Legalizing cannabis edibles linked to increased adolescent use in Canada

University of Manitoba and Memorial University of Newfoundland researchers are reporting that legalization of youth-oriented cannabis edibles and extracts in Canada was associated with higher cannabis use among adolescents during specific study periods.

In October 2018, Canada legalized the sale of dried or fresh cannabis and cannabis oil to individuals above a legal minimum age of 18 or 19 years, depending on the province. A year later, cannabis edibles and extracts became legal in all provinces except Quebec. Products included cannabis-infused chocolates, candies, desserts, and vaping oils, which were considered more appealing to adolescents than dried cannabis.

Quebec maintained a ban on youth-friendly cannabis edibles and vaping products, citing risks of accidental poisoning and concerns about the normalization of cannabis use. Several Atlantic provinces also restricted cannabis vaping products.

Health officials raised concerns that legalization of these products could increase adolescent cannabis use, alter modes of consumption, reduce perceptions of risk, and encourage co-use of alcohol. Existing research has not established clear evidence on these potential effects.

In the study titled “Legalizing Youth-Friendly Cannabis Edibles and Extracts and Adolescent Cannabis Use,” published in JAMA Network Open, researchers conducted a serial cross-sectional study to investigate changes in adolescent cannabis use and cannabis harm perceptions associated with the legalization of youth-friendly cannabis edibles and extracts in Canada.

Surveys were assessed from a cohort of 106,032 students, grades 7 to 11, who participated in the Canadian Student Tobacco, Alcohol and Drugs Surveys during the 2018–2019 and 2021–2022 cycles.

Researchers compared changes in cannabis-related outcomes in provinces that legalized cannabis edibles and extracts with changes in Quebec, where youth-friendly cannabis edibles and cannabis vaping products remained banned. Analyses controlled for student grade, sex or gender, urban versus rural residence, province, and survey year.

Twelve-month cannabis use among adolescents increased from 14.6% to 15.9% in provinces that legalized cannabis edibles and extracts. In Quebec, where these products remained banned, cannabis use declined from 17.4% to 15.6%.

Use of edible cannabis rose from 7.9% to 9.5% in legalization provinces and declined from 7.3% to 5.9% in Quebec. Cannabis smoking increased from 12.8% to roughly 15.3% in legalization provinces and decreased in Quebec. Cannabis vaping increased in both groups, with a slightly smaller increase in legalization provinces than in Quebec.

Legalization was associated with lower perception of harm from occasional cannabis use. The likelihood that adolescents perceived moderate or great harm from occasional cannabis smoking declined by 5.6 percentage points. A 5.2 percentage point decline was observed in perceived harm from occasional use of other modes of cannabis intake. No changes were found in perceptions of harm from regular cannabis use.

Regression analysis showed a larger increase in cannabis use when accounting for the reduction observed in Quebec. Because Quebec reported declining use, comparisons yielded a greater net effect of legalization, without directly isolating increases attributable solely to policy change.

Under this statistical mode, legalization was associated with a net 3.8 percentage point increase in cannabis use, after accounting for the reductions observed in Quebec. A 26% relative increase compared to the pre-legalization baseline. Edible cannabis use showed a net increase of 3.4 percentage points, or 43%, after subtracting the corresponding decline in Quebec. Cannabis smoking increased by 4.4 percentage points, or 34%, using the same comparison. Co-use of cannabis and alcohol increased by 2.4 percentage points, or 28%. Cannabis vaping showed no statistically significant change.

Legalization of youth-oriented cannabis edibles and extracts in Canada was associated with an increase in overall cannabis use among adolescents. In addition to a rise in edible consumption and cannabis smoking, the study found higher rates of co-use of cannabis and alcohol in provinces that legalized these products compared to Quebec, where such products remained banned. Adolescents in legalization provinces were also less likely to perceive occasional cannabis use as harmful.

Researchers noted that these findings reflect associations rather than causation. The observed increases were measured relative to declining rates in Quebec and should be interpreted as net effects. While the study controlled for key demographic and provincial factors, it used only one post-legalization survey cycle and relied on self-reported data.

Authors concluded that further policy measures may be needed to reduce adolescent access to cannabis edibles and extracts.

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