Cannabis Use Disorder and Suicidal Ideation in the United States: Persistent Risk and Stable Trends, 2014-2023.

OBJECTIVE

Amid rising cannabis use, declining perceived harm, and policy liberalization over the past 15 years, we examined whether the association between cannabis use disorder (CUD) and past-year suicidal ideation among U.S. adults changed from 2014-2023 and varied by sex, age, and race/ethnicity.

METHOD: Using data from 415,861 adults in the 2014-2023 National Surveys on Drug Use and Health, we examined temporal association change between past-year suicidal ideation and CUD (≥2 of 9 harmonized DSM-5 criteria). Logistic regression models, adjusted for demographic, social, clinical, and geographic covariates, tested whether survey year moderated the CUD-suicidal ideation association overall and in strata by sex, age, and race/ethnicity.

RESULTS

Adults with cannabis use disorder had 57% higher odds of past-year suicidal ideation than those without (OR, 1.57; 95% CI, 1.44-1.72) across years. Joint Wald tests showed no evidence that the association changed over time overall (p = 0.12) nor within strata defined by sex or age. Although the joint interaction test suggested some variation among Hispanic respondents (p = 0.01), no individual year-specific interaction terms remained statistically significant after Bonferroni correction.

CONCLUSIONS

Adults with CUD had higher odds of suicidal ideation but, contrary to expectations, the strength of this association remained stable from 2014-2023 and did not differ significantly across sex, age, or racial/ethnic groups despite widespread legalization, increased potency, and shifting norms.