Differentiating Cannabis Use: Associations Between Product Type and Mental Health Outcomes

Abstract

Changes in U.S. cannabis policies now largely allow the legal purchase of a variety of cannabis products. Although previous research has linked cannabis use to a variety of mental health issues, most studies were conducted prior to cannabis legalization. Thus, little is known about how different cannabis products impact mental health conditions. This study uses data from the U.S. based 2023 National Survey on Drug Use and Health to examine the associations between eight forms of cannabis use (and a cannabis modality variety scale) and various mental health conditions. Results indicate that not all forms of cannabis use are associated with mental health in the same way, suggesting a need for greater education surrounding the use of various cannabis products.

Keywords

cannabis use cannabis modality variety scale mental health depression suicidality

Get full access to this article

View all access options for this article.

References

Ammerman

Ryan

Adelman

W. P.

, Committee on Substance Abuse, the Committee on Adolescence. (2015). The impact of marijuana policies on youth: Clinical, research, and legal update. Pediatrics, 135(3), e769–e785.

Azcarate

P. M.

Zhang

A. J.

Keyhani

Steigerwald

Ishida

J. H.

Cohen

B. E.

(2020). Medical reasons for marijuana use, forms of use, and patient perception of physician attitudes among the US population. Journal of General Internal Medicine, 35 (7), 1979–1986.

Boakye

Obisesan

O. H.

Uddin

S. I.

El-Shahawy

Dzaye

Osei

A. D.

Benjamin

E. J.

Stokes

A. C.

Robertson

R. M.

Bhatnagar

Blaha

M. J.

(2021). Cannabis vaping among adults in the United States: Prevalence, trends, and association with high-risk behaviors and adverse respiratory conditions. Preventive Medicine, 153, Article 106800.

Boccio

C. M.

Leal

W. E.

(2023). The bully-victim overlap and vaping activity among adolescents. Crime & Delinquency, 69(8), 1489–1510.

Center for Behavioral Health Statistics and Quality. (2024a). 2023 National Survey on drug use and health public use file codebook. Substance Abuse and mental health Services Administration.

Center for Behavioral Health Statistics and Quality. (2024b). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on drug use and health. Substance Abuse and mental health Services Administration.

Cerdá

Wall

M. M.

Keyes

K. M.

Galea

Hasin

D. S.

(2012). Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence, 120(1–3), 22–27.

Chapekis

Shah

. (2024, February 29). Most Americans now live in a legal marijuana state – and most have at least one dispensary in their county. Pew Research Center. https://www.pewresearch.org/short-reads/2024/02/29/most-americans-now-live-in-a-legal-marijuana-state-and-most-have-at-least-one-dispensary-in-their-county/

Crocker

C. E.

Carter

A. J.

Emsley

J. G.

Magee

Atkinson

Tibbo

P. G.

(2021). When cannabis use goes wrong: Mental health side effects of cannabis use that present to emergency services. Frontiers in Psychiatry, 12, Article 640222.

10.

Degenhardt

Coffey

Romaniuk

Swift

Carlin

J. B.

Hall

W. D.

Patton

G. C

. (2013). The persistence of the association between adolescent cannabis use and common mental disorders into young adulthood. Addiction, 108(1), 124–133.

11.

Dunbar

M. S.

Davis

J. P.

Tucker

J. S.

Seelam

Rodriguez

D’Amico

E. J.

(2023). Parallel trajectories of vaping and smoking cannabis and their associations with mental and physical well-being among young adults. Drug and Alcohol Dependence, 251, Article 110918.

12.

Foglia

Schoeler

Klamerus

Morgan

Bhattacharyya

(2017). Cannabis use and adherence to antipsychotic medication: A systematic review and meta-analysis. Psychological Medicine, 47(10), 1691-1705.

13.

Gobbi

Atkin

Zytynski

Wang

Askari

Boruff

Ware

Marmorstein

Cipriani

Dendukuri

Mayo

(2019). Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry, 76(4), 426–434.

14.

Grevenstein

Nagy

Jungaberle

(2014). Development of risk perception and substance use of tobacco, alcohol and cannabis among adolescents and emerging adults: Evidence of directional influences. Substance Use & Misuse, 50(3), 376–386.

15.

Guttmannova

Kosterman

White

H. R.

Bailey

J. A.

Lee

J. O.

Epstein

Jones

T., M.

Hawkins

J. D

. (2017). The association between regular marijuana use and adult mental health outcomes. Drug and alcohol dependence, 179, 109–116.

16.

Hall

Lynskey

M. T.

(2016). Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction, 111(10), 1764–1773.

17.

Hopfer

C. J.

(2014). Implications of marijuana legalization for adolescent substance use. Substance Abuse, 35(4), 331–335.

18.

Jackson

D. B.

Boccio

C. M.

Leal

W. E.

Vaughn

M. G.

(2019). It’s all the rage! Exploring the nuances in the link between vaping and adolescent delinquency. Journal of Criminal Justice, 63, 58-69.

