Is cannabis legalization associated with treatment completion? A study of pregnant women admitted for cannabis use in substance use treatment facilities, 2020-2022.

Abstract

Cannabis is the most used illicit substance during pregnancy in the United States. While cannabis legislation is associated with prevalence and access to care, its relationship with treatment completion among pregnant women is unclear. This study examined the association between cannabis legalization and treatment completion among pregnant women admitted for cannabis use from 2020 to 2022. This retrospective cross-sectional analysis used data from the Treatment Episode Data Set-Discharge (TEDS-D) to analyze treatment completion among pregnant women aged 12 or older who were admitted for cannabis use (n = 13,088) across states with fully legalized, partially legalized (medical use only), or illegal cannabis policies. Multivariable-adjusted logistic regression was used to assess the association between legalization status and treatment completion, with subgroup analyses by treatment setting and referral source. Among pregnant women admitted for cannabis use, 28.3 % completed treatment. Compared to states where cannabis remained illegal, those in states with fully legalized cannabis had significantly lower odds of treatment completion (adjusted odds ratio [AOR], 0.33 [95 % confidence interval, 0.27-0.41]), with a similar trend in states with partial legalization (AOR, 0.33 [0.28-0.40]). The negative association between cannabis legislation and treatment completion was more pronounced in outpatient settings than in residential programs, and stronger among court/other referrals than among voluntary referrals. Cannabis legalization may be negatively associated with treatment completion among pregnant women admitted for cannabis use. Further research is needed to identify policy-related barriers and develop evidence-based interventions that improve treatment engagement and retention in this vulnerable population.