The Effects of Recreational Cannabis Laws on Alcohol and Tobacco Use Among U.S. Adults, 2012-2022.

INTRODUCTION

Many states have legalized the use of cannabis for medicinal and recreational purposes in the past decade. However, it remains unclear how recreational cannabis laws affect alcohol and tobacco use among adults.

METHODS

This was a cross-sectional study of 4.8 million adults from the 2012-2022 Behavioral Risk Factor Surveillance System. A difference-in-differences approach was used to examine the impact of recreational cannabis laws on alcohol and tobacco use, adjusting for individual-level characteristics and time-varying state-level factors. The analyses were performed in 2024.

RESULTS

Three alcohol-use outcomes (current, binge, and heavy drinking) and 2 tobacco-use outcomes (current and smokeless tobacco use) were examined. Considering the passage of laws as cannabis law implementation, recreational cannabis laws were not associated with any alcohol or tobacco use outcomes in the fully adjusted model. However, considering operational dispensary as cannabis law implementation, recreational cannabis laws were associated with a decrease of 0.95 percentage point (95% CI=1.80, 0.09) in current drinking and a decrease of 0.48 percentage point (95% CI=0.85, 0.10) in current cigarette use. Subgroup analysis showed that recreational cannabis laws were associated with reductions in current drinking, binge drinking, and current cigarette use in multiple groups. However, recreational cannabis laws were associated with increases in current smokeless tobacco use for some groups.

CONCLUSIONS

The findings suggest that although the overall effects of recreational cannabis laws on the use of alcohol and tobacco may be limited, there are heterogeneous associations between recreational cannabis laws and drinking and smoking by age, sex, race and ethnicity, education, and income.