Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019

Understanding sex differences in the effects of cannabis legalization and increasing risk for cannabis use disorder (CUD) is important. We hypothesized that from 2005 to 2019, increases in CUD prevalence due to state medical or recreational cannabis laws (MCL; RCL) would differ among male and female veterans treated at the U.S. Veterans Health Administration (VHA), with greater increases among females.

Data obtained through the VHA Corporate Data Warehouse included veterans 18-75 years with ≥1 VHA primary care, emergency department, or mental health visit in a given year, 2005-2019. Staggered-adoption difference-in-difference analyses were used to estimate the role of MCL and RCL on trends in CUD diagnostic prevalence, fitting a linear binomial regression model with fixed effects for state and categorical year, time-varying cannabis law status, state-level sociodemographic covariates, patient-level age group (18-35, 36-64, 65-75 years), race and ethnicity.

CUD prevalences increased in both sexes. CUD increased more in states enacting MCL and RCL than in states that did not enact CL. However, no CUD prevalence increases attributable to the change from no-CL to MCL-only or MCL to RCL differed significantly by sex, with one exception (greater in males aged 35-64).

Increases in CUD prevalence following MCL or RCL enactment were greater than in states with no-CL, but generally did not show differences by sex. The increases in CUD prevalence occurring for males and females throughout the study years indicate the need for cannabis use screening by medical providers and the importance of offering evidence-based treatments for CUD.