Gender identity and cannabis use in Canada and the United States: cross-sectional analysis of the International Cannabis Policy Study

Background Gender identity influences patterns of substance use; however, few population-level studies have included transgender and gender-diverse identities when examining patterns of cannabis use by gender identity. Methods Data are from the International Cannabis Policy Study’s national, repeat cross-sectional surveys conducted annually between 2018–2023 in Canada and the United States. Weighted logistic and linear regression models examined differences by gender identity among 281 533 respondents aged 16–65 (including 2 445 transgender respondents and 783 with gender-diverse identities) for three primary outcomes: patterns of cannabis use, personal effects from cannabis, and comfort consuming cannabis across social settings. Results Daily consumption was reported by approximately 14% of cisgender men, transgender men, and people with gender-diverse identities, with less cisgender women (12%, OR = 0.74, CI95 = 0.72,0.77; p < .001) and transgender women (12%, OR = 0.76, CI95 = 0.59,1.00; p = .047) reporting daily consumption. Approximately 12% of cisgender men, transgender men, and transgender women reported being ‘very addicted’ to cannabis. Transgender 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 cisgender men. People with gender-diverse identities reported greater positive personal effects from cannabis compared to cisgender men ( β =0.53, CI95 = 0.21,0.86, p = .001), with no differences between cisgender men, cisgender women, transgender men, and transgender women. Comfort consuming cannabis across social settings was lower among cisgender women than cisgender men ( β =-0.21, CI95 = -0.23,-0.19; p < .001), with no differences between cisgender men, transgender men, and transgender women. Conclusions Frequent and problematic patterns of cannabis use were more common among cisgender men, transgender men, and transgender women. These disparities warrant further consideration in both research and policy settings.