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Cannabis Use Among Individuals With Psychosis After State-Level Commercial Cannabis Legalization
Andrew S Hyatt1,2, Michael William Flores1,2, Julie Johnson3
1Health Evaluation Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts.
JAMA Psychiatry
|October 8, 2025
Summary
Recreational cannabis legalization (RCL) significantly increased 30-day cannabis use by 9.53 percentage points among individuals with psychosis. These findings highlight the need for regulatory consideration of cannabis policies for vulnerable populations.
Area of Science:
- Public Health
- Psychiatry
- Cannabis Research
Background:
- Individuals with psychosis are particularly vulnerable to adverse effects of cannabis use.
- Previous research has not examined the impact of recreational cannabis legalization (RCL) on cannabis use in this population.
Purpose of the Study:
- To assess the impact of RCL on cannabis use patterns among individuals with a history of psychotic illness in the United States.
Main Methods:
- Utilized data from 2014-2022 from the Population Assessment of Tobacco and Health study, a nationally representative longitudinal cohort.
- Included 1856 adults with a lifetime history of psychosis, analyzing state-level RCL and 30-day cannabis use via difference-in-differences methods.
Main Results:
- Individuals with psychosis in RCL states showed a significant 9.53 percentage point increase in 30-day cannabis use post-legalization.
- Sensitivity analyses indicated this increase was associated with the opening of retail outlets, not the legalization date itself.
- No significant changes were observed in higher-frequency cannabis use.
Conclusions:
- RCL is associated with a substantial increase in current cannabis use among individuals with psychosis, exceeding general population estimates.
- These findings underscore the importance of regulatory policies concerning cannabis taxation, potency, advertising, and health warnings for this vulnerable group.
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