ArticleThe International journal on drug policy2025
Cannabis legalization and increasing cannabis use in the United States: Data from urine toxicology testing in emergency room patients.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Cannabis use and glutamate across the psychosis spectrum: in vivo evidence from 7T proton magnetic resonance spectroscopy.Molecular psychiatry · 2026Article
- Cannabis Legalization and Cannabis Use Disorder by Sex in Veterans Health Administration Patients, 2005-2019.Substance use & misuse · 2026Article
- Cannabis Use and Glutamate across the Psychosis Spectrum: In Vivo Evidence from 7T Proton Magnetic Resonance Spectroscopy.Research square · 2025Article
- Cannabis legalization and cannabis use disorder in United States Veterans Health Administration patients with and without psychiatric disorders, 2005-2022: a repeated cross-sectional study.Lancet regional health. Americas · 2025Article
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Authors and funding
10 authors.
Funding
Abstract
STUDY
objectivesRates of cannabis use disorder (CUD) appear to be increasing nationally, with increases greater in states that legalized cannabis use. However, as legalization has progressed and stigma declined, some of these apparent increases could be due to greater willingness of survey respondents and patients to acknowledge cannabis involvement. Biological indicators of cannabis use overcome some concerns about trends denoted by self-report data whose validity is potentially changing over time. Our objective was to investigate the relationship between medical cannabis laws (MCL) and recreational cannabis laws (RCL) and the prevalence of cannabis-positive urine drug screens (UDS) in a large patient sample.
methodsVeterans Health Administration (VHA) emergency department (ED) patients aged 18-75 years with ≥1 ED visit for any reason in a given year from 2008 to 2019 were included. Staggered-adoption difference-in-difference analysis was used to estimate the association between MCL and RCL enactment on cannabis-positive UDS, fitting adjusted linear binomial regression models.
resultsAdjusted cannabis-positive UDS prevalences increased from 16.4 % to 25.6 % in states with no cannabis law, 16.6 % to 27.6 % in MCL-only-enacting states, and 18.2 % to 33.8 % in RCL-enacting states. MCL-only and RCL enactment was associated with a 0.8 % (95 % CI, 0.4-1.0) and 2.9 % (95 % CI, 2.5-3.3) increase in prevalence of cannabis-positive UDS, respectively.
conclusionsMCL and RCL enactment played a significant role in the overall increases in cannabis-positive UDS among ED patients. The increase in a biological measure of cannabis use helps reduce concerns about reporting bias as cannabis becomes increasingly legalized.
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