Simultaneous cannabis/alcohol use, using both substances within a short time interval so that their effects overlap, has a greater risk of potential negative consequences than single-substance use and is more common in younger age. Relationships between recreational cannabis laws (RCLs) and changes in simultaneous cannabis/alcohol use prevalence remain untested.
To examine trends in simultaneous cannabis/alcohol use from 2008 to 2019, and investigate associations between implementation of RCLs (i.e., presence of active legal dispensaries or legal home cultivation) and simultaneous cannabis/alcohol use in the United States (U.S.).
Repeated cross-sectional samples from the 2008–2019 U.S. National Survey on Drug Use and Health (NSDUH).
Respondents (51% female) aged 12 and older.
Changes in simultaneous cannabis/alcohol use before and after RCL implementation (controlling for medical cannabis law implementation) were compared in different age groups (12–20, 21–30, 31–40, 41–50, 51+), using adjusted multi-level logistic regression with state random intercepts and an RCL/age group interaction.
Self-reported simultaneous cannabis/alcohol use.
From 2008 to 2019, the overall prevalence of simultaneous cannabis/alcohol use declined among those aged 12–20 but increased in adults aged 21+. Model-based simultaneous cannabis/alcohol use prevalence increased after RCL implementation among respondents aged 21–30 years (+1.2%; aOR= 1.15 [95%CI = 1.04–1.27]), 31–40 years (+1.0; 1.15 [1.04–1.27]), and 41–50 years (+1.75; 1.63 [1.34–1.98]), but not in individuals aged <21 or 51+ years.
Implementation of recreational cannabis policies resulted in increased simultaneous use of cannabis and alcohol, supporting the complementarity hypothesis, but only among adults aged 21+. Efforts to minimize harms related to simultaneous cannabis/alcohol use are critical, especially in states with RCLs. Future studies should investigate cultural norms, perceived harm, and motives related to simultaneous use.
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This study was funded by grants from the U.S. National Institutes of Health, National Institute on Drug Abuse R01DA037866 (Martins), T32DA031099 (Hasin), R01DA048860 (Hasin), K01DA045224 (Mauro). This research was supported in part by a Grant 1 R49 CE002096-01 from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention to the Center for Injury Epidemiology and Prevention at Columbia University (New York, NY).
All analyses were conducted at the New York Federal Statistical Research Data Center, a Census Bureau administered facility providing secure access to restricted-access NSDUH microdata. Statistical output was reviewed by Substance Abuse and Mental Health Services Administration (SAMSHA) staff and conformed to SAMSHA disclosure requirements to ensure confidentiality, including sample size rounding (to the nearest hundred) and suppression of values less than 100 or with large standard errors.
The sponsors had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, review, or approval of this manuscript.
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Gonçalves, P.D., Levy, N.S., Segura, L.E. et al. Cannabis Recreational Legalization and Prevalence of Simultaneous Cannabis and Alcohol Use in the United States. J GEN INTERN MED (2022). https://doi.org/10.1007/s11606-022-07948-w
- recreational cannabis laws
- simultaneous cannabis/alcohol use
- cannabis use
- alcohol use