Cannabis use disorder rose among veterans in states that legalized, but the increase was similar for men and women
A study of U.S. veterans from 2005 to 2019 found cannabis use disorder increased more in states that enacted medical or recreational cannabis laws than in states that did not, but the increases were generally similar between male and female veterans.
Quick Facts
What This Study Found
CUD prevalence increased in both sexes across the study period. States enacting medical or recreational cannabis laws saw greater CUD increases than non-legalizing states. However, with one exception (males aged 35-64 under recreational laws), the sex-specific increases were not significantly different. Both sexes showed rising CUD rates regardless of state policy.
Key Numbers
2005-2019 data; veterans ages 18-75; VHA patients; staggered-adoption difference-in-difference design; one significant sex difference: males aged 35-64 showed greater CUD increase after recreational legalization
How They Did This
VHA Corporate Data Warehouse data for veterans ages 18-75 with at least one primary care, emergency, or mental health visit per year from 2005 to 2019. Staggered-adoption difference-in-difference analyses with linear binomial regression, fixed effects for state and year, time-varying cannabis law status, and sociodemographic covariates.
Why This Research Matters
The veteran population has high rates of mental health conditions and substance use. Understanding how legalization affects cannabis use disorder in this population, and whether sex differences exist, is important for VA clinical planning.
The Bigger Picture
This contributes to the growing evidence that cannabis legalization is associated with increased cannabis use disorder, though the effect appears consistent across sexes. The finding that CUD rose even in non-legalizing states suggests broader cultural shifts are also at play.
What This Study Doesn't Tell Us
VHA patients are not representative of all veterans or the general population. CUD diagnosis rates may reflect changes in screening and detection rather than true prevalence changes. Cannot distinguish between increased disorder and increased diagnosis.
Questions This Raises
- ?Why did CUD increase even in states without legalization?
- ?Are VA clinicians screening more for cannabis use disorder over time?
- ?Would different results emerge with a longer post-legalization follow-up period?
Trust & Context
- Key Stat:
- CUD increased more in states with cannabis laws, but sex differences were minimal
- Evidence Grade:
- Strong: large national database with 15 years of data, rigorous difference-in-difference methodology controlling for state and temporal effects.
- Study Age:
- 2026 publication analyzing VHA data from 2005-2019.
- Original Title:
- Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019.
- Published In:
- Substance use & misuse, 61(2), 296-306 (2026)
- Authors:
- Wisell, Caroline G(4), Hasin, Deborah S(31), Wall, Melanie M(16), Alschuler, Daniel, Malte, Carol, McDowell, Yoanna, Olfson, Mark, Keyes, Katherine M, Cerdá, Magdalena, Maynard, Charles C, Keyhani, Salomeh, Martins, Silvia S, Mannes, Zachary L, Livne, Ofir, Fink, David S, Bujno, Julia M, Stohl, Malki, Saxon, Andrew J, Simpson, Tracy L
- Database ID:
- RTHC-08713
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does cannabis legalization increase use disorder among veterans?
Yes. CUD prevalence increased more in states that enacted medical or recreational cannabis laws compared to states that did not. However, CUD also rose in non-legalizing states, suggesting multiple factors are driving the trend.
Are female veterans more affected than male veterans?
Generally no. The sex-specific increases in CUD after legalization were not significantly different, with one exception: males aged 35-64 showed a greater increase under recreational laws.
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Cite This Study
https://rethinkthc.com/research/RTHC-08713APA
Wisell, Caroline G; Hasin, Deborah S; Wall, Melanie M; Alschuler, Daniel; Malte, Carol; McDowell, Yoanna; Olfson, Mark; Keyes, Katherine M; Cerdá, Magdalena; Maynard, Charles C; Keyhani, Salomeh; Martins, Silvia S; Mannes, Zachary L; Livne, Ofir; Fink, David S; Bujno, Julia M; Stohl, Malki; Saxon, Andrew J; Simpson, Tracy L. (2026). Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019.. Substance use & misuse, 61(2), 296-306. https://doi.org/10.1080/10826084.2025.2554866
MLA
Wisell, Caroline G, et al. "Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019.." Substance use & misuse, 2026. https://doi.org/10.1080/10826084.2025.2554866
RethinkTHC
RethinkTHC Research Database. "Cannabis Legalization and Cannabis Use Disorder by Sex in Ve..." RTHC-08713. Retrieved from https://rethinkthc.com/research/wisell-2026-cannabis-legalization-and-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.