19.

Keith

D. R.

Hart

C. L.

McNeil

M. P.

Silver

Goodwin

R. D

. (2015). Frequent marijuana use, binge drinking and mental health problems among undergraduates. The American journal on addictions, 24(6), 499–506.

20.

Kuhns

Kroon

Colyer-Patel

Cousijn

(2022). Associations between cannabis use, cannabis use disorder, and mood disorders: Longitudinal, genetic, and neurocognitive evidence. Psychopharmacology, 239(5), 1231–1249.

21.

Langlois

Potvin

Khullar

Tourjman

S. V.

(2021). Down and high: Reflections regarding depression and cannabis. Frontiers in Psychiatry, 12, Article 625158.

22.

Leal

W. E.

(2024). Vaping behaviors and criminal activity among a nationally representative sample of U.S. adults. Substance Use & Misuse, 59(9), 1293–1302.

23.

Leal

W. E.

Moscrop-Blake

(2024). The many forms of cannabis use: Prevalence and correlates of routes of administration among nationally representative samples of US adult and adolescent cannabis users. Addictive Behaviors, 159, Article 108146.

24.

Leventhal

A. M.

Bae

Kechter

Barrington-Trimis

J. L.

(2020). Psychiatric comorbidity in adolescent use and poly-use of combustible, vaporized, and edible cannabis products. Journal of Psychiatric Research, 124, 91–98.

25.

Lowe

D. J.

Sasiadek

J. D.

Coles

A. S.

George

T. P.

(2019). Cannabis and mental illness: A review. European Archives of Psychiatry and Clinical Neuroscience, 269(1), 107–120.

26.

Mattingly

D. T.

Agbonlahor

Hart

J. L.

McLeish

A. C.

Walker

K. L.

(2024). Psychological distress and cannabis vaping among US adolescents. American Journal of Preventive Medicine, 66(3), 534–539.

27.

Moore

T. H.

Zammit

Lingford-Hughes

Barnes

T. R.

Jones

P. B.

Burke

Lewis

(2007). Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. The Lancet, 370(9584), 319–328.

28.

National Institute of Mental Health. (2024). Mental Illness. https://www.nimh.nih.gov/health/statistics/mental-illness

29.

National Organization for the Reform of Marijuana Laws. (2025). State laws. https://norml.org/laws/

30.

Radhakrishnan

Pries

L. K.

Erzin

Ten Have

de Graaf

van Dorsselaer

Gunther

Bak

Rutten

B. P. F.

van Os

Guloksuz

(2023). Bidirectional relationships between cannabis use, anxiety and depressive symptoms in the mediation of the association with psychotic experience: Further support for an affective pathway to psychosis. Psychological Medicine, 53(12), 5551–5557.

31.

Rup

Freeman

T. P.

Perlman

Hammond

(2021). Cannabis and mental health: Prevalence of use and modes of cannabis administration by mental health status. Addictive Behaviors, 121, Article 106991.

32.

Savage

(2022, December 21). What’s the difference between marijuana products? The Philadelphia Inquirer. Retrieved from https://www.inquirer.com/philly-tips/marijuana-cannabis-product-types-difference-flower-extract-vape-tincture-edible.html.

33.

Schoeler

Petros

Di Forti

Klamerus

Foglia

Murray

Bhattacharyya

(2017). Poor medication adherence and risk of relapse associated with continued cannabis use in patients with first-episode psychosis: A prospective analysis. The Lancet Psychiatry, 4(8), 627–633.

34.

Schuler

M. S.

Tucker

J. S.

Pedersen

E. R.

D’Amico

E. J.

(2019). Relative influence of perceived peer and family substance use on adolescent alcohol, cigarette, and marijuana use across middle and high school. Addictive Behaviors, 88, 99–105.

35.

Steigerwald

Wong

P. O.

Cohen

B. E.

Ishida

J. H.

Vali

Madden

Keyhani

(2018). Smoking, vaping, and use of edibles and other forms of marijuana among U.S. adults. Annals of Internal Medicine, 169(12), 890.

36.

Thomas

S. A.

Thompson

E. C.

Maron

M. M.

Meisel

S. N.

Spirito

Wolff

J. C.

(2024). Cannabis vaping is associated with past 30-day suicide attempts and suicidal ideation among adolescents in a psychiatric inpatient setting. JAACAP Open, 2(4), 263–273.

37.

Urits

Gress

Charipova

Berger

A. A.

Cornett

E. M.

Hasoon

Kassem

Kaye

A. D.

Viswanath

(2020). Cannabis use and its association with psychological disorders. Psychopharmacology Bulletin, 50(2), 56.

38.

Volkow

N. D.

Baler

Compton

W. M.

Weiss

S. R.

(2014). Adverse health effects of marijuana use. The New England Journal of Medicine, 370(23), 2219–2227.

39.

World Health Organization. (2025). Alcohol, drugs and addictive behaviours. https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis