Overdose deaths among teens has more than doubled since 2019. There are many contributing factors at individual, state, and national levels. This study investigated whether cannabis policies may partially explain the increase.
Overdose deaths among teens has more than doubled since 2019. There are many contributing factors at individual, state, and national levels. This study investigated whether cannabis policies may partially explain the increase.
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In 2024, rates of non use of alcohol, cannabis, and nicotine (including vaping and cigarettes) among adolescents reached record highs. Nearly 70% of 12th graders, 80% of 10th graders, and 90% of 8th graders reported no past-30-day use of these substances. However, there has simultaneously been an increase in overdose deaths among adolescents (14-18 years old) since 2019. Between August 2019 and March 2020, overdose deaths among adolescents more than doubled, and they further increased in 2022. There is a variety of contributing factors to substance use and overdoses among young people. One possibility is that adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, this cannabis use may be a “gateway” to the use of other substances, such as opioids, or in more harmful ways. Identifying macro-level factors accounting for these increased overdose rates may help align resources with needs while also driving future policy.
Cannabis policy has undergone substantial and varied changes across the United States. By the beginning of 2021, 14 jurisdictions legalized recreational adult cannabis use, 16 legalized medicinal but not recreational adult cannabis use, and 21 has not legalized any form of cannabis. Cannabis use among adolescents remains illegal in all jurisdictions. Cannabis legalization has been linked to an increased likelihood of adolescent cannabis use. Adolescents that report e-cigarette use and live in a state with legalized recreational cannabis use also have odds of cannabis use 18 times that of adolescents not reporting e-cig use and living in states with legalized recreational cannabis use. Although cannabis legalization has only been for adults, there are possible trickle down or ripple effects for adolescents.
One possible ripple effect of adult cannabis use legalization is an increase in overdose deaths among adolescents. The researchers in this study compared overdose deaths among adolescents between US jurisdictions that legalized recreational cannabis use, only legalized medicinal cannabis use, and have not legalized any cannabis use. The findings may highlight the need for additional education and consideration of adolescent development, even among policies focused on adults.
This study was a retrospective analysis that investigated the relationship between cannabis legalization status and adolescent overdose deaths each year from 2008 to 2021 in the 50 United States and Washington D.C. The overdose death data for adolescents aged 14 to 18 years was obtained from the Centers for Disease Control WONDER database. Each jurisdiction was also classified with a cannabis legalization status based on their legalization as of January 2021: recreational, medicinal only, non-legalized. Each jurisdiction’s cannabis legalization status each year was determined when a jurisdiction implemented the policy, not just passed the legislation. This attempts to account for jurisdiction-level factors that might be associated with opioid overdose rates but were not measured (i.e., policy climate, population). By 2021, 14 jurisdictions legalized recreational use, 16 legalized medicinal only, and 21 had not legalized. The researchers then compared the trends in overdose death between the 3 groups between 2008 and 2021.
Overdose death rates began to increase with recreational legalization
Between 2008 and 2014, the drug overdose death rates in adolescents aged 14-18 years were similar and generally declining in all three groups. In 2015, when jurisdictions began legalizing recreational use, legalizing jurisdictions began to have higher overdose deaths comparatively.
Mean overdose death rates were greater in recreational legalizing jurisdictions compared to non-legalizing
As shown in the graph below, in 2019, jurisdictions that legalize recreational cannabis use had higher overdose deaths compared to non-legalizing ones. Jurisdictions that legalized recreational use had 2-fold, 6-fold, and 2-fold greater overdose death rate compared to non-legalizing jurisdictions in 2019, 2020, and 2021, respectively.
Mean overdose deaths among males and non-Hispanic white individuals were greater than counterparts in states that legalized recreational use
In 2021, the drug overdose death rate among male adolescents was 39% higher in jurisdictions legalizing recreational use compared to non-legalizing jurisdictions. There was not a significant difference in rate among females although there was an upward trend in all jurisdictions. Non-Hispanic White identifying adolescents had significantly higher overdose death rates in legalizing jurisdictions compared to non-legalizing jurisdictions. Among non-Hispanic Black and Hispanic identifying adolescents, there was a similar increase in overdose deaths across all jurisdictions.
In this study, the researchers found that the adolescent overdose death rate was higher in states that legalized recreational cannabis use for adults compared to those jurisdictions that did not legalize any cannabis use. This study underscores the possible ripple effects of adult cannabis legalization among adolescents. There were three categories of legalization: recreational legalization, medicinal only legalization, and non-legalizing jurisdictions. Adolescent drug overdose death rates began to increase in all jurisdictions once recreational cannabis use began to be legalized. By 2019, the rates in jurisdictions legalizing recreational use began to increase at a faster rate than the other jurisdictions. In 2019-2021 legalizing jurisdictions had an average of a 227% higher death rate compared to non-legalizing jurisdictions.
