Cannabis use within the United States: Prevalence of cannabis use by state legal status and perceptions of benefit and harm

Cannabis use has increased in the United States as legalization has spread. While Δ-9 THC remains the most-used federally illegal substance, use of other psychoactive hemp-derived products (Δ-8 THC, Δ-10 THC, HHC, THC-O) has grown. The current study investigated patterns of cannabis use and perceptions of harm and benefit of cannabis across states with differing cannabis laws. Participants (N=639) were adults endorsing past-90-day cannabis use who lived in one of 15 states selected based on cannabis laws (recreational use, medical use, illegal). Participants completed self-report questionnaires endorsing types of cannabis used, methods of consuming and acquiring cannabis, and ranking of potential harm and benefit of consumption methods. The majority (N=573; 89.7% of participants) endorsed past-30-day use of Δ-9 THC, regardless of legal status. There was significantly greater use of alternate cannabis forms in states where Δ-9 THC remains illegal (past-90-day: χ 2 (2)=16.78, p <.001; past-30-day: χ 2 (2)=9.50, p =.009). Individuals from states with legal recreational cannabis most frequently purchased cannabis legally (52.0%), but high levels of non-legal purchase existed regardless of legal status (47.5%). Participants reported primarily consuming Δ-9 THC through smoking (86.1%), CBD through ingestion (50.5%), and alternative cannabis types through vaping (43.8-57.7%). Average harm rankings were lower for smoking if it was the primary method of consumption. Individuals purchased and consumed cannabis regardless of legal status and legal status was not significantly associated with harm or benefit rating, controlling for demographic and use data. Individuals appear more likely to purchase through legal means, if available. • Δ-9 THC was used by participants regardless of state legal status of Δ-9 THC • In states without legal Δ-9 THC, higher use of alternate THC was reported • High levels of non-legal purchase of cannabis remain even when legal options exist • Method of cannabis use varied depending on the type of cannabis used • Individuals who most often smoked cannabis rated it less harmful than other methods