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Young adults' cannabis and alcohol use patterns have changed after state recreational cannabis legalization according to studies based on college samples but not nationally representative samples. Associations between recreational cannabis legalization and changes in cannabis and alcohol use outcomes among young adults were examined, including differences by college enrollment and minor status (ages 18–20 vs 21–23 years). Repeated cross-sectional data (2008–2019) were collected from college-eligible participants aged 18–23 years in the National Survey on Drug Use and Health. Self-reported past-month cannabis use and frequent use (≥20 days) and a proxy for past-year DSM-5 cannabis use disorder were primary outcomes; past-month frequent alcohol use and binge drinking were secondary outcomes. Multilevel logistic regression models quantified changes in outcome prevalence from the study years before to after recreational cannabis legalization, adjusting for secular trends. Analyses were conducted on March 22, 2022. Prevalence increased from before to after recreational cannabis legalization for past-month cannabis use (from 21% to 25%) and past-year proxy cannabis use disorder (from 11% to 13%); the increases were statistically significant [adjusted odds ratio (95% CI) = 1.20 (1.08–1.32) and 1.14 (1.003–1.30), respectively]. Increases were detected for young adults who were not in college and who were aged 21–23 years. Recreational cannabis legalization impacts were not detected for secondary outcomes. Some young adults appear sensitive to state recreational cannabis legalization, including in terms of cannabis use disorder risk. Additional prevention efforts should be directed to young adults who are not in college and timed to occur before age 21 years. [ABSTRACT FROM AUTHOR]

Background: 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. Objective: 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.). Design: Repeated cross-sectional samples from the 2008–2019 U.S. National Survey on Drug Use and Health (NSDUH). Participants: Respondents (51% female) aged 12 and older. Interventions: 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. Measurements: Self-reported simultaneous cannabis/alcohol use. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Cannabis use and binge drinking are increasingly common in the United States, yet little is known about cannabis use patterns among people who engage in binge drinking. This study explored the relationship between several cannabis use outcomes and past-month binge drinking status. Pooled 2015-2018 National Surveys on Drug Use and Health data (N = 226,632) were used to explore the hypothesis that binge drinking is associated with higher prevalence of cannabis outcomes. Cannabis outcomes included past-month and past-year use, daily/almost daily use, and past-year DSM-IV/DSM-5 cannabis use disorder (CUD). Covariates included age, gender, race, total income, and study year. Separate weighted multivariable logistic regressions assessed associations between binge drinking and each cannabis outcome and provided adjusted prevalences of cannabis outcomes by binge drinking status. Past-month binge drinking was positively associated with past-month (OR: 3.72, 95 %CI: 3.56-3.93) and past-year (OR: 3.90, 95 %CI: 3.74-4.06) cannabis use in adjusted regressions. The adjusted odds of DSM-IV and DSM-5 CUD among people who used cannabis were 15 % and 12 % higher among people who engaged in binge drinking than those who did not, respectively (OR: 1.15, 95 %CI: 1.05, 1.26 and OR: 1.12, 95 %CI: 1.03, 1.21). Conversely, the odds of past-month daily cannabis use among people who used cannabis and reported binge drinking was 18 % lower than those who did not (OR: 0.82, 95 %CI: 0.74, 0.91). Our findings provide evidence of associations between binge drinking and cannabis use. Future studies should explore associations between cannabis and other alcohol use behaviors, including heavy drinking, and simultaneous alcohol and cannabis use. [ABSTRACT FROM AUTHOR]