# Cannabis Use and Poor Mental Health: What the New U.S. Trends Show > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/2023-cannabis-mental-health-data-trends/ > **Published:** 2026-06-15T11:14:47-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:52:38-04:00 > **Clinical Summary:** Explore 2023 cannabis mental health data revealing rising poor mental health days among cannabis users. Understand trends and screening needs. --- CED Clinical Relevance #74 Strong Clinical Relevance A very large U.S. survey identifies worsening mental-health burden among adults reporting [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/), but its cross-sectional design cannot determine whether cannabis caused that burden. Clinical Insight | CED Clinic Among U.S. adults reporting past-month [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/), the prevalence of at least one poor-mental-health day rose from 54.54% in 2016 to 67.88% in 2023. The finding supports routine, nonjudgmental mental-health screening, while leaving causality, product potency, dose, and reasons for use unresolved. [Cannabis Use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/)Mental HealthBRFSSYoung AdultsPublic Health Audience Patients, caregivers, primary-care clinicians, mental-health clinicians, cannabis-medicine professionals, and public-health readers Primary Topic National trends in self-reported poor mental health among U.S. adults reporting past-month cannabis use Source [Read the full study](https://link.springer.com/article/10.1007/s00127-026-03145-w) A nationally representative analysis found that poor-mental-health days became more common among adults reporting cannabis use between 2016 and 2023, especially among younger adults and women. The study identifies a screening signal, not proof that cannabis caused the trend. What This Study Teaches Us The paper shows that cannabis use and mental-health burden frequently coexist in contemporary U.S. survey data. It also shows why a simple headline can mislead: the outcome was at least one self-reported poor-mental-health day in the previous month, and the survey could not establish which condition came first. Why This Matters Cannabis conversations often split into two unhelpful extremes: cannabis is treated as either harmless or inherently damaging. Clinicians need a more useful response. When someone reports cannabis use, especially frequent use or use by vaping or dabbing, it is reasonable to ask about stress, depression, anxiety, sleep, coping motives, product strength, and functional change without assuming the answer in advance. Study Snapshot Study Type Repeated cross-sectional analysis of a nationally representative telephone survey Data Source Behavioral Risk Factor Surveillance System, 2016-2023 Population U.S. adults aged 18 years and older Sample Size 865,178 unweighted respondents, representing 448,137,324 weighted respondents Cannabis Measure Any self-reported cannabis use during the previous 30 days; frequency and route were also categorized Mental Health Measure At least one day in the previous 30 days when mental health was reported as not good Analysis Survey-weighted prevalence comparisons and multivariable logistic regression Main Adjustment Variables Year, age, sex, race and ethnicity, education, marital status, income, and employment Journal Social Psychiatry and Psychiatric Epidemiology Published June 11, 2026 PMID 42274737 DOI 10.1007/s00127-026-03145-w Funding / Conflicts The authors reported no supporting funding and no competing interests Clinical Bottom Line The survey found a substantial and widening overlap between cannabis use and self-reported poor mental health. That is enough to justify better screening and more precise conversations, but not enough to say that cannabis caused the observed increase. What the Researchers Actually Measured The investigators analyzed BRFSS responses collected from 2016 through 2023. Respondents were classified as using cannabis if they reported at least one day of use during the previous 30 days. Frequent use meant more than six days, and daily use meant all 30 days. The mental-health outcome was broad. A respondent counted as having past-month poor mental health after reporting at least one day when mental health, including stress, depression, or emotional problems, was not good. This is useful for population surveillance, but it is not equivalent to a diagnosis of depression, anxiety, psychosis, or [cannabis use disorder](https://cedclinic.com/sex-differences-cannabis-stress-reactivity-oxytocin/). What Changed Between 2016 and 2023 Among people reporting cannabis use, the weighted prevalence of at least one poor-mental-health day rose from 54.54% in 2016 to 67.88% in 2023. Across the complete study period, cannabis users reported the outcome more often than non-users: 61.34% compared with 35.14%. The increase appeared across routes of use. In 2023, reported prevalence reached 76.96% among people who vaped cannabis and 77.18% among those who dabbed. Those categories may involve higher THC exposure, but the survey did not directly measure potency or dose. Age, Sex, and Disparity Signals Adults aged 18 to 24 had the highest reported prevalence in 2023 at 80.49%. Adults aged 25 to 34 showed the largest increase, rising from 51.42% in 2016 to 77.67% in 2023. These patterns support closer attention to coping motives, product strength, and functional effects in younger adults. Women reported higher prevalence