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

Matheson, Justin; Le Foll, Bernard · 2023 · OpenAlex-citations

DOI: 10.3389/fpsyt.2023.1127660

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Summary

This narrative review examines sex and gender differences in cannabis use, attitudes, and harms following the legalization of recreational cannabis. The authors address a critical public health gap: while legalization has altered global cannabis landscapes, it remains unclear how these changes differentially impact men and women. The study aims to synthesize existing evidence on sex/gender disparities in cannabis prevalence, attitudes toward legalization, and associated harms, while exploring the biological and sociocultural mechanisms driving these differences. The authors conducted a narrative review of literature spanning multiple countries, including the United States, Canada, Norway, and others. They analyzed data from large-scale surveys such as the US National Surveys on Drug Use and Health (NSDUH), the Canadian Cannabis Survey (CCS), and Monitoring the Future. The review distinguishes between sex (biological attributes) and gender (sociocultural constructs), noting that many studies use binary frameworks and often conflate the two. The authors specifically looked for evidence regarding attitudes, prevalence trends, pregnancy-related use, and cannabis-attributable harms like motor vehicle collisions and hospitalizations. Key findings indicate that men have historically exhibited higher rates of cannabis use and more favorable attitudes toward legalization than women. However, the sex/gender gap in prevalence has narrowed over time, largely driven by increased use among women, particularly young adults. For instance, meta-analyses show the male-to-female cannabis use ratio declined from 2.0 in the 1941–1945 birth cohort to 1.3 in the 1991–1995 cohort. Post-legalization data suggest that increases in cannabis consumption are often more pronounced among women and girls compared to men. Regarding harms, evidence is mixed; while some studies indicate sex/gender differences in cannabis-involved motor vehicle collisions and hospitalizations, results are variable. The review also highlights that transgender and gender-diverse individuals report high rates of use, though this population is underrepresented in current research. The authors conclude that sex and gender significantly influence the impact of cannabis legalization, with women increasingly adopting use patterns previously dominated by men. They emphasize that the narrowing gap may be partly due to shifting social norms and reduced stigma. The review identifies a critical need for future research to include transgender and gender-diverse participants and to employ rigorous sex- and gender-based analyses. Understanding these differences is essential for developing targeted public health interventions and policies that address the specific risks and harms faced by different demographic groups in the post-legalization era.

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• sex gender