Legal Recreational Marijuana Tied to Higher Prevalence of Cannabis Use Disorder

Pauline Anderson

September 06, 2023


Cannabis use disorder (CUD) is common in a state where recreational use is legal, with moderate to severe CUD most prevalent among individuals who use it for nonmedical reasons, new research shows.


  • As of June 2023, 38 US states have legalized medical cannabis, and of these, 23 have legalized recreational use.

  • The study, conducted by Kaiser Permanente in Washington State, where recreational cannabis use is legal, included 1463 predominantly middle-aged and female participants who reported past 30-day cannabis use on a confidential survey.

  • Researchers categorized patients by reason for using cannabis (medical use only, nonmedical use only, or both reasons) and determined CUD diagnosis and severity.

  • Respondents were also asked about modes of cannabis use, including inhalation (smoking, vaping), ingestion (eating, drinking), and application (lotion, ointment), and frequency of use.


  • About 42.4% of respondents (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) reported both reasons for use.

  • The prevalence of any CUD was 21.3% (95% CI, 15.4%-28.6%) and did not differ depending on the reason for use.

  • However, the prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use only, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use only, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01).

  • The most common primary modes of use were application for patients with medical use only (36.1), and inhalation for those with nonmedical use only (59.5%) and those with both reasons for use (69.4%).

  • Patients who reported both reasons for use (medical and nonmedical) were more likely to use cannabis three or more times per day, with 71.8% using cannabis 4 or more days per week.


Identifying CUD and gauging its severity "can support engagement around symptoms, shared decision-making, and offering of treatment if desired, especially for patients with moderate to severe CUD who may benefit most from treatment," the researchers write.


The study was conducted by Gwen T. Lapham, PhD, MPH, MSW, Kaiser Permanente Washington Health Research Institute, Seattle, and colleagues. It was published online August 29 in JAMA Network Open .


The survey response rate (34%) was lower than desired. Results may not generalize to patients outside the healthcare system in the study, including those in states with different cannabis laws. The study could not explore CUD prevalence by reasons for use across patient characteristics (for example, age, sex, race, ethnicity) and cannabis measures (for example, mode and frequency of use).


The study was supported by the National Institute on Drug Abuse Clinical Trials Network. Authors Lapham, Theresa E. Matson, PhD, MPH, Jennifer F. Bobb, PhD, and Katharine A. Bradley, MD, MPH, all from Kaiser Permanente Washington Health Research Institute, reported grants from the National Institute on Drug Abuse during the conduct of the study; no other disclosures were reported.

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