than men in 2023, 77.08% compared with 60.14%. Hispanic respondents had the highest reported prevalence among the racial and ethnic groups presented, at 69.17%. These differences may reflect many factors beyond cannabis, including baseline mental-health disparities, care access, social stressors, and reporting patterns. The Frequency Result Is Not a Simple Dose-Response Story After adjustment, past-month cannabis use was associated with higher odds of reporting poor mental health. Frequent use was also associated with increased odds. Daily use, however, was not significantly associated in the authors’ adjusted model. That apparent inconsistency should discourage easy conclusions. Daily users may differ from other users in age, medical use, tolerance, product selection, reasons for use, or other unmeasured characteristics. A cross-sectional survey cannot turn these categories into a clean biological dose-response curve. How Strong Is This Evidence? The study uses a very large sample, national survey weighting, consistent annual data, route and frequency categories, and adjusted analyses. Those features make it useful for describing population patterns and identifying groups that may warrant additional attention. Where This Paper Deserves Skepticism The design is cross-sectional and relies on self-report. It cannot establish whether cannabis use preceded poor mental health, whether distress prompted cannabis use, or whether a third factor influenced both. The outcome requires only one poor-mental-health day, and the survey did not measure cannabinoid content, potency, dose, product accuracy, diagnosis, treatment, or detailed reasons for use. What This Paper Does Not Show The study does not prove that cannabis caused depression, anxiety, or other mental illness. It does not show that every cannabis user has poor mental health, that medical and nonmedical use carry identical risks, or that CBD-dominant and THC-dominant products are interchangeable. It also does not prove that legalization caused the trend because [state policy](https://cedclinic.com/will-the-coronavirus-force-states-to-legalize-marijuana/) was not linked at the respondent level. How This Fits With the Broader Clinical Conversation Cannabis may be used before, during, or after the emergence of distress. Some people use it to cope with anxiety, insomnia, trauma symptoms, or low mood; others experience worsening anxiety, impaired motivation, panic, or other adverse effects. Both directions can exist within the same population. The clinically useful question is therefore not whether cannabis is categorically good or bad for mental health. It is whether a particular person’s pattern, product, dose, timing, goals, and symptoms form a helpful, neutral, or harmful relationship over time. Dr. Caplan’s Take *A finding like this should change the quality of the conversation, not end it. When cannabis use and emotional distress travel together, the responsible response is curiosity: What is being used, how often, for what purpose, and what happens to mood, sleep, anxiety, motivation, and function afterward?* *The study does not give clinicians permission to blame cannabis for every symptom. It does give us a reason to screen consistently and to help patients notice patterns that broad population data cannot resolve for them.* What a Careful Reader Should Take Away This survey is best read as an alert that cannabis use and poor mental health increasingly overlap, particularly among younger adults and women. It supports screening, follow-up, and product-specific counseling. It does not establish a causal verdict about cannabis. Evidence Interpretation Guide Table of Contents - [Why a Large Association Still Cannot Tell Us Which Came First](#Why_a_Large_Association_Still_Cannot_Tell_Us_Which_Came_First)[Four Questions Between Association and Causation](#Four_Questions_Between_Association_and_Causation) - [The Same Study Can Mean Different Things Depending on the Question Being Asked](#The_Same_Study_Can_Mean_Different_Things_Depending_on_the_Question_Being_Asked)[Use the Finding as a Prompt to Track Your Own Pattern](#Use_the_Finding_as_a_Prompt_to_Track_Your_Own_Pattern) - [Screen Without Assuming the Direction of Cause](#Screen_Without_Assuming_the_Direction_of_Cause) - [The Outcome Is Broad and the Exposure Is Blunt](#The_Outcome_Is_Broad_and_the_Exposure_Is_Blunt) - [Important Confounders and Time Order Remain Unresolved](#Important_Confounders_and_Time_Order_Remain_Unresolved) - [The Results Fit a Larger, Complicated Literature](#The_Results_Fit_a_Larger_Complicated_Literature) - [Product Details Matter More Than the Survey Could Capture](#Product_Details_Matter_More_Than_the_Survey_Could_Capture) - [Longitudinal and Product-Specific Research Is Needed](#Longitudinal_and_Product-Specific_Research_Is_Needed) - [Public Health Messaging Should Inform Without Stigmatizing](#Public_Health_Messaging_Should_Inform_Without_Stigmatizing) - [Frequently Asked Questions](#Frequently_Asked_Questions)[Related](#Related) ## Why a Large Association Still Cannot Tell Us Which Came First Large samples can estimate population patterns with impressive precision. They cannot, by size alone, solve the problem of time order. In this study, cannabis use and poor mental health were measured over the same recent period. That means several explanations remain compatible with the result: cannabis could worsen symptoms for some people, distress could lead some people to