As nonmedical use of cannabis becomes legal in more states, many have wondered if this will lead to an increase in use of other substances such as alcohol and cigarettes. Current research has brought about mixed outcomes on the spillover effect of cannabis legalization on alcohol, tobacco, and opioid use. Washington State (WA) legalized medical cannabis in 1998 and nonmedical cannabis for adults 21 and older in 2012. This study examines alcohol, cigarette, e-cigarette, and pain reliever misuse during the six years following legalization of nonmedical cannabis among young adults in WA.  

The study’s sample consisted of 12,694 young adults ages 18-25 from WA who participated in the Young Adult Health Study. Participants were asked to complete an online survey that assessed past month use of alcohol, cigarettes, e-cigarettes, and cannabis. They were also asked to report pain reliever misuse over the past year. Data was analyzed using regression models to assess for changes in substance use in the years following the legalization of nonmedical cannabis.  

Results of the data analysis showed that the prevalence of alcohol use, heavy episodic drinking, cigarette use, and pain reliever misuse decreased following the legalization of nonmedical cannabis. E-cigarette use increased following the legalization of nonmedical cannabis. Cannabis use did not change significantly for those ages 18-20 but increased over time for those ages 21-25. Occasional (1-19 days) and frequent (20+ days) past-month cannabis use were positive and statistically significant with use of other substances. However, the relationship between cannabis use and pain reliever misuse weakened over time for those ages 21-25 who were both occasional and frequent cannabis users. This weakening effect was also observed between frequent cannabis use and heavy episodic drinking for those ages 21-25.  

Takeaway: Following the legalization of nonmedical cannabis use in Washington State, past month use of substances including alcohol, cigarettes, and pain reliever misuse decreased among young adults. 

Fleming, C.B., Ramirez, J.J., Rhew, I.C., et al. Trends in Alcohol, Cigarette, E-Cigarette, and Nonprescribed Pain Reliever Use Among Young Adults in Washington State After Legalization of Nonmedical Cannabis [published online ahead of print, 2022 May 9]. The Journal of Adolescent Health. 2022;S1054-139X(22)00374-3. doi:10.1016/j.jadohealth.2022.03.006