Although the differences in jurisdictions by 2021 was substantial, the findings from this study does not establish causation, or that the cannabis legalization caused the increase in overdose deaths. There are numerous other factors that may have contributed to higher overdose deaths, which were not accounted for in the study. For example, the cultures or financial stability in some jurisdictions may contribute to substance use and overdose in a meaningful way that was not accounted for in this study. It is also possible that states which legalized recreational cannabis use had more progressive cannabis policies, and a higher concentration of urban areas, where opioid overdoses tend to be higher.
At the same time, there are several possible causal explanations of why cannabis legalization was connected with higher overdose deaths. One hypothesis is that cannabis use acts as a “gateway” to the use of other substances. Adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, those adolescents who use cannabis may be more likely to use other substances, such as opioids, or in more harmful ways. The transition to the use of other substances and riskier use may lead to higher overdose deaths. More research is needed to more clearly identify and account for important factors in a young person’s substance use trajectory across jurisdictions.
This study found that by 2021 jurisdictions that legalized adult recreational cannabis use had higher adolescent overdose death rates compared to jurisdictions that did not legalize any cannabis use. Because this study did not account for other state level factors that could affect both cannabis policy and opioid overdoses, the findings should be replicated with more rigorous adjustment for alternative explanations. Nevertheless, the findings are noteworthy as they echo other studies that show adult-level substance use policy may have unintended effects for adolescents. Additional safeguards, education, and supports for adolescents may be needed, especially in jurisdictions that have more liberal substance use policies.
Bleyer, A., Barnes, B., Stuyt, E., Voth, E. A., & Finn, K. (2025). Cannabis and the overdose crisis among US adolescents. The American Journal on Addictions, 34(3), 327–333. doi: 10.1111/ajad.13669.
l
In 2024, rates of non use of alcohol, cannabis, and nicotine (including vaping and cigarettes) among adolescents reached record highs. Nearly 70% of 12th graders, 80% of 10th graders, and 90% of 8th graders reported no past-30-day use of these substances. However, there has simultaneously been an increase in overdose deaths among adolescents (14-18 years old) since 2019. Between August 2019 and March 2020, overdose deaths among adolescents more than doubled, and they further increased in 2022. There is a variety of contributing factors to substance use and overdoses among young people. One possibility is that adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, this cannabis use may be a “gateway” to the use of other substances, such as opioids, or in more harmful ways. Identifying macro-level factors accounting for these increased overdose rates may help align resources with needs while also driving future policy.
Cannabis policy has undergone substantial and varied changes across the United States. By the beginning of 2021, 14 jurisdictions legalized recreational adult cannabis use, 16 legalized medicinal but not recreational adult cannabis use, and 21 has not legalized any form of cannabis. Cannabis use among adolescents remains illegal in all jurisdictions. Cannabis legalization has been linked to an increased likelihood of adolescent cannabis use. Adolescents that report e-cigarette use and live in a state with legalized recreational cannabis use also have odds of cannabis use 18 times that of adolescents not reporting e-cig use and living in states with legalized recreational cannabis use. Although cannabis legalization has only been for adults, there are possible trickle down or ripple effects for adolescents.
One possible ripple effect of adult cannabis use legalization is an increase in overdose deaths among adolescents. The researchers in this study compared overdose deaths among adolescents between US jurisdictions that legalized recreational cannabis use, only legalized medicinal cannabis use, and have not legalized any cannabis use. The findings may highlight the need for additional education and consideration of adolescent development, even among policies focused on adults.
This study was a retrospective analysis that investigated the relationship between cannabis legalization status and adolescent overdose deaths each year from 2008 to 2021 in the 50 United States and Washington D.C. The overdose death data for adolescents aged 14 to 18 years was obtained from the Centers for Disease Control WONDER database. Each jurisdiction was also classified with a cannabis legalization status based on their legalization as of January 2021: recreational, medicinal only, non-legalized. Each jurisdiction’s cannabis legalization status each year was determined when a jurisdiction implemented the policy, not just passed the legislation. This attempts to account for jurisdiction-level factors that might be associated with opioid overdose rates but were not measured (i.e., policy climate, population). By 2021, 14 jurisdictions legalized recreational use, 16 legalized medicinal only, and 21 had not legalized. The researchers then compared the trends in overdose death between the 3 groups between 2008 and 2021.
Overdose death rates began to increase with recreational legalization
Between 2008 and 2014, the drug overdose death rates in adolescents aged 14-18 years were similar and generally declining in all three groups. In 2015, when jurisdictions began legalizing recreational use, legalizing jurisdictions began to have higher overdose deaths comparatively.
