, providing a comprehensive assessment of the research landscape.

When this study was published

2026 review covering 1994-2025.

The bigger picture

This is part of a broader pattern in clinical research where treatment approaches are developed for and tested on predominantly White populations, then applied to diverse communities without adaptation. For CUD specifically, this means treatments may not address the role of racial discrimination, differential policing, and cultural factors in cannabis use patterns.

Questions still open

Would culturally adapted CUD treatments be more effective for people of color? What specific modifications are needed to address the role of racial discrimination in CUD development and maintenance?

Common questions

Why does racial representation in research matter?

Treatments tested primarily on White populations may not work as well for other groups, especially when cultural factors like racial discrimination play a role in the condition being treated.

Has diversity in CUD research improved?

No. Despite decades of calls for more inclusive research, the racial composition of CUD clinical trials has not improved over time.

Read the original research

Racial diversity in cannabis use disorder research: A systematic review.

Drug and alcohol dependence, 278, 113008

View on PubMed ↗Publisher’s paper ↗

Citation

Reid, Mallet R; Reynolds, Blake; Cape, Jacqueline; Ahmed, Zara; Ali, Hashim; Jaimes-Bautista, Edgar; Gott, Connor; Barajas, Arturo; Müller, Frank; Alshaarawy, Omayma. (2026). Racial diversity in cannabis use disorder research: A systematic review.. Drug and alcohol dependence, 278, 113008. https://doi.org/10.1016/j.drugalcdep.2025.113008