German health insurance data covering nearly 4 million youth found cannabis-related disorder diagnoses increased 22% from 2013 to 2022, with 78% of affected adolescents also diagnosed with at least one psychiatric condition, most commonly depression.
Adolescent psychiatrists, German health policymakers, youth mental health advocates
78.3% of adolescents with cannabis diagnoses also had a psychiatric disorder
What the researchers found
Cannabis-related disorder diagnoses increased from 0.08% to 0.10% (+22.4%) among German adolescents ages 12-17 from 2013 to 2022, with a COVID-19 pandemic dip. Up to age 14, diagnoses were evenly split by sex; from age 15+, males had higher rates. In 2022, 78.3% had at least one co-occurring psychiatric diagnosis, most commonly depression, conduct disorders, adjustment disorders, ADHD, and anxiety disorders.
Why it matters
The extremely high rate of psychiatric comorbidity (78%) underscores that cannabis-related disorders in adolescents rarely occur in isolation. Depression co-occurring with cannabis use disorder in this age group demands integrated treatment approaches.
The numbers in context
Nearly 4 million youth covered; prevalence: 0.08% (2013) to 0.10% (2022) = +22.4%; COVID dip observed; sex ratio equal before 15, male-predominant after 15; 78.3% with co-occurring psychiatric diagnosis in 2022; top comorbidities: depression, conduct disorders, adjustment disorders, ADHD, anxiety
How the study worked
Analysis of outpatient claims data from the German national public health insurance system, covering almost 4 million children and adolescents ages 12-17 from 2013 to 2022. ICD-10 F12.X diagnoses for cannabis-related disorders were examined, stratified by age and sex, with co-occurring psychiatric diagnoses evaluated for 2022.
What this study cannot tell us
Insurance claims data reflect diagnoses, not true prevalence. Changes in clinical awareness and screening may inflate trends. Only captures outpatient treatment-seeking youth. Cannot determine directionality of cannabis-psychiatric comorbidity.
How to read the evidence
Strong: population-level insurance data covering nearly 4 million youth over 10 years with standardized ICD-10 diagnoses.
When this study was published
2026 publication analyzing German insurance data from 2013-2022.
The bigger picture
This parallels trends seen in other Western countries: rising adolescent cannabis use diagnoses alongside high psychiatric comorbidity. Germany's 2024 partial legalization makes this baseline data particularly valuable for tracking future trends.
Questions still open
- Did Germany's 2024 cannabis legalization accelerate or decelerate the trend? Does depression drive cannabis use, or vice versa, in this age group? Would integrated treatment programs addressing both conditions improve outcomes?
Common questions
Are cannabis diagnoses rising among German teens?
How common is it to have a mental health diagnosis alongside a cannabis diagnosis?
Read the original research
Trends in the diagnostic prevalence of cannabis-related disorders and co-occurring psychiatric disorders in adolescents: analysis of German health insurance data from 2013 to 2022.
European journal of public health
Citation
Zarour, Alexander; Bachmann, Christian; Dandolo, Lisa; Holstiege, Jakob; Hoffmann, Falk; Scholman, Constanze; Golub, Yulia. (2026). Trends in the diagnostic prevalence of cannabis-related disorders and co-occurring psychiatric disorders in adolescents: analysis of German health insurance data from 2013 to 2022.. European journal of public health. https://doi.org/10.1093/eurpub/ckaf228
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