Impacts of recreational cannabis legalization on use and harms: A narrative review of sex/gender differences

Abstract

Legalization of cannabis use for non-medical (recreational) purposes is changing the global cannabis landscape. As attitudes toward cannabis use become more positive and prevalence of use increases in complex ways, concerns emerge about the potential for increased cannabis-attributable harms. Understanding the who, why, and when of this likely increase in cannabis-attributable harms is thus an important public health priority. Both sex and gender contribute to variability in the use, effects, and harms of cannabis and thus sex/gender considerations are important when evaluating the impacts of cannabis legalization. The goal of this narrative review is to broadly discuss sex/gender differences in attitudes toward and prevalence of cannabis use, whether there are sex/gender differences in the impacts of cannabis legalization, and why these sex/gender differences might exist. One of our strongest conclusions is that men have always been more likely to use cannabis than women, yet the sex/gender gap in prevalence of cannabis use has narrowed over time, and this might be partly due to cannabis legalization. The existing evidence suggests that there have also been sex/gender differences in the impacts of legalization on cannabis-attributable harms such as cannabis-involved motor vehicle collisions and hospitalizations, though these results are more variable. The body of literature reviewed has focused almost exclusively on samples of cisgender research participants, and thus future research should encourage inclusion of transgender and gender-diverse participants. More consideration of sex- and gender-based analysis in research evaluating long-term impacts of cannabis legalization is a clear research priority.

Effects of sexual assault vs. other traumatic experiences on emotional and cannabis use outcomes in regular cannabis users with trauma histories: moderation by gender?

“…Similarly, while substantial research suggests that men use cannabis more frequently than women (Crocker and Tibbo, 2018), we saw no evidence of greater scores among men on any of our cannabis outcomes. This pattern is consistent with convergence (i.e., women increasing their cannabis use levels to reach levels seen in men; Chapman et al, 2017); convergence is of particular concern in the post-legalization context in Canada, where recreational cannabis use has been legal since 2018 (Matheson and LeFoll, 2023). Indeed, the only main effect of gender in the current study was for cannabis coping motives on the MMM, with women cannabis users with trauma histories scoring higher than their men counterparts.…”

Predicting Maternal and Infant Tetrahydrocannabinol Exposure in Lactating Cannabis Users: A Physiologically Based Pharmacokinetic Modeling Approach

“…The use of cannabis, including smoking, has become increasingly prevalent worldwide, with pregnant individuals and lactating mothers being no exception [1,2]. The growing legalization of recreational cannabis use is expected to contribute further to this phenomenon [3,4]. However, the health risks associated with cannabis smoking are a matter of concern, particularly for vulnerable populations such as lactating mothers and their breastfed infants.…”