Trends in cannabis views and use among American adults: Intersections with alcohol consumption, 2002-2018

Purpose: The present study aims to examine trends in cannabis views and use among US adults who are alcohol abstainers, non-binge drinkers, and binge drinkers.

Methods: We used data from the 2002-2018 National Survey on Drug Use and Health (US adults ages 18 and older, n = 664,152). Consistent with the Centers for Disease Control and Prevention guidelines, we conducted survey-adjusted logistic regression analyses to examine the significance of survey year in relation to cannabis views/use while controlling for demographic factors.

Results: Between 2002 and 2018, the proportion of adults reporting strong disapproval of cannabis use initiation decreased significantly (AOR = 0.947, CI = 0.945-948). While the prevalence of cannabis use increased significantly for non-binge (AOR = 1.070, CI = 1.065-1.076) and binge drinkers (AOR = 1.039, CI = 1.035-1.042), the trend increase was greatest among abstainers (OR = 1.099, CI = 1.088-1.111). The association between disapproval and cannabis use did not change between 2003 and 2018 among alcohol abstainers, but weakened among both non-binge (2003-2006: AOR = 0.154, CI = 0.135-0.176; 2014-2018: AOR = 0.221, CI = 0.200-0.246) and binge drinkers (2003-2006: AOR = 0.297, CI = 0.275-0.321; 2014-2018: AOR = 0.361, CI = 0.333-0.391).

Conclusion: Cannabis disapproval has decreased and cannabis use increased among alcohol abstainers, non-binge drinkers, and binge drinkers between 2002 and 2018. The impact of cannabis disapproval on use attenuated during the study period among drinkers but not among abstainers, suggesting that the effect of anti-cannabis attitudes may be weakening among those most likely to use cannabis.