Mean overdose death rates were greater in recreational legalizing jurisdictions compared to non-legalizing
As shown in the graph below, in 2019, jurisdictions that legalize recreational cannabis use had higher overdose deaths compared to non-legalizing ones. Jurisdictions that legalized recreational use had 2-fold, 6-fold, and 2-fold greater overdose death rate compared to non-legalizing jurisdictions in 2019, 2020, and 2021, respectively.
Mean overdose deaths among males and non-Hispanic white individuals were greater than counterparts in states that legalized recreational use
In 2021, the drug overdose death rate among male adolescents was 39% higher in jurisdictions legalizing recreational use compared to non-legalizing jurisdictions. There was not a significant difference in rate among females although there was an upward trend in all jurisdictions. Non-Hispanic White identifying adolescents had significantly higher overdose death rates in legalizing jurisdictions compared to non-legalizing jurisdictions. Among non-Hispanic Black and Hispanic identifying adolescents, there was a similar increase in overdose deaths across all jurisdictions.
In this study, the researchers found that the adolescent overdose death rate was higher in states that legalized recreational cannabis use for adults compared to those jurisdictions that did not legalize any cannabis use. This study underscores the possible ripple effects of adult cannabis legalization among adolescents. There were three categories of legalization: recreational legalization, medicinal only legalization, and non-legalizing jurisdictions. Adolescent drug overdose death rates began to increase in all jurisdictions once recreational cannabis use began to be legalized. By 2019, the rates in jurisdictions legalizing recreational use began to increase at a faster rate than the other jurisdictions. In 2019-2021 legalizing jurisdictions had an average of a 227% higher death rate compared to non-legalizing jurisdictions.
Although the differences in jurisdictions by 2021 was substantial, the findings from this study does not establish causation, or that the cannabis legalization caused the increase in overdose deaths. There are numerous other factors that may have contributed to higher overdose deaths, which were not accounted for in the study. For example, the cultures or financial stability in some jurisdictions may contribute to substance use and overdose in a meaningful way that was not accounted for in this study. It is also possible that states which legalized recreational cannabis use had more progressive cannabis policies, and a higher concentration of urban areas, where opioid overdoses tend to be higher.
At the same time, there are several possible causal explanations of why cannabis legalization was connected with higher overdose deaths. One hypothesis is that cannabis use acts as a “gateway” to the use of other substances. Adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, those adolescents who use cannabis may be more likely to use other substances, such as opioids, or in more harmful ways. The transition to the use of other substances and riskier use may lead to higher overdose deaths. More research is needed to more clearly identify and account for important factors in a young person’s substance use trajectory across jurisdictions.
This study found that by 2021 jurisdictions that legalized adult recreational cannabis use had higher adolescent overdose death rates compared to jurisdictions that did not legalize any cannabis use. Because this study did not account for other state level factors that could affect both cannabis policy and opioid overdoses, the findings should be replicated with more rigorous adjustment for alternative explanations. Nevertheless, the findings are noteworthy as they echo other studies that show adult-level substance use policy may have unintended effects for adolescents. Additional safeguards, education, and supports for adolescents may be needed, especially in jurisdictions that have more liberal substance use policies.
Bleyer, A., Barnes, B., Stuyt, E., Voth, E. A., & Finn, K. (2025). Cannabis and the overdose crisis among US adolescents. The American Journal on Addictions, 34(3), 327–333. doi: 10.1111/ajad.13669.
l
In 2024, rates of non use of alcohol, cannabis, and nicotine (including vaping and cigarettes) among adolescents reached record highs. Nearly 70% of 12th graders, 80% of 10th graders, and 90% of 8th graders reported no past-30-day use of these substances. However, there has simultaneously been an increase in overdose deaths among adolescents (14-18 years old) since 2019. Between August 2019 and March 2020, overdose deaths among adolescents more than doubled, and they further increased in 2022. There is a variety of contributing factors to substance use and overdoses among young people. One possibility is that adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, this cannabis use may be a “gateway” to the use of other substances, such as opioids, or in more harmful ways. Identifying macro-level factors accounting for these increased overdose rates may help align resources with needs while also driving future policy.
Cannabis policy has undergone substantial and varied changes across the United States. By the beginning of 2021, 14 jurisdictions legalized recreational adult cannabis use, 16 legalized medicinal but not recreational adult cannabis use, and 21 has not legalized any form of cannabis. Cannabis use among adolescents remains illegal in all jurisdictions. Cannabis legalization has been linked to an increased likelihood of adolescent cannabis use. Adolescents that report e-cigarette use and live in a state with legalized recreational cannabis use also have odds of cannabis use 18 times that of adolescents not reporting e-cig use and living in states with legalized recreational cannabis use. Although cannabis legalization has only been for adults, there are possible trickle down or ripple effects for adolescents.
One possible ripple effect of adult cannabis use legalization is an increase in overdose deaths among adolescents. The researchers in this study compared overdose deaths among adolescents between US jurisdictions that legalized recreational cannabis use, only legalized medicinal cannabis use, and have not legalized any cannabis use. The findings may highlight the need for additional education and consideration of adolescent development, even among policies focused on adults.
