Gender identity and cannabis use in Canada and the United States: cross-sectional analysis of the International Cannabis Policy Study

BACKGROUND: Gender identity influences patterns of substance use; however, few population-level studies have included transgender and gender-diverse identities when examining patterns of cannabis use by gender identity. METHODS: Data are from the International Cannabis Policy Study's national, repeat cross-sectional surveys conducted annually between 2018-2023 in Canada and the United States. Weighted logistic and linear regression models examined differences by gender identity among 281 533 respondents aged 16-65 (including 2 445 transgender respondents and 783 with gender-diverse identities) for three primary outcomes: patterns of cannabis use, personal effects from cannabis, and comfort consuming cannabis across social settings. RESULTS: Daily consumption was reported by approximately 14% of cisgender men, transgender men, and people with gender-diverse identities, with less cisgender women (12%, OR = 0.74, CI95 = 0.72,0.77; p < .001) and transgender women (12%, OR = 0.76, CI95 = 0.59,1.00; p = .047) reporting daily consumption. Approximately 12% of cisgender men, transgender men, and transgender women reported being 'very addicted' to cannabis. Transgender women (6%, OR = 0.57, CI95 = 0.53,0.62; p < .001) and people with gender-diverse identities (6%, OR = 0.47, CI95 = 0.24,0.91; p = .025) were less likely to report being 'very addicted' compared to cisgender men. People with gender-diverse identities reported greater positive personal effects from cannabis compared to cisgender men (β=0.53, CI95 = 0.21,0.86, p = .001), with no differences between cisgender men, cisgender women, transgender men, and transgender women. Comfort consuming cannabis across social settings was lower among cisgender women than cisgender men (β=-0.21, CI95 = -0.23,-0.19; p < .001), with no differences between cisgender men, transgender men, and transgender women. CONCLUSIONS: Frequent and problematic patterns of cannabis use were more common among cisgender men, transgender men, and transgender women. These disparities warrant further consideration in both research and policy settings.