Cannabis use disorder rose among veterans in states that legalized, but the increase was similar for men and women

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Strong: large national database with 15 years of data, rigorous difference-in-difference methodology controlling for state and temporal effects.

When this study was published

2026 publication analyzing VHA data from 2005-2019.

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.

Questions still open

• 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?

Common questions

Read the original research

Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019.

Substance use & misuse, 61(2), 296-306

Citation

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

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