use cannabis, shared social or medical factors could influence both, or all three processes could occur in different subgroups. ### Four Questions Between Association and Causation **Association -> Time Order**To infer cause, we first need to know which exposure came before which outcome. This survey cannot establish that sequence. **Cannabis Use -> Actual Exposure**A day of low-dose CBD and a day of high-potency THC dabbing are both counted as cannabis use, despite very different pharmacology. **Poor Mental Health -> Clinical Diagnosis**One self-reported difficult day is meaningful, but it is not the same as a structured diagnosis or a measure of symptom severity. **Population Pattern -> Individual Decision**A national association cannot predict whether one person’s regimen is helping, worsening, or unrelated to that person’s symptoms. The Question Researchers Answered How did self-reported poor-mental-health days change over time among adults who reported cannabis use, and which demographic or use groups reported the highest prevalence? The Question Patients Usually Need Answered Is my specific cannabis pattern improving or worsening my mood, anxiety, sleep, coping, and daily function? The Bottom Line The study answers the population question well enough to justify attention. Answering the personal question requires longitudinal observation, product and dose details, and clinical context. CED Perspective Lens ## The Same Study Can Mean Different Things Depending on the Question Being Asked Scientific papers rarely answer a single question. Patients, clinicians, researchers, and critics can read the same data differently. These evidence-based lenses show where this trial is useful, where it remains uncertain, and how easily it can be overstated. Overview The survey is strongest as a population warning signal and weakest as a causal explanation. Each perspective should preserve that distinction. #### Use the Finding as a Prompt to Track Your Own Pattern The study does not say that cannabis is causing a mental-health problem for every person who uses it. It says that emotional distress is common in this population and has become more common over time. A practical response is to track product type, THC and CBD content, dose, timing, reason for use, short-term effects, next-day effects, and changes in sleep or function. Patterns are more informative than labels. Lens takeaway Screening and self-observation are appropriate; panic and self-diagnosis are not. #### Screen Without Assuming the Direction of Cause Cannabis use should open a brief, nonjudgmental mental-health assessment, particularly for younger adults and people using frequent or high-potency inhaled products. The assessment should include symptom timing, coping motives, substance-use history, suicidality when indicated, sleep, other medications, and whether use changes function. The survey does not justify a predetermined conclusion. Lens takeaway Treat cannabis use as clinically relevant context, not as an automatic diagnosis. #### The Outcome Is Broad and the Exposure Is Blunt At least one poor-mental-health day is a low threshold that combines stress, depression, and emotional difficulty. Cannabis use likewise combines different products, doses, motives, and frequencies. These broad categories can reveal trends but cannot explain mechanism. The very large sample narrows statistical uncertainty while leaving measurement uncertainty intact. Lens takeaway Precision in sample size does not compensate for imprecision in exposure and outcome. #### Important Confounders and Time Order Remain Unresolved The adjusted model included several demographic and socioeconomic variables, but residual confounding remains likely. Trauma, [chronic pain](https://cedclinic.com/cannabinoids-pain-management-opioid-alternative/), other substance use, psychiatric history, treatment access, and reasons for cannabis use could influence both exposure and outcome. Repeated longitudinal measurements within the same individuals would be more informative about whether changes in cannabis use precede changes in mental health. Lens takeaway This is a strong descriptive study, not a causal natural experiment. #### The Results Fit a Larger, Complicated Literature Prior research has linked cannabis use, especially frequent or high-THC use, with several adverse mental-health outcomes. Other research documents symptom relief or coping motives in selected patients. The new paper does not reconcile those literatures. It adds contemporary national trend data and identifies groups in whom closer assessment may be especially useful. Lens takeaway The study strengthens the case for nuance, not for a universal claim. #### Product Details Matter More Than the Survey Could Capture Route categories provide some information, but vaping and dabbing do not reveal THC concentration, inhaled amount, contaminants, or CBD content. Edibles likewise vary widely in dose and timing. Clinically useful counseling requires details the survey lacks: actual product, dose, frequency, co-use, symptom targets, adverse effects, and whether benefits persist beyond intoxication. Lens takeaway Move from the word cannabis to the actual exposure. #### Longitudinal and Product-Specific Research Is Needed Future studies should follow individuals over time, measure baseline psychiatric symptoms, and capture THC and CBD exposure, potency, route, medical indication, and reasons for use. Research should also test whether