The relationship between cannabis use and legalization frameworks: A cross-sectional analysis using a nationally...

State policies related to cannabis have rapidly evolved but the impact of current legislative frameworks on usage is not well characterized. This study explored cannabis use patterns under different legalization statuses in the United States. The dataset included individuals from the Behavioral Risk Factor Surveillance System survey in 2017 and 2018. Respondents were categorized into limited medical use, full medical use, or full legalization groups based on their state's cannabis policies. The primary outcome was cannabis use in the past 30 days. Among users, we characterized frequency, method, and reason for use. Logistic regression models were estimated to assess associations between legal status and these outcome measures. The study sample included 168,299 respondents. The unweighted proportion of respondents reporting cannabis use were: 4.96% in states with limited medical use, 6.50% in states with full medical use, and 12.33% in states with full legalization. Adjusted odds of use were greater for the full medical use group (1.13, 95%CI:1.02-1.25) and the full legalization group (2.53, 95%CI:2.28-2.82) compared to the limited medical use group. Users were more likely to use non-smoking methods in the full legalization group compared to the limited medical use group (1.77, 95%CI:1.41-2.22). A greater proportion of users in the full legalization group reported medical usage than in the other two groups. Policymakers should consider these findings in order to allow for use while safeguarding public health.