Young adult cannabis use disorder treatment admissions declined as past month cannabis use increased in the U.S.: An analysis of states by year, 2008–2017

•Cannabis use increase is associated with declining treatment admissions.•Recreational legalization states had higher cannabis use and lower admissions.•Unmet need for CUD treatment among young adults may be increasing. This short communication reports on the association of annual measures of young adult (age 18–24) past month cannabis use with cannabis use disorder (CUD) treatment admissions by state in the U.S. from 2008 to 2017. Annual data on percentage of past month cannabis use and the total number of CUD treatment admissions among young adults were acquired for each state from SAMHSA NSDUH and TEDS-A data sets. For each state, the correlation over time between cannabis use and treatment admissions rate was calculated and visualized in a choropleth map. Fixed-effects regression, where effects are fixed by state, was used to investigate the association of cannabis use with treatment admissions rate. In 38 out of 50 states, including seven out of the eight states legalizing recreational cannabis during the study period, as young adult cannabis use increased, treatment admissions declined. Cannabis use is significantly and negatively associated with treatment admissions (β = −7.21, 95% CI = −11.88, −2.54), even after controlling for health insurance coverage, criminal justice referral, treatment center availability, and cannabis legalization status. While it is possible that across the U.S. more young adults are using cannabis without developing CUD, we speculate that increasing social acceptance of cannabis use, and declining perception of harm, may influence treatment seeking behavior, potentially resulting in growing unmet need for CUD treatment among young adults. Monitoring state-level trends in cannabis use, CUD prevalence, and treatment admissions is key to developing CUD prevention and treatment policies targeted to timely, state-specific conditions.