changes in product or frequency predict subsequent changes in symptoms and whether those relationships differ across demographic and clinical groups. Lens takeaway The next step is to connect timing and exposure detail to mental-health trajectories. #### Public Health Messaging Should Inform Without Stigmatizing The observed trends support accessible screening, potency education, honest labeling, and mental-health resources. They do not support treating all cannabis use as equivalent or all users as disordered. Policy claims about legalization require separate analysis because the study did not link respondents to [state policy](https://cedclinic.com/will-the-coronavirus-force-states-to-legalize-marijuana/) conditions. Responsible messaging should state that limitation plainly. Lens takeaway Build safeguards around measurable risks without turning association into accusation. Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion](https://cedclinic.com/interact/discussion-forums/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Have thoughts on this? Share it: [Share on X](https://twitter.com/intent/tweet?text=Cannabis+Use+and+Poor+Mental+Health%3A+What+the+New+U.S.+Trends+Show&url=https://cedclinic.com/cannabis-use-poor-mental-health-trends/)[Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https://cedclinic.com/cannabis-use-poor-mental-health-trends/)[Share on Bluesky](https://bsky.app/intent/compose?text=Cannabis+Use+and+Poor+Mental+Health%3A+What+the+New+U.S.+Trends+Show%20https://cedclinic.com/cannabis-use-poor-mental-health-trends/) Source: [Trends and disparities in self-reported past-month poor mental health among individuals using cannabis in the U.S., 2016-2023](https://link.springer.com/article/10.1007/s00127-026-03145-w) Related Reading at CED Clinic Continue exploring the evidence [Cannabis, Inflammation, and Anxiety: What the Research Shows](https://cedclinic.com/cannabis-inflammation-anxiety-sleep/) A closer look at how product composition and baseline biology may shape anxiety and sleep outcomes, illustrating why cannabis exposures should not be treated as interchangeable. [Explore evidence](https://cedclinic.com/cannabis-inflammation-anxiety-sleep/) [Cannabis Depression Studies 2026: Evidence and Research](https://cedclinic.com/cannabis-depression-studies-2026-evidence-research-hanf-magazin/) A review of the evidence and uncertainty around cannabis, CBD, depression, and the limits of current [clinical research](https://cedclinic.com/cannabis-based-therapies-smoking-cessation/). [Review findings](https://cedclinic.com/cannabis-depression-studies-2026-evidence-research-hanf-magazin/) [Cannabis Use and the Developing Brain](https://cedclinic.com/it-may-be-legal-for-adults-but-cannabis-use-a-danger-to-young-brains/) Clinical and public-health context for discussing cannabis exposure, mental health, and neurodevelopment in younger populations. [Continue reading](https://cedclinic.com/it-may-be-legal-for-adults-but-cannabis-use-a-danger-to-young-brains/) ## Frequently Asked Questions Did this study prove that cannabis causes poor mental health? No. It was a cross-sectional survey analysis. Cannabis use and poor mental health were associated, but the study could not determine which came first or whether other factors influenced both. How was poor mental health defined? Respondents were counted if they reported at least one day in the previous 30 days when their mental health, including stress, depression, or emotional problems, was not good. How large was the study? The analysis included 865,178 unweighted respondents and used survey weights representing 448,137,324 respondents across the study years. What changed between 2016 and 2023? Among adults reporting cannabis use, the prevalence of at least one poor-mental-health day increased from 54.54 percent in 2016 to 67.88 percent in 2023. Which age group had the highest prevalence? Adults aged 18 to 24 had the highest reported prevalence in 2023 at 80.49 percent. Adults aged 25 to 34 showed the largest increase over the study period. Did the study measure THC or CBD dose? No. It categorized route and frequency but did not directly measure cannabinoid content, potency, dose, or product accuracy. Were vaping and dabbing associated with higher prevalence? Yes. In 2023, reported prevalence was 76.96 percent among people who vaped cannabis and 77.18 percent among those who dabbed, but the study could not prove those routes caused the difference. Why was daily use not significantly associated in the adjusted model? The study cannot fully explain that result. Daily users may differ in medical use, tolerance, product choice, reasons for use, or other unmeasured factors, so it should not be interpreted as proof that daily use is protective. What should clinicians do with this information? Clinicians can screen nonjudgmentally for cannabis patterns, mood, anxiety, sleep, coping motives, product potency, other substances, and functional change rather than assuming cannabis is either the cause or the solution. Should a patient stop cannabis because of this study? The study cannot make an individual treatment decision. Anyone concerned about worsening mood, anxiety, sleep, or function should review the pattern, product, dose, goals, and alternatives with a qualified clinician. ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Former CMO Canna Care Docs (250,000+ patients supervised), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).