Cannabis-related diagnoses rose 22% among German adolescents from 2013 to 2022, with 78% having a co-occurring psychiatric disorder
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 78.3% of adolescents with cannabis diagnoses also had a psychiatric disorder
- Evidence Grade:
- Strong: population-level insurance data covering nearly 4 million youth over 10 years with standardized ICD-10 diagnoses.
- Study Age:
- 2026 publication analyzing German insurance data from 2013-2022.
- Original Title:
- 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.
- Published In:
- European journal of public health (2026)
- Authors:
- Zarour, Alexander, Bachmann, Christian, Dandolo, Lisa, Holstiege, Jakob, Hoffmann, Falk, Scholman, Constanze, Golub, Yulia
- Database ID:
- RTHC-08734
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Are cannabis diagnoses rising among German teens?
Yes, by 22.4% from 2013 to 2022 (0.08% to 0.10%), with a temporary dip during the COVID-19 pandemic. Rates were higher in older teens and in males starting at age 15.
How common is it to have a mental health diagnosis alongside a cannabis diagnosis?
Very common. In 2022, 78.3% of adolescents with cannabis-related disorders also had at least one psychiatric diagnosis, most often depression, followed by conduct disorders and adjustment disorders.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08734APA
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
MLA
Zarour, Alexander, et al. "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, 2026. https://doi.org/10.1093/eurpub/ckaf228
RethinkTHC
RethinkTHC Research Database. "Trends in the diagnostic prevalence of cannabis-related diso..." RTHC-08734. Retrieved from https://rethinkthc.com/research/zarour-2026-trends-in-the-diagnostic
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.