Secular Trends and Predictors of Frequent Cannabis Use From 2002-2019 in the United States

To evaluate the trajectory of prevalence of frequent cannabis use from 2002 to 2019 in the United States and its predictors.

We investigated individuals 12 years of age or older from the National Survey on Drug Use and Health from 2002 to 2019. Main outcomes were the changing prevalence of cannabis use, frequent cannabis use (defined as 100 to 365 days of use in the past year), and associated factors.

A total of 1,005,421 participants were included. The prevalence of frequent cannabis use doubled from 4.0% in 2002 to 7.8% in 2019 (P<.001). The young adult population was the primary driver of frequent cannabis use. Males were always the majority of frequent cannabis users, but the rate of increase was higher in females. Predictors of frequent cannabis use were male sex (odds ratio [OR], 1.98; 95% CI, 1.93 to 2.03) and young adults 18 to 25 years of age (OR, 1.92; 95% CI, 1.82 to 2.02). Black, Native American, and mixed-race individuals were associated with frequent cannabis use, as was not having a college degree and lower family income. Frequent smoking (OR, 3.84; 95% CI, 3.74 to 3.95) and frequent alcohol use (OR, 2.52; 95% CI, 2.41 to 2.63) were also associated with frequent cannabis use.

Frequent cannabis use in young adults in the United States has increased rapidly. Male sex, race, frequent smoking or alcohol use, low family income, and education level were significant predictors, suggesting population strategies for mitigation of frequent recreational cannabis use and health consequences.