What Drives Cannabis Use?
Researchers say commercial cannabis markets, rather than decriminalization alone, are most strongly associated with increases in cannabis use and related harms.
Since always, one of the biggest concerns surrounding cannabis reform has been the fear that easing restrictions will inevitably lead to more people using the plant. But a major new international review suggests the reality may be more nuanced than many policymakers assume.
According to a comprehensive analysis of cannabis policy changes between 2000 and 2025, it is not decriminalization itself that appears to drive increases in cannabis use. Instead, researchers found that the strongest link was with commercialization—particularly systems that allow large-scale, for-profit cannabis sales.
The findings arrive as governments around the world continue to debate how cannabis should be regulated, with legalization models ranging from strictly controlled public health frameworks to fully commercial retail markets.
Commercial Markets Show Different Outcomes
The review examined evidence from multiple countries and regions that adopted different approaches to cannabis reform over the past two decades. Researchers compared outcomes in jurisdictions that decriminalized possession, introduced tightly regulated legal access, or created commercial cannabis markets.
“When we look globally, there’s been a rapid shift towards more liberal cannabis policies,” said Tom Freeman from the University of Bath and first author of the review, The Guardian reported. “That gives us a chance to evaluate what happened from before to after, in terms of cannabis use, cannabis addiction and psychiatric disorders related to cannabis.”
One conclusion is that removing criminal penalties for personal cannabis possession was generally not associated with significant increases in overall use. Similarly, heavily regulated legal systems showed little evidence of major population-level increases in consumption.
The picture changed, however, when cannabis became part of a competitive commercial marketplace.
In countries and regions where cannabis businesses were allowed to operate for profit—most notably parts of the United States and Canada—researchers observed increases in cannabis use, greater availability of high-potency products, and higher rates of cannabis-related health problems. These included addiction and psychiatric conditions such as psychosis.
Researchers argue that commercial incentives encourage companies to market products aggressively, expand consumer demand, and compete through stronger and cheaper products. According to the review, these market dynamics resemble patterns previously seen in the alcohol and tobacco industries.
A Challenge to Common Assumptions
The findings may challenge a common argument often raised during cannabis policy debates: that any reduction in criminal penalties will automatically lead to widespread increases in use.
Instead, the evidence suggests that the design of the regulatory framework matters more than the simple question of whether cannabis is legal or illegal. Jurisdictions that focused on harm reduction, public health oversight, or limited legal access generally did not experience the same increases observed in commercial markets. Examples include Uruguay, the first legal country in the world, as well as jurisdictions across Europe, Africa, Asia and Oceania.
Experts involved in the review say this distinction is particularly important as more countries reconsider their cannabis laws. Rather than framing policy as a choice between prohibition and commercialization, the research points toward a broader range of regulatory options that may avoid some of the public health risks associated with profit-driven markets.
Ultimately, the study raises a question that legalization advocates and critics alike may struggle to answer: in a capitalist economy, is it possible to legalize cannabis without commercializing it—and what would such a market actually look like?
The answer may already be out there, hidden among policy experiments that have received far less attention than the industry’s biggest success stories.
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Stephen Andrews
