Racial diversity in cannabis use disorder research: A systematic review.

Abstract

Several groups of people of color have a higher prevalence and more severe cases of cannabis use disorder (CUD) compared to White people. They also endure unique issues like racial discrimination, which are linked with an increased likelihood of CUD. We conducted a systematic review to identify the number of people of color in CUD behavioral health RCTs and whether researchers designed interventions to address people of color's unique challenges. We systematically searched PubMed, PsycINFO, and ClinicalTrials.gov for CUD behavioral health RCTs implemented in the United States for adults. We identified 14 out of 966 from 1994 to 2025 for review (12 published, two in ClinicalTrials.gov, completed but not published). White people comprise ~64 % of all participants, and were included at rates 49 times greater than their share of CUD cases. Black people comprise ~19 %, Latiné people 5 %, multiracial/other 0.8 %, Asians 0.6 %, and Indigenous people 0.4 %. No studies were culturally adapted or were designed to address people of color's unique challenges (e.g., racial discrimination). Racial sample diversity has not improved over time. People of color are significantly underincluded in CUD RCTs despite their heightened prevalence and CUD severity. This limits research's generalizability and applicability to people of color. Further, the lack of research into people of color's unique challenges may hinder therapists from meeting the full range of people of color's needs. Finally, despite decades of calls to increase racial sample diversity in RCTs, people of color's inclusion has remained low in CUD RCTs.