Psychological Distress and Cannabis Use Modalities Among U.S. Adults: A National Survey Analysis

Cannabis use in the United States has become increasingly diverse following widespread legalization, with multiple consumption modalities differing in potency, pharmacokinetics, and health effects. Understanding how psychological distress relates to specific cannabis use modalities is essential for targeted public health surveillance.

To examine the association between past-month serious psychological distress (SPD) and cannabis use modalities among U.S. adults.

We analyzed 33,404 adults aged ≥18 years from the 2023 National Survey on Drug Use and Health (NSDUH). Survey-weighted logistic regression models were used to examine associations between SPD and past-month cannabis use modalities, adjusting for sociodemographic characteristics, substance use behaviors, and mental health treatment. Each cannabis modality was modeled separately as a binary outcome.

Overall, 8.9% of adults reported SPD. Cannabis use was more prevalent among adults with SPD than those without (26.8 vs. 12.3%). In adjusted analyses, SPD was associated with higher odds of multiple cannabis modalities, including smoking (AOR = 1.72, 95% CI: 1.47-2.01), vaping (AOR = 1.84, 95% CI: 1.44-2.34), dabbing (AOR = 1.68, 95% CI: 1.29-2.20), blunt use (AOR = 2.06, 95% CI: 1.69-2.50), topical use (AOR = 1.99, 95% CI: 1.26-3.13), and drops/strips (AOR = 2.41, 95% CI: 1.48-3.93). Edible cannabis use was also significantly associated with SPD (AOR = 1.45, 95% CI: 1.14-1.84), whereas associations with pill use were not statistically significant.

Psychological distress is associated with increased likelihood of using multiple cannabis modalities among U.S. adults, with variation across product types. These findings highlight the importance of considering mental health status in cannabis surveillance and the need for modality-specific approaches in prevention and clinical care.