Citation

Hammond CJ, Hyer JM, Boustead AE, Fristad MA, Steelesmith DL, Brock GN, Hasin DS, Fontanella CA. J. Am. Acad. Child Adolesc. Psychiatry 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2023.06.014

PMID

37385585

Abstract

OBJECTIVE: Cannabis use is associated with suicide-related outcomes in both adolescents and adults and may be increasing amidst shifting cannabis policies. However, little is known about the impact of medical marijuana legalization (MML) and recreational marijuana legalization (RML) policies on youth suicide. Using 20 years of national data, we examined associations between MML, RML, and suicide-related mortality among US individuals aged 12 to 25; and assessed whether they varied based on age and sex.

METHOD: Suicide deaths (N=113,512) from the 2000-2019 National Vital Statistics System Multiple Cause of Death files for age groups 12-13, 14-16, 17-19, 20-22, and 23-25 years were examined in relation to time-varying cannabis law status using a staggered adoption difference-in-difference (DiD) approach with a negative binomial regression to determine associations between MML, RML, and suicide rates, controlling for individual- and state-level covariates and accounting for the varying effective dates of MML and RML by state.

RESULTS: The overall unadjusted annual suicide rate was 10.93/100,000, varying from 9.76 (no ML states) to 12.78 (MML states) to 16.68 (RML states). In multivariable analysis, both MML (incidence rate ratio (IRR) = 1.10, 95% CI 1.05-1.15) and RML (IRR=1.16, 95% CI 1.06-1.27) were associated with higher suicide rates among female youth compared to states without ML. Youth aged 14-16 had higher rates of suicide in states with RML compared to states with MML (IRR=1.14, 95% CI 1.00-1.30) and states without ML (IRR=1.09, 95% CI 1.00-1.20).

FINDINGS were consistent across sensitivity analyses.

CONCLUSION: MML and RML were associated with increased suicide-related mortality in female youth and 14-to-16-year-olds of both sexes. Mechanisms through which cannabis policies are related to increased youth suicide warrant further study and should inform legislative reform.

Language: en

Keywords

adolescents; suicide; medical marijuana legislation; recreational marijuana legislation; sex-differences