Narrowing and Reversing Sex Gaps in Cannabis Use and Cannabis Use Disorder Among Adolescents and Young Adults

Historically, cannabis use and cannabis use disorder (CUD) have been more prevalent among males than among females. However, emerging evidence suggests that cannabis use may be increasing faster among females in younger age groups. This study characterized changes in female versus male differences in cannabis use and CUD across age groups and time.

Annual data from the 2014-2023 National Surveys on Drug Use and Health (NSDUH) were analyzed by age groups (12-17 [adolescents], 18-25 years, and 26 years or older) for past-month cannabis use, past-year daily/near-daily cannabis use (300 or more days), and past-year CUD. Prevalence differences (PDs) in percentage points between females and males were evaluated using generalized linear models.

From 2014 to 2023, the prevalence of cannabis use (past-month and daily/near daily) and CUD increased among adults, with shifts in PDs across age groups. In 2022, adolescent females surpassed males in past-month cannabis use (PD = 2.3; 95% CI [1.0, 3.6]). By 2023, both daily/near-daily use and CUD prevalence were higher among adolescent females (e.g., CUD PD = 2.4; 95% CI [1.4, 3.4]). Among adults ages 18-25, all outcomes remained lower among females, but PDs narrowed over the study period. In adults age 26 years or older, females consistently had lower prevalence across all outcomes.

Results showed reversals in female versus male differences among adolescents and narrowing gaps among younger adults. Tailored interventions considering sex and age may prevent and reduce CUD. Further research is needed to understand the reasons behind these shifts.