After recreational cannabis legalization, women showed larger increases in past-year (+3.2%) and past-month (+2.3%) cannabis use than men (+2.1% and +1.7%), but daily use and cannabis use disorder rates did not increase for either gender.
Public health officials, cannabis policy researchers, and gender-focused health advocates.
What the researchers found
RCL enactment was associated with higher increases in past-year cannabis use in women (aOR 1.30, 95% CI: 1.19-1.41) than men (aOR 1.15, 95% CI: 1.06-1.25), and similarly for past-month use. Critically, no increases in daily use or DSM-5 cannabis use disorder were observed after legalization for either gender. No increases in any cannabis outcomes were seen among 12-20 year-olds.
Why it matters
Cannabis legalization appears to be narrowing the historical gender gap in use. While this represents a demographic shift rather than a health crisis (since problematic use did not increase), it has implications for how prevention and treatment services are designed and targeted.
The numbers in context
Women: +3.2% past-year (aOR 1.30), +2.3% past-month (aOR 1.37). Men: +2.1% past-year (aOR 1.15), +1.7% past-month (aOR 1.19). No increase in daily use or CUD for either gender. No increase in any outcome for ages 12-20. 2008-2017 NSDUH data.
How the study worked
Repeated cross-sectional analysis of 2008-2017 NSDUH data examining changes before and after recreational cannabis law enactment. Multi-level logistic regression with state random intercepts and two-way and three-way interactions between RCL, gender, and age group.
What this study cannot tell us
NSDUH data is self-reported and cross-sectional within each wave. Study period ends in 2017, before many states had mature recreational markets. Cannot account for all confounders. DSM-5 CUD was a proxy measure, not a clinical diagnosis. Early legalization effects may differ from longer-term impacts.
How to read the evidence
Large nationally representative dataset with appropriate multi-level modeling and interaction terms, providing strong observational evidence of differential policy effects.
When this study was published
Published 2025, analyzing 2008-2017 NSDUH data.
The bigger picture
The lack of increase in daily use and cannabis use disorder is reassuring from a public health perspective. The gender gap narrowing aligns with patterns seen when other substances became more socially acceptable for women. The absence of youth increases counters a major concern about legalization.
Questions still open
- Whether the gender gap continues to narrow as legal markets mature beyond the 2008-2017 study period
- What specific factors drive women's cannabis use to increase more than men's after legalization
Common questions
Does this mean legalization is causing more women to develop cannabis problems?
Did teen cannabis use increase after legalization?
Read the original research
Gender differences in cannabis outcomes after recreational legalization: a United States repeated cross-sectional study, 2008-2017.
International journal of mental health and addiction, 23(3), 2496-2512
Citation
Segura, Luis E; Levy, Natalie S; Mauro, Christine M; Mauro, Pia M; Gutkind, Sarah; Philbin, Morgan M; Hasin, Deborah S; Martins, Silvia S. (2025). Gender differences in cannabis outcomes after recreational legalization: a United States repeated cross-sectional study, 2008-2017.. International journal of mental health and addiction, 23(3), 2496-2512. https://doi.org/10.1007/s11469-024-01271-7
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