Women's Cannabis Use Increased More Than Men's After Recreational Legalization
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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
Trust & Context
- Key Stat:
- Evidence Grade:
- Large nationally representative dataset with appropriate multi-level modeling and interaction terms, providing strong observational evidence of differential policy effects.
- Study Age:
- Published 2025, analyzing 2008-2017 NSDUH data.
- Original Title:
- Gender differences in cannabis outcomes after recreational legalization: a United States repeated cross-sectional study, 2008-2017.
- Published In:
- International journal of mental health and addiction, 23(3), 2496-2512 (2025)
- Authors:
- Segura, Luis E(2), Levy, Natalie S(2), Mauro, Christine M(5), Mauro, Pia M, Gutkind, Sarah, Philbin, Morgan M, Hasin, Deborah S, Martins, Silvia S
- Database ID:
- RTHC-07612
Evidence Hierarchy
Watches what happens naturally without intervening.
What do these levels mean? →Frequently Asked Questions
Does this mean legalization is causing more women to develop cannabis problems?
No. While more women started using cannabis after legalization, rates of daily use and cannabis use disorder did not increase. The increase was in occasional and moderate use, not problematic use patterns.
Did teen cannabis use increase after legalization?
No. The study found no increases in any cannabis outcome among 12-20 year-olds after recreational legalization, which is consistent with findings from other studies and counters a common concern about legalization.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-07612APA
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
MLA
Segura, Luis E, et al. "Gender differences in cannabis outcomes after recreational legalization: a United States repeated cross-sectional study, 2008-2017.." International journal of mental health and addiction, 2025. https://doi.org/10.1007/s11469-024-01271-7
RethinkTHC
RethinkTHC Research Database. "Gender differences in cannabis outcomes after recreational l..." RTHC-07612. Retrieved from https://rethinkthc.com/research/segura-2025-gender-differences-in-cannabis
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.