Trends in US adolescent cannabis use, 1991–2023

BACKGROUND AND OBJECTIVES: Cannabis use remains a major concern for adolescent health. Monitoring adolescent cannabis use trends and whether demographic subgroups might be differentially impacted remains important for public health planning. METHODS: Data from the 1991-2023 Youth Risk Behavior Survey (YRBS), a biennial school-based survey representative of US high school students, were analyzed. Cross-tabulations and logistic regression models were calculated to examine lifetime, recent, and early-age cannabis use. Trends in cannabis use were examined by sex and race/ethnicity. RESULTS: Across different demographic groups, adolescent cannabis use rates have largely followed a similar inverted-U pattern, with rates peaking in 1999 and subsequently declining. Lifetime cannabis use decreased from 47.3% (95% CI: 44.5-50.2%) in 1999 to 30.1% (95% CI: 27.8-32.3%) in 2023. Recent use declined from 27.1% (95% CI: 24.6-29.6%) to 17.8% (95% CI: 16.2-19.4%). Early-age initiation declined from 11.5% (95% CI: 9.7-13.3%) to 6.5% (95% CI: 4.7-8.4%). A significant gender shift occurred: while males historically reported higher rates, in 2023, females demonstrated higher prevalence of both lifetime (33.4% vs. 27.0%) and recent use (19.4% vs. 16.4%). Consistent racial/ethnic differences persisted, with Asian adolescents reporting consistently lower prevalence and non-Hispanic Black and Hispanic adolescents reporting higher rates across most metrics. CONCLUSION: Rates of lifetime, recent, and early-age cannabis rose through the 1990s, peaked around 1999, and have since declined. Where males formerly reported higher cannabis use rates, females now report higher rates of lifetime and recent cannabis use. Such convergence, noted to be robust across racial/ethnic groups, merits further study.