Cannabis Use Disorder Rising Among Adults

The prevalence of cannabis use disorder (CUD) increased in adults from 2021 to 2024, while the prevalence of alcohol use disorder (AUD) remained stable, a cross-sectional study showed.

Among over 180,000 participants, past-year CUD prevalence increased among men (7.3% to 9.3%, P<0.001) and women (4.5% to 5.6%, P=0.01), reported Nora D. Volkow, MD, of the National Institute on Drug Abuse, and co-authors.

Of note, moderate-to-severe CUD prevalence also increased among men (3.1% to 4.1%, P<0.001), especially among those ages 35-49 and those ages 50 and older, and women (1.7% to 2.5%, P<0.001), especially among those ages 21-34, 35-49, and 50 and older, they noted in JAMA Psychiatry.

“High prevalence of moderate-to-severe CUD among adults who use cannabis challenges the notion that cannabis has low addictive potential,” the authors wrote. “Findings from this cross-sectional study suggest an urgent need for evidence-based, age- and sex-inclusive public health and clinical strategies to address rapidly evolving patterns of cannabis use, CUD, and moderate-to-severe CUD.”

Volkow told MedPage Today that “it was pretty shocking to see a significant rise in the number of people who have a cannabis use disorder,” which contrasts sharply with the perception that cannabis is a “safe drug.”

“These data, based on epidemiology, indicate that actually a much higher percentage of people that get exposed to cannabis are becoming addicted to it,” she said.

On the other hand, AUD prevalence remained stable among men, including the prevalence of moderate-to-severe AUD, with the exception of a decline in moderate-to-severe AUD prevalence for men ages 21-34. Moderate-to-severe AUD prevalence was also stable among women overall and within all subgroups.

A trend of younger adults shifting to cannabis from alcohol has been previously reported. “Specifically, people say, ‘Instead of drinking, I take cannabis,’ because they believe that it is less harmful,” Volkow noted.

Importantly, among both men and women ages 18-20 in 2024, CUD prevalence eclipsed AUD (14.5-14.9% vs 10.3-10.4%), even though the prevalence of alcohol use exceeds cannabis use (47.7-50.5% vs 29.8-30.7%).

Additionally, among men and women ages 18-20 and men ages 21-34, most of those with CUD had moderate-to-severe CUD (51-61% in 2024), with similar trends from 2022 through 2024, Volkow and team noted.

The fact that the prevalence of CUD is now greater than the prevalence of AUD, specifically for those ages 18-20, is notable, said Jack Wilson, PhD, of the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney.

“What we’re seeing here, in this nationally representative dataset, is a reflection of two things: that younger people are engaging in less risky patterns of alcohol use, and that cannabis is just simply more prevalent through greater access and more diverse and potent products,” Wilson told MedPage Today,pointing to the higher concentrations of tetrahydrocannabinol (THC), with “convincing evidence that the use of more potent cannabis products carries a greater risk of developing a cannabis use disorder.”

Meanwhile, the jump in moderate-to-severe CUD prevalence among middle-age adults could be a “cohort effect,” Volkow suggested. The highest rates of drug use are typically seen in adults ages 25-34, but “as these cohorts age into other age groups, they have the same prevalence,” she noted. For adults ages 50 and older, cannabis use is often sought for medicinal purposes, she added.

However, Wilson pointed out that such use is “rarely justified.”

This study assessed data from 186,823 participants in the National Survey on Drug Use and Health (NSDUH) from 2021 through 2024. Overall, 51.3% were women, 4.9% were ages 18-20, 24.1% were ages 21-34, and 24.7% were ages 35-49.

A limitation of the study was that it may underestimate the prevalence and severity of both CUD and AUD due to excluding unhoused and incarcerated individuals. In addition, the NSDUH is a self-report survey and may reflect social-desirability bias.

For clinicians, the message is to screen and intervene with a therapeutic plan or to refer patients to appropriate care, Volkow said.

She noted that future research should also focus on prevention, exploring what is driving the rise in use among specific demographic groups, and on treatment, as more effective CUD treatments are needed.