This study was a retrospective analysis that investigated the relationship between cannabis legalization status and adolescent overdose deaths each year from 2008 to 2021 in the 50 United States and Washington D.C. The overdose death data for adolescents aged 14 to 18 years was obtained from the Centers for Disease Control WONDER database. Each jurisdiction was also classified with a cannabis legalization status based on their legalization as of January 2021: recreational, medicinal only, non-legalized. Each jurisdiction’s cannabis legalization status each year was determined when a jurisdiction implemented the policy, not just passed the legislation. This attempts to account for jurisdiction-level factors that might be associated with opioid overdose rates but were not measured (i.e., policy climate, population). By 2021, 14 jurisdictions legalized recreational use, 16 legalized medicinal only, and 21 had not legalized. The researchers then compared the trends in overdose death between the 3 groups between 2008 and 2021.
Overdose death rates began to increase with recreational legalization
Between 2008 and 2014, the drug overdose death rates in adolescents aged 14-18 years were similar and generally declining in all three groups. In 2015, when jurisdictions began legalizing recreational use, legalizing jurisdictions began to have higher overdose deaths comparatively.
Mean overdose death rates were greater in recreational legalizing jurisdictions compared to non-legalizing
As shown in the graph below, in 2019, jurisdictions that legalize recreational cannabis use had higher overdose deaths compared to non-legalizing ones. Jurisdictions that legalized recreational use had 2-fold, 6-fold, and 2-fold greater overdose death rate compared to non-legalizing jurisdictions in 2019, 2020, and 2021, respectively.
Mean overdose deaths among males and non-Hispanic white individuals were greater than counterparts in states that legalized recreational use
In 2021, the drug overdose death rate among male adolescents was 39% higher in jurisdictions legalizing recreational use compared to non-legalizing jurisdictions. There was not a significant difference in rate among females although there was an upward trend in all jurisdictions. Non-Hispanic White identifying adolescents had significantly higher overdose death rates in legalizing jurisdictions compared to non-legalizing jurisdictions. Among non-Hispanic Black and Hispanic identifying adolescents, there was a similar increase in overdose deaths across all jurisdictions.
In this study, the researchers found that the adolescent overdose death rate was higher in states that legalized recreational cannabis use for adults compared to those jurisdictions that did not legalize any cannabis use. This study underscores the possible ripple effects of adult cannabis legalization among adolescents. There were three categories of legalization: recreational legalization, medicinal only legalization, and non-legalizing jurisdictions. Adolescent drug overdose death rates began to increase in all jurisdictions once recreational cannabis use began to be legalized. By 2019, the rates in jurisdictions legalizing recreational use began to increase at a faster rate than the other jurisdictions. In 2019-2021 legalizing jurisdictions had an average of a 227% higher death rate compared to non-legalizing jurisdictions.
Although the differences in jurisdictions by 2021 was substantial, the findings from this study does not establish causation, or that the cannabis legalization caused the increase in overdose deaths. There are numerous other factors that may have contributed to higher overdose deaths, which were not accounted for in the study. For example, the cultures or financial stability in some jurisdictions may contribute to substance use and overdose in a meaningful way that was not accounted for in this study. It is also possible that states which legalized recreational cannabis use had more progressive cannabis policies, and a higher concentration of urban areas, where opioid overdoses tend to be higher.
At the same time, there are several possible causal explanations of why cannabis legalization was connected with higher overdose deaths. One hypothesis is that cannabis use acts as a “gateway” to the use of other substances. Adolescents may be more likely to use cannabis in jurisdictions where it is legalized, and thus easier to obtain and perceived as less risky. Then, those adolescents who use cannabis may be more likely to use other substances, such as opioids, or in more harmful ways. The transition to the use of other substances and riskier use may lead to higher overdose deaths. More research is needed to more clearly identify and account for important factors in a young person’s substance use trajectory across jurisdictions.
This study found that by 2021 jurisdictions that legalized adult recreational cannabis use had higher adolescent overdose death rates compared to jurisdictions that did not legalize any cannabis use. Because this study did not account for other state level factors that could affect both cannabis policy and opioid overdoses, the findings should be replicated with more rigorous adjustment for alternative explanations. Nevertheless, the findings are noteworthy as they echo other studies that show adult-level substance use policy may have unintended effects for adolescents. Additional safeguards, education, and supports for adolescents may be needed, especially in jurisdictions that have more liberal substance use policies.
Bleyer, A., Barnes, B., Stuyt, E., Voth, E. A., & Finn, K. (2025). Cannabis and the overdose crisis among US adolescents. The American Journal on Addictions, 34(3), 327–333. doi: 10.1111/ajad.13669.
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