Over the past decade, there has been a significant increase in state-level cannabis legalization. As cannabis becomes more widely accepted and accessible throughout the country, more individuals are reporting using it than ever before.

Recent studies have revealed that cannabis use varies significantly across different populations. During the Tuesday APHA 2024 session “Cannabis Use, Vulnerable Populations, and Health Disparities: What Are We Learning?” presenters from around the nation shared new research highlighting the impact of cannabis on sexual minorities.

Cannabis use is growing across most demographic subgroups regardless of the state’s legalization status, said Colin Planalp, with the Cannabis Research Center at the University of Minnesota School of Public Health. 

Planalp analyzed data from the National Survey of Drug Use and Health from 2012 to 2013 and from 2018 to 2019 to compare rates of past-month cannabis use over time. 

Findings show cannabis use was exceedingly prevalent in sexual minority populations. In 2018-2019, 24% of people identifying as lesbian or gay and 30% of those identifying as bisexual reported past 30-day cannabis use, compared to 10% of heterosexuals.

Different groups of people are going to use cannabis products differently, said Michelle Goulette, with the University at Buffalo. 

In the Cannabis and Alcohol Use In Young Adults study from the UB Clinical Research Institute on Addictions, researchers reached similar conclusions to Planalp’s group. Survey data from young adults aged 18-25 revealed that all sexual minority subgroups were more likely to consume cannabis. 

About one-third of survey respondents identified as a sexual minority. People identifying as pansexual reported the highest past-month cannabis use at 67%, followed closely by people identifying as bisexual at 64%.

Frequent cannabis use is linked to the development of cannabis use disorder, with highly potent cannabis products further contributing to this progression. 

Sexual minority subgroups have different cannabis use patterns. Among the survey respondents, pansexual people reported the highest rate of using joints as a method of cannabis administration, while gay and lesbian people showed higher rates of using edibles and vapes.

Reasons for cannabis use reported by respondents

There’s a reason people are using cannabis and it’s not just to “bug public health people,” said Jeff Wood, with California State University Long Beach. 

Young Black people are at an elevated risk of cannabis use. In a Cal State Long Beach study, researchers studied problematic cannabis use and cannabis expectations among young Black men who have sex with men and non-MSM young Black men.

In non-MSM, problematic cannabis use was associated with emotional facilitation, while MSM reported higher levels of problematic use for the purpose of enhancing sexual expectations.

Such expectations included “using cannabis makes sex last longer and sexual negotiation: “I’m more likely to have sex without a condom when I’ve been using cannabis.”

In a study of 31 gay and bisexual men, and transgender and non-binary young adults, of color in Los Angeles, the main reasons for cannabis used were social and recreational uses and to manage symptoms of well-being.

Experiences of sexual racism and discrimination were linked to heightened anxiety symptoms, which in turn contributed to problematic cannabis use. However, many participants felt uneasy about the notion of using cannabis as a coping strategy. 

Research like this “puts you in the perspectives of what teens are thinking” said Danny Azucar, with the Children’s Hospital of Los Angeles. “We (public health professionals) can better communicate in a way they want to hear.”

Photo of cannabis flowers, by Kindel Media, courtesy of Pexels.