Even non-disordered cannabis use in teens was linked to depression, suicidal thoughts, and worse school outcomes
Among 68,000+ US adolescents, those who used cannabis without meeting disorder criteria still had roughly doubled odds of major depression, suicidal ideation, truancy, and low grades compared to non-users.
Quick Facts
What This Study Found
Nondisordered cannabis use (NDCU) was 4 times more prevalent than cannabis use disorder (10.2% vs. 2.5%) among US adolescents. NDCU was associated with 2-4 times greater odds of adverse psychosocial events compared to non-use, forming a stepwise gradient from non-use through NDCU to CUD.
Key Numbers
68,263 respondents representing ~25 million US adolescents annually. NDCU: 10.2%, CUD: 2.5%, non-use: 87.3%. NDCU adjusted odds ratios vs. non-use: depression 1.86, suicidal ideation 2.08, arrest 4.15, fighting 2.04, low GPA 1.80, truancy 1.90.
How They Did This
Cross-sectional analysis of the 2015-2019 National Survey on Drug Use and Health. 68,263 adolescents aged 12-17 classified as non-users, nondisordered cannabis users, or having cannabis use disorder (DSM-5 criteria). Adjusted logistic regression examined associations with adverse psychosocial events.
Why This Research Matters
Clinical attention typically focuses on cannabis use disorder, but subclinical use is four times more common in teens and still carries significant associations with depression, suicidality, and academic problems.
The Bigger Picture
As cannabis is increasingly normalized, the assumption that use below the disorder threshold is harmless deserves scrutiny. This nationally representative data suggests a dose-response pattern where any regular use in adolescence correlates with worse outcomes.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine causation. Adolescents with pre-existing mental health issues may be more likely to use cannabis (reverse causation). Self-reported data may be affected by social desirability. NDCU is defined by absence of disorder criteria, not by frequency or quantity.
Questions This Raises
- ?Does NDCU in adolescence predict later development of cannabis use disorder?
- ?Would prospective studies confirm the associations or reveal that pre-existing vulnerabilities explain the pattern?
Trust & Context
- Key Stat:
- NDCU 4x more common than cannabis use disorder; still linked to 2-4x higher odds of adverse outcomes
- Evidence Grade:
- Large nationally representative sample with validated measures. Cross-sectional design precludes causal inference.
- Study Age:
- Published 2023. Data from 2015-2019.
- Original Title:
- Nondisordered Cannabis Use Among US Adolescents.
- Published In:
- JAMA network open, 6(5), e2311294 (2023)
- Authors:
- Sultan, Ryan S(4), Zhang, Alexander W(2), Olfson, Mark(17), Kwizera, Muhire H, Levin, Frances R
- Database ID:
- RTHC-04968
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
What is nondisordered cannabis use?
It means using cannabis in the past year but not meeting DSM-5 criteria for cannabis use disorder. This includes teens who use occasionally or regularly but have not developed the pattern of compulsive use, tolerance, withdrawal, or functional impairment that defines a clinical disorder.
Does casual cannabis use harm teenagers?
This study found associations between any cannabis use (even below disorder threshold) and higher rates of depression, suicidal thoughts, academic problems, and arrests in teens. However, the cross-sectional design cannot prove cannabis caused these outcomes. Pre-existing mental health issues may lead some teens to both use cannabis and experience these problems.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-04968APA
Sultan, Ryan S; Zhang, Alexander W; Olfson, Mark; Kwizera, Muhire H; Levin, Frances R. (2023). Nondisordered Cannabis Use Among US Adolescents.. JAMA network open, 6(5), e2311294. https://doi.org/10.1001/jamanetworkopen.2023.11294
MLA
Sultan, Ryan S, et al. "Nondisordered Cannabis Use Among US Adolescents.." JAMA network open, 2023. https://doi.org/10.1001/jamanetworkopen.2023.11294
RethinkTHC
RethinkTHC Research Database. "Nondisordered Cannabis Use Among US Adolescents." RTHC-04968. Retrieved from https://rethinkthc.com/research/sultan-2023-nondisordered-cannabis-use-among
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.