Cannabis use within the United States: Prevalence of cannabis use by state legal status and perceptions of benefit and harm
By Andrew P. Bontemps, Elizabeth S. Hawes, Bailey E. Pridgen, William P. Wagner, Dominique Black, Karen L. Cropsey
Background: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.
Method
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.
Results
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: χ2(2)=16.78, p<.001; past-30-day: χ2(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.
Conclusions
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.
Drug and Alcohol Dependence Reports
Available online 14 March 2026, 100431