Background: Few population-level cannabis studies integrate analyses of sex and gender. Therefore, little is known about how patterns of cannabis use differ by gender identity, including individuals with transgender or gender-diverse identities.
Objectives: To examine gender identity differences in patterns of cannabis consumption and indicators of problematic cannabis use, including perceived addiction, positive and negative effects (e.g., mental health, work), and comfort consuming cannabis in social settings.
Methods: Data come from the International Cannabis Policy Study’s national repeat cross-sectional surveys, conducted annually between 2018-2023 in Canada and the United States. Analysis of 281,533 respondents, including 1,161 transgender men, 1,284 transgender women, and 783 people with gender-diverse identities, was undertaken. Weighted logistic and linear regression models examined differences by gender identity.
Results: Approximately one-quarter of men, transgender men, and transgender women reported being ‘a little addicted’ to cannabis, and 12% reported being ‘very addicted’. Women (6%. OR=0.57, CI95=0.53-0.62, p<.001) and people with gender-diverse identities (6%. OR=0.47, CI95=0.24-0.91, p=.025) were less likely to report being ‘very addicted’ compared to men. People with gender-diverse identities reported greater positive personal effects from cannabis compared to men (B=0.53 CI95=0.21-0.86, p=.001), with no difference between men, women, transgender men, and transgender women. Comfort consuming cannabis across social settings was lower among women than men (B=[-0.21], CI95=[-0.23]-[-0.19], p<.001), with no differences between men, transgender men, and transgender women.
Implications: Frequent and problematic patterns of cannabis use were more common among men, transgender men, and transgender women. These disparities signal need for tailored policy change, education, and support.