(Boston)—Cannabis is one of the most widely used drugs, with an estimated 219 million users globally in 2021, with the highest number of users in the Americas. It is also the most used drug among young people. In the U.S., cannabis use among young adults (age 19 to 22) reached a historically high level in 2021, with 42.6% reporting use in the past year.

Effects and impact of recreational cannabis legalization and decriminalization on societies is a topic of global relevance and increasing scientific interest. Despite a rapidly growing body of published evidence, findings remain mostly mixed with little attention given to young adults.

A new study from researchers at Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC) has found that cannabis use among young adults in the country of Georgia, did not increase following recreational use legalization, despite having easier access.

“We saw that a country can carefully legalize cannabis use, without a surge in use in the mid-term. It would be reasonable to additionally actively regulate and control production and distribution, to restrict black market, control the quality of products while keeping populations, particularly young people, safe. We need more studies, preferably longitudinal, from different populations and socio-political contexts, to inform societies and policy makers how to balance between liberty and health.” said corresponding author Ilia Nadareishvili, MD, PhD, a National Institute on Drug Abuse (NIDA) International Visiting Scientists and Technical Exchange Program (INVEST)  fellow working in general internal medicine at the school and BMC.

Georgia legalized cannabis consumption and decriminalized cannabis possession in 2018, becoming one of the first countries in the world and the first in the region to do so. Restrictions on use by persons younger than 21, including the sale and distribution, were retained. The researchers conducted a national, wide-scale survey in 2015 and again in 2022, comparing the data to see how cannabis use changed among young adults following legalization. While usage did not increase following the legalization, they did find age of first use increased significantly. Additionally they found the use of cannabis was associated with gambling, tobacco smoking, alcohol use and with having a higher income.
 

According to the researchers, recreational cannabis use legalization, as implemented in Georgia, could be a useful example of balancing public liberty and public health interests. “This research provides crucial scientific evidence to inform the ongoing discussions surrounding the impact of cannabis legalization, particularly its limited effect on usage rates among emerging adults. The findings offer a critical contribution to both local and international discourse on drug policy and public health.” added Irma Kirtadze, MD, PhD, from Ilia State University (Georgia).

Mentored by BU/BMC’s Karsten Lunze MD, MPH, DrPH and Jeffrey Samet, MD, MA, MPH, Nadareishvili is the sixth NIDA INVEST fellow to join the BU/BMC team. Other researchers involved in this study include: Sowmya R Rao, MA, PhD from BU School of Public Health; Natalia Gnatienko from BMC, and David Otiashvili, MD, PhD from Ilia State University (Georgia). 

These findings appear online in the journal Addiction.

Funding for this study was provided through the National Institutes of Health, National Institute on Drug Abuse, 2023 and 2024 NIDA INVEST Drug Use and Addiction Research Fellowship